RESUMO
Simultaneous tricuspid and aortic valve endocarditis can occur, although rarely, in patients without any predisposing factors for endocarditis and without the presence of an aortic sinus rupture, most probably via the presence of bacteremia for a prolonged period, like the patient presented in this case report who had suffered from a recurrent fever for several weeks which had not been investigated nor treated till the person was admitted to the hospital with both pulmonary and systemic septic emboli
RESUMO
Purpose: The T wave in precordial lead V1 is normally inverted in normal adults. The significance of an upright T wave in precordial lead V1 as to the presence of coronary artery disease is controversial and not well studied in the literature. Our purpose is to show the relation between an upright T wave in V1 and the presence of coronary artery disease and specifically that of the circumflex
Material and methods: We studied, retrospectively, 624 consecutive patients referred for cardiac catheterization with normal electrocardiograms excluding patients with acute coronary syndromes, bundle branch blocks, left ventricular hypertrophy, intraventricular conduction delays, pacemakers, ST-T changes, significant valvular heart disease, cardiomyopathies and metabolic disorders. Significant coronary artery stenosis was considered when the stenosis was > 70%; normal or nonsignificant coronary artery stenosis was considered when the coronary stenosis was < 70% [all patients had < 50% coronary stenosis]. The ECG's and coronary arteriographies were reviewed. The 2x2 chi-square was used for statistical analysis
Results: Out of the 624 patients, 380 [60.89%] had normal coronary arteries out of which only 17 [4.47%] had an upright T wave in V1, 244 [39.11%] had significant coronary artery disease out of which 137 [56.14%] had positive T wave in V1, significantly more than the normal population with a p value < 0.0001. A total of 142 patients had significant circumflex stenosis out of whom 128 [90.1%] had a positive T wave in V1; a total of 482 patients had no significant circumflex stenosis, out of whom only 26 [5.39%] had a positive T wave in V1, the difference was highly significant with a p value < 0.00001 as to the presence of a T upright in V1 in patients with significant circumflex stenosis. This significance was maintained when excluding the patients with diabetis mellitus
Conclusion: An upright T wave in V1 is significantly related to the presence of significant coronary artery stenosis and specifically the circumflex coronary artery
RESUMO
Primary cardiac tumors are rare but potentially fatal. No studies have discussed this issue yet on the national level. We describe the epidemiology of cardiac tumors in adults in Lebanon. The data were taken from the hospitals, the patients and/or their doctors by means of a questionnaire. Fifty-seven cases of cardiac tumors were found, mainly myxomas in the left atrium. Dyspnea was the most frequent symptom. Transthoracic echocardiography was the main diagnostic tool. Transesophageal echocardiography was inconstantly made, scanner and MRI rarely while contrast echocardiography has never been used. Almost half of the patients had a follow-up and none had a familial screening. The collected data urged us to propose a unique and homogenous strategy for diagnosis, treatment and follow-up of cardiac tumors in Lebanon