International journal of cardiology
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We reviewed our clinical and echocardiographic experience in 70 consecutive patients with 73 cardiac myxomas, diagnosed over an 11 year period. There were 21 males and 49 females, ages ranged from 18 to 80 years. Only in 5.7% cases was the diagnosis of myxomas made clinically. 88.6% cases were initially diagnosed as having: mitral valve disease (70%), tricuspid valve disease (10%), ischemic heart disease (5.7%), cardiomyopathy (2.9%), and the remaining 5.7% were detected during family screening and follow-up. ⋯ Post-operative mean echocardiographic follow-up of 60 months showed no recurrence except in 2 with familial myxoma. We conclude that the majority of myxomas mimic many cardiovascular diseases and were detected in symptomatic patients, so a high index of clinical suspicion is important for its early and correct diagnosis. The size and appearance of the myxomas correlated with the presenting symptoms.
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Multicenter Study Comparative Study
Prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. NKP Salve Institute of Medical Sciences, Nagpur, India. Five City Study Group.
To measure the prevalence of hypertension and age-specific blood pressure in urban populations from five Indian cities. Cross-sectional surveys were conducted in six-twenty urban streets in different cities from five different corners of India, using similar methods of sample selection and criteria. There were 3212 randomly selected women from Moradabad (n=902), Trivandrum (n=760), Calcutta (n=365), Nagpur (n=405) and Bombay (n=780), aged 25-64 years, inclusive. ⋯ According to old criteria, the overall prevalence of hypertension (>160/95 mm Hg) was 14.8% (n=481). Multivariate logistic regression analysis on pooled data from the five cities, after adjustment for age, showed that age (odds ratio 1.16), body mass index (1.68) and obesity were strongly associated with hypertension. A sedentary lifestyle and salt intake were weakly associated and alcohol intake was not a factor with these women.
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Case Reports
Postpartum myocardial infarction rescued with an intraaortic balloon pump and extracorporeal membrane oxygenator.
A 37-year-old woman had postpartum myocardial infarction complicated with cardiogenic shock. The infarction was attributed to diffuse coronary artery spasm caused by methylergonovine, which had been used to treat the postpartum haemorrhage due to placenta increta. The haemodynamics could not be maintained with catecholamine infusion and intraaortic balloon counterpulsation. At last, an extracorporeal membrane oxygenator was used to save her life, and the patient was successfully weaned from the machine 100 h later; she made an uneventful recovery thereafter.
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Comparative Study Clinical Trial
Comparative evaluation of transthoracic and transesophageal echocardiography in detection of left atrial thrombus before percutaneous transvenous mitral commissurotomy. Do all patients need transesophageal examination?
We postulated that the sensitivity of transthoracic echocardiography in detection of left atrial cavity or appendage thrombi is better in south-east asian patients with rheumatic mitral stenosis. This was considering that these patients are generally younger, have lesser body weight and thinner chest walls resulting in better transthoracic echogenecity than their western counterparts. We prospectively performed transthoracic and transoesophageal echocardiography in 150 consecutive Indian patients (mean age 28.8+/-7.2 years; 78 men) being evaluated for percutaneous transvenous mitral commissurotomy. ⋯ The sensitivity rose to 83% when patients with poor echogenecity were excluded. Amongst patients with good echogenecity (81% patients) the diagnosis of left atrial thrombi was correctly made or suspected on transthoracic examination in all patients subsequently shown to have thrombi on transoesophageal echocardiography. Significant savings in cost may be safely achieved by limiting transoesophageal echocardiography to patients in whom left atrial cavity or appendage is not adequately visualized on transthoracic examination due to poor echogenecity, or in whom there are shadows suggestive but not diagnostic of thrombi.