1/8. Cases from the osler medical service at Johns Hopkins University.PRESENTING FEATURES: A 29-year-old woman with a history of rheumatic heart disease and one episode of endocarditis as an adolescent was admitted to the hospital after 1 week of headache, fever, and myalgia. Her past medical history was otherwise unremarkable and did not include illicit drug use. On physical examination, she had a previously noted 3/6 holosystolic murmur at the apex, which radiated to her back; a previously noted 1/4 diastolic murmur at the right upper sternal border; diminished strength in her right upper extremity; multiple painful erythematous nodules on her fingers (Figure 1); and red streaks under her nails (Figure 2). magnetic resonance imaging of the brain demonstrated multiple lesions; the largest was in the right frontal lobe with associated hemorrhage (Figure 3).What is the diagnosis?- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. warfarin and herbal products interaction causing prosthetic aortic valve thrombosis presenting as acute myocardial infarction.myocardial infarction (MI) due to coronary artery embolization is a rare and potentially lethal complication of prosthetic heart valve thrombosis. A 58-year-old man in whom the aortic valve was replaced with a bileaflet mechanical valve presented with an acute anterior MI. Valvular dysfunction was detected by physical examination, and confirmed by two-dimensional echocardiography and cinefluoroscopy. coronary angiography disclosed embolization of the left anterior descending artery. Thrombotic encroachment of one of the prosthetic valve leaflets was found at reoperation. Failure to achieve adequate anticoagulation was likely due to an interaction between warfarin and herbal products. These findings have significant implications regarding the diagnosis and treatment of acute MI in patients with left-sided prosthetic heart valves, and emphasizes the importance of appropriate anticoagulation in this setting.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/8. Valve prolapse in Behcet's disease.Valve prolapse was diagnosed solely by echocardiography in three consecutive patients with Behcet's disease. Two patients had prolapse of the posterior mitral valve leaflet, but no clinical manifestations of valve prolapse. In the third patient aortic valve prolapse was associated with physical signs of aortic regurgitation and left ventricular failure. Valve prolapse in these cases may have resulted from structural and functional derangement caused by the underlying non-specific vasculitis that occurs in Behcet's disease.- - - - - - - - - - ranking = 0.048831773334657keywords = physical (Clic here for more details about this article) |
4/8. haemophilus parainfluenzae mitral valve vegetation without hemodynamic abnormality. Demonstration by angiography and serial echocardiography.The occurrence of haemophilus parainfluenzae endocarditis on a previously normal mitral valve of a drug addict is described. A large mitral valve vegetation was demonstrated by serial echocardiography and cineangiography. The vegetation did not produce hemodynamic abnormalities preventing detection by physical examination. Multiple septic emboli to various organs, including brain, resulted in death. The role of serial echocardiography and the levophase of right heart cineangiography in detecting mitral valve vegetation in a patient suspected of having infective endocarditis is emphasized.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/8. Renal arteriovenous fistula masquerading as severe valvar heart disease.Two patients with renal arteriovenous fistulae are described, who presented in high output failure. Murmurs were detected in these patients on routine physical examination years before, and when cardiac failure ensued they were assumed to have decompensated valvar heart disease. Full investigation revealed the arteriovenous fistulae and both patients made a good recovery after surgical ligation.- - - - - - - - - - ranking = 0.048831773334657keywords = physical (Clic here for more details about this article) |
6/8. Cardiac papillary fibroelastoma: a treatable cause of transient ischemic attack and ischemic stroke detected by transesophageal echocardiography.Transesophageal echocardiography (TEE) is used frequently in patients with cerebrovascular ischemia. On TEE, a typical appearance of a cardiac fibroelastoma is that of a pedunculated, mobile mass attached to a leaflet of a valve. Surgical excision of the lesion may lead to resolution of the symptoms and prevent further cerebrovascular ischemic events; valve replacement is seldom necessary. Herein we describe three patients with cerebral or ocular ischemia in whom histologic study confirmed a cardiac papillary fibroelastoma after initial detection by TEE. Cardiac papillary fibroelastomas should be considered in the differential diagnosis of transient ischemic attack and stroke, even in cases of recurrent events in the same vascular distribution. Although the use of echocardiography in the evaluation of stroke and transient ischemic attack is controversial, TEE must be considered in patients in whom the cause of cerebrovascular ischemia is unclear after noninvasive neurovascular studies or transthoracic echocardiography, even if the patient's cardiac history and the findings on physical examination are normal.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/8. Systolic aortic valve compression from partial dehiscence of an aortic valve homograft.Implantation of valve prostheses provide improvement of symptoms and prolongation of life in selected patients with valvular heart disease. Meticulous follow-up of patients after valve surgery is essential as complications of valve failure, valve dehiscence, valve thrombosis, and infection may occur. The major mode of failure of aortic valve homografts is valve regurgitation, which is readily detected by physical examination. We report a case of left ventricular outflow obstruction after implantation of an aortic valve homograft.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/8. Congenital complete atrioventricular block and prolapsing mitral valve.Congenital complete atrioventricular block and prolapsing mitral valve are described in a 41-year-old woman who exhibited ventricular arrhythmias and symptoms initially attributed to her atrioventricular block. The importance of physical examination to elicit clues in the diagnosis of prolapsing mitral valve is emphasized.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |