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H Gen

Publications and source records attributed to H Gen.

At least 37 records · Page 2Linked to original sources
PubMed1996

Trans-systolic murmur during the Valsalva maneuver in a patient with apical aneurysm--a case report.

We present a 74-year-old female in whom a systolic murmur became trans-systolic during the Valsalva maneuver. The patient had had stable effort angina for 20 years and coronary angiography revealed complete obstruction of the left anterior descending artery in addition to other atherosclerotic lesions. Left ventriculography showed a small apical aneurysm with a narrow orifice. Aorto-coronary bypass surgery and aneurysmectomy were performed; true aneurysm was confirmed pathologically. We conclude that apical aneurysm with a narrow orifice can produce trans-systolic murmur.

Aged↗
PubMed1995

Reversible left ventricular dysfunction associated with Guillain-Barré syndrome--an expression of catecholamine cardiotoxicity?

The patient was a 76-year-old female who had a history of Guillain-Barré syndrome 3 years previously; ST-segment elevation was noted in association with reversible left ventricular dysfunction. Left ventrioculogram and coronary angiograms were normal and ergonovine test was negative during the chronic period of Guillain-Barré syndrome. She was hospitalized again due to the recurrence of Guillain-Barré syndrome. Two days later, ST-segment elevation in leads V2 through V5 prompted us to perform cardiac catheterization, although she did not complain of any chest symptoms. A large akinetic area was found mainly around the apex on left ventriculography, despite the lack of coronary stenoses. Peak creatine kinase and C-reactive protein were 400 IU/ml and 3.5 mg/dl, respectively. Left ventricular dysfunction was normalized within one week. During the acute phase of the cardiac episode, plasma norepinephrine and epinephrine were 1340 pg/ml and 112 pg/ml, respectively. I123 metaiodobenzyl-guanidine myocardial scintigram 3 weeks after the episode showed an extensive apical defect which was improved markedly 3 months later. We think that this reversible left ventricular dysfunction was due to the synergistic toxic effect of mildly increased catecholamine and transiently damaged sympathetic nerve endings in the myocardium, presumably due to Guillain-Barré syndrome.

3-Iodobenzylguanidine↗
PubMed1995

Limitations of electrocardiography in the diagnosis of acute myocardial infarction--comparison with two-dimensional echocardiography.

In order to assess the sensitivity of the initial electrocardiogram (ECG) in diagnosing the first attack of acute myocardial infarction (AMI), we compared the findings on ECG and two-dimensional echocardiogram (2-D echo) in 74 patients with single vessel coronary artery disease. Group A consisted of 41 patients with infero-posterior AMI while group B consisted of 33 patients with antero-septal AMI. In group A, 12 patients showed normal ECGs, while 2-D echo failed to reveal abnormal left ventricular wall motion in only 2 patients. In those two patients, the quality of the echocardiogram was poor. In group B, only one patient showed a normal ECG, and all patients showed abnormal left ventricular wall motion on 2-D echo. We conclude that electrocardiography has limitations in diagnosing infero-posterior myocardial infarction especially during the acute phase, but 2-D echo is an additional useful diagnostic procedure.

Echocardiography↗
PubMed1994

Large left-to-right shunt through a small atrial septal defect produced by progressive aortic stenosis in the elderly--a case report.

We present a 74-year-old female who showed a large left-to-right shunt through a small atrial septal defect presumably due to diastolic dysfunction of the left ventricle caused by the progression of aortic stenosis. Accordingly, elderly patients with even small atrial septal defect should be followed carefully, since diastolic dysfunction of the acquired left ventricular disorder could increase the left-to-right shunt.

Aged↗
PubMed1994

Markedly enlarged right atrium associated with physical signs of tricuspid regurgitation--a cause of congestive heart failure in the elderly.

We retrospectively examined 8 patients who had classical physical signs of tricuspid regurgitation associated with congestive heart failure, the cause of which was not identified by echocardiography. Exclusion criteria were as follows; 1) peak velocity of tricuspid regurgitation greater than 3 m/sec, 2) disturbance of left ventricular wall motion, 3) severe mitral regurgitation and/or aortic regurgitation by color Doppler echocardiography, and 4) structural abnormalities of tricuspid and mitral valve complexes. The subjects had a mean age of 81 years and all showed atrial fibrillation without tachycardia. Radiocardiography showed no significant left-to-right shunt. Two-dimensional echocardiography showed a markedly enlarged right atrium and slight enlargement of the right ventricle in all patients. A signal of tricuspid regurgitation was seen throughout the markedly enlarged right atrium on color Doppler echocardiography. Although neither hypoxemia nor hypercapnea were found in any of the patients, pulmonary function tests done in 6 patients were all abnormal. In chest x-ray films, 6 of the patients showed evidence of marked protrusion of the right heart border progressing over the course of several years. Right atrial enlargement due to both long-standing atrial fibrillation and presumably, to right ventricular diastolic dysfunction caused by aging made the tricuspid valve annuls annulus dilate to produce tricuspid regurgitation. In addition, concomitant mild lung disease produced a vicious cycle which led to more severe tricuspid regurgitation resulting in severe congestive heart failure. This pathophysiology can be a cause of congestive heart failure in the elderly.

Aged↗
PubMed1993

Reversible left ventricular dysfunction secondary to rapid atrial fibrillation.

We present the cases of four patients with reversible left ventricular dysfunction associated with severe congestive heart failure presumably induced by rapid atrial fibrillation. The mean heart rate was 159 beats/min and the mean left ventricular end-diastolic dimension was 58.5 mm with diffusely impaired left ventricular motion. None of the patients had a history of preceding upper respiratory infection before the acute episode and no signs of inflammation at onset, and all patients were New York Heart Association Class I or II before the acute episode. Left ventriculography, done about 1 month when congestive heart failure and ventricular rate were controlled with digitalis and diuretics, still showed diffusely decreased left ventricular motion; the mean end-diastolic volume was 165 ml and the mean ejection fraction was 30%. Coronary angiography was normal in three patients and one showed moderate left anterior descending artery stenosis. Right ventricular biopsy, done in three patients showed no evidence of myocarditis. Left ventricular wall motion normalized in 5-36 months on follow-up echocardiography. These findings suggest that persistent rapid atrial fibrillation can cause reversible left ventricular dysfunction which can take a considerable period of time to normalize.

Atrial Fibrillation↗
PubMed1993

Anomalous origin of left coronary artery from pulmonary artery in a 54-year-old woman presenting ventricular tachycardia from anteroseptal scar.

We report a 54-year-old female with anomalous origin of the left coronary artery from the pulmonary artery who came to our hospital complaining of dizziness presumably due to ventricular tachycardia. Electrocardiography, echocardiography and myocardial scintigraphy were indistinguishable from anteroseptal myocardial infarction. Only coronary angiography enabled us to differentiate between atherosclerotic ischemic heart disease and anomalous origin of left coronary artery from the pulmonary artery.

Cicatrix↗
PubMed1993

Deterioration of congestive heart failure after converting to VOO mode from DDD mode in a dilated cardiomyopathy patient; importance of atrial contribution.

We describe a 62-year-old dilated cardiomyopathy patient in whom congestive heart failure progressed shortly after DDD mode was changed to VOO mode because of battery exhaustion. Emergency battery exchange with restoration of DDD mode improved his functional status to the previous level; pulmonary capillary wedge pressure decreased from 28 to 24 mmHg and cardiac output increased from 1.5 to 2.0 L/min associated with widening of the aortic pulse pressure. Maintenance of atrial contraction is therefore important even if left ventricular systolic function is markedly impaired and left ventricular end-diastolic pressure is increased.

Atrial Function↗
PubMed1993

Tuberculous pericarditis: importance of adenosine deaminase activity in pericardial fluid.

We present a case of tuberculous pericarditis that was diagnosed early by a high titer of adenosine deaminase activity in the pericardial fluid and by a strongly positive tuberculin test. Within 2 weeks of initiation of treatment, pericardial effusion gradually decreased while clinical symptoms improved markedly. Culture from sputum, gastric juice, urine, and pericardial fluid were negative for tubercle bacillus. Measurement of adenosine deaminase activity in the pericardial fluid is a supplementary diagnostic test which is as important as for tuberculous pericarditis as it is for tuberculous pleuritis, because negative Ziehl Neelsen staining and culture for tubercle bacillus are common in tuberculous pericarditis.

Adenosine Deaminase↗
PubMed1993

[Transient "moyamoya" echo in a markedly enlarged pulmonary artery after Waterston operation is an expression of decreased pulmonary blood flow].

A 32-year-old-female with single ventricle, 20 years after the Waterston operation is described. The right pulmonary artery was markedly enlarged and the blood flow across the Waterston shunt was 2 m/sec in systole and 1.5 m/sec in diastole. "Moyamoya" echo developed transiently in the markedly enlarged pulmonary artery when she suffered from bacterial bronchitis and PaO2 decreased. Continuous wave Doppler echocardiography showed decreased blood flow across the Waterston shunt. After the bronchitis was resolved and PaO2 returned to the basal level, "Moyamoya" echo was barely seen. This "Moyamoya" echo can be a reflection of decreased pulmonary blood flow, and was a useful marker in the follow-up of this patient.

Adult↗
PubMed1993

[Development of left atrial thrombus after excellent mitral valvuloplasty for chronic severe mitral regurgitation].

We report two cases with chronic severe mitral regurgitation and atrial fibrillation in whom left atrial thrombus was detected by transesophageal echocardiography after excellent mitral valvuloplasty. The reason why thrombus developed after valvuloplasty is that preoperative severe mitral regurgitation made the left atrial blood less stagnant than it was after surgery. Thus, even when mitral valvuloplasty achieves excellent results in patients with severe chronic mitral regurgitation and atrial fibrillation, anticoagulation and left atrial appendage ligation should also be considered.

Aged↗
PubMed1992

Progression of Takayasu's aortitis in a young Japanese woman: serial angiographic study.

Progression of Takayasu's aortitis was observed by serial angiography over 2 years. Acute aortic regurgitation due to marked dilatation of the proximal ascending aorta was followed by aneurysmal dilatation of the distal ascending aorta. Aneurysmal dilatation of the carotid arteries then developed, with subsequent obstruction of both the bilateral vessels by thrombosis.

Adult↗
PubMed1992

Deep negative T waves associated with reversible left ventricular dysfunction in acute adrenal crisis.

We report two cases of reversible left ventricular dysfunction associated with deep negative T waves during acute adrenal crisis due to isolated deficiency of adrenocorticotrophic hormone. There were no symptoms suggestive of heart disease in either case and left ventricular wall motion abnormalities, present mainly around the left ventricular apex, returned to normal in 1-2 weeks. Deep negative T waves normalized 4 weeks after corticosteroid administration. Acute adrenal crisis should be considered when deep negative T waves are associated with left ventricular dysfunction without cardiac symptoms.

Adrenal Insufficiency↗
PubMed1992

Segmental asynergy of the left ventricle in a case of tight aortic stenosis associated with mild ischemic heart disease.

Emergency aortic valve replacement with double aorto-coronary bypass surgery was performed to treat severe intractable congestive heart failure in an 82-year-old man. Mild circumflex and left anterior descending artery lesions were present and the pressure gradient across the aortic valve was 80 mmHg despite a low cardiac output. The preoperative anteroseptal akinesia seen by two-dimensional echocardiography was normalized after surgery. Thus, even in patients with segmental left ventricular dysfunction, tight aortic stenosis might be present when concomitant mild ischemic heart disease is present.

Aged↗
PubMed1992

Transient increase in wall thickness of the left ventricular apex after stunned myocardium: a case report.

A case of transiently increased wall thickness in the left ventricular apex after stunned myocardium due to severe attack of vasospastic angina is described. "Ace of spades" configuration, documented by left ventriculogram and increased apical wall thickness of the left ventricle, as revealed by two-dimensional echocardiograms returned to normal in 2 months. This transiently increased left ventricular mass may have been due to myocardial edema, which is occasionally seen in the recovery course of active myocarditis.

Angina Pectoris↗
PubMed1992

[Usefulness of magnetic resonance imaging (MRI) in evaluation of left ventricular apical aneurysm].

Twenty three consecutive cases of left ventricular aneurysm due to antero-septal myocardial infarction in normal sinus rhythm were studied to decide whether or not magnetic resonance imaging (MRI) can evaluate aneurysm of the left ventricular apex. The apex, as well as the base, of the left ventricle was clearly imaged in 21 out of 23 cases. Poor images were obtained in two cases who showed frequent premature ventricular beats during this procedure. Two-dimensional echocardiography has weak points when visualizing left ventricular apex because, for one thing, the sector angle is maximally 90 degrees, and for another, the cardiac apex is too near the probe for observation of the characteristic of the left ventricular apical wall. However, MRI can make up for the above weak points and can provide supportive information by visualizing the entire left ventricular apex.

Adult↗