Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Apical cardiomyopathy is rare in the West. The characteristic appearance on left ventriculography has been used to confirm the diagnosis of this condition; transthoracic echocardiography can also be useful in this regard. However, apical artifacts may obscure the typical appearance during echocardiography, and although the advent of tissue harmonic echocardiography has resulted in improved image quality, the technique still may be inadequate in the establishment of a diagnosis. We hypothesized that contrast echocardiography, which improves endocardial border delineation, may be the technique of choice for the diagnosis of apical hypertrophic cardiomyopathy. We report the case of a 40-year-old woman with Down syndrome who had chest pain. The electrocardiogram showed T-wave changes in the lateral precordial leads, but cardiac enzymes were normal. Tissue harmonic echocardiography showed apical akinesia. Intravenous contrast echocardiography, however, revealed typical features of hypertrophic apical cardiomyopathy. Thus contrast echocardiography may be used to establish the diagnosis of this condition.
 ...
PMID:Apical hypertrophic cardiomyopathy: bedside diagnosis by intravenous contrast echocardiography. 1128 97

A 69-year-old man with a history of transient chest pain was diagnosed takotsubo cardiomyopathy. In I-123-beta-metyl-iodophenyl pentadecanoic acid myocardial scintigraphy, decreased uptake of apex was seen in the acute phase, and it recovered in 3 months. In I-123-meta-iodobenzyl-guanidine myocardial scintigraphy, decreased uptake of apex persisted for 6 months, and there was a discrepancy between apical and total washout rate in the acute phase and after 3 months, which disappeared after 6 months. We speculate that the discrepancy of sympathetic innervation between the apical and basal region is the cause of the characteristic left ventricular apical akinesia of takotsubo cardiomyopathy.
 ...
PMID:Six-month follow-up of takotsubo cardiomyopathy with I-123-beta-metyl-iodophenyl pentadecanoic acid and I-123-meta-iodobenzyl-guanidine myocardial scintigraphy. 1241 4

As well as pheochromocytoma, in which it has been established that an excess of circulating catecholamines is responsible for the development of catecholamine-induced acute myopathy, some rare cases have been reported of a similar cardiac incident following intense emotional stress. In this study, the case has been examined of a 56-year old female with no history of cardiovascular disorder who presented with intense, nitro-resistant prolonged chest pain mimicking an acute coronary syndrome immediately following a situation involving major psychological stress. The admission electrocardiogram revealed a sharp decrease in R-wave amplitude in the right chest leads associated with an extended QT interval, and secondarily with subepicardiac ischemia in the lower leads. However, a few days after admission the electrical signs and septo-apical akinesia that had initially been observed by echocardiography completely disappeared. The clinical examination ruled out a diagnosis of myocardial necrosis, acute myocarditis, or pheochromocytoma. Moreover, no direct evidence of coronary spasm was found. The outcome was positive, with complete reversibility of all clinical signs and no organic sequelae. It is considered that this was probably a case of catecholaminergic acute cardiomyopathy triggered by intense emotional stress, a rare occurrence that should nevertheless be systematically taken into account in cases with similar clinical signs.
 ...
PMID:[Myocardial pseudo-infarction: "stress"-associated catecholamine-induced acute cardiomyopathy or coronary spasm?]. 1255 32

A 22-year-old woman presented with sudden onset of chest pain. Echocardiography showed a ruptured aneurysm of the noncoronary sinus of Valsalva in the right atrium. Slight ST segment depression was observed on initial electrocardiography (ECG). The patient was transferred to a tertiary care centre 10 h after the onset of symptoms. Surgery consisted of patch closure of the noncoronary sinus and tricuspid valve resuspension through the right atrium. Postoperatively, myocardial infarction (MI) was diagnosed based on a significant increase in cardiac enzymes and a new septal and apical akinesia on echocardiography. The etiology of MI in such a setting is multifactorial. Decreased coronary perfusion secondary to the severe aortic valve regurgitation and increased left ventricular end diastolic pressure, coupled with increased myocardial workload and delay before surgery may be implicated in the genesis of MI.
 ...
PMID:Myocardial infarction in a young woman secondary to a rupture of a noncoronary sinus of Valsalva aneurysm without coronary artery disease. 1277 25

A 53-year-old man experienced persistent chest pain followed by slight shortness of breath after being hit in the chest by a stranger. Chest X-ray study showed no rib fractures but electrocardiography indicated acute anterior wall myocardial infarction. Echocardiography revealed akinesia in both the interventricular septum and anterior left ventricular wall. Emergency cardiac catheterization demonstrated total occlusion of the proximal left anterior descending coronary artery, 9 h after the event. He was successfully treated with coronary angioplasty and stenting procedures. However, poor left ventricular function was observed 3 months after the event despite medications. We conclude that evaluation for possible myocardial injury should be considered soon after blunt chest trauma for early treatment to improve prognosis.
 ...
PMID:Delayed diagnosis of post-traumatic acute myocardial infarction complicated by congestive heart failure. 1624 1

Takotsubo cardiomyopathy (TTC) consists of an acute onset of transient akinesia of various parts of the left ventricle (apex and mid in classical TTC, mid and base in the variant form), without significant coronary artery stenosis, often accompanied by chest pain, dynamic reversible ST-T segment abnormalities and elevation of cardiac enzymes disproportionate to the extent of akinesia. Contrast-enhanced cardiovascular magnetic resonance (CMR) is a useful adjunct in the diagnostic work up of patients with TTC. Delayed hyperenhancement on gadolinium-enhanced CMR, which is indicative of active inflammation (e.g. myocarditis) or myocardial fibrosis (e.g. myocardial infarction), is usually absent in patients with TTC. In this report we present the case of a 46-years old women with TTC who had an extensive area of apical and midventricular akinesia and in whom gadolinium-enhanced CMR demonstrated a small area of subendocardial delayed hyperenhancement. A gadolinium-enhanced CMR performed 6 weeks later exhibited complete reversal of all wall motion abnormalities and an identical area of subendocardial delayed hyperenhancement.
 ...
PMID:Delayed hyperenhancement in a case of Takotsubo cardiomyopathy. 1635 47

Acute and reversible left ventricular apical wall motion abnormalities presenting with chest pain, electrocardiographic (EKG) changes and cardiac markers release, in the absence of coronary artery stenosis, have already been identified as a possible distinct clinical entity: the so-called Tako-Tsubo syndrome. A 65-year-old man with history of hypertension, hypercholesterolemia and smoking, was admitted at the emergency room of a secondary referral institution with a severe and prolonged (45 min) chest pain, irradiated to the left arm, associated with neurovegetative syndrome. The clinical presentation suggested an acute myocardial infarction (AMI). Interestingly no coronary artery stenoses or vasospasm reaction to administration of acetylcholine could be detected. A slow flow phenomenon was present. The left ventricle angiography confirmed a mild depression of left ventricle systolic function (EF 45%), with akinesia of antero-lateral wall and the typical apical ballooning-like profile. At 3-month follow-up, the patient continued to be asymptomatic and the echocardiogram showed a progressive normalization of left ventricle segmental motion and ejection fraction with a complete restoration only after 6 months. At 1 year the coronary angiography confirmed the absence of coronary stenosis, with complete regression of the ventricular apical ballooning at left ventricle catheterization. At two-year follow-up the patient is still asymptomatic. A slow resolution of the syndrome should be included in the diagnostic criteria for apical ballooning.
 ...
PMID:Angiographic long-term follow-up of primary apical ballooning of the left ventricle. 1653 34

A 69-year-old man with no remarkable medical history was admitted to the intensive care unit in septic shock due to severe community-acquired pneumonia. Twelve hours later he developed electrocardiographic abnormalities with ST elevation in leads II, III, aVF, V5, and V6 in the absence of chest pain and the presence of dyspnea, agitation, and hypertension. Serial measurements of cardiac enzymes were also elevated. Acute coronary syndrome was suspected. A cardiac ultrasound revealed left ventricular dilation with akinesia and systolic dysfunction (ejection fraction, 40%). Emergency catheterization revealed normal coronary arteries, suggesting a probable diagnosis of acute myocarditis. From the fourth day, the patient was progressing favorably. Findings in a follow-up ultrasound were consistent with the onset of dilated myocardiopathy, and angiotensin converting enzyme inhibitors were prescribed. All serology and microbiological studies were negative. Fifteen days after admission the patient was discharged to home after clinical, radiologic and analytic recovery.
 ...
PMID:[Myocarditis in the differential diagnosis of acute coronary syndrome]. 1682 73

We describe an acute myocardial infarction in a young athlete with non-obstructive hypertrophic cardiomyopathy (HCM) and normal coronary arteries. A 18 year old athlete came to our attention for dispnoea and chest pain during effort. Echocardiography showed non-obstructive HCM, with restrictive physiology. Cardiac catheterization and coronary angiography showed elevated pulmonary artery pressure and normal coronary arteries. He was discharged on sotalol and diuretics. Nine months later, he was resuscitated from a cardiac arrest during mild effort. The ECG revealed a high rate of atrial fibrillation with significant ST-T changes, and echocardiography an akinesia of interventricular septum. Cardiac enzymes were elevated. The coronary angiogram showed normal coronary arteries. This case is important as a reminder that acute myocardial infarction is not only due to coronary artery disease, and that atrial fibrillation may represent a trigger of serious cardiovascular events in patients with HCM.
 ...
PMID:Myocardial infarction in a young athlete with non-obstructive hypertrophic cardiomyopathy and normal coronary arteries. 1706 6

Dobutamine stress echocardiography is an accepted tool for the diagnosis of coronary artery disease. Some investigators have claimed that 3-dimensional imaging improves the diagnostic accuracy of dobutamine stress echocardiography. The purpose of the present investigation was to examine the role of contrast echocardiography in the improvement of segmental quality and interobserver agreement during stress real-time 3-dimensional echocardiography (RT3DE). The study comprised 36 consecutive patients with stable chest pain referred for routine stress testing. Three-dimensional images were acquired with an RT3DE system with an X4 matrix-array transducer. All available reconstructed 2-dimensional segments were graded as optimal, good, moderate, or poor. Wall motion was scored as normal, mild hypokinesia, severe hypokinesia, akinesia, or dyskinesia. At peak stress, 466 of the 612 segments (76%) could be analyzed during conventional RT3DE. With contrast-enhanced RT3DE, the number of available segments increased to 553 (90%). The image quality index during conventional RT3DE was 2.2, whereas with contrast-enhanced RT3DE, it was 3.1. With conventional RT3DE, 2 independent observers agreed on the diagnosis of myocardial ischemia in 85 of 108 coronary territories (79%, kappa = 0.26). With contrast-enhanced RT3DE, agreement increased to 95 of 108 coronary territories (88%, kappa = 0.59). Study agreement on myocardial ischemia was present in 26 of 36 studies (72%, kappa = 0.43) with conventional RT3DE and in 32 of 36 studies (89%, kappa = 0.77) with contrast-enhanced RT3DE. In conclusion, during stress RT3DE, contrast-enhanced imaging significantly decreases the number of poorly visualized myocardial segments and improves interobserver agreement for the diagnosis of myocardial ischemia.
 ...
PMID:Usefulness of ultrasound contrast agent to improve image quality during real-time three-dimensional stress echocardiography. 1722 33


<< Previous 1 2 3 4 5 6 7 Next >>