The mitral valve E-point septal separation (EPSS) is widely used clinically as an M-mode echocardiographic indicator of a normal or abnormal left ventricular ejection fraction. However, no study has examined systematically the utility of the EPSS in predicting normality of ejection fraction in patients with a reversed septal motion which is often observed in patients with right ventricular volume overload states or right ventricular disease (either primary or due to pulmonary disease). If valid, this measurement would have significant clinical importance because other conventional M-mode echocardiographic correlates of ejection fraction, such as fractional shortening, are not useful in patients with reversed septal motion. Therefore, the purpose of this study was to compare the utility of the EPSS as an indicator of a normal or abnormal ejection fraction in patients with normal and reversed septal motion.
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Since then a Dressler-like syndrome has also been described after pacemaker implantation (as possibly occurred in our first case), blunt trauma to the chest, percutaneous puncture of the left ventricle, and pulmonary embolism. None of these describe the acute findings of our three patients. Cheap Diskus Advair
In summary, three cases are described suggesting an acute noncardiogenic alveolitis or capillary leak syndrome occurring two-three days after cardiac injury. Two had a history of distant myocardial or pericardial injury, and the third had an acute anteroseptal myocardial infarction occurring two-three weeks before cardiac surgery. All three patients reponded dramatically to therapy with corticosteroids, suggesting an autoimmune etiology.
The postcardiotomy syndrome (PPS) and its possible relationship to a hypersensitivity reaction was first described in 1961. The authors described a delayed pericardial reaction following 30 of 100 consecutive congenital heart operations in which the pericardium was widely incised, and they believed that the syndrome probably represented a hypersensitivity response to blood in the pericardial sac that had already undergone traumatic pericarditis. birth control yasmin
The noncardiogenic fulminating pulmonary edema occurring during or after cardiopulmonary bypass is described as occurring within 6 hours of surgery, with the probable cause believed to be an unknown type of allergic reaction secondary to blood or blood products. This “post pump syndrome,” however, is not applicable to our cases, and the present use of membrane oxygenators and improved tubing has made this a rare surgical complication. Rarely, this syndrome is described as not recognized immediately postoperatively, during which time the chest roentgenogram appears normal only to show pulmonary edema 48 to 72 hours later. proventil inhaler
The cases reported suggest an acute autoimmune mechanism precipitated by acute myocardial or pericardial injury in the presence of already existing antiheart antibodies. Unfortunately, measurements of antibody as originally described by Van DerGeld were not available to us, so such considerations remain theoretical. Nevertheless, the history of prior myocardial or pericardial damage associated with the marked elevation of the sedimentation rate and the dramatic response to corticosteroid therapy strongly supports this notion.
On the third postoperative day; there was further deterioration with bilateral pulmonary edema and pleural effusions and a normal heart size on the chest roentgenogram. The Po2 was 41 mm Hg on 40 percent oxygen. No S3 gallop, JVD, heart murmur, or peripheral edema was observed.
By the fourth postoperative day, pulmonary edema had worsened. Because of unexplained pulmonary edema in the presence of good left ventricular function and the elevated sedimentation rate, an acute postpericardiotomy syndrome was considered. Accordingly, the patient was started on a regimen of prednisone 80 mg daily. Within 24 hours there was significant improvement and after 48 hours the Po2 was 62 mm Hg (94 percent saturation) on room air, and there was clearing of the pulmonary edema on chest roentgenogram.
There were no operative complications, and the patient came to the intensive care unit in stable condition. The immediate postoperative chest roentgenogram showed no cardiomegaly or pulmonary edema. Transient hypertension was treated for 4 hours with nitroprusside. The left atrial pressure remained 10 to 15 mm throughout the first postoperative day, and the blood pressure and pulse were stable. The ECG showed no evidence of further damage. Fostextubation blood gases showed a pH of 7.44 Pco2 of 34 mm Hg, and Po2 of 70 mm Hg (saturation of 94 percent) on 4 L oxygen by nasal cannula. antibiotic levaquin
A 56-yeai^old man was seen in the emergency department of a community hospital on June 6, 1989, because of recurring anterior chest and back pains. The ECG showed QRS and T wave changes compatible with an acute anteroseptal MI. Seventeen days later, the patient was referred to Presbyterian Hospital because of recurring chest pain and strongly abnormal results of a treadmill stress test. ventolin 100 mcg
Because of pulmonary edema in the presence of apparent good left ventricular function (left arterial pressure, 7 to 13; PAD, 12 to 16), methylprednisolone 125 mg IV every 12 hours and prednisone 80 mg daily were given empirically. By the following morning, there was dramatic improvement with Po2 increasing to 74. Within 48 hours after the patient received steroids, the Po2 had risen to 75 with a saturation of 95 percent on 40 percent oxygen by face mask. The chest roentgenogram showed gradual improvement and clearing over a four-day period. The patient continued to do well, steroid therapy was gradually weaned prior to hospital discharge, and the patient had an uneventful recovery. Results of subsequent stress testing were normal.
Preoperatively, her chest roentgenogram showed a normal cardiac silhouette and clear lungs with normal vascular markings. The ECG showed nonspecific T-wave variations.
A few hours after surgery, her chest roentgenogram showed no evidence of congestive heart failure and no increase in heart size, and the ECG showed no evidence of perioperative ischemic damage. The left atrial pressure was 7 mm, and there was good oxygenation. She continued to do well for the next 24 hours.