ABSTRACT
The serial changes in intraventricular pressure gradient in the left ventricle and NYHA functional classification in each case. Both the left intraventricular pressure gradient and symptoms improved after right ventricular pacing. In one case, the left intraventricular pressure gradient disappeared immediately after right ventricular pacing, while in the others it disappeared during the chronic phase, more than a year later.
ABSTRACT
During tachycardia, His-bundle potentials preceded Purkinje potentials. When the radiofrequency application was performed at a site where Purkinje potentials could be recorded slightly more peripherally than His-bundle potentials, tachycardia temporarily stopped, but was quickly followed by tachycardia with left-axis deviated because of the complication of the left anterior fascicular block.
ABSTRACT
A comparison between the three-dimensional contact mapping created by the Ensite system and that created by contrast-enhanced computed tomography angiography (CTA). Right atrial appendage was not well delineated on CTA.
ABSTRACT
This is a case of antidromic AVRT in a patient with unapparent preexcitation, and we could successfully diagnose and treat with the careful interpretation of wide QRS tachycardia. We should keep in mind that differentiation between intermittent and unapparent preexcitation is difficult, and some patients with unapparent preexcitation have short refractory periods of those accessory pathways, leading to sudden death.
ABSTRACT
BACKGROUND: Because of its side-effects, long-term administration of ticlopidine limits the use of the sirolimus-eluting stent (SES) in Japan. METHODS AND RESULTS: Side-effects of ticlopidine occurred in 41 (9.3%) of 440 patients who underwent SES implantation. The majority were liver dysfunction (4.5%) and rash (3.6%). One patient died from severe liver dysfunction. Neutropenia occurred in 3 patients (0.7%). It is remarkable that 28% of side-effects occurred >8 weeks after the initiation of ticlopidine. CONCLUSIONS: Ticlopidine has a relative high rate of side-effects. Clopidogrel should be approved for prevention of stent thrombosis as soon as possible.
Subject(s)
Coronary Thrombosis/prevention & control , Immunosuppressive Agents/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Sirolimus/administration & dosage , Stents , Ticlopidine/adverse effects , Aged , Blood Vessel Prosthesis Implantation/methods , Chemical and Drug Induced Liver Injury , Dose-Response Relationship, Drug , Drug Implants , Drug-Related Side Effects and Adverse Reactions , Exanthema/chemically induced , Female , Humans , Incidence , Japan , Male , Middle Aged , Retrospective StudiesABSTRACT
UNLABELLED: The clinical characteristics of reversible left ventricular dysfunction due to "takotsubo" cardiomyopathy have been described, but the origin of this condition remains unclear. This study investigated (123)I-metaiodobenzlguanidine ((123)I-MIBG) myocardial scintigraphy in patients with takotsubo cardiomyopathy. METHODS: Eight consecutive patients with takotsubo cardiomyopathy were studied. Left ventricular wall motion was monitored by echocardiography until wall motion normalized. (123)I-MIBG myocardial scintigrams were performed within 3 d of admission (0 mo) and after the improvement of left ventricular dysfunction (3 mo). Early images were obtained at 30 min after radioisotope injection and delayed images were obtained after 4 h. The heart-to-mediastinum ratio (H/M ratio) and the washout rate were calculated. RESULTS: The mean left ventricular ejection fraction improved significantly (from 42.8% +/- 8.7% to 66.5% +/- 7.9%; P < 0.0001) and normalized after 19.4 +/- 5.4 hospital days. The early H/M ratio was significantly higher than the late ratio at 0 mo (2.16 +/- 0.25 vs. 1.89 +/- 0.24, respectively; P < 0.05), but not at 3 mo. The washout rate was significantly greater at 0 mo than at 3 mo (39.1% +/- 10.2% vs. 25.4% +/- 6.3%, respectively; P < 0.05). CONCLUSION: In patients with takotsubo cardiomyopathy, initial (123)I-MIBG myocardial scintigraphy depicted a unique pattern of ventricular asynergy and indicated the existence of cardiac sympathetic hyperactivity, although coronary blood flow was maintained. These findings strongly suggest that takotsubo cardiomyopathy could be caused by neurogenic myocardial stunning.
Subject(s)
3-Iodobenzylguanidine , Cardiomyopathies/diagnostic imaging , Myocardial Stunning/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Cardiomyopathies/diagnosis , Female , Humans , Male , Myocardial Stunning/diagnosis , Radionuclide Imaging , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and Specificity , Syndrome , Ventricular Dysfunction, Left/diagnosisABSTRACT
A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Takotsubo cardiomyopathy was diagnosed on the basis of these characteristic findings. The creatine kinase and creatine kinase-MB concentrations were elevated at admission and reached maximum levels 6 hours after admission. The plasma level of brain natriuretic peptide was 10.7 pg/mL (reference range, <18.4 pg/mL) on the first hospital day. ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6 persisted at 72 hours after admission. On the third hospital day, sudden rupture of the left ventricle occurred, and despite extensive resuscitation efforts, the patient died. Takotsubo cardiomyopathy presents in a manner similar to that of acute myocardial infarction, but ventricular systolic function usually returns to normal within a few weeks. To our knowledge, this is the first reported case of fatal left ventricular rupture associated with takotsubo cardiomyopathy. We suggest that takotsubo cardiomyopathy may be a newly recognized cause of sudden cardiac death.
Subject(s)
Cardiomyopathies/complications , Heart Rupture/etiology , Aged , Fatal Outcome , Female , Heart Ventricles , HumansABSTRACT
A 64-year-old man was admitted due to hypokalemia-related myopathy. He was heavy drinker. He felt the stress of alcohol withdrawal during his hospitalization. The patient suffered a cardiopulmonary arrest lasting approximately 5 minutes on the fifth hospital day. One day later, ST-segment elevation was observed in leads I, aV(L), and V(2-6). Emergent cardiac catheterization was performed for suspicion of acute myocardial infarction. Normal coronary arteries with anterior akinesis of the left ventricle were revealed during the procedure. The present case may be an atypical form of "Takotsubo cardiomyopathy" in which the left ventricular contraction is due to focal anterior wall motion abnormalities.
Subject(s)
Cardiomyopathies/chemically induced , Cardiomyopathies/physiopathology , Ethanol/adverse effects , Substance Withdrawal Syndrome/complications , Ventricular Dysfunction, Left/physiopathology , Cardiomyopathies/complications , Coronary Angiography , Electrocardiography , Gated Blood-Pool Imaging , Humans , Male , Middle Aged , Ventricular Dysfunction, Left/complicationsABSTRACT
A 67-year-old female with recurrent syncope and no obvious heart disease developed ventricular dysfunction, known as takotsubo cardiomyopathy, following a 90 s episode of polymorphic ventricular tachycardia originating from a ventricular extrasystole with a short coupling interval. Cardiac catheterization performed 30 min after the arrhythmic event revealed angiographically normal coronary arteries, and left ventricular apical akinesis and basal hyperkinesis. An intracoronary injection of acetylcholine revealed no inducible coronary spasm, and an electrophysiological study revealed normal atrioventricular conduction and no inducible ventricular arrhythmia. Thirty hours after the arrhythmic event, electrocardiography revealed deeply inverted T waves in leads V3 to V6, I, and aVL, which continued for more than a week. Although no treatment was given to maintain hemodynamic stability, echocardiography revealed normal left ventricular contraction 14 days after the onset of the ventricular dysfunction. The reversible ventricular dysfunction might have been induced by altered catecholamine dynamics due to the persistent syncope during the occurrence of tachycardia.
Subject(s)
Cardiomyopathies/diagnosis , Tachycardia, Ventricular/diagnosis , Aged , Cardiac Catheterization , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/etiology , Diagnosis, Differential , Electrocardiography , Female , Humans , Syncope/etiology , Tachycardia, Ventricular/complications , Tachycardia, Ventricular/physiopathology , UltrasonographyABSTRACT
An 80-year-old female was admitted for a persistent consciousness disturbance. Electrocardiography revealed ST-segment elevation in leads II, III, aVf, and V3-V6. Coronary angiography demonstrated normal arteries, while left ventriculography revealed asynergy of apical akinesis and basal hyperkinesis. The creatinine kinase and creatinine kinase MB levels were not elevated after the initial measurement on admission. The diffuse ST-segment elevation reached a maximum level 24 hours after admission. In leads V3-V6, ST-segment elevation continued for 48 hours, and was followed-up by deep inverted T waves. Within 24 days, the asynergy improved without any specific treatment, but the giant negative T waves were present on the electrocardiogram. The plasma norepinephrine and brain natriuretic peptide levels on the first hospital day were 2.9ng/mL and 906pg/mL, respectively. The left ventricular dysfunction appeared to be induced by the exposure to high-level plasma catecholamines. (123)I-metaiodobenzyl guanidine scintigraphy also revealed transient dysfunction of the cardiac catecholamine dynamics.
