1/68. mycobacterium avium complex pleuritis accompanied by diabetes mellitus.A 72-year-old woman with diabetic nephropathy was hospitalized with peripheral edema in the extremities and weight increase. After diuretics and human serum albumin administration, her condition improved. From the 15th day she had run a subfever and her breathing was diminished in the left lower lung field. A plain chest x-ray film showed pleural effusion over the left lung field. The fluid was exudative. Fluid cultures were negative. A tuberculin reaction was negative. polymerase chain reaction method disclosed mycobacterium avium complex, indicating rare pleuritis due to mycobacterium avium complex. Eighteen days after chemotherapy, pleural effusion disappeared. Although her hemoglobin A1c (HbA1c) levels were maintained from 6.0 to 6.5% over 4 years, urinary albumin excretion levels and serum creatinine levels increased, indicating deteriorating diabetic nephropathy. serum albumin levels remained low (3.3-3.6 g/dl). malnutrition, impaired cellular immunity and apparently abnormal microvascular circulation due to diabetes mellitus may consequently have induced pleuritis due to mycobacterium avium complex.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/68. Fatal arrhythmia in a juvenile athlete due to myocardial hypertrophy and infarction.This report is a case history of a 16-year-old highly trained athlete who suffered from ventricular fibrillation during exhaustive physical activity. After resuscitation and admission into hospital ECG revealed posterior wall infarction. thrombolytic therapy was advised and ST-segment elevation reversed. Within 48 h cerebral edema evolved due to hypoxic brain damage and the subject deceased after 16 days despite prolonged maximum antiedematous therapy. autopsy confirmed the diagnosis of concentric myocardial hypertrophy (total heart weight 568 g) without signs of coronary artery disease. Systemic inflammatory diseases and drug abuse were ruled out by lab studies, evidence for viral infection was not found. Thus, relative coronary insufficiency in regard to myocardial hypertrophy during excessive athletic activity must be viewed as cause for the fatal arrhythmia.- - - - - - - - - - ranking = 33.300975099286keywords = coronary (Clic here for more details about this article) |
3/68. Huge calcified aneurysm of the sinus of valsalva.Aneurysms of the sinus of valsalva often remain undiagnosed until they rupture. A 61-year-old man had a huge, heavily calcified unruptured aneurysm, originating from the right sinus of valsalva, detected incidentally on a chest radiograph taken for the diagnosis of cardiomegaly. Two-dimensional echocardiography revealed pericardial effusion with a huge calcified mass compressing the right ventricular outflow tract. The Doppler color-flow echocardiogram showed blood flow from the aortic root into the aneurysm. A chest computed tomographic scan revealed a large thrombosed aneurysm originating from the aortic root and measuring 10x10 cm. After pericardiocentesis, cardiac catheterization was performed, which showed that the right ventricular systolic pressure had elevated to 80 mmHg. Aortic root aortography demonstrated a huge unruptured calcified aneurysm in the sinus of valsalva arising from the right coronary sinus. The patient underwent surgical correction to prevent aneurysmal rupture and to relieve the right ventricular outflow obstruction.- - - - - - - - - - ranking = 16.650487549643keywords = coronary (Clic here for more details about this article) |
4/68. Transplantation of an oversized heart.In response to the limited number of available donors, the criteria for accepting hearts have been expanded. In a 46-year-old female (160 cm, 56 kg) with a body surface area (BSA) of 1.58 m(2), an orthotopic heart transplantation was performed. She received the heart from a 34-year-old male donor (190 cm, 90 kg, BSA 2.58 m(2)). During transplantation, the obvious difference between the donor's heart and the recipient's pericardium did not cause a technical problem. However, the postoperative course was characterized by severe circulation problems. Due to a hemodynamically significant right heart impression, a consecutive pericardectomy had to be performed. After excision of the left and the right side of the pericardium, the patient returned to a stable condition. The consecutive course was without cardiopulmonary problems and the patient was discharged from the hospital 20 days later. The last twelve-month follow-up showed good cardiac function and excellent physical condition. We conclude that an oversized donor heart can be used for heart transplantation as long as the pericardium is left open and a left and right pericardectomy is performed.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
5/68. Small aortic root as a cause of sudden death in a young adult: a controversial topic revisited.BACKGROUND: Sudden cardiac death over the age of 35 years is mostly due to coronary atherosclerosis, whereas under the age of 35 years, a variety of mainly congenital malformations prevail. However, hypoplasia of the aortic root in adults, first introduced by Laurie in 1968 as a cause of sudden cardiac death in adults, is never included. CASE REPORT: We present a case of a 29-year-old female who suddenly and unexpectedly collapsed during recreational bicycling. ventricular fibrillation was recorded, but resuscitation attempts failed, and the patient was declared dead about 1 h after the event. autopsy revealed cardiac hypertrophy with extensive scarring and a small aortic root (calculated inlet/outlet diameters=14.9/14.3 mm), without obstructive coronary artery disease or any other plausible cause for sudden cardiac death. CONCLUSIONS: The observations strongly suggest that small aortic root (less than 2 cm in diameter) provided the background for cardiac hypertrophy and, eventually, myocardial ischemia and ventricular fibrillation. Pathologists should be aware of this possibility while evaluating cases of sudden cardiac death without an obvious pathologic substrate.- - - - - - - - - - ranking = 33.300975099286keywords = coronary (Clic here for more details about this article) |
6/68. Vasospastic angina in a 16-year-old female.A 16-year-old female with a family history of coronary artery disease was referred to hospital because of recurrent chest oppression unrelated to exertion. Although a selective coronary angiogram showed no atherosclerotic lesions, coronary spasm was provoked by acetylcholine in the left coronary artery, accompanied by chest pain and depression of blood pressure. This is the youngest healthy young female to be diagnosed with coronary vasospasm by provocation test. Because there are no risk factors, the vasospasm must be related to unknown hereditary factors.- - - - - - - - - - ranking = 83.252437748215keywords = coronary (Clic here for more details about this article) |
7/68. Cardiomyopathy associated with amphetamine administration.A 45-year-old woman with congestive heart failure, in whom there was no evidence of coronary heart disease, valve disease, or other demonstrable cause of heart failure, was found to have taken high doses of dextroamphetamine over a long period. Withdrawal of amphetamine resulted in deterioration, suggesting a physical cardiac dependence on the drug. The clinical and autopsy findings are presented and the similarities to the myocarditis associated with pheochromocytoma are discussed. The evidence presented suggests a causal relationship between administration of dextroamphetamine and the cardiomyopathy.- - - - - - - - - - ranking = 16.650487549643keywords = coronary (Clic here for more details about this article) |
8/68. Subclavian-coronary artery anastomosis in infancy for the Bland-White-Garland syndrome: a three-year and five-year follow-up.Two infants, 4 months and 8 months of age, with anomalous origin of the left coronary artery, underwent direct anastomosis of the left subclavian artery to the left coronary artery. In the patient operated upon at 4 months of age, the anastomosis proved to be patent by angiographic study 3 years postoperatively. However, in the patient operated upon at 8 months of age, the study 5 years postoperatively revaled clinically unsuspected occlusion at the anastomosis site. After operation, both patients symptomatically improved. The heart size decreased on radiograms, the left ventricular ejection fraction improved, and the electrocardiographic abnormality resolved to a great extent. Since the preferred treatment for this abnormality and the ideal age for operation are yet to be established, long-term angiographic follow-up of all such surgically treated patients is needed. An advantage of the subclavian-coronary artery anastomosis is its applicability in the infant.- - - - - - - - - - ranking = 116.5534128475keywords = coronary (Clic here for more details about this article) |
9/68. situs inversus, subaortic and subpulmonic stenosis, ventricular septal defect, and single coronary artery.The unusual occurrence of situs inversus totalis, ventricular septal defect, hypertrophic subaortic and subpulmonic stenosis, and single coronary artery in a 38-year-old man is presented. The clinical course was remarkably mild, as documented by data from 23 years of study including four cardiac catheterizations. At age 35 years, however, syncope, chest pain, and marked elevation of right ventricular pressure prompted complete surgical repair of the left and right ventricular outflow tract obstructions and closure of the septal defect. Three years after surgery the patient continues to lead an active life without symptoms. The unusually mild course can be attributed to the natural banding effects of the subpulmonic stenosis which prevented irreversible pulmonary hypertension.- - - - - - - - - - ranking = 83.252437748215keywords = coronary (Clic here for more details about this article) |
10/68. Coronary artery fistula draining into left ventricle: case report and review.A 6-year-old boy with coronary artery fistula emptying into the left ventricle was reported. An attempt was made to outline clinical manifestations of this disease which have not yet been fully described, based on the experience of the present case and a review of 14 previously reported cases. It is concluded that clinical signs and symptoms are not specific for this anomaly and retrograde aortography is required to establish the definite diagnosis of the lesion. Authors' views are expounded as to the location of maximal intensity of the murmur, genesis of the systolic murmur and electrocardiographic features.- - - - - - - - - - ranking = 16.650487549643keywords = coronary (Clic here for more details about this article) |
| | Next -> |