Cerebral embolism due to a retained pacemaker lead: a case report.

There are only a few reported cases of a pacemaker lead migrating inadvertently into the left atrium or ventricle. An unusual complication of unremoved, unwanted pacemaker lead is presented. The free tip of the lead caused cerebral embolism after perforating the interatrial septum.

[Cerebral embolism caused by a right ventricular pacemaker electrode perforated into the left atrium]. / Cerebralis emboliát okozó, bal pitvarba áthatoló jobb kamrai pacemaker elektróda.

The authors present a new, unusual side effect due to retained pacemaker lead. The free tip of the lead caused cerebral embolism by perforating the interatrial septum. Transoesophageal echocardiographic study showed the lead crossing the interatrial septum. The total abnormal course of the lead was demonstrated by lateral X-ray picture. Diagnostic and therapeutic approaches regarding retained leads in malposition are also discussed.

The treatment of septicemia in pacemaker patients.

The authors analyzed the data of seven patients who had undergone open heart surgery because of pacemaker endocarditis in the past 4 years. Repeated surgical interventions on the pacemaker system were found to be the most common predisposing factors. Staphylococcus aureus and Staphylococcus epidermidis were the most common causative organisms. Two-dimensional echocardiography was important in the diagnosis of cases with atypical clinical picture and negative blood cultures. We concluded that: (1) any pacemaker patient with fever should be considered to have a pacemaker endocarditis; (2) all of these patients should be examined by two-dimensional echocardiography; and (3) the total removal of the infected hardware seems to be the only way to achieve complete recovery.

[Echocardiographic diagnosis of intermittent failure of a mitral valve prosthesis]. / Intermittáló mitralis mübillentyü "beragadás" echocardiographiás diagnózisa.

Three cases are reported who had intermittent diastolic jamming of a mitral tilting disc valve. The clinical presentation of this unfrequent but catastrophic early postoperative complication was different in all cases: the first patient presented with heart failure, the third patient had loss of consciousness with enuresis and the second patient was asymptomatic at the time of the diagnosis. Electromechanical dissociation was first suspected by clinical examination in 2 cases but it was confirmed in all 3 cases by 2 dimensional and Doppler echocardiography. Transesophageal echocardiography did not provide any additional information. Besides opening failure of the valve Doppler echocardiography also demonstrated incomplete or delayed opening in the asymptomatic period. Survival is dependent on correct diagnosis and urgent surgical treatment of this type of prosthetic valve dysfunction.

[The role of two-dimensional echocardiography in the detection of pacemaker-induced endocarditis]. / A kétdimenziós echocardiographia szerepe a pacemaker endocarditis kimutatásában.

UNLABELLED: The authors analysed the data of eight patients who had to undergo open heart surgery because of pacemaker endocarditis in the last four years. Repeated surgical interventions on the pacemaker system was the most predisposing factor. The most common causative organisms were Staphylococcus aureus and Staphylococcus epidermidis. Two-dimensional echocardiography (2DE) had a decision making role in the diagnosis beside the clinical picture and blood culture. CONCLUSIONS: 1. Each pacemaker patient with fever must be considered to have a pacemaker endocarditis; 2. All these patients must be examined by two-dimensional echocardiography.

[Cardiac and cardiopulmonary changes in systemic lupus erythematosus]. / A systemás lupus erythematosus cardialis és cardiopulmonalis elváltozásai.

(SLE) One hundred patients suffering from systemic lupus erythematosus (SLE) were examined by clinical, non invasive cardiological, radiological and laboratory methods. Valve diseases were revealed by M-mode echocardiographic examination in 17 patients. 14 patients had various conduction disturbances. Out of the remaining 83 patients not having any valve disease, systolic dysfunction of the myocardium was detectable in 17 persons and pericardial effusion in 3 persons. Spirometric alterations have been found in 64 persons and cor pulmonale has been diagnosed in 8 persons.

Comparative study on the short-term effects of angiotensin converting enzyme inhibitors (Lopirin, SQUIBB and Tensiomin), and dihydralazine in chronic cardiac failure.

The authors have compared the short-term effect of two captopril (ACE inhibitor) preparations namely the Lopirin (SQUIBB) and Tensiomin (EGIS) and dihydralazine as well as placebo in 15 patients with severe heart failure (NYHA III-IV, class). In case of 8 patients with NYHA IV, functional class the short-term effect of the combined therapy of dihydralazine and Lopirin and dihydralazine and Tensiomin as well dihydralazine and placebo have been compared. The underlying disease was dilated cardiomyopathy (DCM) and ischaemic heart disease (IHD). At the end of the treatment with different drugs and placebo the clinical signs of heart failure (complaints and physical status) and the echo and mechanocardiographic parameters of left ventricular function were assessed. The parameters, apart from the clinical signs, have been evaluated in double blind fashion. Compared to placebo all the three drugs i.e. dihydralazine, Lopirin as well as Tensiomin have decreased significantly the NYHA classes, influenced favorably the non-invasive parameters of left ventricular function and decreased blood pressure. As to the dihydralazine, it improved the left ventricular ejection function and the clinical state of the patients with DCM in a higher degree than the two ACE inhibitors did. The effect of Tensiomin and Lopirin was the same in every respect. Both have influenced more favourable the complaints and physical state of patients with IHD than dihydralazine has. The left ventricular filling pressure, the double product (heart rate x wall tension) indicating the myocardial oxygen demand were more reduced in their effect than in that of dihydralazine. Unlike dihydralazine both decreased the heart rate. Administering one of the two ACE inhibitors to the dihydralazine beneficial additive effects have been experienced; the NYHA classes, the heart rate, the left ventricular wall tension and the double product diminished. The authors, on the bases of the results, consider Tensiomin and Lopirin as equivalent in their effect. In their opinion the administration of these drugs mean a new, efficient way of therapy, first of all in cases of heart failure caused by IHD. In the most severe cases they suggest a trial with the combined dihydralazine-ACE inhibitor therapy.

Cardiac and cardiopulmonary disorders in patients with ankylosing spondylitis and rheumatoid arthritis.

One hundred patients suffering from ankylosing spondylitis (AS) and one hundred patients suffering from rheumatoid arthritis (RA) were examined by clinical, non-invasive cardiological, radiological and laboratory methods to determine the prevalence of their cardiac and cardiopulmonary disorders. Fourteen patients with AS and 24 patients with RA had several valvular abnormalities. Among the patients not having any valvular abnormality, systolic dysfunction of the myocardium was detectable in 15 and 11 cases respectively, and cor pulmonale was diagnosed in 16 and 7 cases respectively. Conduction disturbances were demonstrated in 17 patients suffering from AS and in 14 patients suffering from RA.

Non-invasive assessment of elevated ventricular diastolic pressures in patients with ischaemic heart disease.

For non-invasive assessment of the diastolic pressures of both ventricles, 50 patients with ischaemic heart disease were studied by combined mechano- and echocardiography. Twenty one patients had pulmonary congestion, eleven had acute mitral regurgitation and 18 had signs of left and right heart failure. All patients had undergone cardiac catheterization. The diastolic parts of apexcardiograms (left and right ACG) and the morphological alterations of mitral and tricuspid valve echograms were analysed. Using the invasive and non-invasive data of three groups a non-invasive diastolic pressure scale for both ventricles could be construed.