1/66. Reversible platypnoea and orthodeoxia after surgical removal of an hydatid cyst from the liver.A patient with a large hydatid cyst of the liver developed a positionally symptomatic right to left shunting across a patent foramen ovale with both platypnoea and orthodeoxia, despite normal pulmonary arterial pressures and normal pulmonary function tests. When the patient was in the supine position the calculated right to left shunt was 15.1% and 29.5% when seated. The shunt was attributed to the compression of the right atrium and ventricle by the cyst. Surgical evacuation of the cyst relieved the symptoms and the positionally induced shunting.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/66. Idiopathic annular dilation: a rare cause of isolated severe tricuspid regurgitation.The management of patients with severe tricuspid regurgitation (TR) requires the clinician to clarify the mechanism of regurgitation. Primary disorders of the tricuspid valve, either congenital or acquired, may be readily identified by echocardiography. Severe TR most often results from left-sided heart disease and secondary pulmonary hypertension. Cardiomyopathic processes may also cause right ventricular failure and functional TR. We report three patients with severe TR due to idiopathic annular dilation. The tricuspid valves were otherwise normal on surgical inspection, and the pulmonary pressures were not significantly elevated. Each patient was aged over 65 years and had chronic atrial fibrillation with preserved left ventricular systolic function. Surgical treatment was associated with marked clinical improvement. Clinicians should recognize this unusual but treatable cause of right-sided congestive heart failure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/66. Assessment of myocardial performance with ventricular pressure-volume relations: clinical applications in cardiac surgery.The assessment of myocardial performance in patients with cardiomyopathy is of vital importance in cardiology and cardiac surgery, especially considering the significant increase in the number of patients treated for congestive heart failure. Left ventricular pressure-volume analysis is a method, which can assess accurately myocardial contractility, separating the systolic and diastolic function at different preload and afterload conditions. This technique can be used for determination of the efficacy of a therapeutic pharmaceutical or surgical intervention, for instance the assessment of ventricular function after coronary revascularization. A few studies using the conductance catheter for the analysis of ventricular pressure-volume relations in the field of cardiac surgery have been published. In our center we started to use this technique to analyze cardiac surgical procedures, like mitral valve reconstruction, aortic valve replacement, myocardial revascularization, left ventricular assist, and surgical left ventricular remodeling. This information will be used to develop a therapeutic strategy, which may optimize surgical indications and improve the peri- and postoperative treatment and the efficacy of that surgical technique. In this short review the possible clinical use in cardiac surgery and the methodology of the pressure-volume loops have been described. Three clinical cases are presented to demonstrate functional information related to the surgical treatment of congestive heart failure patients.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
4/66. Prolonged cardiotoxicity from poison lilly (veratrum viride).A 51-y-o otherwise healthy male presented to the emergency department 45 min after ingesting a soup made with boiled "leeks". physical examination was significant for severe vomiting depressed mental status, and sluggishly reactive 2-3 mm pupils. heart rate was 30 bpm and bp was 40/p mmHg requiring atropine and fluid resuscitation. After 60 min substernal chest pressure was noted and an ECG showed new V2-V6 ST segment depression. Recurrent hypotension required the use ofa dopamine infusion. At this time, the regional poison control center botanist identified a sample of the ingested material as veratrum viride. The patient improved slowly over the next 24 hours, although bradycardia and heart block persisted for approximately 48 hours.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/66. Assessment of coronary morphology and flow in a patient with guillain-barre syndrome and ST-segment elevation.patients with guillain-barre syndrome often have cardiac disturbances as a manifestation of autonomic dysfunction. Such abnormalities consist of arrhythmias and disturbances of heart rate and blood pressure. We report a case of a patient with guillain-barre syndrome who developed ST-segment elevation in the inferolateral leads, suggestive of an acute coronary syndrome. cardiac catheterization revealed angiographically normal coronary arteries. Intracoronary ultrasound was also normal. Intracoronary Doppler flow measurements revealed an elevated baseline coronary flow velocity of up to 41 cm/s and decreased coronary flow reserve, particularly in the left circumflex artery. Myopericarditis as cause of the electrocardiographic changes could be ruled out by echocardiography and endomyocardial biopsy. We postulate that the intracoronary Doppler findings are caused by autonomic dysfunction with decrease of coronary resistance and redistribution of the transmural myocardial blood flow.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/66. Return to flight status after cardiac rehabilitation: three case histories.A pilot's license to operate aircraft is not valid unless it is accompanied by a medical certificate. This certificate is revoked if a pilot is diagnosed with a cardiovascular illness. After a lengthy waiting period, the medical certificate may be reinstated if the pilot meets rigid standards. For many pilots, participation in a cardiac rehabilitation program is essential to achieve the minimal functional capacity in exercise testing (10.0 metabolic equivalents), document tolerance of medications, and achieve successful rehabilitation. Our staff has assisted 11 pilots in their quest to resume commercial or recreational flying after heart surgery, pacemaker implantation, or angioplasty. This article summarizes the case histories of three pilots who returned to fight status, in three Federal aviation Administration categories (FAA), after a cardiac illness. The principle goals of our rehabilitation program for pilots are: (1) to achieve the highest possible outcome of the rehabilitation process; (2) to establish a safe and effective independent exercise program; (3) to obtain measures of compliance and success with the independent exercise program; (4) to document tolerance of medications and ensure that medications are acceptable to the FAA; (5) to document stability of the serum glucose in diabetic patients engaged in rigorous, prolonged exercise; and (6) prepare the patient for performance of a treadmill test in which 100% predicted maximum heart rate is achieved without symptoms of cardiovascular distress. An inherent effect of pursuing these goals is dramatic risk factor modification including improved blood pressure and lipid status and reduced body mass index. After resumption of flying, none of our pilot-patients have experienced cardiac symptoms during flight, nor have they required emergency department visits or hospitalization for any reason.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/66. Metabolic acidosis, rhabdomyolysis, and cardiovascular collapse after prolonged propofol infusion.The authors present the hospital course of a 13-year-old girl with a closed head injury who received a prolonged infusion of propofol for sedation and, subsequently, died as a result of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse. The patient had been treated for 4 days at a referring hospital for a severe closed head injury sustained in a fall from a bicycle. During treatment for elevations of intracranial pressure, she received a continuous propofol infusion (100 microg/kg/min). The patient began to exhibit severe high anion gap/low lactate metabolic acidosis, and was transferred to the pediatric intensive care unit at the authors' institution. On arrival there, the patient's glasgow coma scale score was 3 and this remained unchanged during her brief stay. The severe metabolic acidosis was unresponsive to maximum therapy. Acute renal failure ensued as a result of rhabdomyolysis, and myocardial dysfunction with bizarre, wide QRS complexes developed without hyperkalemia. The patient died of myocardial collapse with severe metabolic acidosis and multisystem organ failure (involving renal, hepatic, and cardiac systems) approximately 15 hours after admission to the authors' institution. This patient represents another case of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse observed after a prolonged propofol infusion in a pediatric patient. The authors suggest selection of other pharmacological agents for long-term sedation in pediatric patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/66. Migration of ventriculoperitoneal shunt into the heart--case report.A 76-year-old man underwent ventriculoperitoneal shunting for hydrocephalus after subarachnoid hemorrhage. Eighteen days after the shunt operation, fluoroscopy revealed the peritoneal catheter in the heart. Three-dimensional computed tomography demonstrated penetration of the catheter into the internal jugular vein. Under local anesthesia, part of the peritoneal catheter was pulled out through the cervical incision and cut off. The ends of the peritoneal catheter were connected so that the distal end was settled in the right atrium of the heart under fluoroscopic visualization. The migration of the peritoneal catheter into the heart presumably occurred because the subcutaneous wire guide of the shunt catheter perforated the internal jugular vein and the catheter was drawn into the heart through the internal jugular vein by the negative pressure of the vein and thoracic cavity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/66. Acute renal failure secondary to milrinone in a patient with cardiac amyloidosis.milrinone is a phosphodiesterase type III inhibitor with positive inotropic and vasodilatory effects. A common side effect of milrinone is hypotension from the peripheral vasodilation. Although mild elevations in serum creatinine have been described previously in the setting of milrinone-induced hypotension, acute oligoanuric renal failure requiring renal replacement therapy has not yet been described. This case report is the first to document such a result and to report the successful use of peritoneal dialysis in this setting. Previous case reports documented vasopressin as an effective alternative to catecholamines in the treatment of milrinone-induced hypotension. This report documents the use of four vasopressor agents (including vasopressin) in this patient, with only vasopressin resulting in improvement in systemic vascular resistance and blood pressure. Vasopressin may be the most effective vasopressor agent in the treatment of milrinone-induced hypotension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/66. Acute cardiomyopathy with recurrent pulmonary edema and hypotension following heroin overdosage.An 18-year-old man developed acute pulmonary edema following heroin overdose. Two days after initial improvement, there was recurrence of hypotension and pulmonary edema with severe hypoxemia refractory to mechanical ventilatory support utilizing positive and end-expiratory pressure. cardiac catheterization revealed elevated pulmonary capillary wedge pressure suggestive of left ventricular failure. The use of digitalis and diuretics resulted in prompt clinical improvement and ultimate recovery. Evidence is presented indicating that this patient represents an uncommon but important syndrome of acute cardiomyopathy with left ventricular failure which complicates the clinical course of certain cases of heroin overdose. Its physiologic diagnosis is of obvious importance in the choice of proper therapy, thereby increasing the patient's chances of recovery.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
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