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https://www.readbyqxmd.com/read/28414682/a-left-main-coronary-artery-thrombus-presenting-as-a-non-st-elevation-mi
#1
U Ezema, D Daberkow, T Delord, L Guidry, N R Sells
INTRODUCTION: Left main coronary artery (LMCA); thrombus with an acute myocardial infarction identified with coronary angiography is a clinically rare condition with an extremely high mortality rate. We present a case of LMCA thrombus that presented as a non-ST elevation myocardial infarction (NSTEMI);. CASE: A 45-year-old woman with a history of tobacco use and hyperlipidemia presented with a complaint of 10/10 "hard pain" across her chest radiating to her left shoulder and breast which woke her from sleep...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28414667/the-mysterious-case-of-dyspnea
#2
S Saad, N Turaga, J Grant, N Jain
INTRODUCTION: Dehiscence of a mitral valve annuloplasty ring is a rare occurrence that often manifests as mitral regurgitation and heart failure. We present a case of mitral ring dehiscence which was initially unrecognized by standard 2-dimensional transthoracic echocardiography (2D TTE); and 2-dimensional transesophageal echocardiography (2D TEE);. CASE: A 65-year-old woman was referred to Cardiology clinic for evaluation of dyspnea. Her history included tobacco abuse, atrial fibrillation status post pulmonary vein isolation, nonischemic cardiomyopathy, and prior mitral valve repair with annuloplasty ring for rheumatic valvular disease...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28403392/association-of-central-nervous-system-depression-with-topical-brimonidine-when-used-for-hemostasis-a-serious-adverse-event
#3
Devorah R Shagalov, Drew Taylor, Rachel Schleichert, Jonathan Weiss, Eduardo Weiss
Importance: Minor bleeding is the most common complication of dermatologic surgery. Topical brimonidine, 0.33%, gel has been reported for the use of hemostasis in dermatologic surgery. The safety profile and risk of systemic toxic effects when brimonidine is used topically for hemostasis is unknown. Objective: To determine the risk of systemic toxic effects of topical brimonidine, 0.33%, gel when used for hemostasis. Design, Setting, and Participants: In this case series from a private practice (Hollywood Dermatology), 2 patients presented for dermatologic procedures, complicated by persistent bleeding...
April 12, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28401611/pegylated-bovine-carboxyhaemoglobin-utilisation-in-a-thrombotic-thrombocytopenic-purpura-patient
#4
C Sam, P Desai, D Laber, A Patel, N Visweshwar, M Jaglal
OBJECTIVE: To determine if pegylated bovine carboxyhaemoglobin can be utilised in a thrombotic thrombocytopenic purpura (TTP) patient. BACKGROUND: TTP is a condition characterized by thrombotic microangiopathy and has a high mortality rate when left untreated. Therapeutic plasma exchange is well established as the most effective and evidence-based treatment of TTP. METHODS: The ability to administer plasma exchange therapy is limited in Jehovah's Witnesses who decline blood products due to religious beliefs...
April 12, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28320636/the-significance-of-equivocal-exercise-treadmill-ecg-for-intermediate-risk-chest-pain-assessment-insight-from-coronary-ct-angiography-data
#5
Gary T E Lau, Henry Wei, Jo Wickham, Andrew C Y To
BACKGROUND: Exercise treadmill test (ETT) is commonly the first-line investigation in troponin-negative chest pain patients. Inconclusive results are common and often lead to repeated functional testings. Coronary computed tomographic angiography (CCTA) has excellent negative predictive value for coronary artery disease detection and may play an important role in their diagnostic workup. We aim to analyse ETT and CCTA findings to understand their modern roles in intermediate risk chest pain population with inconclusive ETT...
March 1, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28288889/cardiac-stress-testing-during-workup-for-abdominal-aortic-aneurysm-repair-is-not-associated-with-improved-patient-outcomes
#6
Benjamin S Brooke, Mark R Sarfati, Yingying Zhang, Yue Zhang, Angela P Presson, Tom H Greene, Larry W Kraiss
BACKGROUND: Cardiac stress testing (CST) is commonly used to help determine whether patients with abdominal aortic aneurysms (AAAs) are better candidates for open versus endovascular repair, although it is unknown whether the use of CST achieves its goal of optimizing patient selection and postoperative outcomes. METHODS: We retrospectively identified 3,635 patients in the Vascular Quality Initiative database (2010-2012) with an AAA ≥ 5.0 cm who were candidates for either open or endovascular AAA repair...
March 10, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28275421/treating-a-structural-heart-disease-using-a-non-structural-approach-role-of-cardiac-pacing-in-hypertrophic-cardiomyopathy
#7
Bernard Benjamin P Albano, Erdie C Fadreguilan, Jeffrey M Chua, James Ho, Ana Beatriz Medrano
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease characterized by a thickened non-dilated ventricle in the absence of another cardiac or systemic condition. Its most important hemodynamic consequence is left ventricular outflow tract (LVOT) obstruction. The primary management strategy of this condition is surgical septal myectomy, but an acceptable alternative treatment in patients who are not suitable for (or who refuse) surgery is alcohol septal ablation (ASA). However, in patients with unfavorable coronary anatomy which precludes ASA (i...
February 2017: Cardiology Research
https://www.readbyqxmd.com/read/28275420/non-cardiovascular-computed-tomography-incidental-findings-in-patients-who-underwent-transaortic-valve-implantation-procedure
#8
Ahmed Fathala, Mnahi Bin Saeedan, Ali Zulfiqar, Hani Al Sergani
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a new treatment option for patients with severe aortic stenosis. Pre-TAVI procedure workup includes computed tomography angiography (CTA) of the heart and aorta from aortic annulus to the iliofemoral arteries. Frequently, there are a number of incidental non-cardiac findings (INCFs) in pre-TAVI CTA. However, the frequency and clinical significance of these INCFs are unknown. The aim of our study was to investigate the prevalence of INCFs and their clinical significance...
February 2017: Cardiology Research
https://www.readbyqxmd.com/read/28259551/diagnostic-yield-of-device-interrogation-in-the-evaluation-of-syncope-in-an-elderly-population
#9
Robert N D'Angelo, Christopher C Pickett
BACKGROUND: Device interrogation has become a standard part of the syncope evaluation for patients admitted with permanent pacemakers (PPM) or implantable cardiac defibrillators (ICD), although few studies have shown interrogation yields clinically useful data. The purpose of this study is to determine the diagnostic yield of device interrogation as well as other commonly performed tests in the workup of unexplained syncope in patients with previously implanted PPMs or ICDs. METHODS: We retrospectively reviewed records of 88 patients admitted to our medical center for syncope with previously implanted pacemakers between January 1, 2005 and January 1, 2015 using ICD-9 billing data...
February 27, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#10
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28256404/panic-disorder-in-patients-presenting-to-the-emergency-department-with-chest-pain-prevalence-and-presenting-symptoms
#11
Jaimi H Greenslade, Tracey Hawkins, William Parsonage, Louise Cullen
BACKGROUND: Patients with panic disorder experience symptoms such as palpitations, chest pain, dizziness, and breathlessness. Consequently, they may attend the Emergency Department (ED) to be assessed for possible emergency medical conditions. Recognition of panic disorder within the ED is low. We sought to establish the prevalence of panic disorder in patients presenting to the for ED investigation of potential acute coronary syndrome. We also sought to characterise the cohort of patients with panic disorder in terms of presenting symptoms, risk factors, medical history and major adverse cardiac events (MACE)...
February 16, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28214153/arrhythmogenic-right-ventricular-dysplasia-atypical-clinical-presentation
#12
José Marçalo, Luiz Menezes Falcão
A 67-year-old man was admitted to our hospital after episodes of syncope preceded by malaise and diffuse neck and chest discomfort. No family history of cardiac disease was reported. Laboratory workup was within normal limits, including D-dimers, serum troponin I and arterial blood gases. The electrocardiogram showed sinus rhythm with T-wave inversion in leads V1 to V3. Computed tomography angiography to investigate pulmonary embolism showed no abnormal findings. Transthoracic echocardiography (TTE) displayed massive enlargement of the right ventricle with intact interatrial septum and no pulmonary hypertension...
March 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28196622/non-cardiac-chest-pain-a-review-for-the-consultation-liaison-psychiatrist
#13
Kirsti A Campbell, Elizabeth N Madva, Ana C Villegas, Eleanor E Beale, Scott R Beach, Jason H Wasfy, Ariana M Albanese, Jeff C Huffman
BACKGROUND: Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers...
December 9, 2016: Psychosomatics
https://www.readbyqxmd.com/read/28177278/does-spontaneous-remission-occur-in-polyarteritis-nodosa-%C3%A2
#14
Simon Beyaert, Menno Pruijm, Salah Dine Qanadli, Peter Vollenweider, Matthieu Halfon
BACKGROUND: Polyarteritis nodosa (PAN) is a systemic vasculitis involving mainly medium-sized arteries and, rarely, small-sized arteries. The diagnosis is principally based on clinical exams, biopsy of an affected organ, and/or arteriography of renal or mesenteric arteries. Once diagnosed, immunosuppressive agents, such as glucocorticoids and cyclophosphamide, are generally introduced as soon as possible. Whether spontaneous remission of PAN occurs is therefore largely unknown. PRESENTATION: We describe the case of a 51-year-old woman who presented with a 4-day-history of intense pain in her left flank, hypertension, fever, microscopic hematuria, and acute renal failure...
February 8, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28123762/percutaneous-pfo-closure-for-cryptogenic-stroke-in-the-setting-of-a-systematic-cardiac-and-neurological-screening-and-a-standardised-follow-up-protocol
#15
Stéphane Noble, Robert F Bonvini, Fabio Rigamonti, Roman Sztajzel, Fabienne Perren, Philippe Meyer, Hajo Müller, Marco Roffi
BACKGROUND: There are no uniform workup and follow-up (FU) protocols for patients presenting with cryptogenic embolism (CE) who undergo percutaneous closure of a patent foramen ovale (PFO). METHODS: We prospectively performed a systematic cardiac and neurological FU protocol in all patients who underwent percutaneous PFO closure in order to assess the incidence of subsequent cardiac and neurological adverse events. All patients received dual antiplatelet therapy for 6 months and were systematically included in a 12-month standardised FU protocol including: clinical evaluation-transthoracic and transoesophageal echocardiography, 24-hour Holter monitoring and/or 1-week R-test, and transcranial Doppler...
2017: Open Heart
https://www.readbyqxmd.com/read/28100570/a-rare-cause-of-constrictive-pericarditis
#16
Shane Patrick Flood, Omar Ayah, Satoshi Furukawa, Robert B Norris
A 67-year-old man presented with 3 months of exertional dyspnoea and 1 week of oedema. Examination revealed elevated neck veins, pulsus paradoxus, muffled heart sounds, decreased breath sounds and pedal oedema. Transthoracic echocardiogram (TTE) demonstrated cardiac tamponade, and chest X-ray showed pleural effusion. Pericardiocentesis, thoracocentesis, laboratory investigations and CT did not elucidate an underlying aetiology. Three weeks later, he presented with recurrent cardiac tamponade and pleural effusion...
January 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28069729/systematic-review-on-the-predictive-ability-of-frailty-assessment-measures-in-cardiac-surgery
#17
Yusuf S Abdullahi, Leonidas V Athanasopoulos, Roberto P Casula, Marco Moscarelli, Mark Bagnall, Hutan Ashrafian, Thanos Athanasiou
OBJECTIVES: Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery. METHODS: Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included...
April 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28056866/case-report-whole-exome-sequencing-of-primary-cardiac-angiosarcoma-highlights-potential-for-targeted-therapies
#18
Leah Zhrebker, Irene Cherni, Lara M Gross, Margaret M Hinshelwood, Merrick Reese, Jessica Aldrich, Joseph M Guileyardo, William C Roberts, David Craig, Daniel D Von Hoff, Robert G Mennel, John D Carpten
BACKGROUND: Primary cardiac angiosarcomas are rare, but they are the most aggressive type of primary cardiac neoplasms. When patients do present, it is with advanced pulmonary and/or cardiac symptoms. Therefore, many times the correct diagnosis is not made at the time of initial presentation. These patients have metastatic disease and the vast majority of these patients die within a few months after diagnosis. Currently the treatment choices are limited and there are no targeted therapies available...
January 5, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28045863/postoperative-hemorrhagic-occlusive-retinal-vasculitis-a-forme-fruste-variant
#19
Roger A Goldberg, Courtney Crawford, Jeffrey S Heier
PURPOSE: To present a forme fruste variant of hemorrhagic occlusive retinal vasculitis (HORV) after uncomplicated cataract surgery performed with vancomycin in the irrigating solution. METHODS: A report of a single patient who developed HORV; the clinical features and course are described and compared with previously reported cases. RESULTS: Ultra-widefield fluorescein angiography demonstrated an occlusive vasculitis in both eyes 1 week after uncomplicated cataract surgery in which vancomycin was added to the irrigating solution...
December 29, 2016: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28024941/orthostatic-hypotension-after-continuous-flow-left-ventricular-assist-device-implantation-in-a-patient-with-longstanding-diabetes-mellitus
#20
Derek S Chew, Brett H Shaw, Debra L Isaac, Jonathan G Howlett, Satish R Raj
A continuous-flow left ventricular assist device (CF-LVAD) benefits patients with advanced heart failure as a bridge to cardiac transplantation. However, unanticipated complications may occur. We report a patient with end-stage heart failure and longstanding diabetes who experienced functionally debilitating orthostatic hypotension from autonomic insufficiency after CF-LVAD implantation. This case demonstrates a role for comprehensive autonomic function testing in the workup of orthostatic hypotension after LVAD implantation...
October 28, 2016: Canadian Journal of Cardiology
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