ABSTRACT
Coronary artery embolization has been associated with sudden cardiac death. It is more commonly seen with aortic valve endocarditis. It manifests as acute myocardial ischemia or infarction, causing instability of the cardiac rhythm, which may be fatal. We report a patient with aortic valve endocarditis who had sudden cardiac death following coronary angiography. Autopsy revealed embolic occlusion of the left main coronary artery.
Subject(s)
Aortic Valve/microbiology , Cardiac Catheterization/adverse effects , Coronary Thrombosis/etiology , Endocarditis, Bacterial/complications , Streptococcal Infections/complications , Aortic Valve/pathology , Autopsy , Coronary Angiography , Coronary Thrombosis/diagnosis , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnosis , Fatal Outcome , Humans , Kidney Failure, Chronic/surgery , Kidney Transplantation , Male , Middle Aged , Streptococcal Infections/diagnosisABSTRACT
Although heart failure is a common clinical syndrome, especially in the elderly, its diagnosis is often missed. A detailed clinical history is crucial and should address not only current signs and symptoms of heart failure but also signs and symptoms that point to a specific cause of the syndrome, such as coronary artery disease, hypertension or valvular heart disease. It is important to determine whether the patient has had a previous cardiac event, in particular a myocardial infarction. The physical examination should include Valsalva's maneuver, a test that is highly specific and sensitive for the detection of left ventricular systolic and diastolic dysfunction in patients with heart failure. An electrocardiograph and a chest radiograph should also be obtained. Two-dimensional echocardiography of the heart helps differentiate systolic from diastolic dysfunction. Coronary angiography is indicated in patients with heart failure and anginal chest pain and should be strongly considered in patients with an electrocardiogram suggestive of ischemia or myocardial infarction.
Subject(s)
Heart Failure/diagnosis , Heart Failure/etiology , Algorithms , Coronary Angiography , Decision Trees , Diagnosis, Differential , Echocardiography , Heart Failure/blood , Heart Failure/classification , Humans , Severity of Illness Index , Valsalva Maneuver , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/etiologyABSTRACT
Patent ductus arteriosus (PDA) is a form of congenital heart disease uncommonly diagnosed in adult patients. Transcatheter closure of PDA has been widely used in children. However, the experience is limited in adults especially with use of Gianturco coils. The authors describe a case of successful transcatheter closure of a PDA, incidentally diagnosed in a 41-year-old woman, by successively deploying two coils by a transarterial approach. No residual shunting was seen angiographically after the procedure. A literature review of similar procedures in adult patients is discussed.
