Cardiac Wall Motion Research Articles

The role of catecholamines in the pathogenesis of neurogenic pulmonary edema associated with subarachnoid hemorrhage

Neurogenic pulmonary edema (NPE) occurs frequently after aneurysmal subarachnoid hemorrhage (SAH), and excessive release of catecholamines (epinephrine/norepinephrine) has been suggested as its principal cause. The objective of this retrospective study is to evaluate the relative contribution of each catecholamine in the pathogenesis of NPE associated with SAH. Records of 63 SAH patients (20 men/43 women) whose plasma catecholamine levels were measured within 48 h of SAH onset were reviewed, and the clinical characteristics and laboratory data of those who developed early-onset NPE were analyzed thoroughly. Seven patients (11 %) were diagnosed with NPE on admission. Demographic comparison revealed that the NPE+ group sustained more severe SAH than the NPE- group. Cardiac dysfunction was also significantly more profound in the former, and the great majority of the NPE+ group sustained concomitant cardiac wall motion abnormality. There was no significant difference in the plasma epinephrine levels between NPE+ and NPE- group (324.6 ± 172.8 vs 163.1 ± 257.2 pg/ml, p = 0.11). By contrast, plasma norepinephrine levels were significantly higher in the NPE+ group (2977.6 ± 2034.5 vs 847.9 ± 535.6 pg/ml, p < 0.001). Multivariate regression analysis revealed that increased norepinephrine levels were associated with NPE (OR, 1.003; 95 % CI, 1.002-1.007). Plasma epinephrine and norepinephrine levels were positively correlated (R = 0.48, p < 0.001). According to receiver operating characteristic curve analysis, the threshold value for plasma norepinephrine predictive of NPE was 2,000 pg/ml, with an area under the curve value of 0.85. Elevated plasma norepinephrine may have more active role in the pathogenesis of SAH-induced NPE compared with epinephrine, although both catecholamines may be involved via multiple signaling pathways.

Association between elevated plasma norepinephrine levels and cardiac wall motion abnormality in poor-grade subarachnoid hemorrhage patients

Patients with aneurysmal subarachnoid hemorrhage (SAH) are frequently complicated by acute cardiac dysfunctions, including cardiac wall motion abnormality (WMA). Massive release of catecholamine into the systemic circulation after aneurysmal rupture is believed to result in WMA, and poor-grade SAH seems to be the most important risk factor. However, plasma catecholamine levels have rarely been measured in SAH patients with WMA, and previous studies indicated that the elevated levels might not necessarily predict WMA. The objective of this study is (1) to evaluate relationship between WMA and plasma catecholamine levels in poor-grade SAH patients in the acute phase and (2) to clarify clinical characteristics of SAH patients with WMA. Among 142 poor-grade (World Federation of Neurosurgical Societies grades IV and V) SAH patients, 48 underwent both transthoracic ultrasound and measurement of plasma catecholamine levels within 24h of SAH onset. They were divided into WMA+ (n = 23) and WMA- (n = 25) groups, and intergroup comparison was made on demographics, plasma catecholamine levels, and outcomes. Plasma norepinephrine levels were significantly higher in WMA+ group than in WMA- group (2,098.4 ± 1,773.4 vs. 962.9 ± 838.9pg/mL, p = 0.02), and the former showed significantly worse outcomes 90days after admission. There were no intergroup differences in the plasma levels of epinephrine. Plasma norepinephrine levels were inversely correlated with left ventricular ejection fraction. Multivariate logistic regression analysis revealed that increased plasma norepinephrine levels were predictive of WMA, although age, female sex, and grade V SAH were not. This retrospective study highlights the role of norepinephrine in pathogenesis of SAH-induced WMA.

Energy Harvesting from the Beating Heart by a Mass Imbalance Oscillation Generator

Energy-harvesting devices attract wide interest as power supplies of today's medical implants. Their long lifetime will spare patients from repeated surgical interventions. They also offer the opportunity to further miniaturize existing implants such as pacemakers, defibrillators or recorders of bio signals. A mass imbalance oscillation generator, which consists of a clockwork from a commercially available automatic wrist watch, was used as energy harvesting device to convert the kinetic energy from the cardiac wall motion to electrical energy. An MRI-based motion analysis of the left ventricle revealed basal regions to be energetically most favorable for the rotating unbalance of our harvester. A mathematical model was developed as a tool for optimizing the device's configuration. The model was validated by an in vitro experiment where an arm robot accelerated the harvesting device by reproducing the cardiac motion. Furthermore, in an in vivo experiment, the device was affixed onto a sheep heart for 1h. The generated power in both experiments-in vitro (30μW) and in vivo (16.7μW)-is sufficient to power modern pacemakers.

An Adapted Optical Flow Algorithm for Robust Quantification of Cardiac Wall Motion From Standard Cine-MR Examinations

This paper presents a method for local myocardial motion estimation from a conventional steady-state free precession cine-MRI sequence using a modified phase-based optical flow (OF) technique. Initially, the technique was tested on synthetic images to evaluate its robustness with regards to Rician noise and to brightness variations. The method was then applied to cardiac images acquired on 11 healthy subjects. Myocardial velocity is measured in centimeter per second in each studied pixel and visualized as colored vectors superimposed on MRI images. The estimated phase-based OF results were compared with a reference OF method and gave similar results on synthetic images, i.e., without a significant difference of the mean angular error. Applied on cine-MRI of normal hearts, the calculated velocities from short-axis images concord with values obtained in the literature. The advantage of the presented method is its robustness with respect to Rician noise and to brightness changes often observed in cine-MRI sequences, and especially with the through-plane movement of the heart. Motion assessment using our method on cine-MR images gives promising results on motion estimation on a pixel-by-pixel basis, leading to a regional measurement of the time-velocity course of myocardial displacement in different segments of the heart wall.

The Role of Norepinephrine and Estradiol in the Pathogenesis of Cardiac Wall Motion Abnormality Associated With Subarachnoid Hemorrhage

The majority of patients with ventricular wall motion abnormality (WMA) associated with subarachnoid hemorrhage (SAH) are postmenopausal women. In addition to elevated catecholamine, the role of estrogen in the pathogenesis of WMA has recently been implicated. The objective of this study is to clarify the interrelation among catecholamine, estrogen, and WMA in patients with SAH. A retrospective analysis was performed on the medical records of 77 patients with SAH (23 men, 54 women) whose plasma levels of epinephrine, norepinephrine, and estradiol had been measured and echocardiograms had been obtained within 48 hours of SAH onset. Twenty-four patients (31%) were found to sustain WMA on admission. Multivariate regression analysis revealed that decreased estradiol (P=0.018; OR, 0.902) and elevated norepinephrine levels (P=0.027; OR, 1.002) were associated with WMA. After quadrichotomization of 77 patients based on sex/WMA, plasma norepinephrine levels were markedly elevated in men with WMA, whereas estradiol levels were markedly decreased in women with WMA. Plasma norepinephrine and estradiol levels were not correlated. Fifty-four female patients with SAH were further quadrichotomized based on norepinephrine/estradiol levels with a threshold value of 1375 pg/mL for norepinephrine and 11 pg/mL for estradiol. The incidence of WMA in the high-norepinephrine/low-estradiol group was significantly higher than the low-norepinephrine/high-estradiol group. To our knowledge, this is the first study to evaluate the interrelation among catecholamine, estrogen, and SAH-induced WMA. Lack of estradiol in postmenopausal women may predispose them to develop WMA after poor-grade SAH. However, the precise role of multiple sex hormones in SAH-induced WMA should be evaluated in future prospective studies.

An unusual finding after resuscitation: contusio cordis

Sirs: Contusio cordis is characterized by hemorrhage and patchy fibrosis as a result of strong kinetic forces. Contusio cordis most commonly develops after blunt chest traumas [1, 2]. Cardiac magnetic resonance (CMR) imaging can be a useful tool to visualize the underlying pathological process in such patients. Here, we report on a highly unusual case of cardiac contusion caused by chest compressions during resuscitation that was detected by CMR. A 53-year-old male collapsed as a spectator watching a football game. The onsite emergency services found a pulseless patient and initiated immediate onsite cardiopulmonary resuscitation. The initial onsite ECG showed asystole that in the course of resuscitation converted into a stable sinus rhythm. The patient received epinephrine. No defibrillation was used. The patient was admitted to our Emergency Department. The past medical history of the patient was unremarkable. A thorough examination of the patient, including chest X-ray, pulmonary CT scans and a cardiac evaluation including coronary angiography, echocardiography and an EP study did not show any relevant findings except for unspecific pulmonary nodules. There was no family history for hereditary diseases. ECG gave no evidence for channelopathies. 24-h holter ECG and exercise testing were also normal. There was also no history of prior or recent chest trauma. Blood tests showed signs of myocardial injury with an elevated cTroponin T level [0.75 (normal: 0–0.03) lg/dl] and an elevated CK level [683 (normal: 190 or less) U/l] that were associated with unspecific ECG changes in V2 und V3 (Fig. 1a, b). Coronary artery disease could be ruled out (Fig. 1c, d). For further evaluation, 2 days after the initial event, a cardiac MRI in short axis and 4-chamber view was performed (MAGNETOM Avanto 1.5T, Siemens AG Sector Healthcare, Erlangen, Germany). Late gadolinium enhancement (LGE) imaging with PSIR–SSFP revealed a hyperintense area in the right ventricular wall with a hypointense core zone (Fig. 2a) and a regional wall motion abnormality. Contrast enhanced computed tomography (ceCT) was performed (SOMATOM Sensation 64, Siemens AG Sector Healthcare, Erlangen, Germany) to rule out a thrombus as eligible differential diagnosis for the cardiac alteration. ceCT of the heart revealed a regional wall thickness (Fig. 2b) without circumscribed myocardial or endothelial alteration. On the follow-up cardiac MRI, 1 week later, both the size of the suspicious area and the regional wall motion abnormality were declining (Fig. 2c). On day 9 after the initial event, the blood markers were back in normal range. A 2D transthoracic echocardiographic examination showed a completely normal cardiac function without any abnormalities in regional cardiac wall motion (Fig. 1c, d). After surviving sudden cardiac arrest, the patient received an ICD. It was for this reason that further cardiac MRI studies especially with regard to detection of myocardial fibrosis could not be undertaken. The patient was regularly examined for ICD follow-ups with no further events over 2 years. Long-term follow-up ceCT was performed 2 years later, confirming a complete resolution of wall thickness in CT (Fig. 2d). We here describe a patient with no evident cause for cardiac arrest. However, we were able to describe a set of findings that was highly suggestive of a cardiac contusion caused by forced CPR [3, 4]. The laboratory findings of T. Reiter (&) O. Ritter M. Beer B. Petritsch University Hospital Wuerzburg, Wuerzburg, Germany e-mail: reiter.theresa@googlemail.com; Reiter_T@medizin.uni-wuerzburg.de

Torsades de Pointes in an Elderly Patient with “Broken Heart Syndrome”

Broken heart syndrome, also called transient left ventricular apical ballooning syndrome (TLVABS), is described as an acute cardiomyopathy characterized by acute, but rapidly reversible, left ventricle systolic dysfunction in the absence of atherosclerotic coronary artery disease which appears to be triggered by intense psychological and physical stress. The syndrome is also named takotsubo syndrome, ampulla cardiomyopathy, or stress-induced cardiomyopathy. We report a woman aged 75 years with dyspnea, ST-segment elevation in the precordial leads, elevation of cardiac enzymes, and normal coronary arteriography. Transient apical systolic left ventricular dysfunction and pneumonia were suspected. Gradual prolongation of QT interval and torsades de pointes (TdP) subsequently occurred. Patients had a complete recovery of cardiac function, normalization of QT interval, and normal apical cardiac wall motion in a few days after lidocaine pump and empiric antibiotics use. Since TdP is rarely reported with TLVABS, we should pay more attention to postmenopausal women with chest pain and elevated cardiac enzymes. We should keep TLVABS in mind and use convenient tools, such as bedside echocardiography, for diagnosis.

A Case of Transient Ischemic Attack and Cardiomyopathy Presented with Pheochromocytoma

본 증례에서 환자는 내원 6개월 ì „ 일과성 뇌허혈이 ìžˆì—ˆê³ , 흉통을 호소하며 내원하여 ì‹¬ì „ë„ 및 심근효소에서 급성관상동맥 증후군이 의심되어 ê´€ìƒë™ë§¥ì¡°ì˜ìˆ ì„ 시행하였으나 관상동맥에는 특이 소견이 ì—†ì—ˆê³ , 좌심실 ì¡°ì˜ìˆ ì—ì„œ Takotsubo 심근병증 양상으로 나타났다. 내원 6개월 ì „ì— 있었던 일과성 뇌허혈 및 Takotsubo 심근병증이 모두 ê°ˆìƒ‰ì„¸í¬ì¢ ì—ì„œ 드물게 보일 수 있는 양상이었으며, ë°œìž‘ì ì¸ ê³ í˜ˆì••, 두통, 심계항진 등의 동반 증상 등으로 ê°ˆìƒ‰ì„¸í¬ì¢ ì„ ì˜ì‹¬í•˜ì˜€ê³ , 복부 ì „ì‚°í™”ë‹¨ì¸µì´¬ì˜ 및 24시간 요 ì¹´í Œì½œë¼ë¯¼ 검사에서 확인이 되어 ìˆ˜ìˆ ì  치료로 í˜¸ì „ì´ 된 증례이다. 중심 단어: ê°ˆìƒ‰ì„¸í¬ì¢ ; 심근병증; 일과성 뇌허혈

Cardiac outflow and wall motion in hypothermic chick embryos

Cardiac outflow in the early developmental stage of a chick embryo is known to be highly variable depending on environmental temperature. To investigate the effects of environmental hypothermia on the blood flow in the outflow tract (OFT) of chick embryonic hearts, microscopic flow images were consecutively captured from chick embryos at HH stage 17 (2.5days of incubation) at room temperature. Instantaneous velocity field information of blood flow in OFT was obtained using a micro-particle image velocimetry technique. The cyclic variations of the OFT vessel diameter and wall thickness were simultaneously measured. The experimental results show that environmental hypothermia causes bradycardia with a decrease in peak velocity during systole and the occurrence of backflow during diastole in the OFT. These abnormal phenomena seem to be attributed to the suppression of myocardial wall motion under hypothermic conditions.

Associação entre dissinergia miocárdica e arritmia ventricular na forma indeterminada da doença de Chagas

Chagas' disease can lead to severe and potentially lethal damage of cardiac function. Thus, the identification of cardiac abnormalities in patients presenting the indeterminate form (IF) can be important for risk stratification. This paper aimed to demonstrate whether IF chagasic patients who presented wall motion abnormalities showed functional and electric disturbances compared to patients with normal echocardiogram and Doppler studies. Thirty eight patients with the IF were studied, including 26 chagasic patients with normal electrocardiographic, radiological and echocardiographic exams and 12 chagasic patients showing segmental wall motion abnormalities in the echocardiographic exam. All the patients were submitted to complete echocardiogram and Doppler study, including tissue Doppler imaging (TDI) and Holter 24h monitoring. Among the variables evaluated, significant differences among the two groups were verified in relation to: the ejection fraction (p ≤ 0.001); left ventricular systolic dimension (p = 0.029); isovolumic contraction time, measured by TDI in the basal segments of the left ventricle (p < 0.05); and the presence of isolated (p = 0.0005) and paired ventricular extrasystoles (p = 0.003), in the Holter monitoring. The indeterminate form of Chagas' disease can present cardiac wall motion abnormality, demonstrating functional and electric damage compared to chagasic patients with normal echocardiogram.

Transradial coronary intervention of chronic total occlusion lesion 82 clinical research

Objective To evaluate percutaneous coronary intervention(PCI) on coronary chronic total occlusion(CTO) lesions safety, clinical effectiveness, compared PCI and simple drug treatment of chronic coronary occlusion in patients with long - term prognosis. Methods From February 2008 to February 2010 Shangqiu City Department of Cardiology, First People' s Hospital, 82 cases of hospitalized patients, a total of 116 lesions after radial artery CTO intervention information. Test group: PCI group 50 cases of 67 lesions treated by interventional occlusion of blood vessels open. Drug treatment group :32 patients with 49 lesions due to surgery or surgery was not successful line of PCI given drug treatment alone. Analysis of the clinical symptoms of the two groups, the incidence of major complications; two groups of clinical follow - up 6 months follow - up cases were compared clinical end point event rate; review echocardiography and cardiac function and wall observed movement. Results 116 CTO lesions, 67 lesions after successful opening of the radial artery, 49 lesions could not open, the success rate of 57.8%. The two groups no significant difference in clinical characteristics. Forearm,3 cases of postoperative hematoma, no pulse disease 0, no other serious complications. Operation group with unstable angina, myocardial infarction and mortality were again lower than drug treatment group (P＜ 0. 05),echocardiography showed cardiac surgery group and wall motion was better than drug treatment group (P ＜0. 05). Conclusion The radial artery is safe and feasible intervention CTO lesions, a high success rate, no serious complications and chronic coronary occlusion may improve long - term prognosis of patients, improving quality of life and reduce mortality. Key words: Transradial intervention; Sirolimus-eluting stent; Chronic occlusive disease; Drug therapy

Aconitine intoxication mimicking acute myocardial infarction

Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I level and abnormal scintigraphy findings had not previously been reported. A 60-year-old man developed chest tightness, syncope and convulsion after ingesting processed Aconitum carmichaeli (Chuanwu) extract for treatment of headache. Electrocardiogram showed first degree atrioventricular (AV) block. Troponin I level was elevated at 14.8 ng/mL 13 hours post-ingestion. Creatine kinase was also increased to 414 U/L. However, echocardiography did not show any abnormal cardiac wall motion. Tc-99m-PYP scintigraphy revealed diffusely increased uptake in the myocardium, suggesting the presence of myocardial necrosis or myocarditis. Aconitine poisoning can mimic acute myocardial infarction with chest tightness and elevated cardiac enzymes. Increased cardiac markers and myocardial insult seen in this patient were likely to be related to the toxicity of aconitine. Care should be taken in making the diagnosis in such instances. Management is primarily supportive.

Location of flow axis line in the left ventricle and its interaction with local myocardial motion

The interaction between local myocardial motion and blood flow dynamics should be assessed to evaluate left ventricular pump function. The contour map of the absolute value of blood flow velocity in the left ventricle (LV) was drawn. The ridgeline of the contour was defined as the "flow axis line". LV wall motion was assessed by the tracing endocardial border in consecutive B-mode images and by myocardial tissue velocity distribution obtained by the optical flow method. The location of the main flow axis line was affected by the local myocardial movement in the short axis direction. The flow axis line method is superior to the previous investigations on two-dimensional blood flow analysis because it considered three-dimensional blood flow. The flow axis line represents not only intracardiac blood flow structure but also its interaction with the cardiac wall motion.

NPPV Improves Respiratory Acidosis of Kounis Syndrome

A 75-year old woman was transfered to our hospital because of dyspnea on exersion. On admission, she had tachypnea and tachycardia, but no fever. Physical exam showed bilateral respiratory wheeze. Laboratory test revealed respiratory acidosis and chest X-ray showed bilateral shadows. EKG showed T wave inversion and her cardiac wall motion is hypokinesis at apex. We used noninvasive positive airway pressure ventilation(NPPV) and performed emergent coronary angiogram. Coronary artery is normal, so we diagnosed her apical ballooning syndrome. After improvement her detail history suggested her medication had evoked her clinical picture. We suspect drug-allegy, and diagnosed her kounis syndrome. We recomend her not to take suspicious drugs.

Superior myocardial preservation with HTK solution over Celsior in rat hearts with prolonged cold ischemia

Increasing allograft ischemic time is a significant risk factor for mortality following heart transplantation (HTx). The purpose of this study was to evaluate the protective effects of histidine-tryptophan-ketoglutarate (HTK) and Celsior (CEL) using a rat HTx model with prolonged cold storage. The hearts were excised from donor rats, stored in cold preservation solution for either 6 or 18 hours, and heterotopically transplanted into syngeneic recipients. Serum creatine phosphokinase (CPK), serum troponin I, graft-infiltrating cells, graft mRNA levels for inflammatory mediators, and tissue adenosine triphosphate (ATP) levels were analyzed, as markers of graft injury. The recipients of grafts stored in HTK for 18 hours of prolonged cold ischemia had lower levels of serum CPK and tissue malondialdehyde, less upregulation of the mRNAs for IL-6 and inducible nitric oxide synthase, less apoptosis, and higher ATP levels than those receiving grafts stored in CEL and Saline. Cardiac contraction 3 hours after reperfusion was observed in 43% of the cardiac grafts stored in HTK for 18 hours, while no cardiac wall movement was seen in grafts stored in either saline or CEL. Cold storage in HTK exhibited superior protective effects against prolonged cold ischemia in a syngeneic rat transplantation model.

Induction of Manganese Superoxide Dismutase by Nuclear Translocation and Activation of SIRT1 Promotes Cell Survival in Chronic Heart Failure

Oxidative stress plays a pivotal role in chronic heart failure. SIRT1, an NAD(+)-dependent histone/protein deacetylase, promotes cell survival under oxidative stress when it is expressed in the nucleus. However, adult cardiomyocytes predominantly express SIRT1 in the cytoplasm, and its function has not been elucidated. The purpose of this study was to investigate the functional role of SIRT1 in the heart and the potential use of SIRT1 in therapy for heart failure. We investigated the subcellular localization of SIRT1 in cardiomyocytes and its impact on cell survival. SIRT1 accumulated in the nucleus of cardiomyocytes in the failing hearts of TO-2 hamsters, postmyocardial infarction rats, and a dilated cardiomyopathy patient but not in control healthy hearts. Nuclear but not cytoplasmic SIRT1-induced manganese superoxide dismutase (Mn-SOD), which was further enhanced by resveratrol, and increased the resistance of C2C12 myoblasts to oxidative stress. Resveratrol's enhancement of Mn-SOD levels depended on the level of nuclear SIRT1, and it suppressed the cell death induced by antimycin A or angiotensin II. The cell-protective effects of nuclear SIRT1 or resveratrol were canceled by the Mn-SOD small interfering RNA or SIRT1 small interfering RNA. The oral administration of resveratrol to TO-2 hamsters increased Mn-SOD levels in cardiomyocytes, suppressed fibrosis, preserved cardiac function, and significantly improved survival. Thus, Mn-SOD induced by resveratrol via nuclear SIRT1 reduced oxidative stress and participated in cardiomyocyte protection. SIRT1 activators such as resveratrol could be novel therapeutic tools for the treatment of chronic heart failure.

Tako-Tsubo syndrome: an important differential diagnosis in patients with acute chest pain

The syndrome of Tako-Tsubo cardiomyopathy (TTC) is characterized by the occurrence of acute chest pain, electrocardiographic signs of ischemia, and transient balloon-like abnormalities in cardiac wall motion mostly involving the left ventricular apex. Significant obstructive coronary artery disease is absent. Owing to its clinical and imaging characteristics, TTC is frequently misdiagnosed as an acute coronary syndrome. Tako-Tsubo syndrome was first described in the 1990s in Japan, but meanwhile has been increasingly identified in other parts of the world also. TTC predominantly affects postmenopausal women, and may involve up to 2% of all patients with acute ST-segment elevation myocardial infarction (STEMI). Apart from single case reports, no systematic data from Austria are currently available. We analyzed prevalence, diagnostic characteristics and the clinical course of patients with TTC admitted to our cardiology department during a period of four years (May 2004 - December 2008). Diagnosis of TTC was established by the presence of the typical apical ballooning pattern of the left ventricle shown by ventriculography or echocardiography and by the absence of a significant coronary artery stenosis as demonstrated by coronary angiography. Among 448 patients with suspected acute STEMI and 963 patients with non-STEMI, 31 patients (2.2%) were diagnosed as having TTC. The majority of identified patients with TTC were postmenopausal women (90.3% women, mean age 75 +/- 10.2 years). At the time of acute hospital admission, the principal symptom was chest pain in 24 patients (77.4%), dyspnea in 10 (32.3%) and hypotension in one (3.2%). Preceding emotionally or physically stressful events were identified in 24 patients (77.4%: emotional 29%, physical 48.4%). Acute ST-segment elevation was present in 13 patients (42%) and ST/T wave abnormalities were found in 18 (58%). All patients demonstrated a distinct increase in levels of cardiac enzymes and biomarkers. Significant coronary artery stenosis was absent in all patients. After a clinical follow-up period of 172.4 +/- 342.8 days, three patients had died from non-cardiac causes, TTC had recurred in another patient 13 months after the index event, and the other 27 patients were free from cardiac symptoms and the electrocardiographic and echocardiographic abnormalities had resolved. Patients with TTC display clinical symptoms and electrocardiographic findings that mimic acute myocardial infarction. A history of a preceding stressful event in elderly women, typical echocardiographic findings of TTC, and only a mild elevation of cardiac markers will be informative. Acute-coronary angiography should be performed in order to rule out acute coronary occlusion and to avoid inadequate treatment such as thrombolysis.

Postoperative myocardial infarction after diagnostic video-assisted thoracoscopy and pleurodesis for catamenial pneumothorax: A unique case report

Myocardial infarction (MI) is uncommon in patients undergoing noncardiac surgery without a history of coronary artery disease. But, patients with compromised pulmonary function and coexisting anaemia superimposed by precipitating factors like prolonged hypotension and tachycardia can culminate in myocardial catastrophe even in the absence of risk factors. We are herewith reporting an unusual case of postoperative non-ST elevation MI without any pre-existing ischemic heart disease. A 39-year-old female patient who was submitted for diagnostic video-assisted thoracoscopy and chemical pleurodesis for recurrent pneumothorax developed postoperative MI. After review of all the factors, it was found that the patient developed Type 2 MI as a sequel to oxygen supply and demand mismatch secondary to hypoxia and prolonged hypotension. This was evident in the 12-lead electrocardiogram and was confirmed by elevated cardiac biomarkers and regional wall motion abnormality on echocardiography.

A novel center point trajectory model for cardiac wall motion abnormality assessment compared with echocardiography strain

Methods The method entails the tracking of the left ventricular center point of the left ventricle on 2D SSFP images over time. A polar coordinate map indicating amplitude and angle parameters provides a quantitative way to describe systolic (red) and diastolic (blue) wall motion. Transthoracic echocardiography using 2D strain maps were used to validate the findings from CMR and CPT analysis. Three patients with myocardial infarction (3 Male, 67 ± 4 y/o, EF 54% ± 14%) and one healthy volunteer (1 Female, 51 y/ o, EF 63%) were enrolled in this IRB approved study. On the echocardiography peak systolic strain map, the smaller the magnitude absolute value, the less the echocardiographic strain measurement. Results CPT analysis demonstrates significant movement of the center in the first column Figures 1, 2, 3 (a). The second column (b) represents the corresponding short axis T2 weighted or delayed enhancement positive images. The third column (c) represents the long axis echocardiographic strain maps. Figures 1 and 2 are patients with myocardial infarction of the anteroseptal wall of the left ventricle. The CPT plot provides amplitude and angle of center point progression, which reflects the degree of abnormal wall motion during both systolic contraction, and diastolic filling of the left ventricle. In these two cases, the center point trajectory points toward the hypokinetic anteroseptal wall [arrow on the T2 weighted and myocardial delayed enhancement images (1b and 2b) and echocardiographic strain maps (1c and 2c)]. Figure 3 shows a patient with myocardial infarction of the anterior and anterior lateral wall (3b, arrow) with corresponding hypokinesis and an abnormal strain map clearly visualized on echocardiography. Figure 4 shows a normal volunteer without significant center point movement on CPT and corresponding normal echocardiographic strain maps. Strain analysis from echocardiography confirms the hypothesis of the center point trajectory model from cardiac MR. from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010

Respiratory Failure with Myxedema Ascites in a Patient with Idiopathic Myxedema

Here we report the case of a 50-year-old woman presenting with weight gain, whole-body edema, and massive ascites. Blood examination revealed primary hypothyroidism with TSH-blocking antibody, and the echocardiogram showed diffuse hypokinesis of the left ventricle with pericardial effusion. Although she received thyroid hormone replacement therapy immediately, her ascites increased and she developed type II respiratory failure requiring transient noninvasive positive pressure ventilation (NIPPV). She recovered following the temporary drainage of the ascites, administration of diuretics, and continuous thyroid hormone replacement. The amount of ascites decreased during therapy, along with an increase in thyroid hormone levels. Finally, the ascites disappeared completely, followed by the normalization of the cardiac wall motion. Herein we report this rare case in detail, and also discuss the mechanism by which primary hypothyroidism induced such severe conditions in our patient.