Coronary Artery Ectasia ±
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Coronary artery ectasia is a rare disease that occurs in only 0.3-4.9% of people in North America. Coronary artery ectasia is characterized by the enlargement of a coronary artery to 1.5 times or more than its normal diameter. The disease is commonly asymptomatic and is normally discovered when performing tests for other conditions such as coronary artery disease, stable angina and other acute coronary syndromes. Coronary artery ectasia occurs 4 times more frequently in males than in females and in people who have risk factors for heart disease such as smokers.
While the disease is commonly found in patients with atherosclerosis and coronary artery disease, it can occur by itself and in both cases it can cause health problems. The disease can cause the heart tissue to be deprived of blood and die due to decreased blood flow, and blockages due to blood clots or spasms of the blood vessel.
This blood flow disruption can cause permanent damage to the muscle if the deprivation is prolonged. Coronary artery ectasia also increases the chance of developing large weak spots in the affected coronary arteries, or aneurysms that can rupture and result in death. The damage can result in angina which is pain in the chest and is a common complaint in these patients.
To discover the extent and severity of coronary artery ectasia there are a variety of diagnostic tools used. The most common method for discovering the disease is through angiography. Angiography is the procedure where a contrast dye is entered into the vessels and an x-ray is taken, which will allow the vessels to be seen on the x-ray. Using angiography clinicians are able to display the size, location and number of vessels affected by the disease. Is can also be analyzed through other methods such as intravascular ultrasound, and magnetic resonance imaging.
Using these diagnostic methods, is has been discovered that the disease normally occurs most often in the right coronary artery, followed by the left anterior descending artery, and finally the left anterior circumflex artery. Using these methods Coronary artery ectasia can be divided into four different types: Type 1¬→diffuse ectasia in 2-3 different vessels, Type 2¬→ diffuse disease in 1 vessel and local disease in another, Type 3¬→ diffuse disease in one vessel and Type 4¬→ localized or segmental ectasia.
Coronary artery ectasia is commonly found in patients with diseases of the connective tissue and an increased inflammatory response such as Marfan syndrome and Kawasaki Disease. It can also be found transiently in patients that have undergone stent placement resulting in the stretching of the vessels 1. Coronary artery ectasia is characterized by an increased wall stress of the vessel, thinning of the arterial wall which causes progressive dilation and remodelling of the vessel. The permanent dilation of the artery is thought to be mainly caused by inflammation, triggered by disease, chemicals, or physical stress of the vessel.
The inflammatory response results in an over expression of matrix metalloproteinases, cysteine proteinases, and serine proteinases that causes the partial breakdown of the vessel and weakens it. The inflammation response will also trigger platelet activation which increases the risk of blood clots. The risk of blood clots will increase due to the turbulent blood flow of the enlarged vessel which can activate platelets and form clots. Inflammation elevated oxidative stress is increased, and antioxidant activity is depressed in coronary artery ectasia. This imbalance can cause damage to the cells and cause them to die, weakening the vessels further.
The activation of the inflammatory response causes a detectable increase in C reactive protein, interleukin-6, tumor necrosis factor alpha and cell adhesion molecules, which can be used as a diagnostic marker.
The treatment of coronary artery ectasia is normally done in conjunction with therapies of other heart disorders such as atherosclerosis and hypertension. To prevent the formation of blood clots and the blockage of the vessels, patients are commonly placed on anticoagulant therapy (e.g. warfarin, and aspirin), as well as anti-spasm therapy of calcium channel blockers. Coronary artery ectasia also responds to statins and ACE inhibitors.
CORONARY ARTERY ECTASIA: ASPECTS OF FITNESS TO FLY
Cokkinos, D. V.; Demopoulos, V. P.; Voudris, V.; Manginas, A.; Cotileas, P.; Foussas, S. G., 1999: Coronary artery ectasia: Aspects of fitness to fly. European Heart Journal Supplements 1 (Suppl D): D53-D58
DIGITAL IMAGING AND COMMUNICATIONS IN MEDICINE
DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. The communication protocol is an application protocol that uses TCP/IP to communicate between systems. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format. The National Electrical Manufacturers Association(NEMA) holds the copyright to this standard. It was developed by the DICOM Standards Committee, whose members are also partly members of NEMA.
DICOM enables the integration of medical imaging devices – like scanners, servers, workstations, printers, network hardware, and picture archiving and communication systems (PACS) – from multiple manufacturers. The different devices come with DICOM Conformance Statements which clearly state which DICOM classes they support. DICOM has been widely adopted by hospitals and is making inroads in smaller applications like dentists’ and doctors’ offices.
DICOM is used worldwide to store, exchange, and transmit medical images. DICOM has been central to the development of modern radiological imaging: DICOM incorporates standards for imaging modalities such as radiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and radiation therapy. DICOM includes protocols for image exchange (e.g., via portable media such as DVDs), image compression, 3-D visualization, image presentation, and results reporting.
JOSEPH S R DE SARAM – DICOM IMAGES AT 2 FRAMES PER SECOND
JOSEPH S R DE SARAM – DICOM IMAGE – IM1
JOSEPH S R DE SARAM – DICOM IMAGE – IM94
JOSEPH S R DE SARAM – DICOM IMAGE – IM95
JOSEPH S R DE SARAM – DICOM IMAGE – IM96
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