Angiology
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To compare left ventricular global and segmental function at rest and during right atrial pacing in patients with unstable angina, non-Q wave myocardial infarction, and stable angina (class III angina), low-dose digital subtraction ventriculography was performed at rest and after abrupt cessation of pacing in 42 patients with unstable angina, 8 patients with non-Q wave myocardial infarction and 15 patients with stable angina during selective coronary arteriography. Left ventricular ejection fraction was significantly lower at rest in patients with unstable angina (P < 0.01) and non-Q wave myocardial infarction (P < 0.05) and during pacing (P < 0.01). These two groups of patients had significantly higher values of left ventricular end-diastolic and end-systolic volumes at rest and during pacing as compared with stable angina group. ⋯ Contractility of region of hypokinesia was lowest at rest and during pacing in patients with crescendo angina. This study demonstrates that patients with unstable angina as well as non-Q wave myocardial infarction were characterized by more pronounced global and segmental left ventricular dysfunction at rest and during pacing as compared with patients with stable angina, which may explain the poorer prognosis in the former two groups. This study also shows that patients with crescendo angina have more profound left ventricular global and regional dysfunction as compared with patients with new-onset as well as rest angina.
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Case Reports
Transthoracic visualization of pulmonary thrombus that mimicked left atrial thrombus. A case report.
A forty-five-year-old woman with an unusual case of primary pulmonary hypertension is presented. She showed a progressive dilatation of the pulmonary arteries and pulmonary thrombus over twenty-one years. ⋯ However, when the transducer was rotated clockwise to obtain the short-axis view, a thrombus was observed in the right pulmonary artery with spontaneous echo contrast. Although the visualization of pulmonary arterial thrombus by echocardiography has been quite limited, it would be worthwhile since patients with primary pulmonary hypertension may have enlarged pulmonary arteries, as observed in the present case.
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The authors examined 61 subjects with carotid angiography and 50 with vertebral angiography. Angiograms were evaluated for collateral flow through the ophthalmic, anterior communicating, and posterior communicating arteries. The authors evaluated the patency of collateral vessels directly using transcranial Doppler ultrasonography; they made indirect detection after the compression of carotid and vertebral arteries while monitoring flow velocities in the middle cerebral artery. ⋯ A combination of carotid compressions and transcranial Doppler ultrasonography detected the patency of the ophthalmic and anterior communicating arteries with a specificity and sensitivity of 1.00. Examination of the posterior communicating artery had a sensitivity of 0.97 and specificity of 0.98. Indirect evaluation of collateral vessels can not only detect their presence but also establish their hemodynamic significance with high accuracy.
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Review Case Reports
Bifascicular block complicating blunt cardiac injury. A case report and review of the literature.
A thirty-five-year-old horse trainer presented to the emergency room of the authors' hospital with minimal nonpenetrating chest injury after having been kicked by a horse. No rib or sternum fractures were demonstrated. ⋯ The authors are aware of only two similar reports, but analogous conduction disturbances might have been classified as intraventricular conduction defects. The rarity of these defects may be explained by the anatomic pathways of the bundle of His and its bifurcations.
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The case report of a young patient with recurrence of intraventricular thrombus represents an unusual presentation with no apparent clinical explanation despite echocardiographic, surgical, and pathologic confirmation. The other unusual feature of this case is the absence of predisposing factors for intraventricular thrombus. The patient developed the second left ventricular thrombus after he stopped taking anticoagulants. The authors' recommendation for such a patient is that he continue to receive anticoagulants for life.