g-Kang Chen

Takotsubo Cardiomyopathy as an Underlying Mediator of Myocardial Infarction with Normal Coronary Arteries

Objective: The purpose of the present study was to describe our experience with myocardial infarction with normal coronary arteries (MINCA) with regards to the prevalence, clinical characteristics, possible underlying etiologies (including Takotsubo cardiomyopathy, TCM) and the short- and long-term outcomes associated with this condition. Methods: We retrospectively analyzed the records of 596 consecutive patients presenting with acute myocardial infarction over a 4-year period and identified 24 patients (14 female, 10 male) with angiographically normal coronary arteries. Demographic and clinical variables and outcomes were reviewed. Results: Mean patient age was 59 ± 20 years. The presumed MINCA mechanism was TCM in 10 patients (41.7%), probable myocarditis in 5 (20.8%), coronary spasm in 4 (16.7%), coronary thrombus in 3 (12.5%) and aortic dissection in 2 patients (8.3%). After a mean follow-up of 19 ± 14 months, 2 patients with probable myocarditis had died of cardiovascular causes, 1 patient with aortic dissection had died due to sepsis after surgery and 1 patient with TCM had died of noncardiovascular causes 2 years after discharge. Conclusion: In this study, we found that MINCA occurred in 4% of patients with acute myocardial infarction undergoing emergent coronary angiography, with the most frequent underlying mechanism being TCM.

Isolated Right Ventricular Intracavitary Metastasis of Hepatocellular Carcinoma in a 74-year-old Woman

A 74-year-old woman with a history of chronic hepatitis C and transcatheter arterial chemoembolization for an unresectable hepatocellular carcinoma (HCC) 2 years previously presented with progressive exertional dyspnea of 1 months duration. Two-dimensional echocardiography revealed a huge right ventricular mass with right atrial and right ventricular outflow tract extension. Palliative resection of the tumor and adjunctive chemotherapy was performed. However, the right ventricular mass recurred 1 month later and the patient died 4 months after the operation. To our knowledge, this is the oldest patient reported with isolated right ventricular intracavitary metastasis of HCC, and this report reemphasizes the lower surgical indication in patients with metastatic cardiac tumors.

Inverted Takotsubo Cardiomyopathy Caused by Hypoglycemia

Received: May 26, 2009 Accepted for publication: June 6, 2009 From the Division of Cardiology, Department of Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan Address reprint requests and correspondence: Dr. Yung-Ping Chen Division of Cardiology, Department of Medicine, Chia-Yi Christian Hospital, Taiwan 539 Jungshiao Road, Chiayi City 60002, Taiwan (R.O.C.) Tel: (05)2765041 ext 7354 Fax: (02)89660454 E-mail: d778@cych.org.tw 急重症影像

Cardiac Tamponade after Pacemaker Implantation

We report a 71-year-old woman with syncope that occurred during hemodialysis. The patient underwent transvenous temporary and permanent pacemaker implantation for sick sinus syndrome. Acute cardiac tamponade with shock developed after pacemaker implantation in our intensive care unit, which was successfully managed by emergency pericardiocentesis as well as medical therapy. Our report illustrates the importance of including cardiac tamponade in the differential diagnosis of unexplained shock after pacemaker implantation. A high index of suspicion may lead to early diagnosis, which is essential to reach a good outcome.

Coincidence of Acute Coronary Syndrome and Pulmonary Embolism in a 74-Year-Old Man

Received: December 31, 2009 Accepted for publication: February 5, 2010 From the Division of Cardiology, Department of Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan Address reprint requests and correspondence: Dr. Cheng-Kang Chen Division of Cardiology, Department of Medicine, Chia-Yi Christian Hospital 539 Jhongsiao Road, Chia-Yi City 60002, Taiwan (R.O.C.) Tel: (05)2765041 ext 5023 Fax: (05)2765041 E-mail: 03778@cych.org.tw 急重症影像

Acute and Reversible Mid-ventricular Ballooning: An Atypical form of Takotsubo Cardiomyopathy

A 67-year-old woman was admitted to our hospital for hemorrhoidectomy. The patient was anesthetized with an epidural block with 2% lidocaine. After operation, her heart rate suddenly dropped from 70 beats per minute to nearly cardiac arrest. Atropine 1 mg and epinephrine 0.5 mg were given intravenously but in vain. The patient soon had ventricular tachyarrhythmia requiring defibrillation. She was intubated due to respiratory failure and acute pulmonary edema, which was demonstrated by the radiography of chest. Her electrocardiogram demonstrated sinus tachycardia with mild ST-segment elevation in leads V3-V6, II, III and aVF (Fig. 1B). On next day, she underwent cardiac catheterization for suspicion of acute myocardial infarction. Coronary angiography revealed absence of coronary artery stenosis. Her left ventriculogram demonstrated akinesis of the midventricular segments and hyperkinesis of the basal and apical segments (Fig. 2). After the onset of the event, the patient’s initial troponin I value was 0.860 ng/ml; at 6 hours, 4.7 ng/ml; at 12 hours, 10.5 ng/ml; at 36 hours, 5.7 ng/ml; and at 60 hours, 2.5 ng/ml. With supportive treatment, spontaneous Acute and Reversible Mid-ventricular Ballooning: An Atypical Form of Takotsubo Cardiomyopathy

Type 4 Dual Left Anterior Descending Artery Demonstrated by 64-MDCT

A 62-year-old man, who was a smoker and had a history of type 2 diabetes mellitus, was admitted to our intensive care unit for a sudden onset of chest pain accompanied by cold sweating and nearsyncope. His symptoms improved after medical therapy with aspirin, clopidogrel, diltiazem, nitrate and heparinization. Serial electrocardiograms showed dynamic T-wave inversion over the leads V2-V6, II, III and aVF. Cardiac enzymes measurements were within the normal limits. The following day, left coronary angiograms revealed a short left anterior descending artery (LAD), which terminated at the distal part of the anterior