Diffuse endomyocardial sclerosis; (report of a case diagnosed during life).
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The problems of diagnosis of cardiomyopathies are discussed. Among 13 patients who died in the clinic, a correct diagnosis was made in 10. The observations permit to believe that cardiomyopathy is seen more often in males aged 41 to 55 years. The course of the disease is chronic recurrent, its onset being different in individual cases: rhythm disorders, cardiac pains, recurrent pulmonary infarctions, cerebral circulation disorders. The outcome of the disease consisted, as a rule, in progressive total cardiac insufficiency refractory to therapy. In all the cases cardiomegaly was observed, not so much at the expense of hypertrophy, but rather of dilatation of the cardiac chambers. The anatomic signs included, apart from the cardiac dilatation, moderate hypertrophy with a relative bi- and tricuspid valve insufficiency, also mural thrombi in the heart chambers.
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Clinical and instrumental parameters studied in over 200 progressive muscular dystrophy patients during a period of about 10 yr revealed four different types of cardiopathy in this disease. The most interesting finding was that 38% of patients with Duchènne's dystrophy presented a clinical and ECG picture reminiscent of that of obstructive hypertrophic cardiomyopathy. Some suggestions are made for the pharmacological and rehabilitative management of subjects with myocardiopathy in the course of myodystrophy.
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It is presented the case of a fifty years old women, diagnosed 3 years ago with systemic lupus erythematosus, under therapy with prednisone and cyclophosphamid therapy. She was admitted in our hospital for right decompensated heart disease and the presence of an apical right ventricular mass occluding part of the right ventricular cavity. The endomyocardial biopsy was made to clearify the nature of this mass. After processing the specimen, the histological study evidenciated an organizing apical thrombotic mass formed in a large right ventricular cavity in conditions of pulmonary hypertention. There are presented data concerning the adverse effects of the systemic lupus erythematosus drug therapy, as well. In these circumstances, we demonstrated histologically, that both conditions could alter the heart morphology.
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Fifteen patients with right ventricular tachycardia without evidence of coronary artery disease or dilated or hypertrophic cardiomyopathy were evaluated, by means of electrophysiologic study and right ventricular endomyocardial biopsy. Six cases were diagnosed as definite arrhythmogenic right ventricular dysplasia (ARVD), while 2 cases without characteristic findings of ARVD by noninvasive studies and angiography were diagnosed as probable ARVD on the basis of their electrophysiologic and histopathologic data. In conclusion, ARVD is relatively common as an etiology of right ventricular tachycardia, and detailed electrophysiologic study and endomyocardial biopsy appear to be useful for diagnosis of ARVD.
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Postmortem examination of a former professional basketball player revealed an abnormal heart, most notably a single coronary artery. The literature on single coronary arteries is briefly reviewed, and the possible mechanism which caused the patient's condition is considered. This case is particularly unusual because of the patient's profession, which is so physically demanding.
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Hypereosinophilic syndromes are characterized by very high levels of eosinophils in peripheral blood and a dysfunction of several organs as a consequence of their massive infiltration by eosinophilic cells. Cardiac alterations are traditionally known as fibroplastic endomyocarditis (Loeffler's Syndrome). We present the case of a female patient admitted in another center for the study of an accidentally discovered eosinophilia and referred to us because of her progressive hemodynamic deterioration followed by a poor clinical evolution. The anatomopathologic findings showed the classical injuries of this Syndrome; specially at cardiac level, where it is important to highlight the occupation of all the right ventricule's cavity by a clog. These injuries justified the origin of the stormy clinical presentation.