Clinical cardiology
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Clinical cardiology · Feb 1992
Review Case ReportsDocumentation of successful treatment of prosthetic mitral valve thrombosis with intravenous urokinase infusion for twenty-four hours.
Prosthetic valve thrombosis is a life-threatening situation requiring prompt diagnosis and treatment. Treatment has usually been surgical and has been associated with a high mortality. Thrombolytic therapy is a therapeutic alternative to surgery and has been successful in a number of cases. This report concerns the technique used to diagnose the condition, treatment strategy, and documentation of the results of therapy.
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Clinical cardiology · May 1991
Case ReportsAcute myocardial infarction after simultaneous thrombosis in normal right and left coronary arteries.
A 32-year-old male patient with clinical and electrocardiographic evidence of acute myocardial infarction underwent coronary angiographic study. We observed nonocclusive thrombosis simultaneously in right and left anterior descending coronary arteries, without confirmation of spasm or obstructive artery disease in other coronary branches. ⋯ With the advent of thrombolytic therapy and immediate coronary angiographic studies in patients with evolving myocardial infarction, it has been possible to confirm the presence of thrombus and the type of coronary disease. In this case, we observed total lysis of both thrombi and the final aspect of "normal" angiographically reperfused coronary arteries.
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Clinical cardiology · Feb 1991
Comparative StudyStress-induced changes in blood pressure and left ventricular function in mild hypertension.
Left ventricular function was studied by M-mode echocardiography at rest and during a mental arithmetic stress test and a cold-pressor test in 14 patients with mild hypertension and in 14 matched normotensive subjects. The elevation of blood pressure at rest in the hypertensive group (154 +/- 4/87 +/- 3 vs. 120 +/- 3/66 +/- 3 mmHg in the control group) was due mainly to a higher cardiac output (6.0 +/- 0.3 vs. 5.0 +/- 0.3 L/min), which was related to elevations of stroke volume and heart rate (73 +/- 2 vs. 66 +/- 2 beats/min). Venous plasma catecholamines were similar in the two groups. ⋯ Mental stress appears to elicit a differentiated sympathetic nerve activation pattern resembling the hypothalamic defense reaction. Mild hypertension seems to be associated with increased arousal and cardiac activation at rest. However, an attenuated blood pressure reactivity to mental stress may reflect reduced stroke volume responsiveness, which is related to structural changes, as heart rate reactivity tended to be enhanced in mild hypertension.
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Clinical cardiology · Dec 1990
Case ReportsApical hypertrophic cardiomyopathy presenting with sustained monomorphic ventricular tachycardia and electrocardiographic changes simulating coronary artery disease and left ventricular aneurysm.
A 52-year-old male presented with sustained monomorphic ventricular tachycardia as the initial manifestation of apical hypertrophic cardiomyopathy. The electrocardiogram during normal sinus rhythm showed a pattern of an old anterior wall myocardial infarction with aneurysm formation. ⋯ Monomorphic ventricular tachycardia was reproducibly initiated and terminated during electrophysiological studies and antiarrhythmic drugs failed to control the tachycardia. At the time of implantation of a cardioverter defibrillator, left ventricular apical biopsy revealed pathologic findings characteristic of hypertrophic cardiomyopathy.