Rev Cardiovasc Med
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Review Case Reports
A review of electrocardiography in pulmonary embolism: recognizing pulmonary embolus masquerading as ST-elevation myocardial infarction.
A 64-year-old woman with hypertension and diabetes presented with acute shortness of breath and left-sides chest discomfort. Electrocardiopgram (ECG) demonstrated Q waves, coved ST-segment elevations, and T-wave inversions in leads V₁-V₄, suggesting acute anterior ST-elevation myocardial infarction (STEMI). catheterization revealed nonocclusive coronary artery disease with elevated pulmonary and right heart pressures, confirmed by echocardiography. Ventilation perfusion scan was deemed high probability for pulmonary embolism (PE). ⋯ This case exemplifies similarities in clinical presentation of PE and acute STEMI. The presence of Q waves in anterior leads wih coved ST-elevation after PE has not been described previously. We review the differential diagnosis of ST elevation and the assorted spectrum of ECG changes seen in PE.
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Review Case Reports
Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet.
A 79-year-old woman with a history of bioprosthetic aortic and mitral valve replacement with coronary artery bypass graft surgery presented with pulmonary edema 4 years after surgery. Transthoracic echocardiography and transesophageal echocardiography revealed an obstruction of the left ventricular outflow tract caused by the bioprosthetic mitral valve. We present this case, accompanied by a review of the literature.
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Multiple studies have shown that hypoglycemia is associated with increased mortality and a variety of adverse outcomes. Whether hypoglycemia is a mediator of adverse outcomes or simply represents a marker of critical illness has been unclear until now. Based on observational data, spontaneous (but not iatrogenic) hypoglycemia is associated with increased mortality during hospitalization for acute myocardial infarction. ⋯ Hypoglycemia was, in turn, associated with increased risk of macro- and microvascular events and death, and also with increased risk of noncardiac adverse events, including disorders of the digestive, respiratory, and skin systems. Based on available evidence, hypoglycemia does not appear to directly lead to death or cardiovascular events and is likely a marker for more severe illness and comorbidity burden. Nevertheless, continued efforts to avoid hypoglycemia are clearly warranted.
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Takotsubo cardiomyopathy is a syndrome characterized by transient apical ballooning or reversible midventricular systolic dysfunction. Most cases occur in postmenopausal women and are typically triggered by an acute medical illness or emotional or physical stress. Its presentation is highly suggestive of myocardial ischemia, but there is little or no evidence of epicardial coronary artery disease. To our knowledge there are only three reported cases in the literature of Takotsubo cardiomyopathy induced by opioid agonist withdrawal in adults; ours is the first reported case of iatrogenic methadone withdrawal leading to Takotsubo cardiomyopathy.