1/255. Dissecting intramural haematoma of the oesophagus.The largest series of patients (n = 10) with dissecting intramural haematoma of the oesophagus is described. The typical features, chest pain with odynophagia or dysphagia and minor haematemesis are usually present but not always elicited at presentation. If elicited, these symptoms should suggest the diagnosis and avoid mistaken attribution to a cardiac origin for the pain. precipitating factors such as a forced Valsalva manoeuvre cannot be identified in at least half the cases. Early endoscopy is safe, and confirms the diagnosis when an haematoma within the oesophageal wall or the later appearances of a longitudinal ulcer are seen. Dissecting intramural haematoma of the oesophagus has an excellent prognosis when managed conservatively.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
2/255. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram.Criteria for reperfusion therapy in acute myocardial infarction require the presence of ST elevation in 2 contiguous leads. However, many patients with myocardial infarction do not show these changes on a routine 12-lead electrocardiogram and hence are denied reperfusion therapy. Posterior chest leads (V7 to V9) were recorded in 58 patients with clinically suspected myocardial infarction, but nondiagnostic routine electrocardiogram. ST elevation >0.1 mV or Q waves in > or =2 posterior chest leads were considered to be diagnostic of posterior myocardial infarction. Eighteen patients had these changes of posterior myocardial infarction. All 18 patients were confirmed to have myocardial infarction by creatine phosphokinase criteria or cardiac catheterization. Of the 17 patients who had cardiac catheterization, 16 had left circumflex as the culprit vessel. We conclude that posterior chest leads should be routinely recorded in patients with suspected myocardial infarction and nondiagnostic, routine electrocardiogram. This simple bedside technique may help proper treatment of some of these patients now classified as having unstable angina or non-Q-wave myocardial infarction.- - - - - - - - - - ranking = 597.06286036623keywords = myocardial infarction, cardiac (Clic here for more details about this article) |
3/255. Sudden unexpected death from pulmonary thromboembolism--examination of antemortem chest X-ray.An autopsy case of a woman who died suddenly from undiagnosed and untreated pulmonary thromboembolism (PTE) on her way home from the hospital is described in this report. She had complained of chest pain and dyspnea on exertion when she visited the hospital and a chest X-ray taken at that time showed remarkable manifestation of right heart failure and PTE, compared with former x-rays taken during previous visits to the hospital. In this report we present the findings of four chest x-rays of this patient, which had been taken both before and after the development of PTE.- - - - - - - - - - ranking = 0.10239294842734keywords = heart (Clic here for more details about this article) |
4/255. Differential diagnosis of chest pain: a case report.chest pain in a common presenting complaint in many healthcare settings, including Gl settings. It may be caused by a variety of cardiac and noncardiac abnormalities. nurses can play a critical role in the differential diagnosis of chest pain by obtaining a thorough history and conducting a directed physical examination. This article describes the differential diagnosis of chest pain through a case presentation.- - - - - - - - - - ranking = 2keywords = cardiac (Clic here for more details about this article) |
5/255. Spontaneous pneumomediastinum in an 18-year-old black Sudanese high school student.Spontaneous pneumomediastinum (SPM) is defined as pneumomediastinum in the absence of an underlying lung disease. It is the second most common cause of chest pain in young, healthy individuals (< 30 years) necessitating hospital visits. It is surpassed in frequency in this setting only by spontaneous pneumothorax. These two conditions may coexist in 18% of patients. The incidence of spontaneous pneumomediastinum varies in different communities and generally is relatively uncommon. Inhalational drug use (cocaine and cannabis) have been associated with a significant number of cases, although cases with no apparent etiologic or incriminating factors are well recognized. Also its recurrence, though uncommon, is worthy of note. It is a benign clinical condition with diverse clinical presentations. physicians' knowledge of the presentation, treatment, and prognosis of SPM will guard against the need for expensive radiologic and laboratory tests. The differential diagnosis of chest pain, shortness of breath, and dysphagia include cardiac, pulmonary, and esophageal diseases. The tendency to pursue these entities may lead to laboratory investigations such as electrocardiograms, arterial blood gases, ventilation/perfusion scans, and contrast radiographic studies of the esophagus.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
6/255. A case of vasospastic angina presenting Brugada-type ECG abnormalities.An electrophysiological study and a provocative test of coronary artery spasm was attempted in a 68-year-old man who was having syncopal attacks and chest pain. His electrocardiogram had the characteristics of brugada syndrome and ventricular fibrillation (VF) was induced by programmed electrical stimulation. ST-segment elevation became exaggerated by procainamide, which could not prevent the induction of VF. coronary angiography revealed no stenotic lesions, and spasm in the left coronary artery was induced by intracoronary administration of acetylcholine with similar chest pain to that experienced before. Under treatment with diltiazem and flecainide, which suppressed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patients with syncope should be evaluated carefully.- - - - - - - - - - ranking = 0.040953183211331keywords = attack (Clic here for more details about this article) |
7/255. Catheter-induced vasospasm in the right external iliac and femoral arteries during a cardiac diagnostic procedure.Catheter-induced vasospasm of small caliber arteries, such as the coronary arteries, is frequently observed during cardiac catheterization, but obstruction of the large caliber arteries has not previously been reported. Here we present two cases in which femoral and external iliac arteries were totally obstructed due to spasm during diagnostic coronary angiography.- - - - - - - - - - ranking = 5keywords = cardiac (Clic here for more details about this article) |
8/255. Prehospital ECG monitoring of chest pain patients.Prehospital electrocardiograms (ECGs) have been shown to decrease the time from onset of pain to onset of treatment. They are obtained prior to treatment while the patient is likely to have his/her most intense pain. With paramedics initiating care in the field, patient assessments may be clinically different by the time the patient reaches the hospital. Thus, obtaining an ECG as early as possible during treatment could aid in the access to treatment for the few patients whose ECGs improve with prehospital care. We present a case in which the prehospital presentation was indicative of an acute myocardial infarction (MI), whereas the presentation to the hospital was not as clear-cut. The patient was taken immediately to the catheterization laboratory based on the prehospital findings and was found to have an acute MI that was treated. Laboratory findings indicated that there was a significant improvement in patient outcome based on this early treatment. This case further illustrates the role of a prehospital ECG.- - - - - - - - - - ranking = 49.588571697186keywords = myocardial infarction (Clic here for more details about this article) |
9/255. pneumopericardium mimicking acute myocardial ischemia after laparoscopic cholecystectomy.pneumopericardium occurred after laparoscopic cholecystectomy in a 57-year-old woman. The patient had chest pain accompanied by T-wave inversion on electrocardiogram, with signs and symptoms suggestive of acute myocardial ischemia. Evaluation for myocardial infarction, however, was negative and clinical findings resolved spontaneously. Although pneumopericardium after laparoscopic procedures has been previously reported, this case illustrates how associated findings may mimic those of acute myocardial ischemia or infarction.- - - - - - - - - - ranking = 49.588571697186keywords = myocardial infarction (Clic here for more details about this article) |
10/255. A young man with a heavy heart.A 34 year old man presented with acute chest pain. His ECG was very abnormal but stable and he was treated with opiate analgesia. When his condition did not improve, chest radiography and cardiac ultrasound were performed. Both revealed metal dense deposits in the heart. On questioning, the patient revealed that he had self injected with mercury 15 years before. Self injection of elemental mercury is rare but well described and normally used by those who are suicidally depressed or who seek to improve sexual or athletic performance. Intravenous mercury may be deposited in the right heart and can result in ECG abnormalities, which may later be mistaken for changes due to coronary or other cardiac disease and result in inappropriate medication and hospitalisation.- - - - - - - - - - ranking = 2.6143576905641keywords = cardiac, heart (Clic here for more details about this article) |
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