Cardiac pain in association with mitral stenosis and congenital heart disease

Fetal and neonatal abnormalities due to congenital rubella syndrome: a review of literature

OBJECTIVE

Rubella virus infection during the first trimester of pregnancy can cause congenital rubella syndrome (CRS). We aimed to describe the abnormalities in order to define the ultrasound features to look for when performing prenatal scans. The goal of this review is to focus specifically on the signs of CRS accessible to prenatal diagnosis.

METHODS

We analyzed every case of CRS described before and/or after birth that we identified in the Pubmed database and classified them as accessible or not to prenatal diagnosis.

RESULTS

The most frequently reported malformations accessible to prenatal diagnosis were: cardiac septal defects, pulmonary artery stenosis, microcephaly, cataract, microphtalmia, and hepatosplenomegaly.

CONCLUSION

This extensive literature review shows that the ultrasound features of CRS are not well known, even though rubella was the first teratogenic virus described. This review will help clinicians in the management of rubella during pregnancy by clarifying the findings to be sought.

Respiratory chest pain: diagnosis and treatment

Chest pain from respiratory causes is a common complaint and may indicate the presence of a serious or even life-threatening pathologic condition. Most chest pains are the result of irritation or inflammation of the parietal pleura, as the visceral pleura is insensate, although pain may arise from direct malignant invasion or trauma to the chest wall. Rapid recognition with appropriate understanding of the anatomy and physiology of chest pain from respiratory causes is vital to ensure timely and appropriate therapy.

Differential diagnosis of chest pain: point of view of a cardiologist and a rheumatologist

A terápia utóbbi évtizedekben bekövetkezett rohamos fejlődése a klinikum minden területén szükségessé teszi a mihamarabbi bajmegállapítást, mivel döntően ettől függ a terápiával elérhető eredmény. Ez a cardio- és cerebrovascularis események esetében különösen igaz. Célkitűzés: Tekintettel arra, hogy a mellkasban életveszélyes cardiovascularis és az életet kevésbé veszélyeztető egyéb történések egyaránt fájdalmat okoznak, a szerzők – elsősorban saját tapasztalataik, továbbá az irodalmi adatok alapján – áttekintést adnak a mellkasi fájdalom differenciáldiagnosztikájáról. Módszer: A szerzők a mellkasi fájdalom veszélyességét, gyakoriságát és topográfiáját figyelembe vevő sorrendben és csoportosításban tárgyalják a különböző okokat. Következtetés: A korszerű diagnosztikai és terápiás lehetőségek birtokában sem nélkülözhető, sőt még inkább szükséges a mellkasi fájdalom mint tünet minél részletesebb elemzése.

Relief of right ventricular angina and increased exercise capacity with long-term oxygen therapy

Long-term low-flow oxygen therapy can lead to improved exercise capacity and improved hemodynamics in selected patients with pulmonary hypertension. We report a patient who presented with severe exercise limitation and anginal chest pain that appeared to result from pulmonary hypertension and predominantly right ventricular ischemia. Acute oxygen therapy led to relief of pain but no change in exercise capacity or of pulmonary hypertension. After eight months of oxygen therapy, the patient's pulmonary hypertension was unchanged, but right ventricular hypertrophy and marked increases in exercise cardiac output and exercise capacity developed. Thus, oxygen can relieve right ventricular angina and facilitate the development of compensatory hypertrophy.

Coronary atherosclerosis in mitral stenosis

Eighty-two patients with mitral stenosis underwent cardiac catheterization with coronary angiography. Twenty-one patients (26 percent) had coronary artery disease. Characteristics of the mitral valve area, cardiac output, pulmonary artery pressure, pulmonary vascular resistance, left ventricular end-diastolic pressure, left ventricular ejection fraction, and atypical chest pain did not correlate with findings of angina pectoris or of coronary artery disease; however, there was correlation with sex, age, and angina. Coronary artery disease occurred only after the age of 40 years and was more frequent in males with angina. Coronary artery disease could not be ruled out in patients with mitral stenosis, especially those over age 40, without coronary arteriography.

Pathology of angina pectoris

Among the wide variety of causes of angina pectoris, two major categories may be recognized: the anatomic, causing arterial obstruction, and the functional.

The anatomic causes may be divided according to anatomic sites as follows: (1) the major coronary arterial trunks and their epicardial branches, (2) the coronary ostia at the aorta, and (3) the intramyocardial "small" arteries. The major coronary arteries are by far the most common sites for anatomic lesions. Atherosclerosis in its various anatomic manifestations is responsible for about 90% of the cases of angina. Commonly, hypertension and, less commonly, valvular disease are associated. The balance of cases of angina result from various states given below. Nonatheromatous diseases of the major coronary arteries include embolism, primary dissecting aneurysm of a coronary artery, arteritis, and anomalous communication of a coronary artery. Coronary ostial narrowing results from various diseases of the aorta including atherosclerosis, saccular and dissecting aneurysm, inflammation, and calcification of the aorta in relation to origin of a coronary artery. Lesions causing obstruction of the intramyocardial arteries are commonly part of systemic diseases such as hematologic, embolic, metabolic, and degenerative.

Functional causes of angina pectoris include aortic valvular disease and functionally related conditions, thyroid disease, and pulmonary hypertension.

Value of coronary arteriography in the investigation of ischaemic heart disease

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Mass thrombus of the left auricle

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Electrocardiographic Response to Exercise in Patients with Mitral Stenosis

On the assumption that a positive Master 2 step exercise test is good evidence for the existence of myocardial ischemia, the coronary circulation of 40 patients with rheumatic heart disease and isolated mitral stenosis has been tested by this means. The findings in patients of classes I to III are discussed regarding factors that might be responsible and the relationship of the findings to symptomatology in patients with mitral stenosis.

Myocardial fibrosis and calcareous emboli in valvular heart disease

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Solitary pulmonary hypertension

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Mitral stenosis with very high pulmonary vascular resistance and atypical features

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