1/9. Cardiac failure after initiation of insulin treatment in diabetic patients with beta-thalassemia major. diabetes mellitus is a complication of beta-thalassemia major. Two patients are described who developed severe cardiac failure after initiation or intensification of insulin treatment. We hypothesize that insulin-induced fluid retention combined with reduced cardiac reserve was responsible for the cardiac failure. Careful initiation of insulin treatment in these patients is important. ( info) |
2/9. Severe lower limbs lymphedema following breast carcinoma treatment revealing radiation-induced constrictive pericarditis--a case report. In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors' knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy. ( info) |
3/9. Aborted myocardial infarction: a clinical-magnetic resonance correlation. This report illustrates a magnetic resonance image of aborted myocardial infarction after primary angioplasty. Myocardial oedema in the absence of late enhancement seems to be the magnetic resonance marker of the myocardium at risk of infarction that has been reperfused within 30 minutes and aborted in the clinic. ( info) |
4/9. Reversible attenuation of the ECG voltage due to peripheral edema associated with treatment with a COX-2 inhibitor. A 74-year-old man developed peripheral edema as a side effect of the cyclooxygense-2 selective receptor inhibitor rofecoxib, which he had been taking for severe chronic arthritis. Discontinuation of rofecoxib led to augmentation of electrocardiographic (ECG) voltage and loss of weight gain (and reversibility of peripheral edema), which correlated well (r=0.82; p=0.0002). Other good correlations of the weight and other ECG variables and intercorrelations of ECG parameters underscore the multiple reversible influences peripheral edema has on the ECG. This case highlights an enhanced role of the ECG in monitoring patient therapy with other than strictly cardiovascular drugs. Recently, a syndrome pertaining to the influence of peripheral edema on the ECG was described; its mechanism is via the transforming effect of the body volume conductor on the surface transfer of the heart's potentials. The objective of this report is to describe a patient who developed peripheral edema as a side effect of a cyclooxygenase-2 selective receptor inhibitor. ( info) |
| The clinical features, echocardiographic characteristics, and electrocardiographic findings in two patients with acute myocarditis are presented. The first patient had rheumatic myocarditis and the other had probable viral myocarditis. Both patients had regional wall motion abnormalities on the echocardiogram, and the nuclear magnetic resonance image for each patient showed myocardial edema in the area of the wall motion abnormality. These changes disappeared with resolution of the acute disease process. These preliminary data indicate that nuclear magnetic resonance imaging may show myocardial edema in acute myocarditis. ( info) |
6/9. Fluid removal by haemofiltration in diuretic resistant cardiac failure. A 60 year old woman with diuretic resistant cardiac failure was treated with intermittent haemofiltration before tricuspid valve replacement. This technique can remove large quantities of fluid rapidly, thus controlling oedema and allow appropriate fluid replacement. Haemofiltration is thus a simple and safe method of managing unresponsive oedema in cardiac failure sometimes allowing corrective cardiac surgery. ( info) |
7/9. Cardiac-pulmonary edema and low pulmonary capillary wedge pressure. We describe a patient who presented with acute massive pulmonary edema, clinically and on chest roentgenogram. Two hours later the patient became hypotensive and was found to have a low pulmonary capillary wedge pressure (PCWP). The blood pressure returned to normal after administration of fluids. Acute pulmonary edema develops if PCWP rises higher than 25 to 30 mm Hg. In our patient, the elevated PCWP fell to low normal within two hours, when chest roentgenogram and clinical examination still suggested severe pulmonary edema. A phase lag existed between lowering of the pulmonary capillary wedge pressure and clearing of fluid from the alveolar and interstitial spaces in the lungs. At least three different pathogenetic mechanisms in patients with coronary artery disease can produce this phase lag. Transient global ischemia of the left ventricle was thought to be the responsible mechanism in our patient. ( info) |
8/9. Idiopathic dilated cardiomyopathy. A 43-year-old man had a 9-year history of congestive heart failure manifested by an enlarged heart and symptoms of shortness of breath and chest discomfort. heart failure had been preceded by a "viral illness" and he had been a heavy alcohol user until that time. autopsy showed congestion and edema characteristic of heart failure and cardiomegaly with biventricular dilatation. Either viral or alcoholic disease, or both, could have been the cause of the cardiac problems. ( info) |
9/9. Idiopathic hydropericardium as a cause of death of a preterm neonate. We report a case of a very premature infant who died on day 17 of life because of clinically unsuspected cardiac tamponade due to a pericardial effusion with no gross or microscopic features of myocardial inflammation or perforation. The pericardial effusion probably accumulated for 8 days prior to his death, as evidenced by chest X-ray films. The only relevant microscopic finding was a prominent pericardial and myocardial interstitial edema. Although staphylococcus epidermidis line sepsis, central venous catheter trauma, hypoalbuminemia, anemia, and heart failure could be possible contributory factors, no definitive cause of the pericardial effusion was found and the etiology of this condition remains obscure. ( info) |