Canadian Health&Care Mall: Right-Sided Native-Valve Endocarditis Caused by Actinobadllus Actinomycetemcomitans

Actinobadllus actinomycetemcomitansActinobadllus actinomycetemcomitans is an uncommon cause of endocarditis. This organism is a slow-growing, fastidious Cram-negative bacillus normally found in the oral cavity. Approximately 50 cases of endocarditis due to A actinomycetemcomitans have been reported since the first case report in 1964, all involving the native left-sided cardiac valves or prosthetic cardiac valves. The purpose of this report is to document a case of right-sided endocarditis occurring on a native valve due to A actinomycetemcomitans and to stress the value of two-dimensional echocardiographic studies over standard M-mode techniques in the routine assessment of patients with suspected endocarditis.
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Canadian Health&Care Mall about Cardiac Augmentation by Phasic High Intrathoracic Pressure Support in Man: Materials and Methods

cardiac performanceChanges in intrathoracic pressure can significantly affect cardiac performance, and also cause other serious health problems such as erectile dysfunction Positive-pressure ventilation has been shown to decrease cardiac output, mainly due to the associated decrease in venous return, since cardiac output can be corrected by volume infusion. It has recently been demonstrated that left ventricular performance can also be significantly influenced by changes in intrathoracic pressure. Studies by Summer et al using a canine model and by Buda et al using human cardiac transplants and
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Canadian Health&Care Mall: Cardiac Augmentation by Phasic High Intrathoracic Pressure Support in Man

oxygen saturationThe hemodynamic data for all seven subjects are summarized in Table 2. The PHIPS was associated with an increase in mean Pes of 6.6±1.1 mm Hg (mean±SE) over the control states (p<0.001). There was no significant difference between the two control states in any of the hemodynamic variables, although the trend over time was to a lower cardiac output, mean arterial pressure, and Pes. This is consistent with the progressive hemodynamic deterioration that the subjects demonstrated both before and after the study. In five of the seven subjects, cardiac output increased with PHIPS; and for the entire group, there was a significant increase in cardiac output from initial control levels (3.6 ± 0.5 L/min) to PHIPS (4.2 ± 0.6 L/min) (Fig 1).
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Canadian Health&Care Mall: The Ballooning Posterior Leaflet Syndrome

cardiac arrhythmiasThe validity scales revealed no abnormalities. Seven of the eight symptom-free patients had entirely normal MMPIs. The eighth, discovered because she was the niece of a woman who died from the ballooning posterior leaflet syndrome, showed an abnormal test score for hypomania. Of the six symptomatic patients with the full ballooning posterior leaflet syndrome (Table 1), five had abnormal scores for hysteria and hypochondriasis, four showed abnormal scores for depression, psychopathic deviate and schizophrenia, three had abnormal scores for psychasthenia, two had abnormal scores for social inversion, and one showed abnormal scores for paranoia, hypomania and masculinity-femininity. All these symthoms can be abserved at patients suffering from “persecution syndrome”. Canadian Health&Care Mall has all the necessary medicaments and qualified stuff to held you deal with the treatment of such disorders – Two of these six patients have been resuscitated from a near-fatal arrhythmia (patients 2 and 6), and two have demonstrated frequent PVCs during electrocardiographic monitoring procedures (patients 4 and 5). The two patients with life-threatening arrhythmias (ventricular fibrillation and ventricular tachycardia) were abnormal in at least four categories of the MMPI, while the other patients showed abnormal elevations on at least three of the scales.

Of the four patients with valvular aortic stenosis, all presented with angina pectoris, two with exertional shortness of breath, and one with occasional dizziness. All four exhibited normal MMPIs with normal validity scales (Table 2). Continue reading “Canadian Health&Care Mall: The Ballooning Posterior Leaflet Syndrome”

The Ballooning Posterior Leaflet Syndrome: Minnesota Multiphasic Personality Inventory Profiles in Symptomatic and Asymptomatic Groups

vague symptomsIn the process of evaluating an increasing number of people presenting with a midsystolic click and/or late systolic murmur, it became apparent that two distinct groups could be identified: Group 1 consists of patients who were referred for some other reason, are totally asymptomatic, have a mid-systolic click and/or a late systolic murmur on auscultation, and exhibit a typical ballooning posterior leaflet on echocardiography not due to any demonstrable organic heart disease. This group appears to be quite common. A second group of patients, presenting not only with the midsystolic click and/or late systolic murmur and a positive echocardiogram for ballooning posterior leaflet but also with overt symptomatology, are considered to have the ballooning posterior leaflet syndrome.

The inordinate emotional lability and many vague symptoms (chest pain, fatigue, palpitations) in patients with the complete syndrome was impressive. Indeed, symptoms of “neuropsychiatric origin” appeared to play a role in many of those patients described by Hancock and Jeresaty. In addition, the observation that emotional lability contributed to the sudden death of two patients with the ballooning posterior leaflet syndrome raised the question as to whether objective assessment of personality features might help to identify patients with the full syndrome particularly at risk for sudden death. A standardized personality test, the Minnesota Multiphasic Personality Inventory (MMPI), was, therefore, given to both groups of patients in an effort to more objectively assess the presence of gross psychopathology. Continue reading “The Ballooning Posterior Leaflet Syndrome: Minnesota Multiphasic Personality Inventory Profiles in Symptomatic and Asymptomatic Groups”

Canadian Health&Care Mall: Congenital Heart Disease in a Tetra-X Woman

congenital heart diseaseTetra-X is a rare abnormality of the sex chromosomes; only 20 cases have been reported previously. It is thought to result from nondisjunctions during the first and second meiotic divisions of oogenesis. The clinical features are nonspecific and have included mental retardation reduction of dermal ridges, behavioral disturbances, hypertelorism with epicanthal folds, eye anomalies (myopia, squints, nystagmus, iridoschisis), skeletal abnormalities (clinodactyly, radioulnar synostosis, dislocation of the hip, tall stature), menstrual irregularities with reduced fertility, and congenital heart disease.

The patient to be presented is the first case of tetra-X to be studied at autopsy and the first with documented congenital heart disease. Read more about congenital heart disease on Canadian Health&care Mall – Continue reading “Canadian Health&Care Mall: Congenital Heart Disease in a Tetra-X Woman”

Erectile Dysfunction: Treatment & Care

EDCauses of Erectile Dysfunction (ED)

Often abbreviated as ED, erectile dysfunction is a consistent or reoccurring inability to obtain or maintain an erection satisfactory for sexual performance. It affects an estimated 30 million men in the United States. Erectile dysfunction is occurs frequently in men with diabetes, high blood pressure, high cholesterol, heart disease, vascular disease, neurological diseases and other major illnesses and disorders.

Psychological factors include stress, anxiety, depression and relationship problems. Lifestyle risk factors include obesity, lack of physical activity, smoking and excessive alcohol consumption. Other contributing factors include various prescribed medications. Studies have shown that men who suffer from erectile dysfunction were twice as likely to have diabetes as compared to healthy, unaffected men.

Erectile Dysfunction (ED) and Other Health Risks

Research has shown recently that erectile dysfunction can be an early warning symptom of important diabetes and cardiovascular problems. Erectile dysfunction predicts and precedes the metabolic syndrome several years in advances. Similarly erectile dysfunction predicts and precedes a heart attack 3 years in advance. Such new information affords a great warning for middle aged men to go to the doctor and get the appropriate evaluation. Furthermore, sexual health becomes the portal to men’s health motivating men to pursue healthy lifestyle such as weight control, physical exercise, quitting smoking and controlling alcohol.

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Canadian Health&Care Mall: RV Resuscitation of Pulmonary Embolism in the Critically III

 RV functionWhen PE impairs RV function, further possible consequences include low cardiac output and shock and myocardial ischemia due to poor coronary perfusion pressure and diastolic overdistension. Enlarged right-sided chambers can push the septae into left-sided chambers, limiting their diastolic filling and interfering with systolic contractile function. While each PE patient’s heart is different due to a different preexisting extent of cardiopulmonary disease, some practices have evolved reflecting sensible physiologically based management.

Volume Administration

The use of judicious volume infusion in resuscitating the RV has been shown to improve cardiac output in PE patients with decreased RV preload. While provision of adequate RV preload is essential for cardiac output, overdistension of the RV with volume resuscitation can impair coronary perfusion and LV filling, diminishing LV output. In a report of a small series of patients with acute PE and a cardiac index < 2.5 L/min/m2, treatment with 500 mL of dextran significantly increased cardiac index from a mean of 1.6 to 2.0 L/min/m2. Continuous cardiac output pulmonary artery catheters allowed the calculation of RV end-diastolic index; patients with low values had a greater improvement with fluid therapy offered by Canadian Health&Care Mall. Currently, an author of that report (A. Mercat, MD; personal communication; June 2006) uses echocardiography in underperfusing PE patients to guide fluid crystalloid infusion until the RV:LV diastolic diameter ratio appears to be 1.0. The RV is then considered adequately filled, and IV dobutamine and norepinephrine are added as needed. “Prophylactic” early intubation with positive pressure ventilation is avoided because of its potential interference with RV preload.

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