RESUMEN
Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias del Colon/tratamiento farmacológico , Vasoespasmo Coronario/inducido químicamente , Fluorouracilo/efectos adversos , Anciano de 80 o más Años , Angina de Pecho/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Angiografía Coronaria , Vasoespasmo Coronario/diagnóstico , Vasoespasmo Coronario/terapia , Stents Liberadores de Fármacos , Electrocardiografía , Fluorouracilo/administración & dosificación , Humanos , Leucovorina/administración & dosificación , Leucovorina/efectos adversos , Masculino , Nifedipino/administración & dosificación , Nitroglicerina/administración & dosificación , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Recurrencia , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Vasodilatadores/administración & dosificaciónRESUMEN
Primary cardiac sarcoma is a rare malignant neoplasm, with an incidence of .0001% in collected autopsy series. Angiosarcoma is the most common cardiac sarcoma and is present in up to 33% of the cases that are associated with a poor prognosis. Because angiosarcoma is essentially not responsive to current regimens of chemotherapy and irradiation, early complete resection is recommended as the treatment choice. However, complete resection is difficult because of the limited amount of myocardium and expansion of the tumor at the time of diagnosis. We report a case of right atrial angiosarcoma treated by complete tumor resection with cardiac reconstruction with a bovine pericardium patch.
Asunto(s)
Atrios Cardíacos/cirugía , Neoplasias Cardíacas/cirugía , Hemangiosarcoma/cirugía , Biomarcadores de Tumor/análisis , Bioprótesis , Quimioterapia Adyuvante , Terapia Combinada , Ecocardiografía , Estudios de Seguimiento , Atrios Cardíacos/patología , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/tratamiento farmacológico , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/radioterapia , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/tratamiento farmacológico , Hemangiosarcoma/patología , Hemangiosarcoma/radioterapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/análisis , Cuidados Posoperatorios , Radioterapia Adyuvante , Tomografía Computarizada por Rayos XRESUMEN
Tako-Tsubo cardiomyopathy (TTC), also known as transient left ventricular (LV) ballooning syndrome or stress-induced cardiomyopathy, is characterised by transient LV dysfunction in the absence of significant angiographic coronary stenoses, frequently provoked by an episode of emotional or physical stress. In TTC, typically transient akinesis or dyskinesis of the LV apical segments with normal or hypercontractile basal wall motions is observed. Recently, several cases of atypical or inverted transient TTC sparing the LV apex have been reported. We report a case of inverted TTC showing akinesis of the basal and mid-ventricular segments of the LV with apical hyperkinesia triggered by bronchoscopy with bronchoalveolar lavage.
Asunto(s)
Lavado Broncoalveolar/efectos adversos , Broncoscopios/efectos adversos , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/fisiopatología , Anciano , Femenino , Humanos , Tuberculosis Pulmonar/metabolismo , Tuberculosis Pulmonar/terapiaRESUMEN
Extensive papillary muscle calcification is uncommon and only scarce literature about causes and the clinical significance is available, whereas small calcific deposits are common findings in elderly people and are located most commonly at the apex. Papillary muscle calcification has been associated with coronary artery disease, dilated cardiomyopathy, mitral valve disease, hypercalcemia, and increased calcium phosphate product in end stage renal disease. We reported a rare case of extensive calcification of anterolateral papillary muscle diagnosed by echocardiography and multidetector computed tomography.
RESUMEN
Cardiac infiltration of amyloid fibril results in progressive cardiomyopathy with a grave prognosis and results in cardiac diseases such as congestive heart disease, cardiomyopathy, valvular heart disease, and arrhythmias. We present a rare case of cardiac amyloidosis initially misdiagnosed as syndrome X in which recurrent chest pain and progressive heart failure could be managed finally by heart transplantation.
RESUMEN
This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm(3). Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/patología , Taponamiento Cardíaco/complicaciones , Taponamiento Cardíaco/diagnóstico , Pericarditis/complicaciones , Pericarditis/diagnóstico , Enfermedad Aguda , Adulto , Ensayo de Inmunoadsorción Enzimática , Humanos , MasculinoRESUMEN
Takotsubo cardiomyopathy (TC) is characterized by reversible left ventricular (LV) apical ballooning and no significant coronary artery stenosis. New variants of TC with localized wall motion abnormality or inversed pattern with hyperdynamic apex have been reported. We present the case of a 24-year-old female with atypical presentation of TC occurring in the setting of paranasal sinus surgery under local anaesthesia with post-surgical nasal packing. She did not demonstrate ST-segment elevation on electrocardiogram, but transient moderate LV systolic dysfunction and localized wall motion abnormality affecting basal to mid-ventricular anterior and anteroseptal wall. She rapidly and completely recovered without sequelae.
Asunto(s)
Hemostasis , Nariz , Senos Paranasales/cirugía , Complicaciones Posoperatorias , Cardiomiopatía de Takotsubo/etiología , Tampones Quirúrgicos/efectos adversos , Anestesia Local , Femenino , Humanos , Factores de Riesgo , Sístole , Cardiomiopatía de Takotsubo/patología , Cardiomiopatía de Takotsubo/cirugía , Factores de Tiempo , Ultrasonografía , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/patología , Adulto JovenRESUMEN
In the absence of hypertension, hypertrophic cardiomyopathy is the most common cause of left ventricular hypertrophy (LVH). However, it has been reported that up to 3% of males with unexplained LVH have Fabry disease, an X-linked disorder of glycophospholipid metabolism that is due to a deficiency in the lysosomal enzyme alpha-galactosidase A (alpha-Gal A). A 44-year-old man was admitted to our hospital with palpitations. He had a history of chronic renal failure diagnosed at age 33 followed by kidney transplantation performed at our institution 2 years later, as well as long-standing hypohidrosis. His medications included prednisolone (5 mg daily), mycophenolate mofetil (1,000 mg, bid), and cyclosporine (150 mg, bid). On hospital day two, an echocardiogram demonstrated increased left ventricular wall thickness (septal wall thickness of 28 mm, posterior wall thickness of 20 mm). Diastolic dysfunction was noted on transmitral flow patterns and tissue Doppler imaging. The patient was found to have low plasma alpha-Gal A activity. A previously reported H46R missense mutation was detected in his alpha-Gal A gene and the patient was subsequently diagnosed with Fabry disease.
RESUMEN
Percutaneous coronary intervention of chronic total occlusion (CTO) is one of the greatest challenges in coronary interventions. Retrograde wiring is suggested as a solution to improve the success rate of intervention for CTO. We experienced the coronary perforation during antegrade wiring at the CTO lesion and sealed it using retrograde wiring and antegrade stenting in a patient who underwent coronary arterial bypass grafting. We found that, in selected cases, the retrograde wire technique may provide a valuable rescue option for perforated CTO in a patient having a retrogradely accessible conduit vessel.
Asunto(s)
Angioplastia Coronaria con Balón , Oclusión Coronaria/terapia , Anciano , Enfermedad Crónica , Puente de Arteria Coronaria , Vasos Coronarios/cirugía , Humanos , Masculino , Rotura Espontánea/terapia , StentsRESUMEN
Cor triatriatum is a rare congenital cardiac malformation characterized by a fibromuscular membrane that divides the left atrium into two distinct chambers. In almost all cases, it is diagnosed in childhood, whereas adult cases are extremely rare. Herein, we describe an unusual case of cor triatriatum in a 55-year-old woman who presented with embolic cerebral infarction. The patient experienced sudden-onset, transient left-sided homonymous hemianopsia and echocardiography and multidetector computed tomography detected a membrane-like structure across the left atrium, confirming the diagnosis of a cor triatriatum. The laboratory examination for hypercoagulopathy was negative. She was conservatively treated with anticoagulation and her neurological manifestation gradually improved.
Asunto(s)
Corazón Triatrial/complicaciones , Corazón Triatrial/diagnóstico , Embolia Intracraneal/etiología , Accidente Cerebrovascular/etiología , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiología , Corazón Triatrial/diagnóstico por imagen , Diagnóstico Diferencial , Ecocardiografía , Femenino , Humanos , Embolia Intracraneal/diagnóstico , Imagen por Resonancia Magnética , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico , Tomografía Computarizada por Rayos XAsunto(s)
Aneurisma de la Aorta/complicaciones , Disección Aórtica/complicaciones , Infarto del Miocardio/etiología , Anciano , Disección Aórtica/diagnóstico por imagen , Angiografía , Aneurisma de la Aorta/diagnóstico por imagen , Colonografía Tomográfica Computarizada , Ecocardiografía , Femenino , HumanosRESUMEN
Leclercia adecarboxylata, a motile, gram-negative bacillus of the enterobacteriaceae family, is rarely recovered as a pathogen. We report an exceptionally rare case of L. adecarboxylata endocarditis complicated by embolization of the kidney and spleen in a 48-year-old woman with endometrial cancer. After 4 weeks of antimicrobial treatment, she recovered without sequelae.
Asunto(s)
Endocarditis Bacteriana/complicaciones , Neoplasias Endometriales/complicaciones , Infecciones por Enterobacteriaceae/complicaciones , Enterobacteriaceae/patogenicidad , Adenocarcinoma/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/microbiología , Femenino , Humanos , Infarto/etiología , Riñón/irrigación sanguínea , Persona de Mediana Edad , Infarto del Bazo/etiologíaAsunto(s)
Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Adolescente , Diagnóstico Diferencial , Errores Diagnósticos , Cardiopatías Congénitas/cirugía , Humanos , Masculino , Radiografía , Accidente Cerebrovascular/diagnóstico por imagen , UltrasonografíaRESUMEN
We report a rare case of spontaneous rupture of idiopathic thymic abscess into the pleural cavity. A 64-year-old woman was admitted to hospital with pleuritic retrosternal chest pain. Chest roentgenograms disclosed a small amount of bilateral pleural effusion, the examination of which exposed a sterile serous exudate with a markedly increased CA-125 level. Chest computed tomography revealed a large anterior mediastinal cystic mass with bilateral pleural effusions. Following complete resection of the mass, the histological examination revealed cavitary lesion with necrotic thymic tissue and inflammatory infiltrate surrounded by fibrous wall. The immunohistochemical staining for CA-125 displayed strong positivity at the Hassall's corpuscles. Cyst fluid also revealed a highly elevated CA-125 level. Her serum CA-125 concentration two months after surgery had fallen to 28 IU/L. She is now doing well without recurrence of the cyst five months after surgery.
Asunto(s)
Antígeno Ca-125/metabolismo , Quiste Mediastínico/metabolismo , Derrame Pleural/metabolismo , Femenino , Humanos , Quiste Mediastínico/diagnóstico por imagen , Quiste Mediastínico/patología , Persona de Mediana Edad , Radiografía , Rotura EspontáneaRESUMEN
The authors report the case of multiple right-sided myxomas in a 42-year-old man with Carney complex. He had previously been diagnosed as Cushing's syndrome and undergone resection of pituitary adenoma at the age of 21. After 10 years, bilateral adrenalectomy had been performed with recurrence of Cushing's syndrome. Recently, he complained of palpitation and intracardiac masses were detected. On physical examination, he had nevi on the lips and in the oral cavity. A tiny eyelid nodule was noted and histopathological analysis confirmed the diagnosis of skin myxoma. Thyroid ultrasonography revealed multiple hypoechoic nodules, which were confirmed pathologically as follicular adenomas. Scrotal ultrasonography also revealed small multiple testicular tumors. Echocardiography demonstrated intracardiac masses in right atrium and right ventricle. Right atriotomy revealed a right atrial mass attached to the annulus of the tricuspid valve and another mass arising from the interatrial septum. In right ventricle, a polypoid mass arose from the anterior leaflet of the tricuspid valve. Also, there were multiple tiny to small masses on the interatrial septum. The masses were completely excised and the tricuspid valve was repaired with annuloplasty. Histopathological analysis confirmed myxomas with foci of extramedullary hematopoiesis and ossification.