Cases reported "Myocardial Ischemia"

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11/51. Ischemic heart disease associated with vincristine and doxorubicin chemotherapy.

    OBJECTIVE: To report the ocurrence of ischemic heart disease (IHD) in a patient with multiple myeloma treated with vincristine and doxorubicin. CASE SUMMARY: A 46-year-old man developed a Q-wave inferior and right-ventricle myocardial infarction with postinfarction angina after receiving his third cycle of vincristine and doxorubicin for immunoglobulin a multiple myeloma. Angiography showed two small filling defects consistent with thrombi in the distal right coronary artery. DISCUSSION: IHD may be a serious but uncommon complication of treatment with several chemotherapeutic agents. It is likely that chemotherapy played a role in the development of IHD in our patient. Several putative mechanisms for vascular toxicity have been associated with chemotherapy. CONCLUSIONS: Chemotherapy with vincristine and doxorubicin may play a role in the ocurrence of IHD. physicians should possess an awareness of this potentially serious complication of chemotherapy.
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12/51. Incorrectly aligned fly leads inside the ECG machine causing 'ischaemic' changes.

    We describe a case in which a young woman was inappropriately diagnosed as having ischaemic heart disease after presenting with exertional neck pain and an abnormal ECG. Diffuse Q-wave and T-wave inversion changes were later attributed to erroneous placement of fly leads inside the ECG machine at a recent service. Clinicians should be aware of this uncommon cause of incorrect lead connections, which can result in unnecessary investigations and treatment.
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13/51. Dual-loop intra-atrial re-entry tachycardia in a patient with ischaemic cardiomyopathy.

    A 65-year-old man with ischaemic cardiomyopathy (three prior coronary artery bypass surgery procedures), underwent catheter ablation for recurrent atrial flutter. Electrophysiological study initially revealed clockwise, tricuspid annulus/inferior vena cava isthmus dependent, atrial flutter. During radiofrequency energy ablation atrial flutter changed into a different atrial tachycardia without change in cycle length or interruption of the tachycardia. The new tachycardia was a right atrial free wall re-entry tachycardia. Thus the two atrial tachycardias formed a dual-loop ('figure-of-eight') re-entry circuit, possibly due to atrial scar tissue from multiple cardiac surgery procedures.
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14/51. Increasing myocardial 123I-BMIPP uptake in non-ischemic area in a patient with acute myocardial ischemia.

    The subject was a 65-year-old woman with chest pain. An electrocardiogram revealed T-wave-inversion in leads III, aVF, V1-V5. 99mTc-tetrofosmin myocardial SPECT showed mildly reduced uptake in the anteroseptal wall and the apex. These findings suggested acute myocardial ischemia. coronary angiography did not show any stenotic lesions, but diffuse coronary ectasia was noted in three vessels. Coronary flow velocity was remarkably reduced on coronary angiography. Epicardial coronary spasm was not provoked by ergonovine loading test. Left ventriculography showed diffuse hypokinesis. 123I-BMIPP myocardial SPECT showed mildly reduced uptake in the anteroseptal wall and the apex on the early images. But 4-hour delayed images showed an increase of 8% in myocardial 123I-BMIPP uptake. We treated this patient with ticlopidine and nicorandil. After drug therapy her symptoms and left ventriculography improved. 123I-BMIPP myocardial SPECT findings on the early images improved, whereas delayed images showed a decrease of 28% in myocardial 123I-BMIPP uptake after two weeks and 36% after four weeks. These dynamic changes in 123I-BMIPP findings might be a reflection of myocardial fatty acid metabolism in patients with acute myocardial ischemia. Delayed 123I-BMIPP myocardial SPECT images are useful for the assessment of fatty acid metabolism.
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15/51. Cardiac ischemia during hemolytic uremic syndrome.

    Increased thrombin generation and impaired fibrinolysis during escherichia coli o157:H7-associated hemolytic uremic syndrome (HUS) plausibly diminish myocardial blood flow, but the frequency of cardiac ischemia during HUS is unknown. We identified a 9-year-old boy with HUS in whom myocardial diastolic dysfunction was demonstrated by echocardiography, who also had elevated serum troponin-I and creatine kinase MB mass. However, eight additional patients with HUS did not have elevated markers of cardiac injury. When present, elevated troponin-I should be considered to represent myocardial injury, and not attributed simply to renal insufficiency. It is possible that myocardial ischemia and secondary arrhythmias account for some sudden deaths that occur during acute HUS.
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16/51. Coronary ischemia induced by radiofrequency ablation in the left atrium.

    INTRODUCTION: We report three cases of transient, reversible coronary ischemia occurring after radiofrequency ablation in the left atrium. methods AND RESULTS: A 56-year-old man with a left atrial tachycardia that was mapped to the septum and roof of the atrium using a noncontact mapping developed 5-mm ST elevation in the anterolateral leads. coronary angiography showed an occluded diagonal that was opened using intracoronary nitrate, which led to resolution of the ST changes. A 57-year-old man undergoing right upper pulmonary vein ablation developed 6-mm ST elevation in leads V1-V4, II, III, and aVF. coronary angiography showed normal coronaries with slow flow into the left anterior descending artery, which resolved with nitrates. A 50-year-old man undergoing left lower pulmonary vein ablation developed 3-mm reversible inferior ST elevation. All patients were adequately anticoagulated after transseptal access to the left atrium. CONCLUSION: Ablation in the left atrium, at the roof, septum, and left inferior wall, can cause transient coronary ischemia, possibly due to spasm, which can be reversed with intracoronary nitrates. This phenomenon has not been previously described.
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17/51. Ischemia in the territory of the first major septal perforator branch anomalously originating from the first diagonal branch leads to a transient leftward shift of the QRS axis in the frontal plane: a case report.

    A patient with non-Q wave myocardial infarction had severe luminal narrowing in the first major septal perforator branch, which arose anomalously from the first diagonal branch. In this case, an exercise ECG showed a transient leftward QRS axis shift.
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18/51. Transient abnormal Q waves during exercise electrocardiography.

    Myocardial ischaemia during exercise electrocardiography is usually manifested by ST segment depression or elevation. Transient abnormal Q waves are rare, as Q waves indicate an old myocardial infarction. The case of a patient with exercise induced transient abnormal Q waves is reported. The potential mechanisms involved in the development of such an abnormality and its clinical implications are discussed.
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19/51. ephedrine-induced cardiac ischemia: exposure confirmed with a serum level.

    The temporal association of symptoms consistent with ephedrine toxicity after ingestion of ephedrine-containing dietary supplements is heavily relied upon to confirm exposure. Few reports in the literature attempt to associate toxicity with serum levels of these drugs. We report a case of ephedrine-induced cardiac ischemia confirmed by a plasma level. A 22-year-old woman ingesting an ephedrine- and caffeine-containing product for 2 days presented with multiple symptoms, including palpitations, nausea, tremulousness, abdominal pain, and vomiting. The initial electrocardiogram (ECG) revealed a normal sinus rhythm with 1 mm of ST segment depression in leads V3 and V4, along with inverted T waves in leads V1-V4. Her symptoms and ST segment depression resolved over several hours with medical management. The amplitude of her T wave inversions notably diminished with therapy; however, they did not completely resolve. Troponins at presentation and the following morning were negative, and an echocardiogram showed only trace tricuspid regurgitation. A serum ephedrine level, drawn approximately 6 to 7 hr after ingestion, was 150 ng/mL. She was discharged from the hospital after being instructed to avoid ephedrine-containing products.
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20/51. The hemodynamic benefit of biventricular pacing therapy on mitral regurgitation as demonstrated in a patient with ischemic cardiomyopathy and intermittent left bundle branch block.

    We report a 75-year-old man with ischemic cardiomyopathy who had mitral regurgitation which was increased markedly by intermittent left bundle branch block (LBBB). He complained of angina-like chest pain that was preceded by episodes of LBBB. During LBBB, a marked elevation of the V wave in the pulmonary capillary wedge pressure was shown, and an increase in mitral and tricuspid regurgitation was observed with color Doppler echocardiography. Biventricular pacing (BVP) therapy was selected so as to protect the patient from episodes of LBBB. After BVP, the patient did not experience chest pain or dyspnea. This case sheds valuable light on the ongoing investigation of the hemodynamic benefit of BVP.
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