PubMed Health⌕ Search

Biomedical subjects

J Z Przybojewski

Publications and source records attributed to J Z Przybojewski.

At least 55 records · Page 3Linked to original sources
PubMed1984

Primary cardiac hydatid disease. A case report.

A young Coloured man whose only symptom was that of minimal dyspnoea on exertion, on examination had signs of infundibular stenosis which were confirmed by cardiac catheterization. Additional features were left anterior hemiblock and cardiomegaly as delineated radiologically. Cross-sectional echocardiography revealed a very large cystic mass located within the interventricular septum which encroached upon the right ventricular outflow tract. This cystic mass was further delineated by cardiac cine angiography. It is postulated that this mass was a primary cardiac echinococcal cyst and was directly responsible for the complications of left anterior hemiblock and the infundibular obstruction. The patient declined surgery and a definitive pathological diagnosis could therefore not be made. If this is a hydatid cyst then it is the second case reported in the literature diagnosed by two-dimensional echocardiography and in which left anterior hemiblock has been recorded. The clinical features, complications and surgical correction are briefly outlined.

Adult↗
PubMed1984

Mitral valve prolapse complicated by acute cerebral embolism, arrhythmias and painless myocardial infarction. A case presentation and overview.

A case of 'primary' mitral valve prolapse is documented. The patient was admitted with right-sided hemiplegia of sudden onset, probably caused by a cerebral embolus from the mitral valve. He also had a painless transmural inferior myocardial infarction (MI) of indeterminate age which was diagnosed electrocardiographically and on left ventricular cine angiography. Since selective coronary arteriography delineated the absence of fixed obstructive atherosclerotic disease, and since coronary vasospasm could not be provoked with the ergonovine (ergometrine) maleate test, it is further postulated that a coronary embolus from the abnormal mitral valve apparatus was responsible for the painless MI. A percutaneous right ventricular endomyocardial biopsy specimen displayed findings not indicative of a 'cardiomyopathy'.

Adult↗
PubMed1983

Acute myocardial infarction with a non-diagnostic electrocardiogram. Case presentation and overview.

The clinical presentation of a young hypertensive White man with acute high lateral non-transmural myocardial infarction (MI) is documented. This diagnosis was established on the grounds of a history of chest pain, elevated serial serum enzyme levels, technetium-99m pyrophosphate ('hot-spot') scintigraphy, exercise thallium-201 ('cold-spot') scanning, left ventricular cine angiography and selective coronary arteriography. Daily resting 12-lead ECGs failed to demonstrate unequivocal features of acute non-transmural subendocardial MI. The diagnostic difficulties facing the clinician in a case of acute MI associated with a non-diagnostic ECG are stressed, and the ECG features of acute subendocardial MI are reviewed.

Adult↗
PubMed1983

Syphilitic coronary ostial stenosis. Case reports.

Two young Coloured men with proven syphilitic coronary ostial stenosis had severe angina pectoris unresponsive to conventional medication. One underwent an aortic valve replacement for severe aortic insufficiency associated with subtotal ostial occlusion of the right coronary artery (RCA), which was corrected by an aortocoronary bypass graft; the left coronary artery (LCA) ostium was normal and patent. The other patient had total occlusion of the LCA ostium which resulted in an extensive transmural anteroseptal and anterolateral myocardial infarction; the RCA ostium was unaffected and the aortic valve appeared normal. He was considered unsuitable for cardiac surgery and continued to receive anti-anginal drug therapy with quite satisfactory improvement in symptoms. Non-atheromatous coronary artery disease must always be sought for and excluded when a non-White patient presents with symptoms of ischaemic heart disease. Although atheromatous coronary artery involvement is becoming increasingly prevalent among 'westernized' Black and Coloured subjects, it is still relatively unusual in comparison with the extremely high incidence in the White population.

Adult↗
PubMed1983

Pre-infarction Prinzmetal's angina. A case report and review of the literature.

A 45-year-old White man presented with the classic history of Prinzmetal's variant angina, culminating in a transmural inferior myocardial infarction despite intensive treatment with continuous nitroglycerin infusion and the oral calcium antagonist nifedipine. During the frequent episodes of 'pre-infarction' Prinzmetal's variant angina intermittent second-degree atrioventricular heart block as well as ventricular tachycardia was witnessed, necessitating the insertion of a temporary transvenous right ventricular pacemaker. Selective coronary angiography performed approximately 1 week after the infarction in an attempt to elucidate the cause of continuing chest pain unresponsive to medication showed subtotal occlusion of the distal part of the dominant right coronary artery proximal to the origin of the artery to the atrioventricular node, while only very minor narrowings of the internal lumen were evident in the left coronary artery. The well-known angiographic features of a resolving intracoronary thrombus were visualized without any superimposed reversible coronary vasospasm. After catheterization the angina settled down and the patient was discharged on oral nifedipine and isosorbide dinitrate treatment. The place of coronary artery spasm in the pathophysiology of acute myocardial infarction, one facet of the clinical spectrum of ischaemic heart disease, is reviewed.

Angina Pectoris, Variant↗
PubMed1983

Acute myocardial infarction due to coronary vasospasm secondary to industrial nitroglycerin withdrawal. A case report.

A case of acute transmural anterior myocardial infarction in a 45-year-old Black employee of an explosives factory during a period of withdrawal from industrial nitroglycerin is documented. Angiography revealed that the patient had normal coronary arteries. Coronary vasospasm could not be induced by the ergometrine (ergonovine) maleate provocation test. It is postulated that the infarction was directly attributable to coronary vasospasm provoked by the 'industrial nitroglycerin withdrawal syndrome', since there was no evidence of any other non-atheromatous aetiological factor. The authors believe this to be the first such case in a Black subject reported in the literature.

Coronary Vasospasm↗
PubMed1983

Rupture of sinus of Valsalva aneurysm into the right ventricle.

A young Black woman presented with acute severe right ventricular and moderate left ventricular cardiac failure secondary to rupture of a sinus of Valsalva aneurysm originating from the right coronary sinus. The rupture into the right ventricle was accompanied by severe aortic valve insufficiency. The aortic valve showed congenital myxomatous degeneration with no evidence of infective endocarditis or syphilis. Right ventricular endomyocardial biopsy revealed no evidence of any specific cardiac disease such as amyloidosis. Successful closure of the fistula, together with aortic valve replacement and a De Vega tricuspid annuloplasty, was carried out. M-mode and two-dimensional echocardiography delineated the fistula, as well as the most unusual binding of tricuspid valve fluttering, which persisted after operation. Slight insufficiency of the Björk-Shiley aortic prosthesis was noted at postoperative cardiac catheterization. The patient was discharged from hospital asymptomatic and with no abnormal clinical features.

Adult↗
PubMed1983

Rupture of sinus of Valsalva aneurysm into both right atrium and right ventricle. A case report.

A young man had a congenital sinus of Valsalva aneurysm originating from the right coronary sinus, complicated by fistulas draining into both right atrium and right ventricle, as well as a congenitally abnormal aortic valve with mild aortic insufficiency. His dramatic clinical presentation, with the sudden appearance of severe biventricular cardiac failure unresponsive to intensive medical therapy, was an important clue to making the correct pre-operative diagnosis. The use of non-invasive techniques, such as phonocardiography and M-mode and two-dimensional echocardiography, is highlighted. Full cardiac catheterization was employed to define the cardiac pathophysiology. This was one of the few cases documented in which a catheter could be passed from the aorta into the right ventricle via the fistula connecting these two chambers. The fistulas were closed and the aortic valve replaced. Postoperative investigations confirmed the success of corrective surgery. As far as we are aware this is the first documented case of successful repair of a congenital sinus of Valsalva aneurysm rupturing into both the right atrium and right ventricle, accompanied by aortic insufficiency.

Adult↗
PubMed1983

Hyperkalaemic complete heart block. A report of 2 unique cases and a review of the literature.

Two White male patients with temporary complete heart block (CHB) secondary to hyperkalaemia are presented. One, a 40-year-old man, developed CHB with ensuing shock within the first 24 hours of repeat aortic valve replacement for a paraprosthetic leak caused by previous endocarditis. This patient experienced iatrogenic hyperkalaemia. The second was an 81-year-old man who had chronic renal failure and presented with Stokes-Adams attacks. This patient was initially thought to have degenerative CHB and nearly underwent inadvertent permanent pacemaker insertion. Both patients were initially treated with emergency temporary cardiac pacing with subsequent successful management. Temporary CHB secondary to hyperkalaemia, from whatever cause, has very rarely been documented in the literature. A review of this potentially lethal complication is undertaken and the significance of unifascicular and bifascicular conduction block as a consequence of hyperkalaemia is discussed.

Adult↗
PubMed1983

Acute coronary vasospasm secondary to industrial nitroglycerin withdrawal. A case presentation and review.

A Black employee exposed to industrial nitroglycerin (NG) in an explosives factory presented with severe precordial pain. The clinical presentation was that of significant transient anteroseptal and anterolateral transmural myocardial ischaemia which responded promptly to sublingual isosorbide dinitrate. Despite being removed from exposure to industrial NG and receiving therapy with long-acting oral nitrates and calcium antagonists, the patient continued to experience repeated attacks of severe retrosternal pain, although transient myocardial ischaemia was not demonstrated electrocardiographically during these episodes. Cardiac catheterization revealed a normal myocardial haemodynamic system and selective coronary arteriography delineated coronary arteries free from any obstructive lesions. An ergonovine (ergometrine) maleate provocative test failed to elicit coronary artery spasm, although this was undertaken while the patient was on nitrate and calcium-blocker therapy. Clinical records of previous significant constrictive pericarditis (probably due to tuberculosis) with resultant abnormalities on the ECG complicated the diagnosis. Evaluation was further hindered by the known "variant pattern' seen on the ECGs of members of the Black population. We postulate that this patient's clinical features were a direct result of severe vasospasm affecting the left coronary artery; it is also strongly suggested that withdrawal from contact with industrial NG precipitated this potentially lethal coronary vasospasm. The role played by industrial NG in ischaemic heart disease is reviewed, as well as the importance of the "normal variant pattern' in the assessment of cardiac disease in Black patients. As far as we are aware this is the first time that the use of the ergonovine maleate provocative test has been documented in the industrial NG withdrawal syndrome.

Acute Disease↗
PubMed1983

Multiple coronary vasospasm: a cause of repeated myocardial infarction and symptomatic 'torsade de pointes' (atypical ventricular tachycardia). A case presentation and review.

A middle-aged Coloured man had a 6-year history of chest pain induced by effort and also experienced at rest. Quite dramatic episodes of associated arrhythmias, specifically 'torsade de pointes' (atypical ventricular tachycardia) and syncope were experienced by the patient, despite the use of numerous anti-arrhythmic and anti-anginal agents. Transmural anteroseptal and non-transmural anterolateral myocardial infarctions were documented in the presence of a normal left coronary artery (LCA). Severe reversible vasospasm of the right coronary artery (RCA) was provoked with the use of ergonovine (ergometrine) maleate at cardiac catheterization. It is postulated that the cause of the previous myocardial infarctions was significant vasospasm of the LCA branches, and that he was subject to multiple coronary vasospasm, as was highlighted by the visualization of spasm superimposed on atheromatous plaque within the RCA. Furthermore, it is strongly suggested that the potentially lethal ventricular arrhythmias, including 'torsade de pointes', were a direct result of coronary vasospasm, which in turn gave rise to his presyncope and syncope attacks. No evidence of sinoatrial node disease could be found. The only risk factor for ischaemic heart disease which applied in his case was heavy cigarette smoking. Control of his disabling symptoms seems to have been achieved by the use of maintenance nifedipine (a calcium-blocking agent), long-acting nitrates (isosorbide dinitrate) and quinidine gluconate, confirming the probable vasospastic aetiology of the 'torsade de pointes'. At no stage was there dangerous prolongation of the QT interval, an oft-quoted prerequisite for this arrhythmia. Some of the more important aspects of coronary vasospasm are discussed; as far as I am aware this is the first patient documented in the literature with 'torsade de pointes' associated with angiographically demonstrated coronary artery spasm.

Cineangiography↗
PubMed1982

Iatrogenic aortocoronary vein fistula. A case presentation and review of the literature.

A patient underwent aortocoronary saphenous bypass grafting to the left anterior descending coronary artery (LADA) and its first diagonal branch for the relief of severe angina pectoris. There was difficulty in exposure of the LADA, which was covered by a thick layer of epicardial adipose tissue. Postoperatively the patient continued to experience severe retrosternal pain which prompted early repeat coronary angiography. This revealed an aortocoronary vein fistula (AVF) secondary to the inadvertent anastomosis of one of the saphenous vein grafts to the left anterior descending coronary vein (LADV). It was only after this procedure that clinical examination revealed a grade 2/6 high-frequency continuous murmur best heard in the 2nd and 3rd left intercostal spaces. The persistance of severe angina pectoris at rest and on effort led to performance of a revision operation. The LADV was then transected and ligated, and an extended saphenous vein reimplanted into the LADA proper. This provided complete relief from angina. This is the first such case reported in South Africa and the sixth documented. In all the aortosaphenous vein grafts had been inserted into the LADV; all exhibited the classic continuous murmur postoperatively, apart from 1 patient who had an ejection systolic murmur. None of the other 5 patients complained of postoperative angina and only 3 were subjected to revision surgery. The literature is reviewed, with emphasis on the rationale for performing the first elective aortocoronary vein anastomosis in 1968. Clinical features of iatrogenic AVF are detailed and an attempt is made to assess when re-operation is indicated. It is easy to fail to notice this complication; however, its correction can have a dramatic effect on the patient's symptoms. It is the author's belief that many more such cases exist but are not being detected, probably because of lack of appreciation of the possibility of this iatrogenic condition occurring.

Adult↗
PubMed1982

Penetrating wounds of the heart and great vessels--a new therapeutic approach.

A series of 36 Black and Coloured patients, presenting during a 1-year period with life-endangering intrathoracic trauma secondary to assault, is presented. Penetrating wounds of the heart were documented in 32 of these patients, 6 of whom died almost immediately after having been brought into the Resuscitation Unit of Tygerberg Hospital, Parowvallei, CP. The remaining 26 patients had clinical features of cardiac tamponade and circulatory collapse, and in 4 of these patients an emergency thoracotomy was performed in the Resuscitation Unit as it was considered inadvisable to delay surgery until theatre had been arranged. Three of the latter 4 were discharged home completely recovered. Total peri-operative mortality was 13.3%, most deaths being due to lacerations of the left ventricle. Penetrating wounds of the ventricles accounted for some 85% of the total cardiac lacerations; other lacerations affected the pulmonary artery and its branches, the aorta, left atrium and internal thoracic artery. The incision most frequently employed at surgery was a median sternotomy (53%), followed by left thoracotomy (40%) and right thoracotomy (7%). Pre-operative emergency management based on pathophysiological principles is discussed. The fact that relatively inexperienced surgical registrars performed many of these operations with good results emphasizes the need for the establishment of resuscitation units in more peripheral hospitals where many of these patients could primarily be treated. These units would then be able to manage many of these patients, probably at an earlier stage than if they were referred to a teaching hospital such as Tygerberg.

Adolescent↗
PubMed1981

Polyarteritis nodosa in the adult. Report of a case with repeated myocardial infarction and a review of cardiac involvement.

A young Coloured man with a history of acute transmural anteroseptal and anterolateral myocardial infarction presented with angina pectoris. Skeletal muscle biopsy showed unequivocal evidence of polyarteritis nodosa. Complete cardiac catheterization, left ventricular cine angiography, and selective coronary arteriography demonstrated a large aneurysm involving the apex and the left ventricular free wall. Diffuse aneurysmal dilatation of the right coronary artery was noted, as well as very severe obstructive lesions of the proximal left anterior descending and left circumflex coronary arteries. Five days after cardiac catheterization the patient suffered an acute transmural inferior myocardial infarction, complicated by acute pericarditis and complete heart block, which necessitated insertion of a pacemaker. This was soon followed by acute perforation of a peptic ulcer (documented at laparotomy), after which the patient died. As far as the author can ascertain, this is the first adult with polyarteritis nodosa (PAN) who underwent cardiac catheterization and selective coronary arteriography. The literature on cardiac involvement in the adult with PAN is reviewed.

Adult↗
PubMed1981

Supravalvular aortic stenosis in the adult. A case presentation with unique associated features.

A 42-year-old symptomatic woman with possible adult Williams's syndrome (mental retardation, 'elfin facies' and supravalvular aortic stenosis (SVAS)) is documented. This patient displayed many unique features in addition to the severe SVAS (peak systolic gradient 96 mmHg): there was an associated persistent left superior vena cava draining into the coronary sinus, mitral valve prolapse (Barlow's syndrome) and complete right bundle-branch block on ECG. Peripheral pulmonary artery stenosis was absent. M-mode echocardiograhy in the adult with SVAS is described for the first time in the literature, as is the use of the 60 degrees cross-sectional scan. Both these non-invasive procedures proved of value in the diagnosis. The degree of subendocardial ischaemia, as determined by the 'endocardial viability ratio', was calculated and the possible mechanisms producing angina pectoris with 'coronary artery hypertension' in this condition are discussed. The literature on associated mitral valve abnormalities in SVAS is reviewed. A successful surgical result was obtained; the various forms of operation are outlined.

Adult↗