Left Ventricular Pseudoaneurysm and Left Ventricular Thrombus in a Patient Presenting with an Acute ST-Elevation Myocardial Infarction.

BACKGROUND ST-elevation myocardial infarction (STEMI), when associated with acute left ventricular (LV) free-wall rupture, is often a lethal complication, and if not followed by sudden death, the rupture may be contained by the parietal pericardium and a local thrombus, leading to the formation of a left ventricular (LV) pseudoaneurysm. The incidence of LV pseudoaneurysm after STEMI is ~ 0.3%. CASE REPORT A 73-year-old man who presented with an acute syncopal episode and intermittent chest pain for 7 days was found to have an anterolateral myocardial infarction (MI) with lateral wall rupture and pseudoaneurysm formation. He had an LV thrombosis in the LV aneurysm. While this increased his risk of thromboembolic events, it likely stopped the evolution of the rupture and stabilized the pericardial effusion size. The patient underwent coronary artery bypass grafting (CABG), thrombectomy, and lateral wall repair. CONCLUSIONS Left ventricular pseudoaneurysm and left ventricular thrombus in a patient presenting with an acute ST-elevation myocardial infarction is a rare complication of myocardial infraction, with an incidence of <1%. It is often a lethal complication and requires stabilization and repair if not followed by sudden death.

A Large Intrathoracic Hiatal Hernia as a Cause of Complete Heart Block.

Hiatal hernia is a not uncommon anatomic disorder resulting in portions of the bowel occupying space in the thoracic cavity. There are a number of antecedent risk factors including obesity but not hiatal hernias resulting in symptoms. When symptoms do occur, they can include chest pain, nausea, abdominal pain, and gastroesophageal reflux. Cardiac arrhythmias have also been reported as associated conditions resulting from a hiatal hernia. To date, however, a complete heart block secondary to a hiatal hernia has not been reported. An 88-year-old female with a history of GERD (gastroesophageal reflux disease) was found to have a large hiatal hernia at endoscopy after she presented to the emergency department with nausea and abdominal pain. Prior to her scheduled surgical repair, she developed symptomatic third degree heart block which resolved with nasogastric tube deflation of the gastric contents. After surgical repair of the hiatal hernia, she developed episodes of atrial fibrillation with rapid ventricular response and was started on diltiazem. She eventually converted back to normal sinus rhythm and remained dysrhythmia free. In addition to other known arrhythmias associated with hiatal hernia, a complete heart block can also be seen. Acute management requires deflation of the chest occupying hernia. This appears to be the one of the first reported cases of complete heart block caused by hiatal hernia.

Effects of feeding the herb Borreria latifolia on the meat quality of village chickens in Malaysia.

An experiment was carried out to estimate the meat quality characteristics of village chickens (Gallus gallus) fed diets supplemented with dry leaves of Borreria latifolia (BL) used as a potential antioxidant source in chicken feed. In this study, 252 sexed 9-week-old village chickens with mean live body weight of 1,525.4 g for males and 1,254.1 g for females were divided into 7 groups (each group 18 birds) for each sex represented in 2 experiments. The first experiment was to evaluate the antioxidant activity of BL and the effect on meat quality through a comparison with Rosmarinus officinalis (RO); hence, 3 groups were conducted and included: T1 (control), basal diet without supplementation; T2, basal diet with 1% of BL; T3, basal diet with 1% of RO. T2 and T3 significantly affect pH value, lipid oxidation, cooking loss, and overall acceptability compared to T1, while no significant difference was observed between the dietary groups in respect of drip loss, color, tenderness, fatty acid profile, and meat composition. Furthermore, a significant effect of sex on lipid oxidation, pH, yellowness, and fatty acid profile was observed. There was no significant effect of sex on WHC, tenderness, lightness, redness, and sensory evaluation. A significant influence of postmortem aging period was detected on lipid oxidation, pH, tenderness, cooking loss, and redness. The obtained result in this study revealed a significance in the interaction of herb by sex in pH parameter and between herb and sex, herb by aging period, sex by aging period, and the herb by sex by aging period interactions with regard to lipid oxidation test. The second experiment was to estimate the effect of 3 different levels of BL on meat quality. Four groups were provided and involved: T1 (control), basal diet without supplementation; T2, basal diet with 1.5% of BL; T3, basal diet with 2% of BL; and T4, basal diet with 2.5% of BL. The result of this study showed a significant effect (P < 0.05) of the dietary groups on redness value, sensory evaluation, and lipid oxidation. A significant effect of sex on fatty acid profile and lipid oxidation was detected in addition a significant effect of postmortem aging period on redness, pH, tenderness, cooking loss, and lipid oxidation was noticed. There was no significance in the interaction between herb and sex through pH test while a significance in the interaction between herb and sex, herb  × aging period, sex × aging period, and herb × sex × aging period interactions with regard to lipid oxidation was found. It can be concluded that dietary supplementation of BL improved oxidative stability and enhanced meat quality.