Cases reported "Myocardial Infarction"

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1/289. myocardial infarction and coronary artery involvement in giant cell arteritis.

    PURPOSE: To describe the pathologic findings in an unusual case of giant cell arteritis that presented initially with visual loss and rapidly culminated in myocardial infarction. CASE REPORT: After the death of the patient, a complete autopsy was performed, including bilateral enucleation. All specimens, including a temporal artery biopsy completed before the patients death, were processed for routine paraffin histology and initially stained with hematoxylin and eosin. Elastic stains were subsequently used on specimens of temporal and coronary artery. The patient presented with loss of vision in the right eye. The clinical diagnosis was anterior ischemic optic neuropathy, secondary to temporal arteritis. The temporal artery biopsy was positive. Despite high-dose corticosteroid administration, the patient progressed to neurologic impairment, and subsequently to a fatal myocardial infarction. DISCUSSION: Previous reports of temporal arteritis with coronary involvement are summarized. myocardial infarction may be a more common early complication of temporal arteritis than appreciated previously. This important complication can occur despite administration of high-dose corticosteroid therapy.
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2/289. survival without surgical repair of acute rupture of the right ventricular free wall.

    rupture of the myocardial free wall is an infrequent complication of acute myocardial infarction. Unless it occurs in a space confined by pericardial adhesions, only surgical emergency repair of ruptured myocardium can prevent death. In this paper we report the case of an 81-year-old woman who was admitted to the emergency room with cardiac tamponade, resulting from inferolateral acute myocardial infarction and a subsequent rupture of the right ventricular free wall, with the formation of pericardial thrombus and effusion. The patient refused to undergo any surgical or invasive intervention, and therefore she was only treated conservatively. Nevertheless, her condition improved dramatically, as her blood pressure increased and echocardiography abnormalities almost disappeared. Follow-up echocardiography 7 months post discharge was unremarkable. We believe that this rare case emphasizes that in special circumstances, such as creation of a thrombus that prevents more blood from extravasating, free-wall rupture without surgical repair is compatible with long-term survival.
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3/289. Histopathologic effects of radiofrequency catheter ablation in previously infarcted human myocardium.

    INTRODUCTION: The use of catheter-based radiofrequency (RF) ablation for the treatment of ventricular tachyarrhythmias due to previous myocardial infarction has been steadily increasing. The histopathologic changes caused by this technique are not well described in humans. methods AND RESULTS: Three patients with hemodynamically tolerated ventricular tachycardias (VTs) due to previous myocardial infarction underwent endocardial mapping and catheter based RF ablation. All patients received between 5 and 11 RF lesions each of 60-second duration. One patient underwent myocardial resection of a left ventricular aneurysm 1 day following RF ablation, one expired 7 days after RF ablation, and one expired 9 months after RF ablation. None of the deaths occurred as a result of RF ablation. Pathologic specimens obtained early after RF ablation revealed areas of focal acute inflammation and fibrin deposition. Later specimens revealed several focal areas of fibrosis and granulation tissue. Specimens obtained late after RF ablation revealed a dense band of fibrosis, measuring 17 x 17 x 5 mm (1,250 mm3). CONCLUSION: Catheter-based RF ablation of ischemic VT in humans causes lesions that initially resemble coagulation necrosis. This is followed by the development of an inflammatory infiltrate and, finally, the development of fibrosis. Repeated application of RF ablation may result in much larger lesions than have been previously reported.
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4/289. 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.
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5/289. myocardial infarction and death after caesarean section in a woman with protein s deficiency and undiagnosed phaeochromocytoma.

    We describe the case of a 36-year-old woman, with a previous history of recurrent abortion due to protein s deficiency, undergoing an elective Caesarean section at 39-weeks gestation. During pregnancy no signs of hypertension or cardiovascular disease were reported, but at the end of the surgical procedure, the patient developed acute hypertension, leading to myocardial infarction, severe heart failure and death. The autopsy revealed a 2-cm undiagnosed phaeochromocytoma in the right adrenal gland. Clinical diagnostic features of phaeochromocytoma during pregnancy as well as the main therapeutic approaches suggested in the literature are discussed.
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6/289. Human hypersensitivity angiitis: an uncommon cause of death after trauma.

    INTRODUCTION: The article demonstrates, using a case report, that death following an accident may have rarely encountered causes that are not a direct result of trauma and that can only be detected by autopsy. CASE: An unconscious woman aged 57 years was admitted to hospital. Despite immediate surgery for intracranial haemorrhage diagnosed by means of cranial computed tomography, the patient died showing clinical symptoms of circulatory depression after a brief period of stabilisation. The autopsy established myocardial infarction with hypersensitivity angiitis as the cause of death. CONCLUSION: In this case, the authors hold the opinion that the intravenous application of antibiotics during the patient's stay in hospital resulted in hypersensitivity angiitis. The factors causing hypersensitivity angiitis, the morphological picture (clinical, histological) and therapeutic measures are described.
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7/289. pulmonary embolism mimicking acute myocardial infarction.

    pulmonary embolism is a major cause of death in the united states. A high index of suspicion is required to achieve an accurate diagnosis. We report a case of a patient with syncope, ischemic electrocardiographic changes, and an elevated troponin i level, presenting just like acute myocardial infarction. The case highlights the value of an early use of 2-dimensional echocardiography in obtaining an accurate diagnosis, thus avoiding unnecessary and inappropriate treatment.
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8/289. A simplified method for postmortem coronary angiography using gastrograffin.

    OBJECTIVE: To assess the adequacy of perfusion of the heart at autopsy with a gastrograffin and dye mixture to obtain rapid postmortem angiograms while simultaneously documenting the vascular distribution of the myocardium. BACKGROUND: Postmortem coronary angiography is occasionally used in the evaluation of suspected cardiac deaths. Angiography provides legal documentation and can serve to guide subsequent cardiac dissection. Multiple techniques have been suggested in the literature for coronary angiography using infusion of radio-opaque silicone or gelatin. These techniques are cumbersome and require equipment generally not available in autopsy suites. methods: Following removal of the heart, a mixture of gastrograffin and colored dyes is injected into each coronary artery via a syringe. The coronary arteries are ligated and radiographs are obtained. After fixation, the heart is dissected in the usual manner. RESULTS: Adequate postmortem coronary angiograms are routinely obtained with this method. The coronary arterial distribution within the myocardium is easily documented at both the gross and microscopic levels because of the presence of differential coloration. CONCLUSIONS: The aforementioned technique using a gastrograffin and dye mixture provides a simplified approach to postmortem angiography. The novelty of the procedure stems from the low cost, ease of implementation, dual ability to assess vascular anatomy radiologically (gastrograffin), and gross distribution and histologic findings of dependent tissue using the light microscope (colored dye). This technique is inexpensive, rapid, and easily used, making it more suitable for general hospital practice and medical examiners' offices than previously described methods.
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9/289. Exertion and acute coronary artery injury.

    Twelve cases of myocardial infarction as related to strenuous exertion are presented with the pathological findings in several of these cases. Three cases with coronary arteriography are also presented. The pathology of coronary arteriosclerotic plaques and the vulnerability to acute injury is reviewed and discussed. It is concluded that strenuous exertion can cause acute injury to coronary artery plaques due to the unusual stressful whip-like action to which coronary arteries are subject. These injuries may initiate as cracks in the plaques or subintimal hemorrhages and proceed to coronary occlusion and ultimate myocardial infarction. With this concept in mind we use the term of "crack in the plaque" (Black's Crack in the Plaque) to account for the sudden appearance of clinical coronary artery disease appearing during or shortly after exertion, or other stressful situations in patients without previous existing evidence of clinical coronary artery disease. This could also account for exacerbation of symptoms or death occurring after exertion in previously quiescent asymptomatic known coronary artery disease subjects. This concept may explain some of the puzzling features of coronary disease.
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10/289. Results of saphenous vein graft stent implantation: single center results from use of oversized balloon catheters.

    The results and complications of a single-center experience of stent implantation in old saphenous vein grafts (SVGs) need to be defined. The authors studied their initial consecutive 92 patients (125 stents, 1.4 stents/per patient) with a mean age of 67 /-9 years. The patients' mean saphenous vein graft (SVG) age was 10 /-4 years, and the mean left ventricular ejection fraction was 46% /-15. Patient population included unstable angina (65%), stable angina (10%), myocardial infarction (21%), and silent ischemia (4%). The authors implanted 122 Palmaz-Schatz/biliary and three Gianturco-Roubin stents. They aimed at a balloon-artery ratio of 1.1/1.0. Procedural success, defined as stent deployment with <50% stenosis without death/Q-wave myocardial infarction/coronary artery bypass grafting (MI/CABG) was 95%. The mean luminal diameter (MLD) increased from 0.6 /-0.5 to 3.3 /-0.8 mm (p<0.001) and mean SVG stenosis diameter was decreased from 80% /-14 to -10% /-11 (p<0.001). Angiographic SVG lesions exhibited thrombus (17%), ulceration (38%), and plaque rupture (28%). Sixty-two patients were treated with warfarin and aspirin and 30 with ticlid and aspirin. Complications included death in three patients (3.3%) who sustained subacute stent thrombosis, and two of three had Q-wave MI. Distal embolization occurred in seven patients (8%); six of seven sustained a non Q-wave acute myocardial infarction (AMI); and one of seven a Q-wave MI. Eight (9%) patients had major groin hematoma, two had pseudoaneurysm (2.2%), one had arteriovenous (A-V) fistula (1.1%), two had vascular surgery (2.2%), nine had blood transfusion (9.8%), and three had stent migration (3.3%). Single-center experience with stents in SVGs indicates a highly successful procedural and angiographic immediate result. However, it was complicated by significant risk of non Q-wave MI due to distal coronary embolization which may affect prognosis.
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