1/6. Diagnostic utility of metabolic exercise testing in a patient with cardiovascular disease.Disproportionate exercise limitation in patients with cardiovascular disease is a common problem faced by clinical cardiologists and other physicians. Symptoms may be attributed to psychological factors or hypothetical pathophysiological mechanisms that are difficult to confirm clinically. This case report describes how the use of metabolic exercise testing in a 28 year old woman with morphologically and haemodynamically mild hypertrophic cardiomyopathy and severe exercise limitation led to the diagnosis of an alternative cause for the patient's symptoms, namely a primary disturbance of the mitochondrial respiratory chain probably caused by a nuclear encoded gene defect.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Familial hypertrophic cariomyopathy and lentiginosis.Members of three generations of a family studied, manifest profuse lentiginosis and hypertrophic cardiomyopathy. The autosomal dominant inheritance of this syndrome is established. Lentiginosis should alert the physician to possible underlying heart disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Hypertrophic cardiomyopathy in a college athlete.The greatest catastrophy in sports is an athlete's unexpected sudden death. Identifying those athletes at risk remains a great challenge to physicians performing preseason examinations. Hypertrophic cardiomyopathy is the most common cause of nontraumatic sudden death in athletes. Most cases of this diseased heart are diagnosed easily by echocardiography. The case presented exemplifies the attention to detail required to differentiate the borderline diseased heart from the conditioned athletic heart. Once a diagnosis of hypertrophic cardiomyopathy is made, further participation in intense physical exercise is discouraged. This recommendation is necessary despite the unknown relative sudden death risk for the minimal criteria cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Sudden cardiac death: ethical considerations in the return to play.The team physician-athlete relationship prompts many basic questions in medical ethics. Return-to-play decisions form many of the core responsibilities facing team physicians, and occasionally these decisions can have overriding ethical dilemmas. Therefore, a structured ethical decision-making process is a valuable skill for every successful sports medicine physician. An ethical question is confronted here in a case presentation that weighs the risk of repeat sudden cardiac death and the potential for failed cardiac resuscitation against the athlete's interest to play competitive basketball. The article applies a four-step framework for ethical decision making in sports medicine. The important first step includes gathering medical information and understanding the preferences of the athlete. Step 2 brings together the decision-making stakeholders, the team physician as a member, to define ethical issues and apply ethical principles: beneficence, non-maleficence, and patient autonomy. Step 3 selects a course of action with unbiased analysis and arrives at a good choice that merits an action plan in step 4. This decision need not be perfect, but should reinforce the team physician's responsibilities to the athlete and center on the athlete's welfare.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
5/6. Cardiac valve disorders: growing significance in the elderly.Accompanying the aging of the population has been a change in the presentation and the manifestations of valvular heart disease. Calcific aortic stenosis is now the most frequent reason for valvular heart surgery and differs greatly from the stenosis produced by rheumatic fever or a congenital bicuspid valve. Mitral insufficiency is found with increasing frequency and is often due to a calcified mitral valve annulus. mitral valve prolapse, once thought to be a disease found in younger patients, is being diagnosed more and more in the elderly and is a significant cause of mitral regurgitation. It is important for the physician caring for the older patient to be aware of the differing presentations, manifestations, and implications of valvular diseases in the elderly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Idiopathic hypertrophic subaortic stenosis and aortic regurgitation in an 84-year-old man.During the ninth decade of life, idiopathic hypertrophic subaortic stenosis (IHSS), particularly when associated with other cardiac disorders, presents a confusing clinical problem. Unless the physician has a high index of suspicion, the diagnosis is easily overlooked, and consequently inappropriate management of the patient may lead to serious complications. One such case in an 84-year-old man is described. Administration of certain drugs may only intensify symptoms. echocardiography is invaluable for diagnosis. Pertinent clinical features of IHSS in the eighth and ninth age decades are outlined.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |