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RISS 인기검색어
- 검색키워드
- 저자 : ( Franz Albert Go ) (검색결과 3 건)
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( Franz Albert Go ),( Raul Jara ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Transient bundle branch block has been defi ned as an interventricular conduction defect that subsequently returns, to normal conduction. Of particular concern is the severe coronary artery disease etiology of this particular phenomenon which may have a diagnostic as well as prognostic value in such patients and may modify subsequent management strategies. Case: We present a case of transient left bundle branch block occurring in 60 year old female patient who presented with intermittent chest pain. First ECG on consult revealed sinus rhythm with complete left bundle branch block. A repeat ECG on follow up demonstrated an initial CLBBB pattern at lead 1 then reverting back to Narrow QRS sinus rhythm on the succeeding leads. Resting echocardiogram showed concentric left ventricular remodelling with normal wall motion, contractility and systolic function with grade 1 diastolic dysfunction. Dobutamine stress was performed revealing normal result with 88% MHR with no stress-induced ischemia. Hence, a coronary angiogram was done showing 3 vessel disease with signifi cant left main coronary involvement. She underwent CABG which remarkably improved her angina symptoms. Conclusions: This case report shows an unusual case of severe CAD presenting as transient CLBBB. The clinical presentation may be obvious clinically but certain diagnostic tests, particularly plain and stress echocardiogram, which can aid the physician in the diagnosis, may miss out the exact diagnosis. While a non-invasive echocardiogram is preferred over an invasive coronary angiogram for CAD workup, it is noteworthy to emphasize that a good history and physical examination with aid of conventional 12 lead ECG can guide physicians as to subsequent workup of this particular case.
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Poster Session : PS 0102 ; Cardiology : Isolated Partial Anomalous Pulmonary Venous Connection
( Garol Franz Albert Go ),( James Ho ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Isolated partial anomalous venous connection (PAPVC) is a very rare variant of PAPVC and mostly involves the anomalous drainage of the right upper pulmonary vein into the superior vena cava (SVC) with no associated interatrial septal defect. It presents with right sided heart failure, arrhythmias, pulmonary vascular disease and may mimic other more common congenital anomalies, such as atrial septal defect. Case: We present a case of isolated PAPVC occurring in 26 year old female patient who presented with palpitations, exertional dyspnea and easy fatigability. Physical examination revealed dynamic precordium, RV heave, and tricuspid regurgitation murmur. Transthoracic echocardiogram showed right atrial, ventricular, and main pulmonary artery dilatation with moderate pulmonary hypertension. Hemodynamic study was performed revealing isolated partial anomalous venous connection with severe pulmonary hypertension. She underwent Warden`s procedure (superior vena cava translocation with atriocaval anastomosis) which remarkably improved her symptoms. Conclusions: This case report shows a very rare case of isolated PAPVC presenting with heart failure symptoms and right sided chamber enlargement. The clinical presentation may not be specifi c for particular cardiac disease entity and may simulate more common diseases like acyanotic ASD and primary pulmonary hypertension. It is important to report such a case, because this can highlight the importance of high index of suspicion in considering isolated PAPVC in patients with right sided cardiac chamber dilatation.
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( Garol Franz Albert Go ),( Maribel Tanque ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: VTE incorporates 2 distinct but interrelated disease conditions, deep vein thrombosis (DVT) and pulmonary embolism (PE). Prompt recognition of the disease is equally important in the diagnostic and therapeutic approach to this condition. Methods: This is a retrospective cohort study of 408 PHC patients with VTE from 2000 to 2013. This study aims to present the clinical profiles, outcomes and mortality/ survival predictors. Results: There was female predominance with mean age of 55 years old. Immobility and HF were the most common risk factors. HPN, DM and CAD were the most common comorbidities. Dyspnea, extremity swelling and pain were the most common complaints during initial presentation. The lower extremities were most commonly involved in DVT. Most common findings on workup include cardiomegaly (CXR), abnormal D-dimer, DVT (VDS), intermediate probability for PE (VQ Scan), PE (CTscan), pulmonary hypertension and RV enlargement (2DED), hypoxemia (ABG), and sinus rhythm (ECG). A diagnosis of PE was made in 93%, DVT in 84%, and post-thrombotic syndrome in 8%. Anti-coagulation with heparin and warfarin was the most common treatment given. For the outcomes, 78% were discharged improved, 32% suffered in-hospital mortality or death, 7% had bleeding and 13% had thromboembolic events. Conclusions: The clinical profi les and outcomes of these VTE patients were similar with existing international data. There were significant correlation with survival among females, pay category, previous DVT/PE, recent surgery, malignancy, PAD, hypercoagulability, extremity swelling, extremity pain, extremity erythema, alert level of consciousness, regular auscultatory and electrocardiographic rhythm, low probability PE on perfusion scan, and heparin anticoagulation. There was significant association with mortality among patients with edema, DVT on venous duplex scan, metabolic acidosis on arterial blood gas, and use of IVC filter & mechanical ventilation.
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