Prognostic Value of Transvalvular Flow Rate in Aortic Stenosis: Implications for Risk Stratification.

Background: Timing of treatment of aortic stenosis (AS) is of key importance. AS severity is currently determined by transthoracic echocardiography (TTE) with a main focus on mean trans-aortic gradients. However, echocardiography has its limitations.

Correlation between baseline immature platelets fraction levels and peak troponin in patients with acute myocardial infarction.

Introduction: Elevated peak cardiac troponin levels have been linked with increased morbidity and mortality in patients with acute myocardial infarction (AMI). Immature Platelets are young and relatively large platelets that are hyper-reactive and pro-thrombotic compared to regular platelets. Increased immature platelet fraction (IPF) has been associated with an elevated risk of thrombotic events.

Partial penetrance and phenotypic variability of aplasia of lacrimal and salivary glands caused by a novel FGF10 donor splice-site mutation.

Thirteen affected individuals of six generations of a single kindred presented with epiphora evident from infancy. Physical exam and Schirmer test revealed variable expression of tear deficiency, congenital punctal atresia, and dry mouth with multiple caries, without concomitant abnormalities of the ears or digits, commensurate with a diagnosis of aplasia of the lacrimal and salivary glands (ALSG). Reconstruction of the upper lacrimal drainage system was performed in some of the affected individuals.

Medieval Roots of the Myth of Jewish Male Menstruation.

The Jews in Western Europe during the middle ages were often perceived as distinct from other people not only in their religion, but also by virtue of peculiar physical characteristics. Male Jews were circumcised, which made them physically distinct in the sexual realm. They were believed to have a flux of blood due to hemorrhoids that was thought to more abound in Jews because they consumed salty foods and gross undigested blood, and were melancholic.

Historical Advancements and Evolution in Understanding Human Anatomy and Pathology: The Contribution of the Middle Ages.

Dissections and autopsies are critical for understanding human anatomy, pathology, and uncovering mechanisms of disease. This review presents an historical journey from ancient times until the late Middle Ages. The major steps and developments are summarized with key figures and events presented.

Association of heart block with uncommon disease States.

A variety of diseases, other than the common Lev-Lenègre disease, are associated with cardiac conduction system abnormalities. These include acute processes, such as acute rheumatic fever, and other disorders, such as sarcoidosis, connective tissue disorders, neoplasms, and bacterial endocarditis with cardiac abscess formation. The purpose of the study is to raise awareness of these rare conditions.

Clinical Significance of Conditions Presenting with ECG Changes Mimicking Acute Myocardial Infarction.

The electrocardiogram (ECG) is the primary tool in the diagnosis of acute myocardial infarction (AMI). However, other clinical conditions, both cardiac and noncardiac originated pathologies, may result in ECG tracing of AMI. This may lead to an incorrect diagnosis, exposing the patients to unnecessary tests and potentially harmful therapeutic procedures.

The significance of bradycardia in anorexia nervosa.

Anorexia nervosa (AN) is a life-threatening condition, with a significant risk for death, due to cardiovascular complications. It is characterized by abnormal eating behavior and has the highest mortality rate of all psychiatric disorders. It has been associated with bradycardia (a heart rate [HR] of less than 60 beats per minute) (up to 95%), hypotension, mitral valve prolapse, and heart failure.

The physiological impact of intermittent sequential pneumatic compression (ISPC) leg sleeves on cardiac activity.

Background: Pneumatic sleeves are widely used in surgery to prevent venous stasis and to improve cardiac function. The aim of this study was to assess the underlying cardiovascular mechanism induced by the activation of intermittent sequential pneumatic compression (ISPC) in healthy volunteers.

Methods: Twenty male subjects underwent transthoracic echocardiographic and tissue Doppler imaging evaluation before and during the activation ISPC devices.

Acute myopericarditis complicating acute tonsillitis: a prospective study.

Objectives: We describe a prospective study of 100 consecutive cases of acute tonsillitis tested for cardiac involvement. There was 1 clear-cut case of acute myopericarditis and 5 more patients with pathological findings suggesting cardiac complication.

Methods: During a 6-month period (November 2006 to April 2007), we prospectively studied 100 consecutive patients admitted to our department with acute tonsillitis for the purpose of detecting acute myopericarditis.

Acute myopericarditis complicating acute tonsillitis: beware the young male patient with tonsillitis complaining of chest pain.

Objectives: We describe 11 cases of myopericarditis complicating bacterial tonsillitis.

Methods: We performed a retrospective study of all cases of myopericarditis treated at one hospital during the years 2005 and 2006.

Results: The patients were all young men.

Filtered signal-averaged P-wave duration during pneumoperitoneum in patients undergoing laparoscopic cholecystectomy: A reflection of pathophysiological cardiac changes.

Background: Induction of pneumoperitoneum (PP) may lead to adverse cardiac functions secondary to changes such as decreased venous return and hypercarbia. The assessment of cardiac electrical activity by signal averaging may reflect various hemodynamic derangements and serve as a prognostic marker for arrhythmias. The aim of the study is to examine characteristic electrocardiographic changes that may occur during PP, by using signal-averaged P-wave analysis.

Percutaneous coronary intervention in patients receiving enoxaparin or unfractionated heparin after fibrinolytic therapy for ST-segment elevation myocardial infarction in the ExTRACT-TIMI 25 trial.

Objectives: We sought to evaluate whether enoxaparin (ENOX) is superior to unfractionated heparin (UFH) as adjunctive therapy for patients with ST-segment elevation myocardial infarction (STEMI) who receive fibrinolytic therapy and subsequently undergo percutaneous coronary intervention (PCI) by analyzing data from the ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) trial.

Background: Limited data are available on the use of ENOX compared with UFH as adjunctive therapy in STEMI patients treated with fibrinolytic therapy and subsequent PCI.

Methods: A total of 20,479 STEMI patients who received fibrinolytic therapy were randomized to a strategy of ENOX throughout index hospitalization or UFH for at least 48 h, with blinded study drug to continue if PCI was performed.

"Burning tongue" sensation during routine coronary angiography--a phenomenon related to a rare coronary anomaly.

We present the case of rare coronary circulation anomaly discovered during the routine coronary angiography that was associated with unusual "burning" sensation reported by the patient.

Effect of erythropoietin therapy on red cells filterability and left ventricular mass in predialysis patients.

Background: Cardiovascular complications are the leading cause of mortality in patients with end-stage renal disease. Left ventricular hypertrophy (LVH) is recognized as an independent risk factor for cardiovascular morbidity and mortality. At the onset of dialysis, more than 70% of the patients with chronic kidney disease have echocardiographic evidence of LVH.

Power spectral analysis of heart rate variability during helium pneumoperitoneum: The mechanism of increased cardiac sympathetic activity and its clinical significance.

Background: Carbon dioxide pneumoperitoneum (PP) is known to induce increased cardiac sympathetic expression. The role of the insufflated gas involved in this mechanism should be elucidated in an attempt to eliminate its possible serious consequences.

Methods: Twenty-five patients undergoing elective laparoscopic cholecystectomy were prospectively analyzed for cardiac autonomic nervous activity by spectral heart rate variability.

Improving the adverse changes in cardiac autonomic nervous control during laparoscopic surgery, using an intermittent sequential pneumatic compression device.

Background: The creation of positive pressure pneumoperitoneum (PP) may lead to adverse cardiovascular effects during laparoscopic operations. It can also lead to increased sympathetic cardiac activity, that might have serious consequences. We hypothesized that by reversing the hemodynamic effects, the use of intermittent sequential pneumatic compression device (Lympha-press) on the lower extremities would lead to improved cardiac autonomic control.

[The clinical significance of postictal electrocardiographic changes mimicking acute myocardial infarction].

The electrocardiogram (ECG) is of critical importance in the diagnosis of acute myocardial infarction. Clinical conditions such as acute pericarditis, esophageal rupture, pancreatitis, subarachnoid hemorrhage, perforated duodenal ulcer, pneumothorax and status following elective DC cardioversion result in ECG changes that include ST elevation and T wave inversion. This report aims to increase the awareness of non-cardiac syndromes, with ECG abnormalities mimicking acute myocardial infarction, and thus to avoid unjustified thrombolytic therapy.

Bilateral coronary fistulae to pulmonic valve in presence of severe three-vessel coronary artery disease.

A 62-year-old man was admitted to the coronary care unit due to anginal pain and palpitations--coronary angiography revealed three-vessel coronary artery disease. The unexpected finding was the presence of coronary to pulmonary artery fistulae bilaterally, from both the proximal RCA and the proximal LAD. Right heart catheterization revealed normal right ventricular and pulmonary artery pressure and absence of hemodynamically significant left to right shunt.

Uneventful 25-year course of an intracardiac intravenous catheter fragment in the right heart.

We describe a patient with an intracardiac intravenous catheter fragment in the right heart that was found during fluoroscopy. The catheter fragment had broken off from an intravenous catheter inserted 25 years previously when the patient was admitted after a road accident. There were no complications during these years.

An awl inflicted chest wound causing acute myocardial infarction.

Penetrating chest wounds are frequent. When involving the heart, they usually cause tamponade. In our case, caused by an awl, laceration of the LAD occured without intrapericardial bleeding.