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Symptomatic premature ventricular complexes (PVCs) are a common clinical problem. Although most of ventricular ectopic foci can be easily ablated, some are very challenging and require special manoeuvers. This case report presents an approach to improve electrode stability during ablation.
A 19-year-old Asian male patient presented with frequent symptomatic PVCs having an inferior axis, left bundle branch morphology, and R/S transition in V4. Structural heart disease was excluded by echocardiography and general blood tests were normal. The treatment with a class Ic antiarrhythmic (ethacizine) over 2 months was ineffective and the patient was admitted for radiofrequency ablation. Activation mapping revealed a PVC focus in the superior part of the tricuspid annulus, but the femoral access approach resulted in frequent dislocation of the ablation tip. An internal jugular vein approach though resulted in improved stability and successful elimination of the PVC.
In cases with PVCs from the superior portions of the right heart, stability of the electrode may be improved by a jugular venous access.
In cases with PVCs from the superior portions of the right heart, stability of the electrode may be improved by a jugular venous access.
Benign metastasizing leiomyoma (BML) is a smooth muscle tumour of genital origin occurring in women with a history of uterine or pelvic leiomyoma. Although histologically benign, it exhibits metastatic behaviour. Lungs are the most common site of metastasis. The heart is a rare site and metastasis at this location has been described in just few cases.
A 42-year-old woman with a resected uterine leiomyoma and a subsequent and still not-resected left periovarian solid mass began complaining of shortness of breath 2 weeks before presentation. Echocardiography showed a mass located in the right ventricular cavity, enlargement of the right ventricle, and severe tricuspid regurgitation. Cardiac magnetic resonance revealed two masses suggestive of tumours in the right ventricle causing right ventricular outflow tract obstruction. Cardiac surgery was performed and, intraoperatively, a third small mass was detected on the tricuspid valve. The masses were resected, and tricuspid valve replacement was performed. Tenthe tricuspid valve and the right face of the interventricular septum.
Circulatory collapse during/post-pulmonary vein (PV) isolation by cryo-balloon ablation is a Cardiology emergency that has multiple potential causes and requires a methodical investigative approach. Some of the complications that can arise include cardiac tamponade, bleeding/vascular injury, anaphylaxis, Addisonian crisis, acute pulmonary embolism, acute PV stenosis, oesophageal injury, and vagal reaction.
Here, we present a case of a 76-year-old lady who developed profound circulatory collapse during an elective pulmonary vein isolation by cryo-balloon ablation for symptomatic paroxysmal atrial fibrillation (AF). Cardiac tamponade, bleeding/vascular injury, and other less common causes were excluded. She only responded transiently to fluid resuscitation and developed intermittent bradyarrhythmias and hypotension which responded to isoprenaline. She was discharged home at Day 3 post-AF ablation after remaining well and continued to do so at follow-up.
Circulatory collapse during/post-PV cryo-balloon ablpresence of vagal response has been observed to be a marker of ANS modulation although its significance on the long-term outcome post-ablation has yet to be elucidated. The true cause of our patient's profound circulatory collapse is uncertain but a vital learning point in this case is the systematic exclusion of common and potentially life-threatening complications following AF ablation. A persistent vagal reaction secondary to PV cryo-balloon ablation can usually be managed with supportive medical therapy as demonstrated in our case.
The onset prevention and early diagnosis in cardiotoxicity due to cancer chemotherapy are important, and it is important to detect cardiac dysfunction at an early stage and start treatment to enhance the therapeutic effect.
A 31-year-old female with breast cancer received chemotherapy with epirubicin (400 mg/m
) and cyclophosphamide followed by docetaxel. click here Two months after the initiation of her chemotherapy, the left ventricular (LV) ejection fraction (LVEF) determined by echocardiography fell to 41.2%, and she was diagnosed with cancer therapy-related cardiac dysfunction (CTRCD). Three months after the initiation of cancer treatment, the peak velocity of late diastolic transmitral Doppler flow (A wave) became undetectable. Peak longitudinal strain (LS) and peak LS rate, which reflect left atrium (LA) reservoir function, gradually declined like the LVEF and LV-global LS (GLS). Seven months after the initiation of cancer treatment, she was diagnosed with acute decompensated heart failure. The changes in peak LS and peak LS at the onset were greater than those in LVEF and LV-GLS.
This is a case report suggesting that LA reservoir function might be a more sensitive indicator than LVEF or LV-GLS in detecting CTRCD and that LA booster function might be the earliest. Left atrium reservoir function might be a more sensitive than conventional LV pump function and optimal indicator in CTRCD.
This is a case report suggesting that LA reservoir function might be a more sensitive indicator than LVEF or LV-GLS in detecting CTRCD and that LA booster function might be the earliest. Left atrium reservoir function might be a more sensitive than conventional LV pump function and optimal indicator in CTRCD.
Raynaud's syndrome is a commonly encountered disorder. The relationship between the grade of Raynaud's phenomenon and severity of vasoconstriction is unclear. Recently, various methods including colour Doppler ultrasonography have been used for assessment of vascularity of the extremities including fingers.
A 53-year-old man had a 6-year history of Raynaud's phenomenon with typical tri-coloured changes proceeding from white, blue to red and slight pain and slight paresthaesia in the fingers of both hands when his fingers were exposed to cold. He was diagnosed with primary Raynaud's syndrome. After treatment with the calcium channel blocker amlodipine (5 mg once daily), a cold challenge did not induce Raynaud's phenomenon on the fingers in the present patient. After the cold challenge, colour Doppler ultrasonography showed that vascularity was markedly decreased or was absent, whereas there was little difference in skin colour of the fingers.
In Raynaud's phenomenon, vasospasm may occur even if the symptoms are well-controlled with a calcium channel blocker.
