Acute coronary syndromes (ACS) are the most frequent cause of hospitalization in western countries and may be complicated by acute heart failure or sudden cardiac death. The underlying mechanism of ACS is plaque rupture, endothelial erosion, and/or intraplaque haemorrhage with partial or complete occlusion of an epicardial coronary artery. Vulnerable plaques are characterized by increased inflammatory infiltrates circulating inflammatory biomarkers of vulnerable plaques have been identified. They provide valuable diagnostic and prognostic information. However, they do not provide insight in the anatomic localization of vulnerable plaques. Intravascular ultrasound (IVUS) can provide detailed, high-quality tomographic images of coronary plaque and identify unstable plaque. We describe a case report of a vulnerable patient with two vulnerable plaques, with antero-inferior ST elevation acute coronary syndrome.

Importance: Sestamibi imaging has been available for approximately three decades. During that time there has been considerable evidence published in the medical literature demonstrating that Sestamibi redistributes. Despite these publications, Lantheus has continued to insist that Sestamibi does not redistribute and that two doses of radioactive isotope are needed to conduct myocardial perfusion imaging. Isotope package inserts have maintained that Sestamibi is initially taken up by the heart within minutes without redistribution making it not only possible but acceptable to wait until 60-minutes to begin imaging. This approach then requires a second dose of Sestamibi to acquire comparative images for clinical decision-making according to the Sestamibi package insert.

Beginning in 1999, Fleming began the development of a quantitative method (FMTVDM), which accurately used nuclear imaging to truly quantify both [1], heart disease and [2], breast cancer.

Coronary artery disease is the leading cause of death in the United States and has been so for several decades affecting an estimated 12 million Americans. This year approximately 1.1 million Americans are expected to have an acute cardiac event with almost 2/3rds of these (650,000) being recurrent cardiac episodes in people already being treated for heart disease; accounting for 1 out of every 3 deaths [1]. This high rate of recurrence clearly illustrates that the problem doesn’t go away following initial medical treatment, interventional procedures and/ or by simply telling people to change their diet and lifestyle; particularly given all the confusion about what is a health diet and lifestyle.

We have recently been asked to review an article published in the JAMA in 2000 concerning the utilization of endotracheal intubation versus bag-valve mask oxygenation in the pre-hospital emergency setting by Paramedics. The article entitled “Effect of Out-of-Hospital Pediatric Endotracheal Intubation on Survival and Neurological Outcome: A Controlled Clinical Trial” is anything but a truly “Controlled Clinical Trial” [1].