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At least 667 records · Page 37Linked to original sources
PubMed1996

[Anesthetic management of a patient complicated with restrictive cardiomyopathy for gastrectomy].

Restrictive cardiomyopathy is a rare condition characterized with endomyocardial fibrosis, which interferes diastolic ventricular filling. A 52-year-old man with a 38 year history of dyspnea on effort presented with advanced gastric cancer. Subtotal gastrectomy under general anesthesia was scheduled. Preoperative examination showed biventricular dysfunction, impaired liver function and chronic renal failure. General anesthesia was induced using fentanyl, pancuronium and isoflurane, and maintained with nitrous oxide/oxygen, isoflurane and fentanyl. Extensive invasive monitoring included arterial blood pressure, central venous pressure, pulmonary artery pressure and oxygen saturation of mixed venous blood as indices of left-sided pump function. Dopamine and nitroglycerin infusion was also started after the tracheal intubation. Although a transient improvement of cardiac function was noted after the removal of ascites 5 liter, restricted fluid administration induced desaturation of mixed venous blood and tachycardia. The start of low dose prostaglandin E1 markedly improved cardiac output without hypotension, while an increase of intravenous nitroglycerin did not prove to be beneficial. PGE1 was more selective in decreasing left ventricular afterload, while nitroglycerin produces greater decrease of preload.

Alprostadil↗
PubMedDate not supplied

Morphological evaluation of endomyocardial biopsy.

Endomyocardial biopsy (EMB) has evolved as a simple and safe procedure with minimal morbidity and mortality. It is performed via the transvascular approach and can be done either as an individual procedure or, more commonly, at the time of routine cardiac catheterization. Sequential biopsies can be performed without ill-effects. Conventionally, the right ventricle is biopsied through the transvenous approach. It has been shown that biopsies from the right side are adequately representative if the disease is biventricular. The left ventricle can be biopsied in disease states affecting that chamber, viz. left ventricular tumour or predominant involvement of the left ventricle in endomyocardial fibrosis. For proper evaluation, biopsy pieces need to be handled and processed carefully. A large amount of valuable information can be retrieved from routinely processed tissue-a process which can be done in all laboratories. Important indications for EMB include diagnosis and monitoring of cardiac allograft rejection, adriamycin toxicity and diagnosis and follow up of myocarditis. Pathologists need to be aware of inherent artefacts of the biopsy procedure and should interpret these with caution. Thus, EMB provides useful information for diagnosis, follow up, monitoring of therapy and studying the evolution of several cardiac disorders.

Biopsy↗
PubMed1977

Pattern of heart disease in adults of the Nigerian Savanna: a prospective clinical study.

The pattern of heart disease in 404 patients seen prospectively from the guinea savanna region of Africa is presented. Over 90% presented with cardiac failure. Hypertension, Peripartal Cardiac Failure (PPCF), Congestive Cardiomyopathy and Rheumatic Heart Disease are major problems. The highest incidence of PPCF in the world probably occurs in this area but the prognosis is good. The reasons for this and the possible interrelationship of hypertension with cardiomyopathy and PPCF are discussed. In contrast to the tropical rainforests, no case of endomyocardial fibrosis was seen. During the period of study, vascular thrombosis is uncommon and coronary heart disease is non-existent in Zaria.

Adolescent↗
PubMed1998

Löeffler endomyocarditis: a clinical presentation as right ventricular tumor.

A four-year-old girl presented with an apical mass of the right ventricle, pulmonary embolism and hypereosinophilia, and was shown to be infected with Toxocara canis. Cardiac involvement was represented by endomyocardial fibrosis, mainly at the apex of the right ventricle, mural thrombi and tricuspid regurgitation. Hypereosinophilia appears to be the head point at the basis of multiple organ damage in Löeffler endomyocarditis. The disease mechanism proposed is the eosinophilic production of peroxidases, which are cytotoxic when released in large amounts into the blood flow. Treatment is based on etiologic and corticosteroid therapy (prednisolone 1-2 mg/kg/day); surgical therapy is indicated in the end stages of the pathologic process.

Animals↗
PubMed1978

[Cardiac findings in bilharziasis without pulmonary arterial hypertension].

1. A systematic search was made for cardiac abnormalities (clinical, radiological and ECG) and haemodynamic disorders (catheterisation of the right side of the heart and pulmonary artery) in 37 cases of confirmed biharziasis. It was generally found that:--14 patients (37.8%) had no symptoms;--8 patients (21.6%) had pulmonary hypertension (PH) with the corresponding cardiac signs (these will be reported separately);--15 patients (40.5%) had cardiac signs with no PH; these are studied in this paper. 2. Iatrogenic myocarditis was noted on the ECG. It was found in 3 of the 37 cases (8.1%). This points to the importance of careful monitoring of treatment. There was also ECG evidence of anaemyic myocardial changes in 5 cases of the 37 (13.5%). In 3 of these 5 cases this was found to be due to bleeding. Hypertensive myocardial disease was found in 1 case (2.7%), a patient with renal disease. Myocardial signs were also found in 3 cases because of coexistant disease. 3. Three cases (8.1%) remain in whom there were ECG changes, but without PH and without any other definable cause. These could have been due to bilharzia myocarditis; the authors review the experimental and clinical evidence for such a possibility. The real incidence of this condition remains to be determined. 4. Although there was no such case in this series, the authors suggest that bilharziasis might cause endomyocardial fibrosis (EMCF). 5. The authors put forward the hypothesis that the pulmonary arteritis is a tissue immunological reaction, and also that the myocarditis (and possibly the EMCF) is a manifestation of circulating antibodies.

Adult↗
PubMed1993

Restrictive cardiomyopathy with complete atrioventricular block and distal myopathy with rimmed vacuoles.

Two-dimensional echocardiography, cardiac catheterization, electrophysiologic studies, and biopsies of cardiac and skeletal muscle were performed in a patient with complete atrioventricular block as the initial manifestation of restrictive cardiomyopathy. The patient also showed distal myopathy with rimmed vacuoles. Weakness of the distal leg muscles occurred several years after the initial cardiac manifestations and the patient developed congestive heart failure 1 year before the second admission. Endomyocardial biopsy showed patchy myocardial fibrosis without endomyocardial fibrosis or any other specific findings of myocardial disease. Histochemical examination of skeletal muscle showed the typical features of distal myopathy with rimmed vacuoles. In some patients with atrioventricular block as the initial manifestation of restrictive cardiomyopathy, the cardiomyopathy may be just 1 manifestation of a more generalized disorder affecting both cardiac and skeletal muscle.

Adult↗
PubMedDate not supplied

Echocardiographic patterns of myocardial fibrosis in hypertensive patients: endomyocardial biopsy versus ultrasonic tissue characterization.

Echocardiographic image texture has been demonstrated to reflect the physical properties of the tissue under examination. To evaluate the role of collagen in determining the echo pattern of the left ventricular wall, we studied nine hypertensive patients with left ventricular hypertrophy (left ventricular mass index > 125 gm/m2) and biopsy-proven different degrees of myocardial fibrosis by analyzing the echocardiographic examinations performed before the biopsy. Myocardial tissue was sampled under fluoroscopy and two-dimensional echo guidance in the interventricular septum. Collagen volume fraction (CVF; normal range up to 2%) was taken as an index of fibrosis. The echo patterns were assessed by analyzing standard two-dimensional parasternal long-axis echocardiograms recorded on videotape. Images were color-coded at 256 levels (0 = yellow, 256 = black) and digitized off-line onto a personal computer. The region of analysis was set using a selection tool (20 x 10 mm) in the general area of septum where the specimen was taken. For each selection a color-level histogram, representing the frequency distribution, was derived with estimates of the average pixel intensity (mCS), skewness (SK), kurtosis (K), and the broad band (Bb) of the echoes about the distribution. Echo-derived parameters in each patient were compared with corresponding CVF values. CVF was out of range in all patients, ranging from 2.6% to 7.6% (mean 4.3% +/- 1.6%). No correlation was found between CVF and mCS, whereas a significant correlation was found at end diastole between CVF and the parameters describing histogram morphology, respectively, SK (r = 0.73), K (r = 0.69), Bb (r = 0.72). These findings for the first time demonstrate in vivo in hypertensive patients with left ventricular hypertrophy an agreement between echo amplitude and histologically assessed collagen volume. Thus in our studied patients collagen content appears to be the major determinant of regional echo intensity, its increase resulting in a significant and progressive wider asymmetrical left shift (yellow) of the color histogram.

Adult↗
PubMed1989

Nonspecific myocarditis: a statistical and clinicopathological study of autopsy cases.

Among a total of 634,440 autopsy cases in "The Annuals of Pathological Autopsy Cases in Japan" from 1958 to 1984, 929 cases with nonspecific myocarditis were registered. The average incidence was 0.15%, fluctuating around 3- to 5-year intervals with a remarkable rise observed after 1974. The major complications in cases of myocarditis were pneumonitis, hepatitis or hepatic cirrhosis, pancreatitis, malignancies, lymphatic or thymic involvements. A clinicopathological study of 36 cases of myocarditis and 27 cases of postmyocarditic cardiomegaly indicated a classification of acute, subacute, healing and chronic or recurrent stages as well as dilatation-hypertrophy- and right ventricle-dominant types. Acute myocarditis was characterized by diffuse inflammatory cell infiltration and showed various types of arrhythmias and shock. Subacute myocarditis showed ventricular dilatation, edematous interstitium and severe congestive heart failure. Chronic myocarditis with dilatation and/or hypertrophy and irregular fibrosis included right ventricular involvement, endomyocardial disease, sick sinus syndrome in selected cases, congestive heart failure in most cases, and showed a male predominancy. Postmyocarditic cardiomegaly was similar to chronic myocarditis but showed more hypertrophy, preexcitation waves and prominent negative T waves in electrocardiography and sudden death.

Adolescent↗