Severe hypoxemia in a patient with acute myocardial infarction.

A case report of a patient with acute myocardial infarction and severe hypoxemia due to acute right to left interatrial shunt (RLIAS) is presented. Diagnostic and therapeutic procedures are discussed.

Drug-related cardiac iatrogenic illness as the cause for admission to the intensive cardiac care unit.

BACKGROUND: Iatrogenic illness, defined as a disease that results from a diagnostic procedure or from any form of therapy, is a well-recognized phenomenon in clinical practice. OBJECTIVES: To study and evaluate major cardiac iatrogenic disease as the cause of admission to the intensive cardiac care unit in the modern era. METHODS: We assessed 64 critically ill patients suffering from major cardiac iatrogenic problems among a total of 2,559 patients admitted to the intensive cardiac care unit during 3 years. Iatrogenic illness was defined as any problem that resulted from therapy. Only cardiac problems were included in the study. Complications of interventional cardiovascular procedures, suicide attempts or accidental intoxications were excluded. RESULTS: There was evidence of a major cardiac iatrogenic problem as the cause for admission in 64 patients (2.5%): 58 (91%) suffered from arrhythmias (mainly bradyarrhythmias) secondary to beta-blockers, amiodarone, calcium antagonists, electrolyte imbalance or a combination, and 6 (9%) had non-arrhythmic events (hypotension, syncope or acute heart failure). In 41 patients (64%) the iatrogenic event was considered preventable. CONCLUSIONS: Major cardiac iatrogenic complications are an important factor among patients admitted to the intensive cardiac care unit. Most of the events are bradyarrhythmias related to anti-arrhythmic agents. Almost two-thirds of events are preventable.

Diffuse alveolar hemorrhage following thrombolytic therapy for acute myocardial infarction.

We describe a 66-year-old patient with hemoptysis, a drop in hematocrit, hypoxemia and new bilateral alveolar infiltrates after receiving streptokinase for acute myocardial infarction. Markedly increased carbon monoxide diffusion capacity suggested a diagnosis of alveolar hemorrhage. Underlying conditions included congestive heart failure. The patient recovered uneventfully within 7 days of conservative treatment. Alveolar hemorrhage is a rare and often unrecognized life-threatening complication of thrombolytic therapy. Particular attention should be paid to the pulmonary status of patients with congestive heart failure scheduled to receive thrombolytic therapy.

[Myocardial contractile function of the left ventricle in the early stage of alcoholic heart lesion]. / Sokratitel'naia funktsiia miokarda levogo zheludochka na rannem étape alkogol'nogo porazheniia serdtsa.

An echocardiographic study of 72 chronic alcoholic patients showing no cardiomegaly or heart failure demonstrated an impairment of local septal contractility in 44 (61.1%) patients, left ventricular posterior wall contractility in 35 (48.6%) and left ventricular pumping function in 21 (29.1%). Left cavity was dilated in 11 (13.8%) patients. These changes were more marked and frequent in cases of long years of alcohol abuse.

[Central hemodynamic function of neurocirculatory dystonia patients at rest and during the performance of load tests]. / Sostoianie tsentral'noi gemodinamiki u bol'nykh neirotsirkuliatornoi distoniei v pokoe i pri provedenii testov s nagruzkoi.

Central hemodynamic (CH) parameters were examined in 288 patients with neurocirculatory dystonia (NCD) and 50 normal subjects, using radiocardiography (RCG), echocardiography (EchoCG) and heart catheterization thermodilution (TD). All the tests were carried out at rest and during bicycle ergometry (BEM), the atrial stimulation test (AST) and the intravenous isadrin test (IT). Patients with severe NCD and basically hyperkinetic hemodynamic type responded to stress with an inadequate rise in the minute volume (MV) and a decline of the stroke index (SI). Thermodilution during the AST demonstrated increased MV, lowered end diastolic left-ventricular pressure and insignificantly reduced SI. TD and EchoCG during stress exposure produced similar results.

[Variants of the echocardiographic picture of chronic alcoholics in the early stages of the disease]. / Varianty ékhokardiograficheskoi kartiny u bol'nykh khronicheskim alkogolizmom na rannikh étapakh zabolevaniia.

An M-echocardiographic study of 72 young patients (mean age: 33.8 years) with second- or third-stage chronic alcoholism revealed asymmetric and symmetric left-ventricular hypertrophy and increased myocardial weight in a large proportion of the cases so that two echocardiographic patterns could be identified in patients with early chronic alcoholism.

[Hypertrophic cardiomyopathy: variants of the clinical picture]. / Gipertroficheskaia kardiomiopatiia: varianty klinicheskoi kartiny.

The authors describe a variety of the clinical manifestations of hypertrophic cardiomyopathy (HTCM) and identify the most frequent variants of its clinical picture, namely pseudocoronary, pseudorheumatic, dystonic. A number of symptoms and their combinations indicative of the presence of the HTCM are also described. The key role of echocardiography in the diagnosis of this disease was demonstrated. The syndrome of giant negative T waves was observed in 35% of the patients with the HTCM; this syndrome was shown to correlate with the predominance of hypertrophy in the apical area. A correlation was established between the echocardiographic signs of impairment of the diastolic pliability of the left ventricle and the presence of circulatory failure. The authors discuss the role of myocardial ischemia in the genesis of pains and ECG changes in patients with the HTCM as well as the significance of research into the myocardial metabolism in the diagnosis of myocardial ischemia in this category of patients.

[Clinical symptoms and the diagnosis of the hyperkinetic cardiac syndrome]. / Klinicheskaia simptomatika i diagnostika giperkineticheskogo kardial'nogo sindroma.

The authors examined 40 patients with the hyperkinetic syndrome (HS) who underwent thorough clinical and instrumental examination including ECG, PCG, bicycle ergometry, hyperventilation and orthostatic tests, and determination of the central hemodynamic indices by echocardiography and the rate heart indices in dopplercardiography. The great diagnostic possibilities of doppler-cardiography are demonstrated. The diagnostic criteria of HS are suggested and general recommendations for treatment are given.