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Biomedical subjects

A Sheikhzadeh

Publications and source records attributed to A Sheikhzadeh.

72 records · Page 4Linked to original sources
PubMed1984

Chronic traumatic tricuspid insufficiency.

Isolated tricuspid insufficiency (TI) is relatively uncommon and mostly of traumatic origin. We report clinical noninvasive and invasive findings and surgical results in 5 cases. All patients had complete clinical, noninvasive and invasive studies including right and left catheterization, and coronary angiographies in 3 patients. All but 1 patient had nonpenetrating trauma. All had large jugular V waves, right precordial impulse, systolic liver pulse, positive Carvallo sign documented also by noninvasive techniques. Right heart failure was present in 3 patients. Chest x-ray showed prominent right atrium and distended vena cavae. Electrocardiogram showed normal sinus rhythm in 4 patients and atrial fibrillation in 1. Two patients had right bundle-branch block, and 2 presented RSR'-pattern. Echocardiogram showed large right atrium (RA) (6-10 cm), floppy tricuspid valve (TV) in all, dilated right ventricle (RV) in 2 patients. Findings of left heart were normal in all. Three patients had right-to-left shunt. In RA A waves were 4-8, Y waves 1-3, and V waves 12-22 mmHg, respectively (mean RV and PA pressures were 23/3 and 23/10 mmHg, respectively). Four patients had anuloplasty, 2 of them repair of valve and chordae. Surgical results were good in 2 patients with valve repair, satisfactory in 1; there was significant TI resistance in 1 case. We conclude that TI has distinctive clinical findings and must be ruled out in all patients with chest trauma. Surgery must include not only anuloplasty, but, cusps and chordae must also be evaluated and reconstructed if necessary.

Electrocardiography↗
PubMed1983

Unusual cardiovascular manifestations in a case of pheochromocytoma.

A case of proven pheochromocytoma is reported of a patient who presented with attacks of apparent hypotension, pulmonary edema, and myocardial injury with typical ECG and enzyme change. In spite of unmeasurably low peripheral blood pressure recordings during the attack, central aortic pressure was well above 240/140 mmHg. A clinical shocklike state was in effect due to severe arterial vasoconstriction. The pulmonary artery pressure was 48/26 mmHg during attacks, wedge pressure was 26 mmHg, and cardiac index 1.8 liters/min/m2. The coronary angiogram showed abnormal pooling of dye in the myocardial capillary network. It is concluded that: (1) Apparent hypotensive episodes in pheochromocytoma may be misleading and central arterial measurements may be needed to demonstrate the hypertensive crisis. (2) The abnormal coronary angiogram in our patient may be due to myocardial necrosis and damage to the intact arteriolar and microvascular system of the myocardium.

Adrenal Gland Neoplasms↗
PubMed1983

Congestive heart failure in valvular heart disease in pregnancies with and without valvular prostheses and anticoagulant therapy.

The course and complications of pregnancies in 46 patients with valvular disease and congestive heart failure with or without valve prostheses are described. In group I consisting of 33 women without valve replacement and without anticoagulant therapy one thromboembolic event was seen, emergency closed or open heart surgery was necessary five times. One still-birth happened after open heart surgery. In group II, of 13 patients with prosthetic valve replacement and anticoagulation therapy there was no thromboembolism, but 2 spontaneous abortions and 2 premature stillbirths; 2 fetuses died after delivery, 3 had congenital abnormalities. Pregnancies in patients with valvular disease and congestive heart failure can be sustained relatively safely for the mother, even if emergency heart surgery becomes necessary. Heart surgery and anticoagulation treatment carry a higher risk for the fetus. Uterine blood loss is not increased, if coumadine treatment is switched to heparin administration shortly before delivery.

Abnormalities, Drug-Induced↗
PubMed1983

Severe tricuspid valve stenosis. A cause of silent mitral stenosis.

The diastolic rumbling murmur of mitral stenosis (MS) may be attenuated in the presence of low cardiac output, right ventricular enlargement, Lutembacher's syndrome, pulmonary emphysema, and obesity. In this report we would like to stress that the presence of tricuspid stenosis (TS) is an additional significant cause of silent MS. The clinical material consisted of 73 patients with rheumatic TS who had undergone cardiac surgery. Five of these cases had clinical findings of TS without auscultatory findings of MS. They were found to have severe MS at the time of operation and to require mitral valve surgery. At cardiac catheterization the mean diastolic gradient (MDG) across the mitral valve (MV) was less than 3 mmHg and pulmonary arterial systolic pressure was 29-42 mmHg. The MDG across the tricuspid valve was 6-17 mmHg. In conclusion, TS can mask clinical and hemodynamic findings of MS. The reason for this is the mechanical barrier imposed by TS proximal to the MV.

Adolescent↗
PubMed1983

Pulmonary arteriovenous fistulas. Case presentations and clinical recognition.

This report describes characteristic features and clinical presentation of six young patients (ranging in age from five to 25 years) with various congenital forms of pulmonary arteriovenous fistulas as well as one 21-year old patient with traumatic intrapulmonary arteriovenous fistula. The former six patients were cyanotic, had clubbing of the digits and exertional dyspnea; two, additionally, had telangiectasia. All patients underwent cardiac catheterization and pulmonary angiography. None had pulmonary hypertension. Angiographically, four had diffuse arteriovenous fistulas in both lungs (Figures 1 and 3 to 5) and two had arteriovenous fistulas localized in one pulmonary segment. Four patients were additionally studied with radionuclide angiography and pulmonary perfusion scintigraphy. In three of these, substantial right-to-left shunt in the region of the lungs was detected; the diagnosis could not be established in only one of the latter with a small traumatic intrapulmonary arteriovenous shunt of less than 10%. While noninvasive methods provide adjunctive diagnostic support, pulmonary angiography is still required to assess, with certainty, the nature and localization of the lesion. In cyanotic patients with no evidence of cardiac disease, differential diagnostic consideration should be given to pulmonary arteriovenous fistulas.

Adolescent↗
PubMed1983

Effect of buccal nitroglycerin on pulmonary artery pressure at rest and during exercise: a comparison with sublingual nitroglycerin in patients with coronary artery disease.

60 patients with ischemic heart disease and angina pectoris, aged 42 to 74 years (mean 59), were included in this randomized study. All suffered from coronary disease demonstrated by ECG changes and/or positive exercise test results. Twenty percent of the patients had coronary angiograms revealing significant CAD. All patients had had typical angina pectoris episodes for a period of 22 +/- 10 months at a frequency of 4 +/- 2 attacks a week. A positive response to sublingual nitroglycerin was observed in all patients. The patients were randomly assigned to four groups (1 mg, 2.5 mg, or 5.0 mg buccal nitroglycerin and a control group with 0.8 mg sublingual nitroglycerin). Exercise testing was done by bicycle ergometer in the recumbent position at maximal work loads in 3-min periods; hemodynamic measurements were performed using a pulmonary artery catheter (Grandjean). Pulmonary artery pressure, heart rate, systemic blood pressure, and ST-segment changes in the ECG were recorded before administration of the drug as well as 5, 15, 30, 60, 120, and 180 s after administration. Exercise tests were performed 3, 30, and 180 min after administration. The study demonstrates that buccal Synchron nitroglycerin has immediate hemodynamic and clinical effects, documented by the reduction in pulmonary artery pressure values at rest and exercise and the increase in exercise tolerance and cardiac output. The best antianginal effects were achieved with the dosage of 2.5 mg buccal nitroglycerin. We conclude that buccally administered nitroglycerin has early effects similar to those of nitroglycerin administered sublingually; the hemodynamic and clinical effects, however, persist over a minimum of 180 min.

Blood Pressure↗
PubMed1983

[His-bundle electrographic localization of a complete intra-His AV block in a patient with congenital corrected transposition of the great vessels].

Patients with corrected congenital transposition of the large arteries (CCT) often develop atrioventricular (AV) conduction disturbances, which may lead to syncope or sudden death. This report is concerned with our findings in a 24-year-old man with a CCT accompanied by a small ventricular septal defect and a complete AV block. While published case reports of electrophysiologically investigated third-degree AV blocks show conduction disturbances proximal to the bundle of His, we found the block to be localized in the intra-His region, which makes the case a rarity.

Adult↗
PubMed1982

A survey of uncommon forms of coronary arteries.

Among 854 coronary angiograms, we found the following abnormalities of the coronary arteries. Three cases had nonatherosclerotic coronary artery aneurysms. One case, a 27-year-old man with a diffuse lesion, expired after two episodes of myocardial infarction. In 2 other cases the lesions were localized and the patients underwent successful coronary bypass surgery. In 2 cases, a small vascular network was found: a 23-year-old man with pheochromocytoma who also had myocardial injury and pulmonary edema, and a case with contusio cordis who had angina pectoris but had normal coronary arteries. In 3 cases the coronary arteries originated abnormally from the aorta. A congenital right coronary artery-right ventricular fistula was detected in a 17-year-old female with multiple cardiac abnormalities. Abnormally wide coronary arteries were also found in 17 cases with apical hypertrophy, a form of hypertrophic nonobstructive cardiomyopathy.

Adult↗
PubMed1982

A case of asymmetrical apical hypertrophy which is a form of hypertrophic nonobstructive cardiomyopathy with giant negative T-waves.

Clinical, hemodynamic, electrocardiographic (ECG), echocardiographic, left ventricular (LV), and coronary angiographic (CA) findings are reported in a case with apical hypertrophy (AH), a form of hypertrophic nonobstructive cardiomyopathy (HNCM). The most striking symptom was chest pain and the most conspicuous electrocardiographic finding consisted of giant negative T waves, reaching an amplitude of 4.0 mV. Echocardiography revealed an apical thickness of the septum and posterior wall of 40 mm; this was significantly greater than septal and posterior free wall thickening in the LV outflow area. The anterior motion (SAM) of the anterior mitral leaflet, was present, and, in hemodymic investigation, the isoproterenol test was negative. The left ventricular end-diastolic pressure (LVEDP) and the EF were elevated. In the LV angiogram from the right anterior oblique position (RAO), the LV free wall thickness at the apex was significantly thicker than at the outflow tract level. The patient had dilated coronary arteries. We conclude that these findings are typical for AH (HNCM) and it seems that hypertrophic obstructive cardiomyopathy (IHSS, MO), and hypertrophic non-obstructive cardiomyopathy (ASH, AH) are different manifestations of a wide spectrum of hypertrophic cardiomyopathy.

Adult↗
PubMed1982

Occlusive thromboaortopathy (Takayasu's disease): clinical findings and angiographic classification.

We report the findings in 26 cases of occlusive aortopathy (Takayasu's disease) encountered during eight years. The mean age was 25.3 years and female to male ratio was 2.7:1. Chest and local pain, fever, hypertension (70%) and absent pulses were accompanied by high erythrocyte sedimentation rate (ESR) 38 to 126 mm, eosinophilia 4 to 26%. All immunological tests were negative except tuberculin-test (PPD) with 65% positive. EKG was normal in three cases, 23 showed left ventricular hypertrophy, ST-T changes in two and acute myocardial infarction in two cases. The classification: Type I cervico-brachial or arch type with five cases, type II thoraco-abdominal type with six cases, type III peripheral type with four cases and generalized types combination of two or more of three types and/or pulmonary artery involvement, showed good correlation with clinical findings and prognosis. The occlusive aortopathy is an inflammatory disease of unknown origin, an auto-immune or genetic etiology may be involved.

Adolescent↗
PubMed1982

[Rheumatic tricuspid stenosis--a clinical overview with surgical considerations].

73 patients are reported on who ad different and multiple valvular heart lesions, always including tricuspid stenosis (TS). The pre- and postoperative hemodynamic and clinical findings are presented (as well as the results of surgical treatment). The conclusion is arrived at that TS is frequently involved in rheumatic valvular heart disease and that it needs special attention. It should be confirmed by simultaneous measurements of the right ventricular and right atrial pressures. The surgical results are encouraging. Tricuspid commissurotomy is the favored method, leaving the least gradient. Surgical mortality was 2.7%. Postoperative clinical improvement could be seen in 96% of all patients.

Adolescent↗
PubMed1981

Persistent left superior vena cava draining into the left atrium, atrial septal defect, and absence of the coronary sinus. Recognition and surgical correction.

The diagnosis of atrial septal defect (ASD), persistent left superior vena cava (LSVC) and absence of coronary sinus was established by cardiac catheterization in a 20 years old female. At surgery the coronary vein ostia were located in the left atrium. LSVC was ligated and pericardial patch was sutured around the orifices of the coronary veins and extended to the ASD to redirect the coronary blood flow into the right atrium and close the defect. The postoperative cardiac catheterization and hemodynamic studies revealed good result.

Adult↗
PubMed1981

Papillary muscle hypertrophy in chronic rheumatic mitral valve stenosis. A clinicopathologic study.

A quantitative pathologic study was performed on papillary muscles in 15 cases of chronic rheumatic mitral stenosis. The papillary muscles were grossly hypertrophied as compared with papillary muscles in 10 normal specimens. Hypertrophy of papillary muscles was associated with pronounced fibrosis. Angiographically, these hearts were remarkable in small left ventricular cavity with almost complete cavity elimination at end systole. Left ventricular wall dyskinesia was also present. It is probable that derangement of the mitral valve structure due to rheumatic process leads to more stress on the supporting elements, thus resulting in papillary muscle hypertrophy.

Adolescent↗
PubMed1978

Rheumatic tricuspid stenosis. A clinical overview.

The clinical, hemodynamic findings and surgical results of forty patients with rheumatic tricuspid stenosis are presented. It is concluded that tricuspid stenosis is a frequent lesion. Its signs should be sought carefully and documented by simultaneous measurements of the right ventricular diastolic and right atrial pressures. Tricuspid stenosis is usually associated with other valvular lesions, whose clinical and hemodynamic findings might be altered. Surgical procedures on these patients involved tricuspid valve repair, commissurotomy or prosthetic valve replacement, in addition to the procedures necessary to correct other associated valvular lesions. Results of surgery were gratifying with significant improvement in 87 percent of patients and a mortality of 3 per cent.

Adolescent↗
PubMedDate not supplied

Occlusive thromboaortopathy (Takayasu disease): clinical and angiographic features and a brief review of literature.

The aim of this study was to evaluate the diagnostic criteria and angiographic classifications of Takayasu arteritis by presenting the clinical, angiographic, and prognostic findings and a prospective follow-up of 78 patients. Occlusive thromboaortopathy or Takayasu arteritis is a large vessel vasculitis. The disease is systemic with an autoimmune and genetic etiology. The complete clinical and angiographic manifestations are reported for 78 cases based on diagnostic criteria of the American College of Rheumatology with a mean 6 +/- 3.2 years follow-up. The mean age was 34.7 and female:male ratio was 3.6:1. According to National Institute of Health criteria, 61.5% of patients were in the acute phase of disease with systemic symptoms such as fever, weight loss, malaise, and elevated C-reactive protein levels. Immunologic markers, such as antinuclear antibody and antineutrophil cytoplasmic antibodies, were negative. The tuberculin test result was positive in 47%. Vascular bruit was present in 89%. Almost all patients had stenoses, occlusions, or aneurysmatic changes of the aorta and its main branches. Hypertension was detected in 58% and left ventricular hypertrophy was initially present in 22 (28%) patients. The angiographic manifestations were classified as type I, cervicobrachial type with 20 cases (25.6%); type II, thoracoabdominal type with 13 cases (16.6%); type III, peripheral type with 10 cases (12.8%); and type IV, generalized type with 35 cases (44.8%). The coronary arteries were involved in 6 cases, pulmonary arteries in 11 initially 5 in follow-up (16 cases), and renal arteries in 28 cases, respectively. A good correlation of the clinical manifestations and the prognosis was observed. During follow-up, five patients suffered from myocardial infarction, six had cerebrovascular accident, seven patients underwent aortic valve replacement, and six patients died (mortality rate, 7.6%). The specificity and sensitivity of diagnostic criteria were 94% and 76%, respectively. In contrast to ours and Nasu's classification in the new classification of Numano, some angiographic types and subtypes of Takayasu arteritis are not present in our patients.

Adolescent↗