Search

Esophageal perforation is the most feared complication of transesophageal echocardiography (TEE), although the overall risk is extremely low. We report a case of esophageal perforation in a 77-year-old woman who had no apparent contraindications to TEE. Chronic steroid therapy for symptoms of asthma as well as osteophytic changes of the cervical vertebrae contributed to her increased risk of perforation. Unlike in prior reports, the perforation in this case was fortuitously recognized rapidly due to ingestion of a carbonated beverage for evaluation of a hiatal hernia suspected during a subsequent transthoracic echocardiogram performed because of inadequate TEE images after a difficult intubation. The incidence of esophageal perforation in our series (1 in 5,000 TEEs, 0.02%) is similar to that reported in the literature. Early recognition and prompt surgical repair of the esophageal perforation led to favorable outcome in our patient.

ObjectivesOur goal was to examine the effects of implementing a fully automated wireless network to reduce door-to-intervention times (D2I) in ST-segment elevation myocardial infarction (STEMI).BackgroundWireless technologies used to transmit prehospital electrocardiograms (ECGs) have helped to decrease D2I times but have unrealized potential.MethodsA fully automated wireless network that facilitates simultaneous 12-lead ECG transmission from emergency medical services (EMS) personnel in the field to the emergency department (ED) and offsite cardiologists via smartphones was developed. The system is composed of preconfigured Bluetooth devices, preprogrammed receiving/transmitting stations, dedicated e-mail servers, and smartphones. The network facilitates direct communication between offsite cardiologists and EMS personnel, allowing for patient triage directly to the cardiac catheterization laboratory from the field. Demographic, laboratory, and time interval data were prospectively collected and compared with calendar year 2005 data.ResultsFrom June to December 2006, 80 ECGs with suspected STEMI were transmitted via the network. Twenty patients with ECGs consistent with STEMI were triaged to the catheterization laboratory. Improvement was seen in mean door-to-cardiologist notification (−14.6 vs. 61.4 min, p < 0.001), door-to-arterial access (47.6 vs. 108.1 min, p < 0.001), time-to-first angiographic injection (52.8 vs. 119.2 min, p < 0.001), and D2I times (80.1 vs. 145.6 min, p < 0.001) compared with 2005 data.ConclusionsA fully automated wireless network that transmits ECGs simultaneously to the ED and offsite cardiologists for the early evaluation and triage of patients with suspected STEMI can decrease D2I times to

We present a case of a 53-year-old woman with intractable shortness of breath that was originally ascribed to bronchiolitis obliterans organizing pneumonia. Subsequently evaluation by echocardiography and cardiac catheterization revealed that she had Lutembacher's syndrome, an uncommon combination of congenital atrial septal defect (ASD) and acquired mitral stenosis that is difficult to diagnose clinically. Our case illustrates the pitfalls and advantages of echocardiographic assessment of the mitral valve area (MVA) and the left atrial pressure (LAP). The pressure half-time method used most commonly for estimating MVA echocardiographically is inaccurate and may lead to underestimation of the severity of mitral stenosis in patients with Lutembacher's syndrome. On the other hand, the presence of ASD provides an additional method of calculating LAP, the most important determinant of symptoms in patients with mitral stenosis.

We present the multidetector CT appearance of a case of isolated dextroversion. Dextroversion is a rare anomaly characterized by extreme right-sided rotation of the heart resulting in dextrocardia with the left ventricle anterior and to the left of the right ventricle. The diagnosis is easily made with ECG-gated multidetector CT.

We report the case of an enormous right atrial hemangioma in an asymptomatic 42-year-old woman. The diagnosis was made by echocardiogram after the patient was found to have an abnormal EKG during a routine medical exam. The hemangioma is the largest described in English literature. The tumor was surgically resected and the patient did well postoperatively. In this case report, we discuss the discovery of the tumor and treatment of our patient. A brief discussion of cardiac hemangiomas follows.

A 59-year-old woman with hypertension presented with right flank pain. Magnetic resonance imaging of the abdomen revealed a 9 cm × 8 cm right renal mass and a filling defect (tumour extension) in the inferior vena cava (IVC), with protrusion into the right atrium (Figure 1). Figure 1) Magnetic resonance imaging of the abdomen showing a 9 cm × 8 cm right renal mass and a filling defect (tumour extension) in the inferior vena cava (thin arrow) with protrusion into the right atrium (thick arrow) Transthoracic echocardiography showed a large mobile mass (Figure 2) protruding from the IVC into the right atrium. The patient underwent radical right nephrectomy and excision of the mass from the IVC and right atrium. Microscopic examination of the renal mass and its intracaval and intracardiac extension demonstrated renal cell carcinoma of clear cell type. The patient remained stable on follow-up examination. Figure 2) Transthoracic echocardiogram showing a large mobile mass (arrow) protruding from the inferior vena cava (IVC) into the right atrium. Ao Ascending aorta; RV Right ventricle Malignant renal tumours represent approximately 2% of all malignant neoplasms (1). Patients with renal cell carcinoma and extension into the atrium have a significantly worse prognosis than those with other levels of vena caval involvement (2). Echocardiography plays an important role in diagnosing tumour clot extension into the right heart through the IVC.

We present a case of AIDS-related Burkitt's type cardiac lymphoma in a middle-aged woman with Epstein-Barr virus infection and profound immunodeficiency. The original features of our case include left ventricular location, female sex, and the use of contrast echocardiography to help establish the diagnosis. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007

ObjectiveWe discuss the CT findings in a case of pulmonary embolism complicated by paradoxical embolism in a patient with a patent foramen ovale and atrial septal aneurysm.ConclusionWhen confronted with a case of pulmonary embolism on CT, besides evaluating the extent of pulmonary artery occlusion, the radiologist should examine the cardiovascular system to identify any unsuspected underlying or associated conditions.

269 THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2005 VOL. 14 NO. 5 S is the leading cause of morbidity in the elderly and the third leading cause of mortality in the United States. Cardioembolic causes may account for approximately 15%–20% of all strokes.1 The potential sources of cardiogenic embolism include atrial fibrillation, left ventricular dysfunction, rheumatic heart disease, prosthetic heart valves, and less commonly, intracardiac tumors. The frequency of primary cardiac tumors is approximately 0.02%, corresponding to 200 tumors in one million autopsies.2 Cardiac papillary fibroelastoma (PFE) is the second most common primary cardiac tumor (myxoma being the most frequent). These benign endocardial tumors predominantly affect the cardiac valves, and account for 75% of all cardiac valvular tumors. This case illustrates detection and surgical removal of the PFE in a patient who presented with a transient ischemic attack. A 64-year-old woman with a history of treated systemic hypertension presented to the emergency department complaining of a new right facial droop and difficulty speaking, which she noticed upon arising from sleep. She denied any prior neurologic events. Cardiac exam revealed a decrescendo grade II/IV diastolic murmur along the left sternal border with no radiation. Computed tomography of the head and bilateral carotid ultrasound exams were unremarkable. A two-dimensional transthoracic echocardiogram and a subsequent transesophageal echocardiogram (Figure 1) showed trace aortic regurgitation and a 1.3 × 0.8 cm rounded mobile mass on the Images in Geriatric Cardiology

We report a case of a 56-year-old man with traumatic aortic rupture (TAR) sustained in a motor vehicle accident diagnosed by helical computed tomography, aortography, and transesophageal echocardiography. A large majority of patients with TAR never make it to the hospital, and for those who do, a timely diagnosis is critical for survival. We discuss the merits and pitfalls of the three imaging modalities.

Background: Anemia is a significant co-morbidity among patients with heart failure and a normal ejection fraction (HFNEF), commonly called ‘‘diastolic heart failure’’ (DHF). Data in these subjects are emerging to suggest a significant relationship between anemia, clinical symptoms, left ventricular (LV) structure, hemodynamics, and morbidity. We sought to determine whether HFNEF patients with anemia defined by World Health Organization (WHO) criteria had a true anemia or were simply hemodiluted. Methods: Twenty six subjects with HFNEF and anemia by WHO definition (Hgb!12 for women, and Hgb!13 for men) underwent blood volume analysis using the Iodine tagged albumin method. Specimens were analyzed with an automated system (BVA-100 Blood Volume Analyzer, Daxor Corp., NY). Mean values of each blood volume were calculated, as well as compared to ideal volume based on the study subject’s gender and body size, in order to determine a blood volume deficit or excess. Anemia was defined as having !95% predicted RBC volume. Results: The average age for the subjects was 71 6 14 years, and 77% were female. The average hemoglobin was 10.96 6 0.98 g/dL. Moreover, as a cohort, these patients were truly anemic, as 88.5% of patients had red cell deficits that were less than 95% RBC volume predicted for gender and body size. The average red cell volume deficit was 387 6 319 ml. Concomitantly, these patients were hypervolemic with an average plasma volume expansion of 268 6 829 ml. Eighteen patients (69%) were found to have plasma volumes that exceeded their ideal plasma volume for gender and body size suggestive of a concomitant volume overloaded state. Conclusions: Patients with HFNEF and low hemoglobin often have a true anemia characterized by, on average, a greater than one unit decrement in red cell volume. Accompanying the deficit in red cell volume in these patients is a plasma volume expansion suggesting that impaired renal function may be the underlying mechanism of both anemia and volume overload in these subjects.