Acute renal infarction secondary to left ventricular thrombus, masquerading as a renal calculus--a case report and brief review of literature.

Acute embolic renal infarction is an entity that is often misdiagnosed as a renal calculus because of similar presenting symptoms. This leads to delay in the initiation of treatment and to increased morbidity. Few case reports exist relating cardiac emboli to acute renal infarction. The authors present a patient with a renal embolism secondary to left ventricular thrombus. A brief review of the literature highlighting the importance of clinical suspicion in making an accurate diagnosis, the utility of various diagnostic studies, and comparison of various treatment options is presented.

A randomized study of sheaths versus guidewires for arterial access during elective cardiac catheterization.

PURPOSE: The aim of this study was to compare the ease and safety of intravascular sheaths versus guidewires for maintaining arterial access during cardiac catheterization. METHODS: Two hundred patients with normal coagulation status undergoing routine diagnostic cardiac catheterization were randomized to intravascular sheath access versus guidewire access groups. Procedure times and difficulties were recorded during the procedure. Patients were asked to evaluate groin discomfort immediately after the procedure and two weeks later. Complications including groin hematoma, vascular damage, and stroke were assessed at the end of the procedure and the following morning. RESULTS: There were no differences between the sheath and guidewire groups in patient discomfort, procedural time or difficulty, or total complications. Hematomas occurred in 18% of patients (sheath 16% vs. guidewire 20%, p = NS) and were more often large in the guidewire group (5% vs. 0%, p = .05). None required vascular repair. Oozing around the catheter was more frequent in the guidewire group (6% vs. 0%, p = .03) but did not lead to any significant complications. CONCLUSIONS: We conclude that using guidewires for arterial access during cardiac catheterization leads to more large hematomas and more access site oozing during the procedure. However, there were no differences in patient comfort, overall procedural difficulty, or total complications between sheath and guidewire techniques.

Acute myocardial infarction complicating urokinase infusion for total saphenous vein graft occlusion.

Saphenous vein graft occlusions have been successfully treated with extended urokinase infusions. We report a case of myocardial infarction complicating this treatment. A review of reported cases suggests that this complication may not be uncommon. The optional drug, dose, and infusion technique for intra-graft lytic therapy has not been determined. The costs, risks, and difficulty of this technique may limit its application.

Adenosine: a clinical experience and comparison with verapamil for the termination of supraventricular tachycardias.

The efficacy and side-effects of adenosine for treatment of supraventricular arrhythmias were compared to verapamil therapy in patients presenting to the emergency room. Clinical variables and the time interval from the initiation of treatment to the termination of the supraventricular tachycardia, as well as the time from the initial effective dose of medication to the termination of supraventricular tachycardia were compared for adenosine and verapamil. Adenosine was given to a total of 44 patients, 16 patients in the electrophysiology laboratory, and 28 patients in the emergency room for evaluation and termination of their tachycardia. In the electrophysiology laboratory, 7 patients had AV node reentry, 5 had Wolff-Parkinson-White syndrome, 2 of whom had atrial flutter and fibrillation but no bypass tract reentry, 1 had concealed bypass tract reentry, 1 had Lown-Ganong-Levine syndrome, 1 had intraatrial reentry, and 1 had an automatic atrial tachycardia. Twenty-five patients received adenosine in the emergency room and 3 patients in the hospital for 31 episodes of supraventricular arrhythmias. In the emergency room, 11 patients had supraventricular tachycardia due to AV node reentry, 3 had Wolff-Parkinson-White syndrome, 6 had atrial flutter or intra-atrial re-entry, 2 had ventricular tachycardia, and 3 had sinus tachycardia. In the hospital, 2 patients had atrial flutter and one had sinus tachycardia. The group of 14 patients with supraventricular tachycardia due to Wolff-Parkinson-White syndrome or AV node reentry presenting in the emergency room were compared in a retrospective manner to the patients treated with standard verapamil therapy with respect to time from initiation of therapy to termination of supraventricular tachycardia and time from effective dose of medication to the termination of supraventricular tachycardia, as well as side-effects. There was no significant difference between the two groups with respect to clinical variables. Adenosine converted 18 of 18 episodes of supraventricular tachycardia in 14 patients 24.6 +/- 9.6 seconds from the administration of the effective dose (0.104 +/- 0.024 mg/kg) and a mean of 4.4 +/- 2.0 minutes from the initiation of therapy. Verapamil converted 29 of 32 episodes of supraventricular tachycardia in 20 patients, 10.9 +/- 7 minutes from the administration of the effective dose, and a mean of 16.8 +/- 20 minutes from the initiation of therapy using a mean of 8.4 +/- 3.4 mg of IV verapamil.(ABSTRACT TRUNCATED AT 400 WORDS)