1/9. Echocardiographic evolution of left ventricular and left atrial thrombi in a patient with left ventricular dysfunction due to alcoholic cardiomyopathy, chronic atrial fibrillation and multiple non-fatal systemic embolisms.The echocardiographic characteristics and evolution of multiple pedunculated left atrial and left ventricular intracavitary thrombi in a patient with alcoholic cardiomyopathy are reported. The patient had a long history of left ventricular dysfunction and atrial fibrillation but the referring physician had not prescribed anticoagulant prophylaxis. Multiple, non-fatal, systemic embolizations occurred during hospitalization and echocardiography was used to monitor the effect of the anticoagulant therapy on the remodelling and final dissolution of intracavitary thrombi.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Detection of pseudoaneurysm of the left ventricle by fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging.This report highlights the importance of interpretating images throughout the course of a dobutamine MRI stress test. Upon review of the baseline images, the left ventricular (LV) endocardium was not well seen due to flow artifacts associated with low intracavitary blood-flow velocity resulting from a prior myocardial infarction. Physicians implemented a cine fast imaging employing steady-state acquisition (FIESTA) technique that was not subject to low flow artifact within the LV cavity. With heightened image clarity, physicians unexpectedly identified a LV pseudoaneurysm.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Transient left ventricular apical ballooning: a review of the literature.Transient left ventricular apical ballooning is a newly defined syndrome characterized by sudden onset of chest symptoms, electrocardiographic changes characteristic of myocardial ischemia, transient left ventricular dysfunction-particularly in the apical region, low-grade troponin elevation, and no significant coronary stenosis by angiogram. This syndrome is also referred to as takotsubo cardiomyopathy, "Ampulla" cardiomyopathy, Human Stress cardiomyopathy, and Broken Heart Syndrome. Emergency physicians, family physicians, general internists, and cardiologists may all encounter this syndrome at the point of contact. The similarity to acute coronary syndrome requires all clinicians who may potentially care for these patients to familiarize themselves with this newly recognized disease. We provide a recent case and review the current literature surrounding this syndrome.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/9. Severe reversible global and regional ventricular dysfunction associated with high-dose interleukin-2 immunotherapy.Cardiac toxicity and hemodynamic alterations are frequently associated with high-dose interleukin-2 (IL-2) immunotherapy in cancer patients. Serious cardiac events including myocardial infarction, ischemia, and noninfectious myocarditis have been observed. We document two cases of unusually severe but reversible cardiac abnormalities related to IL-2 therapy: one patient with a profound form of global myocardial hypocontractility and a second patient with regional aneurysmal and dyskinetic changes of the left ventricle. These cases exhibit unique features not previously described in IL-2-treated patients. The possible pathophysiologic mechanisms underlying these global and regional forms of cardiomyopathy, including the production of secondary-messenger molecules such as nitric oxide and myocardial stunning, are discussed. Both patients remain disease free of their cancer (> 3 years since completing therapy), are without residual cardiac dysfunction or recurrent related symptoms, and have not experienced any additional cardiac events. The report demonstrates the complexity of the cardiac toxicities associated with IL-2-based immunotherapy and recognizes a need for treating physicians to be familiar with their management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. heart failure from diastolic dysfunction.heart failure from diastolic dysfunction is a clinical syndrome similar to, but distinct from, failure from systolic dysfunction. Because the standard cardiac diagnostic tools may not be helpful, the advance practice nurse and physician collaborate on the diagnosis. Interventions are aimed toward improving diastolic filling and reducing hemodynamic compromise for these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Transient normalization of systolic and diastolic function after support with a left ventricular assist device in a patient with dilated cardiomyopathy.A 19-year-old man who had fulminant heart failure caused by an idiopathic dilated cardiomyopathy was supported with a left ventricular assist device for 183 days as a bridge to heart transplantation. At the time of intended transplantation it was noted that the patient's heart had returned to normal size, had a normal ejection fraction, and was able to maintain normal pressures and flows. In view of the apparent recovery of cardiac properties, the left ventricular assist device was explanted and the transplantation was not performed. However, the heart dilated, ejection fraction worsened, and the patient died of heart failure exacerbated acutely by a systemic viral illness. Although such recovery of systolic function is uncommon, as use of the left ventricular assist devices becomes more widespread other physicians might encounter similar findings and, in this regard, they might find our experience useful as they contemplate their treatment options.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Management of the intraaortic balloon pump patient. Pharmacologic considerations.This article reviews the common pharmacologic agents used in conjunction with the IABP for treatment of LV failure. The complex interaction between the IABP and pharmacologic agents must be carefully monitored to optimize outcome in this critically ill patient group. It is important that ICU nurses be aware of the treatment goals and their rationale, as well as monitored parameters which detect, trend and predict the direction of hemodynamic change. By using these early indicators of hemodynamics, early information can be given to the physician and intervention can be implemented on a timely basis. Early and appropriate intervention can improve outcome in many patients and may ultimately reduce costs.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Hypocalcemic heart failure: a reversible form of heart muscle disease.This paper reports the case of a 53-year-old woman with hypocalcemia-induced reversible cardiomyopathy. Laboratory tests showed hypocalcemia caused by idiopathic hypoparathyroidism. Her left ventricular dysfunction persisted for a long period even after normalization of the serum calcium level. Observations suggest that physicians should be aware that hypocalcemia can be a reversible cause of cardiomyopathy and congestive heart failure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Reversible myocardial dysfunction in a patient with alcoholic ketoacidosis: a role for hypophosphatemia.A 39-year-old woman had alcoholic ketoacidosis complicated by reversible life-threatening myocardial dysfunction. This complication occurred a few hours after correction of acidosis in association with severe hypophosphatemia. A marked improvement in clinical, echocardiographic, and hemodynamic features was associated with the normalization of the serum phosphorus level. This case illustrates a rare complication of hypophosphatemia, emphasizing the need for emergency physicians to consider this metabolic disorder in the treatment of patients with alcoholic ketoacidosis. The pathogenesis of hypophosphatemia in alcoholic ketoacidosis, its potential role in myocardial dysfunction, and its therapeutic implications in emergencies are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |