1/84. The combination of risk factors for sudden death in a resuscitated elderly patient with an exceptional cause of left ventricular hypertrophy.The work-up of a previously asymptomatic 72-year-old man presenting with sudden cardiac death revealed a coarctation of the aorta as the cause of arterial hypertension, severe left ventricular hypertrophy, in combination with coronary artery disease with an apical myocardial infarction, severe autonomic dysfunction, and AV-nodal reentrant tachycardia. All these elements and their complex, probably synergistic interactions might have been involved in the development of sudden cardiac death.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
2/84. 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 = 3455.2155725046keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
3/84. 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 = 2keywords = dysfunction (Clic here for more details about this article) |
4/84. Acute ischemic hepatic failure resulting from intraaortic balloon pump malposition.We describe a rare intraaortic balloon pump (IABP) vascular complication as a result of malpositioning of the IABP. A 61-year-old man with unstable angina underwent emergency coronary artery bypass grafting soon after the insertion of an IABP. Postoperative hemodynamics were stable, but acute hepatic dysfunction occurred on the second postoperative day. Doppler echography revealed the absence of hepatic arterial flow. The IABP was removed, and arterial flow was immediately restored. Thereafter, the hepatic function recovered rapidly. This is a rare case that demonstrates how IABP can cause mechanical abdominal arterial branch obstruction. Evaluations using Doppler echography are useful in detecting such IABP complications.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
5/84. 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) |
6/84. Intracoronary measurement of pulsus alternans.Pulsus alternans is typically found in patients with left ventricular systolic dysfunction. We describe a woman with biventricular systolic dysfunction and pulsus alternans in the right ventricle, pulmonary artery, and aorta. coronary angiography revealed an intermediate stenosis in the proximal left anterior descending (LAD) coronary artery. Pulsus alternans was demonstrated in the mid LAD using a 0.014" guidewire-mounted pressure sensor. An abnormal fractional flow reserve was measured in the LAD. Cathet. Cardiovasc. Intervent. 51:335-338, 2000.- - - - - - - - - - ranking = 2keywords = dysfunction (Clic here for more details about this article) |
7/84. Diagnostic superiority of continuous-loop electrocardiographic recording over other testing in a patient with recurrent syncope and underlying coronary artery disease with severe left ventricular dysfunction.Dysrhythmic causes of syncope may elude diagnosis in postinfarction patients despite elaborate testing, including electrophysiologic study. For a correct diagnosis, capture of cardiac rhythm during patient's typical symptoms is crucial. This report describes a patient with coronary artery disease and decreased left ventricular ejection fraction who experienced recurrent syncopal episodes without obvious precipitating factors. The 12-lead electrocardiogram showed left bundle-branch block indicating a possible conduction abnormality as the underlying cause of syncope. Twenty-four-h Holter monitoring exhibited no sinus rhythm or conduction disturbances but revealed a nonsustained run of ventricular tachycardia. Findings at electrophysiologic testing led to a presumptive diagnosis of tachyarrhythmic cause of syncope; however, the correct diagnosis was only made with use of a loop monitor which documented a 15-s sinus pause during a syncopal episode.- - - - - - - - - - ranking = 3455.2155725046keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
8/84. erectile dysfunction: is there silent obstructive coronary artery disease?erectile dysfunction (ED) has long been ascribed to the ageing process. patients presenting with ED often have their symptoms ignored in terms of both underlying aetiology and treatment. It is now clear that, in many cases, the pathological processes in ED are common to those involved in vascular disease. Men with proven coronary artery disease (CAD) have a high incidence of ED when directly questioned. In some, the onset of ED pre-dates the symptoms and diagnosis of CAD as exemplified in our two cases. Patient 1 developed ED two months before an acute anterior myocardial infarction. Patient 2 had several cardiovascular risk factors but only the presence of ED prompted investigations which eventually led to an angiographic diagnosis of three-vessel disease. The presence of silent co-existing myocardial ischaemia should be considered in men who present with ED, particularly when they have other cardiovascular risk factors.- - - - - - - - - - ranking = 5keywords = dysfunction (Clic here for more details about this article) |
9/84. Tetrahydrobiopterin improves endothelial dysfunction in coronary microcirculation in patients without epicardial coronary artery disease.OBJECTIVES: We aimed to determine whether intracoronary supplementation with nitric oxide (NO) synthase co-factor tetrahydrobiopterin (BH4) improves NO-dependent coronary microvascular dilation in patients with coronary risk factors but no significant organic stenosis. BACKGROUND: Impaired coronary microvascular dilator reserve attributable to endothelial dysfunction plays an important role in the regulation of coronary blood flow (CBF). methods: Fifteen patients were measured for CBF (Doppler-wire and quantitative coronary angiography). Stimulated release of NO in the coronary microcirculation was evaluated by percent increase in CBF (¬BF) at graded doses of intracoronary acetylcholine (1, 3, 10 and 30 microg/min). Measurements were repeated after intracoronary co-infusion of BH4 (4 mg/min) and acetylcholine. RESULTS: The patients were divided into two groups on the basis of CBF responses to acetylcholine: those with "diminished" (ÞltaCBF <300%, n = 8) and "normal" (ÞltaCBF >300%, n = 7) flow responses. Tetrahydrobiopterin significantly (p < 0.0001) improved acetylcholine-induced increases in CBF in patients with diminished flow responses, but exerted no effect in those with normal flow responses. Among the 15 studied patients, the magnitude of flow improvement by BH4 was inversely correlated with baseline flow responses (p < 0.02). Microvascular dilator response to direct NO donor (isosorbide dinitrate) was not affected by BH4. CONCLUSIONS: We demonstrated for the first time that intracoronary BH4 improved acetylcholine-induced microvascular dilator responses in patients with endothelial dysfunction in vivo. Thus, supplementation with BH4 may be a novel therapeutic means to increase NO availability for patients with coronary microvascular disease.- - - - - - - - - - ranking = 6keywords = dysfunction (Clic here for more details about this article) |
10/84. A case of successful primary coronary intervention for the total occlusion of left main stem with the aid of abciximab.A 61-yr-old male patient presented with severe chest pain with cardiogenic shock due to an extensive anterolateral myocardial infarction. Two-dimensional echocardiogram showed severe left ventricular systolic dysfunction (ejection fraction=17%). Emergent coronary angiogram obtained immediately after placing temporary pacing electrode revealed total thrombotic occlusion in the left main stem. We performed direct coronary intervention using kissing balloon technique with the aid of Abciximab (ReoPro) infusion. Residual stenosis with thrombus remained even after high pressure balloon dilatations, therefore we placed two stents, one in the ostia of left anterior descending (LAD) and the other in left circumflex artery (LCX). Coronary angiogram after kissing stents showed improved LAD and LCX flows without residual stenosis. chest pain resolved and blood pressure normalized after coronary intervention. The whole procedure time was 15 min. Follow-up coronary angiogram taken one week later showed patent previous stented arteries, and echocardiography demonstrated 40% of left ventricular ejection fraction. The clinical course for one-year follow-up was uneventful.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
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