1/13. Transient left ventricular failure following bilateral lung transplantation for pulmonary hypertension.BACKGROUND: Bilateral lung transplantation is an established therapy for end-stage pulmonary hypertension. Its early postoperative outcome may be biased by various complications resulting in unexpected deterioration of the patient in terms of hemodynamics and blood gases. methods: We have reviewed the early postoperative course of patients who underwent bilateral lung transplantation for pulmonary hypertension at our institution and analyzed all available data, especially hemodynamic measurements, echocardiographic documentation and therapeutical strategies, in those cases where cardiac dysfunction was found to be responsible for clinical deterioration. RESULTS: Three out of 20 lung transplant recipients operated for pulmonary hypertension experienced severe respiratory insufficiency accompanied by hemodynamic decompensation during the first days after surgery. Clinical and laboratory findings together with results of echocardiography and pulmonary artery catheterism helped establish the diagnosis of left ventricular failure. This proved to be transitory, but the response to therapy (inotropic drugs, afterload reduction and eventually prostaglandins) was very variable. Adequately treated, this complication did not preclude the outcome of transplantation by itself. CONCLUSION: Left ventricular failure is a possible complication after lung transplantation for pulmonary hypertension. Echocardiography and pulmonary artery catheterism may be useful adjuvant diagnostic tools, beside routine physical examination, chest X-ray, and laboratory analysis. Therapy of this complication must be adapted individually and may be complex.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/13. Pseudoaneurysm of the left ventricle progressing from a subepicardial aneurysm.A 56-year-old man presented with an inferior myocardial infarction and a huge pseudoaneurysm below the inferior surface of the left ventricle, which had progressed from a small subepicardial aneurysm over a 6-month period. Transthoracic echocardiography, doppler color flow images, radionuclide angiocardiography, magnetic resonance imaging and contrast ventriculography all revealed an abrupt disruption of the myocardium at the neck of the pseudoaneurysm, where the diameter of the orifice was smaller than the aneurysm itself, and abnormal blood flows from the left ventricle to the cavity through the orifice with an expansion of the cavity in systole and from the cavity to the left ventricle with the deflation of the cavity in diastole. coronary angiography revealed 99% stenosis at the atrioventricular nodal branch of the right coronary artery. At surgery the pericardium was adherent to the aneurysmal wall and a 1.5-cm orifice between the aneurysm and the left ventricle was seen. Pathological examination revealed no myocardial elements in the aneurysmal wall. The orifice was closed and the postoperative course was uneventful. Over-intense physical activity as a construction worker was considered to be the cause of the large pseudoaneurysm developing from the subepicardial aneurysm. These findings indicate that a subepicardial aneurysm may progress to a larger pseudoaneurysm, which has a propensity to rupture, however, it can be surgically repaired.- - - - - - - - - - ranking = 0.28225099025762keywords = physical (Clic here for more details about this article) |
3/13. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. angina pectoris-myocardial infarction Investigations in japan.OBJECTIVES: To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study. BACKGROUND: Only several case presentations have been reported with regard to this syndrome. methods: We analyzed 88 patients (12 men and 76 women), aged 67 /- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies. RESULTS: Thirt-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart association function on discharge. The LV ejection fraction improved from 41 /- 11% to 64 /- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 /- 14 months, two patients showed recurrence, and one died suddenly. CONCLUSIONS: A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.- - - - - - - - - - ranking = 0.56450198051524keywords = physical (Clic here for more details about this article) |
4/13. Large ascending aortic aneurysm and severe aortic regurgitation in a 7-year-old child with marfan syndrome and a review of the literature. marfan syndrome in childhood.A 7-year-old girl was admitted because of dyspnea on exertion and palpitations. Her symptoms had gradually worsened for the last 6 months. She had physical features of the marfan syndrome. Transthoracic echocardiography showed an ascending aortic aneurysm, severe aortic regurgitation, and mildly dilated left ventricle. Because of marked aortic aneurysm and severe aortic regurgitation, the patient was treated with a beta-blocker and an angiotensin converting enzyme inhibitor. Surgery was refused by her parents. We describe here a child with marfan syndrome in whom significant dilatation of the ascending aorta and severe aortic regurgitation is encountered and major cardiovascular complications of marfan syndrome were reviewed.- - - - - - - - - - ranking = 0.28225099025762keywords = physical (Clic here for more details about this article) |
5/13. A case of transient left ventricular apical ballooning. A condition simulating an acute myocardial infarction.Transient left ventricular apical ballooning, sometimes associated with intraventricular pressure gradient, is a condition simulating an acute myocardial infarction and may occur in patients presenting with chest pain, electrocardiographic changes and minimal myocardial enzyme release typically without coronary angiographic stenosis. It was originally described in the Japanese population and is often associated with cerebrovascular accidents, surgical procedures and emotional and physical stress. We report the case of a 65-year-old woman presenting with chest pain typical of myocardial ischemia, dyspnea, electrocardiographic abnormalities and signs of hemodynamic instability, occurring after a severe emotional stress. Echocardiography and contrast ventriculography showed normokinesis confined to the basal segments of the left ventricle, with a markedly decreased ejection fraction. Scintigraphy was suggestive of a large perfusion defect. The electrocardiographic abnormalities and dyskinesis persisted for many hours. coronary angiography, performed in the acute phase, was completely normal. Five months later, the functional and electrocardiographic abnormalities had totally disappeared.- - - - - - - - - - ranking = 0.28225099025762keywords = physical (Clic here for more details about this article) |
6/13. Depressed left ventricular contractile reserve diagnosed by dobutamine stress echocardiography in a patient with Duchenne muscular dystrophy.Cardiomyopathy is a leading cause of death in patients with Duchenne muscular dystrophy. Congestive heart failure is often sub-clinical and unrecognized as a result of the severe physical limitations of this patient population. We report the case of a 16-year-old boy with Duchenne muscular dystrophy who demonstrated normal left ventricular systolic function at rest by screening transthoracic echocardiogram. This patient, however, was noted to have depressed left ventricular contractile reserve by dobutamine stress echocardiography. dobutamine stress echocardiography can have an important role in unmasking subclinical heart failure in this patient population.- - - - - - - - - - ranking = 0.28225099025762keywords = physical (Clic here for more details about this article) |
7/13. chylous ascites as the main manifestation of left ventricular dysfunction: a case report.BACKGROUND: Ascites is one of the most common complications of liver diseases, even though in 15% of the cases it is related to extrahepatic diseases; 3% are of cardiac nature and they appear associated with signs and symptoms of heart failure. CASE PRESENTATION: A 70 year old man was admitted with more than one year history of abdominal distension and a weight gain of 10 kilograms. He is asymptomatic and walks 2000-3000 meters a day without angor or dyspnea. The physical examination shows moderate abdominal distension, with no hepatosplenomegaly or edema, and there is mild jugular vein distension. The studies performed (complete laboratory work up, paracentesis, liver biopsy, echocardiogram, intrahepatic pressure measurements, etc.) showed a chylous ascites related to portal hypertension, and left ventricular dysfunction was the only probable cause found. CONCLUSION: Asymptomatic heart dysfunction can mimic liver disease and should be kept in mind as a cause of chylous ascites.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/13. A case of left ventricular pseudoaneurysm with long survival and congestive heart failure as first presentation. Case report and review of the literature.BACKGROUND: Left ventricular pseudoaneurysm is a rare and extremely fatal complication of acute myocardial infarction. It is defined as a rupture of the myocardium contained by epicardial adhesions or the epicardial wall. CASE REPORT: A 76-year-old woman was brought to our department suffering from acute pulmonary edema and left ventricular pseudoaneurysm. This condition was caused by an unrecognized high lateral myocardial infarction, which was diagnosed and treated conventionally. Four years after the diagnosis was made, the patient is in good physical condition. The presentation, imaging findings, and the prognosis of such cases are briefly discussed. We have especially focused on the imaging techniques currently used to confirm the diagnosis and on the fact that although the patient refused to have an operation (most appropriate for the diagnosis), she still lives in good physical condition (NYHA II). CONCLUSIONS: We report a case of post infarction pseudoaneurysm along with review of the literature on the subject. We discuss the role of computed tomography and magnetic resonance imaging to ascertain the diagnosis and the algorithm of therapeutic management. Based on current literature, we believe that surgical resection is the treatment of choice for patients in whom a pseudoaneurysm is detected within three months after myocardial infarction, for patients with other indications for cardiac surgery, and for symptomatic patients with ventricular tachycardia or recurrent embolism related to the pseudoaneurysm. Optimum medical therapy is the only alternative in those high-risk patients who refuse surgical operation.- - - - - - - - - - ranking = 0.56450198051524keywords = physical (Clic here for more details about this article) |
9/13. Left ventricular apical ballooning--a novel cardiac disease mimicking acute coronary syndrome: a case report in a Caucasian patient.The syndrome of "apical ballooning" consists of an acute onset of transient extensive akinesia of the apical portion of the left ventricle, without significant stenosis on the coronary angiogram, accompanied by chest symptoms, ECG changes, and a limited release of cardiac markers disproportionate to the extent of akinesia. So far, the vast majority of cases with this syndrome have been reported from Japanese patients and only a few cases of Caucasian patients have been described. Emotional or physical stress or other preceding triggering factors might play a key role in this cardiomyopathy, but the precise etiology remains unknown. We describe a case of "apical ballooning" in a white patient, who presented at our institution with this novel heart syndrome. Despite severe initial presentation, conservative medical management leads to good long term outcome in most patients.- - - - - - - - - - ranking = 0.28225099025762keywords = physical (Clic here for more details about this article) |
10/13. Transient left ventricular apical ballooning mimicking acute coronary syndrome in four patients from central europe.The syndrome of "apical ballooning" consists of an acute onset of transient extensive akinesia of the apical portion of the left ventricle, without significant stenosis on the coronary angiogram. The syndrome is accompanied by chest symptoms, electocardiographic changes, and limited release of cardiac markers disproportionate to the extent of akinesia. So far, the vast majority of cases with this syndrome have been reported among Japanese population and only a few cases among Caucasian population. We describe "apical ballooning" in four Caucasian patients, three women and one man, who presented at a tertiary referral center over a period of eight months. Their age ranged between 64 and 84 years. Three of them presented with chest symptoms. All four patients had electrocardiographic changes and increased concentration of troponin t. One patient developed hemodynamic instability, but none died or showed recurrence of symptoms during the follow-up of 1-8 months. In all patients, a preceding triggering factor was identified, such as emotional or physical stress. In all patients left ventriculography showed extensive akinesia of the apex of the left ventricle ("apical ballooning") in the absence of a significant coronary artery stenosis. Left ventricular systolic function recovered completely within three days to three weeks. Emotional or physical stress or other preceding triggering factors might play a key role in this cardiomyopathy, but the precise etiology remains unknown. Despite severe initial presentation, conservative medical management leads to good long term outcome.- - - - - - - - - - ranking = 0.56450198051524keywords = physical (Clic here for more details about this article) |
| | Next -> |