International journal of cardiology
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Review Case Reports
Pulmonary wedge aspiration cytology in the diagnosis of recurrent tumour embolism causing pulmonary arterial hypertension.
Recurrent subacute pulmonary embolism leading to pulmonary arterial hypertension is an uncommon presentation of malignancy. We describe one such patient who presented to us with features of pre-capillary pulmonary arterial hypertension. A novel yet simple technique, involving pulmonary wedge aspiration cytology, provided the tissue diagnosis of trophoblastic malignancy, thus enabling prompt institution of chemotherapy and consequent impressive clinical improvement. This technique appears to be a hitherto unreported indication for intravascular catheterisation in the diagnostic work up of pulmonary arterial hypertension.
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Comparative Study
Determinants of survival after rodent cardiac arrest: implications for therapy with adrenergic agents.
Coronary perfusion pressure and its relation with the expired carbon dioxide concentration (end-tidal CO2) was examined in a rodent model of sustained ventricular fibrillation and subsequent cardiopulmonary resuscitation. Equipressor dosages of the pure alpha 1-agonist methoxamine, the mixed alpha/beta-agonists epinephrine and norepinephrine were randomly compared with 0.9% NaCl. Thirty two Sprague-Dawley rats were anesthetized and catheters were advanced into the aorta, right ventricle, right atrium and inferior vena cava. ⋯ Resuscitation success was determined by coronary perfusion and mean aortic pressures generated during cardiopulmonary resuscitation but not by arterial or venous blood gases. Adrenergic agents increased coronary perfusion and mean aortic pressures but decreased end-tidal CO2 which failed to correlate with these pressures. Accordingly, alpha-adrenergic agents mitigated the accuracy of end-tidal CO2 as a non-invasive hemodynamic monitor and predictor of survival after rodent cardiopulmonary resuscitation.
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A 26-year-old female was involved in a car accident with impaction of the steering wheel to the anterior chest. She became unconscious immediately. ⋯ At operation, a right atrial tear measuring 1 cm in length was noted and was repaired with cardiorrhaphy. She recovered uneventfully.
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Review Case Reports
Pre-hospital cardiac arrest associated with coronary artery spasm.
A 37-yr-old woman with an 8-month history of chest pain, unrelated to exercise, was successfully resuscitated from out-of-hospital cardiac arrest due to ventricular fibrillation. Cardiac catheterisation revealed minor coronary artery disease. Ergometrine injection was associated with complete occlusion of the left anterior descending coronary associated with identical chest pain and pronounced ST-segment changes.
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We present a 3-yr-old girl with coarctation of aorta and patent ductus arteriosus in whom mycotic aneurysm and bacterial endarteritis developed postoperatively and was diagnosed by two-dimensional and Doppler echocardiography. Five weeks after the operation of ligation of ductus and resection of coarctated segment, the patient was readmitted with complaints of vomiting, fever and coughing. ⋯ The patient died, most probably due to aortic rupture, before surgical treatment could be undertaken. Autopsy study confirmed our diagnosis.