Zeitschrift für Kardiologie
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Patients with obstructive sleep apnea (OSA) frequently suffer from cardiovascular diseases. Mechanisms like intrathoracic pressure variations, changes in blood gases (hypoxia), arousals and neurohumeral adaptation mechanisms, combined with breathing disorders are causing these cardiovascular sequelae. ⋯ A systematic anamnesis with questions to daytime conditions (hypersomnia, decrease of performance), snoring and apneas while sleeping is easy to ascertain, and will lead to the correct diagnosis in more than 90% of cases. The extent and need for therapy should be assessed by three criteria: 1) daytime symptoms, 2) the extent of breathing disorder and 3) cardiovascular comorbidity.
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Lyme carditis is typically associated with AV nodal conduction abnormalities. We describe the case of a 66 year old female patient, who experienced a series of syncopal attacks after several tick bites two weeks earlier. ⋯ Pacemaker implantation was not necessary. We therefore have to assume that in this patient Lyme carditis was the cause of symptomatic sinus node dysfunction.
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Comparative Study
Concomitant CABG-procedures in elderly patients undergoing aortic valve replacement. An additional risk factor?
Preoperative coronary angiography in elderly people referred to the hospital for aortic valve replacement (AVR) often shows additional significant stenoses of the coronary arteries (CAD). The benefit of concomitant coronary artery bypass grafting (CABG) in these patients is still discussed controversially. By some authors, an isolated AVR in elderly patients with additional CAD is even described to have a better outcome. ⋯ With our results we could not identify concomitant CABG as a predictor of poor surgical outcome in elderly patients with AVR. We could even show that an additional bypass grafting of moderate stenoses of the LAD is important for a good outcome of these patients. Comparable stenoses in the right coronary or circumflex artery may be ignored with the advantage of a shorter period of intraoperative ischemia and the possibility of a secondary catheter intervention.
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Review Case Reports
[Peripartum cardiomyopathy-the (un)known obstetricalcardiologic emergency situation].
Peripartum cardiomyopathy (PPCM) is rare cardiac complication afflicting women during pregnancy or until 5 months post partum with the typical signs of acute cardiac failure. PPCM is similar to dilated cardiomyopathy (DCM) in terms of symptoms, histopathology and treatment but is characterized by a better outcome with a high rate of spontaneous normalization of left-ventricular size and function. The understanding of the etiology is limited. ⋯ It has to be assumed that PPCM is often undetected or misdiagnosed because of the low incidence, the unspecific symptoms and the fact that other pregnancy-related factors have similar clinical appearance. The treatment is also unspecific and similar to DCM and acute cardiac failure. The severity of the disease requires an interdisciplinary approach in a perinatal center with consequent follow-up of the patients for risk stratification including echocardiography.
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The present case will focus on the potential of hypoperfusion detection with myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI). PDHI is normally performed in a triggered mode. Microbubbles were destroyed by the ultrasound energy in the myocardium, and myocardium has to be refilled with microbubbles within the time interval between the ultrasound pulses to obtain repetitive information about perfusion. ⋯ The present case suggests that different MCE techniques can analyze different compartments of the myocardial vasculature in clinical practice. This methodological comparison between triggered and real-time PDHI shows obviously differences in the DI signal detection due to the different microbubble behavior. Clinicians should be aware of the potentials of MCE to improve noninvasive diagnostic procedures in patients with ischemic heart disease.