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This document provides a summary of a multicenter, randomized clinical trial comparing very early invasive strategy (IS) with standard care IS in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The study aimed to determine if there was a difference in the primary composite endpoint of all-cause mortality, new myocardial infarction (MI), or hospitalization for heart failure (HHF) between the two groups. The trial was terminated early due to slow recruitment, but the results showed no significant difference in the primary endpoint between the two groups. The length of hospital stay was shorter in the very early IS group, but the study was underpowered to demonstrate a significant difference. The optimal timing of IS in patients with NSTE-ACS remains uncertain. The text also discusses the challenges in implementing early IS in practice and the potential economic savings associated with it. However, the trial was underpowered to detect a difference in outcomes, and further research is needed to inform clinical practice. This document is a reference to two medical articles: "Cardiac angiosarcomas: A review and a case report" published in Cancer in 1986, and "Heart" published in April 2024. The articles discuss cardiac angiosarcomas, a rare type of cancer that affects the heart. [Extracted from the article]

Background Sinus of Valsalva aneurysm (SVA) is a rare but potentially life-threatening condition. Acute myocardial infarction (MI) is a rare consequence of aneurysmal dilatation of one or more sinuses of Valsalva. We present a case of an unruptured and partially thrombosed left SVA, presenting as anterior MI and congestive heart failure. Case summary A 55-year-old gentleman was admitted with pulmonary oedema and a late presenting ST-elevation MI with Q wave. After initial treatment on furosemide infusion, a coronary angiography showed significant stenosis in both his left main stem (LMS) and left anterior descending artery (LAD). This is likely a result of external compression, potentially from the enlarged left sinus of Valsalva. A subsequent transthoracic echocardiogram and transoesophageal echocardiogram (TOE) confirmed large SVA involving the left coronary cusp measured 9.9 cm compressing both LMS and LAD. Discussion Left SVAs are rare and frequently asymptomatic, typically being identified incidentally. Due to the close proximity of the left coronary system, they can present with myocardial ischaemia due to extrinsic compression of the coronary system. We were able to perform a comprehensive multi-modality assessment of left SVA, which helped establish this unusual diagnosis and guide management. Transthoracic echocardiogram and TOE helped assess the SVA and demonstrated the thrombus in situ , aortic valve insufficiency, and cardiac function. The computed tomography scan aided in accurately defining the extent of the aneurysm and the extent of compression of the left coronary system and cardiac magnetic resonance scan was able to demonstrate viability in LAD and circumflex territory. [ABSTRACT FROM AUTHOR]

Background Rotational atherectomy has become increasingly utilised over the past decade. Although a relatively safe procedure in appropriately trained physicians' hands, there are a number of recognised complications. Case summary We describe the case of a 64-year-old female who presented with chest pain and was diagnosed with non-ST-segment elevation acute coronary syndrome. A transthoracic echocardiogram (TTE) showed normal biventricular function and no valve disease. Invasive coronary angiogram was performed which revealed a severely calcified ostial right coronary artery (RCA) disease which was felt to be the culprit of the presentation. Balloon dilatation was unsuccessful, therefore, rotational atherectomy with an Amplatz left 0.75 guide and a 1.5 mm rota-burr was utilised and improved calcium burden. This was complicated by ostial dissection, treated with stenting. A TTE following the procedure revealed moderate aortic regurgitation (AR). The patient was discharged as she remained asymptomatic. An outpatient transoesophageal echocardiogram performed eight months later showed evidence of severe eccentric AR. Cardiac magnetic resonance imaging confirmed severe AR with left ventricular dilatation. Repeat angiogram 10 months after index procedure revealed in-stent restenosis, and the patient was accepted by heart multidisciplinary team for aortic valve replacement and grafting of RCA. Discussion As the field of rotational atherectomy continues to expand, we propose that novel complications such as reported in this case may become recognised. Finally, we stress the importance of multi-modality imaging in the investigation and timely planning of interventions in the management of these patients. [ABSTRACT FROM AUTHOR]

Spontaneous coronary artery dissection is an underdiagnosed cause of acute coronary syndrome, often occurring in younger females. Such a diagnosis should always be considered in this demographic. In this case report, we focus on the importance of optical coherence tomography in the diagnosis and management of this condition in the elective setting. [ABSTRACT FROM AUTHOR]

The autosomal-dominant progressive neurodegenerative disorder Huntington's disease leads to specific neuronal loss and dysfunction in the striatum and cortex. There is a lack of understanding about the molecular pathways mediating the neuropathology of Huntington's disease. Evidence of caspase-1 activation in the brains of mice and humans with the disease has been demonstrated, and it is shown that intracerebrovenricular administration of a caspase inhibitor delays progression and mortality in the mouse model.