1/30. Hypertrophic cardiomyopathy with mid-ventricular obstruction and splenic infarction associated with paroxysmal atrial fibrillation: a case report.A 54-year-old woman had been treated for hypertrophic cardiomyopathy and paroxysmal atrial fibrillation since 1992. She was admitted with paroxysmal atrial fibrillation which was resolved by medical treatment. However, on the next day, left lateral chest pain appeared. Computed tomography disclosed a low density area in the spleen. She received anticoagulant therapy under a diagnosis of splenic infarction, and the pain disappeared. echocardiography showed hypertrophic cardiomyopathy with mid-ventricular obstruction. She was treated with cibenzoline to prevent paroxysmal atrial fibrillation attack and attenuate the hemodynamic load. After treatment, the pressure gradient decreased from 41 to 7 mmHg. This patient with hypertrophic cardiomyopathy suffered a rare isolated splenic infarction associated with paroxysmal atrial fibrillation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/30. atrial fibrillation and continuous hypotension induced by sildenafil in an intermittent WPW syndrome patient.A 55-year-old Japanese man was hospitalized for palpitations and severe chest oppression one hour after he ingested about 1500 ml of beer and sildenafil (Viagra) 50 mg. At 43 years of age, he had been diagnosed with intermittent WPW syndrome following a paroxysmal supraventricular tachycardia (PSVT) attack. He took a 1 mg tablet of doxazosin daily for mild hypertension. On admission, his blood pressure was 90/54 mmHg and his heart beat was weak and irregular with a rate of about 220/min. Since atrial fibrillation (Af) was diagnosed on an electrocardiogram (minimum RR interval; 0.22 seconds), direct current shock was performed with 100 joules and 150 joules but conversion to sinus rhythm failed. Sinus rhythm returned spontaneously from Af four hours after taking sildenafil. Since blood pressure was 50/17 mmHg despite the return to sinus rhythm, blood pressure was maintained by dopamine for twelve hours after sinus rhythm returned. The patient underwent catheter ablation for curative therapy and thereafter has not had any further episodes of tachycardia.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
3/30. Antihypertensive therapy reduces increased plasma levels of adrenomedullin and brain natriuretic peptide concomitant with regression of left ventricular hypertrophy in a patient with malignant hypertension.We investigated the potential role of increased plasma adrenomedullin and brain natriuretic peptide (BNP) levels in a patient with malignant hypertension. A 51-year-old man was admitted to our hospital with a chief complaint of visual disturbance. His blood pressure was 270/160 mmHg on admission. Papillary edema associated with retinal bleeding was observed. echocardiography revealed marked concentric left ventricular hypertrophy with mild systolic dysfunction. plasma levels of adrenomedullin and BNP were markedly elevated. Antihypertensive therapy reduced the plasma levels of adrenomedullin in association with a concomitant decrease in blood pressure. The plasma level of BNP also decreased and regression of left ventricular hypertrophy and normalization of left ventricular systolic function were observed. Our findings suggest that adrenomedullin may be involved in the defense mechanism against further elevations in blood pressure in patients with hypertension and that the plasma level of BNP may reflect left ventricular systolic dysfunction, left ventricular hypertrophy, or both, in patients with severe hypertension.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
4/30. Biventricular pacing and atrioventricular junction ablation as treatment of low output syndrome due to refractory congestive heart failure and chronic atrial fibrillation.A 71-year-old male patient with end-stage heart failure, atrial fibrillation, congestive and low output symptoms, underwent biventricular pacing and atrioventricular junction ablation while anuric and hypotensive. Following atrioventricular junction ablation blood pressure increased by 20 mmHg during biventricular but not during right ventricular apical pacing. A rapid clinical improvement was observed and the patient was discharged from the hospital in NYHA functional class III.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/30. Acute adrenal failure associated with fluconazole after administration of high-dose cyclophosphamide.A 63-year-old man received high-dose cyclophosphamide for peripheral blood stem-cell (PBSC) harvest. He received 200 mg fluconazole. On day 3, atrial fibrillation developed with blood pressure declining to 78 mmHg. The rapid adrenocorticotropin (ACTH) test showed blunted adrenal responses. He was suspected as having adrenal failure, and fluconazole was discontinued. The rapid ACTH test became normal on Day 14, and PBSCs were successfully harvested. To clarify the association between adrenal failure and fluconazole, we resumed 400 mg fluconazole on Day 16 and repeated the test on Day 21, which showed blunted adrenal responses. This case demonstrates that prophylactic use of fluconazole can cause adrenal insufficiency.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/30. Conversion of atrial fibrillation into a sinus rhythm by coronary angioplasty in a patient with acute myocardial infarction.Atrial tachyarrhythmias are important complications occurring in more than 8% of acute myocardial infarctions (AMI). atrial fibrillation (AFi) during the early phase of AMI is caused by atrial ischaemia, atrial distension due to the left ventricular failure or significant diastolic left ventricular dysfunction. AFi in patients with inferior and posterior AMI indicates at least two vessel coronary diseases, a circumflex coronary artery (CX) occlusion before taking off of the left atrial branches as well as significant stenosis or occlusion of the right coronary artery (RCA). In this article the case of a 67-year-old woman with an acute infero-posterior AMI is described. AMI was complicated with a left heart failure, acute AFi with tachyarrhythmia, transient arterial hypotension and ischaemic mitral regurgitation. Emergency coronary angiography disclosed occlusion of the CX, myocardial infarct related artery, and significant stenoses of the RCA. After opening the occluded CX during the PTCA, AFi with a tachyarrhythmia of 160 beats per minute (bpm) immediately converted into a sinus rhythm with 80 bpm, followed by a normalization of blood pressure and cardiac recompensation. Our case report supports the opinion that AFi in patients with inferior and posterior AMI indicates at least a two-vessel coronary disease. Reopening of the occluded atrial coronary branches during urgent medical treatment was casual and effective treatment of both ischaemic heart disease and consequent AFi.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/30. Left atrial thrombosis following mitral valve repair and maze procedure: case report.The case is described of a 71-year-old woman with left atrial thrombosis after successful mitral valve repair and a Kosakai-maze procedure. At three months after surgery, electrocardiography showed a normal sinus rhythm, but echocardiography revealed a mural thrombus on the posterior wall of the left atrium. During those three months, the anticoagulation level (thrombotest index range: 29-41%) was lower than target level. Anticoagulant therapy with heparin plus warfarin failed to reduce the thrombus size. Anticardiolipin antibodies were positive, and lupus anticoagulants negative. A Doppler study of the mitral valve indicated peak velocity 1.48 m/s, mean pressure gradient 4.5 mmHg, and valve area 2.1 cm2. During reoperation, an old spherical thrombus (weight 38 g) which was firmly adhered to the posterior wall and included an incision line of the Kosakai-maze procedure, was identified and totally removed. After reoperation, the patient received warfarin and an antiplatelet agent to maintain the INR at 2.5-3.5. echocardiography performed at 11 months postoperatively revealed no thrombus formation on the left atrium.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/30. Combined cox maze procedure, septal myectomy, and mitral valve replacement for severe hypertrophic obstructive cardiomyopathy complicated by chronic atrial fibrillation.atrial fibrillation (AF) has been reported to be an important prognostic indicator for clinical deterioration particularly in patients with hypertrophic obstructive cardiomyopathy (HOCM). A 66-year-old female complained of severe exertional dyspnea and tachycardia, which were resistant to medical treatments. Doppler echocardiography demonstrated a peak left ventricular outflow tract (LVOT) gradient of 117 mmHg at rest. A catheter examination revealed left ventricular end diastolic pressure of 34 mmHg, a cardiac index of 1.94 L/minute/m(2), and a peak LVOT gradient of 70 mmHg at rest. A transaortic septal myotomy/myectomy was performed first, and Cox maze III procedure was performed through the right and left atrium followed by mitral valve replacement. The patient recovered dramatically except for temporary complete atrioventricular block. One year after operation, the patient is doing well with sinus rhythm and the echocardiogram revealed a peak LVOT pressure gradient of 7.6 mmHg at rest. This surgical approach might be recommended for the treatment of AF in HOCM. (Ann Thorac Cardiovasc Surg 2003; 9: 323-5)- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
9/30. Improvement of cheyne-stokes respiration, central sleep apnea and congestive heart failure by noninvasive bilevel positive pressure and medical treatment.A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed cheyne-stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
10/30. Interpretation of cardiac pathophysiology from pressure waveform analysis: coronary hemodynamics. Part II: Patterns of coronary flow velocity.These specialized tracings illustrate several important patterns of coronary blood flow velocity that may occur in patients during diagnostic cardiac catheterization. Recent advances in catheter methodologies permit easy measurement of coronary blood flow during routine coronary angiography. At the current time, measurement of coronary blood flow velocity remains a research technique but is of continuing interest in clinical syndromes of atypical angina, myocardial hypertrophy and infarction, early transplant rejection, or premature (subangiographic) atherosclerosis in some patients. A later hemodynamic rounds will examine the effects of coronary blood flow velocity and various hyperemic stimuli to assess coronary vasodilatory reserve.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
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