1/61. Immediate and persistent complete heart block following a horse kick.Nonpenetrating chest trauma has been reported to cause acute and transient disorders of impulse formation and propagation, including intraventricular conduction delay and heart block. We report a case of immediate and sustained complete heart block following blunt chest injury.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/61. Multiple idiopathic left ventricular aneurysms in a Japanese woman.Idiopathic aneurysms of the left ventricle (LV) are uncommon in Western society. Multiple idiopathic LV aneurysms are distinctly unusual and are rarely reported. As with aneurysms of atherosclerotic origin, these entities may be associated with chest discomfort, congestive heart failure, cardiac dysrhythmias, and thromboembolic phenomena. We present the case of a Japanese woman living in the united states with chest discomfort, ventricular arrhythmias, and a previous transient ischemic attack who demonstrated four discrete LV aneurysms on ventriculography. Extensive evaluation demonstrated no clear cause for these aneurysms. The patient was treated conservatively with medical therapy and has continued to do well without adverse clinical sequelae.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/61. borrelia burgdorferi as a cause of Morgagni-adams-stokes syndrome. Long time follow-up study.According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-adams-stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.- - - - - - - - - - ranking = 4.4218133456448keywords = chest pain, chest (Clic here for more details about this article) |
4/61. Mid-systolic click, late systolic murmur syndrome associated with complete heart block.A 60 year old woman is presented who had the mid-systolic click, late systolic murmur syndrome, documented by phonocardiogram and left ventricular angiography. During an episode of non-anginal chest pain, advanced heart block was demonstrated and permanent transvenous pacemaker therapy was subsequently instituted. The association of the mid-systolic click, late systolic murmur syndrome and heart block is reviewed. It is suggested that 24-hour continuous electrocardiographic monitoring, as well as exercise stress testing, be included in the evaluation of patients with this syndrome.- - - - - - - - - - ranking = 4.4218133456448keywords = chest pain, chest (Clic here for more details about this article) |
5/61. Acute myocardial injury caused presumably by coronary spasm after magnesium fluoro-silicate ingestion.A patient who developed magnesium fluoro-silicate poisoning is described. This condition was manifest by the findings of acute chest pain, dysphagia, diarrhea, metabolic acidosis, hypocalcemia and hypomagnesemia and was complicated by acute myocardial injury-a phenomenon not previously described. Coronary cineangiography showed normal coronary arteries. The physiopathologic mechanisms of this electrocardiographic finding are discussed.- - - - - - - - - - ranking = 4.4218133456448keywords = chest pain, chest (Clic here for more details about this article) |
6/61. Apparent bradycardia-dependent advanced second-degree atrioventricular block.A 65-year-old man with repeated chest discomfort and dizzy spells was transferred by an emergency car. On the way to hospital, his pulse was palpable as regular 4 to 5 beats followed by an unpalpable period of about 4 s. His electrocardiographic monitor showed that 4 to 5 sinus QRS complexes were followed by consecutive 3 to 4 blocked sinus P waves, which occurred repeatedly. When PP intervals gradually shortened during inspiration, sinus impulses were conducted to the ventricles, whereas when PP intervals lengthened during expiration, 3 to 4 sinus impulses were blocked in succession. An attempt was made to explain the mechanism for such apparent bradycardia-dependent atrioventricular block by using the concepts of periodic increases in vagal tone due to respiration and concealed electrotonic conduction of blocked impulses. Such a peculiar form of advanced second-degree atrioventricular block has never been reported before.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
7/61. Intermittent left anterior hemiblock. A rare case report.The Authors report a rare case of intermittent left anterior hemiblock in a 86-year-old man admitted to Department of emergency medicine for progressive impoverishment of intellectual functions and episodes of chest pain. They present this rare case of intermittent left anterior hemiblock where the intermittence was not linked to heart rate variations preceding the beginning of the hemiblock being present on the same ECG two different QRS complexes with no modification in frequency or A-V conduction: this finding suggesting a vascular origin of the disturbance. They also stress the importance of a prompt diagnosis in a Department of emergency medicine.- - - - - - - - - - ranking = 4.4218133456448keywords = chest pain, chest (Clic here for more details about this article) |
8/61. Ebstein's anomaly, atrial paralysis and atrio-ventricular block: an uncommon association.We report here the case of a 22-year-old female patient with an incomplete Ebstein's anomaly, complete heart block and atrial standstill. Atrial paralysis associated with Ebstein's anomaly is the most important feature, since there is a report of familial Ebstein's anomaly associated with atrial standstill but isolated cases have not been described. The patient presented with atypical chest pain and a symptomatic bradycardia of 37 beats per minute. A VVIR pacemaker was implanted. She has subsequently been symptom free.- - - - - - - - - - ranking = 4.4218133456448keywords = chest pain, chest (Clic here for more details about this article) |
9/61. Safe right bundle branch block pattern during permanent right ventricular pacing.It is known that an electrocardiogram (ECG) after transvenous right ventricular (RV) pacing should yield left bundle branch block (LBBB) QRS patterns. When right bundle branch block (RBBB) pacing morphology appears in a patient with a permanent or temporary transvenous RV pacemaker, myocardial perforation or malposition of the pacing lead must be ruled out, even though the patient may be asymptomatic. We report a case of a 77-year-old man who underwent permanent transvenous VDD pacemaker implantation for symptomatic heart block. The postoperative ECG revealed a RBBB pacing configuration, but his chest X-ray and echocardiographic studies confirmed uncomplicated RV pacing. We review and discuss the literature concerning the differential diagnosis of such a safe RBBB ECG pattern.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
10/61. rhabdomyolysis causing AV blockade due to possible atorvastatin, esomeprazole, and clarithromycin interaction.OBJECTIVE: To report rhabdomyolysis (RML) causing third-degree atrioventricular block secondary to a possible interaction between atorvastatin, esomeprazole, and clarithromycin. CASE SUMMARY: A 51-year-old white woman presented to the emergency department with severe weakness, near syncope, shortness of breath, and chest pain. On admission, her electrocardiogram demonstrated bradycardia (40 beats/min) and third-degree heart block. A creatine kinase (CK) level was >7000 U/L. Her medication history was significant for long-term use of atorvastatin (>1 y), a 6-week history of esomeprazole use, and three 500-mg doses of clarithromycin just prior to admission. Her symptoms of weakness, shortness of breath, and chest pain coincided with starting the esomeprazole. During her hospitalization, the woman required pacemaker placement and her CK continued to rise to >40,000 U/L. Screening for other causes of RML, such as thyrotoxicosis, infection, and immune or hepatic diseases, was negative. She gradually improved over a 26-day hospitalization. DISCUSSION: This is a case of RML resulting in third-degree atrioventricular blockade. An objective causality assessment of the adverse reaction via the Naranjo probability scale revealed a probable association with atorvastatin and a possible association with esomeprazole and clarithromycin. The pharmacokinetic profiles of these agents suggest that a possible contribution to this reaction was p-glycoprotein (PGP) inhibition by esomeprazole altering atorvastatin's normally significant first-pass clearance. CONCLUSIONS: PGP drug interactions with atorvastatin and other hydroxymethylglutaryl coenzyme a reductase inhibitors (statins) may be associated with unreported risks for RML. Further investigation into PGP impact on HMG-CoA appears warranted.- - - - - - - - - - ranking = 8.8436266912895keywords = chest pain, chest (Clic here for more details about this article) |
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