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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anomalous origin of the left coronary artery (LCA) from the pulmonary trunk (PT) is an uncommon but frequently lethal congenital lesion of infancy. Clinically it may be difficult to distinguish from congestive cardiomyopathy, and the diagnosis is usually made by angiography. We describe the case of a 38 years old woman, in whom identification of this anomaly was achieved by 2D-Echo, pulsed Doppler and color flow mapping. She complained of fatigue, effort dyspnea and atypical chest pain. A II/VI systolic murmur at left sternal border was heard. There was cardiac enlargement on chest X-ray and ECG was suggestive of an old anterolateral myocardial infarction. The 2D-Echo study showed a dilated, poorly contracting left ventricle. A prominent right coronary ostium was recorded, but the LCA ostium could not be visualized. There was retrograde diastolic and systolic flow in proximal PT, where an anomalous vessel was seen in continuity with it by color flow mapping. Cardiac catheterization confirmed the diagnosis. The patient underwent successful reimplantation of the anomalous LCA, from the PT to the aorta. This case demonstrates usefulness of Echocardiography in the assessment of coronary artery anomalies.
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PMID:[Anomalous origin of the left coronary from the pulmonary artery in adults: diagnosis with bidimensional, pulsed and color Doppler echocardiography]. 152 May

We present 3 cases of apical hypertrophic cardiomyopathy. The presenting symptoms were dyspnea on exertion in 2 of 3 patients, typical anginal pain in 1 patient, atypical chest pain in 1 patient, and fatigue in 1 patient. One patient was asymptomatic with an abnormal electrocardiogram. Sustained apical impulse was noted in all patients, Grade 1/6 systolic murmur was audible in 2 patients. Electrocardiogram showed T wave inversion in the left precordial leads in all patients with amplitudes of 1.4, 0.8 and 2.0 mV, respectively. Isolated apical hypertrophy was noted in all patients. Two-dimensional echocardiogram and the left ventriculogram revealed a "spade-shaped" configuration of the left ventricular cavity at endo-diastole in only one patient. Left ventricular end diastolic pressures were elevated and coronary angiograms were normal in all 3 cases. We conclude that this disease entity should be considered in patients whose electrocardiogram shows a large inverted T wave in the left precordial leads, either accompanied by symptoms such as dyspnea on exertion or chest pain, or even when asymptomatic. Echocardiogram is the most useful screening tool in the diagnosis of apical hypertrophic cardiomyopathy.
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PMID:Apical hypertrophic cardiomyopathy: clinical, echocardiographic and angiographic features in 3 Chinese patients. 197 49

Eleven cases with 13, incidentally found coronary-pulmonary fistulous communications were discovered out of about 11,000 diagnostic coronary angiograms performed in different patients, over the period 1968 to 1989. These patients were followed-up for an average period of 4.4 years (range 2-11 years). The majority had a fistulous malformation originating from the proximal part of the left anterior descending artery and terminating in the pulmonary trunk. In three subjects, the right coronary artery participated in formation of the shunt. The fistulas consisted either of a convoluted mass of serpentive vessels, sometimes with aneurysmal formation, or of a solitary single vessel. Angina pectoris, atypical chest pain and fatigue were the most common symptoms. All patients were treated conservatively except one, who underwent ligation of the fistula and coronary arterial bypass grafting. Two subjects are still free of symptoms. No death occurred. None of the patients developed subacute bacterial endocarditis, acute myocardial infarction or left ventricular failure during the period of follow-up of more than four years. Three individuals, prior to the follow-up period, had suffered myocardial infarction contralateral to the shunt. They had no recurrence.
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PMID:Coronary-pulmonary fistula: long-term follow-up in operated and non-operated patients. 236 8

This study assessed behavioral activity, dietary and emotional variables among patient cohorts with angina pectoris, atypical chest pain, and no chest pain in whom coronary disease is suspected. Questionnaire responses of 3,899 employed male patients at the time of coronary arteriography were analyzed. Patients with angina pectoris had high levels of coronary-prone and neurotic attitudes, and fatigue variables including feeling unrested on awakening, easy fatiguability, reducing activity at work and arriving home tired. Atypical chest pain patients showed coronary-prone and neurotic attitudes similar to the angina pectoris group but had less coronary occlusion and lower levels of fatigue variables. Compared to the other groups, atypical chest pain patients were more likely to skip breakfast and showed a trend to eat fast. These findings suggest that including assessment of activity levels, fatiguability, eating behavior, neurotic traits and coronary-prone attitudes at time of coronary arteriography can have some limited value for patients with chest pain who may seek cardiac treatment but could benefit from alternative approaches.
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PMID:Chest pain and behavior in suspected coronary artery disease. 334 20

I studied the prevalence and symptoms of idiopathic mitral valve prolapse by auscultation in 972 consecutive patients in an adult general medical population. Forty-five patients (4.6%) had idiopathic mitral valve prolapse defined by a nonejection click with or without a late systolic murmur. The prevalence was not significantly different in men and women. The mean age (49.9 yr) and age distribution of patients with prolapse were similar to those of patients without prolapse (47.7 yr). The prevalence of dizziness (4.1% vs. 1.5%), fatigue (4.4% vs. 2.6%), and palpitations (4.4% vs. 1.3%), was not significantly greater in patients with or without prolapse. Atypical chest pain (13% vs. 4.3%) and chronic anxiety (8.8% vs. 2.9%) were more frequent (less than 0.05) in the patients with prolapse than in those without prolapse. Of the patients with prolapse, 29 were healthy without clinically identifiable diseases while 16 had medical diseases. In the group without prolapse, 184 patients were healthy and 707 had other diseases. When patients with isolated prolapse without other associated diseases were compared to healthy patients without prolapse, the prevalence of atypical chest pain (17.4% vs. 17.2%) and chronic anxiety (7.1% vs. 10.3%) were not significantly different. When patients with prolapse and other diseases were compared to patients without prolapse and other diseases, the prevalence of atypical chest pain (6.2% vs. 1.1%) and chronic anxiety (6.2% vs. 1.7%) was again not significantly different. Thirty-two patients without prolapse were suspected but not confirmed of having disease and were not included in this analysis. The results would have been unaltered by their inclusion in the diseased group without prolapse.
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PMID:Does mitral valve prolapse cause nonspecific symptoms? 711 10

Most medical specialities have defined medically unexplained syndromes such as fibromyalgia, to categorize patients with prominent but unexplained symptoms. Other such syndromes include irritable bowel syndrome, chronic fatigue syndrome and atypical chest pain. In this chapter we present evidence to suggest that fibromyalgia is not a unique clinical entity, but shares much with these other syndromes. We use historical, clinical and epidemiological evidence to illustrate this idea. The historical data emphasize the essentially arbitrary way in which fibromyalgia developed. The clinical evidence shows the considerable overlap between patients with fibromyalgia and those with other unexplained syndromes. From an epidemiological perspective we emphasize the strong associations between symptoms such as myalgia and fatigue. We conclude by suggesting that fibromyalgia is one of many medically unexplained syndromes which have more similarities than differences between them.
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PMID:Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence. 1056 73

Although several investigations on mitral valve prolapse syndrome (MVPS) have been performed, clinical symptoms of this syndrome are not yet clarified. Atypical chest pain, palpitations, fatigue, dyspnea and anxiety are the most frequent symptoms associated with this syndrome. However, dizziness and syncope may be serious symptoms in MVPS. Dizziness and syncope are related to cardiac arrhythmias and are proposed to distinguish types, frequency of arrhythmias and relation to the symptoms. Orthostatic hypotension and tachycardia rarely occur in MVPS. The physiopathological mechanisms of these symptoms are not known clearly, but multifactorial causes are thought to be responsible including autonomic dysfunction, hyperadrenergic state, abnormalities in regulation of baroreceptors, parasympathetic derangements, decrease of intravascular volume, abnormal renin-aldosterone response to depletion of intravascular volume and abnormal release of atrial natriuretic factor.
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PMID:[Mitral valve prolapse syndrome: orthostatic hypotension and physiopathology of its clinical symptomathologies]. 1262 13

We report on the case of a 60-year-old woman with complaints of fatigue, coughing, anorexia, atypical chest pain, recurrent fever, and also ear pain and hearing loss. A test for anti-neutrophil cytoplasmic antibody (ANCA) was myeloperoxidase positive with p-ANCA specificity. Laboratory acute phase parameters were increased. A 2-deoxy-2-[(18)F]fluoro-D: -glucose positron emission tomography/computed tomography investigation showed pathological uptake in the aorta ascendens, with no other involvement of the large vessels. After therapy with methylprednisolon intravenously and later prednisolon orally with methothrexate, her general condition and hearing loss improved both subjectively and objectively. "Atypical" Cogan's syndrome was diagnosed on the basis of sensorineural deafness with improvement on steroids and large-vessel vasculitis of the aortic arch.
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PMID:The role of PET/CT in Cogan's syndrome. 1763 64

Cardiac hemangiomas are very rare benign cardiac tumors. They can present at any age and clinical presentation varies according to location and size. Most common symptoms include shortness of breath, palpitations, atypical chest pain and arrhythmia. The natural history of these tumors is unpredictable. They can regress, cease growing or proliferate over time. Diagnosis is usually made with echocardiography and surgical resection is the treatment of choice. Follow-up is recommended to identify any recurrence. We report a case of a 38-year-old man who presented with fatigue and palpitations. Echocardiography revealed a mobile spherical mass within the left ventricle, whereas left ventriculography showed an intracavity-filling defect without any tumor blushing. The tumor was removed surgically through the left atrium. It was a smooth oval nodule with a pedicle that was attached to the top of a papillary muscle. Microscopy revealed the presence of numerous vessels within fibrous tissue that ranged from lobules of capillary hemangioma to large thin-walled cavernous vessels, compatible with a hemangioma of mixed capillary-cavernous type. The patient had an uneventful postoperative course and recovered quickly.
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PMID:Cardiac hemangioma in the left ventricle and brief review of the literature. 1942 78

A 65-year-old woman was evaluated for fatigue, malaise, and atypical chest pain. One year prior she had undergone subtotal gastrectomy and jejunostomy in treatment of a large gastrointestinal stromal tumor. Two-dimensional echocardiography was performed, which showed a small circumferential pericardial effusion with a soft tissue echo density attached to the right atrial/right ventricular junction that extended over the right ventricle. Because of concern about possible malignant disease, thoracoscopy and biopsy of the pericardial mass were recommended. Normal fibro-adipose tissue was found with no evidence of neoplasm. Pericardial fat deposition is common in multiple conditions. It can be found in any location but is most common over the anterior portion of the heart. In this case, the concomitant presence of a small pericardial effusion and prominent fat pad at the right atrial/right ventricular junction gave the appearance of pericardial tumor.
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PMID:Pericardial fat masquerading as tumor. 2038 Jun 71


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