Faculty Bibliography

Percutaneous coronary intervention (PCI) is now a part of the treatment strategy of patients with both unstable syndromes and chronic angina. As our patients age and live longer with coronary artery disease, many having had PCI, they are more likely to develop potentially life-threatening comorbid conditions, including neoplastic disorders. In the United States, for example, an estimated 41% of the population will develop some form of malignancy.1 As such, they become subject to a multitude of interactions between their cardiac and oncologic diseases, and the therapies used to treat each. This is especially the case when patients have had PCI with drug-eluting stents (DES), as a careful balance between thrombosis and bleeding must be maintained, and is particularly vulnerable to the interactions described above. The following cases and accompanying review will highlight potential risks of very late stent thrombosis with acquired prothrombotic states, following coronary intervention with implantation of both 1st and second-generation DES.

Anaphylaxis during diagnostic catheterization and coronary intervention is a rare and potentially life-threatening complication. Fortunately, with standard intervention, fatality is rare. We report a case of medically refractory anaphylaxis during a coronary intervention that ultimately responded to percutaneous cardiopulmonary bypass (CPB). The proposed mechanics and use of CPB for shock are discussed.

PURPOSE/OBJECTIVE:Recently, Shen and colleagues described a single-stage isoproterenol protocol: Head Up Tilt Table testing (HUTT). The purpose of this study was to compare the introduction of this single-stage tilt protocol to sequential two-staged tilt table testing. METHODS:Patients with recurrent or dramatic syncope or near syncope were referred for HUTT. A total of 100 patients underwent HUTT via a two-staged tilt protocol: 60 passive tilt for 30 minutes and, if negative, followed by a 10-minute tilt with isoproterenol titration to a 20% heart rate increase (two-staged HUTT). The next 100 patients underwent single stage isoproterenol protocol, which consisted of a 10-minute, 70 tilt with fixed dose isoproterenol infusion (0.05 ug/kg/minute). Patients with isoproterenol contraindications underwent a passive tilt (40 minutes for a conventional two-staged 60-degree tilt, and 45 minutes for a single-staged 70 tilt. RESULTS:In the single-stage method, 40% of those that received isoproterenol had a positive test, as compared to 24% for two-stage HUTT protocol (p < 0.001). CONCLUSION/CONCLUSIONS:A single-staged isoproterenol HUTT provides a rapid method of increasing the overall test yield as compared to conventional two-staged HUTT. Further research is necessary to elucidate the overall utility of this rapid single-stage protocol.