A Rare Case of Single Right Coronary Artery with Absent Left Main Coronary Artery
Aidan (Jia Sheng) Yu1*, Matthew Rowe2, John Atherton1, Arun Dahiya1
1Royal Brisbane and Women’s Hospital, Australia
2Princess Alexandra Hospital, Australia
A 54-year-old female presented with chest pain and was noted to have new T-wave inversion on her electrocardiograph (ECG) in leads V2-V6. The patient has a past history of recurrent DVT/PE and recently had a subtotal colectomy for ulcerative colitis. Serial troponin I measurements were normal (<0.040 µg/l). Transthoracic echocardiogram revealed an impaired left ventricular ejection fraction of 35-40% with hypokinesis within the lateral and apical segments. A coronary angiogram was performed and the left main coronary artery (LMCA) could not be located despite cuspal injections, ascending aortogram and left ventriculogram. A large, dominant right coronary artery (RCA) was visualised which passed around the left ventricular apex to the area normally supplied by the obtuse marginal (OM), diagonal and distal left anterior descending (LAD) arteries. Computed tomography coronary angiography (CTCA) revealed a superdominant RCA supplying the LV apex and lateral wall with no LMCA coming off the left coronary cusp. The left circumflex (LCx) was small and arose from a conus branch with a separate origin to the RCA. No significant stenosis was visualised on CTCA. The T-wave changes were deemed to be secondary to physiological stress/supply-demand ischaemia particularly at the distal end of the RCA, where it supplied the LAD. The patient was commenced on metoprolol 25mg b.d. and continued warfarin on discharge.
Single RCA with absent LMCA is extremely rare with only a few isolated cases reported in the literature. Use of CTCA in combination with coronary angiography was useful in defining this unusual anatomy and excluding a haemodynamically significant lesion. This anomaly is a variation to the typical Lipton subtypes and may represent a new subtype not previously described before.
DOI: 10.29245/2578-3025/2019/2.1167 View / Download Pdf Diet and Nutrition: Implications to Cardiometabolic Health
Melissa Johnson*
College of Agriculture, Environment and Nutrition Sciences, Tuskegee University, USA
Cardiometabolic diseases and disorders continue to be the most significant and leading causes of morbidity and mortality in the United States, as well as globally. Among the cardiometabolic disorders, cardiovascular diseases (CVDs) have the greatest prevalence; other cardiometabolic disorders closely related to CVDs such as diabetes mellitus and Metabolic Syndrome (MetS) continue to contribute to the public health burden as well. Common risks for cardiometabolic disorders include biological (i.e. genetic predisposition, race, age, gender), demographic (socioeconomic status), dietary (dietary intake), behavioral (e.g., physical activity) and environmental (e.g., obesogenic, atherogenic, carcinogenic environments) characteristics. Paradoxically, dietary risk is both the most modifiable and least modifiable risk for certain diseases, as other modifiable and non-modifiable characteristics act in synergy to influence dietary intake. Although many inconclusive and conflicting research findings exist, the benefits of consuming a high quality diet are consistently valued and the role of diet in safeguarding cardiometabolic health cannot be underestimated. Diets rich in whole grains, non-starchy vegetables, and fruits, moderate in processed foods and refined grains, and consequently lower omega-6 to omega-3 fatty acid ratios appear to offer the greatest potential benefit. This mini review briefly summarizes the implications of diet and nutritional intake to cardiometabolic health.
DOI: 10.29245/2578-3025/2019/2.1168 View / Download Pdf