1/8. Occupational asthma with paroxysmal atrial fibrillation in a diamond polisher.We present a case of a diamond polisher who developed occupational asthma as a result of prolonged exposure to various potent and well-recognized asthma-inducing agents, including cobalt dust. Although the patient was seen by various medical professionals during the initial course of his illness and given an early diagnosis of a respiratory condition, there were no attempts to evaluate the nature of his work, and therefore to establish a possible causal relationship with his exposures. This case clearly illustrates the importance of such an assessment. The ultimate fate of this patient (he had to retire from his job with a chronic and permanent illness) could have been avoided by early environmental intervention. In addition, this case illustrates a possible complication of asthma, that is, a severe cardiac arrhythmia. In this case, both the patient's symptoms and the prescribed medications contributed to worsening of the patient's underlying condition. early diagnosis and intervention of this patient's work practices could have avoided this complication.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. Dissimilar atrial rhythms: coexistence of reentrant atrial tachycardia, atrioventricular nodal reentrant tachycardia and interatrial conduction block.We report a patient in whom mapping of the right atrium with multipolar catheters and electroanatomic mapping revealed the presence of three dissimilar rhythms: a reentrant atrial tachycardia in the antero-lateral wall of the right atrium and an atrioventricular nodal reentrant tachycardia (AVNRT) isolated from each other and a conduction disturbance at the interatrial septum resulting in a rate-related interatrial block and a slow left atrial rhythm. The AVNRT was stopped with intravenous adenosine (6 mg) and induced repeatedly by atrial extrastimuli associated with a critical atrioventricular delay and dual atrioventricular nodal pathways. Electroanatomic mapping disclosed extensive fibrosis isolating viable myocardium of the antero-lateral wall from the rest of the right atrium. The viable myocardium in the antero-lateral wall was activated by a reentrant rhythm circulating around an islet of fibrosis located in the middle of the viable tissue. The AVNRT was ablated by a standard approach and the reentrant atrial tachycardia by producing a linear lesion bridging the central islet of fibrosis with the anterior tricuspid annulus. This case highlights the complicated nature of some dissimilar atrial rhythms and the power of electroanatomic mapping tools to reveal the exact mechanism and guide radiofrequency ablation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. Cardiogenic embolism producing crescendo transient ischemic attacks.Lateralizing, repetitive transient ischemic attacks are characteristic of symptomatic carotid bifurcation atherosclerotic plaques. We report a case in which a cardiogenic embolus, after lodging at the left carotid bifurcation, produced crescendo episodes of expressive aphasia and mild right upper extremity weakness. Complete neurological recovery was achieved following emergent carotid embolectomy and endarterectomy. This case demonstrates that the laminar nature of internal carotid blood flow may result in the localization of embolic events to a single region of the cerebral vasculature, regardless of the source lesion in the carotid artery. The role of endoluminal techniques in the diagnosis and management of such lesions is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Spinal epidural hematoma after spinal manipulative therapy in a patient undergoing anticoagulant therapy: a case report.OBJECTIVE: We report on the case of a patient with spinal epidural hematoma (SEH) after spinal manipulative therapy and review features of reported cases of a similar nature. CLINICAL FEATURES: The patient was undergoing Coumadin anticoagulant therapy for atrial fibrillation and presented to the chiropractor complaining of a stiff neck. After cervical manipulation, he developed paresthesia in both feet, progressing to motor deficits in all 4 extremities. He required a laminectomy and evacuation of a clot indenting the spinal cord. RESULTS: review of the literature revealed 7 reported cases of SEH after manipulation; 5 patients underwent cervical manipulation and 1 patient received Coumadin therapy. CONCLUSION: Practitioners of spinal manipulative therapy should be aware of SEH as a possible complication of manipulation in patients at risk and should exercise caution in the care of patients undergoing anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. lipoma of the interatrial septum in a patient with chronic atrial fibrillation: A case report.The authors report on a 70-year-old woman with chronic atrial fibrillation that was hospitalized for digitalis intoxication and incidentally was found to have an interatrial lipoma. The diagnosis was established by transesophageal echocardiography, computed tomography (CT) scanning, and magnetic resonance imaging (MRI). Owing to the asymptomatic character and the benign nature of the tumor, a decision for conservative management was made.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. atrial fibrillation and electrical appliance injury.Electrocardiographic changes and cardiac arrhythmias have been reported frequently in patients suffering high tension (greater than 1,000 V) electrical injuries as well as low tension (less than 350 V) electrical injuries. An association of atrial fibrillation with low tension electrical injury from a household appliance, however, has not been described in the recent literature. We describe a patient with atrial fibrillation induced by a shock from a household toaster. Pathophysiologic mechanisms and approach to treatment are reviewed, emphasizing the transient nature of most electrically induced arrhythmias.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. thyrotoxicosis-induced congestive heart failure in an urban hospital.thyrotoxicosis has been associated with several cardiac complications, including atrial fibrillation (AF), functional cardiomyopathy, and congestive heart failure (CHF). thyrotoxicosis-induced CHF has been considered an unusual complication of thyrotoxicosis, occurring generally in older patients. To determine the nature and frequency of this complication of thyrotoxicosis in an adult, hospitalized population, the authors consecutively evaluated all admissions to a 535-bed urban hospital during a 14-month period. Admitted during the study period were 177 individuals with a principal diagnosis of AF and 21 individuals with a principal diagnosis of thyrotoxicosis. Eleven of these individuals had concomitant AF and thyrotoxicosis, which was 6% of the AF group. Of these 11 patients, 5 had clinically apparent CHF without evidence of other organic heart disease (Group A) and 6 had only AF without clinical CHF (Group B). The 5 patients with CHF had a significantly lower mean age (36) than the 6 with thyrotoxicosis and AF only (P < 0.03). echocardiography revealed Group A to have a mean of 2.8 cardiac chambers enlarged compared with a mean of 1 in Group B (P < 0.008). Four of the five patients with CHF had normal left ventricular function. Mean levels of serum thyroxine, albumin, hematocrit, left ventricular percent shortening, and left atrial diameter were similar in groups A and B. Based on the authors' data, thyrotoxicosis-induced CHF is not as rare a complication of thyrotoxicosis in young individuals as reported previously. thyrotoxicosis-induced CHF most commonly has a dilated cardiomyopathy and high output failure.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. desmin myopathy involving cardiac, skeletal, and vascular smooth muscle: report of a case with immunoelectron microscopy.desmin myopathy is a rare idiopathic disorder characterized by abnormal aggregates of desmin-type intermediate filaments, which affects cardiac and skeletal muscle, and rarely the intestinal smooth muscle. We report a 42-year-old woman with atrial fibrillation and progressive restrictive cardiomyopathy. Left ventricular biopsy, cardiac explant, and subsequent autopsy study of skeletal muscle revealed cytoplasmic granulo-filamentous inclusions that were continuous with Z-lines and were immunoreactive for desmin filaments both at the light immunohistochemical and electron microscopic level. In addition, we report the presence of characteristic inclusions within the smooth muscle of intramural coronary blood vessels. This is the first description of desmin inclusions within vascular smooth muscle, and underscores the systemic nature of this rare myopathy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |