Stress cardiomyopathy - Takotsubo and File:Coronary anatomy AHA.svg: Difference between pages

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{{Case
1. PRXRCA (proximal right coronary artery). Main stem of RCA from the
|Title = Takotsubo
ostium to one half the distance to the acute margin of the heart.
|CasePresentation = Mimicking myocardial infarction by a stress cardiomyopathy
2. MIDRCA (middle RCA). Main stem of RCA from end of above segment
 
to acute margin of the heart.
An 81-year-old woman with no cardiac history presented with acute chestpain which radiated to the left arm. The blood pressure was 140/80 mmHg and a heart rate of110/min. Physical examination revealed no abnormalities. The electrocardiogram was compatible with acute anterior myocardial infarction. (A) Immediate coronary angiography showed normal coronary arteries (B and C). A left ventricular (LV) angiogram revealed a Tako-tsubo-like cardiomyopathy, recognized by a hypercontractile base and a bulging out of the LV-apex at systole (D), which normalizes at diastole (E). This typical LV-angiogram resembles a local octopus trap in Japan , where this cardiomyopathy was first described. Although clinical presentation can be quite severe, prognosis is usually good with complete LV recovery. It occurs commonly in post-menopausal woman, usually provoked after extreme emotional stress. In a second interview, the patient told she had a severe emotional experience at a parking lot that morning, after which she developed chestpain.
3. DSTRCA (distal RCA). Main stem of RCA usually running along the
 
posterior right atrioventricular groove, from the acute margin of the heart to
|Courtesy = Courtesy of M. Meuwissen, MD, PhD, AMC, The Netherlands
the origin of the posterior descending artery (PDA).
 
4. RPDA (right PDA). Artery of the posterior interventricular groove,
|filepointer1=[[Image:MM0100.jpg|300px]]
which gives off septal perforators and is supplied by the distal right (90%).
|file_name1=
5. RPLS (right posterolateral segment). Continuation of the distal right
|descriptionfile1=Figure A: Electrocardiogram
beyond the origin of the posterior descending artery. This segment is situated
 
in the posterior atrioventricular groove, in the region of the crux of the heart,
|filepointer2=<flash>file=MM0099.swf|quality=best|align=center|width=300|height=300</flash>
and may have an inverted U-shaped configuration. It usually gives off the
|file_name2=MM0099
A-V node artery and a variable number of branches, which run parallel to the
|descriptionfile2=Movie B: Angiography RCA
PDA, on the posterolateral surface (or inferior surface) of the left ventricle.
 
6. RPL1 (first RPLS branch). First branch off the RPLS and often the only
|filepointer3=<flash>file=MM0097.swf|quality=best|align=center|width=300|height=300</flash>
branch; synonym, left ventricular branch.
|file_name3=MM0097
7. RPL2 (second RPLS branch). Usually not present.
|descriptionfile3=Movie C: Angiography LCA
8. RPL3 (third RPLS branch). Usually not present.
 
9. Inf Septal (inferior septal). Posterior descending septal arteries are the
|filepointer4=<flash>file=MM0098.swf|quality=best|align=center|width=300|height=300</flash>
septal perforator arteries originating from the PDA then extending into the
|file_name4=MM0098
inferior septunm.
|descriptionfile4=Movie D: Left ventricular angiography
10. AC MARG (acute marginal vessels). A large branch or branches supplying
 
the acute marginal wall of the right ventricle. The origin of the largest
}}
of these vessels may be variable, but usually coincides with the acute margin
of the heart. These vessels are often an important source of collateral circulation.
11. LMCA (left main coronary artery). Aortic ostium to bifurcation.
12. PRXLAD (proximal left anterior descending). Extends from its origin
off the left coronary artery to the first visible septal no matter how small this
vessel is. In some cases there will be a major septal proceeded by one or more
small septals. In this instance, the definition should still be rigidly adhered to
and the first visible septal, no matter what size, should be used to indicate the
end of the proximal segment of the LAD.
13. MIDLAD (middle LAD). LAD immediately distal to the origin of the
first major septal branch and extending to a point where the LAD forms an
angle (Right anterior oblique [RAO] view), often, but not always, coinciding
or close to the origin of the second diagonal branch. If said angle or branch
is not identifiable, the segment ends one half the distance from the first major
septal to the apex of the heart.
14. DSTLAD (distal LAD). Terminal segment of the LAD running along
the interventricular sulcus, beginning with the end of the previous segment,
and usually extending beyond the apex.
15. Ist DIAG (first diagonal; D-1). The largest, and usually the first, diagonal
branch having its origin from the proximal segment of the LAD and
supplying the anterior wall. Occasionally, a separate branch of the main left
coronary artery. If there is no diagonal with its origin from the proximal LAD,
then D-1 should be coded with a -5" under morphology of distal vessel to
signify anatomically not present.
16. 2nd DIAG (second diagonal; D-2). The second diagonal branch, which
often has its origin at the angle of the anterior descending when visualized in
the RAO projection. Origin is usually near junction of middle and distal thirds
of LAD, but may come off higher, from MIDLAD.
17. Ist Ant Septal (first anterior septal). This vessel is designated as the
first large branch of the LAD to penetrate into the anterior interventricular
septum.
18. PRXCX (proximal circumflex). That portion of the circumflex artery
from its origin off the main left coronary artery to and including the origin
of the first obtuse marginal branch (No. 20). The distal circumflex (No. 19)
may originate before the first marginal but the proximal circumflex continues
until the origin of the first marginal.
19. DSTCX (distal circumflex). Begins from the proximal portion of the
circumflex as the circumflex runs along or close to the posterior left atrioventricular
groove. In right dominant circulation, the distal circumflex may be
very small or absent.
Marginal circumflex branches that are very small or "twigs" are not to be
counted as marginals or described. The first marginal branch (No. 20) may
sometimes be a very large branch with the second marginal (No. 21) appearing
as a division of the first marginal. All branches that come off the distal circumflex
will be labeled marginals (Nos. 20, 21, and 22 below), and all branches
that come off the left atrioventricular artery will be labeled left posterolateral
branches (No. 24, 25, and 26 below).
20. Ist OB MARC (first obtuse marginal). The first major branch of the
circumflex artery supplying the lateral left ventricular wall, in the general
area of the obtuse margin of the heart.
21. 2nd OB MARC (second obtuse marginal). The second branch of the
circumflex distributing to the lateral surface of the ventricle. Sometimes
smaller in caliber than the first obtuse marginal. May be absent or may be a
division of the first obtuse marginal branch.
22. 3rd OB MARC (third obtuse marginal). The third branch of the circumflex
supplying the posterolateral left ventricular wall (often absent). Runs
parallel to the LPDA in the left predominant pattern.
23. LAV (left atrial ventricular artery). The left atrial ventricular artery
is present only in a left dominant or balanced circulation. This artery is a
continuation of the distal circumflex and has been arbitrarily defined as the
distal half of the remainder of the circumflex after the take-off of the first
marginal. The proximal half of the circumflex after the take-off of the first
marginal will be defined as the distal circumflex (No. 19). Note that this definition
is appropriate only for left dominant or balanced circulation.
Left posterolateral branches that are very small or "twigs" are not to be
counted as branches or described. The first left posterolateral branch (No. 24)
may sometimes be a very large branch with the second left posterolateral
branch (No. 25) appearing as a division of the first branch. All branches that
come off the distal circumflex will be labeled marginals (No. 20, 21, and 22),
and all branches that come off the left atrioventricular artery will be labeled
left posterolateral branches (Nos. 24, 25, and 26).
24. 1st LPL (first left posterolateral branch). First branch off the LPL
segment and often the only branch; synonym, left ventricular branch.
25. 2nd LPL (second left posterolateral branch). Second branch off the
LPL segment.
26. 3rd LPL (third left posterolateral branch). Third branch off the LPL
segment. Usually not present.
27. LPDA (left PDA). Posterior descending when present as a branch of
the circumflex in the predominant left coronary artery.

Revision as of 21:02, 7 October 2009

1. PRXRCA (proximal right coronary artery). Main stem of RCA from the ostium to one half the distance to the acute margin of the heart. 2. MIDRCA (middle RCA). Main stem of RCA from end of above segment to acute margin of the heart. 3. DSTRCA (distal RCA). Main stem of RCA usually running along the posterior right atrioventricular groove, from the acute margin of the heart to the origin of the posterior descending artery (PDA). 4. RPDA (right PDA). Artery of the posterior interventricular groove, which gives off septal perforators and is supplied by the distal right (90%). 5. RPLS (right posterolateral segment). Continuation of the distal right beyond the origin of the posterior descending artery. This segment is situated in the posterior atrioventricular groove, in the region of the crux of the heart, and may have an inverted U-shaped configuration. It usually gives off the A-V node artery and a variable number of branches, which run parallel to the PDA, on the posterolateral surface (or inferior surface) of the left ventricle. 6. RPL1 (first RPLS branch). First branch off the RPLS and often the only branch; synonym, left ventricular branch. 7. RPL2 (second RPLS branch). Usually not present. 8. RPL3 (third RPLS branch). Usually not present. 9. Inf Septal (inferior septal). Posterior descending septal arteries are the septal perforator arteries originating from the PDA then extending into the inferior septunm. 10. AC MARG (acute marginal vessels). A large branch or branches supplying the acute marginal wall of the right ventricle. The origin of the largest of these vessels may be variable, but usually coincides with the acute margin of the heart. These vessels are often an important source of collateral circulation. 11. LMCA (left main coronary artery). Aortic ostium to bifurcation. 12. PRXLAD (proximal left anterior descending). Extends from its origin off the left coronary artery to the first visible septal no matter how small this vessel is. In some cases there will be a major septal proceeded by one or more small septals. In this instance, the definition should still be rigidly adhered to and the first visible septal, no matter what size, should be used to indicate the end of the proximal segment of the LAD. 13. MIDLAD (middle LAD). LAD immediately distal to the origin of the first major septal branch and extending to a point where the LAD forms an angle (Right anterior oblique [RAO] view), often, but not always, coinciding or close to the origin of the second diagonal branch. If said angle or branch is not identifiable, the segment ends one half the distance from the first major septal to the apex of the heart. 14. DSTLAD (distal LAD). Terminal segment of the LAD running along the interventricular sulcus, beginning with the end of the previous segment, and usually extending beyond the apex. 15. Ist DIAG (first diagonal; D-1). The largest, and usually the first, diagonal branch having its origin from the proximal segment of the LAD and supplying the anterior wall. Occasionally, a separate branch of the main left coronary artery. If there is no diagonal with its origin from the proximal LAD, then D-1 should be coded with a -5" under morphology of distal vessel to signify anatomically not present. 16. 2nd DIAG (second diagonal; D-2). The second diagonal branch, which often has its origin at the angle of the anterior descending when visualized in the RAO projection. Origin is usually near junction of middle and distal thirds of LAD, but may come off higher, from MIDLAD. 17. Ist Ant Septal (first anterior septal). This vessel is designated as the first large branch of the LAD to penetrate into the anterior interventricular septum. 18. PRXCX (proximal circumflex). That portion of the circumflex artery from its origin off the main left coronary artery to and including the origin of the first obtuse marginal branch (No. 20). The distal circumflex (No. 19) may originate before the first marginal but the proximal circumflex continues until the origin of the first marginal. 19. DSTCX (distal circumflex). Begins from the proximal portion of the circumflex as the circumflex runs along or close to the posterior left atrioventricular groove. In right dominant circulation, the distal circumflex may be very small or absent. Marginal circumflex branches that are very small or "twigs" are not to be counted as marginals or described. The first marginal branch (No. 20) may sometimes be a very large branch with the second marginal (No. 21) appearing as a division of the first marginal. All branches that come off the distal circumflex will be labeled marginals (Nos. 20, 21, and 22 below), and all branches that come off the left atrioventricular artery will be labeled left posterolateral branches (No. 24, 25, and 26 below). 20. Ist OB MARC (first obtuse marginal). The first major branch of the circumflex artery supplying the lateral left ventricular wall, in the general area of the obtuse margin of the heart. 21. 2nd OB MARC (second obtuse marginal). The second branch of the circumflex distributing to the lateral surface of the ventricle. Sometimes smaller in caliber than the first obtuse marginal. May be absent or may be a division of the first obtuse marginal branch. 22. 3rd OB MARC (third obtuse marginal). The third branch of the circumflex supplying the posterolateral left ventricular wall (often absent). Runs parallel to the LPDA in the left predominant pattern. 23. LAV (left atrial ventricular artery). The left atrial ventricular artery is present only in a left dominant or balanced circulation. This artery is a continuation of the distal circumflex and has been arbitrarily defined as the distal half of the remainder of the circumflex after the take-off of the first marginal. The proximal half of the circumflex after the take-off of the first marginal will be defined as the distal circumflex (No. 19). Note that this definition is appropriate only for left dominant or balanced circulation. Left posterolateral branches that are very small or "twigs" are not to be counted as branches or described. The first left posterolateral branch (No. 24) may sometimes be a very large branch with the second left posterolateral branch (No. 25) appearing as a division of the first branch. All branches that come off the distal circumflex will be labeled marginals (No. 20, 21, and 22), and all branches that come off the left atrioventricular artery will be labeled left posterolateral branches (Nos. 24, 25, and 26). 24. 1st LPL (first left posterolateral branch). First branch off the LPL segment and often the only branch; synonym, left ventricular branch. 25. 2nd LPL (second left posterolateral branch). Second branch off the LPL segment. 26. 3rd LPL (third left posterolateral branch). Third branch off the LPL segment. Usually not present. 27. LPDA (left PDA). Posterior descending when present as a branch of the circumflex in the predominant left coronary artery.