Cases reported "Coronary Disease"

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1/11. Noninvasive revascularization by enhanced external counterpulsation: a case study and literature review.

    Nearly 8 million people in the united states suffer from symptoms of coronary artery disease (CAD). Unfortunately, the population of patients with ischemic coronary disease that is not readily amenable to surgical or percutaneous revascularization continues to grow. For patients who are not candidates for standard revascularization procedures and in whom aggressive medical therapy fails to control symptoms, enhanced external counterpulsation (EECP) is a new, noninvasive outpatient method to improve quality of life by decreasing ischemic symptoms and permit increased activity. We report the case of a 56-year-old woman with severe, symptomatic CAD receiving maximal medical therapy who underwent a course of EECP therapy because she was not a good candidate for other forms of revascularization. She demonstrated dramatic improvement in her anginal symptoms and complete resolution of myocardial ischemia on repeat nuclear stress imaging. This case suggests that EECP is a safe and effective method for reducing symptoms of myocardial ischemia in patients for whom standard percutaneous or surgical revascularization is not suitable treatment.
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2/11. Intracoronary thrombolysis and intraaortic balloon counterpulsation for the emergency treatment of probable coronary embolism after repair of an acute ascending aortic dissection.

    IMPLICATIONS: This report shows that if diffuse coronary thromboembolism is encountered during ascending aortic dissection-repair, the option of combining single-bolus, intracoronary thrombolysis with intraaortic balloon counterpulsation should be considered.
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3/11. Central venous pulsations associated with a falsely low oxygen saturation measured by pulse oximetry.

    Venous pulsations are thought, but to our knowledge have never been demonstrated, to result in underestimation of oxygen saturation measured by pulse oximetry (SpO2); however, to our knowledge, this has never been demonstrated. A patient with ischemic cardiomyopathy requiring intra-aortic balloon counterpulsation (IABC) had to withstand a temporary cessation of IABC (period I), during which she had marked central venous pulsations and a pulse oximeter bias of -18%. After IABC was reinstituted (period II), the venous pulsations disappeared and the bias was reduced to 0%. cardiac output, systemic vascular resistance, and temperature during both periods were comparable. Pulmonary vascular resistance, however, was much lower during period II. We postulate that the bias was caused by venous pulsations significantly contributing to the AC, or variable component, of light absorption.
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keywords = counterpulsation
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4/11. paraplegia following intraaortic balloon assistance.

    In a patient receiving intraaortic balloon counterpulsation following myocardial revascularization, paraplegia developed two days post-operatively. Postmortem examination demonstrated a dissecting hematoma of the thoracic aorta and spinal cord infarction. The neurological deficit is thought to be due to embarrassment of spinal cord blood supply, and mechanisms of injury are discussed.
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keywords = counterpulsation
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5/11. Resolution of congestive failure, mitral regurgitation, and angina after percutaneous transluminal coronary angioplasty of triple vessel disease.

    Congestive heart failure, unstable angina, and moderate mitral regurgitation improved after double-vessel angioplasty in a 41-year-old woman who was considered inoperable because of high risk of bypass surgery. With the concomitant use of balloon counterpulsation, angioplasty reduced the cross-sectional stenosis in the left anterior descending coronary artery from 98 to 20% and in the left circumflex coronary artery from 90 to 0%. The right coronary artery was completely occluded and angioplasty was not attempted. The ejection fraction was 17% prior to angioplasty and 50% 2 months later at follow-up.
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keywords = counterpulsation
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6/11. Use of rapid atrial pacing to induce 2:1 atrioventricular block with marked improvement in hemodynamics.

    Rapid atrial pacing by means of temporary atrial pacing wires was used to effect a regular sinus rhythm in a patient with 2:1 atrioventricular block and frequent premature atrial contractions. The change in rhythm allowed effective intra-aortic balloon counterpulsation and markedly improved the hemodynamic situation.
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keywords = counterpulsation
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7/11. Intra-aortic balloon counterpulsation for cardiac support during noncardiac operations.

    Major noncardiac surgery is a serious hazard to patients with advanced coronary disease. Perioperative infarction is common, and preliminary coronary bypass is often unwarranted. We suggest that the use of the intra-aortic balloon pump (IABP) for perioperative support of such patients makes perioperative infarction unlikely and permits otherwise hazardous operations. Three patients with advanced coronary disease (unstable angina in two) had major thoracotomies for lung masses without cardiac complications. This management plan has wider implications for other noncardiac surgical problems in such patients, particularly for mandatory operations wuch as relieving intestinal obstructions.
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keywords = counterpulsation
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8/11. Fulminating noncardiogenic pulmonary edema. A newly recognized hazard during cardiac operations.

    At new york University Medical Center over the past 18 months, a distinctive and potentially lethal syndrome of fulminating noncardiogenic pulmonary edema has been observed in three patients following cardiopulmonary bypass. The clinical appearance is virtually identical to that produced by acute left ventricular failure, and the condition could have been diagnosed incorrectly in the past as myocardial infarction with left ventricular failure and pulmonary edema. Thus it is uncertain whether this is a new syndrome or whether it has long been present. Fulminating noncardiogenic pulmonary edema can be diagnosed by finding a low left atrial or pulmonary artery wedge pressure combined with a high protein content in the pulmonary edema fluid when compared to simultaneous measurements of the plasma protein level. As no other etiologic agent could be identified in our three patients, the probable cause seems to be an unknown type of allergic reaction to blood or blood products, manifested by acute pulmonary edema--the pulmonary capillary membranes being the first to be exposed to fluids administered intravenously. The significant point is that a nearly fatal degree of pulmonary congestion can be managed safely and effectively with corticosteroids, antihistamines, positive-pressure ventilation, diuretics, and albumin. Presently, two important questions remain: (1) Should fluids be restricted and balloon pump counterpulsation and vasopressors utilized to maintain systemic pressure? (2) How long after administration of steroids is it safe to give intravenous albumin? Meanwhile, both the mechanism and frequency of this syndrome remain unknown.
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keywords = counterpulsation
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9/11. Intra-aortic balloon counterpulsation as adjunct to aneurysmectomy in high-risk patients.

    patients with severe coronary artery disease that is not amenable to coronary artery bypass surgery face formidable risks when major aortic surgery becomes necessary. In this report we present such a patient, who successfully underwent abdominal aortic aneurysm resection and graft replacement with the prophylactic use of intra-aortic balloon counterpulsation. The use of intra-aortic balloon counterpulsation at the time of surgery has the potential of improving cardiac function in patients with left ventricular dysfunction and favorably influencing the perioperative and postoperative mortality in these patients. Its use also appears worthy of trial in patients with ruptured abdominal aortic aneurysm and shock, in the hope that it will result in improved survival in these patients.
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ranking = 1.2
keywords = counterpulsation
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10/11. Coronary angioplasty for the control of intractable ventricular arrhythmia.

    Ventricular arrhythmias (VAs) that occur following an acute extensive anterior myocardial infarction (MI) usually respond to conventional antiarrhythmic regimes of treatment. Rarely, the VA may prove intractable to therapy. This report is of three patients who presented at varying time frames (3 h to 10 weeks) following an anterior MI. They exhibited sustained monomorphic ventricular tachycardia and hemodynamic instability despite multiple antiarrhythmic drug therapy, intravenous magnesium, direct-current cardioversion (DCCV), overdrive pacing (in one case), and intra-aortic balloon counterpulsation (IABP). Although there was no clinical evidence of continuing ischemia and although coronary angiography that was done in each case showed the infarct-related artery (IRA) to subtend akinetic areas on left ventricular (LV) angiogram, percutaneous transluminal coronary angioplasty (PTCA) of the IRA was done in all three cases. Reestablishing patency of the IRA helped in controlling the VA dramatically with average therapeutic doses of antiarrhythmic drugs. All three patients showed this control to have been maintained over a follow-up period of more than 1 year, with partial improvement in LV function and signal-averaged electrocardiogram negative for late potentials. Thus, in patients with extensive infarction and intractable VA, PTCA of the IRA may provide control of VA even in the absence of clinical signs of active ischemia or viable muscle mass.
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ranking = 0.2
keywords = counterpulsation
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