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1.
Pacing Clin Electrophysiol ; 38(3): 295-6, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25599594

ABSTRACT

Transseptal catheterization is required for atrial fibrillation ablation and many ablations for atrial tachycardias, left atrial flutters, and accessory pathways. Using a Brockenbrough needle or other specialized device adds time, expense, and risk of potential complications such as atrial or aortic perforation, pericardial effusion, and tamponade to these procedures. We present a simple, low-risk technique for transseptal catheterization.


Subject(s)
Accessory Atrioventricular Bundle/surgery , Atrial Fibrillation/surgery , Atrial Flutter/surgery , Cardiac Catheterization/methods , Catheter Ablation , Heart Septum/surgery , Accessory Atrioventricular Bundle/physiopathology , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/physiopathology , Atrial Flutter/physiopathology , Female , Humans , Male , Middle Aged , Time Factors , Treatment Outcome
2.
J Nucl Med ; 49(5): 746-51, 2008 May.
Article in English | MEDLINE | ID: mdl-18413386

ABSTRACT

UNLABELLED: Morbidity and mortality increase when diastolic dysfunction accompanies coronary artery disease (CAD). An elevated stress (201)Tl lung-to-heart ratio (LHR) is a traditional marker of elevated left ventricular end-diastolic pressure (LVEDP), which adds prognostic value in CAD. Since the introduction of (99m)Tc-labeled agents, this valuable marker has been lost. Hence, there is only a limited ability to assess diastolic dysfunction by myocardial perfusion imaging (MPI). METHODS: Fifty-two consecutive patients with an ejection fraction of >or=45% underwent MPI and cardiac catheterization within 15 d. Peak filling rate (PFR), time to PFR (TPFR), and filling rate during the first third of diastole (1/3FR) were obtained from MPI with SPECT software. Resting (201)Tl LHR was calculated manually, and LVEDP was obtained at catheterization. RESULTS: PFR, TPFR, and 1/3FR correlated significantly with LVEDP (r= -0.53, 0.45, and -0.45, respectively; P=0.00005, 0.0009, and 0.0009, respectively), whereas resting (201)Tl LHR did not (r=0.10, P=0.49). Receiver-operating-characteristic curve analysis of PFR, TPFR, and 1/3FR for detecting LVEDPs of >or=18 mm Hg showed areas under the curve of 0.83, 0.75, and 0.80, respectively. The combination of PFR and 1/3FR showed a negative predictive value of 84%, a positive predictive value of 86%, and a specificity of 94%. CONCLUSION: Diastolic filling variables obtained with the SPECT software showed a significant correlation with LVEDP. PFR, TPFR, and 1/3FR were superior to resting (201)Tl LHR and showed good sensitivity, specificity, and predictive power for detecting LVEDPs of >or=18 mm Hg. Hence, combining data on the presence of perfusion defects with data on diastolic impairments can be achieved by adding these variables to MPI results.


Subject(s)
Blood Circulation , Blood Pressure , Cardiac Catheterization/methods , Heart/diagnostic imaging , Heart/physiology , Ventricular Function, Left , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , ROC Curve , Rest/physiology , Thallium Radioisotopes , Tomography, Emission-Computed, Single-Photon
3.
Am Heart J ; 155(5): 924-9, 2008 May.
Article in English | MEDLINE | ID: mdl-18440343

ABSTRACT

BACKGROUND: Several modalities to diagnose diastolic dysfunction by transthoracic echocardiography (TTE) exist. We compared the ratio of early mitral filling velocity (E) to early diastolic velocity by tissue Doppler imaging at the medial (E/E'm) and the lateral (E/E'l) mitral annulus and developed a model to diagnose elevated left ventricular end-diastolic pressure (LVEDP). METHODS: Sixty patients underwent same-day cardiac catheterization and TTE. Left ventricular end-diastolic pressure was recorded in addition to TTE data, including left atrial area (LAA), E/E'm, and E/E'l. An LVEDP >15 mm Hg was considered to be elevated and diagnostic of diastolic dysfunction. RESULTS: E/E'm had a significantly higher correlation (r = 0.68, P < .001) than did E/E'l (r = 0.46, P < .001). By univariate analysis, LAA >18.75 cm(2), E/E'l >11.2, and E/E'm >15.75 were found to be significant predictors of high LV filling pressure. By multivariate binary logistic regression model analysis, only E/E'm and LAA were independent predictors of LVEDP >15 mm Hg. The presence of 1 variable had a sensitivity of 95% and a specificity of 43.4%, whereas the presence of 2 variables had a sensitivity of 76.2% and a specificity of 100%. CONCLUSIONS: Use of a diagnostic model based on easily derived measurements such as E/E'm and LAA was a powerful noninvasive diagnostic modality for elevated LVEDP. Measurement of the mitral annulus velocity by tissue Doppler imaging at the medial aspect of the mitral valve appeared to be superior to that at the lateral aspect.


Subject(s)
Blood Pressure/physiology , Mitral Valve/diagnostic imaging , Ultrasonics , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Pressure/physiology , Adult , Aged , Aged, 80 and over , Blood Flow Velocity , Cardiac Catheterization , Diastole/physiology , Female , Humans , Male , Middle Aged , Sensitivity and Specificity , Ultrasonography , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left/physiology
4.
Am J Med Sci ; 335(2): 151-3, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18277126

ABSTRACT

Several techniques exist for surgical reimplantation of the coronary arteries to a composite aortic graft for repair of the ascending aorta. The Cabrol graft is an attachment of a Dacron tube between the coronary arteries and the composite aortic graft in aortic root replacement. Very late presentation of myocardial ischemia related to the Cabrol conduit graft is exceedingly rare. We report a rare and late development of angina due to a dysfunctional Cabrol conduit, which was successfully cured with coronary bypass grafting. Knowledge of this technique is vital for the accurate interpretation of coronary angiograms and CT scan findings and crucial for the treatment planning in patients who have had previous implantation of the Cabrol graft.


Subject(s)
Angina Pectoris/diagnostic imaging , Angina Pectoris/etiology , Blood Vessel Prosthesis/adverse effects , Polyethylene Terephthalates/adverse effects , Adult , Angina Pectoris/surgery , Aorta/surgery , Aortic Valve/surgery , Coronary Angiography , Coronary Artery Bypass , Coronary Vessels/surgery , Female , Humans , Tomography, X-Ray Computed
5.
South Med J ; 100(10): 1006-14; quiz 1004, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17943047

ABSTRACT

Pharmacologic stress agents (dipyridamole, adenosine and dobutamine) allow virtually all patients to be safely assessed for ischemic heart disease. These agents have mild but significant side effects, mandating a thorough knowledge of indications, contraindications, side effects and management before their use. Adjunctive exercise improves image quality in vasodilator pharmacologic myocardial perfusion imaging. Diabetics, especially women, have a much higher cardiac event rate than nondiabetics for an equal amount of ischemia. They also have a higher incidence of asymptomatic ischemia. There is growing support for screening with myocardial perfusion imaging (MPI) for asymptomatic ischemia in diabetics. The ability of MPI to identify hypocontractile but viable myocardium, thus predicting improvement in myocardial function after revascularization, is one of the most powerful uses of the modality. Vasodilator MPI should be used as the initial test in patients with left bundle branch block or paced ventricular rhythm, even if they are able to exercise.


Subject(s)
Coronary Circulation/physiology , Diagnostic Imaging , Exercise Test/methods , Vasodilator Agents , Diabetes Complications , Humans , Myocardial Contraction/physiology , Myocardial Ischemia/diagnosis
6.
Chemotherapy ; 53(5): 316-9, 2007.
Article in English | MEDLINE | ID: mdl-17713324

ABSTRACT

Constrictive bronchiolitis (CB) is a rare disease with unclear etiology. We report a 37-year-old female with CB who developed progressive dyspnea and cough after completing a course of 5-fluorouracil (5-FU) for colon cancer. The patient had evidence of irreversible obstructive lung disease and lung biopsy showed typical findings of chronic inflammation, submucosal thickening and obliteration of bronchioles. To the best of our knowledge this is the first reported case of CB after treatment with 5-FU.


Subject(s)
Bronchiolitis/complications , Bronchiolitis/pathology , Colonic Neoplasms/drug therapy , Colonic Neoplasms/pathology , Fluorouracil/therapeutic use , Adult , Colonic Neoplasms/complications , Female , Humans , Tomography Scanners, X-Ray Computed
7.
J Invasive Cardiol ; 18(9): E241-3, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16954590

ABSTRACT

Single coronary ostium is a very rare congenital anomaly with an incidence of 0.024% in angiographic series. This is the third case of Shirani-Roberts subtype IB4: solitary ostium in the left coronary sinus associated with a retroaortic-coursing right coronary artery that arises from the left main coronary artery. The patient is a 45-year-old male with no past medical history, and who was seen in the clinic for evaluation of a murmur. Echocardiography showed rheumatic heart disease with mild mitral regurgitation and moderate aortic regurgitation; no shunts were present. Coronary and aortic root angiography did not show a vessel originating from the right coronary cusp. The right coronary artery originated from the left main coronary artery and had an aberrant course which was dorsal to the ascending aorta. No associated congenital heart disease was present.


Subject(s)
Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/pathology , Coronary Angiography , Echocardiography , Echocardiography, Transesophageal , Humans , Incidence , Male , Middle Aged
8.
Am J Med Sci ; 332(2): 103-105, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16909061

ABSTRACT

BACKGROUND: Nontraumatic rhabdomyolysis has been associated with alcohol and drug abuse, seizures, strenuous exercise, muscle hypoperfusion, hyperthermia, electrolyte disturbances, diabetic coma, and hypothyroidism. Hyperthyroidism can be associated with several neuromuscular manifestations, such as thyrotoxic myopathy and thyrotoxic periodic paralysis, both associated with weakness and normal creatine phosphokinase levels. There have been only three reported cases of rhabdomyolysis as a result of thyrotoxicosis. We are reporting the fourth case of such association. CASE REPORT: The patient is a 26-year-old black woman with history of hypertension. She presented to the clinic with blurred vision, headaches, palpitations, weight loss, weakness, and persistent high blood pressure. She was found to have exophthalmus, lid lag, and a symmetric, smooth, and diffuse goiter. Ptosis and diplopia were absent; neurologic examination findings was normal. The patient had positive TPO antibodies, elevated free T4 level, and low thyroid-stimulating hormone (TSH) level. Graves disease was diagnosed and propylthiouracil was prescribed. The patient then returned to the clinic 2 weeks later with weakness and myalgias. Her physical examination findings were unchanged except for mild muscle weakness. Laboratory evaluation showed normal electrolytes, normal renal function, and negative urine drug screening. Creatine phosphokinase was 1276 U/L. Her free T4 and T3 levels were elevated and TSH level was low. The patient was treated with aggressive oral fluid resuscitation. Propylthiouracil was continued and free T4 and T3 normalized along with creatine phosphokinase with resolution of symptoms. CONCLUSIONS: Hyperthyroidism may, theoretically, cause rhabdomyolysis by means of increasing energy consumption associated with depletion of muscle energy stores and substrates. Our patient constitutes the fourth reported case of rhabdomyolysis associated with hyperthyroidism.


Subject(s)
Graves Disease/complications , Rhabdomyolysis/etiology , Adult , Antithyroid Agents/administration & dosage , Female , Graves Disease/blood , Graves Disease/diagnosis , Graves Disease/diet therapy , Humans , Propylthiouracil/administration & dosage , Remission Induction , Resuscitation/methods , Rhabdomyolysis/blood , Rhabdomyolysis/diagnosis , Rhabdomyolysis/drug therapy
9.
Am J Cardiol ; 98(1): 70-4, 2006 Jul 01.
Article in English | MEDLINE | ID: mdl-16784924

ABSTRACT

Accumulating evidence has shown a strong association between the metabolic syndrome (MS) and a chronic inflammatory state predisposing to atherosclerosis. We investigated leukocyte, platelet, and endothelial activation markers and cellular interactions in 33 patients with the MS and 25 healthy controls. Using flow cytometry, we measured: (1)P-selectin expression in platelets; (2) platelet microparticles identified by CD31 expression; (3) endothelial microparticles (EMPs) identified by expression of CD31 (EMP(31)), CD62E (EMP(62E)), and CD51 (EMP(51)); (4) conjugates of leukocytes with platelet microparticles/platelets and with EMPs identified by CD54 (EMP(54)); and (5) CD11b expression in leukocytes. Patients with the MS had markedly elevated EMP(31), although EMP(62E) levels were normal, suggesting that EMP(31) levels were increased because of endothelial cell apoptosis, rather than activation. EMP(51), EMP(54)-lymphocyte conjugates, platelet expression of P-selectin, CD11b expression in leukocytes, and platelet-lymphocyte conjugates were also increased in patients with the MS. Platelet-leukocyte conjugates correlated with leukocyte activation, suggesting that platelet binding to leukocytes regulates leukocyte activation in vivo. In conclusion, our data demonstrate endothelial cell microparticle release, platelet and leukocyte activation, and increased binding of EMPs and platelets to leukocytes in patients with the MS.


Subject(s)
Blood Platelets/metabolism , Endothelium, Vascular/chemistry , Leukocytes/metabolism , Metabolic Syndrome/blood , Metabolic Syndrome/physiopathology , Biomarkers/blood , CD11b Antigen/analysis , Case-Control Studies , Female , Flow Cytometry , Humans , Integrin alphaV/analysis , Integrin beta3/analysis , Intercellular Adhesion Molecule-1/analysis , Male , Middle Aged , P-Selectin/blood , Platelet Activation , Receptors, IgG/analysis
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