ABSTRACT
Regardless of the improvements in the design of prosthetic heart valves and the use of anticoagulation, systemic embolism and valve thrombosis remains the most dreaded complications of mechanical heart valve replacement. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. The safety of thrombolysis in early pregnancy is not known. We describe a primigravida with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.
Subject(s)
Fibrinolytic Agents/administration & dosage , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis , Mitral Valve Stenosis/surgery , Pregnancy Complications, Cardiovascular/drug therapy , Streptokinase/administration & dosage , Thrombolytic Therapy , Thrombosis/drug therapy , Adult , Echocardiography, Doppler, Color , Female , Heart Valve Prosthesis Implantation/instrumentation , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/etiology , Thrombosis/diagnosis , Thrombosis/etiology , Treatment OutcomeABSTRACT
Bilateral coronary artery to pulmonary artery fistulas is an uncommon congenital anomaly. These fistulas have a clinical and embryological significance. We report a rare case of combination of right coronary and left circumflex coronary fistula draining into main pulmonary artery, who presented in the emergency room with acute pain chest. The fistula had significant 1.7:1 left to right shunt and also myocardial ischemia as demonstrated by exercise Thallium(201) SPECT myocardial imaging. He was managed conservatively during the last 5 years without any percutaneous or surgical intervention.
Subject(s)
Arterio-Arterial Fistula/complications , Myocardial Ischemia/etiology , Pulmonary Artery/diagnostic imaging , Arterio-Arterial Fistula/diagnostic imaging , Coronary Angiography , Coronary Vessels , Humans , Male , Middle Aged , Myocardial Ischemia/diagnostic imaging , Tomography, Emission-Computed, Single-PhotonABSTRACT
Paced rhythms can mask ECG changes of several conditions. ECG changes due to hyperkalemia during paced rhythm have not been well described. We report a patient with isolated noncompaction of left ventricle with left ventricular dysfunction and complete heart block on a permanent pacemaker who developed hyperkalemia. Typical ECG changes of hyperkalemia including widening of QRS complex and sine waves were seen even during paced rhythm that reverted with correction of hyperkalemia.
