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Biomedical subjects

Richard W Lee

Publications and source records attributed to Richard W Lee.

6 recordsLinked to original sources
PubMed2006

Transient midventricular ballooning syndrome: a new variant.

We describe a new variant of transient left ventricular (LV) ballooning in North American Caucasian patients in which only the midventricle is affected. The patients described in this case series initially presented with emotional or physical stress and had similarities to transient apical ballooning syndrome; however, this variant is unique in that the transient ballooning involves the midventricle with hypercontractility of the apical and basal segments. The presentation, clinical features, and transient nature of the reported cases in this series are similar to transient LV apical ballooning and suggest a shared pathophysiologic etiology. Sparing of the apical segment with involvement of midventricle only supports etiologies not related to an epicardial coronary artery distribution. Although the pathophysiologic mechanism of the transient ventricular ballooning syndromes and other cases of catecholamine-associated transient ventricular dysfunction are not well understood, the emergence of this new variant raises further questions in the understanding of the "brain-heart" relationship.

Aged↗
PubMed2004

Relief of pseudostenosis using the transit exchange catheter.

Pseudostenosis is a generally benign complication of percutaneous coronary intervention that is caused by the mechanical deformation of a tortuous artery by the guidewire. We describe two cases of a tortuous right coronary artery in which pseudostenosis was relieved by placing a Transit exchange catheter (Cordis) distally and subsequently removing the guidewire. This technique safely confirmed the diagnosis of pseudostenosis without losing guidewire position or requiring additional wires and balloons.

Adolescent↗
PubMed2003

Increased incidence of coronary atherosclerosis in type 2 diabetes mellitus: mechanisms and management.

Type 2 diabetes mellitus is a metabolic disease of carbohydrate metabolism. However, it should also be considered a vascular disease because diabetic patients have a strong predilection for atherosclerosis. With the increasing prevalence and earlier age at onset of diabetes, the projected effect of diabetes on cardiovascular health and resource utilization is sobering. The mechanisms of the high rate of atherosclerosis are multifactorial and give clinicians and researchers insights into potential preventive therapies. Effective pharmacologic and lifestyle interventions are available for primary and secondary prevention of cardiovascular complications. However, data show that these interventions continue to be underutilized. Treatment of patients with type 2 diabetes and coronary artery disease is similar to that of patients with coronary artery disease alone. However, patients with diabetes benefit more from treatments that reduce coronary artery disease risk.

Coronary Artery Disease↗
PubMed2003

Biventricular implantable cardioverter defibrillator and inappropriate shocks.

A 53-year-old man with nonischemic cardiomyopathy underwent implantation of a biventricular implantable cardioverter defibrillator (ICD) for symptomatic ventricular tachycardia. He received five shocks while attempting to exercise, 48 hours after implantation. Interrogation of the device revealed double counting of ventricular sensed events by the left and right ventricular leads. Shortening the AV delay and AV nodal blockade (beta-blocker) to promote ventricular pacing failed to prevent additional inappropriate ICD discharges. After detailed consideration of all options including AV nodal ablation, we chose to disconnect the left ventricular lead pending availability of newer devices with sensing functions limited to the right ventricular lead. Since then, the patient has not experienced any additional inappropriate discharges.

Atrioventricular Node↗
PubMed2003

Swallow syncope.

Swallow syncope is a rare disorder caused by hypersensitive vagotonic reflex in response to deglutition. A 26-year-old man complained of recurrent light-headedness and near syncope on swallowing was hospitalized for monitoring and evaluation. Continuous electrocardiographic and invasive arterial pressure monitoring showed ingestion of a solid meal evoked light-headedness and complete AV block without an escape rhythm that lasted for 5.6 seconds. This patient received a Medtronic Kappa (401B) DDDR pacemaker with the rate drop feature. The patient has remained asymptomatic on follow-up for the past 2 years.

Adult↗