Cases reported "Cardiomyopathies"

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1/169. Evidence of cell-mediated cardiac myocyte injury involved in the heart failure of a patient with progressive systemic sclerosis.

    A 54-year-old woman with progressive systemic sclerosis (PSS) was admitted to hospital because of dyspnea and chest pain. Echocardiogram revealed diffuse hypokinesis of the left ventricle (ejection fraction 24%). methylprednisolone, heparin, and diuretics were administered, without benefit. anemia, thrombocytopenia, and renal dysfunction rapidly progressed, and she died of heart failure on the 14th hospital day. Immunohistochemical study of the myocardial tissue showed mild to moderate cell infiltration, mainly consisting of natural killer (NK) cells, macrophages, cytotoxic T lymphocytes (CTLs), and T helper cells. perforin, a cytolytic factor, was expressed in the infiltrating CTLs and NK cells, indicating that these cells were activated killer cells. Furthermore, human leukocyte antigen classes I and II, intercellular adhesion molecule-1, as well as costimulatory molecules B7-1, B7-2, and CD40, all of which are known not to be expressed in cardiac myocytes under normal conditions, were moderately to strongly expressed in cardiac myocytes. There was no detectable level of enterovirus genomes in the polymerase chain reaction products from the myocardial tissue of this patient. These findings strongly suggest that the infiltrating killer cells recognized cardiac myocytes as target cells and directly damaged them by releasing perforin. Enhanced expression of these antigens may have played an important role in the activation and cytotoxicity of the infiltrating killer cells. Absence of enterovirus genomes in the myocardial tissue may suggest that this autoimmune process is primarily induced by PSS.
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2/169. A case of hereditary amyloidosis transthyretin variant Met 30 with amyloid cardiomyopathy, less polyneuropathy, and the presence of giant cells.

    Transthyretin-Met 30 (TTR-Met 30) is a variant of transthyretin and is usually associated with familial amyloid polyneuropathy. It is rare that patients with TTR-Met 30 will primarily develop amyloid cardiomyopathy. This report presents a patient with late-onset TTR-Met 30 who primarily developed amyloid cardiomyopathy, with less amyloid polyneuropathy in the peripheral nervous system than is usually seen. An autopsy was performed, and histological examination revealed many foreign-body giant cells and macrophages in the area of amyloid deposition that was found in nearly all of the organs.
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3/169. A depressed myocardium.

    BACKGROUND: Venlafaxine is a potent neuronal serotonin and noradrenaline re-uptake inhibitor, and to a lesser extent an inhibitor of dopamine reuptake. paroxetine is a potent selective inhibitor of serotonin reuptake. CASE REPORT: A 27-year-old man ingested 1987.5 mg of venlafaxine and 360 mg of paroxetine. He subsequently developed systolic and diastolic hypertension, transient electrocardiographic abnormalities, and an area of persistent myocardial damage. He recovered from his overdose with his blood pressure and electrocardiogram returning to normal. The area of myocardial damage was documented on echocardiogram as an area of marked hypokinesia at the basal anterior septum. Despite the absence of confirming blood levels or the absolute exclusion of cocaine, this case indicates that venlafaxine and paroxetine have the potential for serious cardiotoxicity when taken in overdose.
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4/169. Acute myocardial injury: an entity of acute coronary syndromes.

    A 46-year-old Indian man was admitted with unstable angina (Braunwald's class IIIB1)--the chest pain at rest was associated with inferolateral ischaemia on the ECG at admission. His serial total creatine kinase levels were elevated but CKMB was not detected. Serial serum troponin t levels were significantly raised suggesting the presence of significant acute myocardial injury.
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5/169. Cardiac hydatid cyst revealed by complete heart block.

    Hydatid cyst of the heart is an uncommon lesion. The infection is most common in sheep-raising areas of the world. We report a rare case of cardiac hydatid cyst revealed by complete heart block, which was removed with the patient under cardiopulmonary bypass. This case stresses the importance of echocardiography for the diagnosis of cardiac echinococcosis.
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6/169. Recurrent cerebral embolism in a familial amyloid polyneuropathy patient who received partial liver transplantation from a living donor.

    Cerebral embolism in relation to cardiac amyloidosis has not been widely noted. A 47-year-old woman who had been suffering from familial amyloid polyneuropathy (FAP) for 7 years was treated with partial liver transplantation from a living donor and her early postoperative course was uneventful. During the 391st to 613th postoperative day she experienced recurrent cerebral infarctions, but clinical examinations revealed no disorders capable of producing cerebral embolism. At autopsy splenic infarction and intracardiac thrombi adhering to the mitral valve and left atrium were found, and these areas showed severe amyloid deposition. Amyloid heart is considered to be one possible cause of systemic embolism.
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7/169. Rytand-Lipsitch syndrome.

    An 84-year-old woman had Rytand-Lipsitch syndrome, ie, total atrioventricular block resulting from destruction of the central areas of the conducting system due to extension of calcification from the fibrous ring of the mitral valve. In a postmortem coronary arteriographic study of 500 hearts, degenerative calcification of the fibrous ring of the mitral valve was demonstrated in 4.4% (95% confidence limits--2.8% to 6.6%), rheumatic valvular changes not being included. There were significantly more women than men with calcification of the mitral valve apparatus (P less than .00005). Division of the material into two groups larger than or equal to 70 years and less than 70 years showed a statistically significant sex difference in the former group (P les than .005), whereas the sex difference was of borderline significance in the latter group (.1 greater than P greater than .05).
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8/169. Hydatid disease of the interventricular septum causing pericardial effusion.

    Echinococcal infestation of the heart is uncommon. We report a case of a 35-year-old man with an hydatid cyst located in distal interventricular septum. Clinical presentation was chest pain and urticaria. diagnosis was made by echocardiography and magnetic resonance imaging. Surgical resection was performed; the cyst was punctured and its content was drained, hypertonic glucose solution was instilled for sterilization, and it was removed. The patient did well and remains asymptomatic. diagnosis and ultimate surgical treatment of this disease prevented potentially lethal complications such as cyst rupture with embolic phenomena and anaphylactic shock.
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9/169. Conjunctival myxoma, zollinger-ellison syndrome and abnormal thickening of the inter-atrial septum: a case report and review of the literature.

    PURPOSE: To report a 36-year-old man with a slowly growing painless bulbar conjunctival mass. RESULTS: Following excision of the lesion, histological examination was performed and a diagnosis of myxoma was made. A cardiac echogram showed thickening of the interatrial septum. Seventeen years previously he had had Zollinger Ellison syndrome due to gastrinoma of the pancreas which was treated by surgical removal. A review of the literature shows ocular myxomas may be associated with endocrine abnormalities such as Cushing's syndrome, acromegaly, sexual precocity and cardiac myxoma. CONCLUSION: In this case we report a novel association of conjunctival myxoma with zollinger-ellison syndrome and inter-atrial septal thickening.
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ranking = 0.0030889157678495
keywords = pain
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10/169. Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism.

    PURPOSE: To underline the crucial role of urgent echocardiography in the differential diagnosis of acute respiratory and/or circulatory failure in the postpartum period. CLINICAL FEATURES: A 24-yr-old woman was admitted to the intensive care unit (ICU) with a preliminary diagnosis of pulmonary embolism (PE) one week after cesarean section. Neither computerized tomography nor Doppler sonography showed any signs of deep venous thrombosis or PE. In the ICU she required intubation and ventilatory support for acute respiratory and circulatory failure. Bedside echocardiography revealed features of left ventricular failure. A diagnosis of postpartum cardiomyopathy (PPCM) was made, appropriate treatment instituted and the patient soon improved. A 29-yr-old, previously healthy primipara presented at the Maternity Clinic on the fourth postpartum day complaining of increasing dyspnea and fatigue. Within eight hours she required intubation, ventilatory support and subsequent defibrillation due to cardiac arrest. She was transferred to the ICU with a preliminary diagnosis of PE. She developed pulmonary edema followed by cardiac arrest with successful resuscitation. Bedside echocardiography revealed a left ventricular ejection fraction below 30% with an increased systolic diameter of the left ventricle, restrictive diastolic abnormalities and no signs of pulmonary hypertension. Peripartum cardiomyopathy was diagnosed and supportive treatment for heart failure was instituted. CONCLUSION: It is possible to misdiagnose postpartum cardiomyopathy for PE. An error in diagnosis is life-threatening for the patient. echocardiography is a valuable tool in the differential diagnosis. As a noninvasive procedure, it should be performed at the bedside as soon as possible to institute proper treatment and to avoid potentially fatal errors.
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