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Studies were conducted to determine the association between the prevalence of patent foramen ovale and cryptogenic stroke in patients younger than 55 years of age and above 55 years. The data suggest association between foramen ovale and cyrptogenic stroke in both older and young patients and paradoxical embolism is cause of stroke in both age groups.

Heparin and alteplase appear to be beneficial when used together to treat pulmonary embolism, according to a study of 256 patients. Pulmonary embolism occurs when a blood clot forms in the legs and travels to the lungs. Alteplase is a drug that breaks down blood clots.

Surgical repair of atrial septal defects in patients older than 40 may be more effective than medical therapy in prolonging survival and preventing heart dysfunction. Atrial septal defect is an abnormal opening between the chambers of the heart. Researchers analyzed records and questionnaires of 179 patients who had been diagnosed with this heart defect after the age of 40. Eight-four of the patients had surgical closure of the defect and 95 patients received drug treatment with digitalis, nitrates or diuretics. The average follow-up period was 8.9 years. The estimated probability of survival after 10 years was 95% among surgical patients and 84% among medically treated patients. Surgery was also more effective than medical treatment in preventing loss of heart function. However, surgery and medical therapy were equally effective in reducing the risk of arrhythmias, heart attacks, and strokes. Patients undergoing surgery should be closely monitored for these complications.

Individuals who have a heart attack that affects the right ventricle of the heart may have a higher risk of complications or death in the hospital than other heart attack patients. Right precordial electrocardiography may be an effective method for diagnosing right ventricular involvement. Among 200 patients admitted to the hospital after suffering a heart attack, 19% died in the hospital and 47% developed major complications. An elevated ST-segment on the right precordial V4R lead was detected using electrocardiography in 54% of the patients. Detection of an elevated ST-segment in the V4R was more effective in predicting a heart attack with right ventricular involvement than other diagnostic procedures. Thirty-one percent of the patients with an elevated ST-segment in the V4R lead died in the hospital and 64% developed major complications.

A pacemaker is an electrical device implanted in the chest to regulate the heartbeat in persons whose natural heartbeat is irregular, too fast or too slow. Artificial pacemakers can become infected; this occurs in one to three percent of cases. Original implantation of the device can cause infection, but the pacemaker can also develop infection years after placement. An unrelated infection in the body, such as an ear infection, can introduce bacteria into the bloodstream which can lodge on the pacemaker lead (wire); a common cause of this is Staphylococcus aureus bacteria. Evidence of bacterial growth on the device is very difficult to detect, but is important because infection can cause a blood clot, pulmonary embolism, or abscess. One approach to diagnosis is to remove the pacemaker lead by pulling it out through a vein slowly over several days, or if this fails by a surgical procedure. Echocardiography is an approach that it helpful for locating the pacemaker and the infection; it uses ultrasound to visualize the heart and pacemaker without removing the device. While two-dimensional echocardiography has been used, an improved technique is transesophageal (through the esophagus) echocardiography which is able to show small vegetations (bacterial colonies) on the pacemaker more effectively. The case of a 70-year-old man who suffered from a fever unresponsive to antibiotics for seven months is described; he had developed a pacemaker lead infection following an ear infection. Transesophageal echocardiography detected the vegetations and the pacemaker was removed successfully using a new extraction technique, which is described. (Consumer Summary produced by Reliance Medical Information, Inc.)