ABSTRACT
OBJECTIVES: Intrapulmonary vascular abnormalities resulting in right-to-left shunt have been described in patients with severe liver disease, especially advanced hepatic cirrhosis. They result in hypoxemia which is associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Since Rydell and Hoffbauer first described intrapulmonary shunt in a cirrhotic patient in 1956, it has been reported recently that 13 to 47 percent of the end-stage hepatic disease patients have these intrapulmonary vascular abnormalities. Contrast echocardiography(CE) has been proved useful in detecting intrapulmonary shunt. The aim of the study is to determine the prevalence of intrapulmonary shunt by CE in patients with hepatic cirrhosis, and to compare the clinical characteristics of those with and without evidence of intrapulmonary shunt. METHODS: We performed CE studies in 24 stable cirrhotic patients without the evidence of severe complications such as massive ascites, upper GI bleeding, and hepatic coma. Clinical information including symptom and sign, results of liver and pulmonary function tests, and arterial blood gas values measured both at the supine and erect position, were analyzed in each group of patients with or without intrapulmonary shunt. RESULTS: Positive CE suggesting intrapulmonary shunt was found in 8 of 24 patients(33.3%). However the degree of relative opacifications were one positive(1+) in all 8 patients, and hypoxemia and its related symptom and sign appeared to be rare. Any of the parameters of liver and pulmonary function test did not show the significant difference between CE-positive and CE-negative group. CONCLUSION: Only the presence of spider angioma was associated with intrapulmonary shunt among the several clinical signs, which suggests common pathogenesis of both vascular abnormalities.
Subject(s)
Humans , Hypoxia , Ascites , Echocardiography , Hemangioma , Hemorrhage , Hepatic Encephalopathy , Liver Cirrhosis , Liver Diseases , Liver , Lung Diseases , Prevalence , Respiratory Function Tests , SpidersABSTRACT
The provocation test of variant angina are known as ergonovine test, hyperventilation, acetylcholine, exercise and cold pressor test, but beta-blocker provocation test has not been reported as a case. So, this paper reports on the diagnosis of variant angina by beta-blocker provocation test and the case of subendocardial infarcion induced by this test. This study reports with literature and investigation about the following case : A 45-year-old man with a history of recurrent episode of typical angina on the early morning for the past 20 days. He was administrated beta-blocker given by oral route, and on the next morning there was chest pain as same degree as before, Holter EKG displayed ST segment elevation and ventricular tachycardia. It was confirmed focal spasm on coronary angiography, ST segment elevation on EKG, and newly developed hypokinesia on left ventriculogram and followed-up echocardiagraphy. When the chest pain is absent, EGK was normal. And we confirmed that elevation of cardiac enzyme was absent as a result of serial follow up study.
Subject(s)
Humans , Middle Aged , Acetylcholine , Chest Pain , Coronary Angiography , Diagnosis , Electrocardiography , Ergonovine , Follow-Up Studies , Hyperventilation , Hypokinesia , Infarction , Spasm , Tachycardia, VentricularABSTRACT
No abstract available.
Subject(s)
Humans , Pericardial Effusion , Pericardial Window Techniques , Renal DialysisABSTRACT
The high prevalence of migraine. Raynaud's phenomenon, visual field defect and Crohn's disease in variant angina raises the possibility that a common underlying defect of mechanism may partially account for all conditions. These are generalized vascular smooth muscle hypercontractility syndromes. Recently high prevalence of esophageal motility disorders has been noted in patients with coronary artery spasm or microvascular angina, leading to the hypothesis of a generalized abnormality in smooth muscle function1,4,5). We expirienced a case of 55-year-old man with angiographically proven variant angina. Who showed reflux esophagitis, classic migraine and Raynaud's disease.
Subject(s)
Humans , Middle Aged , Coronary Vessels , Crohn Disease , Esophageal Motility Disorders , Esophagitis, Peptic , Microvascular Angina , Migraine Disorders , Migraine with Aura , Muscle, Smooth , Muscle, Smooth, Vascular , Prevalence , Raynaud Disease , Spasm , Visual FieldsABSTRACT
Typically, patients afflicted with syndrome X complained of stress induced angina pectoris, and their electrocardiograms show corresponding ST-segment depressions during exercise. However, angiography is unable to demonstrate significant coronary artery luminal narrowing and significant coronary artery spasm to provocation test. And left ventricular performance at rest remains remarkably unimpaired. Syndrome X is characterized by reduction of coronary vascular reserve but without depression of left ventricular performance or negative effect on survival. The reduction of coronary vascular response is supposed to be resulted from reduced coronary vasodilator reponse due to abnormal contraction of coronary prearteriolar vessels. This case is a 43-year-old female who has had exertional chest pain since 5 months ago. The chest pain was relieved by rest and subligual nitroglycerin administration. The exercise electrocardiography showed significant ST segment depressions on lead II, III aVF and V4-V6 at stage 1, when she experienced chest pain. On 24 hour ambulatory electrocardiogram, significant ST segment depression was recorded at the time when the patient had chest pain. But coronary arteriography demonstrated normal coronary artery and no significant coronary artery spasm to provocation test with ergonovine maleate. On exercise thallium-201 scintigraphy, perfusion decrease was suspected on anterolateral wall of left ventricle. The patient was diagnosed as a syndrome X and was managed with isosorbide and nifedipine and her exercise tolerance increased significantly on follow up exercise test performed 1 month later. But she has complained of a few of attack of chest pain until now.