- T wave inversions in a young athlete. [Journal Article]
- HHeart 2018 May 10
- A 21-year-old black athlete presented for a preparticipation medical examination prior to playing collegiate basketball. He had no exercise limitations, syncope, dizziness or palpitations. He took no...
A 21-year-old black athlete presented for a preparticipation medical examination prior to playing collegiate basketball. He had no exercise limitations, syncope, dizziness or palpitations. He took no medications. There was no family history of coronary artery disease, cardiomyopathy, sudden cardiac arrest, drowning or seizures. Physical examination revealed a tall, well-appearing young man with an athletic build. Blood pressure was 119/61 mm Hg. Cardiac examination was unremarkable with no murmurs. A screening ECG is shown in Figure 1.heartjnl;heartjnl-2018-313088v2/F1F1F1Figure 1Resting 12-lead ECG performed in clinic. Patient was asymptomatic at the time of acquisition.
- Report of a lung carcinoma extended to the left atrium through pulmonary vein. [Journal Article]
- JTJ Thorac Dis 2018; 10(1):E46-E51
- Lung cancers may extend along or grow through the pulmonary veins to invade or lie within the left atrium (LA). A 62-year-old man, previously healthy, presented with 1-month ventilatory-independent r...
Lung cancers may extend along or grow through the pulmonary veins to invade or lie within the left atrium (LA). A 62-year-old man, previously healthy, presented with 1-month ventilatory-independent right hemithorax back pain, dry cough and large effort dyspnea. He also referred weight loss of 12 kg in 10 months and denied hemoptysis. As antecedents, he smoked for 40 years and moderate daily alcoholism. On physical examination, the patient was in good general condition, hydrated and regular respiration at rest [blood pressure (BP) =120/80 mmHg; heart rate (HR) =90 bpm; respiratory rate (RR) =16 rpm]. Cardiac auscultation revealed two standard rhythmic sounds without murmurs. Pulmonary auscultation revealed a slightly diminished vesicular murmur in the lower 1/3 of the right hemithorax without adventitious noises. Chest radiography showed a mass over the right lower lung. A CT scan confirmed the radiography image with the mass extending along the right inferior pulmonary vein and a tumor in the LA. Transthoracic and transesophageal echocardiography revealed large mass within the LA (occupying almost the entire cavity), measuring about 10 cm × 3 cm at its largest diameter, prolapsing into the left ventricle. Bronchoscopy, head CT scan, and whole-body bone scintigraphy investigation did not show any distant metastasis. The patient was successfully operated removing the intracardiac and inferior pulmonary vein tumor with the aid of cardiopulmonary bypass, followed by a right inferior lobectomy carried out after 25 days. After 30 days from surgery presented seizures associated a brain metastasis evidenced by CT when adjuvant radio and chemotherapy was started. During the next 90 days, the clinical conditions worsened, and the patient died 4 months after the surgical treatment. The case report has two primary justifications, even considering the poor outcome: (I) rarity and (II) the possibility of the surgical treatment.
- A dairy worker with fever and an abnormal echocardiogram. [Journal Article]
- HAHeart Asia 2017; 9(2):e010915
- A 38-year-old male presented with history of progressively increasing dyspnoea of 25 days duration. He gave history of low -grade fever associated with malaise and weight loss over the preceding 6 mo...
A 38-year-old male presented with history of progressively increasing dyspnoea of 25 days duration. He gave history of low -grade fever associated with malaise and weight loss over the preceding 6 months. He worked in the dairy industry in the Middle East and returned to India owing to his illness. On clinical examination, he was found to be tachypneic and cachectic. Jugular venous pressure was raised with a prominent 'a' wave. There was a short early diastolic murmur over the aortic area. His blood investigations, including renal and liver function tests, were normal. Three sets of blood cultures were sterile. Two-dimensional trans-thoracic and trans-oesophageal echocardiography revealed thickened bicuspid aortic valve cusps, with moderate eccentric aortic regurgitation and an abnormal structure posterior to the left ventricular outflow tract and aorta (figure 1A-C). A small vegetation was seen attached to the fused right-left aortic cusp (supplementary figure 1). The patient was started on appropriate intravenous antibiotics and antifailure medications, and was referred for early surgical treatment.Figure 1(A) Transthoracic echocardiography parasternal long axis view. (B) Transesophageal echocardiography (mid esophageal level) long axis view. (C) Transthoracic echocardiography parasternal short axis view.10.1136/heartasia-2017-010915.supp1Supplementary Figure 1.
- A Diastolic Murmur and the Mitral Valve. [Journal Article]
- JCJ Cardiothorac Vasc Anesth 2018 Feb 14
- Atrial myxoma presenting as infective endocarditis. [Journal Article]
- BCBMJ Case Rep 2018 Mar 09; 2018
- A 23-year-old Asian student presented to our service with a 1-month history of fever, weight loss of 10 kg, night sweats, fatigue and general malaise. He was previously well with no significant medic...
A 23-year-old Asian student presented to our service with a 1-month history of fever, weight loss of 10 kg, night sweats, fatigue and general malaise. He was previously well with no significant medical or family history. He had a low-grade pyrexia and cardiac auscultation revealed a diastolic murmur consistent with 'tumour plop'. He had no sequelae of endocarditis. He had low-grade pyrexia of 37.7°C, and ECG showed sinus tachycardia at 130 bpm. He had raised inflammatory markers and was started on broad spectrum antibiotics. Blood cultures grew Streptococcus viridans twice. Transthoracic and transo-oesophageal echocardiography revealed a large mobile mass attached to the interatrial septum, suspicious for atrial myxoma, flopping into the left ventricle but not causing left ventricular outflow tract obstruction. All valves looked normal in appearance. He was treated with antibiotics for 2 weeks until inflammatory markers normalised. The patient was referred for cardiothoracic surgery where a large atrial myxoma (5 cm×3 cm) was excised just superior to the mitral valve. It had areas of necrosis and was colonised with S. viridans He had an unremarkable postoperative course and made a complete recovery.
- Cardiac Auscultation Using Smartphones: Pilot Study. [Journal Article]
- JMJMIR Mhealth Uhealth 2018 Feb 28; 6(2):e49
- CONCLUSIONS: Cardiac auscultation using smartphones was feasible. Discrimination using convolutional neural networks yielded high diagnostic accuracy. However, using the built-in microphones alone, the acquisition of reproducible and interpretable heart sounds was still a major challenge.
- Early detection of myocardial dysfunction using two-dimensional speckle tracking echocardiography in a young cat with hypertrophic cardiomyopathy. [Journal Article]
- JOJFMS Open Rep 2018 Jan-Jun; 4(1):2055116918756219
- A 5-month-old intact female Scottish Fold cat was presented for cardiac evaluation. Careful auscultation detected a slight systolic murmur (Levine I/VI). The findings of electrocardiography, thoracic...
A 5-month-old intact female Scottish Fold cat was presented for cardiac evaluation. Careful auscultation detected a slight systolic murmur (Levine I/VI). The findings of electrocardiography, thoracic radiography, non-invasive blood pressure measurements and conventional echocardiographic studies were unremarkable. However, two-dimensional speckle tracking echocardiography revealed abnormalities in myocardial deformations, including decreased early-to-late diastolic strain rate ratios in longitudinal, radial and circumferential directions, and deteriorated segmental systolic longitudinal strain. At the follow-up examinations, the cat exhibited echocardiographic left ventricular hypertrophy and was diagnosed with hypertrophic cardiomyopathy using conventional echocardiography.
- Valvular Heart Disease. [Review]
- PCPrim Care 2018; 45(1):81-94
- This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate ...
This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading. Patients with progressive valvular heart disease should be followed annually by cardiology and imaging should be performed based on the severity of valvular dysfunction. Surgery or intervention is recommended only when symptoms dictate or when changes in left ventricular function occur. Surgery or intervention should be performed after discussion by a heart team, including cardiologists and cardiac surgeons.
- Mild cough · wheezing · loud heart sounds · Dx? [Case Reports]
- JFJ Fam Pract 2018; 67(2):95-98
- A 25-year-old man, who was an active duty US Navy sailor, went to his ship's medical department complaining of a mild cough that he'd had for 2 days. He denied having any fevers, chills, night sweats...
A 25-year-old man, who was an active duty US Navy sailor, went to his ship's medical department complaining of a mild cough that he'd had for 2 days. He denied having any fevers, chills, night sweats, angina, or dyspnea. He said he hadn't experienced any exertional fatigue or difficulty completing the rigorous physical tasks of his occupation as an engineman on the ship. The patient had no medical or surgical history of significance, and he wasn't taking any medications or supplements. On exam, he was not in acute distress and his vital signs were within normal limits. Auscultation revealed mild wheezing throughout the upper lung fields and loud heart sounds throughout his chest that were audible even with gentle contact of the stethoscope diaphragm. He had no discernible murmurs, rubs, or gallops. In light of the unusually loud heart sounds heard on exam, we performed an electrocardiogram. The EKG revealed a normal sinus rhythm, slight right axis deviation indicated by tall R-waves in V1 (also suggestive of right ventricular hypertrophy), an incomplete right bundle branch block, and a crochetage sign (a notch in the R-waves of the inferior leads). A chest x-ray revealed a normal-sized heart and dilated pulmonary vasculature suggestive of pulmonary hypertension.
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- Fever of unknown origin and splenomegaly: A case report of blood culture negative endocarditis. [Case Reports]
- MMedicine (Baltimore) 2017; 96(50):e9197
- CONCLUSIONS: Bartonella species are frequently the cause of negative blood culture endocarditis. Molecular biology techniques are the only useful tool for diagnosis. Valvular replacement is often necessary and antibiotic regimen with Gentamicin and either Ceftriaxone or Doxycycline is suggested as treatment.Echocardiogram and blood cultures must be performed in all cases of FUO. When blood cultures are negative and echocardiographic tools are indicative, early use of Bartonella serology is recommended.