1/40. myocardial stunning caused by sympathetic nerve injury after an operation on cervical vertebrae.In this case, electrocardiographic inverted T waves appeared after cervical laminaplasty and echocardiogram showed temporary wall motion abnormality. Myocardial metaiodobenzylguanidine (MIBG) uptake was obviously reduced in the same area where the wall motion abnormalities appeared in the echocardiogram, although no abnormalities were detected with myocardial thallium scintigraphy and coronary angiography. The myocardial stunning was caused by injury to the sympathetic nerves from a surgical procedure on the cervical vertebrae.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/40. pulmonary embolism and myocardial hypoxia during extracorporeal membrane oxygenation.The treatment of a newborn with severe meconium aspiration by venoarterial extracorporeal membrane oxygenation (ECMO) was complicated by myocardial hypoxia with a marked decrease of myocardial contractility. The onset of the cardiac hypoxia was related to a pulmonary artery embolus. The origin of the embolus was a deep femoral vein thrombosis, caused by a central vein catheter, which was inserted 1 day before ECMO by venous cutdown. The possible pathophysiology of myocardial hypoxia in this patient is discussed, especially with regard to myocardial perfusion, supporting the hypothesis of coronary perfusion occuring with blood from the left ventricle and not from the arterial cannula in the aorta.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
3/40. The hibernating heart: reversible left ventricular dysfunction in chronic heart failure.A patient with severe heart failure secondary to coronary heart disease is presented. Following investigation he was thought to have significant areas of myocardial hibernation and was therefore treated with coronary revascularisation, with major clinical benefit.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
4/40. Detection of a biphasic response of hibernating myocardium by dobutamine-stress electrocardiography-gated technetium-99m-tetrofosmin single photon emission computed tomography--a case report.A woman with coronary artery disease underwent a new imaging technique: dobutamine-stress electrocardiography (ECG)-gated tetrofosmin-single photon emission computed tomography (SPECT). dobutamine-stress ECG-gated tetrofosmin-SPECT with automatic left ventricular function analysis software programs detected improvement and a biphasic response of dysfunctional myocardium during dobutamine infusion, which suggested viable but hibernating myocardium. dobutamine-stress ECG-gated tetrofosmin-SPECT with automatic left ventricular function analysis software programs has the potential to detect viable but dysfunctional myocardium with contractile reserve.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
5/40. Subarachnoid haemorrhage with transient myocardial injury and normal coronary arteries.We present a case of cerebral subarachnoid haemorrhage, with T-wave inversions and myocardial akinesia on echocardiography and ventriculography. Acute coronary angiography showed normal arteries. An aneurysm of the right middle cerebral artery was clamped. Echocardiogram was normalized. We discuss coronary spasm as the possible mechanism of myocardial stunning in subarachnoid haemorrhage.- - - - - - - - - - ranking = 6keywords = coronary (Clic here for more details about this article) |
6/40. myocardial stunning in hyperthyroidism.The cases of two patients with hyperthyroidism and acute left ventricular (LV) dysfunction with segmental wall motion abnormalities resulting in heart failure are reported. Both had electrocardiographic changes mimicking ischemic coronary artery disease. Treatment with antithyroid medications, beta blockers, and angiotensin-converting enzyme inhibitors rapidly restored LV function. The rapid reversibility suggests a role for myocardial stunning, an important entity to recognize in hyperthyroidism since this form of LV dysfunction can be reversed with appropriate treatment.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
7/40. Stunned myocardium after hip arthroplasty.We report a case of ST-segment elevation occurring in all leads of the ECG during hip arthroplasty. It is thought that this resulted from a stunned myocardium because wall motion abnormalities were reversible, there was no evidence of fixed or vasospastic coronary occlusion and there was only a slight increase in serial cardiac enzymes. Treatment with nicorandil improved the patient's cardiac function. A [123I]MIBG test revealed a high myocardial washout rate, suggesting that the stunned myocardium was caused by exposure to excessive norepinephrine induced by anaesthesia or surgery.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
8/40. Transient pathological Q waves in suspected acute myocardial infarction: 'electrical stunning'.In acute coronary syndromes the development of pathological Q waves is usually taken as evidence of established myocardial infarction (MI). We describe two patients with suspected acute MI who developed transient pathological Q waves. Cardiac enzymes were normal and cardiac catheterisation showed severe proximal coronary disease. Recognition of 'non-infarction' Q waves is important and may influence management of these patients.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
9/40. Identification of viable myocardium by perfusion imaging with intravenous contrast echocardiography after acute myocardial infarction.Myocardial perfusion contrast echocardiography is evolving into an effective method for the evaluation of myocardial blood flow after acute coronary events. The direct injection of ultrasound contrast agents into the aortic and coronary circulation has been shown to accurately identify areas of viable myocardial tissue. Recently, intravenous ultrasound contrast has been found to be useful in detecting microvascular blood flow after the restoration of blood flow in patients with myocardial infarction. We present the case of a patient in whom intravenous ultrasound contrast assisted in the detection of viable myocardial tissue after an acute ischemic syndrome.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
10/40. Uncommon and dynamic changes detected by 123I-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid myocardial single photon emission computed tomography in a stunned myocardium induced by coronary microvascular spasm.A 55-yr-old man underwent surgery. Soon after the procedure was finished, the patient complained of chest pain, and the electrocardiogram showed increase in the ST-segment in some leads. Emergency angiography showed normal coronary arteries, but there was asynergy in the left ventricle, and delayed filling of contrast medium was observed in the LCA. An intracoronary infusion of isosorbide dinitrate did not improve the delayed filling of contrast medium or ST segment increase in the electrocardiogram. Soon after nicorandil was injected into the LCA, the patient's symptoms, electrocardiogram, and delayed filling of contrast medium dramatically improved. On the second day, initial imaging by 123I-BMIPP myocardial SPECT showed a moderate increase in tracer uptake in the apico-anteroseptal region and a moderate decrease in tracer uptake in the lateral region, in which the first left ventriculography showed akinesis, and delayed imaging revealed a moderate increase in tracer uptake in the apical region and a high washout of 123I-BMIPP in the anteroseptal and lateral regions. On the sixth day, initial imaging by 123I-BMIPP myocardial SPECT showed a moderate decrease in tracer uptake in the apical and lateral regions and a mild decrease in tracer uptake in the anteroseptal region, and delayed imaging revealed a moderate increase in tracer uptake in the apical region and a high washout of 123I-BMIPP in the anteroseptal and lateral regions. By the 30th day, 123I-BMIPP myocardial SPECT had normalized. We consider that these dynamic changes in 123I-BMIPP myocardial SPECT imaging may reflect metabolic changes in fatty acids in the ischemic state, the size of the triacylglycerol pool, and the degree of turnover in the triacylglycerol pool.- - - - - - - - - - ranking = 6keywords = coronary (Clic here for more details about this article) |
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