Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0392680 (shortness of breath)
 5,217 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Exercise electrocardiography (ECG) is one of the most commonly utilized tests in cardiology. Despite the drawbacks, exercise ECG is widely preferred due to low cost, standardization, and strong prognostic information. A prolonged PR interval during recovery has recently been proposed as an indicator of mortality. Herein, we report an interesting case of a patient who presented with the complaint of exertional dyspnea and exhibited PR lengthening during the recovery period on the exercise ECG. The patient had a PR interval of 240 ms before exercise, which decreased to 160 ms at peak stress. However, during recovery, the PR interval prolonged gradually, reaching 320 ms at the second minute and persisting at that length until the end of the recovery period. The patient achieved 87% of the age predicted maximum heart rate, and experienced non-disabling shortness of breath and a pressure sensation in the chest, with no apparent ST segment depression. Recovery parameters, including heart rate recovery and systolic blood pressure recovery, were also within normal limits. The patient underwent coronary angiography with the suspicion of CAD which revealed severe multi-vessel disease. This rare case emphasizes the importance of PR lengthening in the recovery period as a sign of severe ischemia, in addition to other signs, such as prominent ST-segment changes, chronotropic incompetence, impaired hemodynamic response, and poor exercise capacity during stress ECG evaluation.
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PMID:A rare sign of ischemia during exercise ECG: PR interval lengthening in the recovery period. 2351 87

Repair of mitral regurgitation (MR) with the MitraClip device (Abbot Vascular, Menlo Park, CA) to treat degenerative MR is associated with improved acute and long-term outcomes. There is an increasing adoption of the device and operators are now testing the limits of the therapy even for unfavorable anatomies. Isolated cleft mitral leaflets are rare but represent a challenge to percutaneous repair. We present two cases of successful repair of severe MR and cleft mitral leaflets. In the first case, a 52-year-old male with a dilated cardiomyopathy and an ejection fraction (EF) of 15% presented in decompensated heart failure. Workup revealed a pseudo-cleft anterior mitral leaflet and a cleft posterior leaflet. A strategy to treat the restricted posterior leaflet lateral of the posterior cleft with a provisional second clip resulted in trace residual MR with only one clip, and an EF improvement to 50% at 2-month follow-up. In the second case, an 80-year-old male with a history of obstructive CAD with a normal EF but severe MR and a restricted anterior leaflet presented with severe shortness of breath. An initial strategy to grasp the middle of the valve was unsuccessful due to the cleft. Instead, two clips were placed side-by-side on either side of the cleft resulting in trivial residual MR. Despite challenging anatomy percutaneous repair can allow for dramatic reduction in MR, resulting in significant left ventricular remodeling and improvement of EF and cardiac output.
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PMID:Cleft mitral leaflets and severe mitral regurgitation: Testing the limits of percutaneous mitral valve repair. 3043 Jul 18