1/37. Acute myocardial infarction: a rare presentation of pancreatic carcinoma.Secondary neoplastic involvement of the heart is common but usually asymptomatic. Malignancy rarely presents as acute pericarditis, cardiac tamponade, and myocardial infarction in the same patient. We report a patient with unsuspected metastatic pancreatic adenocarcinoma who presented with acute pericarditis and cardiac tamponade and subsequently developed a myocardial infarction due to coronary artery occlusion secondary to a metastatic deposit around the left anterior descending artery.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/37. Restrictive pericarditis.BACKGROUND: Pericardial thickening is an uncommon complication of cardiac surgery. OBJECTIVES: To study pericardial thickening as the cause of severe postoperative venous congestion. SUBJECTS: Two men, one with severe aortic stenosis and single coronary artery disease, and one with coronary artery disease after an old inferior infarction. Both had coronary artery bypass grafting surgery. methods: magnetic resonance imaging (MRI), Doppler echocardiography, and cardiac catheterisation. RESULTS: venous pressure was raised in both patients. MRI showed mildly thickened pericardium, and cardiac catheterisation indicated diastolic equalization of pressures in the four chambers. Jugular venous pulse showed a dominant "Y" descent coinciding with early diastolic flow in the superior vena cava, and mitral and tricuspid Doppler forward flow proved restrictive physiology. The clinical background suggested pericardial disease so both patients had pericardiectomy. This proved the pericardium to be thickened; the extent of fibrosis also involved the epicardium. CONCLUSIONS: Although rare, restrictive pericarditis (restrictive ventricular physiology resulting from pericardial disease) should be considered to be a separate diagnostic entity because its pathological basis and treatment are different from intrinsic myocardial disease. This diagnosis may be confirmed by standard investigational techniques or may require diagnostic thoracotomy.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
3/37. Staphylococcal pericarditis following percutaneous transluminal coronary angioplasty.Infectious complications occurring after percutaneous transluminal coronary angioplasty are uncommon. We are reporting a case of bacterial pericarditis developing 1 week after coronary angioplasty and stent implantation. Treatment with appropriate antibiotics and drainage of the infected pericardial effusion was followed by a protracted hospital course and eventual control of infection and discharge of the patient.- - - - - - - - - - ranking = 6keywords = coronary (Clic here for more details about this article) |
4/37. cardiac tamponade complicating myocardial infarction in the era of thrombolytics and platelet IIb/IIIa: case report and literature review.Pericardial tamponade is a rare complication of acute myocardial infarction. The authors present the case of a patient with a large anterior myocardial infarction administered thrombolytics who developed postinfarction pericarditis. Because of a stuttering course with concomitant postinfarction angina, urgent angiography, leading to percutaneous transluminal coronary angioplasty and stent implantation, was performed. Administration of abciximab prior to percutaneous transluminal coronary angioplasty appears to have precipitated pericardial tamponade. The authors review the literature concerning numerous commonly utilized therapeutic options that could have contributed to the development of pericardial tamponade.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
5/37. Unusual cardiac reaction to chemotherapy following mediastinal irradiation in a patient with Hodgkin's disease.A 27 year old man with Hodgkin's disease experienced three separate episodes of chest pain, each occurring on the sixth day of a cycle of mustargen, oncovin, procarbazine, prednisone (MOPP) combination chermotherapy. The first episode appeared to represent a myocardial infarction, whereas the next two were less serious. Numerous studies were performed including coronary angiography, cardiac catheterization and open pericardial biopsy. It is suggested that the patient represents an example of a previously undescribed syndrome due to chemotherapy administered after cardiac irradiation.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
6/37. Acute pericarditis following percutaneous transluminal coronary intervention--a case report.A 68-year-old man underwent percutaneous transluminal coronary angioplasty for unstable angina. During the balloon inflation, coronary artery dissection with total occlusion was noted and recanalized by coronary stenting. The serial electrocardiograms revealed ST segment and T wave changes without elevation of the cardiac isoenzyme, which is suggested to represent acute pericarditis following the coronary intervention.- - - - - - - - - - ranking = 8keywords = coronary (Clic here for more details about this article) |
7/37. The importance of the evolution of ST-T wave changes for differentiating acute pericarditis from myocardial ischemia.A 28-year-old, moderately obese man with dyslipidemia (low-density lipoprotein 163 mg/dL, high-density lipoprotein 33 mg/dL), hypertension, active tobacco use (1 pack per day), and a family history for premature coronary artery disease (CAD) initially presented with burning, nonexertional chest discomfort exacerbated by deep inspiration. His initial electrocardiogram (ECG; Fig. 1A) was interpreted as pericarditis because of the diffuse mild ST-segment elevation and PR-segment depression. An echocardiogram demonstrated normal left ventricular systolic function and a trivial pericardial effusion. He was treated with nonsteroidal antiinflammatories and his symptoms resolved. Follow-up ECG performed the next morning (Fig. 1B) demonstrated sinus rhythm, persistent mild ST elevation, and biphasic T waves in leads V3-V4 as well as in leads III and aVF. Four months later, the patient returned with similar symptoms of chest discomfort and was admitted with the diagnosis of unstable angina. The admission ECG was unremarkable showing no persistent PR or ST-T abnormalities. He was ruled out for myocardial infarction by serial enzymes. An exercise myocardial perfusion imaging study was obtained. The patient exercised for 7 minutes 33 seconds on a standard Bruce protocol, obtained 9.4 METs, and reached 69% of maximum predicted heart rate. His exercise ECG revealed up to 2.5 mm of ST-segment elevation in leads V3-V5 accompanied by chest discomfort. The patient's chest pain resolved with cessation of exercise and 1 sublingual nitroglycerin. The ECG returned to baseline within 3 minutes of recovery. He was referred for coronary angiography and was found to have a proximal left anterior descending (LAD) stenosis and underwent percutaneous coronary intervention with stenting. He was discharged home on postprocedure day 3.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
8/37. Percutaneous endovascular occlusion of symptomatic coronary arteriovenous fistulas with cyanoacrylate.We describe four cases with symptomatic coronary artery fistulas that were treated primarily with endovascular cyanoacrylate embolization. Coils were also used as adjunctive embolic agents in two of these cases. All four cases showed symptomatic improvement after closure of the fistulas. Complications occurred in three cases including transient ST-segment elevation in one, symptomatic pulmonary embolization in a second, and transient pleuritic chest pain, pericarditis and acute renal failure in a third. The technical aspects of all four cases are given together with a review of the use of cyanoacrylate as an embolic material. We conclude that cyanoacrylate embolization could be considered as an alternative technique for the endovascular closure of coronary artery fistulas but must also caution that the use of this embolic agent is hazardous and should be restricted to practitioners experienced in its usage.- - - - - - - - - - ranking = 6keywords = coronary (Clic here for more details about this article) |
9/37. Use of a handheld epicardial ultrasonic Doppler flow detector to locate an intramyocardial coronary artery encased in inflamed neoplastic pericardium.A 44-year-old man had severe stenosis of the left main coronary artery. The middle portion of the left anterior descending coronary artery was in an intramyocardial location. The pericardium, ascending aorta, epicardium, and coronary arteries were encased by a metastatic, poorly differentiated papillary adenocarcinoma. The left anterior descending artery was located with the aid of a handheld epicardial ultrasonic Doppler flow detector, and grafted with the left internal thoracic artery on a beating heart. Subsequently, the patient underwent 10 cycles of chemotherapy More than 22 months later, he was asymptomatic and in remission from neoplastic disease.- - - - - - - - - - ranking = 7keywords = coronary (Clic here for more details about this article) |
10/37. A rare case of actinomyces israelii presenting as pericarditis in a 75-year-old man.actinomyces israelii is a gram-positive bacillus that is rarely associated with infections in the general population. A. israelii belongs to the normal flora of the body and it rarely becomes pathogenic. Cardiac involvement is rare and in most cases involves the pericardium. Fewer than 20 cases of pericardial actinomycosis have been reported in the literature since 1950. We report the case of a 75-year-old man with a history of coronary artery disease with recent myocardial infarction and stent placement, atrial fibrillation, and recent colonic perforation with subsequent colectomy/colostomy who presented to our hospital with a 2-week history of left-sided chest pain. Workup revealed the presence of a pericardial effusion and pericarditis. Pericardial fluid analysis demonstrated A. israelii. An examination and discussion of the literature is performed regarding this rare manifestation of human actinomycosis.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
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