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Renin-angiotensin system inhibition after surgical aortic valve replacement for aortic stenosis

Heart BMJ

Objective The optimal medical therapy after surgical aortic valve replacement (SAVR) for aortic stenosis remains unknown. Renin–angiotensin system (RAS) inhibitors could potentially improve cardiac remodelling and clinical outcomes after SAVR. Both treatment with ACE inhibitors (aHR 0.89 (95% CI 0.82

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Abstract 4142012: Ectasias of Multiple Coronary Arteries and a Coronary Cameral Fistula Between Right Coronary Artery and Coronary Sinus

Circulation

Notably, the LAD had multiple aneurysmal segments and areas of eccentric stenosis upto 90%.Multislice Cardiac MRI did not show significant ischemic findings.The patient received medical therapy consisting of antiplatelet agents, high dose statin, beta blocker and ACE inhibitor, as well as diuretics.

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What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

Even in patients whose moderate stenosis undergoes thrombosis, most angiograms show greater than 50% stenosis after the event. However, one can certainly imagine that many thromboses of non-obstructive lesions completely lyse and do not leave a stenosis on same day or next day angiogram. Lindahl et al.

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

1-4 Surprisingly, serial angiographic studies have revealed that the plaque at the site of the culprit lesion of a future acute myocardial infarction often does not cause stenosis that, as seen on the antecedent angiogram, is sufficiently severe to limit flow. There may be a chronic tight stenosis and a non-obstructed lesion that thrombosed.

Plaque 52