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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration. Her medical history only included some episodes of bronchitis and no history of hypertension. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle-branch block. Laboratory tests, including cardiac troponin I, were within normal reference values. Chest radiography showed no significant pulmonary alterations and revealed in mediastinum a huge abnormal shadow overlapping the right heart compatible with a gastric bubble.The gastroscopy confirmed a large HH. A 2-dimensional transthoracic echocardiogram, using all standard and modified apical and parasternal views, revealed an echolucent mass, compatible with HH, compressing the right atrium. Also, it showed an altered left ventricular relaxation and a mild increase of pulmonary artery pressure (35 mm Hg). Spirometry showed a mild obstruction of the small airways, whereas coronary angiography showed normal coronary arteries. We concluded that the patient's symptomatology was related to the compressive effects of the large hiatal ernia, a neglected cause of cardiorespiratory symptoms. The surgical repair of HH was indicated.
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PMID:Large hiatal hernia at chest radiography in a woman with cardiorespiratory symptoms. 2263 6

Thoracoscopy - Looking into the thoracic cavity was first described in 1910 by the Swedish physician, Jacobeus. He used a cystoscope intrapleuraly in order to diagnose pleural diseases. He also used his method for cutting adhesions in order to achieve collapse of the lung in patients with tuberculosis of the lung. Thoracic sympathicotomy was first performed by Kotzareff in 1920. The operation was found to be effective for treatment of palmar hyperhidrosis. Different open techniques for sympathicotomy have since been described, the most common being the dorsal approach by Cloward in 1969. Sympathicotomy was found to be effective not only for palmar, but also axillar hyperhidrosis, vascular insufficiency of the arm and hand, causalgia and angina pectoris (Lindgren 1950). However, the operation using the open technique was difficult and, though effective, not many patients were prepared to meet the demands for problems such as hyperhidrosis. Therefore, the operation became rather common. In the middle of the 1940's, several attempts were made to make the sympathicotomy through thoracoscopic approach and in 1951, Kux described a large number of patients treated in this way for many different diseases such as duodenal ulcer, diabetes mellitus, as well as the generally accepted indications. He published his experiences in a book; but for some obscure reason, his technique did not achieve general acceptance. In the late 1970's and the 1980's, the principle was again taken up by different centers (Byrnes, et. al.). I will describe here a technique which can be regarded as a simplification of previous methods. The technique was elaborated in our department and the first operation was performed in 1987 (Claes, et. al.). By June 1993, six hundred and seventy operations have been carried out.
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PMID:Thoracoscopic sympathicotomy. 2595 45

Acute fulminant myocarditis is a life-threatening inflammatory disease of the myocardium characterized by the rapid deterioration of the hemodynamic status of the affected individual. With prompt recognition and appropriate management, complete recovery of ventricular function is likely within a few weeks. We introduce a 28-year-old man with acute fulminant myocarditis, who experienced circulatory collapse following acute angina and dyspnea. The patient had high troponin levels with low ejection fraction and normal coronary arteries. He was successfully bridged to recovery with a left ventricular assist device but was complicated by flail mitral valve. Perioperative myocardial biopsy was also compatible with myocarditis. At 4 months' follow-up, the patient was stable with functional capacity I according to the New York Heart Association's classification. A possible mechanism for this very rare complication is the rupture of the chordal structure secondary to the fragility of an inflamed subvalvular apparatus stretched by a recovered ventricle.
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PMID:Acute Fulminant Myocarditis Successfully Bridged to Recovery with Left Ventricular Assist Device and Complicated by Flail Mitral Valve. 2740 89


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