1/16. Unclassified connective tissue disease presenting as cardiac tamponade: a case report.This report describes a case of cardiac tamponade as the initial manifestation of unclassified connective tissue disease (UCTD). A 68-year-old Japanese woman was admitted to hospital because of dyspnea and edema. She had undergone a radical left mastectomy for the treatment of breast cancer 18 years before. On admission, bilateral leg edema, hepatomegaly, and a paradoxical pulse were noted on physical examination. The erythrocyte sedimentation rate was elevated and the c-reactive protein was 2.8 mg/dl. Antinuclear antibodies and anti-SS-A/Ro antibodies were present. The scl-70 and anticentromere antibodies were elevated. Chest radiography showed cardiomegaly. echocardiography revealed a large pericardial effusion, but the pericardial fluid did not contain malignant cells or bacteria. She did not meet the diagnostic criteria for any known connective tissue diseases, so was diagnosed with cardiac tamponade due to UCTD. prednisolone (30 mg/day) was administered, which resulted in a gradual resolution of the pericardial effusion. Although connective tissue diseases are known to cause pericardial effusion, cardiac tamponade as the initial manifestation of the disease in the absence of other symptoms is quite rare.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/16. Fatal arrhythmia in a juvenile athlete due to myocardial hypertrophy and infarction.This report is a case history of a 16-year-old highly trained athlete who suffered from ventricular fibrillation during exhaustive physical activity. After resuscitation and admission into hospital ECG revealed posterior wall infarction. thrombolytic therapy was advised and ST-segment elevation reversed. Within 48 h cerebral edema evolved due to hypoxic brain damage and the subject deceased after 16 days despite prolonged maximum antiedematous therapy. autopsy confirmed the diagnosis of concentric myocardial hypertrophy (total heart weight 568 g) without signs of coronary artery disease. Systemic inflammatory diseases and drug abuse were ruled out by lab studies, evidence for viral infection was not found. Thus, relative coronary insufficiency in regard to myocardial hypertrophy during excessive athletic activity must be viewed as cause for the fatal arrhythmia.- - - - - - - - - - ranking = 0.20703131575051keywords = physical (Clic here for more details about this article) |
3/16. Transplantation of an oversized heart.In response to the limited number of available donors, the criteria for accepting hearts have been expanded. In a 46-year-old female (160 cm, 56 kg) with a body surface area (BSA) of 1.58 m(2), an orthotopic heart transplantation was performed. She received the heart from a 34-year-old male donor (190 cm, 90 kg, BSA 2.58 m(2)). During transplantation, the obvious difference between the donor's heart and the recipient's pericardium did not cause a technical problem. However, the postoperative course was characterized by severe circulation problems. Due to a hemodynamically significant right heart impression, a consecutive pericardectomy had to be performed. After excision of the left and the right side of the pericardium, the patient returned to a stable condition. The consecutive course was without cardiopulmonary problems and the patient was discharged from the hospital 20 days later. The last twelve-month follow-up showed good cardiac function and excellent physical condition. We conclude that an oversized donor heart can be used for heart transplantation as long as the pericardium is left open and a left and right pericardectomy is performed.- - - - - - - - - - ranking = 0.20703131575051keywords = physical (Clic here for more details about this article) |
4/16. Idiopathic chylopericardium: 131-I-triolein scan for noninvasive diagnosis.We report idiopathic chylopericardium in a physically active, asymptomatic 29-year-old man. Preoperative diagnosis was made by external cardiac imaging after oral administration of 131-I-labeled triolein. To our knowledge this is the first report of preoperative noninvasive diagnosis of chylopericardium. After open drainage and pericardial biopsy, the patient is asymptomatic without recurrence after 8 months.- - - - - - - - - - ranking = 0.20703131575051keywords = physical (Clic here for more details about this article) |
5/16. Cardiomyopathy associated with amphetamine administration.A 45-year-old woman with congestive heart failure, in whom there was no evidence of coronary heart disease, valve disease, or other demonstrable cause of heart failure, was found to have taken high doses of dextroamphetamine over a long period. Withdrawal of amphetamine resulted in deterioration, suggesting a physical cardiac dependence on the drug. The clinical and autopsy findings are presented and the similarities to the myocarditis associated with pheochromocytoma are discussed. The evidence presented suggests a causal relationship between administration of dextroamphetamine and the cardiomyopathy.- - - - - - - - - - ranking = 0.20703131575051keywords = physical (Clic here for more details about this article) |
6/16. Sequestration of the lung in children.Nine cases of sequestration of the lung were seen in children. bronchopulmonary sequestration of the lung is a distinct congenital anomaly and clinical entity that can be distinguished from other congenital abnormalities of the lung. Such a congenital anomaly must be considered in children who, on roentgenologic examination, are found to have an opacity in the lower lung fields. Intralobar bronchopulmonary sequestration often is associated with recurrent pulmonary sepsis, whereas extralobar sequestration is less likely to be symptomatic and usually exhibits no abnormal physical findings. In a unique case, we found an extralobar sequestration associated with an esophageal duplication that communicated with the sequestered lobe but not with the esophagus. This situation represents a transitional stage in embryonic development of extralobar sequestration. Intralobar and extralobar forms of sequestration show many common characteristics indicating a common embryogenesis. Surgical excision, consisting of lobectomy or segmentectomy, is safe and effective and may be accomplished without morbidity or mortality.- - - - - - - - - - ranking = 0.20703131575051keywords = physical (Clic here for more details about this article) |
7/16. Hypercontractile cardiac states simulating hypertrophic cardiomyopathy.Hypertrophic cardiomyopathy (HCM) or idiopathic hypertrophic subaortic stenosis (IHSS) has been defined as an autosomal dominant myocardial disease characterized by specific physical findings, echocardiographic features, asymmetric septal hypertrophy and disordered myocardial architecture. Echocardiographic and scintiphotographic studies failed to reveal evidence of asymmetric septal hypertrophy in four patients with systolic anterior movement of the mitral valve and the typical ausculatory and peripheral pulse abnormalities characteristic of HCM. Postmortem examimination in one patient demonstrated mild concentric left ventricular hypertrophy and a normal arrangement of myocardial muscle fibers. These observations in four patients demonstrate that both systolic anterior movement of the mitral valve and the physical findings characteristic of HCM are not specific for the autosomal dominant myocardial disease characterized by asymmetric septal hypertrophy and abnormal septal histology.- - - - - - - - - - ranking = 0.41406263150102keywords = physical (Clic here for more details about this article) |
8/16. High output heart failure 8 months after an acquired arteriovenous fistula.Congestive heart failure (CHF) due to hyperkinetic states can occur in systemic diseases and in arteriovenous fistulas. An 18 year old Turkish male patient complaining of dyspnea and palpitations, who had suffered a stab wound to his abdomen eight months earlier, was admitted to our clinic. auscultation revealed a systolodiastolic murmur over the entire abdomen. Chest x-rays demonstrated significant cardiomegaly. echocardiography revealed biatrial enlargement and significant mitral and tricuspid regurgitation accompanied by dilatation of the inferior vena cava. Right heart catheterization showed increased oxygen saturation at the inferior vena cava. A diagnosis of an aortocaval fistula was made by aortography. The symptoms subsided and valvular regurgitations ceased alter surgical correction. This rare case demonstrates the significance of routine physical examination and history of the patient.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/16. Remission of high-output heart failure after surgical repair of 30-month arteriovenous femoral fistula: case report.We present a 15-year-old male patient who was admitted to our hospital because of breathlessness and palpitations at minimal physical effort (new york Heart association class II). The patient had a history of an abdominal and left thigh firearm wound that was surgically treated 30 months earlier. auscultation over the left femoral groin region revealed a systolodiastolic murmur. X-ray examination of the chest demonstrated significant cardiomegaly. Transthoracic echocardiography revealed an enlargement of 4 cardiac chambers, as well as significant mitral and tricuspid regurgitation. Vascular ultrasound of the femoral artery and vein confirmed the diagnosis of a traumatic arteriovenous fistula. The patient underwent surgical correction of the fistula, after which the symptoms subsided rapidly. Follow-up echocardiography performed 2 months after surgical repair showed a substantial reduction of cardiac size and a nearly complete absence of valvular regurgitations. This case highlights the importance of the recognition of arteriovenous fistulas as a cause of unexpected heart failure and demonstrates that the condition may improve substantially and rapidly after fistula correction.- - - - - - - - - - ranking = 0.20703131575051keywords = physical (Clic here for more details about this article) |
10/16. An unusual cause of obstructive emphysema.A 6-month-old child presented with a history, physical signs and radiographic findings suggestive of the presence of a foreign body in the tracheobronchial tree. However, further investigation revealed extrinsic compression of the left main bronchus by a grossly enlarged left atrium. Treatment of the patient's heart failure resulted in resolution of the signs. Anomalous origin of the left coronary artery was found to be the cause.- - - - - - - - - - ranking = 0.20703131575051keywords = physical (Clic here for more details about this article) |
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