The Canadian journal of cardiology
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Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi. It is the most common reported vector-borne illness in the United States. The clinical course of Lyme disease is divided into early and late phases. ⋯ Disturbance of atrioventricular conduction is the most commonly recognized cardiac manifestation of Lyme disease. This is usually self-limited and does not require permanent cardiac pacing. A case of Lyme carditis with atrioventricular block requiring permanent pacing is reported and the indications for cardiac pacing in this disease are reviewed.
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Aortic ring abscess and mitral valve aneurysms complicating infective endocarditis have previously been described as surgical or autopsy findings. More recently, transesophageal echocardiography has been shown to be more sensitive than standard transthoracic echocardiography or other imaging modalities in detecting each of these complications. ⋯ This report describes a 35-year-old male with congenitally abnormal aortic valve which became infected and in whom both an aortic ring abscess and mitral valve aneurysm occurred. These findings are discussed and the pertinent literature is reviewed.
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Case Reports
Atypical retrograde atrial activation in 'typical' atrioventricular nodal reentrant tachycardia.
Atrioventricular nodal reentrant tachycardia (AVNRT) can be cured by radiofrequency catheter ablation by selective ablation of the slow or the fast pathway. Retrograde fast pathway ablation is performed anterosuperiorly at the apex of Koch's triangle, whereas slow pathway ablation is performed at the base of Koch's triangle near the coronary sinus ostium. ⋯ Loss of retrograde fast pathway conduction occurred after radiofrequency ablation at the base of Koch's triangle, suggesting an atypical location of the fast pathway. This supports recent evidence that the retrograde fast pathway may be located near the coronary sinus ostium in some patients with otherwise typical AVNRT.
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To examine the association among panic disorder, atypical chest pain and coronary artery disease (CAD). This article's purpose is to inform cardiologists of the prevalence of psychiatric disorders, primarily panic disorder, among patients consulting for chest pain. Panic disorder is described. Treatment modalities are summarized, and social, financial and medical consequences of nondetection are underlined. ⋯ Physicians should attend to the panic symptomatology and, when in doubt, refer possible panic patients with or without CAD to a mental health professional for assessment and treatment. Future panic prevalence studies in cardiology patients should be prospective, attempt to increase sample size and use randomized protocols where experimenters are blind to chest pain and medical diagnoses. Studies should also focus on CAD patients with atypical chest pain refractory to optimal cardiac therapy.
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To reduce surgical waiting lists at the University of Alberta Hospitals. A cost reduction program was initiated, allowing more cases to be performed on the same budget. Reducing the cost of delivering health care services has become necessary as demands upon the system increase. ⋯ Substantial cost savings can be made by changing practice patterns, without adverse consequences. ICU and hospital length of stay are the most important cost determinants.