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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Using hemodynamic monitoring by flow-directed heart catheterization in acute myocardial infarction, left ventricular dysfunction can be analyzed and quantified. Differential therapy concerning substitution of volume and administration of drugs with influence on pre- and after-load is facilitated. Since the introduction of the Swan-Ganz flow-directed catheter the monitoring has been technically improved with the additional advantage of lower incidence of catheter-induced arrhythmias and the possibility to measure the pulmonary capillary wedge pressure. The Swan-Ganz thermodilution catheter further improved the technical assessment of cardiac output. Using hemodynamic monitoring during acute myocardial infarction different phases of cardiac failure can be discerned, e.g., backward failure with increased filling pressure, foreward failure with decreased cardiac output, and cardiogenic shock with the combination of both. In some cases a hyperkinetic hemodynamic status is observed. The differential diagnosis of pulmonary embolism, and cardiac and pulmonary shock can be clarified. Complications of myocardial infarction as acute mitral insufficiency due to papillary muscle rupture in inferior myocardial infarction, rupture of the septal myocardium in septal infarction, as well as myocardial rupture with pericardial tamponade show characteristic diagnostic findings. Drug therapy with influence on pre- and after-load and therapy with positive-inotropic agents can be adjusted to the individual hemodynamic status and to the monitored drug effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Uses and risks of hemodynamic monitoring by inflow catheter in acute myocardial infarct]. 306 63

Atrial fibrillation (AF), the most common of all sustained cardiac arrhythmias, is frequently resistant to antiarrhythmic drugs, and physicians have seen limited success with catheter ablation limited to the right atrium. As a result, the safety and efficacy of systematic biatrial linear ablation for drug resistant AF was investigated. Forty-four patients (54 +/- 7 years) underwent catheter ablation of daily drug-resistant AF. Two right-atrial lines (1 septal and 1 cavotricuspid) and 3-4 left-atrial lines were transseptally performed: 2 joining each superior pulmonary vein to the posterior mitral annulus and 1 interconnecting them. An additional left-atrial septal line from the right superior pulmonary vein (RSPV) to the foramen ovalis was performed in 23 patients. Radiofrequency was delivered with a conventional thermocouple-equipped ablation catheter or with an irrigated tip ablation catheter for resistant cases and for sparing the endocardium. Of the 44 patients, 25 (57%) were successfully treated without antiarrhythmic drugs. Twelve patients (27%) improved (<6 hours of AF per trimester under a previously ineffective drug) and 7 (16%) were considered treatment failures. Multiple sessions were required to ablate new left-atrial macro-reentry and initiating foci (2.7 +/- 1.3 procedures per patient). Five patients had a pericardial effusion and 1 each a pulmonary embolism, an inferior myocardial infarction, and a reversible cerebral ischemic event. One patient had thrombosis of the 2 left pulmonary veins. Despite a relatively high success rate, this procedure is too long, and the safely and efficacy need to be improved and applied to a broader range of patients.
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PMID:Efficacy and safety of septal and left-atrial linear ablation for atrial fibrillation. 1056 73

Idiopathic granulomatous inflammation of the pituitary gland occurs rarely, and is usually identified as an incidental finding at autopsy. However, it may present during life as a mass lesion that clinically mimics other more common pituitary gland lesions. We report a 54-year-old woman presenting with acute onset diabetes insipidus whose MRI showed a 1.1 cm pituitary mass, with infundibular thickening and meningeal enhancement. Biopsy demonstrated granulomatous hypophysitis with multinucleate histiocytes. Special studies for infectious organisms were negative. The patient's disease progressed following biopsy, causing complete loss of vision in the right eye. This responded to high-dose steroids and local lowdose radiation. She later developed an acute inferior myocardial infarction. Laboratory tests failed to demonstrate an underlying autoimmune process. While recovering from this myocardial infarction, she succumbed to pulmonary embolism. Autopsy revealed moderate residual chronic infundibular inflammation. No evidence of systemic or residual pituitary granulomatous disease was identified. To the best of our knowledge, this is the first case of idiopathic granulomatous hypophysitis initially diagnosed by biopsy to have post-mortem neuropathologic examination.
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PMID:Idiopathic giant-cell granulomatous hypophysitis. Report of a case with autopsy follow-up. 1112 23

Aortic dissection is a relatively uncommon but catastrophic illness classically thought to present with acute, sharp, chest pain with radiation to the back. However, aortic dissection can manifest in a number of different ways that include congestive heart failure, inferior myocardial infarction, stroke, focal pulse and neurologic deficits, abdominal pain, or acute renal failure. According to some studies, only about 80% of patients with type A dissection present with severe anterior chest pain, and only about 60% describe their pain as being sharp. Another series reports that treating clinicians fail to initially entertain the diagnosis of aortic dissection in up to 35% of cases. Many patients later found to have aortic dissection are initially suspected to have other conditions such as acute coronary syndrome, pericarditis, pulmonary embolism, or even cholecystitis. In this article we present a case of an unusual presentation of aortic dissection and a review of this condition.
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PMID:Aortic dissection: a dreaded disease with many faces. 1537 42

76-year-old male with inferior myocardial infarction and right nephrectomy due to cancer in the past, was admitted to our Department due to incidents of chest pain and syncope. During physical examination we found dilated superficial veins of abdomen, chest and lower extremities. Laboratory tests, except creatinine and D-dimer levels were normal. Consulting neurologist excluded neurological reasons of syncope. Holter monitoring showed ventricular extrasystolies and results of transesophageal stimulation of left atrium were normal. Coronary angiogram demonstrated critical stenoses in some of the coronary arteries. Doppler examination showed left femoral vein obstruction. Computer tomography of abdominal cavity demonstrated inferior vena cava obstruction and abdominal wall veins dilatation. Due to thromboembolic disease symptoms pulmonary embolism was suspected. Consulting surgeon and cardiosurgeon decide against surgery due to it's extensive risk, among other things due to possibility of renal function worsening. To prevent embolic complications patient started antithrombotic therapy. Our patient's case shows many vital pathologies in cardio vascular system which occur in one subject. His example demonstrates need to perform multidirectional diagnostics and therapy of such patients.
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PMID:[Inferior vena cava obstruction in patient with coronary artery disease]. 2022 10