Cardiol J
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Case Reports
Anterior mitral leaflet perforation identified by real time three-dimensional transesophageal echocardiography.
With its unique en face view, real time three-dimensional transesophageal echocardiography has been reported to be more precise than conventional two-dimensional studies in evaluating mitral regurgitation etiology, and can locate diseased segments correctly. We present a case with severe mitral regurgitation due to anterior mitral leaflet perforation. Intraoperative real time three-dimensional transesophageal echocardiography demonstrated its value in diagnosis and surgical planning for this perforation, which had not been identified preoperatively. This technique should be applied more widely for dedicated mitral valve assessment in clinical practice.
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To assess the influence of electrocardiographic (ECG) pattern on prognosis and complications of patients hospitalized with acute pulmonary embolism (APE). ⋯ In our population of APE patients, the sum of negative T waves, the number of leads with negative T waves and the ST segment elevation in lead V1 were independent predictors of death during hospitalization. In turn, the sum of negative T waves, the number of leads with negative T waves, and RBBB and ST segment elevation in leads V1 and aVR were independent predictors of complications during hospitalization. We conclude that ECG analysis may be a useful noninvasive method for risk stratification of patients with APE.
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The interval from the pacemaker stimulus to the onset of the earliest paced QRS complex (latency) may be prolonged during left ventricular (LV) pacing. Marked latency is more common with LV than right ventricular (RV) pacing because of indirect stimulation through a coronary vein and higher incidence of LV pathology including scars. During simultaneous biventricular (BiV) pacing a prolonged latency interval may give rise to an ECG dominated by the pattern of RV pacing with a left bundle branch block configuration and commonly a QS complex in lead V1. ⋯ During LV only pacing (RV channel turned off) RV anodal pacing may also occur in a more obvious form so that the ECG looks precisely like that during BiV pacing. RV anodal stimulation may complicate threshold testing and ECG interpretation and should not be misinterpreted as pacemaker malfunction. Programming the V-V interval (LV before RV) in the setting of RV anodal stimulation cancels the V-V timing to zero.
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Case Reports
Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus.
The prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. ⋯ Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection.