Assuntos
Pericardite Constritiva/diagnóstico por imagem , Infecções Pneumocócicas/diagnóstico por imagem , Adulto , Tamponamento Cardíaco/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Ecocardiografia , Ecocardiografia Doppler de Pulso , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagemRESUMO
A 76-year-old woman with a history of repeated right-sided cardiac failure during the past 2 years presented with tricuspid and mitral regurgitation due to congenital hypoplasia of atrioventricular valves. Two-dimensional echocardiography demonstrated enlarged right atrium and right ventricle, and discoaptation between the leaflets. Color Doppler echocardiography revealed severe tricuspid regurgitation through the gap between the leaflets. Autopsy showed congenital hypoplasia of the leaflets and the chordae tendineae in the tricuspid and mitral valvular apparatus.
Assuntos
Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/anormalidades , Idoso , Ecocardiografia Doppler em Cores , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Tricúspide/patologia , Insuficiência da Valva Tricúspide/diagnóstico por imagemRESUMO
Sarcoidosis is a multisystem granulomatous disorder of unknown etiology which mainly affects the lungs, skin, the lymphoreticular system, and the heart. We report a case of cardiac sarcoidosis in which a remarkably thin ventricular septum was demonstrated on two-dimensional echocardiography.
Assuntos
Cardiomiopatias/patologia , Septos Cardíacos/patologia , Sarcoidose/patologia , Atrofia , Cardiomiopatias/diagnóstico por imagem , Ecocardiografia , Feminino , Septos Cardíacos/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Sarcoidose/diagnóstico por imagemAssuntos
Ruptura Aórtica/complicações , Cordas Tendinosas , Seio Aórtico , Valva Tricúspide , Ruptura Aórtica/diagnóstico por imagem , Cordas Tendinosas/diagnóstico por imagem , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etiologia , Humanos , Pessoa de Meia-Idade , Ruptura Espontânea , Seio Aórtico/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagemAssuntos
Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Circulação Coronária , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Oral flecainide treatment was given to five patients who were refractory to conventional antiarrhythmic agents. The five patients included one with atrioventricular reentrant tachycardia (AVRT), one with non-sustained ventricular tachycardia (nsVT) and three with sustained VT (sVT). Flecainide produced favorable responses in patients of AVRT, nsVT and sVT with arrhythmogenic right ventricular dysplasia (ARVD). In the case of AVRT, flecainide exhibited a preventive effect on tachycardia induced by programmed electrical stimulation (PES). In the case of nsVT, flecainide markedly reduced the number of VPC and abolished the VT on the Holter ECG. In the case of sVT with ARVD, sVT was not induced by PES after the flecainide. Long-term treatment with flecainide on these three cases produced complete prevention of tachycardias. As an adverse effect of flecainide, an aggravation of congestive heart failure was recognized in one case with cardiac sarcoidosis. PQ interval and QRS interval in all the cases were prolonged after flecainide. The results indicate that flecainide is a useful antiarrhythmic agent for tachyarrhythmias refractory to treatment with conventional drugs.
Assuntos
Arritmias Cardíacas/tratamento farmacológico , Flecainida/uso terapêutico , Administração Oral , Adulto , Avaliação de Medicamentos , Eletrocardiografia , Feminino , Flecainida/administração & dosagem , Flecainida/efeitos adversos , Humanos , MasculinoRESUMO
A case of Lassa fever associated with effusive constrictive pericarditis and bilateral atrioventricular annular constriction was reported. A 49-year-old man, who had been diagnosed by indirect fluorescent antibody test as the first case of Lassa fever in Japan, was referred to the Hiroo Hospital because of syncope, progressive hepatomegaly, ascites and pericardial effusion in spite of pericardiocentesis and corticosteroid therapy. On admission, his blood pressure was 92/60 mmHg and he had a paradoxical pulse. Two-dimensional echocardiography revealed a localized pericardial effusion adjacent to the right ventricular wall and behind the left ventricular posterior wall. Bilateral atrioventricular annular constriction was also present. On pulsed Doppler echocardiography, the peak inflow velocities of the right and left ventricles increased during atrial systole. Right heart catheterization revealed a mean diastolic pressure gradient of 8 mmHg across the tricuspid valve. After pericardiectomy, a diastolic dip and plateau pattern became evident in the right ventricular pressure tracing, suggesting the presence of residual constriction. However, the atrioventricular annular constriction was no longer evident on two-dimensional echocardiography. This is considered the first reported case of subacute effusive constrictive pericarditis caused by Lassa fever.
Assuntos
Febre Lassa/complicações , Derrame Pericárdico/etiologia , Pericardite Constritiva/etiologia , Valva Tricúspide , Cateterismo Cardíaco , Constrição Patológica/etiologia , Ecocardiografia , Eletrocardiografia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Pericardite Constritiva/diagnósticoRESUMO
The effects of intracoronary thrombolysis (ICT) were studied in 88 acute myocardial infarction patients. Total coronary occlusion was observed in 67 of the 88 patients (76.1%) who were evaluated within 6 hours of the onset of symptoms. Among these 67 patients 42 (62.7%) were successfully recanalized by intracoronary urokinase. The recanalization rate was higher in the lesion at the left anterior descending artery, in younger patients (49 years or less) and in patients with a shorter history of pre-infarction angina. Eight of 11 patients (72.7%) with subtotal coronary occlusion and 17 of 35 patients (48.6%) with recanalization after ICT showed spontaneous regression of the residual coronary stenosis at the chronic stage angiography. There was no re-occlusion in the subtotal occlusion group and only 6 cases of re-occlusion (17.1%) in the recanalization group. The majority of re-occlusions progressed from the lesion with 99% residual stenosis and delayed filling. Accordingly the true value of additional percutaneous transluminal coronary angioplasty would be limited to the latter cases. Reduction in infarct size and improvement in left ventricular function were limited to those patients with incomplete or subtotal coronary occlusion and were not seen in cases with total obstruction which was recanalized by ICT.
Assuntos
Doença das Coronárias/tratamento farmacológico , Trombose Coronária/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Adulto , Idoso , Angiografia Coronária , Feminino , Seguimentos , Coração/fisiopatologia , Humanos , Injeções Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagemAssuntos
Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Mitral/complicações , Espondilite Anquilosante/complicações , Insuficiência da Valva Aórtica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Espondilite Anquilosante/diagnósticoAssuntos
Bloqueadores dos Canais de Cálcio/farmacologia , Diástole , Ecocardiografia , Hipertensão/fisiopatologia , Contração Miocárdica , Nicardipino/farmacologia , Esforço Físico , Adulto , Diástole/efeitos dos fármacos , Teste de Esforço , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacosRESUMO
A case of aortic dissection associated with aortic regurgitation which was induced by diastolic prolapse of an intimal flap into the left ventricular outflow tract was reported. This 57-year-old man, referred for evaluation of sudden onset of chest oppression and a heart murmur, was hypertensive for several years. His admission blood pressure was 184/44 mmHg, and a systolic ejection murmur and a diastolic decrescendo murmur were audible along the left sternal border. Two-dimensional echocardiography revealed an intimal flap in the markedly enlarged aortic root. The intimal flap moved posteriorly in systole and anteriorly in diastole, and prolapsed into the left ventricular outflow tract during diastole. Associated with the movement of the intimal flap, an aortic cusp was shifted from its original position to the left ventricular outflow tract in diastole. Aortography disclosed type I aortic dissection and severe aortic regurgitation. After medical treatment for four months, the patient underwent a Bentall surgical procedure and recovered. Impaired coaptation of the aortic valve induced by diastolic prolapse of the intimal flap into the left ventricular outflow tract is a newly encountered echocardiographic finding in proximal aortic dissection.
Assuntos
Aneurisma Aórtico/complicações , Dissecção Aórtica/complicações , Insuficiência da Valva Aórtica/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A case of transient obstruction of the left ventricular outflow tract after excessive intake of alcohol was reported. This 41-year-old man was admitted to the Hiroo Hospital because of a syncopal attack experienced while walking. He had been drinking excessively for one week until the day before admission. On admission, physical examination revealed a bifid carotid pulse and a grade 3/6 systolic ejection murmur accentuated by Valsalva maneuvers and prompt standing. The second heart sound was paradoxically split. Echocardiography showed typical systolic anterior motion of the mitral valve (SAM). The interventricular septal and left ventricular posterior wall thicknesses were 13 mm and 11 mm, respectively. No enlargement or displacement of the papillary muscles was noted. The redundant mitral chordae tendineae protruded into the left ventricular outflow tract in systole, and both the anterior and posterior mitral valve leaflets were retracted upwards approximating the interventricular septum by these chordae, resulting in obstruction of the left ventricular outflow tract. All signs of left ventricular outflow obstruction, including SAM, disappeared within several days after admission, and prolapse of the anterior mitral leaflet became evident. Since ejection fraction was markedly increased and the corrected QT interval was prolonged on admission, this patient was considered to be in hyperadrenergic state induced by excessive alcohol intake. In this case, left ventricular outflow tract obstruction was attributed to hyperadrenergic state and a redundant mitral apparatus.