Intravenous Thrombolysis of Occlusion in the Middle Cerebral and Retinal Arteries from Presumed Ventricular Myxoma

Background. Although thrombolytic therapy has been shown to be beneficial to stroke patients, the effectiveness of intravenous thrombolysis in ischemic stroke patients with ventricle myxoma is unknown. Case Description. A 22-year-old woman with left hemiplegia was sent to the emergency department at a teaching hospital. The magnetic resonance angiography showed occlusion of the right middle cerebral artery, and the echocardiography showed a mass in the left ventricle. Intravenous recombined tissue plasminogen activator (rt-PA) was administrated, and the postthrombolysis transcranial Doppler exam showed that her right middle cerebral artery was circulative. The patient's condition improved gradually, and no complication was observed up to 16 months of follow-up. Conclusion. Intravenous rt-PA is a reasonable treatment for stroke patients with ventricle myxoma

Oxaliplatin-induced acquired long QT syndrome with torsades de pointes and myocardial injury in a patient with dilated cardiomyopathy and rectal cancer

AbstractA 67-year-old woman presented with a history of dilated cardiomyopathy with congestive heart failure since 2003, who subsequently developed lower rectal cancer (adenocarcinoma) with liver, bone, and lymph node metastasis. Abdominoperineal resection and hepatectomy were performed. The patient received two rounds of intravenous chemotherapy, including 12 and six courses of FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin; 85 mg/m2 per cycle). She underwent a third round of intravenous FOLFOX4 because of tumor progression. During the 21st course of FOLFOX4 regimen, the patient developed ST segment depression in lead II and prolongation of QT interval with polymorphic ventricular tachycardia, torsades de pointes right after the start of oxaliplatin infusion. Immediate defibrillation and cardiopulmonary resuscitation were administered, and the patient regained spontaneous circulation and consciousness. Twelve-lead electrocardiogram showed ST segment elevation in III, aVF, and ST segment depression in V4–6 after resuscitation. To our knowledge, prolongation of QT interval with torsades de pointes and coronary spasm with myocardial injury that were stabilized in one patient following oxaliplatin infusion has not been reported. We present a patient with these rare complications

[[alternative]]The effect of Tai Chi Chuan on exercise capacity, lipid profiles, autonomic function and left ventricular function in patients with coronry artery disease

[[abstract]]　　背景：冠狀動脈心臟病為全世界主要死亡原因之一。不運動的生活型態是冠狀動脈心臟病的危險因子之一。太極拳是我國傳統之武術或運動，研究證實太極拳對生活品質及生活功能有療效的部份，包括活動耐受性、心血管功能、疼痛治療、身體平衡與預防跌倒、提昇免疫功能、改善身體彈性、強度及Kinesthetic sense。　　　　實驗方法：本臨床研究共61 名冠狀動脈心臟病患參與，依其意願分為兩組，太極拳組共22 名，對照組共39 名，太極拳組施以太極拳訓練，對照組鼓勵在家作輕度運動，兩組皆繼續原有藥物治療。六個月後，評估運動功能、血脂肪、自主神經功能、左心室收縮及舒張功能。　　　　實驗結果顯示：體重、身體質量指數、腰圍、收縮壓、舒張壓及心率功能，兩組之間沒有顯著差異( p>0.05)。跑步機運動功能測試，結果亦顯示：運動中最高心率，太極拳組高於對照組，太極拳組0 個月與6 個月之間顯著下降，兩組之間存在顯著差異（p=0.033）。然而，運動前心率與收縮壓乘積(運動前雙產物)之數據顯示：對照組之數值高於太極拳組，兩組之間存在顯著差異（p=0.003）。運動中最高心率與最高收縮壓乘積(運動中最高雙產物)之數據顯示：太極拳組，0、6 個月有差異(p=0.009)，呈下降趨勢。對照組，組內無差異。以一般線性模式的重複量數　　　　　分析結果顯示，兩組的Peak RPP 改變，受試者內效應項的檢定(假設為球形)，0、3、6 個月間有交互作用(interaction) (p= 0.048)，代表太極拳組Peak RPP 的下降比對照組顯著。運動中最高心率與最高收縮壓乘積減運動前心率與收縮壓乘積(運動中最高雙產物與運動前雙產物之差值)之數據亦顯示：兩組之間存在顯著差異（p=0.028）。自主神經功能實驗結果顯示：太極拳組0 個月與6個月與對照組0 個月與6 個月之間自主神經功能無顯著差異（p>0.05）。比較太極拳運動前後與跑步機運動前後之自主神經功能之實驗數據：太極拳組運動3 個月後之心率變異性，平均RR 間期、SDNN、SDNNi、Total power、VLF power 顯著呈上升趨勢( p0.05）。總膽固醇與低密度脂蛋白膽固醇，0、3，0、6 個月間有顯著差異，呈下降趨勢，以一般線性模式的重複量數分析結果顯示，兩組的總膽固醇與低密度脂蛋白膽固醇改變，受試者內效應項的檢定(假設為球形)，0、3、6 個月間有交互作用(interaction)（p=0.027, 0.019），代表太極拳組總膽固醇與低密度脂蛋白膽固醇的下降比對照組顯著。檢查心臟超音波，左心室等容積鬆弛時間(Isovolumicrelaxation time)、舒張早期左心室充填速度E 波、心房收縮造成舒張晚期左心室充填速度A 波、E 波最高振幅減速時間(Deceleration time)、E 波與A 波比值、心室收縮期肺靜脈波血流　速度S 波與心室舒張期肺靜脈波血流速度D 波、左心室射出分率、左心室舒張末期容積、左心室收縮末期容積等功能，比較太極拳實驗組與對照組之檢驗結果顯示無顯著差異（p>0.05）。　　　　　結論：運動中最高心率，太極拳組高於對照組，太極拳組0 個月與6個月之間顯著下降，兩組之間存在顯著差異。運動中最高心率與最高收縮壓乘積，太極拳組0 個月與6 個月之間呈下降趨勢，與對照組有顯著差異。運動中最高心率與最高收縮壓乘積減運動前心率與收縮壓乘積，太極拳組0 個月與6 個月之間顯著下降，與對照組兩組之間存在顯著差異。顯示太極拳運動訓練，降低運動中心肌氧氣需求，提高運動中心肌缺血閥值。次極度跑步機運動試驗為高強度運動，運動後30 分鐘則僅使運動後兩組之平均心率上升，對照組之LF power 上升，太極拳組無變化，可能因高強度運動使自主神經恢復較慢有關。中強度太極拳運動後30 分鐘平均心跳率下降，心率變異值上升，顯示中強度太極拳運動使自主神經恢復較快，心率變異總能量上升，交感、副交感神經之調控得到改善，對運動後短期副交感再活化較次極度跑步機運動提早。太極拳組總膽固醇與低密度蛋白膽固醇的下降比對照組顯著。[[abstract]]　　Background: Coronary artery disease is a leading cause of death worldwide. Physical　inactivity is one of the risk factors of　coronary artery disease. Tai Chi Chuan (TC) is a traditional Chinese martial art and exercise. 　　　　Accumulated evidences were found to confirm the therapeutic benefits of TC exercise with regard to quality of life, physical function including activity tolerance and cardiovascularfunction, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense.　　　　Methods: A total of 61 subjects with　coronary artery disease, defined as more than 50 percent stenosis in diameter or 75% stenosis in area by angiography, were enrolled. Twenty-two subjects received TC exercise　training and 39 subjects continued their daily physical　activity. Treadmill exercise test, lipid profiles, heart rate variability and systolic　and diastolic function of the left ventricle　were evaluated at baseline, 3 months and, 6　months.　　　　Results: There was no significant difference on body weight, body mass index, waist　circumference, systolic blood pressure,　diastolic blood pressure, resting heart rate between the two groups. On treadmill exercise　test, peak heart rate during exercise at　baseline decreased after　6 months of TC. The decrement was significantly different from that of controlled group (P=0.033). The pre-exercise rate pressure product of controlled group was significantly higher than the TC group (P= 0.028). The peak rate pressure product of the TC group was significantly decreased between baseline and 6 month. The within-subjects effect (sphericity assumed) was significantly different between two groups (p=0.048). There was　interaction between TC and controlled group. The decrement of peak rate pressure product of TC group was significantly different from that of controlled group. The difference between peak and pre-exercise rate pressure product also decreased in the TC group after 6 months of　exercise, significantly different from the controlled group (p= 0.028). Resting heart rate variability was no significant difference　between two groups. Heart rate variability before and post-Texercise showed decreased mean heart rate, increased SDNN, SDNNi, total power, VLF power on 3 months and decreased mean heart rate, nHF, increased SDNNi, total power, LF power, LF/HF,nLF on 6 months. Heart rate　variability before and post-treadmill exercise test showed increased mean heart rate on two groups and increased LF power on control group. 　　　　　　Triglyceride, HDL-cholestrol, cholesterol/HDL-C, creatinine, glucose, uric acid, hs-CRP were not　significantly different between the two groups. Total cholesterol and LDL-cholesterol decreased significantly between 0, 3 and 0, 6 months in TC group. The within-subjects effect (sphericity assumed) was　significantly different between two groups (p=0.027, 0.019). There was　interaction between two groups. The decrement of total cholesterol and LDL-cholesterol of the Tai Chi group was significantly different from that of control group. Isovolumic relaxantion time, E wave velocity, A　wave velocity, E/A ratio, deceleration time of E wave, S wave and D wave of pulmonary flow, ejection fraction, left ventricular end diastolic volume, left ventricular end systolic volume were no significant differences between two groups.　　　　Conclusion: The peak heart rate during treadmill exercise decreased after 6 months of TC. The decrement of peak heart rate was significantly different from that of controlled group.The peak rate pressure product of the TC group was significantly decreased between baseline and 6 month. The decrement of peak rate pressure product of TC group was significantly different from that of controlled group. Thedifference between peak and pre-exercise rate pressure product also decreased in the TC group after 6 months of exercise, significantly different from the controlled group. TC decreased O2 consumption during exercise at the same intensity and duration of exercise. Comparing TC with treadmill exercise test, heart rate decreasedsignificantly after TC 30 minutes and increased significantly after treadmill exercise test. Heart rate variability increased post-TC, but not post-treadmill exercise test. TC had a quicker restoration of vagalmodulation than treadmill exercise test after termination of exercise. The decrement of total cholesterol and LDL-cholesterol of the Tai Chi group was significantly different from that of control group

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 unre-sectable hepatocellular carcinoma (HCC) 2 years previously presented with progressive exertional dyspnea of 1 month's 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

Acute pericarditis following treatment of a metastatic liver tumor with radiofrequency ablation: a case report

Abstract Background Radiofrequency ablation is a common and minimally invasive procedure used to treat liver tumors. However, the potential threat of heat injury to adjacent structures if the hepatic lesion is near the diaphragm is often overlooked and misunderstood. Rare cardiovascular complications have been reported. How best to identify the patients at risk to allow for prompt treatment is an important issue. Case presentation A 56-year-old man with underlying oral cancer received radiofrequency ablation for a metastatic liver tumor at segment II. Pleuritic chest pain developed on the day after radiofrequency catheter ablation. Diffuse ST elevation and echocardiography showed the new onset of small to moderate pericardial effusion without tamponade sign. Inflammatory markers were also elevated. Acute pericarditis due to heat penetration and stimulation was favored. His symptoms and signs resolved after treatment with anti-inflammatory medication. Conclusion Potential cardiovascular complications are possible after radiofrequency catheter ablation for liver tumors located at segment II. Artificial ascites with normal saline before radiofrequency ablation may separate the liver and diaphragm to prevent cardiac complications. During the procedure, electrocardiographic monitoring and close observation of the patient’s symptom are required. Echocardiography can be used to confirm cardiac complications

Association between heart rate recovery after exercise and renal function in patients referred for treadmill exercise test.

INTRODUCTION:Heart rate recovery (HRR) is a marker of parasympathetic activity recovery after exercise, and it is associated with cardiovascular mortality and total mortality. Impaired renal function is also associated with cardiac mortality. The aim of this study was to investigate the association between HRR after exercise and renal function in patients referred for a treadmill exercise test. PATIENTS AND METHODS:This cross-sectional study was conducted at a regional hospital in southern Taiwan. Patients who completed a symptom-limited treadmill exercise test from January 2015 to February 2018 were recruited. Before the treadmill exercise test, patients were asked to complete a questionnaire on the past disease history and lifestyle factors. Serum creatinine measurement within two years prior to or after the date of the treadmill exercise test of the patients was also obtained from the medical records for these patients. Estimated glomerular filtration rate (eGFR) was calculated. Simple and multiple linear regression analyses were performed to investigate the association between one-minute HRR and eGFR. RESULTS:A total of 2,825 patients completed the treadmill exercise test, and serum creatinine measurement was identified from medical records for 2,153 patients (76.2%). Multiple linear regression analysis revealed that a lower eGFR was significantly associated with lower one-minute HRR (P< 0.001), adjusting for other significant independent factors, including age, waist circumference, type 2 diabetes mellitus, and smoking. CONCLUSIONS:In this cross-sectional observational study, a lower eGFR was significantly and independently associated with decreased one-minute HRR, suggesting that parasympathetic activity recovery after exercise could be impaired by a decrease in renal function