Butane-induced acute global myocardial ischemia without coronary artery pathology.

The case report describes a case of acute myocardial ischemia precipitated by propane butane inhalation. The dependency of this substance around the world is still moderate but is increasing due to the easy availability of the substance and the facility with which the effects can be concealed. The toxicity of the substance is significant; affecting the heart, the brain and the liver. The most common outcome is sudden death. In this article, we describe a survivor after an episode of acute poisoning and his interesting cardiac pathology.

Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?

AIMS: The current guidelines recommend reperfusion therapy in acute myocardial infarction (AMI) with ST-segment elevation or left bundle branch block (LBBB). Surprisingly, the right bundle branch block (RBBB) is not listed as an indication for reperfusion therapy. This study analysed patients with AMI presenting with RBBB [with or without left anterior hemiblock (LAH) or left posterior hemiblock (LPH)] and compared them with those presenting with LBBB or with other electrocardiographic (ECG) patterns. The aim was to describe angiographic patterns and primary angioplasty use in AMI patients with RBBB. METHODS AND RESULTS: A cohort of 6742 patients with AMI admitted to eight participating hospitals was analysed. Baseline clinical characteristics, ECG patterns, coronary angiographic, and echocardiographic data were correlated with the reperfusion therapies used and with in-hospital outcomes. Right bundle branch block was present in 6.3% of AMI patients: 2.8% had RBBB alone, 3.2% had RBBB + LAH, and 0.3% had RBBB + LPH. TIMI flow 0 in the infarct-related artery was present in 51.7% of RBBB patients vs. 39.4% of LBBB patients (P = 0.023). Primary percutaneous coronary intervention (PCI) was performed in 80.1% of RBBB patients vs. 68.3% of LBBB patients (P< 0.001). In-hospital mortality of RBBB patients was similar to LBBB (14.3 vs. 13.1%, P = 0.661). Patients with new or presumably new blocks had the highest (LBBB 15.8% and RBBB 15.4%) incidence of cardiogenic shock from all ECG subgroups. Percutaneous coronary intervention was done more frequently (84.8%) in patients with new or presumably new RBBB when compared with other patients with blocks (old RBBB 66.0%, old LBBB 62.3%, new or presumably new LBBB 73.0%). In-hospital mortality was highest (18.8%) among patients presenting with new or presumably new RBBB, followed by new or presumably new LBBB (13.2%), old LBBB (10.1%), and old RBBB (6.4%). Among 35 patients with acute left main coronary artery occlusion, 26% presented with RBBB (mostly with LAH) on the admission ECG. CONCLUSION: Acute myocardial infarction with RBBB is frequently caused by the complete occlusion of the infarct-related artery and is more frequently treated with primary PCI when compared with AMI + LBBB. In-hospital mortality of patients with AMI and RBBB is highest from all ECG presentations of AMI. Restoration of coronary flow by primary PCI may lead to resolution of the conduction delay on the discharge ECG. Right bundle branch block should strongly be considered for listing in future guidelines as a standard indication for reperfusion therapy, in the same way as LBBB.

Ageing of ex-sportsmen: ergonometric parameters of ex-elite athletes.

After the cessation of physical activity for six or more years, processes start to occur in previously active sportsmen that cause aerobic capacity to reach the values observed in people of the same age who have never participated in sport. However, the physical capacity of these people remains above the average level for the same age group. The important factors related to the aerobic capacity of ex-elite sportsmen are the age, current physical activity and body weight. There is no relationship between their maximal aerobic capacity and the type of sport discipline practiced by the ex-athlete in the past.

Typical electrocardiographic deviations after cessation of physical activities in elite sportsmen.

We observed that ECG changes associated with high levels of sporting activity are reversible in the majority of cases after cessation of the sports career. This is probably related to the normalization of the raised vagal tone and diminution of the effort-related heart hypertrophy and chamber dilatation in ex-sportsmen. The persistent ECG changes observed in some of the ex-sportsmen could be related to the ageing processes observed in the general population as well. It is important that all ECG deviations in ex-sportsmen be considered seriously and interpreted in the context of the ECGs obtained during the active sports career.

Isolated bilateral ostial coronary stenosis with proximal right coronary artery occlusion.

The incidence of coronary ostial stenosis in patients undergoing coronary arteriography has been found to range between 0.07 and 0.25%. A slightly higher incidence has been observed in patients with angiographically confirmed coronary artery disease: between 0.13 and 2.7%. Bilateral ostial stenosis is even less common. Although cardiovascular syphilis is no longer a prominent condition, it must be considered in the differential diagnosis since it carries a very high risk (50%) of cardiovascular complications if left untreated. Ostial coronary stenosis occurs in 26% of patients with syphilitic aortitis. This paper reports on a 41-year-old Wasserman (WR)-positive woman with progressive angina caused by bilateral ostial coronary stenosis.

Diagnosis and Management of Complicated Left Atrial Mural Endocarditis: The Role of Transesophageal Echocardiography.

Mural endocarditis that involves the left atrial wall is rare. We report on the transesophageal findings in a patient with left atrial mural endocarditis and discuss its recognition, complications, and treatment.