Ascites ; complications ; etiology ; Heart Failure ; complications ; etiology ; Hemochromatosis ; complications ; diagnosis ; Humans ; Middle Aged

Adolescent ; Cardiomyopathies ; complications ; diagnosis ; Echocardiography ; Heart Failure ; diagnosis ; etiology ; Heart Ventricles ; abnormalities ; Humans ; Male

A 51-yr-old man presented exertional dyspnea as a consequence of iliocaval fistula combined with paradoxical pulmonary embolism and high-output heart failure. Endovascular stent-graft repair was performed to cover iliocaval fistula and restore the heart function. After the procedure, dyspnea was improved and procedure related complication was not seen. A 6-month follow-up computed tomography showed regression of pulmonary thromboembolism and well-positioned stent-graft without graft migration, aortacaval communication or endoleak. Stent graft implantation should be considered an alternative of open repair surgery for treament of abdominal arteriovenous fisula, especially in patient with high risk for surgery.
Dyspnea/diagnosis ; Endovascular Procedures ; Fistula/complications/*diagnosis ; Heart Failure/complications/*diagnosis/surgery ; Humans ; Iliac Vein ; Male ; Middle Aged ; Pulmonary Embolism/complications/*diagnosis/surgery ; *Stents ; Tomography, X-Ray Computed

OBJECTIVETo study the correlation between various complications of chronic heart failure (CHF) patients and Chinese medical syndromes, thus indicating distribution laws of Chinese medical syndromes in various complications of CHF patients.

METHODSChinese medical syndrome typing was performed in 630 CHF patients by cross-sectional study of the demographic data, history of present diseases, related information on Chinese medical four diagnostic methods, and the distribution of complications. Logistic regression analysis was used to determine the correlation of various complications of CHF patients and Chinese medical syndromes.

RESULTSIn this study, recruited were common complications such as hypertension, diabetes, arrhythmia, hyperlipemia, and cerebral vascular accident, and so on. Main syndromes were sequenced as qi deficiency syndrome, blood stasis syndrome, water retention syndrome, yin deficiency syndrome, phlegm turbid syndrome, yang deficiency syndrome. Results of Logistic regression analysis indicated that correlation existed between common complications and Chinese medical syndromes. In CHF complicated hypertension patients, Logistic regression analysis showed qi deficiency syndrome and yang deficiency syndrome were negatively correlated with hypertension (P < 0.05). In CHF complicated diabetes patients, Logistic regression analysis showed phlegm turbid syndrome and water retention syndrome were positively correlated with diabetes (P < 0.05). In CHF complicated arrhythmia patients, there was no statistical difference in the distribution of each syndrome (P > 0.05). In CHF complicated hyperlipemia patients, Logistic regression analysis showed qi deficiency syndrome and water retention syndrome were negatively correlated with hyperlipemia (P < 0.05), while blood stasis syndrome, yin deficiency syndrome, and phlegm turbid syndrome were positively correlated with hyperlipemia (P < 0.01). In CHF complicated cerebral vascular accident patients, Logistic regression analysis showed qi deficiency syndrome and yang deficiency syndrome were negatively correlated with cerebral vascular accident (P < 0.01, P < 0.05).

CONCLUSIONSThere existed certain correlations between complications of CHF and the distribution of main Chinese medical syndromes. It could be used as guidance for treating CHF and its various complications by Chinese medicine and pharmacy.

Aged ; Chronic Disease ; Cross-Sectional Studies ; Female ; Heart Failure ; complications ; diagnosis ; Humans ; Logistic Models ; Male ; Medicine, Chinese Traditional ; Yang Deficiency ; complications ; diagnosis ; Yin Deficiency ; complications ; diagnosis

BACKGROUND: Cardiac myxoma is uncommon, even though accounts for 50% of primary cardiac tumor, histologically benign disease but may be lethal because of its strategic position. It has diverse clinical manifestations mimicking various diseases, which can be described under the three headings: constitutional, obstructive and embolic and the diagnosis can be easily missed unless clinician has high index of suspicion. A correct diagnosis is made before operation with the development of echocardiography. We reviewed our clinical experience in diagnosis and management of 21 cases of myxomas from 1985 to 2000. METHODS: There were 4 males (19%) and 17 females (81%). Their ages ranged from 17 to 66 years (mean 42.2 years). All the patient's medical records on their clinical features, laboratory findings, chest X-rays, electrocardiograms, echocardiographic findings, operative findings and postoperative follow-up were reviewed. RESULTS: Seventeen cases (81%) of the myxomas originated in left atrium and four (19%) in right atrium. Most common symptom was that of intracardiac obstruction such as dyspnea or dyspnea on exertion (62%). Fatigue which accounted for most of the constitutional symptom found in 38% of the 21 patients while embolism accounted for 38%. In all patients, echocardiography was used for diagnosis and the diagnostic accuracy of echocardiography was 100%. All patients received surgical treatment and immediate postoperative complications occurred in seven patients (33%). Among them, serious complications were found in two cases and one expired due to congestive heart failure. Follow-up duration ranged from 2 months to 15 years. There was no recurrence or other problem in all patients during the follow-up period. CONCLUSION: Although clinical suspicion is difficult due to the nonspecific presentation of myxoma, the diagnosis can be made easily with echocardiographic examination in all cases and surgical excision of myxoma may be curative with good long-term result.
Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography ; Embolism ; Fatigue ; Female ; Follow-Up Studies ; Head ; Heart Atria ; Heart Failure ; Heart Neoplasms ; Humans ; Male ; Medical Records ; Myxoma* ; Postoperative Complications ; Recurrence ; Thorax

Acute myocardial infarction is one of the conditions frequently managed in the emergency department. There are many complications associated with right ventricular infarction, and the incidence of right ventricular infarction associated with inferior myocardial infarction is as high as 51% based on electrocardiographic findings. We herein report the case of a 45-year-old Chinese man with inferior myocardial infarction complicated by right ventricular failure. He had hypoxaemia refractory to supplemental oxygen due to an acute right-to-left shunting through a patent foramen ovale (PFO). He underwent coronary angioplasty and closure of the PFO. It is crucial for the attending physician to consider the presence of a right-to-left shunt when there is persistent uncorrectable hypoxaemia despite maximal oxygen supplementation in the setting of right ventricular infarction, as there are clinical implications and certain clinical managing principles that should be applied.
Angioplasty, Balloon, Coronary ; Electrocardiography ; Foramen Ovale, Patent ; complications ; diagnosis ; Heart Failure ; complications ; Humans ; Hypoxia ; diagnosis ; Male ; Middle Aged ; Myocardial Infarction ; complications ; Oxygen ; therapeutic use ; Pulmonary Embolism ; complications ; diagnosis ; Ventricular Dysfunction, Right ; complications

BACKGROUNDAlthough acute congestive heart failure (CHF) patients typically present with abnormal auscultatory findings on lung examination, lung sounds are not normally subjected to rigorous analysis. The goals of this study were to use a computerized analytic acoustic tool to evaluate lung sound patterns in CHF patients during acute exacerbation and after clinical improvement and to compare CHF profiles with those of normal individuals.

METHODSLung sounds throughout the respiratory cycle was captured using a computerized acoustic-based imaging technique. Thirty-two consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created, geographical area of the images and lung sound patterns were quantitatively analyzed.

RESULTSThe geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were (67.9 +/- 4.7) and (60.3 +/- 3.5) kilo-pixels, respectively (P < 0.05). In CHF patients without and with radiographically evident pulmonary edema (REPE), after clinical improvement the geographical area of vibration energy image of lung sound increased to (74.5 +/- 4.4) and (73.9 +/- 3.9) kilo-pixels (P < 0.05), respectively. Vibration energy decreased in CHF patients with REPE following clinical improvement by an average of (85 +/- 19)% (P < 0.01).

CONCLUSIONSWith clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image. Lung sound analysis may be useful to track in acute CHF exacerbations.

Adult ; Aged ; Diagnosis, Computer-Assisted ; Female ; Heart Failure ; complications ; Humans ; Male ; Middle Aged ; Pulmonary Edema ; etiology ; pathology ; Respiratory Sounds ; physiology

Changes in renal function are one of the most common manifestations of severe illness. There is a clinical need to intervene early with proven treatments in patients with potentially deleterious changes in renal function. Unfortunately progress has been hindered by poor definitions of renal dysfunction and a lack of early biomarkers of renal injury. In recent years, the definitional problem has been addressed with the establishment of a new well-defined diagnostic entity, acute kidney injury (AKI), which encompasses the wide spectrum of kidney dysfunction, together with clearer definition and sub-classification of the cardio-renal syndromes. From the laboratory have emerged new biomarkers which allow early detection of AKI, including neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C. This review describes the new concepts of AKI and the cardio-renal syndromes as well as novel biomarkers which allow early detection of AKI. Panels of AKI biomarker tests are likely to revolutionise the diagnosis and management of critically ill patients in the coming years. Earlier diagnosis and intervention should significantly reduce the morbidity and mortality associated with acute kidney damage.
Acute Kidney Injury/*diagnosis ; Biological Markers/analysis/blood/urine ; Cystatin C/blood/urine ; Heart Failure/complications/etiology ; Humans ; Kidney Diseases/complications/*diagnosis/etiology ; Lipocalins/blood/urine ; Syndrome

We report the rare case of a patient with advanced renal cell carcinoma (RCC) who initially presented to the hospital with symptoms of cardiac failure. Preoperative cardiac studies did not reveal any underlying ischemia. After resection of a large 14-cm left renal tumor, cardiac function was noted to improve dramatically. We discuss this case of concomitant RCC and nonischemic cardiomyopathy.
Asian Continental Ancestry Group ; Carcinoma, Renal Cell/*diagnosis/surgery ; Cardiomyopathies/*diagnosis ; Female ; Heart Failure/*etiology ; Humans ; Middle Aged ; Paraneoplastic Syndromes/complications ; Thalassemia/complications

Idiopathic peripartum cardiomyopathy is an uncommon malady disease. Making the diagnosis is often difficult and it is always necessary to exclude other prior heart disease and other causes of left ventricular dysfunction in pregnant women. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are further amplified when the common complications of pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy. This may be aggravated by making a late diagnosis and providing inappropriate treatment. We experienced a 38-year-primigravida who has diagnosed with idiopathic peripartum cardiomyopathy and underwent elective cesarean section with general anesthesia.
Anesthesia ; Anesthesia, General ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cesarean Section ; Delayed Diagnosis ; Female ; Heart Diseases ; Heart Failure ; Humans ; Hypertrophy ; Peripartum Period ; Pregnancy ; Pregnancy Complications ; Pregnant Women ; Ventricular Dysfunction, Left