Clinical cardiology
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Clinical cardiology · Nov 2009
Case ReportsTraumatic brachiocephalic pseudoaneurysm presenting as stroke in a seventeen-year-old.
We present a 17-y-old male who presented to the emergency room with left arm weakness along with slurred speech. On physical examination, he had stable vital signs with left facial weakness suggestive of lower motor neuron seventh nerve palsy. He was also noted to have a small pulsatile mass in the right infraclavicular region. ⋯ Traumatic pseudoaneurysm with thrombus formation is an extremely rare cause of stroke. It has been reported in association with the carotid artery, but to our knowledge, this is the first reported case with isolated innominate artery pseudoaneurysm. This case highlights the need for a broad differential when evaluating young patients with neurological deficits.
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Clinical cardiology · Nov 2009
Case ReportsVentilation-perfusion mismatch resulting from iatrogenic pulmonary vein stenosis after radiofrequency ablation: a case report.
A lobar ventilation-perfusion mismatch is reported in a patient with right superior pulmonary vein stenosis, developing after radiofrequency ablation for atrial fibrillation. Radionuclide lung perfusion tomography was performed to assist with clinical management. Serial planar lung scintigraphy demonstrated no improvement in the perfusion abnormality despite interventional stenting. Iatrogenic pulmonary vein stenosis may potentially mimic pulmonary embolic disease.
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Clinical cardiology · Nov 2009
Usefulness of brain natriuretic peptide level at implant in predicting mortality in patients with advanced but stable heart failure receiving cardiac resynchronization therapy.
Brain natriuretic peptide (BNP) level has emerged as a predictor of death and hospital readmission in patients with heart failure (HF). The value of baseline BNP assessment in advanced HF patients receiving cardiac resynchronization defibrillator therapy (CRT-D) has not been firmly established. ⋯ Baseline BNP independently predicted mortality and HF hospitalization in a predominantly older white male population of advanced HF patients receiving CRT-D. Elevated BNP levels may identify a vulnerable HF population with a particularly poor prognosis despite CRT-D.
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Right to left shunting through a patent foramen ovale (PFO) or atrial septal defect (ASD) can cause platypnea-orthodeoxia even in a setting of normal pulmonary artery pressures. However, the late onset of symptoms despite the congenital origin of the anatomical defects is not well understood. We report a case series of patients presenting with dyspnea and orthodeoxia who developed right to left shunting as a result of associated anatomical changes that occur with aging such as tortuosity and elongation of the aorta. We propose that these acquired anatomical changes can favor right to left shunting in the setting of congenital abnormalities, therefore explaining the late onset of symptoms.
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Clinical cardiology · Nov 2009
A new electrocardiographic algorithm to locate the occlusion in left anterior descending coronary artery.
Early prediction of proximal left anterior descending coronary artery (LAD) occlusion is essential from a clinical point of view ⋯ This sequential ECG algorithm based on ST-segment deviations in different leads allowed us to predict the location of occlusion in LAD with good accuracy. Cases with proximal LAD occlusion present the most markers of poor prognosis. We recommend the use of the algorithm in everyday clinical practice.