Clinical cardiology
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The effects of several prescription and illicitly-used drugs on electrocardiographic repolarization are well documented, most frequently manifested as prolongation of the corrected QT (QTc) interval. The combination of multiple repolarization-modulating drugs taken in high dosage can occasionally lead to extreme abnormalities of the QTc interval and ST-segment on the surface ECG, which can lead to the erroneous diagnosis of underlying myocardial ischemia and inappropriate treatment. We report on one such case in which the acute management of a syncopal patient was detrimentally influenced by misinterpretation of a very unusual ECG.
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Brucellosis is frequently seen in Mediterranean and Middle East countries, including Turkey. We report the medical and surgical management of 31 cases of native endocarditis. ⋯ In our retrospective study, combination of adequate medical and surgical therapy resulted in declined morbidity and mortality rate. The valve replacement with aggressive debridement is the most important part of the treatment, which should be supported with efficient preoperative and long term postoperative medical treatment.
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Clinical cardiology · Feb 2010
Comparative StudyA novel noninvasive ultrasonic cardiac output monitor: comparison with cardiac magnetic resonance.
USCOM, a novel continuous wave Doppler (CWD) device, has been introduced for noninvasive determination of cardiac output (CO). The present study aimed to compare the accuracy and reproducibility of the new device, using cardiovascular magnetic resonance imaging (CMR) as the noninvasive gold standard. ⋯ Continuous wave Doppler is a feasible technique for measuring cardiac function. Although the overall agreement with CMR was acceptable, CWD showed a trend to underestimate CO. The estimated LVOT diameter by CWD is likely to be an important source of error. Nevertheless, the CWD device could be of clinical use especially for detection of intraindividual hemodynamic changes since a high reproducibility could be demonstrated.
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Clinical cardiology · Feb 2010
Restrictive right ventricular physiology and right ventricular fibrosis as assessed by cardiac magnetic resonance and exercise capacity after biventricular repair of pulmonary atresia and intact ventricular septum.
The hypertrophic myocardium, myocardial fiber disarray, and endocardial fibroelastosis in pulmonary atresia and intact ventricular septum (PAIVS) may provide anatomic substrates for restrictive filling of the right ventricle. ⋯ Restrictive RV physiology reflects RV diastolic dysfunction and is associated with more severe RV fibrosis but better exercise capacity in patients after biventricular repair of PAIVS.
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Clinical cardiology · Feb 2010
Case ReportsIrreversible end-stage heart failure in a young patient due to severe chronic hypocalcemia associated with primary hypoparathyroidism and celiac disease.
Chronic hypocalcemia may cause electrocardiographic (ECG) changes and mimic acute myocardial infarction. It has also been associated with reversible cardiac dysfunction. On the other hand cardiomyopathy and heart failure have been reported in patients with idiopathic hypoparathyroidism or celiac disease. ⋯ This case demonstrates an unusual clinical condition where 2 calcium homeostasis disorders led to severe hypocalcemia with clinical manifestations of end-stage heart failure. The severe cardiac failure appeared to be nonreversible after calcium repletion suggesting permanent cardiac muscle dysfunction due to associated cardiomyopathy.