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.

Effect of Eicosapentaenoic Acid on Endothelial Cell-U937 Cell Adhesion

BACKGROUND: Epidemiological studies have shown correlation between low incidence of coronary heart disease and high consumption of fish products. It has been suggested that this may be due to the high content of polyunsaturated fatty acids of the n-3 fatty acid group in fish oil. In animal studies eicosapentaenoic acid (EPA) inhibited attachment of monocytes to the arterial endothelium. METHOD: Adhesion assay was performed on the endothelial cells of the human umbilical vein with 25, 50, 100, 200 micrometer EPA-treated U937 cells. The endothelial cells were activated with lipopoysaccharide (LPS). The adhesion assay was repeated with oxidized EPA. EPA was oxidized with CuSO4 and ascorbic acid. RESULT:Viability of U937 cells were not affected by concentrations up to 200 micrometer of EPA and oxidized EPA. LPS treatment of endothelium notably increased the number of U937 cells attached to endothelial cells on the adhesion assay. However, treatment of EPA, native or oxidized, to U937 cells did not affect the number of U937 cells attached to LPS activated endothelial cells. CONCLUSION: EPA treatment, native or oxidized, of U937 cells did not affect U937 cell-endothelial cell adhesion. This suggests that inhibition of monocyte-endothelial cells attachment by EPA is not due to the effects of EPA on monocytes.

LV Mass and Left Ventricular Systolic Function After Antihypertensive Theraphy

BACKGROUND: Left ventricular hypertrophy is one of independent predictors of cardiovascular mortality and morbidity. Many studies have shown that the left ventricular hypertrophy could be regressed with the anti-hypertensive therapy. This study was designed to clarify that the left ventricular hypertrophy could be regressed with the anti-hypertensive therapy. METHOD: Thirty six patients with essential hypertension were studied and patients with coronary heart disease, valvular heart disease, or secondary hypertension were excluded. Echocardiographic measurements were obtained at the start of anti-hypertensive therapy and followed up after 6 months of therapy or later. Used anti-hypertensive agents were calcium channel blockers, Angiotensin converting enzyme inhibitors, beta blockers or diuratics, alone or combined. RESULT: The results can be summareid as follows. 1) Mean initial blood pressure was 158/100mmHg and significantly fell to 135/83 after anti-hypertensive therapy. 2) Mean LV mass was also markedly reduced from 302 grams to 255 grams. 3) Fractional shortening and ejection fraction were increased from 33% to 36% and from 68% to 73% respectively. CONCLUSION: These results suggest that antihypertensive therapy could reduce left ventricular hypertrophy and improve left ventricular systolic function.

On-Line Assessment of Left Ventricular Cavity Area and Function by Automatic Border Detection Echocardiography

BACKGROUND: Assessment of left ventricular function with conventional 2-dimensional echocardiography (2D echo) remains largely qualitative and subjective because the manual tracing of endocardial borders is laborious and tedious. An automatic border detection (ABD) echo has been recently developed that permits real-time measurements of chamber areas and cardiac function. METHODS: To determine usefulness of ABD echo, left ventricular cross-sectional areas were automatically measured from the parasternal short-axis image in 25 cases including 9 cardiac patients, and compared with those by off-line analysis of the conventional 2D echo image. RESULTS: In on-line ABD analysis, short axis end-diastolic area averaged 13.1+/-2.2cm2, end-systolic area 5.3+/-1.3cm2 and fractional area change 59.4+/-9.0% and off-line manual analysis yielded corresponding values of 14.7+/-2.5cm2, 6.2+/-1.3cm2, and 57.1+/-7.1%. The end-diastolic and end-systolic areas by both methods were significantly different, respectively. Left ventricular end-diastolic and end-systolic area and fractional area change obtained from ABD echo correlated significantly with those of off-line measurements(r=0.897, p<0.001 ; r=0.505, p<0.01 ; r=0.427, p<0.05). CONCLUSION: Thus, these facts suggest that ABD echo is useful for on-line continuous measurement of chamber areas and cardiac function.

Relation between left artrial size and atrial fibrillation in rheumatic mitral stenosis

No abstract available.