1/47. Sudden death of a young hockey player: case report of commotio cordis.Despite the use of protective gear, a 15-year-old hockey player died when he was struck in the chest by a puck. This is the fifth recorded hockey death related to so-called commotio cordis, that is, blunt chest injury without myocardial structural damage. In light of inadequacies of commercial chest protectors currently in use for hockey, the authors hope to educate players and coaches about the danger of blocking shots with the chest. physicians should be aware that commotio cordis represents a distinctive pathological condition, in the event of which immediate recognition, precordial thump, CPR, and defibrillation are potentially lifesaving. Appropriate medical supervision at amateur hockey games, 911 telephone access, and on-site automated external defibrillators are issues that deserve careful consideration.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/47. A case of vasospastic angina presenting Brugada-type ECG abnormalities.An electrophysiological study and a provocative test of coronary artery spasm was attempted in a 68-year-old man who was having syncopal attacks and chest pain. His electrocardiogram had the characteristics of brugada syndrome and ventricular fibrillation (VF) was induced by programmed electrical stimulation. ST-segment elevation became exaggerated by procainamide, which could not prevent the induction of VF. coronary angiography revealed no stenotic lesions, and spasm in the left coronary artery was induced by intracoronary administration of acetylcholine with similar chest pain to that experienced before. Under treatment with diltiazem and flecainide, which suppressed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patients with syncope should be evaluated carefully.- - - - - - - - - - ranking = 5.2384110320517keywords = chest pain, chest (Clic here for more details about this article) |
3/47. Inappropriate shocks diagnosed by stored electrograms of implantable cardioverter defibrillators--two case reports.An implantable cardioverter defibrillator is an important therapeutic option for patients with high risk of life-threatening ventricular arrhythmias. However, their use is also associated with several complications including inappropriate shock. Although the most frequent cause of inappropriate shock is supraventricular tachyarrhythmias, lead fracture can also be associated with inappropriate shock. diagnosis of lead fracture can be made by chest x-ray radiography, fluoroscopic examination, interrogation of the device, and intracardiac electrograms. In this report, the authors present two cases of inappropriate shock due to lead fractures in the costoclavicular region that could only be diagnosed by the help of stored intracardiac electrograms. methods for diagnosis of lead fractures and modalities to avoid recurrences are also discussed.- - - - - - - - - - ranking = 0.25keywords = chest (Clic here for more details about this article) |
4/47. Homicidal commotio cordis in two children.This paper's objective is to describe two cases of fatal commotio cordis resulting from the deliberate striking of children's chests by adults with their fists. These deaths involve two male children, ages 3 years and 14 months. The clinical histories, events in the households prior to the deaths, behaviors of the children, autopsy findings, and investigation results are all similar. In both cases, fatal blows were delivered to the anterior chest with a closed fist. Both children collapsed immediately, unable to be resuscitated. Confessions were obtained in both cases by investigators soon after the children's deaths. Autopsies showed chest contusions in only one child, presumably due to knuckle impact. The cardiac rhythms noted by paramedics were ventricular fibrillation and asystole. Due to the lack of physical findings, an immediate and thorough investigation is critical. An accurate history of events preceding death must be obtained.- - - - - - - - - - ranking = 0.75keywords = chest (Clic here for more details about this article) |
5/47. Recurrent ventricular fibrillation in a marathon runner during exercise testing.We report a case of a marathon runner who presented with chest tightness, ST-segment depression, and ventricular fibrillation following treadmill exercise testing. At cardiac catheterization, the patient was found to have an isolated lesion in the left anterior descending (LAD) artery that was hemodynamically insignificant by accepted angiographic and coronary flow reserve standards. ventricular fibrillation was thought to be idiopathic, and an implantable cardioverter defibrillator was placed. chest pain and ST-segment depression followed by ventricular fibrillation was reproduced during follow-up treadmill testing, prompting reconsideration of the original diagnostic hypothesis. A coronary stent was deployed in the LAD artery. The patient has been asymptomatic and arrhythmia free during follow-up treadmill testing and recreational running.- - - - - - - - - - ranking = 0.25keywords = chest (Clic here for more details about this article) |
6/47. Dangerous impact--commotio cordis.Sudden death following blunt chest trauma is a frightening occurrence known as 'commotio cordis' or 'concussion of the heart'. It is speculated that commotio cordis could be caused by ventricular fibrillation secondary to an impact-induced energy that was transmitted via the chest wall to the myocardium during its vulnerable repolarization period. We describe a survivor of commotio cordis caused by a baseball. In this patient, an initial ventricular fibrillation was documented and converted by direct current defibrillation. Serial electrocardiographic changes (bifascicular conduction block and T wave inversion in precordial leads) were noticed in this patient. Our case suggested that coronary vasospasm might also play a role in commotio cordis.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
7/47. Metastatic cardiac papillary carcinoma originating from the thyroid in both ventricles with a mobile right ventricular pedunculated tumor.A 62-year-old man with a history of surgical therapy for papillary thyroid carcinoma was admitted because of chest pain, dyspnea on effort, pretibial edema, and slight fever. An electrocardiogram showed ST segment elevation in the precordial leads and low voltage in the limb leads. A large solid mass was demonstrated in both ventricles, with pericardial effusion, by echocardiography, thoracic computed tomography scan, transesophageal echocardiography, and angiography. A punch biopsy of the tumor revealed metastatic papillary carcinoma. During radiation therapy, the patient suddenly died of ventricular fibrillation. At autopsy, the tumor occupied almost the entire right ventricular cavity, expanding toward the main trunk of the pulmonary artery with a mobile peduncle and it had infiltrated the left ventricular wall through the interventricular septum. Microscopic examination confirmed metastatic papillary thyroid carcinoma. Only 2 other cases of cardiac metastases of papillary thyroid carcinoma have been reported and this case is the first report of metastases in both ventricles with a mobile right ventricular pedunculated tumor.- - - - - - - - - - ranking = 2.6192055160258keywords = chest pain, chest (Clic here for more details about this article) |
8/47. Successful management of intractable coronary spasm with a coronary stent.Although the long-term survival of patients suffering from coronary spasm is usually excellent, serious complications can develop, such as disabling pain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. A 40-year-old man who had intractable chest pain from coronary artery spasm suffered ventricular fibrillation and an acute anterior myocardial infarction upon first admission. The patient underwent a coronary angiogram, which revealed a spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was treated by the combination of nitrate and calcium channel blocker, but continued to complain of severe chest pain despite intensive medical therapy and he had to be treated in the emergency room 5 times during an 8-month follow-up period. An ergonovine coronary angiogram was performed and an intracoronary ultrasound examination, which revealed a focal spasm at the same site of the proximal LAD with a small amount of localized eccentric atheromatous plaque. A coronary artery stent was placed in the proximal LAD and his symptoms resolved. A follow-up coronary angiogram was performed 3 years after stenting and the stent remained patent without any in-stent restenosis or spasm.- - - - - - - - - - ranking = 5.2384110320517keywords = chest pain, chest (Clic here for more details about this article) |
9/47. Vasospastic angina accompanied by Brugada-type electrocardiographic abnormalities.brugada syndrome and Vasospastic Angina. We present two patients with vasospastic angina and Brugada-type ECG abnormalities. The first patient complained of chest pain, and transient ST segment elevation was confirmed on ECG. Coronary angiogram showed no organic stenosis. The second patient had syncopal episodes following anginal chest pain, and the same symptoms were reproduced by intracoronary acetylcholine injection that induced vasospasm. In both patients, ECG at rest showed ST segment elevation in leads V1 and V2 and a right bundle branch block pattern that were accentuated by a Class I antiarrhythmic drug. ventricular fibrillation also was induced by programmed electrical stimulation. Susceptibility to ventricular fibrillation can be modulated by the interaction of coronary vasospasm with brugada syndrome or vice versa; therefore, it is important to study the clinical implications of the coexistence of the two diseases in such patients.- - - - - - - - - - ranking = 2.8692055160258keywords = chest pain, chest (Clic here for more details about this article) |
10/47. Fatal cardiac arrhythmia after oral sumatriptan.Typically, 3% to 5% of patients experience sensations of heaviness, pressure, and tightness in the chest after administration of sumatriptan, but there is little ECG evidence of ischemia. The serious cardiovascular incidents after consuming sumatriptan have been associated mostly with the subcutaneous dosage form of this drug and with patients with underlying cardiovascular risk factors. We report a case of fatal cardiac arrhythmia in an otherwise perfectly healthy patient with migraine after consuming a single 100-mg dose of oral sumatriptan.- - - - - - - - - - ranking = 0.25keywords = chest (Clic here for more details about this article) |
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