1/32. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram.Criteria for reperfusion therapy in acute myocardial infarction require the presence of ST elevation in 2 contiguous leads. However, many patients with myocardial infarction do not show these changes on a routine 12-lead electrocardiogram and hence are denied reperfusion therapy. Posterior chest leads (V7 to V9) were recorded in 58 patients with clinically suspected myocardial infarction, but nondiagnostic routine electrocardiogram. ST elevation >0.1 mV or Q waves in > or =2 posterior chest leads were considered to be diagnostic of posterior myocardial infarction. Eighteen patients had these changes of posterior myocardial infarction. All 18 patients were confirmed to have myocardial infarction by creatine phosphokinase criteria or cardiac catheterization. Of the 17 patients who had cardiac catheterization, 16 had left circumflex as the culprit vessel. We conclude that posterior chest leads should be routinely recorded in patients with suspected myocardial infarction and nondiagnostic, routine electrocardiogram. This simple bedside technique may help proper treatment of some of these patients now classified as having unstable angina or non-Q-wave myocardial infarction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/32. thyrotoxicosis, unstable angina and normal coronary angiogram.It is well known that thyrotoxicosis may elicit acute myocardial ischemia even in patients with angiographically normal coronary vessels. The involved mechanisms are not clearly defined although some hypothesis have been suggested. We report a case of a 54-year-old woman affected by Graves' disease with thyrotoxicosis which was referred to our Institute because of unstable angina. During hospitalization a two dimensional echocardiogram, performed during chest discomfort, showed left ventricular apical akinesis and impaired global systolic function. A subsequent coronary angiography revealed normal epicardial vessels. She was successfully treated with high-dose methimazole and propranolol and a repeat echocardiogram evaluation showed normalization of left ventricular systolic function. Six months later, because of the appearance of paroxysmal atrial fibrillation, the patient underwent total thyroidectomy and a substitutive therapy with L-T4 (100 micrograms/die) was started. The authors review the possible mechanisms involved in the pathogenesis of myocardial ischemia during thyrotoxicosis.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/32. Normal electrocardiogram with total occlusion of the left anterior descending coronary artery.Total occlusion of the left anterior descending coronary artery is usually characterized by ST-segment elevation in the anterior leads of the surface electrocardiogram. We report a case of a patient who had a persistently normal electrocardiogram throughout his hospitalization despite the angiographic findings of total occlusion of the left anterior descending coronary artery and no collateral vessels. Percutaneous transluminal coronary angioplasty with stent placement was performed successfully.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/32. Migration of a K-wire from the distal radius to the heart.K-wires and Steinmann pins are used to provide internal fixation for fractures or osteotomies. In some instances, removal of the implant is planned and the implant is left long to facilitate its removal. In other instances, implant removal is not planned and the implant is cut off at the level of the bone. Migration of these implants to solid organs or body cavities has been reported. Extravascular migration may occur along tissue planes assisted by muscle motion. Large vessel penetration can occur and has been reported with subsequent migration of the implant to the heart. This case report documents the loosening of a K-wire used in the distal radius to supplement the fixation of a complex intra-articular fracture, migration of the implant along tissue planes, penetration into a peripheral vein, and continued migration of the implant to the heart. There are multiple reports documenting wandering bullets, venous catheter tips, and invasive monitoring devices in the extremities. This is only the second case report that the authors are aware of that confirms migration of an implant from the distal extremity to the heart.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/32. Langerhans' cell histiocytosis presenting with a para-aortic lesion and heart failure.Langerhans' cell histiocytosis (LCH) is an uncommon disease with variable manifestations. We report a case of LCH with the unusual initial presentations of chest pain and progressive heart failure in a 5-year-old boy. Chest radiography revealed a wide mediastinum with cardiomegaly. electrocardiography showed first-degree atrioventricular block and an inverted T wave over V4-V6. echocardiography, computed tomography, and magnetic resonance imaging of the chest all showed an infiltrating lesion that enveloped the entire heart, great vessels, and coronary arteries. Pathologic examination of the biopsy specimen revealed LCH. Chemotherapy, which included prednisolone, vincristine, methotrexate, and 6-mercaptopurine, had only a minimal effect on the tumor. After the addition of etoposide, the lesion decreased in size, and the symptoms and signs of heart failure and chest pain were ameliorated.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/32. Conversion of atrial fibrillation into a sinus rhythm by coronary angioplasty in a patient with acute myocardial infarction.Atrial tachyarrhythmias are important complications occurring in more than 8% of acute myocardial infarctions (AMI). atrial fibrillation (AFi) during the early phase of AMI is caused by atrial ischaemia, atrial distension due to the left ventricular failure or significant diastolic left ventricular dysfunction. AFi in patients with inferior and posterior AMI indicates at least two vessel coronary diseases, a circumflex coronary artery (CX) occlusion before taking off of the left atrial branches as well as significant stenosis or occlusion of the right coronary artery (RCA). In this article the case of a 67-year-old woman with an acute infero-posterior AMI is described. AMI was complicated with a left heart failure, acute AFi with tachyarrhythmia, transient arterial hypotension and ischaemic mitral regurgitation. Emergency coronary angiography disclosed occlusion of the CX, myocardial infarct related artery, and significant stenoses of the RCA. After opening the occluded CX during the PTCA, AFi with a tachyarrhythmia of 160 beats per minute (bpm) immediately converted into a sinus rhythm with 80 bpm, followed by a normalization of blood pressure and cardiac recompensation. Our case report supports the opinion that AFi in patients with inferior and posterior AMI indicates at least a two-vessel coronary disease. Reopening of the occluded atrial coronary branches during urgent medical treatment was casual and effective treatment of both ischaemic heart disease and consequent AFi.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/32. ST elevation in the anterior precordial leads during right ventricular infarction: lessons learned during primary coronary angioplasty--a case report.ST elevation in the anterior leads may be due to isolated right ventricular infarction associated with occlusion of a nondominant or codominant right coronary artery. The authors report a case of isolated right ventricular infarction from a dominant right coronary artery's proximal occlusion in the presence of collateral circulation provided by the left coronary artery. Extensive damage occurred owing to compromise of the collateral circulation during primary coronary angioplasty. This is an unusual angiographic pattern for isolated right ventricular infarction. The potential consequences of percutaneous interventions to collateral vessels is discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/32. Prehospital rounds. The quick stop.The coroner's post-mortem examination revealed a tom aorta. This case illustrates that although a patient may appear stable, a major catastrophic event may nonetheless be taking place. How many times have we responded to MVAs similar to the one described here and seen those involved deny injuries? We carry a higher suspicion of aortic injury after someone has been ejected from a vehicle or involved in a high-speed crash. That's not always the case, however, and understanding how internal organs respond to high-speed impacts is crucial. Damage to the aorta may result after a sudden deceleration injury of any type: a fall, vehicle crash or violence. The most common forms of traumatic aortic injury occur where the aorta is "tethered" in place: at its intersection with the heart and at its distal portion just beneath the left subclavian artery near the ligamenta arteriosum. Approximately 80% of patients with aortic injury die at the scene. The injury may be hidden in the other 20%, but they have the potential to rapidly deteriorate and die. Those who survive typically are at a trauma center and are cared for by providers who have a suspicion of the injury. A high index of suspicion should be maintained on all rapid-deceleration injuries and with patients who experience chest pain, dyspnea, a difference in pressure between the upper and lower extremities, and paralysis. paralysis can occur when aortic injury cuts off blood supply [table: see text] to the spinal cord. The spinal cord obtains its blood supply from arteries coming directly off the aorta, and a torn aorta can shear off these vessels, leaving the spinal cord to infarct and the patient to lose all distal function. When a victim sustains a sudden-deceleration injury to the chest, signs of aortic injury should be sought. It is imperative to maintain a high index of suspicion throughout patient care and be aware that although a patient may appear to be quite stable, the reality might be otherwise, and rapid transport to a trauma center will be necessary to save their life.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/32. acute coronary syndrome in patients with human immunodeficiency virus disease.With more effective prophylactic treatment and an increased time of survival, noninfectious conditions associated with human immunodeficiency virus (hiv) disease are being recognized with increasing frequency in hiv patients. Cardiac involvement in hiv-infected patients varies from clinically silent to a fatal disease with a direct cardiac cause of mortality estimated at 1% to 6%. pericardial effusion, pericarditis, myocarditis, cardiomyopathy, endocarditis, and pulmonary hypertension are known cardiac manifestations associated with hiv infection. coronary artery disease (CAD) has not been a recognized complication of hiv disease, although some recent case reports have suggested occurrence of premature CAD and accelerated atherogenesis in hiv-infected patients. The role of protease inhibitors have been suggested in the development of this complication. After reviewing records of the last 7 years, the authors found 10 cases of acute coronary syndrome in hiv-infected patients who had no other risk factor for CAD except smoking. The presence of CAD was confirmed by angiography or autopsy. The mean CD4 count was 380 cells/mm3, and the mean duration between the diagnosis of hiv infection and CAD was 7.5 years. Four patients had single-vessel disease, 1 patient had 2-vessel disease, and 5 patients had 3-vessel disease. Three patients underwent coronary bypass surgery and 1 patient died of cardiogenic shock. CAD may be associated with hiv disease.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
10/32. Increasing myocardial 123I-BMIPP uptake in non-ischemic area in a patient with acute myocardial ischemia.The subject was a 65-year-old woman with chest pain. An electrocardiogram revealed T-wave-inversion in leads III, aVF, V1-V5. 99mTc-tetrofosmin myocardial SPECT showed mildly reduced uptake in the anteroseptal wall and the apex. These findings suggested acute myocardial ischemia. coronary angiography did not show any stenotic lesions, but diffuse coronary ectasia was noted in three vessels. Coronary flow velocity was remarkably reduced on coronary angiography. Epicardial coronary spasm was not provoked by ergonovine loading test. Left ventriculography showed diffuse hypokinesis. 123I-BMIPP myocardial SPECT showed mildly reduced uptake in the anteroseptal wall and the apex on the early images. But 4-hour delayed images showed an increase of 8% in myocardial 123I-BMIPP uptake. We treated this patient with ticlopidine and nicorandil. After drug therapy her symptoms and left ventriculography improved. 123I-BMIPP myocardial SPECT findings on the early images improved, whereas delayed images showed a decrease of 28% in myocardial 123I-BMIPP uptake after two weeks and 36% after four weeks. These dynamic changes in 123I-BMIPP findings might be a reflection of myocardial fatty acid metabolism in patients with acute myocardial ischemia. Delayed 123I-BMIPP myocardial SPECT images are useful for the assessment of fatty acid metabolism.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
| | Next -> |