Coronary artery fistula draining into the pulmonary artery.
Explore the source record for details and available documents.
Cardiac Catheterization↗
Biomedical subjects
George V Moukarbel
Publications and source records attributed to George V Moukarbel.
Acute pharyngitis: an unusual presentation of acute endemic typhus.
Explore the source record for details and available documents.
Acute Disease↗
Contrast-enhanced echocardiography for the diagnosis of apical hypertrophic cardiomyopathy.
The echocardiographic diagnosis of apical hypertrophic cardiomyopathy can be difficult in patients with poor acoustic windows. However, contrast-enhanced echocardiography can provide better images in these patients and lead to the correct diagnosis. We present a patient with apical hypertrophic cardiomyopathy who was diagnosed using contrast-enhanced echocardiography. The use of contrast-enhanced echocardiography for the diagnosis of apical hypertrophic cardiomyopathy in patients with poor acoustic windows is discussed and the experience in the literature reviewed.
Aged↗
Pharmacological therapy for myocardial reperfusion injury.
In the ischemic myocardium, reperfusion is necessary for the salvage of cells and cardiac function. However, reperfusion itself causes 'reperfusion injury', leading to the damage of myocardial cells. This is reduced by several interventions, as measured by the limitation of infarct size or reduction of arrhythmias. Pharmacological agents that protect against injury include Na(+)/H(+) exchanger inhibitors, antioxidants, calcium antagonists, renin-angiotensin system antagonists and adenosine. N-acetylcysteine, diltiazem, verapamil, enalaprilat and adenosine have all showed promising results in patients with acute myocardial infarction when given before reperfusion. Cariporide was beneficial when added to cardioplegia. However, their use in daily practice awaits results from large clinical trials.
Animals↗
Spontaneous coronary artery dissection: management options in the stent era.
Spontaneous coronary artery dissection (SCAD) is a rare cause of coronary obstruction, usually affecting women in the childbearing age. Pathogenetic mechanisms are elusive, and optimal treatment is not established. We describe a case of spontaneous coronary artery dissection that was successfully treated by coronary stenting. The published literature regarding the outcome of this modality of treatment in patients with SCAD is reviewed. A patient with spontaneous coronary artery dissection treated by stenting is described along with a review of the published literature regarding treatment of similar patients.
Aortic Dissection↗
Successful treatment of pacemaker related endocarditis with acute embolic stroke without device removal.
Pacemaker related endocarditis is a rare potentially fatal condition, most commonly acquired during manipulation of the pacemaker system. Most patients have involvement of the right heart. Only rarely has involvement of the left-heart been documented. In the absence of controlled studies regarding management of such cases, many recommend complete removal of the pacing system along with intravenous antibiotics. We present a patient with documented pacemaker related left-sided endocarditis associated with an acute embolic stroke who was treated with antibiotics with complete recovery and its two-year follow up.
Aged↗
Sequential use of thrombolytic agents for thrombosed mitral valve prosthesis during pregnancy.
Thrombolytic therapy has gained popularity as an alternative to surgery in the treatment of prosthetic heart valve thrombosis. We report on the sequential use of streptokinase followed by recombinant tissue type plasminogen activator (rt-PA) for the treatment of a thrombosed prosthetic mitral valve in a pregnant woman at 26 weeks of gestation. Although thrombolysis was unsuccessful, the patient carried till 34 weeks of gestation and delivered by cesarean section a live newborn with an uneventful postpartum course. Based on our case and on what has been previously described in the literature, thrombolytic therapy should be considered as an option in the management of hemodynamically unstable pregnant patients with prosthetic valve thrombosis. When a single agent proves insufficient, combination therapy should be considered as it might provide hemodynamic stability and improvement in cardiac function that would allow patients at a high surgical risk to carry their pregnancy to viability.
Adult↗
Diffuse coronary artery spasm induced by guidewire insertion.
Coronary artery spasm is reported to occur in 1 5% of percutaneous coronary interventions. However, coronary spasm induced solely by guidewire insertion is very rare. We present a case of diffuse coronary artery spasm induced by guidewire insertion, which responded promptly to intracoronary nitrates. The case illustrates the importance of the recognition of this phenomenon for the selection of the optimal balloon and stent size.
Aged↗