1/28. Reversible catecholamine-induced cardiomyopathy in a heart transplant candidate without persistent or paroxysmal hypertension.BACKGROUND: Both dilated and hypertrophic cardiomyopathy have been reported in patients with pheochromocytoma, who were almost always hypertensive. The outcome frequently has been fatal, yet cardiac dysfunction can be reversible after medical or surgical therapy for the pheochromocytoma. methods: We report the case of a patient with dilated cardiomyopathy without persistent or paroxysmal hypertension, who was found to have a pheochromocytoma during initial medical evaluation. RESULTS: The identification and treatment of the pheochromocytoma led to significant improvement in cardiac function and cardiac transplantation was avoided. CONCLUSIONS: This case illustrates some unusual features in pheochromocytoma-induced cardiomyopathy: (1) absence of persistent or paroxysmal hypertension, (2) initial presentation with acute myocardial infarction and normal coronary arteries, and (3) recurrent episodes of nonsustained ventricular tachycardia.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
2/28. Percutaneous transmyocardial revascularization with holmium laser in patients with refractory angina: a pilot feasibility study.BACKGROUND: Percutaneous transluminal myocardial revascularization (PTMR) is a new procedure to improve perfusion of the ventricular wall for patients with intractable angina that is untreatable by surgery or conventional catheter-based intervention. PTMR allows the creation of myocardial channels through the controlled delivery of holmium laser energy from the ventricular chamber. Preliminary studies in animals and human subject have yielded promising results. We now report the feasibility study of PTMR using a laser delivered through a novel Eclipse system, and we present the results of this sole therapy in patients with severe coronary disease and angina refractory to maximal medical treatment angina (III-IV CCS). methods: Percutaneous vascular access for PTMR treatment was obtained via the femoral artery. A 9F directional catheter carrying flexible fiber optics was used with a holmium laser (Eclipse system) and was placed across the aortic valve into the left ventricle cavity to create channels with a depth of 5 mm from the endocardial surface into the myocardial tissue. From April to November 1998, 15 patients underwent PTMR with Eclipse system. Two patients were female; the mean age was 66 /- 8 (range 59-74). Five patients had a severe LV dysfunction (FE < 30%). Preoperative angina class was III in 10 patients and IV in 5 and previous myocardial procedures had been performed in all patients. RESULTS: The procedure was well tolerated and procedural success was obtained in 14 of 15 patients. There was one myocardial perforation because of guiding-catheter manipulation (pericardial drainage in fourth day). We performed a mean of 13 /- 4 channels in a mean fluoro time of 23 /- 11 min. Upon release and during follow-up (5.3 months /- 4.2, range 2-10), angina class had significantly improved in 14 of 14 patients with complete PTMR treatment, with 4 asymptomatic patients, 6 patients in CCS I, 3 in CCS II, 2 in CCS III and only one patient hospitalized due to angina. CONCLUSION: This pilot study confirmed the safety and technical feasibility of PTMR. Immediate and short-term results confirm that a clinical improvement is obtained in most patients. Although these are early clinical benefits, the true efficacy of this approach will necessarily be defined by a randomized trials with prospectively-defined endpoints and with PTMR compared with medical therapy.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
3/28. angina pectoris after aortic valve replacement.angina pectoris after aortic valve replacement may be due to reduced myocardial blood flow (coronary artery stenosis or valvular dysfunction) or to increased myocardial oxygen demand (idiopathic hypertrophic subaortic stenosis or valvular dysfunction). If a patient does not do well after an aortic valve replacement, causes other than dysfunction of the prosthesis should be sought.- - - - - - - - - - ranking = 3keywords = dysfunction (Clic here for more details about this article) |
4/28. Stenting to reverse left ventricular ischemia due to left main coronary artery compression in primary pulmonary hypertension.Angina is a common symptom of severe pulmonary hypertension. Although many theories for the source of this pain have been proposed, right ventricular ischemia is the one most commonly accepted as the cause. We report on two patients with primary pulmonary hypertension who had angina with normal activity or on provocation. One patient had severe left ventricular dysfunction. Both were found to have severe ostial stenosis of the left main coronary artery as a result of compression from a dilated pulmonary artery. Both patients underwent stenting of the left main coronary artery with excellent angiographic results, and complete resolution of the signs and symptoms of angina and left ventricular ischemia. Left ventricular ischemia due to compression of the left main coronary artery may be a much more common mechanism of angina and left ventricular dysfunction in patients with pulmonary hypertension than previously acknowledged. Stenting of the coronary artery can be done safely with the resolution of these symptoms.- - - - - - - - - - ranking = 762.5792193324keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
5/28. Neurologic and cardiac progression of glycogenosis type VII over an eight-year period.Little is known about the progression of phosphofructokinase deficiency (glycogenosis type VII, Tarui's disease). We describe a 66-year-old woman who had this disease diagnosed in 1997. Initial manifestations had included simple partial seizures since 1977, anginal chest pain since 1982, and muscle cramps since 1983. To prevent recurrent myocardial infarction, anticoagulation therapy with phenprocumon was initiated. Cardiac involvement progressed over an 8-year period, manifesting as low-voltage electrocardiogram (ECG), ectopic supraventricular tachycardia, thickened mitral valve, mitral valve insufficiency, enlarged left atrium, left ventricular hypertrophy, and diastolic dysfunction. Progression of neurologic involvement manifested as complex partial seizures, double vision, reduced tendon reflexes, central facial palsy, bradydiadochokinesia, and distal weakness of the upper extremities. Discontinuance of oral anticoagulation after 19 years, initiation of enalapril therapy, and administration of carbamazepine markedly improved the patient's condition.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
6/28. Successful treatment of symptomatic coronary endothelial dysfunction with enhanced external counterpulsation.Enhanced external counterpulsation (EECP) is a valuable therapeutic option for patients with coronary artery disease and refractory angina. Although the exact mechanisms by which this technique exerts favorable effects remain unclear, improvement in endothelial function is considered a potential mechanism contributing to the clinical benefit associated with EECP. We describe a young woman with severely symptomatic coronary endothelial dysfunction in the absence of obstructive coronary artery disease who experienced a dramatic and sustained reduction in symptoms in response to a standard 35-hour course of EECP.- - - - - - - - - - ranking = 5keywords = dysfunction (Clic here for more details about this article) |
7/28. Beneficial effects of human atrial natriuretic peptide on renal function in a patient with repeated coronary interventions: a case report.Among percutaneous coronary intervention post procedural complications, renal acute dysfunction due to administration of contrast agent is commonly seen in patients with pre-existing renal impairment, especially with co-existent diabetes mellitus and/or congestive heart failure. Although several strategies have been proposed to ameliorate this condition, their effects are inconsistent. A 66-year-old diabetic man at high risk for this complication underwent three distinct percutaneous coronary intervention procedures. Different strategies were used during each intervention to prevent the development of contrast medium-induced nephropathy. Dramatic renal protection was observed with human atrial natriuretic peptide administration or hemofiltration, whereas saline hydration had no apparent effect.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
8/28. Obstructive sleep apnea presenting with nocturnal angina, heart failure, and near-miss sudden death.An obese woman with a one-year history of episodic nocturnal chest pain was admitted because of shock and pulmonary edema. A clinical diagnosis of acute myocardial infarction and cardiogenic shock was made. She was ventilated and successfully resuscitated. Subsequent investigations showed no evidence of cardiac dysfunction or coronary disease, but sleep study confirmed the diagnosis of obstructive sleep apnea syndrome (OSAS). We suggest that the nocturnal angina and heart failure in this patient might have resulted from extreme hypoxemia produced by OSAS. This case raised the possibility that the high cardiovascular mortality rate reported in OSAS might not necessarily relate to underlying coronary artery disease. Further investigations are required to delineate the true incidence of coronary disease in patients with OSAS.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
9/28. Aneurysmal dilatation of the coronary arteries: diagnostic patterns and clinical significance.In order to define the clinical features, clinical patterns and significance of aneurysmal dilatation of the coronary arteries, five cases are presented which were diagnosed by coronary angiography. Three cases presented with left ventricular dysfunction secondary to coronary arterial occlusive disease and the fourth patient presented with thromboembolic cerebrovascular disease. The fifth case presented with manifestations of acute myocardial infarction.- - - - - - - - - - ranking = 381.2896096662keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
10/28. Differential diagnosis of orofacial pain.No attempt has been made to deal with all of the various diseases that the dentist has to consider when diagnosing orofacial pain. One of the most important causes of facial pain--so-called temporomandibular joint or myofascial pain dysfunction (MPD) syndrome--has not been mentioned, yet it accounts for many of the patients attending facial pain clinics. There are several textbooks devoted to the MPD and the reader is referred to these for a full description of the condition. Whenever a patient presents for evaluation of orofacial pain the dentist must remember: (1) to take a detailed history of the characteristics of the pain; (2) to complete a full examination of not only the teeth and the oral cavity but also the face, head, and neck; (3) not to assume that the patient in his chair necessarily has a dental condition producing his pain; (4) that if he is unaware of the existence of certain diseases he will never diagnose them!; and (5) to have no hesitation in referring a patient for evaluation rather than perform irreversible dental procedures.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
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