RESUMEN
A 49-year-old man visiting New Orleans from Chile comes to the hospital complaining of exertional dyspnea for 2 months with the more recent onset of ankle edema. He is a slender man with a blood pressure of 91/60 mmHg, crackles at both lung bases, and markedly distended neck veins. His cardiac rhythm is irregular. A soft murmur of mitral regurgitation and a soft S-3 are heard at the left ventricular apex. All four pedal pulses are easily palpable. Epigastric tenderness is noted on palpation; although the patient has a history of peptic ulcer disease, the tenderness is probably due to an enlarged left lobe of his liver, the result of hepatic congestion from his heart failure. A chest radiograph shows generalized cardiomegaly with an especially large left ventricle. Pulmonary congestion and small bilateral pleural effusions also are noted. The Figure shows the electrocardiogram recorded on admission.
Asunto(s)
Ecocardiografía Doppler en Color/métodos , Insuficiencia Cardíaca/diagnóstico , Edema , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The patient underwent closure of an atrial septal defect at age 3, had a leaking "mitral" valve repaired at age 9, and at age 13 had a "mitral" valve replacement. He began taking warfarin sodium at that time and remained symptom-free until 10 days before his initial visit here when he presented to another hospital with dyspnea and palpitations. Treatment there consisted of lisinopril 10 mg qd, carvedilol 6.25 mg bid, aldactone 25 mg qd, furosemide 40 mg qd, digoxin 0.25 mg qd, and a continuation of warfarin sodium 7.5 mg qd. An echocardiogram showed a left ventricular ejection fraction of 20%. After diuresis, he was referred to our cardiology clinic. On his initial visit here, his heart rate was an irregular 120 beats/min, his blood pressure was 106/77 mmHg, and closing and opening snaps of a normally functioning mechanical mitral valvular prosthesis were heard. He was obese (height, 5' 9"; weight, 272 lbs). An electrocardiogram was recorded (Figure 1).
Asunto(s)
Arritmias Cardíacas/diagnóstico , Defectos del Tabique Interatrial/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Adulto , Fibrilación Atrial/diagnóstico , Bloqueo de Rama/diagnóstico , Electrocardiografía , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , MasculinoRESUMEN
A 43-year-old man came to the hospital because of increasing dyspnea for two weeks. At age nine months the patient was evaluated for failure to thrive, and a diagnosis of valvular aortic stenosis was made. At operation the aortic stenosis was found to be supravalvular, and the ascending aorta was enlarged with a Teflon patch, the proximal end of which was placed in the noncoronary sinus of Valsalva. The aortic valve was bicuspid but otherwise appeared normal. Postoperatively the patient did well until six years ago when he developed increasing dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Echocardiography revealed a peak systolic pressure gradient across the aortic valve of 80 mmHg, severe aortic regurgitation, and moderate mitral regurgitation thought to be functional. Coronary arteriograms were normal. The patient underwent aortic valve replacement with a 23 mm Hancock 2 porcine heterograft prosthesis. He again did well postoperatively until a year before the current admission when dyspnea on exertion developed and culminated in two weeks of severe orthopnea and paroxysmal nocturnal dyspnea. The electrocardiogram (ECG) recorded on admission is shown in the Figure.
Asunto(s)
Estenosis Aórtica Supravalvular/cirugía , Bloqueo Atrioventricular/fisiopatología , Electrocardiografía , Frecuencia Cardíaca/fisiología , Implantación de Prótesis de Válvulas Cardíacas/métodos , Nodo Sinoatrial/fisiopatología , Adulto , Estenosis Aórtica Supravalvular/complicaciones , Estenosis Aórtica Supravalvular/fisiopatología , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/etiología , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/fisiopatología , Ecocardiografía Doppler , Estudios de Seguimiento , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Humanos , Masculino , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
Most patients with double-chambered right ventricles are diagnosed in childhood, but some escape definitive diagnosis until adulthood, as was the case in the patient described here.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/diagnóstico , Ventrículos Cardíacos/anomalías , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Electrocardiografía , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A 55-year-old man with syncopal episodes was found to have sinus bradycardia at a rate of 37 beats/min, an episode of nonsustained ventricular tachycardia, and left ventricular noncompaction cardiomyopathy. After placement of a dual-chamber cardioverter defibrillator 4 years ago, he has had no further syncopal episodes, and there have been no defibrillator shocks.
Asunto(s)
Bradicardia/etiología , Cardiomiopatías/complicaciones , Electrocardiografía , Síncope/etiología , Bradicardia/diagnóstico , Bradicardia/fisiopatología , Cardiomiopatías/diagnóstico , Cardiomiopatías/fisiopatología , Ecocardiografía , Humanos , Masculino , Persona de Mediana Edad , Síncope/diagnóstico , Síncope/fisiopatologíaAsunto(s)
Bradicardia/fisiopatología , Conducto Arterioso Permeable/diagnóstico , Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Soplos Cardíacos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , Adulto , Bloqueo de Rama/fisiopatología , Conducto Arterioso Permeable/cirugía , Frecuencia Cardíaca , Humanos , Masculino , Dispositivo Oclusor Septal , Resultado del TratamientoRESUMEN
A woman with systemic lupus erythematosus and a regular supraventricular tachycardia continues to have electrocardiographic abnormalities after the spontaneous return of normal sinus rhythm.
Asunto(s)
Lupus Eritematoso Sistémico/complicaciones , Taquicardia Supraventricular/fisiopatología , Adulto , Electrocardiografía , Femenino , Humanos , Lupus Eritematoso Sistémico/fisiopatología , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologíaAsunto(s)
Endocarditis Bacteriana , Infecciones Estreptocócicas , Streptococcus agalactiae , American Heart Association , Antiinfecciosos/uso terapéutico , Ecocardiografía , Urgencias Médicas , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/prevención & control , Humanos , Pierna , Imagen por Resonancia Magnética/métodos , Masculino , Dolor/etiología , Factores de Riesgo , Infecciones Estreptocócicas/diagnóstico , Estados UnidosAsunto(s)
Dolor en el Pecho/diagnóstico , Pericarditis/diagnóstico , Taquicardia Sinusal/diagnóstico , Enfermedad Aguda , Adulto , Antiinflamatorios/uso terapéutico , Dolor en el Pecho/etiología , Dolor en el Pecho/patología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Lisinopril/uso terapéutico , Pericarditis/complicaciones , Pericarditis/tratamiento farmacológico , Prednisona/uso terapéutico , Taquicardia Sinusal/etiología , Taquicardia Sinusal/patologíaRESUMEN
Unlike anomalous origin of the left coronary artery (CA) from the pulmonary trunk (PT), right CA from the PT, a rare congenital malformation, may present in adulthood. We herein describe a man with anomalous origin of the right CA from the PT who presented with angina and syncope at age 63.