1/103. Incidental detection of acute myocardial infarction during routine performance of three-dimensional dynamic MR angiographic study with dynamic injection of gadolinium.We report on the MR appearance of acute myocardial infarction in a 61-year-old man with ehlers-danlos syndrome using motion-independent, T2-weighted echo train spin echo and immediate post-gadolinium three-dimensional gradient echo imaging performed as an MRI angiographic study of the aortic arch. The region of acute infarction was of high signal intensity on the T2-weighted images and demonstrated greatly diminished enhancement on the immediate post-gadolinium three-dimensional gradient echo images. MRI findings showed good correlation with autopsy specimens obtained within 24 hours of the MRI study.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/103. Reverse redistribution of Tc-99m-tetrofosmin in patients with acute myocardial infarction.We examined reverse redistribution (RR) of Tc-99m-tetrofosmin after a single injection in patients with acute myocardial infarction (AMI). Tc-99m-tetrofosmin myocardial SPECT was performed in 28 patients with AMI 10-14 days after the onset. Myocardial images were obtained 30 min and 180 min after the injection of 740 MBq of Tc-99m-tetrofosmin. The left ventricular wall was divided into 9 segments. Regional myocardial uptakes of Tc-99m-tetrofosmin were scored by 4-point scoring (0 = normal, 1 = mildly reduced, 2 = moderately reduced, and 3 = defect). RR was defined as an increase of more than 1 in the regional score in images at 180 min. RR of Tc-99m-tetrofosmin was observed in 17 of 20 patients with direct PTCA and 3 of 8 patients without reperfused therapy. RR was observed in 61 of all 252 segments. coronary angiography performed 1 month later revealed that the infarct-related artery was patent in 19 of 20 patients (95%) with RR and in 3 of 8 patients (37.5%) with persistent defects (PD) (p < 0.05). In segment-by-segment analysis, the incidence of regional wall motion abnormality I month later was reduced in regions with RR compared to those with PD (p < 0.0001). In conclusion, RR of Tc-99m-tetrofosmin was frequently observed in patients with successful direct PTCA. As the segments with RR showed signs of preserved function 1 month later, this phenomenon may reflect a salvaged myocardium in AMI.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/103. Transient severe mitral regurgitation complicating myocardial stunning due to coronary vasospasm.As in papillary muscle dysfunction complicating mitral prolapse, dyskinesis of the left ventricular wall underlying the papillary muscles has been shown to cause mitral regurgitation following myocardial infarction. myocardial stunning has been experimentally evidenced to cause mitral regurgitation due to a wall motion abnormality, but it has not yet been clinically defined. We report a clinical case of transient severe mitral regurgitation complicating myocardial stunning caused by coronary vasospasm. Transient wall motion abnormality beneath the anterolateral papillary muscle was considered to be responsible for the mitral regurgitation.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
4/103. Acute myocardial infarction following sildenafil citrate (Viagra) intake in a nitrate-free patient.Since its introduction to the market in March 1997, sildenafil acetate (Viagra) has been prescribed to 1.7 million people. Sixteen men who were taking the drug have died, 7 of them during or soon after sexual activity. Most of these data have been derived from the media and not from the scientific literature. There is a general impression that cardiovascular complications of sildenafil occur mainly when the drug is taken concomitantly with nitrates. We describe a 65-year-old man with known coronary artery disease who had an acute myocardial infarction shortly after taking sildenafil and engaging an sexual activity. The patient had not been using nitrates. We suggest that the emotional arousal induced by Viagra, followed by the heavy physical exertion during sexual activity, triggers plaque rupture that leads to acute myocardial infarction.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/103. Contrast echocardiography in the diagnosis of myocardial stunning.The identification of viable myocardium within dysfunctional myocardium has important clinical implications. By using a microvascular tracer, myocardial contrast echocardiography may have the potential for prediction of myocardial viability in the acute and subacute phases of myocardial infarction. In the case presented, the normal myocardial perfusion observed after intravenous injection of the contrast agent, combined with severe wall motion abnormality following prolonged chest pain, suggested myocardial stunning. This was confirmed by normal coronary angiography and by restoration of normal left ventricular function at 1-month follow-up echocardiography.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/103. myocardial stunning after streptokinase: what is the significance of the Q wave?A 58 year old woman presented with symptoms and electrocardiographic features consistent with acute infero-posterior myocardial infarction. The attempt at reperfusion with aspirin and thrombolytic treatment was deemed unsuccessful in view of Q wave development on ECG, a 48 hour period of hypotension and oliguria, and extensive wall motion abnormality on echocardiography. This was at variance with findings of a minimal cardiac enzyme rise. On the seventh day, list mode acquired, ECG gated, cineimages of perfusion and blood pool demonstrated strikingly normal perfusion despite continued contractile dysfunction. Six weeks later ECG, echocardiography, and radionuclide blood pool ventriculography had all normalised consistent with resolution of myocardial stunning. This practical method for the diagnosis of stunning, the significance of the ECG changes in particular the development of Q waves, and the time taken to resolution of this phenomenon are discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/103. Severe intracranial bleeding mimicking acute inferior myocardial infarction with right ventricular involvement.Electrocardiographic (ECG) changes and wall motion abnormalities of the left ventricle have been observed in patients with severe intracranial hemorrhage. However, ECG evidence of an acute myocardial infarction in this setting is extremely rare but may have important therapeutic consequences. We report the case of a 45-year-old female who became unconscious with respiratory insufficiency after an endoscopic retrograde cholangiopancreaticoscopy with ECG changes consistent of an inferior myocardial infarction with right ventricular involvement. Immediate coronary angiography revealed normal coronaries; however, left ventricular angiography showed extensive wall motion abnormalities predominantly in the anteroseptal region. Immediate cranial computer tomography demonstrated massive intracranial bleeding. Intracranial hemorrhage can be associated in the initial phase with ECG evidence of an acute myocardial infarction. This has to be taken into consideration in the setting of unexplained loss of consciousness or nonresponsiveness of a patient. A rapid diagnostic evaluation has to be initiated to rule out a myocardial infarction and to diagnose intracranial hemorrhage before the use of thrombolytic or anticoagulant therapy.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/103. Primary angioplasty for isolated right ventricular infarction.We describe a case of isolated right ventricular infarction that has rarely been diagnosed antemortem. Electrocardiogram showed ST segment elevation in left precordial chest, right precordial chest, and inferior leads, which mimicked those of anterior and inferior left ventricular infarction. coronary angiography revealed that culprit lesion was totally occluded right coronary artery. Infarcted artery was nondominant right coronary artery with branches supplying only right ventricular wall. Restoration of coronary blood flow was obtained by primary stenting and resulted in prompt ST segment normalization in all leads. Despite extensive right ventricular wall motion abnormality, subsequent right ventricular dysfunction was not observed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/103. pulmonary embolism with isolated right ventricular infarction.Concomitant occurrence of pulmonary embolism and right ventricular infarction is rare. It poses important diagnostic and therapeutic implications. A case of pulmonary embolism with isolated right ventricular anterior wall infarction presented with ventricular tachycardia. One pathology could have led to the other. Two-dimensional echocardiography was useful in documenting pulmonary artery hypertension as well as regional wall motion abnormality of the right ventricle. thrombolytic therapy and dobutamine infusion were useful. nitrates, fluid infusion and diuretics should be used cautiously.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/103. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. angina pectoris-myocardial infarction Investigations in japan.OBJECTIVES: To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study. BACKGROUND: Only several case presentations have been reported with regard to this syndrome. methods: We analyzed 88 patients (12 men and 76 women), aged 67 /- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies. RESULTS: Thirt-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York heart association function on discharge. The LV ejection fraction improved from 41 /- 11% to 64 /- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 /- 14 months, two patients showed recurrence, and one died suddenly. CONCLUSIONS: A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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