A Case of Traumatic Acute Pericarditis Mimicking Acute Myocardial Infarction, Caused by Swallowing Fishhook

A patient, with severe chest pain and isolated ST segment elevation, was evaluated in order to differentiate ischemic heart disease, such as acute myocardial infarction. A fishhook was incidentally found during coronary angiography, chest CT and esophagoscopy. With this information, the patient was re-interviewed, and it was learned that the patient had swallowed the fishhook from cooked fish after fishing trip. The patient was diagnosed as traumatic acute pericarditis with acute mediastinitis, associated with esophageal and pericardial perforation. The patient was successfully treated by surgical treatment drainage and adequate antibiotic use. We report a case of traumatic acute pericarditis, which mimicked an acute myocardial infarction, with a review of the literature.

Clinical Characteristics of the Patients with Myocardial Rupture after Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Myocardial ruptures, including: ventricular free wall rupture (VFWR) and ventricular septal rupture (VSR), after acute myocardial infarction (AMI), are fatal complications. Recently, ubiquitous use of echocardiographs, and other imaging techniques, allows us to diagnose these complications in the antemortem period. Thus, this study retrospectively evaluated the clinical characteristics of patients with myocardial ruptures following AMI. SUBJECTS AND METHODS: 620 patients that had had AMIs, between January 1999 and June 2001, were analysed for the purpose of this study. Myocardial ruptures were diagnosed from their clinical symptoms, echocardiographs, and pericardiocenteses or cardiac catheterizations. The clinical characteristics of the patients with myocardial ruptures (n=15) were compared to those patients with myocardial infarction, without rupture (n=397), from their Q waves. RESULTS: The patients with myocardial ruptures were older than those without (67+/-9.7 years vs 60+/-11.7 years, p<0.05), and ruptures were more frequent in women (66.7% vs 25.2%, p<0.001). The frequency of systemic hypertension, DM, and the distribution of infarction sites were similar in both groups. Also, clinical characteristics between patients with VFWR, and those with VSR, were similar. Of the patients with VFWR (n=8), 7 suddenly died, and 1 was alive directly following surgery. Of the patients with VSR (n=7), 4 died. CONCLUSION: Myocardial rupture is a fatal complication of AMI, which is more frequent in women, and the patients with ruptures, in our study, were older than those without.

Left Ventricular Mass Measurement Using Tc-99m MIBI Myocardial Perfusion SPECT: Comparison with Echocardiographic Method

BACKGROUND AND OBJECTIVES: A left ventricular mass (LVM) can be used as a prognostic factor in patients with cardiovascular disease, and echocardiographic LVM measurements are most commonly used. We have measured LVM using quantitativel gated myocardial perfusion SPECT (QGS), and compared these results with LVM measured by echocardiography. SUBJECTS AND METHODS: One hundred and sixteen subjects (M/F=66/50, mean age: 58 yrs) underwent both rest QGS with Tc-99m MIBI and echocardiography. On visual interpretation, thirty-six subjects (31%) showed perfusion defects. The myocardial volume was obtained using the AutoQUANT program, and the LVM (LVMSPECT) was calculated by multiplying the volume by the specific gravity of the myocardium. We also measured the echocardiographic LVM (LVMEcho) by the Devereux formula, within one month of the LVMSPECT. RESULTS: The LVMSPECT and LVMEcho were well correlated (r=0.717, p<0.001), but a significant difference was noted between the two values. The mean difference between the LVMSPECT and LVMEcho was 24 g. The LVMEcho was smaller than the LVMSPECT in those subjects with a small LVMEcho, and greater than the LVMSPECT in the subjects with a large LVMEcho. The difference between the LVMEcho and LVMSPECT (LVMEcho-LVMSPECT) was positively correlated with the LVMEcho (r=0.893, p<0.001). CONCLUSION: The LVMs measured by gated myocardial perfusion SPECT and echocardiography were well correlated. But they were significantly different, especially in subjects with large LVMs.

Effect of a Meal on Cardiac Performance in Patients with Coronary Artcry Disease

BACKGROUND: It has been well recognized that exercise tolerance and angina threshold in patients with coronary artery disease (CAD) are reduced after a meal. But precise mechanism leading to the postprandial worsening of angina has yet to be adequately defined. This study was undertaken to determine the effect of a mixed meal on cardiac performance and heart rate variability (HRV) in patients with CAD. METHODS: 24 patients with angina or myocardial infarction were studied. Echocardiographic examination and heart rate variability test were performed in the fasting state and the other 40-60 minutes after a 600-800 kcal mixed meal. RESULTS: In the postprandial state, resting heart rate was significantly increased by 5.2% from 64.8+/-10.69 beats/min to 68.2+/-10.2 beats/min (p<0.01), stroke volume by 8.1% from 59.6+/-17.3 ml to 64.4+/-18.1 ml (p<0.01), cardiac output by 14.2% from 3.8+/-1.06 to 4.3+/-1.21 (p<0.01). E wave and A wave of mitral filling flow and E/A ratio were not significantly different in the fasting and postprandial tests. But DT and IVRT were significantly increased in the postprandial state (p<0.05, p<0.01 respectively). HRV was not different in the fasting and postprandial state. CONCLUSIONS: In patients with CAD, a 600-800 kcal mixed meal significantly increased resting heart rate, stroke volume, cardiac output, DT and IVRT.

Cor Triatriatum with Coronary Artery Disease in an Old Man: A Case Report / 대한흉부외과학회지

Cor triatriatum is a rare anomaly in old age. This is a case report of a 66 year-old man who had been preoperatively diagnosed as coronary artery disease and cor triatriatum. The operative findings revealed that the left atrium had an intra-atrial septum with one small opening 10mm in diameter, the upper compartment received both pulmonary veins, and there were no other anomalies like anormalous pulmonary venous connection or atrial septal defect. The patient successfully underwent open heart surgery ; the anomalous septum was resected, the mitral valve was reconstructed using French technique with Carpentier-Edwards ring, and coronary artery bypass grafting was performed.

Coronary Artery Dissection Secondary to Blunt Chest Trauma: A Case Report / 대한흉부외과학회지

A 27-year-old male presented with an anterior myocardial infarction following blunt chest trauma sustained in motorcycle accident. On examination, there was no visible wound on the chest wall. Echocardiogram showed dyskinesia over anterior left ventricular wall. Subsequent coronary angiogram demonstrated dissection at the proximal portion of the left anterior descending coronary artery and left ventriculogram showed apical anerysm and thrombus. He was treated by coronary artery bypass graft.