1/10. Free-floating ball thrombus in the left atrium.Free-floating ball thrombi in the left atrium are rarely seen. They can cause sudden death by occluding the mitral valve. A 47-year-old female patient who showed signs of mitral stenosis during a physical examination and atrial fibrillation by electrocardiography was not administered anticoagulant therapy. On the transthoracic echocardiogram, a stenotic mitral valve and a floating mobile mass were seen inside the large left atrium. This mass was rounded (ball-like), had smooth contours, and occasionally occluded the stenotic mitral valve. The patient underwent emergency surgery to remove the mass, which was later proven to be a thrombus pathologically. Additionally, mitral valve replacement was performed. The importance of anticoagulant therapy for patients with rheumatic mitral stenosis has been emphasized by this case.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Left ventricular outflow tract obstruction produced by redundant mitral valve tissue in a neonate. Clinical, angiographic, and operative findings.An unusual case of left ventricular outflow tract obstruction associated with severe left ventricular failure in a neonate is reported. The physical and laboratory data were consistent with the diagnosis of infantile valvular aortic stenosis. At operation, however, redundant gelatinous pedunculated tissue attached to the mitral valve annulus appeared to move through and obstruct the aortic valve during systole. The aortic valve showed only minimal thickening of the right and left coronary cusps. A distinct angiographic pattern was demonstrated during left ventricular cineangiography. In the frontal projection a large ovoid filling defect appeared to protrude through the aortic valve during systole and return to a subvalvular location during diastole. Recognition of this angiographic pattern should facilitate diagnosis and subsequent repair. Complete correction is possible by operative excision of the obstructing tissue without damaging the mitral valve. In contrast to isolated congenital infantile valvular aortic stenosis, a condition in which the valve leaflets are often primitive and deformed, aortic valvotomy and/or subsequent valve replacement are not necessary, resulting in a better long-term prognosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. Acute myocardial infarction in a patient with severe unrecognized mitral stenosis.BACKGROUND: Acute myocardial infarction is a rare complication of mitral stenosis. Acute myocardial infarction in the setting of severe unrecognized mitral stenosis has not been described. CASE REPORT: A 47-year-old-woman was admitted to our department for chest pain typical of myocardial infarction. Electrocardiogram showed ST segment elevation in leads II, III, and aVF and atrial fibrillation. creatine kinase level was elevated to 268 U/L. The diagnosis of acute myocardial infarction of the inferior wall was established. The patient reported breathlessness after physical exertion over the last 2 years; however, she had not sought medical help and was unaware of her heart disease. Transthoracic echocardiography showed severe mitral stenosis (surface mitral valve area <1 cm2) and inferior wall akinesia. CONCLUSIONS: We present a case of acute myocardial infarction in a patient with unrecognized severe mitral stenosis and atrial fibrillation. Our suggestion is that acute myocardial infarction in this patient with no risk factors for coronary atherosclerosis was of thromboembolic origin, from left atrial thrombi.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. Management of valvular heart disease: an illustrative cases approach.As indicated by the 22 illustrative cases included in this monograph, a stepwise approach to the assessment of valvular heart disease provides the information necessary to make good clinical decisions. The ECG and chest x-ray add useful information to the history and physical examination. echocardiography, doppler, and color flow Doppler techniques have an important role in defining the presence and severity of valvular stenosis and regurgitation. Nuclear techniques provide useful information about global biventricular systolic function, regional wall motion, and myocardial perfusion. Exercise testing is most valuable in confirming objectively the patient's functional status and exercise tolerance. Newer imaging techniques, such as cine CT and MRI, are capable of displaying and measuring cardiac chamber size and myocardial thickness; however, visualization of the cardiac valves and demonstration of flow abnormalities are difficult, limiting the current usefulness of these techniques in patients with valvular heart disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. Constrictive pericarditis after cardiac surgery: report of three cases and review of the literature.Constrictive pericarditis after cardiac surgery is a rare phenomenon occurring with an incidence of 0.2% to 0.3%. To date only 158 cases have been reported in the world literature. Symptoms include dyspnea (81%), chest pain (34%), and fatigue (29%). Peripheral edema (90%) and an elevated jugular venous pressure (86%) were the most common abnormal signs found during physical examination. Chest x-ray and ECG abnormalities were not helpful in making the diagnosis, and abnormal echocardiographic findings were reported in less than half of the cases. Computerized tomography and magnetic resonance imaging scans of the heart were usually of great diagnostic benefit. Diastolic equalization of cardiac pressures remains the sine que non for diagnosis. Oral steroids have been reported to favorably alter the course early in the disease, but pericardial stripping remains the definitive form of therapy. Operative mortality rates vary from 5.5% to 14.5%.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Bilateral brachial artery emboli presenting as aortic dissection.Loss of peripheral pulses in a patient with chest pain suggests the diagnosis of aortic dissection. An 80-year-old woman presented with an episode of chest pain and acute bilateral loss of upper extremity pulses that was initially treated as aortic dissection. Findings of physical examination and echocardiography were consistent with mitral stenosis. Angiography revealed bilateral brachial artery emboli, which were treated by embolectomy. To our knowledge, this case represents the first report of simultaneous brachial artery emboli in association with mitral stenosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. Left atrial myxoma and unrelated mitral valve disease.Two cases of left atrial myxoma and concomitant, but unrelated mitral valve disease are reported. The first patient had severe mitral stenosis and mitral regurgitation due to rheumatic heart disease in addition to a large immobile left atrial myxoma. At surgery, the tumor was considered unresectable because of its size and widespread attachment to the left atrium. A mitral commissurotomy was performed with temporary improvement. The second patient had mitral regurgitation due to mitral valve prolapse (myxomatous degeneration) and an unrelated tumor. The patient's condition improved after mitral valve reconstruction and resection of the tumor. In both cases, the relatively immobile tumor was not physically in contact with the mitral valve and probably was not responsible for the valve disease. Both patients presented with dyspnea, to which the tumors may have contributed by causing partial obstruction of the pulmonary veins. Diagnostic and therapeutic problems resulting from the association of atrial myxoma and unrelated mitral valve disease are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Case report: factors involved in the production of the presystolic murmur in a patient with mitral stenosis and atrial trigeminy. Correlation of echocardiographic, phonocardiographic, and hemodynamic data.The study of a patient with mitral stenosis and periods of atrial trigeminal rhythm afforded an opportunity to test some factors important in the production of the presystolic murmur. The echocardiogram and phonocardiogram were correlated with hemodynamic data obtained both with the patient at rest and with right atrial and ventricular pacing. The results showed that atrial contraction was a major determinant in the production of the presystolic murmur and seemed to exert an even greater influence than did either the end-diastolic pressure gradient across the mitral valve or the duration of the preceding RR interval. Corollaries from this study may have practical application for the clinician in his bedside physical examination. The data suggested that the production of the presystolic murmur in our patient might have been related to geometrical shifts of intracardiac anatomical structures resulting from changes in the left ventricular end-diastolic distending pressure.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Case report: trivalvular rheumatic stenosis: documentation of disease progression by serial cardiac catheterization.A 56-year-old female with known rheumatic tricuspid stenosis was admitted for treatment of palpitations, abdominal discomfort and supraventricular tachyarrhythmias. Twenty years after an initial study, cardiac catheterization disclosed additional mitral and aortic stenoses. Trivalve prosthetic replacement was recommended, but cardiac arrest occurred, allowing pathologic confirmation of the hemodynamic findings. documentation of disease progression in nonoperated multivalvular rheumatic heart disease by cardiac catheterizations over such extended intervals of time has not previously been described. Also, the clinician is warned that historical and physical signs in such cases can underplay the actual severity and extent of disease, and he should not, therefore, be misled by unimpressive findings that the valvular deformity is insignificant.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Supravalvular mitral stenosis associated with ventricular septal defect.We describe three patients with supravalvular mitral stenosis caused by a diaphragm located just above the mitral valve and associated with a ventricular septal defect. Two of our three patients also had an associated coarctation of the aorta. The physical signs, ECGs, chest roentgenograms, and cardiac catheterization data are described. Points helpful in the differential diagnosis of this malformation are emphasized. All three patients were treated successfully by surgery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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