1/7. Cardiopulmonary auscultation: duo for strings--Opus 99.In spite of increasing mechanization in medicine and reliance on "high-tech" diagnostic tools, bedside clinical skills of the attending physician can still identify findings that are missed by the more sophisticated devices. Using a stethoscope, we relied on our skills in inspection, palpation, percussion, auscultation, as well as echocardiography and phonocardiography to diagnose a patient whose murmur was very reminiscent of the D-sharp pizzicato in the Cello Sonata in F, Opus 99, by Johannes Brahms. Initial echocardiography was not helpful. We suspected an anomalous chorda and confirmed this with phonocardiography and a second echocardiography. Although advances in cardiac imaging are extremely helpful, the use of simple clinical skills, in addition to being fun, is not obsolete. Cardiopulmonary auscultation should receive more emphasis in the medical school curriculum and clinical training.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Early detection of cardiac disease masquerading as acute bronchospasm: The role of bedside limited echocardiography by the emergency physician.We report two cases in which the patients experienced dyspnea, cough, and acute bronchospasm. Pulmonary pathology was initially suspected. Failure to respond to an initial trial of inhaled bronchodilator prompted the use of bedside limited echocardiography by the emergency physician. The potential role of limited echocardiography by the emergency physician as a triage tool in facilitating early diagnosis and emergent therapy, reducing time to final discharge, and enhancing interaction between the pediatric emergency physician and cardiology consultants is highlighted.- - - - - - - - - - ranking = 7keywords = physician (Clic here for more details about this article) |
3/7. Fatal amphetamine-associated cardiotoxicity and its medicolegal implications.amphetamines are popular drugs of abuse, particularly among youngsters and at dance scenes. Cardiotoxicity (manifested as cardiomyopathy, acute myocardial infarction/necrosis, heart failure, or arrhythmia) after the recreational (mis)use of amphetamine and its synthetic derivatives has been documented but is rather rare. Amphetamine-related cardiac fatalities are even more rare. We present 6 cases of young persons who died unexpected after the chronic abuse of amphetamines. death was not attributed to a lethal intoxication but to an acute myocardial necrosis, a right ventricle rupture, a cardiomyopathy, or an arrhythmia. Two of the deceased persons presented prior to their death to the emergency department, but their complaints were not considered (probably due to their young age) to be of cardiac origin. One case was a sport-related fatality where medical screening failed to identify the underlying cardiac pathology or the amphetamine abuse, and 1 case was a so-called idiopathic dilated cardiomyopathy where substance abuse was not considered by the treating physician. We think that amphetamine-associated cardiotoxicity is a rare but probably genuine entity that should be considered both in forensic and clinical/emergency medicine because of its potential medicolegal implications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Unusual manifestations of peripartal cardiac disease.Because peripartal cardiac disease occurs infrequently, its manifestations may be unfamiliar to most physicians. We report two unusual cases of postpartum cardiac disease: one patient presented with cerebral and peripheral arterial embolization, and the second patient developed late eclamptic seizures with subsequent myocardial infarction. Both patients recovered. Nonobstetric physicians should be aware of these pregnancy-associated medical complications to allow prompt diagnosis and aggressive therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/7. Cardiomyopathy associated with tricyclic antidepressants.Nine other cases of cardiomyopathy in patients taking tricyclic antidepressants have been reported. The patient we have described had been taking tricyclic antidepressants for years before cardiomyopathy developed. While a cause-and-effect relationship between tricyclic antidepressants and cardiomyopathy cannot be proven, physicians should keep in mind the association and discontinue the medication if cardiomyopathy develops. Further, tricyclic antidepressants should be used with great caution in patients with cardiomyopathy because of possible risk of ventricular fibrillation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Post-partum dilated cardiomyopathy in anti-phospholipid positive woman.Recurrent fetal loss and pregnancy complications, especially severe early-onset preeclampsia, are frequently associated with anti-phospholipid antibodies. We report a case of post-partum cardiac involvement leading to dilated cardiomyopathy in a woman with a persistent positivity for anti-cardiolipin and anti-nuclear antibodies. Her clinical and obstetric record reported two previous fetal losses but no other signs characteristic of the anti-phospholipid syndrome or diagnostic for a systemic lupus erythematosus. Post-partum cardiomyopathy might be another cardiac presentation of the anti-phospholipid syndrome, in addition to the well known valvular involvement. In patients with persistent positivities for anti-phospholipid antibodies, a prompt identification of such a complication in the post-partum period should be taken into account by physicians. Adequate cardiologic treatment associated with antiaggregant and steroid therapy might be useful to prevent further complications in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Transient normalization of systolic and diastolic function after support with a left ventricular assist device in a patient with dilated cardiomyopathy.A 19-year-old man who had fulminant heart failure caused by an idiopathic dilated cardiomyopathy was supported with a left ventricular assist device for 183 days as a bridge to heart transplantation. At the time of intended transplantation it was noted that the patient's heart had returned to normal size, had a normal ejection fraction, and was able to maintain normal pressures and flows. In view of the apparent recovery of cardiac properties, the left ventricular assist device was explanted and the transplantation was not performed. However, the heart dilated, ejection fraction worsened, and the patient died of heart failure exacerbated acutely by a systemic viral illness. Although such recovery of systolic function is uncommon, as use of the left ventricular assist devices becomes more widespread other physicians might encounter similar findings and, in this regard, they might find our experience useful as they contemplate their treatment options.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |