Articles: function.
-
Cardiovascular CasesSESSION TYPE: Case ReportsPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMINTRODUCTION: Primary cardiac tumors are extremely rare with a prevalence of 0.02% in pooled autopsy studies. Lymphomas involving the heart have a prevalence between 1% to 2% of primary cardiac tumors. Diagnosis usually requires tissue biopsy either by open surgical tissue resection or image-guided biopsy. We report a case of a patient who found to have a primary cardiac T-cell lymphoma (PCTCL) of the right atrium (RA) diagnosed by biopsy guided by intracardiac echocardiography (ICE). (1, 2)CASE PRESENTATION: A 66-year-old woman who presented with a 2 month history of progressive shortness of breath and orthopnea. Her ejection fraction decreased from 65% to 35% over a 4 year period. Coronary computed tomography angiography (CTA) revealed normal coronary arteries and a RA mass vs thrombus (Fig 1). A cardiac MRI with contrast was performed and the characteristic of the mass was suggestive of a lymphoma (Fig 2). Patient subsequently underwent percutaneous transcatheter biopsy of the RA mass using fluoroscopic and ICE guidance. Pathologic specimens demonstrated a T-cell lymphoma. ⋯ Patients with PCTCL typically remain asymptomatic until the mass leads to either obstruction of circulation, embolization, interference with valve function, decreased myocardial contractility or conduction disturbances. Histological diagnosis is made by biopsy and typically requires an open-chest procedure under general anesthesia. Transcatheter biopsy with transesophageal echocardiography guidance also requires general anesthesia. However, ICE imaging allows transcatheter biopsy of an intracardiac mass, especially of the right atrium. This can be made under direct visualization with conscious sedation, minimizing the risk for perforation. (3)CONCLUSIONS: Intracardiac mass biopsy using ICE is an attractive modality which provides precise localization of cardiac structures under conscious sedation. This case illustrates successful use of imaging to minimize risk in the assessment of a cardiac mass.Reference #1: Reynen K. Frequency of primary tumors of the heart. Am J Cardiol 1996;77:107-10.Reference #2: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of12,485 consecutive autopsies. Arch Pathol Lab Med 1993;117:1027-31.Reference #3: Kuppahally S.,Litwin S. Endomyocardial Biopsy of Right Atrial Angiosarcoma Guided by Intracardiac Echocardiography. Cardiology Research and Practice Volume 2010, Article ID 681726DISCLOSURE: The following authors have nothing to disclose: Ahmed Al-Badri, Sean Wilson, Chad Klinger, Carlos RuizNo Product/Research Disclosure Information.
-
Physiology/PFTs/Rehabilitation PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Heavy metal exposure may contribute to increased oxidative stress and inflammation in the lungs, resulting in tissue destruction manifesting clinically as obstructive lung disease (OLD). We aimed to evaluate the association of serum lead and cadmium concentration with lung function and prevalence of OLD. ⋯ The following authors have nothing to disclose: Ah Young Leem, Song Yee Kim, Eun Young Kim, Kyung Soo Jung, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Ji Ye JungNo Product/Research Disclosure Information.
-
Critical Care Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Diffuse alveolar hemorrhage (DAH) is associated with negative pressure pulmonary edema secondary to acute upper airway obstruction. There have been no associations with the upper airway obstruction of obstructive sleep apnea. Negative intrathoracic pressure leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. We present a case of DAH in a patient on anticoagulation with positive anti-cardiolipin antibody and low level anti-dsDNA triggered by severe obstructive sleep apnea. ⋯ The following authors have nothing to disclose: Sadaf Mir, Silviana Marineci, Mary O'SullivanNo Product/Research Disclosure Information.
-
Cardiovascular Case Report Posters ISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: For regional anesthesia, lidocaine bupivacaine combination is popular due to the advantage of quick onset action of lidocaine and longer duration of action of bupivacaine. Although a safe procedure, toxicity from local anesthetics can result from local absorption and/or inadvertent direct IV injection. Direct cardiac toxic effects of local anesthetics involve arrhythmias and/or direct myocardial injury/ suppression. A recent study showed that bupivacaine induce mitochondrial swelling in myocarium with resultant negative inotropic effects. Bupivacaine in high doses or unintentional intravascular injection may lead to high plasma levels and related depression of the myocardium, heart block, hypotension, bradycardia, ventricular arrhythmias, and cardiac arrest. There is very limited echocardiographic and ventriculographic evidence of bupivacaine induced cardiac dysfunction. ⋯ This case describes inverted takotsubo cardiomyopathy as a mechanism for bupivacaine induced cardiac suppression and demonstrates the need for increased awareness of the rare but serious cardiotoxic effects of bupivacaine when used for nerve blocks.Reference #1: Coyle DE et el Anesth Analg. 1994 Aug; 79(2):335-339DISCLOSURE: The following authors have nothing to disclose: Martinus Dyrud, Rakesh Gupta, Rumi KhanNo Product/Research Disclosure Information.