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Biomedical subjects

Josef Finsterer

Publications and source records attributed to Josef Finsterer.

At least 55 records · Page 3Linked to original sources
PubMed2006

Transient left ventricular dysfunction (tako-tsubo phenomenon): Findings and potential pathophysiological mechanisms.

Tako-tsubo-like left ventricular dysfunction phenomenon (TTP) is characterized by transient left ventricular apical ballooning associated with symptoms, electrocardiographic changes and minimal cardiac enzyme release in the absence of coronary artery disease. Initially described in Japan, TTP occurs worldwide, predominantly in women and frequently after emotional or physical stress. Symptoms include anginal chest pain, dyspnea and syncope. Electrocardiographic ST elevations may be present only for several hours, and are followed by negative T waves that persist for months. Arterial hypertension is found in up to 76% of TTP patients, hyperlipidemia in up to 57% and diabetes mellitus in up to 12%. Potential pathophysiological mechanisms for TTP include catecholamine-induced myocardial stunning or hyperkinesis of the basal left ventricular segments, coronary vasospasm, plaque rupture, myocarditis and genetic factors. TTP patients should be monitored similarly to myocardial infarction patients because organ failure, cardiogenic shock, ventricular fibrillation or rupture may occur. Beta-blockers are indicated, whereas catecholamines and nitrates should be avoided. The long-term prognosis is unknown.

Chest Pain↗
PubMed2006

Consequences of misdiagnosing mitochondrial disorder.

Diagnosing mitochondrial disorder remains a challenge. In a 75-year-old women, with short stature, muscle cramps, ptosis, fasciculations and progressive, proximal limb weakness and wasting, hyponatriemia, abnormal lactate-stress-test, and slightly abnormal electromyography, muscle biopsy suggested granulomatous myositis. Corticosteroids and azathioprin were ineffective. After a second work-up amyotrophic-lateral-sclerosis was diagnosed. Riluzole was started, without effect. She developed respiratory insufficiency, requiring mechanical ventilation. Apical ballooning was found. After switching to non-invasive positive pressure ventilation and physiotherapy, she markedly improved. After a third diagnostic work-up, mitochondrial disorder was suspected. Unfortunately, she died suddenly from a cardiac arrhythmia at home. Mitochondrial disorder may mimic motor neuron disease, muscle biopsy may mimic myositis, and may show only little evidence for respiratory chain disorder.

Aged↗
PubMed2006

Mitochondrial disorder aggravated by propranolol.

Although there are indications that beta-blockers affect the skeletal muscle in therapeutic dosages, their influence on mitochondrial disorders is unknown. A 52-year-old woman developed double vision, myalgias, muscle cramps, and hip and thigh muscle stiffness. Clinical neurologic examination revealed ptosis, dysarthria, sore neck muscles, weakness and wasting of the thighs, and generally brisk tendon reflexes. Lactate stress testing was significantly abnormal. Needle electromyography was nonspecifically abnormal and myopathic. Muscle biopsy showed mild myopathic changes, target fibers, and a single COX-negative fiber. Probable mitochondrial disorder was diagnosed. The patient had been on 30 mg of propranolol during 7 years for arterial hypertension. Shortly after discontinuation of the drug, her double vision gradually disappeared, myalgias and muscle cramps gradually resolved, and the patient reported an increase in muscle mass on repeated follow-ups. Long-term administration of propranolol may aggravate a mitochondrial disorder. Discontinuation of propranolol may result in a gradual resolution of these adverse reactions.

Adrenergic beta-Antagonists↗
PubMed2006

Chronic long-standing headache due to neurocysticercosis.

A 35-year-old Chinese woman presented with a 26-year history of persistent headache, relieved only by diuretics. Characteristic CT findings, peripheral eosinophilia, lymphocytic CSF pleocytosis, elevated CSF IgG, positive oligoclonal bands, antibody-positive ELISA, and Western blot results with Taenia solium antigen, and a favorable response to albendazole led to the diagnosis of neurocysticercosis.

Adult↗
PubMed2006

Creatine kinase elevation in creutzfeldt-jakob disease.

OBJECTIVES: Creutzfeldt-Jakob disease (CJD) is not only a disorder of the central nervous system but also affects the skeletal muscle. Subclinical skeletal muscle involvement, manifesting as hyper-creatine-kinase (CK)-emia, is rare. CASE REPORT: The patient, a 60-year-old male, developed progressive dementia, accompanied by dysphagia and bursts of aggression, disorientation and optic hallucinations. Five months after onset of the cognitive decline, hyper-CK-emia of 117 U/l (normal: <81 U/l) was noted for the first time. During 12 months until decease, hyper-CK-emia was permanently present and reached a maximum of 354 U/l. Hyper-CK-emia was attributed to subclinical involvement of the skeletal muscle in CJD. Hyper-CK-emia due to progressive brain damage, double trouble of an additional primary myopathy or due to excessive myoclonic jerking was excluded. CONCLUSIONS: This case shows that CJD may be present with mild hyper-CK-emia in individual patients, most likely due to concomitant undiagnosed involvement of the skeletal muscle in the primary disease.

Creatine Kinase↗
PubMed2006

Non-compaction of the right atrium and left ventricle in Ebstein's malformation.

Ebstein's malformation (EM) is characterized by dysplasia and displacement of the tricuspid inferior and septal leaflets from the true atrioventricular (AV) junction. Left ventricular hypertrabeculation/non-compaction (LVHT) including the 'atrialized' portion in EM has not been described. A 42-year-old man with a history of radiofrequency ablation of a Mahaim-like bundle suffered from chest pain. Coronary angiography was normal, but echocardiography showed a septal tricuspid leaflet inserting 3.5-cm apically beyond the AV junction, deep recesses of the atrialized interventricular septum, and a heavily trabeculated left ventricle; these were confirmed by cardiac magnetic resonance imaging. Neurologically, hypoacusis, positive pyramidal signs, postural tremor and brisk tendon reflexes were identified.

Adult↗
PubMed2005

Neuromuscular implications in left ventricular hypertrabeculation/noncompaction.

This review focuses on recent advances in the association between left ventricular hypertrabeculation/noncompaction (LVHT), a form of unclassified cardiomyopathy, and neuromuscular disorders (NMD). So far, LVHT has been found in single patients with dystrophinopathy, dystrobrevinopathy, laminopathy, zaspopathy, myotonic dystrophy, infantile glycogenosis type II (Pompe's disease), myoadenylate-deaminase deficiency, mitochondriopathy, Barth syndrome, Friedreich ataxia, and Charcot-Marie-Tooth disease. Most frequently LVHT is found in patients with Barth syndrome and mitochondrial disorders. The prevalence of LVHT in NMD patients is not known. On the contrary, NMD can be detected in up to four fifths of the patients with LVHT. Because LVHT is associated with an increased risk of rhythm abnormalities and heart failure, it is essential to detect LVHT as soon as possible. Because of adequate therapeutic options, all patients with NMD should undergo a comprehensive cardiological examination as soon as their neurological diagnosis is established. In reverse, all patients with LVHT should undergo a comprehensive neurological investigation following the detection of LVHT.

Heart Defects, Congenital↗