A Rare Association of Takotsubo Cardiomyopathy with High-degree Atrioventricular Block

Here we present a case of a patient who got trapped in an elevator; on initial evaluation patient was found with bradycardia; on further evaluation electrocardiogram (EKG) showed new onset 2nd-degree Mobitz type 2 AV block. On admission patient developed ischemic changes on EKG and troponin elevation. Transthoracic echocardiogram showed reduced ejection fraction as well as apical inferior, anterior, lateral, and septal hypokinesia. Coronary angiography showed nonobstructive coronary artery disease and ventriculogram demonstrated anterolateral and apical hypokinesia suggesting takotsubo cardiomyopathy (TCM). Atrioventricular block (AV) is rarely seen as initial presentation of TCM and has a prevalence of about 2.9%. AV block during early presentation of TCM poses a therapeutic dilemma with regard to the timing and the need to place a temporary or permanent pacemaker. The decision to place a permanent pacemaker may be on a case-by-case basis and more research is needed on formulating standardized recommendations in patients with TCM and conduction tissue abnormalities

D-shaped Left Ventricle, Anatomic, and Physiologic Implications

Right ventricular loading/pressure influences left ventricular function because the two ventricles pump in series and because they are anatomically arranged in parallel, sharing the common ventricular septum. Flattening of the interventricular septum detected during echocardiographic examination is called D-shaped left ventricle. We present a case of an elderly male of African descent, who presented with increased shortness of breath. Transthoracic echocardiogram showed flattening and left sided deviation of interventricular septum causing a decreased size in left ventricle, secondary to volume/pressure overload in the right ventricle. While patient received hemodialysis therapy and intravascular volume was removed, patient blood pressure was noted to increase, paradox. Repeated transthoracic echocardiogram demonstrated less left deviation of interventricular septum compared with previous echocardiogram. We consider that it is important for all physicians to be aware of the anatomic and physiologic implication of D-shaped left ventricle and how right ventricle pressure/volume overload affects its function and anatomy

The kinetics and mechanisms of reactions of human tooth enamel in buffered solutions of high fluoride concentrations

The experimental results were quantitatively compared with the theory based on a physical model representing the reaction and with the experiments involving synthetic hydroxyapatite discs. The experimental initial rates self-consistently compared well with the theoretical predictions. An analysis of the experimental initial rate data yielded a reaction constant, [kappa], for the reaction representing apatite dissolution and calcium fluoride precipitation. It is proposed that the value for [kappa] is a result of both supersaturation with respect to calcium fluoride and undersaturation with respect to apatite at the apatite-calcium fluoride reaction sites. This finding is also consistent with the analysis of the experiments with synthetic apatite discs.Important similarities and significant differences were found between the experiments with the enamel sections and with synthetic apatite discs. The experiments with the synthetic apatite discs were reported to proceed "normally" as predicted by the physical model over the entire course of the reaction. In contrast to these findings, while the initial rates of the enamel-fluoride reaction were found to proceed relatively rapidly and according to the theoretical predictions, the rates at later times were drastically reduced. This "choking off" was observed to be most severe in the experiments at low pH and high fluoride concentrations, and little or no "choking oft" was observed at low fluoride concentrations and high pH.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22291/1/0000731.pd

A Rare Association of Takotsubo Cardiomyopathy with High-Degree Atrioventricular Block

Here we present a case of a patient who got trapped in an elevator; on initial evaluation patient was found with bradycardia; on further evaluation electrocardiogram (EKG) showed new onset 2nd-degree Mobitz type 2 AV block. On admission patient developed ischemic changes on EKG and troponin elevation. Transthoracic echocardiogram showed reduced ejection fraction as well as apical inferior, anterior, lateral, and septal hypokinesia. Coronary angiography showed nonobstructive coronary artery disease and ventriculogram demonstrated anterolateral and apical hypokinesia suggesting takotsubo cardiomyopathy (TCM). Atrioventricular block (AV) is rarely seen as initial presentation of TCM and has a prevalence of about 2.9%. AV block during early presentation of TCM poses a therapeutic dilemma with regard to the timing and the need to place a temporary or permanent pacemaker. The decision to place a permanent pacemaker may be on a case-by-case basis and more research is needed on formulating standardized recommendations in patients with TCM and conduction tissue abnormalities

The Kinetics And Mechanisms Of Reaction Of Tooth Enamel In Buffered Solutions Of High Fluoride Concentrations.

PhDPharmacologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/186735/2/7123896.pd

Precipitation of Drugs Due to Injection or Dilution

A simple graphical technique is developed to predict whether a solubilized drug solution will become supersaturated (and thus have a potential for precipitation) when it is diluted with water. </jats:p