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C B Wong

Publications and source records attributed to C B Wong.

12 recordsLinked to original sources

Pulmonary embolism mimicking acute myocardial infarction.

Pulmonary embolism is a major cause of death in the United States. A high index of suspicion is required to achieve an accurate diagnosis. We report a case of a patient with syncope, ischemic electrocardiographic changes, and an elevated troponin I level, presenting just like acute myocardial infarction. The case highlights the value of an early use of 2-dimensional echocardiography in obtaining an accurate diagnosis, thus avoiding unnecessary and inappropriate treatment.

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Stenting of an anomalous left circumflex coronary artery arising from the right sinus of Valsalva.

Anomalous origin of coronary arteries is rare, occurring in about 1% of patients undergoing cardiac catheterization. Coronary atherosclerosis is not uncommon in these patients. Percutaneous angioplasty of anomalous coronary arteries poses a particular technical challenge secondary to the vessel characteristics. Stenting of the anomalous coronary arteries has not been described previously. We report a 47-year-old man with unstable angina in whom a MULTI-LINK coronary stent was placed successfully in an anomalous circumflex coronary artery.

Cardiac Catheterization

Acute myocardial infarction in a patient with von Willebrand disease.

Coronary atherosclerosis is uncommon in patients with von Willebrand factor deficiency. Occurrence of acute myocardial infarction is even rarer in these patients. We report on a 69-year-old woman with a long-standing history of von Willebrand disease who presented with acute myocardial infarction. Thrombolytic therapy with rtPA, heparin, and aspirin, followed by percutaneous transluminal coronary angioplasty and coronary stenting, was performed without significant bleeding or other complications.

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Segmental analysis of coronary arteries with equivalent plaque burden by intravascular ultrasound in patients with and without angiographically significant coronary artery disease.

These IVUS-derived data indicate that failure of compensatory dilation is an important factor in the development of clinically and angiographically significant coronary artery disease independent of plaque burden. We observed an actual reduction in total vessel area at the most stenotic site in coronary arteries that had a quantitatively significant angiographic lesion.

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Erythromycin induced torsades de pointes.

Erythromycin is a widely used antibiotic in today's armamentarium of antibiotics. Although erythromycin induced ventricular tachyarrhythmia is rare, this potentially life-threatening reaction should be kept in mind. The relative rarity of 'torsades de pointes' arrhythmia suggests that other predisposing factors contribute to the acquired long QT syndrome. Since more and more macrolide products have been approved by the Food and Drug Administration for use in the United States, the potential problem with 'torsades de pointes' may exist with each of the macrolide antibiotic. Until the exact mechanisms of the arrhythmia are worked out, close monitoring of rhythms and QT intervals of high risk patients who require erythromycin is certainly advisable. Only a heightened awareness among the physicians and medical personnel can the adverse outcome be minimized.

Erythromycin

Clinical applications of signal-averaged electrocardiography in patients after myocardial infarction.

In conclusion, signal-averaged electrocardiography is a useful, noninvasive technique to identify patients after myocardial infarction at risk for future arrhythmic events, especially in conjunction to existing tools, such as 24 hour ambulatory monitoring, echocardiography, nucleotide angiography and coronary angiography. It has a limited positive predictive value, but has an excellent negative predictive value. The optimum time to do signal-averaged electrocardiograms after myocardial infarction is unclear, 6 to 14 days after myocardial infarction has the highest sensitivity. Time domain analysis remains the most common method used to record late potentials. The definition of late potential and the scoring of a high resolution electrocardiogram as normal and abnormal have not yet been resolved. The criteria proposed by the Task Force Committee of the European Society of Cardiology, the American Heart Association and the American College of Cardiology (see introduction) should be observed at present. Many studies on signal-averaging were done in the prethrombolytic era. In patients who have received thrombolytic therapy, the positive predictive value of signal-averaged electrocardiograms has decreased. There are other limitations in applying signal averaging technique. The faster the ventricular tachycardia is induced in electrophysiological studies, the shorter is the late potential. Thus, a faster tachycardia which causes sudden cardiac death may not be detected by late potentials. The management strategies for patients who have abnormal signal-averaged electrocardiograms after myocardial infarction have not be defined. One should note that any management strategy has to prove that it improves prognosis. More prospective, randomized clinical trials are required to address these issues.

Arrhythmias, Cardiac

L-tryptophan-related eosinophilia-myalgia syndrome: a case report.

Eosinophilia-myalgia syndrome (EMS) is characterized by intense eosinophilia and, very often, debilitating generalized myalgia in the absence of infectious or neoplastic causation. The Centers for Disease Control have established that the latter two features, along with an eosinophil count greater than 1000 cells per cu mm, are criteria for the syndrome. EMS has been reported in epidemic proportions over the last several months. Early data strongly suggested that in at least a small percentage of patients the syndrome leads to death. Epidemiological work in New Mexico, Minnesota, and Oregon has linked EMS most impressively to L-tryptophan-containing products (LTCPS).

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