Cases reported "Myocardial Infarction"

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1/13. Viability and differentiation of autologous skeletal myoblast grafts in ischaemic cardiomyopathy.

    Autologous skeletal myoblast transplantation might improve postinfarction ventricular function, but graft viability and differentiation (ie, proof of concept) has not been shown. A 72-year-old man had autologous cultured myoblasts from his vastus lateralis injected to an area of transmural inferior myocardial infarction in non-reperfused scar tissue. He showed improvement in symptoms and left-ventricular ejection fraction. When he died 17.5 months after the procedure, the grafted post-infarction scar showed well developed skeletal myotubes with a preserved contractile apparatus. 65% of myotubes expressed the slow myosin isoform and 33% coexpressed the slow and fast isoforms (vs 44% and 0.6%, respectively, in skeletal muscle). Myoblast grafts can survive and show a switch to slow-twitch fibres, which might allow sustained improvement in cardiac function.
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2/13. mitral valve endocarditis: an uncommon cause of myocardial infarction.

    A 39 year old woman presented with acute anterior myocardial infarction. At coronary angiography the distal left anterior descending coronary artery (LAD)was occluded despite otherwise normal coronary arteries. The LAD was successfully recanalized using PTCA. Subsequently, a transesophageal echocardiogram revealed vegetations and a significant incompetence of the mitral valve.blood cultures identified out enterococcus faecalis. Despite intra-venous antibiotic treatment guided by sensitivity testing, the patient ultimately required elective mitral valve replacement. During a prior outpatient diagnostic work-up of fever/malaise, the diagnosis of infective endocarditis was not made.This case conveys two main messages: 1) because the history and physical sings of bacterial endocarditis can be subtle or non-specific, the first step to diagnose infective endocarditis is to include it in the differential diagnosis. 2) percutaneous coronary intervention is an effective treatment of septic embolic occlusion of a major coronary artery.
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3/13. Four days of percutaneous cardiopulmonary support and sixteen days of percutaneous left atrium-artery bypass: a case report of survival of acute myocardial infarction with cardiogenic shock and severe rhabdomyolysis [corrected]

    A severe acute myocardial infarction patient with cardiogenic shock was successfully treated with percutaneous coronary intervention, percutaneous cardiopulmonary support (PCPS), and percutaneous left atrium-artery bypass (LAAB). LAAB assisted the patient's circulation sufficiently, with few complications. The patient recovered from shock after LAAB. High fever and elevation of CPK disappeared after removal of the intra-aortic balloon pump (IABP). staphylococcus epidermidis was detected in the culture of the IABP tip later. A small left atrium-right atrium shunt remained for ten months after LAAB removal and disappeared naturally. The patient was discharged 7 months after his initial myocardial infarction. He has been well for over one year since discharge without the need for re-hospitalization [corrected]
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4/13. Myoblast transplantation on the beating heart.

    Cellular cardiomyoplasty using various types of donor cells is now validated by a large number of experimental studies. We report a case of cellular cardiomyoplasty performed on a beating heart using autologous skeletal myoblasts, thus combining the efficacy of both procedures. Approximately 2.5 g of rectus femoris muscle tissue biopsy was taken from the patient and cultured using a patented procedure to generate human myoblasts. The cell type and the purity of the cell culture were ascertained by immunostaining for human desmin expression. Under direct vision and stabilization with the Octopus III tissue stabilizer, 3.70 x 10(8) myoblasts in 3 ml of the patient's own serum were injected into the myocardium in 20 sites on the anterior wall and near the apex on the posterior wall, in and around the infarcted areas. In this case report, this procedure was found to be a safe and viable option, with improvement in cardiac function.
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5/13. Discordance between echocardiographic and MRI findings in two cases of acute myocarditis mimicking myocardial infarction.

    Two male adolescents were admitted due to chest pain influenced by the respiratory movements. A lobar pneumonia caused by mycoplasma pneumoniae, was radiographically and serologically diagnosed in the first patient (a 15-year-old boy) and a febrile diarrhea of unidentified etiology, despite repetitive stool cultures and serological assessments in the second one (a 19-year-old male). Both patients combined the aforementioned infectious conditions with outstanding thoracic pain the previous hours before admission, markedly elevated cardiac enzymes and ST-segment elevation in the inferior and left precordial leads with a normal coronary angiogram, thus composing a clinical setting highly indicative of acute myocarditis. Surprisingly however, the echocardiogram performed in both patients failed to reveal any regional or global wall motion abnormalities or even diastolic dysfunction and remained absolutely normal throughout their 3-month follow-up period. Cardiac MRI within 7 days, using T2-weighted and gadolinium-enhanced T1-weighted images demonstrated extensive focal contrast enhancement, consistent with acute inflammatory myocardial involvement. It can therefore be concluded that contrast MRI is a more sensitive method than the echocardiogram for the diagnosis of acute focal myocarditis.
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6/13. Long-term bridge to transplantation with the Symbion acute ventricular assist device system.

    A 48-year-old man was supported for 164 days with Symbion biventricular assist devices. During that time, his cytotoxic antibody screen fell from 97% positivity to less than 10%, enabling cardiac transplantation. Complications during the implantation included a 3-minute episode of amaurosis fugax, one positive blood culture, and anemia, which responded to decreased frequency of blood drawing. He is now alive 7 months after transplantation.
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7/13. Streptococcal tonsillitis and acute nonrheumatic myopericarditis.

    Two young men with streptococcal tonsillitis had acute myopericarditis mimicking myocardial infarction. Subsequently, 264 consecutive army conscripts hospitalized with a fever and sore throat underwent throat cultures. Group A streptococci were found in 84 patients. When these patients were systematically screened by serial electrocardiography for myocarditis, one case of probable asymptomatic myocarditis was diagnosed. None had signs of acute rheumatic fever. All three patients received penicillin therapy when the signs of myocarditis appeared. Their recovery was good.
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8/13. Myocardial abscess after silent myocardial infarction.

    A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present. A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable. No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment. After two years the patient is doing well. Only one case of survival has been reported before, also after surgical intervention. This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture.
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9/13. Two cases of myocardial infarction in type 4 ehlers-danlos syndrome.

    ehlers-danlos syndrome is an inherited connective tissue disorder. Clinical manifestations of this syndrome are due to fragile connective tissue. Though many cardiovascular disorders in association with it have been reported, myocardial infarction is quite rare. In this report, two cases with type 4 ehlers-danlos syndrome and myocardial infarction are described. Patient 1 was a 30-year-old woman. She was diagnosed as having myocardial infarction on the basis of typical changes in electrocardiograms and serum enzymes (CPK, SGOT and LDH). The diagnosis of type 4 ehlers-danlos syndrome was made by the microscopic examination of her connective tissue. Patient 2 was a 32-year-old man. He was also diagnosed as having acute myocardial infarction. His fibroblasts were cultured and they could not synthesize type 3 collagen. Type 4 ehlers-danlos syndrome was diagnosed. It was likely that myocardial infarction might have resulted from the fragility of their coronary arteries in type 4 ehlers-danlos syndrome.
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10/13. Cerebral and myocardial infarction induced by nonbacterial thrombotic endocarditis in a patient with ovarian cancer: report of a case.

    A 40-year-old woman was admitted to our hospital because of left hemiplegia. She was affected with myocardial infarction and cerebral infarction. Echocardiogram revealed that the aortic and mitral valves had thick and uneven echoes suggesting vegetations. Judging from the finding that repeated blood cultures were negative, we had considered in her lifetime that myocardial and cerebral infarctions were due to embolization associated with nonbacterial thrombotic endocarditis (NBTE). At autopsy, histological diagnosis was made as ovarian cancer with disseminated intravascular coagulation. From the clinical course and the histological findings, we diagnosed this patient as NBTE.
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