Angiology
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A case of a renovascular hypertension due to an arteriovenous fistula between the right renal artery and the IVC secondary to a gunshot wound 8 years previously is reported. The diagnosis was made initially by the clinical signs of a continuous bruit heard over the anterior abdomen and by the characteristic findings of diastolic hypertension. ⋯ The result was confirmed by postoperative aortography and by disappearance of the preoperative physical findings. The present case, to our knowledge, is the sixth in the literature.
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Six cases of digitalis intoxication presenting with cardiac arrhythmias are described. Multiple cardiac arrhythmias consisting of multifocal, or unifocal, multiform ventricular ectopic beats, bidirectional tachycardia, complete heart block, accelerated junctional rhythm with exit block, nonparoxysmal junctional tachycardia, atrial fibrillation, atrial tachycardia with block, and multifocal tachycardia were observed. The presence of such multiple arrhythmias occurring simultaneously should always suggest the high possibility of digitalis intoxication.
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A reduction in impedance or afterload produces beneficial hemodynamic effects in patients with mitral regurgitation. This mechanism has been studied via intravenous infusion of nitroprusside, phentolamine, and hydralazine. But there is little information on the effect of nitroglycerin ointment in patients with mitral insufficiency. ⋯ The control cardiac index fell from 2.79 to a treatment value of 2.05 L/min/m2 (P < 0.01), while the stroke index also decreased from 29 to 22 ml/beat/m2 (P < 0.05). There was a nonsignificant increase in peripheral resistance. Thus nitroglycerin ointment can be detrimental when given to patients with mitral insufficiency.
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Two cases of ventricular fibrillation occurring during a physician-directed exercise program are described. Both were successfully resuscitated. No single clinical parameter can predict which patient is at increased risk for exercise-induced ventricular fibrillation. We conclude that all cardiac patients who wish to exercise should do so only with physician supervision.
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Case Reports
Enlarged left atrium causing possible false positive echocardiographic diagnosis of pericardial effusion.
Echocardiographic examination in a patient with IHSS, mitral insufficiency, and cardiomegaly suggested the possibility of a pericardial effusion. Echocardiographic M-mode scanning documented the continuity of the space posterior to the pericardium with an enlarged left atrium. Subsequent cineangiographic studies confirmed an enlarged left atrium and the absence of pericardial effusion. Left atrial enlargement may cause a false positive echocardiographic diagnosis of pericardial effusion.