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Cardiology Research Dec 2015Aneurysmal dilatation of segment of the left ventricle in the absence of coronary disease has been reported and termed diverticulum, which appears to be a congenital...
Aneurysmal dilatation of segment of the left ventricle in the absence of coronary disease has been reported and termed diverticulum, which appears to be a congenital anomaly. A 56-year-old white female was admitted to our hospital with chest pain that has been intermittent over the past 1 month. The pain was described as exertional, substernal and pressure-like in quality, radiating to left arm and jaw, and lasting approximately 30 minutes each episode; it was associated with shortness of breath. She has had approximately 10 such episodes in the past 1 month. The patient denied any dizziness, palpitations, syncope, orthopnea or paroxysmal nocturnal dyspnea (PND). She has had a history of hypertension for many years, however has not been compliant with her medications for the past 6 months. On admission, vital signs revealed blood pressure of 185/100 mm Hg, and regular heart rate of 94 beats per minute. Physical examination revealed a normal body habitus. Cardiac examination revealed no murmurs or extra cardiac sounds on auscultation. The pulmonary and abdomen examinations were unremarkable. The chest radiograph was normal. The electrocardiogram showed sinus rhythm, with borderline prolongation of the QT interval. The laboratory test results, including cardiac enzymes, were normal. Transthoracic echocardiography (TTE) revealed normal left ventricular systolic function, with localized dyskinesis of the apex. No significant valvular abnormalities were identified. Coronary angiography revealed angiographically normal coronary arteries; left ventriculography showed abnormal apical "filling defect" consistent with an aneurysm. A repeat echocardiogram using Definity contrast revealed left ventricular apical diverticulum with hypertrabeculation. The patient was placed on antihypertensive medications with resolution of her chest pain, and was able to ambulate comfortably. The patient was counseled thoroughly on the importance of compliance with her medications. This case describes an apical left ventricular diverticulum found incidentally and demonstrated on contrast echocardiography in a patient with chest pain.
PubMed: 28197257
DOI: 10.14740/cr442e -
Pneumonologia I Alergologia Polska 2015A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found....
A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found. Echocardiography revealed narrowing of pulmonary artery with high pressure gradient. Computed tomography of the chest revealed the presence of large tumour localised in the upper anterior mediastinum. Due to the risk of total closure of the pulmonary artery, interventional mediastinotomy was performed and diagnosis of carcinoma embryonale was established. Subsequent chemotherapy (BEP regimen) has brought regression of tumour and significant improvement in haemodynamic parameters (relief of pressure gradient in pulmonary artery). During the second surgery, the resection of all accessible tumour mass together with marginal resection of the right upper lobe was performed. No signs of cardiac or great vessels infiltration was found. Histopathologic examination revealed the necrotic masses and neoplastic foci diagnosed as teratoma immaturum. In a four-month follow-up the patient's condition remained good. The patient is still under the care of both oncological and cardiological specialists. Thus far he has not required further chemotherapy. Holter ECG monitoring revealed no arrhythmia, but the patient is still treated with mexiletine. The patient is planning to return to work.
Topics: Adult; Anti-Arrhythmia Agents; Carcinoma, Embryonal; Echocardiography; Heart Murmurs; Humans; Male; Mediastinal Neoplasms; Mediastinum; Mexiletine; Stenosis, Pulmonary Artery; Tomography, X-Ray Computed
PubMed: 25754058
DOI: 10.5603/PiAP.2015.0024 -
Tidsskrift For Den Norske Laegeforening... Feb 2024Ventricular septal rupture (VSR) following acute myocardial infarction is rare in the modern revascularisation era. Nevertheless, clinical awareness is paramount, as...
BACKGROUND
Ventricular septal rupture (VSR) following acute myocardial infarction is rare in the modern revascularisation era. Nevertheless, clinical awareness is paramount, as presentation may vary.
CASE PRESENTATION
A middle-aged male with no history of cardiovascular disease developed progressive heart failure symptoms while travelling abroad. Initial workup revealed a prominent systolic murmur, but findings were inconsistent with acute coronary syndrome. Transthoracic echocardiogram showed a small hypokinetic area in the basal septum, preserved left ventricular function and no significant valvulopathy. Despite the absence of chest pain, an invasive angiography revealed occlusion of a septal branch emerging from the left anterior descending artery, otherwise patent coronary arteries. Despite administration of diuretics, the patient remained symptomatic and presented two months later to his primary care provider with a persisting systolic murmur. He was subsequently referred to the outpatient cardiology clinic where echocardiography revealed a large VSR involving the basal anteroseptum of the left ventricle with a significant left-to-right shunt. After accurate radiological and haemodynamic assessment of the defect, he successfully underwent elective surgical repair.
INTERPRETATION
Although traditionally associated with large transmural myocardial infarctions, VSR may arise also from minor, subclinical events. A new-onset murmur is a valuable hint for the alert clinician.
Topics: Humans; Male; Middle Aged; Systolic Murmurs; Myocardial Infarction; Ventricular Septal Rupture; Echocardiography; Dyspnea
PubMed: 38349103
DOI: 10.4045/tidsskr.23.0373 -
The Eurasian Journal of Medicine Jun 2018Extrinsic pulmonary artery stenosis caused by anterior mediastinum teratoma presenting with an ejection systolic murmur is a rare phenomenon. Till date, 15 cases have...
Extrinsic pulmonary artery stenosis caused by anterior mediastinum teratoma presenting with an ejection systolic murmur is a rare phenomenon. Till date, 15 cases have been reported (inclusive of this case) in the English literatures. Herein we report a 20 year old female with extrinsic pulmonary artery stenosis because of compression by an anterior mediastinal teratoma with a loud ejection systolic murmur. The case report aims to highlight the awareness of such rare presentation of anterior mediastinal teratomas that may mimic congenital valvular heart diseases among clinicians.
PubMed: 30002584
DOI: 10.5152/eurasianjmed.2018.17388 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Dec 2017The patient, a 43-year-old man, had paroxysmal headache three months ago, and he had complained the left occipital sharp pain, which could be alleviated by itself, with...
The patient, a 43-year-old man, had paroxysmal headache three months ago, and he had complained the left occipital sharp pain, which could be alleviated by itself, with alalia and the right side of the upper limb numbness. Head computed tomography (CT) revealed a left temporal lobe intraparenchymal hemorrhage with the left side of the subarachnoid hemorrhage in small quantities. Digital subtraction angiography (DSA) revealed a suspicious aneurysm on the left internal carotid artery siphon. He had intermittent fever 1 month ago, with maximum body temperature 39 °C. He suffered headache again 20 days ago, with pain nature, duration and the way of easing up similar to the earlier onset. General examination demonstrated 2/6 grade blowing systolic murmurs at apex area. Neurological examination revealed that Babinski's sign was positive on the right side. Echocardiographic found an anterior mitral valve ve-getation on the 4th day in hospital. So his clinical diagnosis was infective endocarditis with cerebral embolism. He received vancomycin treatment immediately. His three blood cultures remained negative in hospital. His blood specimens were sent to Chinese Center for Disease Control and Prevention, indirect immunofluorescence method (IFA) IgG antibody detection revealed that the Bartonella henselae IgG antibody was positive. Therefore the clinical diagnosis was Bartonella endocarditis complicated with subarachnoid hemorrhage and cerebral embolism. Bartonella, an intracellular fastidious, gram-negative bacilli, was first documented as a cause of endocarditis in 1993 and since then has been increasingly recognized as an important etiology of infective culture-negative endocarditis. In cases of documented Bartonella endocarditis, the Infectious Diseases Society of America (IDSA) guidelines recommended 2 weeks of gentamicin plus 6 weeks of doxycycline treatment, to achieve a higher cure rate.
Topics: Adult; Bartonella Infections; Blood Culture; Endocarditis, Bacterial; Humans; Male; Subarachnoid Hemorrhage
PubMed: 29263486
DOI: No ID Found -
Australasian Journal of Ultrasound in... May 2019To assess right ventricular systolic time intervals, specifically, time to peak velocity (TPV) in the pulmonary artery as a marker of persistent pulmonary hypertension...
PURPOSE
To assess right ventricular systolic time intervals, specifically, time to peak velocity (TPV) in the pulmonary artery as a marker of persistent pulmonary hypertension of the newborn (PPHTN).
METHODS
This was a retrospective case-control study of 30 infants with pulmonary hypertension requiring intensive care management. Cardiac ultrasounds were re-analysed, comparing TPV measurements to a group of 31 controls who had cardiac ultrasounds performed for incidental murmurs with structurally normal hearts.
RESULTS
Time to peak velocity was significantly shorter in the PPHTN group compared to controls, 47 vs. 95 ms, respectively. This was statistically significant with a P-value of <0.001.
CONCLUSION
Time to peak velocity in the pulmonary artery is a useful marker of PPHTN in the first week of life. This measurement is especially useful if neither tricuspid regurgitation or a patent ductus are present for interrogation on ultrasound.
PubMed: 34760546
DOI: 10.1002/ajum.12120 -
Indian Heart Journal 2015
Topics: Adult; Cardiac Surgical Procedures; Double Outlet Right Ventricle; Echocardiography, Doppler; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Magnetic Resonance Imaging, Cine; Male; Systolic Murmurs
PubMed: 26432742
DOI: 10.1016/j.ihj.2015.06.017 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2015A descending aorta to vertebral venous plexus fistula is an extremely rare form of arteriovenous fistula. A 10-month-old infant was referred to the hospital for...
A descending aorta to vertebral venous plexus fistula is an extremely rare form of arteriovenous fistula. A 10-month-old infant was referred to the hospital for evaluation of a murmur. On examination, a continuous murmur was heard in the entire back. Transthoracic echocardiography revealed left heart chamber dilatation in the presence of preserved left ventricle systolic function. Computerized tomography angiography with 3-dimensional reconstruction, and lateral projection aortography revealed a descending aorta-vertebral venous plexus fistula measuring 4.8 mm in the aortic orifice. The fistula was embolized using an Amplatzer Vascular Plug 2.
Topics: Aorta, Thoracic; Arteriovenous Fistula; Balloon Occlusion; Coronary Angiography; Echocardiography; Embolization, Therapeutic; Heart Murmurs; Humans; Infant; Male; Septal Occluder Device
PubMed: 26363751
DOI: 10.5543/tkda.2015.72317