| A young woman is reported with intractable sustained ventricular tachycardia thought to originate in the right ventricle, which was treated successfully with encainide after failure to respond to beta-blockers and several class IA antiarrhythmic agents. She became pregnant twice while on encainide and gave birth to two healthy children. This is the first report of pregnancy during treatment with encainide. A literature review showed no other reported case of encainide taken during pregnancy, but several reports of the safe use of flecainide, a similar class IC drug, during pregnancy. Other antiarrhythmics are also reviewed. ( info) |
| Acute right ventricular dysfunction has been established both as a diagnostic and prognostic indicator in pulmonary embolism. This report illustrates the utility of thallium-201 scintigraphy as an adjunctive noninvasive test in the diagnosis of pulmonary embolism by demonstrating increases in regional right ventricular perfusion and its subsequent resolution with treatment presumably as a result of decreased pressure work. ( info) |
3/205. A patient with hypertrophic cardiomyopathy accompanied by right ventricular dilation of unknown cause. Hypertrophic cardiomyopathy (HCM) is a disease characterized by an unknown cause of hypertrophy in the left or right ventricle. The dilated phase of HCM shows disease conditions resembling dilated cardiomyopathy, such as ventricular dilation, thin ventricular wall, and reduction of the ejection fraction. A patient presented with left ventricular concentric hypertrophy accompanied by right ventricular dilatation of unknown cause. Right ventricular endomyocardial biopsy specimens showed characteristic myocardial disarray. Therefore, there is the possibility that the patient had right and left ventricular HCM in the process toward the dilated phase, in which dilatation first occurred in the right ventricle. ( info) |
4/205. Extracorporeal right to left atrial bypass to treat right ventricular failure. Graft right ventricular failure after heart transplantation, secondary to preoperative functional pulmonary hypertension, was successfully managed in a 49-year-old patient using an extracorporeal right to left atrial bypass. We comment on the case and discuss the type of mechanical assistance used. ( info) |
5/205. Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited. The computed tomographic (CT) pulmonary angiogram appearances of acute right ventricular dysfunction due to massive pulmonary embolus in a patient are described. Abnormal findings comprised right ventricular dilatation, interventricular septal shift, and compression of the left ventricle. These changes resolved following thrombolysis. Use of CT pulmonary angiography to diagnose pulmonary emboli is increasing. Secondary cardiac effects are established diagnostic features shown by echocardiography. These have not been previously described but are important to recognise as they may carry important prognostic and therapeutic implications. ( info) |
| A fulminant pulmonary embolism can be treated surgically if thrombolytic therapy is contraindicated. A 31-year-old woman developed a fulminant pulmonary embolism after right-sided deep venous thrombosis 1 day after undergoing a cesarean section. A pulmonary embolectomy with cardiopulmonary bypass was performed, but the patient was brain-dead. After 2 days of echocardiographic observation, her heart was explanted for a 61-year-old man with ischemic cardiomyopathy. His right heart data were unremarkable, and he remains well 16 months after transplantation. Despite the sudden strain on the right ventricle that occurs with a pulmonary embolism, such a heart may be transplanted successfully after a pulmonary embolectomy. ( info) |
| A 32-year-old female is described, who was admitted with symptoms of severe right heart failure. The most likely diagnosis of pulmonary embolism was excluded. echocardiography and left-right catheterisation confirmed the diagnosis of primary pulmonary hypertension. A possible mediator in the process of PPH could be the appetite suppressants she had taken for some months after her second pregnancy. Before further pharmacologic tests could be performed the patient died in circulatory collapse. Postmortem pathological examination confirmed the diagnosis of PPH by the presence of narrowed pulmonary arterioles, media hypertrophy, thrombotic lesions and normal surrounding pulmonary parenchyma. The literature on primary pulmonary hypertension is revised with special emphasis on diagnosis and treatment algorithms. ( info) |
8/205. Reversible biventricular dysfunction secondary to ischemia in a patient with acute airway obstruction: a case report and review of the literature on reversible causes of acute ventricular dysfunction. Reversible causes of acute myocardial dysfunction are important for clinicians to recognize. Reversible biventricular dysfunction secondary to myocardial ischemia is presented in a patient with acute upper airway obstruction. The differential diagnosis of reversible acute myocardial dysfunction is reviewed. ( info) |
9/205. Pulmonary stenosis and severe biventricular dysfunction: improvement following percutaneous valvuloplasty. A 15-year-old boy with severe pulmonary stenosis associated with severe right and left ventricular systolic dysfunction is reported. After successful percutaneous pulmonary valvuloplasty, there was an initial and early improvement in right ventricular (RV) function, followed by a delayed and more gradual improvement in left ventricular (LV) function. At long-term follow up, both RV and LV systolic functions were nearly normalized. Several mechanisms may be implicated, including ventricular interdependence, geometric factors, altered compliance and intrinsic alteration in the LV muscle. A delayed, but sustained, improvement in LV systolic function following relief of RV pressure overload suggests that the latter mechanism must have played an important role in the genesis of the LV dysfunction. Pulmonary stenosis associated with severe biventricular dysfunction may be treated primarily by percutaneous pulmonary balloon valvuloplasty with near-total recovery of the ventricular function. ( info) |
10/205. Right ventricular ischemia mimicking acute anterior myocardial infarction. Isolated right ventricular ischemia in combination with myocardial infarction (MI) is uncommon, accounting for fewer than 3% of all MI cases. A young man who presented with acute right ventricular ischemia from occlusion of a codominant right coronary artery proximal to an acute marginal branch is presented. His presenting electrocardiogram (ECG) showed ST segment elevation in V1 to V4 mimicking acute anterior MI. ECG criteria for isolated right ventricular ischemia are discussed. ( info) |