心血管疾患と診断

A 7 year old boy with a history of repaired tetralogy of Fallot with aortic valve replacement was scheduled to undergo laparoscopic cholecystectomy. His significant history comprises of post cardiac surgery with warfarin anticoagulant. Perioperatively warfarin was converted to low molecular weight heparin and the patient underwent general endotracheal anaesthesia with caudal epidural anaesthesia for laparoscopic cholecystectomy. Anaesthesia induction, intraoperative course and postoperative period proceeded uneventfully and the patient quickly progressed to the preoperative level of functioning. The perioperative anticoagulant management in such patients of repaired tetralogy of Fallot with aortic valve replacement is reviewed.

Objective: The incidence of gastrointestinal (GI) complications in patients undergoing coronary artery bypass grafting (CABG) is increasing as the population ages. The reported incidence ranges from 0.3% to 3.7%. Coronary Artery Bypass Grafting (CABG) is one of the most common operations performed. The outcome of patients who undergo abdominal operations for GI complications after CABG is not known. The purpose of the study is to determine the impact of abdominal surgery on patients who undergo CABG.

Methods: A retrospective review of nationwide data of all patients undergoing CABG from 2006 to 2010. A total of 160,513 patients who underwent CABG were reviewed.

Results: A total of 236 patients out of the 160,513 patients who underwent CABG developed GI complications that required abdominal surgery. The abdominal procedures included small and large bowel resections as well as colostomy formation. The indications for abdominal surgery varied and included ischemic bowel, and bowel obstruction. The patients who underwent concomitant abdominal surgery were more likely to develop renal Confidence Interval (CI) (8.5 to 14.2) (P<0.0001), respiratory CI (8.5 to 14.8) (P<0.0001), and infectious CI (16.3 to 28.6) (P<0.0001) complications. They were also more likely to have higher mortality CI (16.2 to 29.0), (P<0.0001). Patients who underwent abdominal operations had longer length of stay (LOS) 37.23 ± 32.8 days versus 8.2 ± 6.1 days (P<0.0001) and higher hospital charges, $389,586 ± 2 60,546 compared to $111,290 ± 82,462.2 (P<0.0001).

Conclusion: Although rare, the impact of abdominal surgery resulting from GI complications is significant. The patients who had abdominal surgery and underwent CABG were more likely to develop multiple complications. As a result, these patients had a higher rate of mortality, longer LOS, and higher hospital costs. Taken together, these results indicate that patients with GI complications should be identified promptly and aggressively treating these patients is of paramount importance.

Objective: To study the height LDLsd levels and coronary disease relation.

Methods: Experimental transversal and retrospective study of sample not probabilistic random. 62 individuals were studied of both sex who did attended a consultation specialized in cardiology at the University Queen Fabiola Clinic of Cordoba city Argentina. The LDLsd are separated using vertical polyacrylamide gradient gel electrophoresis to 3% in non-reducing conditions. The presence of LDLsd was established when identified in the serum LDLsd abnormal band with Rf>0.36.

Results: 26 patients have LDLsd elevated and 36 patients with normal LDLsd Rf<0.36). In 36 (58%) patients with normal LDLsd, 27 (75%) of them have not coronary disease and diabetes. A correlation study between factors of risk and coronary disease with a 95% of statically significance resulted that 16 patients with coronary disease had height LDLsd (Rf>0.36) and 7 patients without disease (p<0.001).

Conclusion: The research revealed high levels of LDLsd in subjects assessed, by association with coronary disease increased significantly. Patients with normal TGR who had elevated levels of LDLsd had developed coronary artery disease; it confirms to LDLsd as independent of coronary disease risk factor.

Acute aortic dissection is a catastrophic episode that usually presents as a sudden, painful, ripping sensation in the chest or back. It has an estimated annual incidence of approximately 5 to 30 per million.The primary event in aortic dissection is a tear in the aortic intima. The most important predisposing factor for acute aortic dissection is systemic hypertension. Other predisposing factors include disorders of collagen (Marfan syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve, aortic coarctation, Turner syndrome, coronary artery bypass graft surgery, previous aortic valve replacement, crack cocaine use, strenuous resistance training and trauma.

Approximately half of the aortic dissection observed in women under 45 years old has been reported to be related to pregnancy. Herein, we present a case of type A aortic dissection diagnosed in a 37 year old non hypertensive, nonpregnant female. Aortic dissection is not uncommon or impossible in a young healthy and previously asymptomatic female. A high level of suspicion is required for prompt diagnosis and treatment.

Purpose: Flecainide is a class 1C antiarrhythmic drug especially used for the management of supraventricular arrhythmia. Flecainide also has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias including paroxysmal fibrillation, Paroxysmal Supraventricular tachycardia and ventricular tachycardia. Flecainide works by regulating the flow of sodium in the heart, causing prolongation of the cardiac action potential. The proarrhythmic effects however noted are not widely reported.

Method: We report a case of paroxysmal atrial fibrillation with structurally normal heart who was treated with oral Flecainide. Despite subjective improvement and no adverse events [QTc prolongation] a repeat holter detected him to have multiple short non sustained ventricular arrhythmias.

Results: Development of ventricular arrhythmias, salvos & non sustained ventricular tachycardia after a month of initiation of oral Flecainide detected by 24 hours ECG holter lead to discontinuation of Flecainide and subsequent early electro physiological studies and successful ablation.

Conclusion: Initiation of oral Flecainide in a case of atrial fibrillation with subjective improvement and regular ECG monitoring, no QTc prolongation can still lead to development of dangerous ventricular arrhythmias. A cautious approach and thorough investigations and follow up are recommended.

Dyslipidemia is one of the most important risk factor for cardiovascular diseases, which are the main cause of death worldwide. There are two treatment options for dyslipidemia that complement each other. Despite the spread of lipid-lowering therapy and its increasing use in clinical practice, a large numbers of patients still remain in high “residual cardiovascular risk.” Currently at the forefront of lipid-lowering agents, statins significantly lower LDLcholesterol but in the terms of effect on the levels of triglycerides and HDL-cholesterol there is much less impact. This is a serious problem, especially in patients with atherogenic dyslipidemia, typical for patients with metabolic syndrome. For this reason, high attention has recently been given to combination of lipid-lowering agents. It is also important to mention the important pleiotropic effects of hypolipidemics. This article provides an overview of current lipid-lowering agents, their comparisons as well as new recommendations in the management of dyslipidemia.

Acute aortic dissection can occur at the time of intense physical exertion in strength-trained athletes like weightlifters, bodybuilders, throwers, and wrestlers.

Rapid rise in blood pressure and history of hypertension are the most common causes of aortic dissection in athletes. It is a very tragic event because of its high mortality rate of about 32% in young patients. We report a case of aortic dissection in a young weightlifter with history of anabolic steroid usage with an extensive intimal tear of the aorta at Sino tubular junction and arch.