Texas Heart Institute journal
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The incidence of arrhythmias after acute myocardial infarction of the inferior wall varies with the affected segment and increases when there is right ventricular involvement. This paper provides a clear review of the blood supply to the conduction system and gives an anatomic explanation of that supply. We dissected 20 human hearts after anterograde and retrograde injection of latex. ⋯ The incidence of arrhythmias after acute myocardial infarction of the inferior wall is greater when the occlusion of the coronary trunk is at or near the origin. This is due to the existence of the right superior descending artery, which is given off by the right coronary trunk less than 1 cm from the origin. The arrhythmias caused by the occlusion of the circumflex artery are due to the existence of Kugel's artery, which displays a peculiar anastomotic pattern.
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Biography Historical Article
At the cutting edge of the impossible: a tribute to Vladimir P. Demikhov.
Vladimir P. Demikhov (1916-1998) performed the world's first experimental intrathoracic transplantations and coronary artery bypass operation. ⋯ Ironically, his transplantation of a dog's head drew more publicity than did his pioneering thoracic surgical accomplishments, and he became an easy target for criticism. An account of Demikhov's life and work is presented herein.
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Case Reports
Dual atrioventricular-nodal physiology, elicited by pacing and leading to a reversible cardiomyopathy.
Atrioventricular nodal re-entry tachycardia is the most common form of regular paroxysmal tachycardia in the adult population. This tachycardia is a re-entrant rhythm that uses the anatomic location of the atrioventricular node and its surrounding perinodal atrial tissue. The simplest concept regarding the atrioventricular nodal physiology that allows re-entry is founded upon the postulated existence of 2 atrioventricular nodal pathways with different conduction velocities and refractory periods. ⋯ He developed a tachycardia-induced cardiomyopathy with a perpetual dual response to the pacemaker stimulus. The tachycardia displayed characteristic dual atrioventricular-nodal physiology that was suppressed by amiodarone therapy, leading to a reversal of the cardiomyopathy. We discuss the mechanisms that surround such phenomena.
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We sought to determine, retrospectively, whether obesity was associated with adverse renal outcomes in 17,630 patients who underwent cardiac surgery from January 1995 through December 2006. Obesity was defined as a body mass index > or = 30 kg/m2. The primary outcome was any episode of postoperative renal insufficiency (requiring or not requiring dialysis) before hospital discharge. ⋯ Obesity was associated with an increased risk of postoperative renal insufficiency in patients undergoing isolated CABG (OR, 1.38; 95% CI, 1.18-1.61), isolated valve surgeries (OR, 1.39; 95% CI, 1.05-1.85), and combined CABG and valve surgeries (OR, 1.35; 95% CI, 0.99-1.83; statistically nonsignificant). Development of postoperative renal insufficiency was associated with a significantly higher mortality rate (P <0.0001) and with a significantly longer hospital stay (23 vs 10.5 days; P <0.0001). We conclude that obesity is associated with a significant increase in postoperative renal insufficiency in cardiac surgery patients, an effect that we attribute to an increase in postoperative renal failure that does not require dialysis.
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Case Reports
Pericardial tamponade consequent to a dynamite explosion: blast overpressure injury without penetrating trauma.
Acute cardiac tamponade is a life-threatening emergency that requires prompt treatment by either percutaneous or surgical pericardiocentesis. It may occur after penetrating or blunt chest trauma. ⋯ Physicians should be aware of the possibility of pericardial tamponade in victims of barotraumatic events such as dynamite or bomb explosions, even in the absence of penetrating trauma. Cardiac tamponade, although life-threatening, is easy to treat when recognized.