1/7. Sudden death due to ventricular septal defect.Ventricular septal defects (VSD) are usually considered non-life-threatening, usually closing spontaneously or causing symptoms of congestive heart failure, which can be surgically treated in time to save the patient's life. Despite the usually benign clinical course of VSD, serious arrhythmias occur in 16-31% of patients. Sudden death accounted for one-third of all deaths in a series of medically managed patients and occurred in 4.2% of patients in a study of VSD and arrhythmias. Cardiac hypertrophy is the common denominator in all cases reported in detail of VSD-associated sudden death. We have encountered four cases of sudden unexpected death from VSD in infants ranging in age from 1 week to 3 and (1/2) months. In each case there was cardiomegaly and in one case there was pulmonary arteriolar medial thickening, with extension of smooth muscle into small intralobular vessels. In half of our cases the attending physician was sued for malpractice. We believe that VSD in infants and young children are potentially life-threatening malformations which warrant careful clinical follow-up.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. growth failure with pericardial constriction. The syndrome of mulibrey nanism.The features of the syndrome of mulibrey nanism, an autosomal recessive disorder of unknown pathogenesis, include severe growth failure, yellow pigmentation of the retina, evidence of pericardial constriction, J-shaped sella turcica, and fibrous dysplasia of bones. To date, 24 individuals from finland and a boy from egypt have been reported with the syndrome. The patient reviewed in this article is the first known affected child from the united states. It is important that physicians look for this disorder in children with severe growth failure and hepatomegaly because of the potential seriousness of undetected pericardial constriction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Anomalous left coronary artery masquerading as infantile bronchiolitis.Four infants less than six months of age with anomalous left coronary artery from the pulmonary artery who present with symptoms of wheezing are described. All had cardiomegaly on chest radiographs and because of wheezing received beta-agonist agents (albuterol alone or with epinephrine). One developed cardiopulmonary collapse secondary to supraventricular tachycardia after administration of these agents. The literature is reviewed for utility of chest radiographs in infants presenting with wheezing and for the efficacy of beta-adrenergic agents in infants less than six months of age. The authors suggest that physicians have a low threshold for obtaining a chest radiograph prior to treating a first-time wheezing infant less than six months of age with a beta-agonist agent.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. autoantibodies and the spectrum of sjogren's syndrome.In studies reported recently, the sera of patients with sjogren's syndrome were found to contain precipitating antibodies to nuclear antigens that can be identified by immunodiffusion analysis. These precipitating autoantibodies have been termed SS-A and SS-B antibodies. We show that identification of these autoantibodies helped in establishing the diagnosis of sjogren's syndrome in 12 of 30 patients in whom the diagnosis had not been considered at the time of the physician's initial examination. The reasons for this were related to lack of spontaneous complaints of keratoconjunctivitis sicca and xerostomia and prominence of symptoms associated with arthritis, myalgia, pulmonary fibrosis, and cardiac disease. This study re-emphasizes the importance of multisystem disease in sjogren's syndrome and shows that specific serologic assays for autoantibodies aided in diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Congestive heart failure: a review and case report from a chiropractic teaching clinic.OBJECTIVE: To discuss the case of a 62-year-old woman with congestive heart failure (CHF), precipitated by a previous arteriovenous malformation, and to review the clinical presentation, pathophysiology, and treatment options for patients with CHF. CLINICAL FEATURES: The patient complained of pain, rapid weight gain, and shortness of breath. The index event for this patient was known to be an arteriovenous malformation. Biventricular cardiomegaly with pulmonary venous hypertension was evident on chest radiographs. INTERVENTION AND OUTCOME: The patient received both medical care (drug therapy) and chiropractic care (manipulation and soft tissue techniques to alleviate symptoms and discomfort). CONCLUSION: patients with known and undiagnosed CHF may visit the chiropractic physician; thus, knowledge of comprehensive care, differential diagnosis, and continuity of care are important. chiropractic management may be helpful in alleviating patient discomfort. Further clinical investigations may help to clarify the role of complementary and alternative care in the diagnosis and treatment of CHF.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Monitoring and perioperative intervention in the postoperative patient with heart disease.The perioperative care of patients with preexisting cardiac disease is smoothest and easiest when preoperative assessment has identified patients at risk, and when such patients are invasively and intensively monitored in the postoperative period. Using real-time measurements of cardiovascular functions permits the physician to rationally decide on a course of drug support. Several clinical situations are presented in order to illustrate the relevance of these measurements for the management of the patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Cardiac and arterial hypertrophy and atherosclerosis in hypertension.Clinical evaluation of the hypertensive patient has traditionally relied on physician measurement of blood pressure and assessment of target-organ involvement by simple laboratory tests. However, this approach is limited in its ability to identify individual patients at high or low risk of complications. In recent years, noninvasive methods have been developed to identify pathological transformations of the heart and arteries that collectively comprise "preclinical hypertensive disease." Measurements by echocardiogram or other methods of left ventricular mass and relative wall thickness identify a spectrum of cardiac adaptations to hypertension, including concentric and eccentric hypertrophy, the recently described pattern of "concentric left ventricular remodeling" (normal mass but increased relative wall thickness), and normal ventricular geometry. In clinical studies, each anatomic pattern is associated with a distinct profile of resting hemodynamics, ambulatory blood pressure, myocardial contractility, and risk of adverse outcomes. Ultrasonic imaging of the carotid or other arteries makes it possible to detect increased arterial wall thickness and discrete atheromas noninvasively. Carotid wall thickness and lumen diameter parallel similar ventricular dimensions in normotensive and hypertensive humans, indicating the presence of integrated patterns of cardiac and vascular adaptation to hypertension. Furthermore, peripheral atherosclerosis is associated with higher ventricular mass and a more adverse 24-hour blood pressure profile. In summary, noninvasive visualization of the heart and blood vessels reveals a spectrum of patterns of anatomic and functional adaptations that are related to the pathophysiology and prognosis of hypertension.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |