Clinical cardiology
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Clinical cardiology · Jan 2010
Case ReportsMassive pulmonary embolism and paradoxical migration during surgical embolectomy: role of transesophageal echocardiogram.
Patent foramen ovale (PFO) in the setting of venous thromboembolism is associated with paradoxical embolization. We describe a patient who presented with pulmonary embolism, underwent pulmonary embolectomy, and postoperatively developed paradoxical embolization to the lower extremity. A 27-year-old African American male presented to the hospital with shortness of breath and midsternal chest pain along with neck vein distention. ⋯ At this point vascular surgery for revascularization of the left lower extremity was performed. Two days later, the patient was taken for a repeat cardiac surgery and the left-sided thrombus was removed along with a closure of the PFO. This case signifies the importance of complete TEE and a search for PFO in patients with massive pulmonary embolism especially prior to surgical embolectomy because hemodynamic disturbances of pulmonary embolism and surgical embolectomy may cause migration of the thrombus from the right side to the left side of the heart.
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Clinical cardiology · Jan 2010
Heart rate recovery and oxygen kinetics after exercise in obstructive sleep apnea syndrome.
Patients who suffer from obstructive sleep apnea (OSA) have a decreased exercise capacity and abnormal autonomic nervous function. However, the kinetics of early oxygen (O2) and heart rate recovery (HRR) have not been described. ⋯ Patients with OSA demonstrate reduced exercise capacity, delayed oxygen kinetics, and reduced HRR. These data point to abnormal oxygen delivery and/or oxidative function of the peripheral muscles and impaired autonomic nervous activity in OSA patients.