ABSTRACT
The authors report a case where four novel strategies were successfully used in the management of advanced right ventricular failure with severe pulmonary hypertension and complex adult congenital heart disease. These included combination and optimisation of three advanced therapies for pulmonary hypertension, therapeutic abdominal paracentesis, correction of underlying metabolic/endocrine disturbance and a new inotropic agent.
Subject(s)
Hypertension, Pulmonary/complications , Hypertension, Pulmonary/therapy , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/therapy , Adult , Anti-Bacterial Agents/therapeutic use , Antihypertensive Agents/therapeutic use , Ascites/therapy , Cardiotonic Agents/therapeutic use , Combined Modality Therapy , Disease Progression , Drug Therapy, Combination , Echocardiography , Electrocardiography , Epoprostenol/therapeutic use , Female , Humans , Hydrazones/therapeutic use , Hypertension, Pulmonary/physiopathology , Paracentesis/methods , Pyridazines/therapeutic use , Simendan , Ventricular Dysfunction, Right/physiopathologyABSTRACT
It is becoming increasingly common to offer primary percutaneous coronary intervention as first line treatment for ST elevation myocardial infarction (STEMI). In a subset of patients presenting with suspected STEMI, coronary arteries appear normal at coronary angiography. In this article, the current literature of this group of patients is reviewed. The incidence of 'normal' angiography, the clinical and electrocardiographic features of this group of patients and the alternative diagnoses for presentation are discussed. This article reviews the factors leading to such presentation, the clinical characteristics of such patients and the implications, clinical and economic.