1/35. Anesthetic management of high-risk cardiac patients undergoing noncardiac surgery under the support of intraaortic balloon pump.patients with severely impaired left ventricular function, an uncorrectable coronary artery disease, and a recent myocardial infarction are at high risk of cardiac complications after major noncardiac surgery. We present two patients with extensive three-vessel coronary artery disease who underwent intraperitoneal surgery under the support of intraaortic balloon pump (IABP). In one patient, the IABP was inserted urgently because of the development of chest pain with significant ST depression on arrival in the operating room, and the other patient was managed with prophylactic IABP. There were no intraoperative or postoperative cardiac events in either patient. Thus, IABP should be considered in the perioperative management of patients with severe cardiac diseases.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
2/35. Transformation of mitral valve prolapse to dynamic left ventricular outflow tract obstruction and back again in a patient with acute transient myocardial depression.We describe an unusual case of transient resolution of preexisting mitral valve (MV) prolapse during acute cardiac dysfunction and the development of dynamic left ventricular (LV) outflow tract obstruction. The patient presented with lightheadedness, chest pain, and compromised hemodynamic status. echocardiography revealed akinesis and deformation of the LV anterior wall and apex, hyperdynamic activity in the bases, anterior MV leaflet systolic anterior motion without prolapse, and a dynamic outflow tract gradient. Myocardial function fully recovered over 1 month. Repeat ultrasonography showed posterior MV leaflet prolapse and no anterior MV leaflet systolic anterior motion. Elongated MV leaflets may have contributed to dynamic outflow tract obstruction and life-threatening hemodynamic compromise during LV conformational change.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
3/35. Reversible left ventricular dysfunction "takotsubo" cardiomyopathy associated with pneumothorax.An 83 year old woman presented to the emergency department with chest pain and dyspnoea. Chest radiography showed pneumothorax of the left lung. arteries were normal on coronary angiography. Left ventriculography showed asynergy of apical akinesis and basal hyperkinesis. Within 18 days, the asynergy improved without any specific treatment. In the present case the left ventricular dysfunction may have been induced by altered catecholamine dynamics as a result of pneumothorax.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
4/35. Atypical presentation of an anomalous origin of the right coronary artery with severe compression between the great vessels.Anomalous aortic origin of the right coronary artery is a rare coronary anomaly which, in a minority of cases, can cause clinical manifestations such as ischemic chest pain or arrhythmic syncope. We describe a case of anomalous aortic origin of the right coronary artery characterized by signs of left heart failure associated with ventricular tachycardia.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
5/35. Six-month follow-up of takotsubo cardiomyopathy with I-123-beta-metyl-iodophenyl pentadecanoic acid and I-123-meta-iodobenzyl-guanidine myocardial scintigraphy.A 69-year-old man with a history of transient chest pain was diagnosed takotsubo cardiomyopathy. In I-123-beta-metyl-iodophenyl pentadecanoic acid myocardial scintigraphy, decreased uptake of apex was seen in the acute phase, and it recovered in 3 months. In I-123-meta-iodobenzyl-guanidine myocardial scintigraphy, decreased uptake of apex persisted for 6 months, and there was a discrepancy between apical and total washout rate in the acute phase and after 3 months, which disappeared after 6 months. We speculate that the discrepancy of sympathetic innervation between the apical and basal region is the cause of the characteristic left ventricular apical akinesia of takotsubo cardiomyopathy.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
6/35. Acute parvovirus B19 infection associated with myocarditis in an immunocompetent adult.Inflammatory heart disease is causally linked with progressive left ventricular dysfunction and congestive heart failure. In childhood, infection with parvovirus B19 (PVB19) is usually benign, causing erythema infectiosum. However, severe fetal PVB19 infection may be associated with hydrops fetalis and fetal death caused by myocarditis. Here we report a PVB19-induced myocarditis in a previously healthy 37-year-old patient admitted to the hospital because of chest pain and dyspnea due to left ventricular dysfunction. Four weeks after the onset of symptoms, we found lymphocytic infiltrates and PVB19 genome in left ventricular endomyocardial biopsy specimens. Consistently, acute PVB19 infection was indicated serologically by elevated IgM titers and the presence of PVB19 genome in peripheral blood lymphocytes. In conclusion, PVB19 infection may be complicated by acute myocarditis in immunocompetent adults. Because PVB19 myocarditis may progress to chronic dilated cardiomyopathy, early diagnosis by endomyocardial biopsy is important to initiate anti-inflammatory treatment.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
7/35. Apical ballooning of the left ventricle: first series in white patients.BACKGROUND: A cardiac syndrome of "apical ballooning" was recently described, consisting of an acute onset of transient extensive akinesia of the apical and mid portions of the left ventricle, without significant stenosis on the coronary angiogram, accompanied by chest symptoms, ECG changes, and a limited release of cardiac markers disproportionate to the extent of akinesia. Until now, this syndrome has been reported only in Japanese patients. OBJECTIVE: To describe 13 white patients who presented with this syndrome over the previous four years. RESULTS: All but one of the patients were women with a mean age of 62 years. Eight of them presented with chest pain, of whom six had cardiogenic shock. In nine patients a triggering factor was identified: emotional stress in three, trauma in one, pneumonia in one, asthma crisis in one, exercise in two, and cerebrovascular accident in one. In all patients left ventriculography showed very extensive apical akinesia ("apical ballooning") in the absence of a significant coronary artery stenosis, not corresponding with the perfusion territory of a single epicardial coronary artery. Mean maximal creatine kinase MB and troponin rise were 27.4 microg/l (range 5.2-115.7 microg/l, median 16.6 microg/l) and 18.7 microg/l (range 2.0-97.6 microg/l, median 14.5 microg/l), respectively. Six patients were treated with intra-aortic balloon counterpulsation. One patient died of multiple organ failure. On necropsy, no myocardial infarction was found. In the 12 survivors, left ventricular systolic function recovered completely within three weeks. CONCLUSIONS: This is the first series of "apical ballooning" to be reported in white patients. Despite dramatic initial presentation, left ventricle function recovered completely within three weeks in the survivors.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
8/35. A syndrome of transient left ventricular apical wall motion abnormality in the absence of coronary disease: a perspective from the united states.BACKGROUND: The syndrome of chest pain associated with characteristic anterior electrocardiographic changes, moderate increases in cardiac enzymes, and a reversible apical wall motion abnormality in the absence of coronary artery disease has been documented in japan, but has received relatively little attention in other countries. methods: The clinical and echocardiographic data of 12 patients (11 women, mean age 64 /-14 years) who presented with chest symptoms, electrocardiographic (ECG) changes indicative of an acute anteroapical myocardial infarction, abnormal cardiac enzyme levels and echocardiography showing an apical wall motion abnormality were collected. coronary angiography was performed in 10 patients. A follow-up echocardiogram was obtained within 2 weeks of the initial diagnosis in most cases. RESULTS: An identifiable, precipitating ("trigger") event could be identified in all 12 individuals. Respiratory distress was present in 7, the death of a relative in 3, in 4 a surgical or medical procedure had been performed, and in 1 a panic disorder was diagnosed. The echocardiograms showed a characteristic wall motion pattern of significant apical dysfunction. All of the patients who underwent coronary arteriography had noncritical coronary artery disease. Follow-up echocardiography showed normalization of the LV dysfunction in all instances. CONCLUSION: We identified a syndrome of chest pain, dyspnea, ECG and enzyme changes mimicking acute myocardial infarction, similar to the "Takotsubo" syndrome described in japan. It is likely that the widespread use of echocardiography, coupled with increased recognition of this syndrome, will result in this diagnosis being made more commonly.- - - - - - - - - - ranking = 2keywords = chest pain (Clic here for more details about this article) |
9/35. Transient left ventricular dilatation in the absence of epicardial disease on angiography.A 58-year-old woman with a previous anterior myocardial infarction, recurrent chest pain, transient adenosine-induced left ventricular dilatation but no apparent epicardial disease on angiography is presented. Transient ischemic dilatation during myocardial perfusion imaging, and the reported causes of transient left ventricular dilatation in the absence of epicardial disease, are discussed.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
10/35. Transient left ventricular apical ballooning in a patient with bicuspid aortic valve created a left ventricular thrombus leading to acute renal infarction.A 44-year-old woman had tako-tsubo-like ventricular dysfunction with chest pain and ST segment elevation on the ECG. echocardiography revealed a bicuspid aortic valve with moderate to severe aortic regurgitation. She developed mild heart failure during the clinical course, but the medication (furosemide, enalapril, and asprin) had to be stopped because of skin eruptions. Four weeks after ceasing the antiplatelet agent, she was re-admitted with acute renal infarction. Enhanced chest computed tomography revealed a filling defect in the left ventricle and echocardiography showed a high echogenic mass in the left ventricular apical wall. These findings strongly suggested that the renal infarction was caused by an embolism derived from a left ventricular thrombus that formed during the clinical course of the transient left ventricular apical ballooning. Anticoagulation therapy with urokinase and warfarin successfully lysed the thrombus. Left ventricular thrombus should be considered a complication of transient left ventricular apical ballooning, especially in patients with organic heart disease.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
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