Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction.

Acute right ventricular infarction presenting with ST-segment elevation in the anterior precordial electrocardiographic leads is an unusual event. Anterior ST-segment elevation typically suggests occlusion of the left anterior descending coronary artery. It should be recognized, however, that occlusion of a right coronary artery branch can cause isolated ST-segment elevation in leads V and V on a standard 12-lead electrocardiogram.

Haemodynamic and structural correlates of the first and second heart sounds in pulmonary arterial hypertension: an acoustic cardiography cohort study.

Objective: To examine the relationship between acoustic characteristics of the first and second heart sounds (S1 and S2) and underlying cardiac structure and haemodynamics in patients with isolated pulmonary arterial hypertension (PAH) and controls.

Design: Prospective multicentre cohort study.

Setting: Tertiary referral and community hospitals.

Isolated thigh pain in myocardial infarction.

The referred pain of angina to upper half of the body is well known. However, isolated pain in the thigh as a presenting symptom in myocardial infarction is neither considered nor discussed at all. Here, we report a middle-aged man without demonstrable risk factors who presented to the emergency department for isolated bilateral anteromedial thigh pain.

Defective T wave combined with incomplete right bundle branch block: a new electrocardiographic index for diagnosing atrial septal defect.

Background: Incomplete right bundle branch block (ICRBBB) is commonly associated with atrial septal defect (ASD), but lacks sufficient diagnostic test characteristics. An abnormal T wave is also often observed in ASD, with horizontal or inverted displacement of the proximal T wave limb in the right precordial leads, termed "defective T wave" (DTW).

Methods: We examined the diagnostic test characteristics of combining ICRBBB with DTW as a new index to diagnose ASD.

Cardiovascular Complications in Ciguatera Fish Poisoning: A Wake-up Call.

Ciguatera fish poisoning occurs with ingestion of fish containing ciguatoxin. It causes a clinical syndrome that comprises classic gastrointestinal, neurological and cardiovascular symptoms. Ciguatoxin is a sodium channel agonist with cholinergic and adrenergic activity.

Significance of the intima-media thickness of carotid and thoracic aorta in coronary artery disease in the South Indian population.

Background: Ultrasound detected intima-media thickness (IMT) of the carotid artery and thoracic aorta are possible screening tests to assess the risk of coronary artery disease (CAD) in asymptomatic individuals.

Objective: Aim of the study was to assess the utility of carotid and aortic IMT as a predictor of CAD and to assess the extent of IMT with severity of CAD in a South Indian population.

Patients And Methods: A cross-sectional and analytical study was carried out among 40 cases, who had angiographic evidence of CAD against 30 healthy control subjects with a normal treadmill test.

Contemporary use of adjunctive thrombectomy during primary percutaneous coronary intervention for ST-elevation myocardial infarction in the United States.

Objectives: We sought to examine the contemporary use of thrombectomy during primary percutaneous coronary intervention (PCI) in the United States.

Background: Adjunctive thrombectomy during primary PCI for patients with ST-segment elevation myocardial infarction (STEMI) has demonstrated mixed results. While earlier studies showed either unfavorable or neutral effects with rheolytic thrombectomy, recent clinical trials have shown benefits with manual or rheolytic thrombectomy when compared to PCI alone.

Ventricular fibrillation after exposure to air freshener-death just a breath away.

A case of ventricular fibrillation due to butane toxicity after unintentional inhalation of air freshener is reported for its rarity and to create awareness among practitioners and the public. A 25-year-old woman collapsed in the supermarket after unintended exposure to air freshener sprayed into her nostrils. Her husband started cardiopulmonary resuscitation immediately, and she was brought to the hospital.

Potential of delayed gadolinium enhancement magnetic resonance imaging for quantification of reverse remodeling of the peri-infarct zone in patients with ischemic cardiomyopathy treated with chronic vasodilator therapy: initial experience.

Purpose: The peri-infarct zone represents the morphologic substrate for reentry ventricular tachycardia after myocardial infarction, and its extent is a strong predictor of major cardiac events. Although delayed gadolinium enhancement magnetic resonance imaging (DGE-MRI) was shown to allow for detailed characterization of myocardial infarction by quantifying infarct core zone and peri-infarct zone volume, potentials of DGE-MRI for measuring changes in peri-infarct zone volume are unknown. Therefore, we aimed to assess changes in volume of the peri-infarct zone among patients with ischemic cardiomyopathy treated with chronic vasodilator therapy.

Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.

Venous thromboembolism (VTE) is responsible for the hospitalization of >250 000 Americans annually and represents a significant risk for morbidity and mortality. Despite the publication of evidence-based clinical practice guidelines to aid in the management of VTE in its acute and chronic forms, the clinician is frequently confronted with manifestations of VTE for which data are sparse and optimal management is unclear. In particular, the optimal use of advanced therapies for acute VTE, including thrombolysis and catheter-based therapies, remains uncertain.

Electrocardiographic changes during inhalational oleander toxicity.

Inhalational oleander toxicity was considered in a family of 4 by history of exposure to smoke from burning oleander twigs. Electrocardiography revealed first- and second-degree atrioventricular block with digoxin-like ST-T-wave changes, suggestive of oleander toxicity in the absence of exposure to digoxin or other herbal medicines, and without systemic illness. Complete blood count, biometabolic profile, chest x-ray, and echocardiography did not reveal any abnormalities.

Acoustic cardiographic indices of transmyocardial ischemia during percutaneous coronary intervention.

Background: Transmyocardial ischemia is manifested as ST-segment elevation (STE). We examined acoustic cardiographic indices of STE that occur during percutaneous coronary intervention (PCI).

Methods: Of 83 patients undergoing coronary angiography, 25 underwent PCI, including 5 who developed STE.

Percutaneous patent foramen ovale closure using Helex and Amplatzer devices without intraprocedural echocardiographic guidance.

Objectives: We compared procedural outcomes of patients undergoing patent foramen ovale (PFO) closure using Helex (W.L. Gore & Assoc.

Can echocardiographic evaluation of cardiopulmonary hemodynamics decrease right heart catheterizations in end-stage heart failure patients awaiting transplantation?

Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In this study, invasive hemodynamics from right-sided cardiac catheterization were compared with values obtained by validated equations from Doppler 2-dimensional transthoracic echocardiography. This prospective study was conducted in 40 patients with end-stage heart failure evaluated for heart transplantation or ventricular assist device implantation.

Noninvasive prediction of left ventricular systolic dysfunction in patients with clinically suspected heart failure using acoustic cardiography.

The signs and symptoms of systolic heart failure are frequently insensitive and nonspecific, making an accurate bedside diagnosis of left ventricular systolic dysfunction (LVSD) challenging. B-type natriuretic peptide (BNP) is often used, but is not diagnostically useful when in the indeterminate range. The authors investigated the diagnostic test characteristics of acoustic cardiographic parameters to identify patients with LVSD.

Ex vivo hemodynamic assessment of mechanical aortic valve gradients using a high-fidelity pressure wire.

Objectives: Accurate assessment of prosthetic mechanical valve malfunction is challenging for non-invasive and invasive techniques. We evaluated a 0.014-inch pressure-sensing coronary guidewire to assess mechanical valve dysfunction.

Retrograde left-ventricular hemodynamic assessment of mechanical aortic and mitral valve gradients using a high-fidelity pressure wire: a case series.

Noninvasive assessment of mechanical heart valve function with echocardiography is challenging. There are important safety issues when considering placing a standard catheter across a mechanical valve with for invasive hemodynamic measurements. The feasibility of using a high-fidelity micromanometer coronary pressure guide wire to assess hemodynamics across mechanical valves has been reported.

Utility of intracardiac echocardiography for atrial baffle leak closure in repaired transposition of the great arteries.

A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle.

Acute effects of intravenous nesiritide on cardiac contractility in heart failure.

Background: Although nesiritide is a potent vasodilator, studies using myocytes and isolated muscle strips have shown that recombinant B-type natriuretic peptide (BNP; nesiritide) decreases contractility. We sought to determine whether nesiritide decreases contractility in heart failure patients.

Methods And Results: Twenty-five heart failure patients underwent left heart catheterization (using a pressure-volume conductance catheter) and echocardiography at baseline and after a 2 mcg/kg bolus and 30-minute nesiritide infusion (0.

Noninvasive diagnosis of pulmonary hypertension using heart sound analysis.

Right-heart catheterization is the most accurate method for measuring pulmonary artery pressure (PAP). It is an expensive, invasive procedure, exposes patients to the risk of infection, and is not suited for long-term monitoring situations. Medical researchers have shown that PAP influences the characteristics of heart sounds.

Endomyocardial biopsy of right atrial angiosarcoma guided by intracardiac echocardiography.

We report a case of a 22-year-old female who presented with pericardial effusion and cardiac tamponade. She was diagnosed with a right atrial mass by computed tomography and was referred to our institution for biopsy of this mass. Transcatheter biopsy was performed with intracardiac echocardiography (ICE) guidance, avoiding the need for transesophageal echocardiography or surgery to obtain the biopsy.

Utility of a bedside acoustic cardiographic model to predict elevated left ventricular filling pressure.

Background: The authors previously described an acoustic cardiographic model that predicted echocardiographic correlates of elevated left ventricular (LV) filling pressure. This study evaluated this bedside acoustic cardiographic model against invasive measurements of LV filling pressure.

Methods And Results: Data were prospectively obtained from 68 adults referred for right heart catheterisation.