1/23. 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) |
2/23. Antihypertensive therapy reduces increased plasma levels of adrenomedullin and brain natriuretic peptide concomitant with regression of left ventricular hypertrophy in a patient with malignant hypertension.We investigated the potential role of increased plasma adrenomedullin and brain natriuretic peptide (BNP) levels in a patient with malignant hypertension. A 51-year-old man was admitted to our hospital with a chief complaint of visual disturbance. His blood pressure was 270/160 mmHg on admission. Papillary edema associated with retinal bleeding was observed. echocardiography revealed marked concentric left ventricular hypertrophy with mild systolic dysfunction. plasma levels of adrenomedullin and BNP were markedly elevated. Antihypertensive therapy reduced the plasma levels of adrenomedullin in association with a concomitant decrease in blood pressure. The plasma level of BNP also decreased and regression of left ventricular hypertrophy and normalization of left ventricular systolic function were observed. Our findings suggest that adrenomedullin may be involved in the defense mechanism against further elevations in blood pressure in patients with hypertension and that the plasma level of BNP may reflect left ventricular systolic dysfunction, left ventricular hypertrophy, or both, in patients with severe hypertension.- - - - - - - - - - ranking = 2keywords = dysfunction (Clic here for more details about this article) |
3/23. myocardial ischemia detected by transesophageal echocardiography in a patient undergoing peripheral vascular surgery.Prevention and early treatment of myocardial ischemia remain among the primary goals of the anesthesiologist taking care of high-risk patients, such as those undergoing vascular surgery. Guidelines have been published to assist in directing preoperative evaluation and optimization of cardiovascular status. Although perioperative monitoring allows early detection of ischemic events, all monitors have limitations that must be understood before they can be used effectively. We present a case of severe intraoperative myocardial dysfunction detected only by transesophageal echocardiography in a patient undergoing a peripheral vascular procedure. Preoperative and intraoperative management is also discussed.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
4/23. Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries.BACKGROUND: Development of left ventricular hypertrophy in aortic stenosis (AS) is accompanied by coronary microcirculatory dysfunction, demonstrated by an impaired coronary vasodilator reserve (CVR). However, evidence for regional abnormalities in myocardial blood flow (MBF) and the potential mechanisms is limited. The aims of this study were to quantitatively demonstrate differences in subendocardial and subepicardial microcirculation and to investigate the relative contribution of myocyte hypertrophy, hemodynamic load, severity of AS, and coronary perfusion to impairment in microcirculatory function. methods AND RESULTS: Twenty patients with isolated moderate to severe AS were studied using echocardiography to assess severity of AS, cardiovascular magnetic resonance to measure left ventricular mass (LVM), and PET to quantify resting and hyperemic (dipyridamole 0.56 mg/kg) MBF and CVR in both the subendocardium and subepicardium. In the patients with most severe AS (n=15), the subendocardial to subepicardial MBF ratio decreased from 1.14 /-7 at rest to 0.92 /-7 during hyperemia (P<0.005), and subendocardial CVR (1.43 /-3) was lower than subepicardial CVR (1.78 /-35; P=0.01). Resting total LV blood flow was linearly related to LVM, whereas CVR was not. Increase of total LV blood flow during hyperemia (mean value, 89.6 /-6%; range, 17% to 233%) was linearly related to aortic valve area. The decrease in CVR was related to severity of AS, increase in hemodynamic load, and reduction in diastolic perfusion time, particularly in the subendocardium. CONCLUSIONS: CVR was more severely impaired in the subendocardium in patients with LVH attributable to severe AS. Severity of impairment was related to aortic valve area, hemodynamic load imposed, and diastolic perfusion rather than to LVM.- - - - - - - - - - ranking = 5keywords = dysfunction (Clic here for more details about this article) |
5/23. Noninvasive and invasive evaluation of noncompaction cardiomyopathy.Noncompaction cardiomyopathy is a recently described rare congenital cardiomyopathy; patients can be asymptomatic or develop diastolic and/or systolic left ventricular dysfunction with heart failure, systemic emboli or ventricular arrhythmias. Long-term prognosis is poor. Currently, diagnosis is based on findings on 2D echocardiography; in the current case report we demonstrate the use of MRI to diagnose noncompaction cardiomyopathy.- - - - - - - - - - ranking = 124.54549874579keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
6/23. Left ventricular dysfunction resulting from frequent unifocal ventricular ectopics with resolution following radiofrequency ablation.A case is presented, in which asymptomatic but persistent right ventricular outflow tract (RVOT) ectopics resulted in left ventricular (LV) dilatation and systolic dysfunction. The patient underwent extensive investigation with no other cause for the cardiomyopathy being found. Successful ablation of the RVOT ectopic focus resulted in normalization of LV size and function. This case suggests that frequent ventricular ectopy should be considered as a potentially remediable cause of LV dysfunction.- - - - - - - - - - ranking = 304.42004515447keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
7/23. Acute myocardial infarction in sickle cell anemia.Cardiovascular dysfunction consistent with ischemia has been observed during episodes of painful crisis and following periods of heavy physical exertion in individuals with sickle cell disease. Similar findings have been observed in other individuals while taking the alpha-adrenergic agonist pseudoephedrine. However, acute myocardial infarction is extremely rare. The authors describe a case of sudden death in a child with sickle cell disease due to acute myocardial infarction and suggest that heavy exertional stress and use of pseudoephedrine may have precipitated the event.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
8/23. Noncompaction of the ventricular myocardium associated with mitral regurgitation and preserved ventricular systolic function.Noncompaction of the ventricular myocardium is an embryonic cardiomyopathy that is increasingly being recognized. Mitral regurgitation, when present, is usually a result of the associated left ventricular systolic dysfunction. We report 4 patients with noncompaction of the ventricular myocardium in whom ventricular systolic function was preserved. Mitral regurgitation was associated with changes in the mitral valve leaflets and an abnormal coaptation pattern. This association of noncompaction of the ventricular myocardium with mitral regurgitation has not, to our knowledge, been reported.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
9/23. Amplitude of the electrocardiographic QRS complexes during and after severe pulmonary edema.There is recent evidence that anasarca peripheral edema, irrespective of its etiology, attenuates ECG QRS potentials. pulmonary edema (PE) also is thought to cause reduction in the amplitude of QRS complexes. The case reported herein is of a patient with severe PE, hypertension, left ventricular diastolic dysfunction, and no peripheral edema who did not show changes in the QRS complexes with the management of her pulmonary edema. Thus it appears that PE does not attenuate the amplitude of QRS complexes, and alleviation of this condition does not cause augmentation of QRS voltage. This is in contrast to alterations of peripheral edematous states in the setting of congestive heart failure, which result in changes in the QRS amplitude, as shown previously.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
10/23. hiv disease and an atherosclerotic ascending aortic aneurysm.Cardiovascular dysfunction appears to be an important complication of human immunodeficiency virus (hiv) infection and is being reported with greater frequency. There have been recent reports in the literature of hiv patients who suffer from vascular lesions such as large artery vasculopathy secondary to vasculitis, as well as accelerated atherosclerosis of the coronary arteries. The latter has been linked to patients on protease inhibitors that are used as part of a highly active antiretroviral therapy (HAART) regimen and have also been implicated in a lipodystrophy syndrome. We report a rare case of an hiv-infected patient on HAART who presented with a large ascending aortic aneurysm associated with symptomatic severe aortic regurgitation. A noteworthy finding on pathological analysis of the aorta was an etiology of accelerated atherosclerosis rather than the more expected vasculitis.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
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