International journal of cardiology
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A man with congestive heart failure, atrial fibrillation and increasing dyspnoea on exertion was shown to have a large right atrial thrombus and multiple pulmonary emboli. The patient was anticoagulated and a subsequent echocardiogram showed that the thrombus was no longer present. This report demonstrates the need for echocardiography in patients presenting with pulmonary emboli and questions the value of anticoagulation in patients with intracavitary thrombi.
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Case Reports
Echocardiographic demonstration of resolving intrapericardial mass in tuberculous pericardial effusion.
A patient with tuberculous pericardial effusion is described who presented with cardiac tamponade. Subsequent to pericardiocentesis, a large echodense intrapericardial mass was observed which disappeared completely with antituberculous chemotherapy. The resolution of the mass suggests that it was a conglomeration of fibrinous exudates deposited in the pericardial cavity. Presence of such exudates should not be considered an indication for surgical intervention.
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Cardiac arrest has been reported in patients with mitral valve prolapse; however, clinical characteristics and survival information are limited since most of the cases reported include autopsy data. Nine patients (2 male, 7 female) with mitral valve prolapse were identified who had cardiac arrest; ventricular fibrillation was documented in 8 patients; resuscitation was unsuccessful in 2. Eight had a history of palpitations (months to 15 years duration) and ventricular arrhythmias, 3 had a history (5-15 years) of recurrent syncope, and 1 was totally asymptomatic. ⋯ All 9 patients had auscultatory and echocardiographic evidence of mitral valve prolapse. Seven survivors (6 still alive) were followed from 3 to 14 years after cardiac arrest. A subset of patients with mitral valve prolapse and cardiac arrest is described in whom past medical history is compatible with cardiac arrhythmias or syncope, and whose long-term prognosis appears better than patients with other causes of cardiac arrest.
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Comparative Study
Similarities and differences between the epidemiology and possible dietary causes of coronary arterial disease and strokes.
The findings of a previous statistical study of the relationship between food consumption and mortality from coronary arterial disease are compared with those of a new study of food consumption and cerebrovascular disease. The previous study found strong positive correlation between male mortality from coronary arterial disease and the consumption of two food items, milk and oats. Stroke mortality appears to be linked with the consumption of a wide variety of proteinaceous plants. ⋯ The relative effect of the two groups of proteins is of the order of 6/1, but the proteins with a relatively mild effect are consumed in large quantities in comparison with those having a strong effect so that their effect is not negligible. The correlation coefficient between male cerebrovascular mortality in the younger age groups and the combined consumption of the two groups of plant proteins is 0.91. That between male mortality from coronary arterial disease and the consumption of milk and oats found in the previous study was 0.94.
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The influence of echocardiography on pre-operative cardiac catheterization was assessed in a retrospective analysis comparing two 12-month periods. Of 245 operations in 1983, 200 (82%) had pre-operative cardiac catheterization when two-dimensional echocardiography only was used in the pre-operative assessment compared to 162 of 238 (68%) operations in July 1985-June 1986 when pulsed Doppler echocardiography also was used (P less than 0.001). ⋯ Echocardiogram diagnostic errors occurred in 22/245 (9%) in 1983 compared to 9/238 (4%) in 1985/86 (P less than 0.05). Echocardiography has resulted in a significant reduction in pre-operative cardiac catheterization and has become more accurate in diagnosis.