International journal of cardiology
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Letter Case Reports
Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur.
A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. ⋯ A new heart sound, especially a continuous murmur, may be detected during physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients.
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Comparative Study
Does hospitalization for congestive heart failure occur more frequently in Ramadan: a population-based study (1991-2001).
Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is essentially a radical change in lifestyle for the period of one lunar month, so it is important to see the response of congestive heart failure patients to this change. Our objective in this study is to investigate whether Ramadan fasting has any effect on the number of hospitalization for congestive heart failure (CHF) in a geographically defined population. ⋯ This population-based study demonstrates that no significant difference was found in number of hospitalization for CHF while fasting in Ramadan when compared to the non-fasting months.
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Chronic heart failure (CHF) is a common medical problem and B-type natriuretic peptide (BNP)-guided heart failure management for outpatients with symptomatic CHF was found to reduce the readmission rate and mortality, but the costs of treatment may provoke concern in the current cost-conscious clinical setting. ⋯ Introduction of BNP measurement in heart failure management may be cost-effective.
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Letter Case Reports
Atrial fibrillation and prominent J (Osborn) waves in critical hypothermia.
The J wave is a deflection that appears on the surface ECG as a late delta wave following the QRS complex. Also known as an Osborn wave, the J wave has been observed in various conditions and diseases. Our case highlights the typical electrocardiographic manifestations of hypothermia including the J deflection and ST segment elevation during atrial fibrillation. Thorough knowledge of these findings is important for prompt diagnosis and treatment of hypothermic states.