International journal of cardiology
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Letter Case Reports
"Lots of clots": multiple thromboemboli including a huge paradoxical embolus in a 29-year old man.
Paradoxical embolism occurs when a venous thrombus passes into the arterial circulation, most commonly through an intracardiac shunt. This phenomenon has been associated with catastrophic outcomes such as stroke and ischemic limb. We report the case of a 29-year old man with multiple thromboemboli including a deep venous thrombus, bilateral pulmonary emboli, and a paradoxical embolus into his left subclavian artery. We postulate the underlying predisposition and sequence of events that may have resulted in these multiple blood clots and report on his successful surgical outcome.
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Letter Case Reports
Free floating right atrial thrombus leading to acute pulmonary embolism.
The presence of right heart thrombi appears to increase the risk of mortality compared to the presence of pulmonary thromboemboli alone. The increased use of two-dimensional echocardiography has led to increased detection of these thromboemboli, particularly in patients with suspected or confirmed pulmonary emboli. The optimal management of the right heart thromboemboli remains unclear, but thrombolytic therapy with rt-PA appears to be rapidly effective in most patients resulting with complete resolution of the thrombus and improvement of pulmonary perfusion. Here, we present a case of free floating, worm-like thrombus in the right atrium which was lysed successfully by fibrinolytic therapy in a patient presenting with acute massive pulmonary embolism.
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Dobutamine stress echocardiography (DSE) has been shown to be a very useful non-invasive technique for the detection of coronary artery disease. However, inadequate transthoracic images preclude the use of DSE in a significant proportion of patients. Transesophageal (TEE) or transthoracic contrast echocardiography (CE) can however overcome this limitation. ⋯ The kappa value for identical interpretation of a stress echocardiography study was nearly identical with both modalities 0.75 to 0.78. In poorly echogenic patients, DSE-CE is a valuable alternative for the detection of myocardial ischemia in comparison with DSE-TEE. Because DSE-CE is more comfortable than TEE, it should be used in patients with suboptimal transthoracic echocardiograms for the evaluation of coronary artery disease during DSE.
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Letter Case Reports
Atrial fibrillation with intermittent right axis deviation in the presence of complete left bundle branch block.
Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ecg shows an LBBB with changing QRS morphology and changing axis deviation. We describe a case of atrial fibrillation with intermittent right axis deviation in the presence of complete left bundle branch block in an 84-year-old Italian woman in the Cardiology Unit.
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Letter Case Reports
Echocardiographic diagnosis of syndrome of left ventricular-right atrial shunt (Gerbode defect).
Left ventricular-to-right atrial communications are rare types of ventricular septal defect known collectively as the Gerbode defect. These defects are usually congenital and they have also been reported after bacterial endocarditis and after acute myocardial infarction. Echocardiography is the most useful diagnostic method. We describe a case of echocardiographic diagnosis of Gerbode defect in a 68-year-old Italian woman.