Cases reported "Heart Diseases"

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21/66. Left ventricular mobile thrombus associated with ventricular assist device: diagnosis by transesophageal echocardiography.

    Ventricular assist devices (VADs) have been used as a bridge to cardiac transplantation in patients with end-stage congestive heart failure. Despite adequate anticoagulation, thromboembolism is a major complication and in particular, a left ventricular (LV) thrombus associated with VADs has been reported as an important cause of thromboembolic complications. The frequency of LV thrombus formation in the patients with VAD support using LV apical cannulation is reported to be low. A 61-year-old woman supported with VAD with LV apical cannulation had a mobile LV thrombus adjacent to the inflow cannula diagnosed by transesophageal echocardiography.
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22/66. Irregular connexin43 expressed in a rare cardiac hamartoma containing adipose tissue in the crista terminalis.

    Cardiac hamartomas are very rare and are demarcated masses of enlarged, hypertrophied, mature myocytes and collagen tissue. Cardiac hamartomas are generally circumscribed in the right ventricle or atrium, but not reported in the crista terminalis (CRT). The CRT is crucial in electrophysiology, is related to arrhythmogenesis, and is targeted by radiofrequency catheter procedures. Previous works only described the benign natures of prominent CRT using non-invasive methods. This study describes an unusual cardiac hamartoma originating from the CRT and extending toward the tricuspid valve. Microscopically, this hamartoma comprised dense collagen and adipose tissue, mixed with hypertrophy, but with disarrayed cardiomyocytes. An irregular gap junction, connexin43, was demonstrated in this cardiac hamartoma.
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23/66. rupture of chordae tendineae in patients with beta-thalassemia.

    Cardiac disease is the primary cause of mortality in beta-thalassemia patients. Except for ventricular dysfunction and pulmonary hypertension that represent the main forms of heart disease in these patients, valvular abnormalities including valvular regurgitation, endocardial thickening and calcification and mitral valve prolapse have also been described. Here we present two patients with thalassemia major and mitral chordal rupture, a previously undescribed abnormality in this population. Pathogenesis of this finding may involve thalassemia-related pseudoxanthoma elasticum-like syndrome, a diffuse elastic tissue defect, which is observed with a notable frequency in these patients and has been associated with numerous cardiovascular complications, including valvular ones.
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24/66. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.

    BACKGROUND: Radiofrequency ablation for atrial fibrillation is becoming widely practiced. methods AND RESULTS: Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic embolic events causing cerebral and myocardial damage. One patient survived after emergency cardiac and esophageal surgery; the other died of extensive systemic embolization. An atrio-esophageal fistula was identified in both patients. CONCLUSIONS: Atrio-esophageal fistulas can occur after catheter ablation in the posterior wall of the left atrium. This diagnosis should be excluded in any patient with symptoms or signs of endocarditis after left atrial ablation, and expeditious cardiac surgery is critical if the diagnosis is confirmed. Lower power and temperature settings for applications of radiofrequency energy along the posterior left atrial wall may prevent further cases of fistula formation.
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25/66. Tall R wave in lead V1.

    Tall R waves in lead V1 present the life insurance company medical director with a diagnostic dilemma. This ECG pattern may be present in applicants with right bundle branch block, right ventricular hypertrophy, wolff-parkinson-white syndrome, posterior myocardial infarction, hypertrophic cardiomyopathy, muscular dystrophy, dextrocardia, misplaced precordial leads, as well as in normal individuals. This ECG case study discusses the ECG features involved in the differential diagnosis.
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26/66. Radiofrequency ablation of a concealed right anterior accessory pathway associated with right atrial diverticulum in a child.

    A 9-year-old boy had refractory supraventricular tachycardia and a right atrial (RA) diverticulum as diagnosed by ultrafast computed tomography. An electrophysiological study under transesophageal echocardiography guidance revealed a concealed right anterior accessory pathway passing through the body of the RA diverticulum. Radiofrequency ablation was performed to eliminate retrograde ventriculoatrial conduction.
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27/66. Cardiac findings during uncomplicated acute influenza in ambulatory adults.

    BACKGROUND: Previous studies have reported abnormal cardiac findings in up to 43% of ambulatory adults with influenza. This study was conducted to determine the frequency, magnitude, and duration of myocardial dysfunction in such persons. methods: We enrolled 30 previously healthy young adults without known cardiovascular disease who presented to the clinic patients received antiviral therapy, and all underwent serial electrocardiography and had blood specimens collected on days 1, 4, 11, and 28 after presentation for measurement of total creatine kinase (CK) level, CK isoenzyme MB (CK-MB) level, troponin i level, and selected cytokine levels. echocardiography was performed on days 4, 11, and 28. RESULTS: None of the patients had an elevated CK-MB index or troponin i level. Abnormal electrocardiogram findings were noted in 53%, 33%, 27%, and 23% of patients on days 1, 4, 11, and 28, respectively, but none of the findings were considered to be clinically significant. No patient had significant changes in the ejection fraction or abnormal wall motions. CONCLUSIONS: Most ambulatory young adults with acute influenza have clinically insignificant abnormal electrocardiogram findings early during the illness. These abnormalities resolve promptly and are not associated with changes in cardiac markers or echocardiogram findings.
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28/66. Dynamic electrocardiographic changes due to cardiac compression by a giant hiatal hernia.

    A 79-year-old woman was admitted due to chest pain with T wave inversion and anasarca. echocardiography demonstrated a mass compressing the heart and computed tomography revealed a giant hiatal hernia within the intrathoracic stomach located just behind the heart. After drainage of the gastric contents, the T wave inversion disappeared, but subsequent ST elevation in leads V1-V6 was noted. After surgical correction of the hiatal hernia, the ST segment elevation returned to a nearly normal level. The changes in the compressed heart induced by hiatal hernia may cause pericarditis resulting in electrocardiographic changes.
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29/66. Poor R-wave progression.

    Poor R-wave progression is a common ECG pattern, which is often inconclusively interpreted by medical directors. Although this ECG pattern is commonly attributed to anterior myocardial infarction, it may also be caused by left bundle branch block, wolff-parkinson-white syndrome, right and left ventricular hypertrophy as well as by faulty ECG recording technique. Failure to make a definitive interpretation of this pattern may result in a delay or loss of business.
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ranking = 142.38011532383
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30/66. Echocardiographic findings in patients with wegener granulomatosis.

    OBJECTIVE: To describe the spectrum and clinical implications of echocardiographic findings associated with wegener granulomatosis. patients AND methods: We retrospectively reviewed the clinical records and echocardiographic data of consecutive patients with confirmed wegener granulomatosis referred to the echocardiography laboratory during the 21-year period from 1976 through 1997. RESULTS: Of the 85 patients Identified as having confirmed wegener granulomatosis, 73 (86%) were found to have echocardiographic abnormalities. In 26 (36%) of these 73 patients, lesions appeared directly related to wegener granulomatosis. We found regional wall motion abnormalities in 17 (65%) of these 26 patients. Left ventricular systolic dysfunction with decreased ejection fraction was found in 13 patients (50%) and pericardial effusion in 5 patients (19%). Other findings Included valvulitis, left ventricular aneurysm, and a large intracardlac mass. A significantly increased mortality rate was observed among patients who had cardiac involvement of wegener granulomatosis found by echocardiography. CONCLUSIONS: We found a high frequency of echocardiographic abnormalities that appear to be related to wegener granulomatosis and associated with Increased mortality. Because cardiac involvement in wegener granulomatosis often is silent and associated with Increased morbidity and worse prognosis, echocardlographic screening of patients with active wegener granulomatosis may be of clinical value.
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