1/3879. Pericardial heart disease: a study of its causes, consequences, and morphologic features. This report reviews morphologic aspects of pericardial heart disease. A morphologic classification for this condition is presented. An ideal classification of pericardial heart disease obviously would take into account clinical, etiologic and morphologic features of this condition but a single classification combining these three components is lacking. Pericardial heart disease is relatively uncommon clinically, and when present at necropsy it usually had not been recognized during life. The term "pericarditis" is inaccurate because most pericardial diseases are noninflammatory in nature. Morphologically chronic pericardial heart disease may present clinically as an acute illness. Even when clinical symptoms are present, however, few patients develop evidence of cardiac dysfunction (constriction). When pericardial constriction occurs, it is the result of increased pericardial fluid or increased pericardial tissue or both. Increased fluid is treated by drainage; increased tissue is treated by excision. In most patients with chronic constrictive pericarditis the etiology is not apparent even after histologic examination of pericardia. ( info) |
| A 35 year old woman presented with acute myocardial infarction without any of the usual risk factors: she had never smoked; she had normal blood pressure; she did not have diabetes; plasma concentrations of total cholesterol and high and low density lipoprotein cholesterol, fibrinogen, homocysteine, and Lp(a) lipoprotein were normal. She was not taking oral contraceptives or any other medication. coronary angiography showed occlusion of the left anterior descending coronary artery but no evidence of arteriosclerosis. Medical history disclosed a previous leg vein thrombosis with pulmonary embolism. Coagulation analysis revealed protein c deficiency. The recognition of protein c deficiency as a risk factor for myocardial infarction is important as anticoagulation prevents further thrombotic events, whereas inhibitors of platelet aggregation are ineffective. ( info) |
| PURPOSE: To describe the pathologic findings in an unusual case of giant cell arteritis that presented initially with visual loss and rapidly culminated in myocardial infarction. CASE REPORT: After the death of the patient, a complete autopsy was performed, including bilateral enucleation. All specimens, including a temporal artery biopsy completed before the patients death, were processed for routine paraffin histology and initially stained with hematoxylin and eosin. Elastic stains were subsequently used on specimens of temporal and coronary artery. The patient presented with loss of vision in the right eye. The clinical diagnosis was anterior ischemic optic neuropathy, secondary to temporal arteritis. The temporal artery biopsy was positive. Despite high-dose corticosteroid administration, the patient progressed to neurologic impairment, and subsequently to a fatal myocardial infarction. DISCUSSION: Previous reports of temporal arteritis with coronary involvement are summarized. myocardial infarction may be a more common early complication of temporal arteritis than appreciated previously. This important complication can occur despite administration of high-dose corticosteroid therapy. ( info) |
| PURPOSE: To describe a case of a massive gastric bleeding following emergency coronary artery bypass surgery associated with transoesophageal echocardiographic (TEE) examination. CLINICAL FEATURES: A 50-yr-old man was referred for an acute myocardial infarction and pulmonary edema (Killip class 3). Twelve hours after his myocardial infarction, he was still having chest pain despite an i.v. heparin infusion. coronary angiography revealed severe three-vessel disease with multifocal stenosis of the left anterior descending, circumflex and total occlusion of the right coronary artery. The patient was transferred to the operating room for emergency coronary artery bypass graft surgery. After total systemic heparinization (3 mg.kg-1) was obtained for cardiopulmonary bypass, a multiplane TEE probe was inserted without difficulty to monitor myocardial contractility during weaning from CPB. During sternal closure, the TEE probe was removed and an orogastric tube was inserted with immediate drainage of 1,200 ml red blood. Endoscopic examination demonstrated a mucosal tear near the gastro-oesophageal junction and multiple erosions were seen in the oesophagus. These lesions were successfully treated with submucosal epinephrine injections and the patient was discharged from the hospital eight days after surgery. CONCLUSION: This is a report of severe gastrointestinal hemorrhage following TEE examination in a fully heparinized patient. This incident suggest that, if the use of TEE is expected, the probe should preferably be inserted before the administration of heparin and the beginning of CPB. ( info) |
5/3879. Anomalous origin of the left coronary artery from the pulmonary artery: natural history and normal pregnancies. Two female patients are described with anomalous origin of the left coronary artery arising from the pulmonary artery who sustained an anterolateral myocardial infarction in infancy. Neither patient received surgical treatment although both have lived to middle age with minimal cardiovascular problems and have had uncomplicated pregnancies. Good exercise tolerance and long term survival may be possible even without surgery for patients with this anomaly. ( info) |
6/3879. Pseudo myocardial infarct--electrocardiographic pattern in a patient with diabetic ketoacidosis. diabetic ketoacidosis is an extremely serious complication of diabetes mellitus. It arises because of a complex disturbance in glucose metabolism. There is usually a precipitating cause such as sepsis or myocardial infarction. If not recognised and appropriately treated, it can have devastating consequences. This is a case report of a patient with severe diabetic ketoacidosis and interesting electrocardiographic findings. The initial electrocardiographic (ECG) findings were suggestive of an acute myocardial infarction. The ECG changes normalised remarkably following initial management of the diabetic ketoacidosis. There have been only occasional reports of hyperkalemia causing electrocardiographic changes, closely resembling those of acute myocardial infarction. ( info) |
7/3879. Coronary stent deployment in a young adult with Kawasaki disease and recurrent myocardial infarction. A 19-year-old man developed a huge coronary aneurysm and stenosis in the right coronary artery as a sequela of Kawasaki disease (KD) that resulted in recurrent episodes of myocardial infarction. Coronary ischemic events were successfully prevented after balloon angioplasty followed by coronary stent implantation into the stenotic lesion. The stent deployment may have an advantage compared with balloon angioplasty and other new devices for the treatment for patients with KD showing stenotic lesions without dense calcification. ( info) |
8/3879. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram. Criteria for reperfusion therapy in acute myocardial infarction require the presence of ST elevation in 2 contiguous leads. However, many patients with myocardial infarction do not show these changes on a routine 12-lead electrocardiogram and hence are denied reperfusion therapy. Posterior chest leads (V7 to V9) were recorded in 58 patients with clinically suspected myocardial infarction, but nondiagnostic routine electrocardiogram. ST elevation >0.1 mV or Q waves in > or =2 posterior chest leads were considered to be diagnostic of posterior myocardial infarction. Eighteen patients had these changes of posterior myocardial infarction. All 18 patients were confirmed to have myocardial infarction by creatine phosphokinase criteria or cardiac catheterization. Of the 17 patients who had cardiac catheterization, 16 had left circumflex as the culprit vessel. We conclude that posterior chest leads should be routinely recorded in patients with suspected myocardial infarction and nondiagnostic, routine electrocardiogram. This simple bedside technique may help proper treatment of some of these patients now classified as having unstable angina or non-Q-wave myocardial infarction. ( info) |
9/3879. The association of the combination of sumatriptan and methysergide in myocardial infarction in a premenopausal woman. Acute myocardial infarction occurred in a 43 year-old premenopausal woman with controlled hypertension and no known coronary artery disease following the use of the antimigraine medications sumatriptan succinate injectable form and methysergide maleate. The use of sumatriptan is contraindicated within 24 hours of using ergotamine or ergotamine-type medications such as methysergide. This contraindication is based on the theoretical possibility of prolonged vasospasm with the combined use. methysergide is primarily a serotonin type 2 (5-HT2) antagonist, although it does act as a partial agonist at 5-HT1 receptors. It is believed that a major component of coronary artery vasospasm is possibly due to 5-HT supersensitivity mediated by 5-HT1Dbeta receptor activation. Drugs that selectively stimulate the 5-HT(D) receptors, such as sumatriptan, are potentially hazardous in people with underlying coronary artery disease, and agents with additional agonistic properties at these receptors may potentiate this effect. physicians should be warned to inquire about prior 24-hour medication use before prescribing antimigraine medication. ( info) |
10/3879. 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. ( info) |