1/7. Trapped renal arteries: functional renal artery stenosis due to occlusion of the aorta in the arch and below the kidneys.Acute renal failure is a well recognized complication from the use of angiotensin-converting enzyme inhibitors in patients with severe bilateral renovascular disease. A 54-year-old woman presented with acute pulmonary edema with intractable hypertension and a history of lower limb claudication. The addition of lisinopril to her antihypertensive regimen resulted, within 48 h, in the development of acute renal failure that remitted with cessation of the drug. She was found to have a heavily calcified occlusion of her aortic arch and another occlusion of the aorta below the renal arteries. angiography and Doppler ultrasonography showed normal renal arteries. This is the first reported case of angiotensin-converting enzyme inhibitor-induced renal failure occurring in a patient with atherosclerotic occlusion of the aorta. The literature on suprarenal aortic occlusion is reviewed to determine the manner of presentation, prevalent risk factors and physical findings that typify this unique clinical entity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/7. Interventional treatment of multiple vascular involvement in young male with heterozygous familial hypercholesterolemia.We report a case of 31 year old man with heterozygous familial hypercholesterolemia and excessive tobacco use leading to acute myocardial infarction as the first manifestation of premature atherosclerosis. The patvent was treated by primary PTCA of occluded first marginal artery and at this time an attempt of recanalisation of occluded LAD was unsuccessful. The patient was referred for mini coronary bypass graft of the LIMA to LAD. During evaluation of carotid arteries we found a significant stenosis of the left internal carotid artery and occlusion of the left subclavian artery which made the use of LIMA unsuitable. Therefore, another attempt of PTCA of the occluded LAD was performed, this time with success. Hence PTA of the occluded subclavian artery was performed with good result. The patient was treated with the standard therapy of CAD and combined lipid lowering agents with significant reduction of plasma cholesterol. However, 2 years after the first MI, he suddenly died after swimming at the age of 31. In this patient the risk of premature CAD was increased by the presence of another powerful risk factor--the excessive tobacco use. Acute physical exercise probably acted as a trigger of acute coronary events at the time of both MI. Interventional methods were very effective in the treatment of multiple atherosclerotic lesions in this patient and provided significant relief of symptoms. Treatment of heterozygous FH is briefly discussed in this article.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/7. Coronary heart disease in marathon runners.Six highly trained marathon runners developed myocardial infarction. One of the two cases of clinically diagnosed myocardial infarction was fatal, and there were four cases of angiographically-proven infarction. Two athletes had significant arterial disease of two major coronary arteries, a third had stenosis of the anterior descending and the fourth of the right coronary artery. All these athletes had warning symptoms. Three of them completed marathon races despite symptoms, one athlete running more than 20 miles after the onset of exertional discomfort to complete the 56 mile Comrades Marathon. In spite of developing chest pain, another athlete who died had continued training for three weeks, including a 40 mile run. Two other athletes also continued to train with chest pain. We conclude that the marathon runners studied were not immune to coronary heart disease, nor to coronary atherosclerosis and that high levels of physical fitness did not guarantee the absence of significant cardiovascular disease. In addition, the relationship of exercise and myocardial infarction was complex because two athletes developed myocardial infarction during marathon running in the absence of complete coronary artery occlusion. We stress that marathon runners, like other sportsmen, should be warned of the serious significance of the development of exertional symptoms. Our conclusions do not reflect on the possible value of exercise in the prevention of coronary heart disease. Rather we refute exaggerated claims that marathon running provides complete immunity from coronary heart disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/7. Atherosclerotic coarctation of the abdominal aorta in women.In the ten year interval from 1967 to 1976, in a group of 200 patients with aortoiliac occlusive disease, six were identified who presented a unique combination of physical findings, angiographic abnormalities and pathologic changes. Atherosclerotic coarctation describes this entity because of the discreteness of the lesion found, the extent to which the aorta is occluded and the presence of extensive collaterals. Pathologically, the lesion is an organized thrombus forming on a single ulcerated plaque in an aorta with a lumen that is otherwise well preserved. Distally, infantile vessels are found. Other features have been the absence of diabetes mellitus and the fact that all of these patients have been women. All but one patient smoked cigarettes. Local endarterectomy restored pedal pulses and provided lasting relief of symptoms in all of the patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/7. Peripheral atheroembolism: an enigma.Fifteen patients with peripheral atheroembolism were studied and followed up for from one to three years. Clinical recognition of this condition is often masked by its elusive presentation. foot pain may be the very earliest symptom. Transient presentation is an important feature. Eventually, gangrene develops in the toes. ankle pulses are present on physical examinations. Both aortography showing proximal ulcerative plaques and digital arteriograms revealing the sharp cutoff pattern of an arterial embolus provide diagnostic confirmation. The results of treatment were satisfactory in all instances following aortoiliac endarterectomy or Dacron graft interposition. In five patients wiht gangrenous changes, toe amputation was necessary.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/7. rupture of dissecting aneurysm in a china Airlines co-pilot.A 46-year-old male co-pilot of china Airlines developed shortness of breath during landing on a flight from tokyo to Taipei on May 17, 1994. He was found dead shortly after landing. He was well and had passed his semi-annual health examination with no history of cardiovascular disease or hereditary disease. A dissecting aneurysm of DeBakey type I and cardiac tamponade with 200 ml blood inside the pericardial cavity during autopsy was noted. The right and left coronary arteries showed atherosclerotic changes with the lumen narrowing down to 30% in the anterior descending branch. Focal myocardial infarction with a healing scar, atheroma and arteriosclerosis of the small arteries including the kidney were observed. Nonspecific changes of the chest X-Ray and EKG with hyperlipoproteinemia suggests that a more advanced technique is required to carefully examine the heart condition during regular physical checkups to prevent sudden illness that might contribute to mass disaster.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/7. Atherosclerotic abdominal aorta saccular protrusion.Fourteen saccular abdominal aortic protrusion patients (ages ranged from 55 to 84, mean age 69.1 years) were reported. Their lesions were pathologically or bacteriologically suggested to be of atherosclerotic origin. Other origins were eliminated by using the patients past history or physical and diagnostic examination. All patients were classified into 1 of 3 types; solitary, adjacent to fusiform AAA, and independent of fusiform AAA. diagnosis and surgical techniques were complicated when coexisting with a fusiform abdominal aortic aneurysm (AAA) and located in the AAA neck. The treatment of choice for 13 patients was surgery. Postoperatively two patients died of hepatic failure at 5 weeks, and from apoplexia at four months, after surgery, respectively. The remaining patients' prognosis is good after a 3-month to 6-year follow-up with a mean period of 2.9 years except 1 medically treated patient. Accordingly, atherosclerotic abdominal aorta saccular protrusion should be carefully diagnosed and be surgically treated in the usual AAA manner. Only juxtarenal saccular protrusions require careful reconstruction, preserving the renal or visceral function.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |