Clinical cardiology
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Clinical cardiology · Mar 1996
Case ReportsPostpericardiotomy syndrome and cardiac tamponade following transvenous pacemaker placement.
This is the first reported case of cardiac tamponade presumed to be caused by postpericardiotomy syndrome (PPS) following endocardial pacemaker placement. An 84-year-old woman developed fever and dyspnea 3 weeks after pacemaker placement. Physical examination revealed hypotension, tachycardia, and pulsus paradoxus. ⋯ PPS is a common complication of cardiothoracic surgery and chest trauma. It rarely occurs after percutaneous procedures such as percutaneous transluminal coronary angioplasty and transvenous pacemaker placement. While usually having a benign, self-limited course, PPS can cause a serious complication as illustrated in this case report.
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Clinical cardiology · Mar 1996
Comparative StudyLeft ventricular outflow tract obstruction as a cause for hypotension and symptoms during dobutamine stress echocardiography.
Hypotension has been found to occur in more than one-third of patients during DBSE. Unlike traditional treadmill exercise stress testing, hypotension does not appear to be associated with significant coronary artery disease or left ventricular (LV) dysfunction. Several ischemic and nonischemic mechanisms such as dynamic LV intracavitary obstruction have been implicated in the pathogenesis of hypotension and the induction of symptoms during DBSE. ⋯ Dobutamine stress echocardiography precipitates LVOT obstruction in certain patients. The development of a gradient corresponded with a fall in blood pressure and a decline in cardiac output in nearly half of the patients. These findings suggest that stress-induced LVOT obstruction may be responsible in part for the hemodynamic changes and symptoms experienced by these patients during exercise.
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Clinical cardiology · Mar 1996
Transesophageal echocardiography in the detection of inferior vena cava and cardiac metastasis in hepatocellular carcinoma.
Antemortem diagnosis of inferior vena cava (IVC) and cardiac metastasis of hepatocellular carcinoma (HCC) is difficult but important before consideration of curative resection. There are only a few cases of cardiac metastasis of HCC which have been diagnosed antemortem by echocardiography. Accordingly, 18 consecutive patients with HCC who were potential candidates for curative resection were studied by transthoracic (TTE) and transesophageal echocardiography (TEE). ⋯ In summary, TEE may be more useful than TTE in the detection of cardiac metastasis of HCC, which occurred in 22% of patients whose primary tumor was considered to be surgically resectable in our series. This can be safely performed in patients with HCC and can provide optimal visualization of the IVC and RA. The high prevalence of subclinical cardiac metastasis in HCC mandates the use of TEE in all patients with HCC prior to surgical intervention.
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Clinical cardiology · Mar 1996
Case ReportsAnomalous origin of the right coronary artery from the pulmonary trunk: is surgical reimplantation into the aorta a method of choice?
The origin of the right coronary artery (RCA) from the pulmonary trunk (PT) is a rare congenital anomaly. Although most of the patients remain asymptomatic, prophylactic reimplantation of the RCA into the aorta has been recommended to prevent an adverse outcome. The report describes postoperative results in two patients following uneventful RCA reimplantation. ⋯ The second patient, a 36-year-old woman, with isolated anomalous origin of the RCA from the PT, continued to present with myocardial ischemia on exertion. The original observation of an angiographic "slow-flow" phenomenon in the reimplanted RCA in both patients implies the impairment of myocardial microvessels. These findings give rise to the question of whether the reimplantation of the anomalous artery is really superior to simple ligation of its origin in order to relieve the "coronary steal" effect.