http://stcccv.org.tn/web/app_dev123.php/QuizCasdemois/87/reponse

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GET
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52.167.144.194
Profiled on
Fri, 18 Jul 2025 05:47:19 +0200
Token
3f81e2

QuizcasdemoisController :: ReponseAction

Request

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No GET parameters

POST Parameters

No POST parameters

Request Attributes

Key Value
Quiz 
Quiz {#753
  -id: 87
  -titre: "One train may hide another"
  -titreEn: null
  -type: "Imagerie cardiaque"
  -typeEn: null
  -auteur: "Dr Majed Hassine, Dr Mehdi Boussaada"
  -service: """
    <p style="text-align:center"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#002060">Associate Professor, Fattouma Bourguiba Hospital,</span></span></span></strong></p>\r\n
    \r\n
    <p style="text-align:center"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#002060">Cardiology A department</span></span></span></strong></p>
    """
  -serviceEn: null
  -photoAuteur: "7e1acae6bb9dbf0c18f3ba31d811411d.jpeg"
  -filephoto: null
  -photoPartager: "52229cc8e2a610741fcde186ec647e18.jpeg"
  -commentaire: """
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a subgroup of patients with anterior wall acute STEMI, the ECG records concomitant inferior ST-segment elevation (STE) in addition to anterior STE or T wave inversion in anterior leads. This phenomenon is generally explained by a &ldquo;wrap-around&rdquo; LAD artery occlusion, which also supplies the inferior wall of the left ventricle. </span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This is a case with wrapped around LAD supplying the inferior left ventricle and showed acute inferior myocardial ischemia</span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A wrap-around LAD was defined as an LAD wrapping more than one-fourth of the inferior wall of LV, and the frequency of LAD wrapping around LV apex was reported to be 26%&ndash;34.%. </span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The identification of patients with this anatomic substrate is clinically important because it has been shown that patients with wrap-around LAD artery occlusion have higher mortality and morbidity rates, both short term and long term. </span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A twelve-lead ECG is still the reliable standard for diagnosing the size and site of infarction. Decisions on the basis of initial investigation may save time and facilitate the management and prevention of emergencies.</span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">As the occlusion of LAD artery showing STEMI in the inferior lead and indicated anterior myocardial infarction is an unusual presentation of ST-segment elevation. It is nearly impossible to diagnose a wraparound LAD diagnosed by ECG.</span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Using cardiac magnetic resonance imaging (cMRI), we have reported that in patients who had a MI, having a wrap-around LAD was related to an apical wall infarction</span></span></p>
    """
  -commentaireEn: null
  -description: """
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A 28-year-old man presented to the emergency department of a peripheral hospital with acute chest pain that started about 45 minutes ago. The pain was very suggestive: oppressive retro-sternal pain with irradiation to the left forearm. He reported no cardiovascular risk factors except for smoking estimated to 20 cigarettes per day over the past 10 years. The physical examination showed a symmetrical blood pressure of 140/80 mm Hg, a heart rate of 78 bpm, oxygen saturation was 98% spontaneously, cardiac auscultation showed regular heart sounds without murmurs, and there were no signs of heart failure. The ECG showed ST-segment elevation in the inferior leads (II, III, aVF) with ST-segment depression in the anterior leads (Figure 1). Trans-thoracic echocardiography rapidly ruled out pericardial effusion and showed moderate impairment of left ventricular function in relation to hypokinesia of the mid-anterior and the inferior segments. </span></span></p>\r\n
    \r\n
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The diagnosis of inferior STEMI was retained and a fibrinolytic treatment was decided as &quot;The door to balloon time&quot; was &gt; 2 hours. On arrival at the tertiary center, the ECG performed 90 minutes after fibrinolysis showed complete regression of ST-segment elevation in the inferior leads with the appearance of negative T waves in the anterior leads (from V2 to V6). Figure 2</span></span></p>\r\n
    \r\n
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Coronary angiogram performed the next day showed a left-dominant coronary circulation with a short and normal left main, a mid narrowing in the mid LAD with normal TIMI flow, the left circumflex as well as the RCA were normal (Figure 3,4). </span></span></p>\r\n
    \r\n
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Facing this MINOCA, an MRI was performed which detected an apical wall infarction with severe hypokinesis in the mid and apical segments of the anterior wall associated to T2-weighted high signal due to edema (Figure 5, video 1) .</span></span></p>
    """
  -descriptionEn: null
  -casdemois: Casdemois {#544 …}
  #question: PersistentCollection {#711 …}
  #media: PersistentCollection {#776 …}
}
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    -class: "GestionCasdemoisBundle:Quiz"
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]
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"Reponse"
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  "id" => "87"
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quiz 
Quiz {#753
  -id: 87
  -titre: "One train may hide another"
  -titreEn: null
  -type: "Imagerie cardiaque"
  -typeEn: null
  -auteur: "Dr Majed Hassine, Dr Mehdi Boussaada"
  -service: """
    <p style="text-align:center"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#002060">Associate Professor, Fattouma Bourguiba Hospital,</span></span></span></strong></p>\r\n
    \r\n
    <p style="text-align:center"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#002060">Cardiology A department</span></span></span></strong></p>
    """
  -serviceEn: null
  -photoAuteur: "7e1acae6bb9dbf0c18f3ba31d811411d.jpeg"
  -filephoto: null
  -photoPartager: "52229cc8e2a610741fcde186ec647e18.jpeg"
  -commentaire: """
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a subgroup of patients with anterior wall acute STEMI, the ECG records concomitant inferior ST-segment elevation (STE) in addition to anterior STE or T wave inversion in anterior leads. This phenomenon is generally explained by a &ldquo;wrap-around&rdquo; LAD artery occlusion, which also supplies the inferior wall of the left ventricle. </span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This is a case with wrapped around LAD supplying the inferior left ventricle and showed acute inferior myocardial ischemia</span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A wrap-around LAD was defined as an LAD wrapping more than one-fourth of the inferior wall of LV, and the frequency of LAD wrapping around LV apex was reported to be 26%&ndash;34.%. </span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The identification of patients with this anatomic substrate is clinically important because it has been shown that patients with wrap-around LAD artery occlusion have higher mortality and morbidity rates, both short term and long term. </span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A twelve-lead ECG is still the reliable standard for diagnosing the size and site of infarction. Decisions on the basis of initial investigation may save time and facilitate the management and prevention of emergencies.</span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">As the occlusion of LAD artery showing STEMI in the inferior lead and indicated anterior myocardial infarction is an unusual presentation of ST-segment elevation. It is nearly impossible to diagnose a wraparound LAD diagnosed by ECG.</span></span></p>\r\n
    \r\n
    <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Using cardiac magnetic resonance imaging (cMRI), we have reported that in patients who had a MI, having a wrap-around LAD was related to an apical wall infarction</span></span></p>
    """
  -commentaireEn: null
  -description: """
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A 28-year-old man presented to the emergency department of a peripheral hospital with acute chest pain that started about 45 minutes ago. The pain was very suggestive: oppressive retro-sternal pain with irradiation to the left forearm. He reported no cardiovascular risk factors except for smoking estimated to 20 cigarettes per day over the past 10 years. The physical examination showed a symmetrical blood pressure of 140/80 mm Hg, a heart rate of 78 bpm, oxygen saturation was 98% spontaneously, cardiac auscultation showed regular heart sounds without murmurs, and there were no signs of heart failure. The ECG showed ST-segment elevation in the inferior leads (II, III, aVF) with ST-segment depression in the anterior leads (Figure 1). Trans-thoracic echocardiography rapidly ruled out pericardial effusion and showed moderate impairment of left ventricular function in relation to hypokinesia of the mid-anterior and the inferior segments. </span></span></p>\r\n
    \r\n
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The diagnosis of inferior STEMI was retained and a fibrinolytic treatment was decided as &quot;The door to balloon time&quot; was &gt; 2 hours. On arrival at the tertiary center, the ECG performed 90 minutes after fibrinolysis showed complete regression of ST-segment elevation in the inferior leads with the appearance of negative T waves in the anterior leads (from V2 to V6). Figure 2</span></span></p>\r\n
    \r\n
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Coronary angiogram performed the next day showed a left-dominant coronary circulation with a short and normal left main, a mid narrowing in the mid LAD with normal TIMI flow, the left circumflex as well as the RCA were normal (Figure 3,4). </span></span></p>\r\n
    \r\n
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Facing this MINOCA, an MRI was performed which detected an apical wall infarction with severe hypokinesis in the mid and apical segments of the anterior wall associated to T2-weighted high signal due to edema (Figure 5, video 1) .</span></span></p>
    """
  -descriptionEn: null
  -casdemois: Casdemois {#544 …}
  #question: PersistentCollection {#711 …}
  #media: PersistentCollection {#776 …}
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