Between 1960 and 1973, a total of 104 patients at the Mayo Clinic had a diagnosis of idiopathic dilated cardiomyopathy on the basis of clinical and angiographic criteria; these patients were followed up for 6 to 20 years. Twenty-one percent of the patients had a history of excessive consumption of alcohol, 20 percent had had a severe influenza-like syndrome within 60 days before the appearance of cardiac manifestations and 8 percent had had rheumatic fever without involvement of cardiac valves several years before; thus, possible etiologic risk factors of infectious-immunologic type may be important. Eighty patients (77 percent) had an accelerated course to death, with two thirds of the deaths occurring within the first 2 years. Twenty-four patients (23 percent) survived, and 18 of them had clinical improvement and a normal or reduced heart size. Univariate analysis at the time of diagnosis revealed three factors that were highly predictive (p less than 0.01) of the clinical course: age, cardiothoracic ratio on chest roentgenography and cardiac index. Systemic emboli occurred in 18 percent of the patients who did not receive anticoagulant therapy and in none of those who did; thus, anticoagulant agents should probably be prescribed unless their use is contraindicated.

The natural history of idiopathic dilated cardiomyopathy

https://www.amjmed.com/article/S0002-9343(70)80115-2/pdf

Primary pulmonary hypertension

Isolated single coronary artery is a rare congenital anomaly occuring in approximately 0.024% of the population. This entity can be diagnosed during life only by coronary angiography. Ten patients with isolated single coronary artery are reported. Based on angiographic analyses, a new classification is proposed, according to the site of origin and anatomical distribution of the branches. Typical angina did not occur with single coronary artery in the absence of coexisting coronary artery disease or aortic stenosis. No correlation was apparent between the type of anomalous patterns and the symptoms of angina.

Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.

Muscle overlying the intramyocardial segment of an epicardial coronary artery, first mentioned by Reyman1 in 1737, is termed a myocardial bridge, and the artery coursing within the myocardium is called a tunneled artery (Figure 1). It is characterized by systolic compression of the tunneled segment, which remains clinically silent in the vast majority of cases. An in-depth analysis of autopsy samples was first presented by Geiringer et al2 in 1951, but clinical interest and systematic research was triggered by an observed association of myocardial bridging with myocardial ischemia.2–5 



Figure 1. Typical systolic compression (arrows) of the mid LAD at two sites in series. Diastolic lumen dimensions are normal. The coronary tree shows no angiographic signs of coronary atherosclerosis.



New imaging techniques have led to improved identification and functional quantitation of myocardial bridging in vivo, which is crucial for establishing a link between systolic compression and the clinical presentation, and hence for commencing appropriate therapy. In the present article, we summarize clinically relevant aspects of myocardial bridging with an emphasis on morphological and hemodynamic alterations and their representation in imaging techniques.

The prevalence varies substantially among studies with a much higher rate at autopsy versus angiography (Table).2,4–28 Variation at autopsy may in part be attributable to the care taken at preparation and the selection of hearts. Polacek, who included myocardial loops, reports the highest rate with bridges or loops in 86% of cases.29 On average, myocardial bridges are present in about one third of adults. 

View this table:

Prevalence of Myocardial Bridging at Autopsy and Angiography 



The rate of angiographic bridging is <5%, attributable to thin bridges causing little compression. In subjects with angiographically normal coronary arteries, the use of provocation tests may enhance systolic myocardial compression and thereby reveal myocardial bridges in ≤40% of cases.26,30

A …

Update on Myocardial Bridging

Left ventricular pseudoaneurysm

Scorpion envenomation is a common medical problem and life hazard in many countries of the world. Scientific investigations have addressed the interrelationship between the stimulatory effects of the venom on the autonomic nervous system and adrenals and the subsequent effects of released transmitters on the cardiovascular system. A number of clinical cardiovascular syndromes may dominate the initial clinical presentation after envenomation: the syndromes usually vary with the age of the victim, the size of the offender and the season. Central nervous system dysfunction is seen in children but rarely observed in adults; if accompanied by severe hypertension the clinical picture is consistent with acute hypertensive encephalopathy. Heart failure, pulmonary edema or a shock-like syndrome has been observed in 25% and hypertension in 30% to 77% of our patients. The electrocardiographic abnormalities recorded in the majority of the patients after envenomation include an "acute myocardial infarction-like pattern." Rhythm disturbances are frequent but conduction abnormalities are rare. Echocardiographic, radionuclide and experimental hemodynamic observations have provided evidence that heart failure and pulmonary edema after envenomation are multifactorial with diminished systolic performance following the initially increased left ventricular contractility and decreased ventricular diastolic compliance. Clinical laboratory data reporting increased catecholamine metabolite excretion and elevated plasma renin and aldosterone are consistent with the stimulatory effects of the venom on the autonomic nervous system. Treatment, including our experience with vasodilators and calcium channel blockers, is reviewed.

The cardiovascular system after scorpion envenomation. A review.

Respiratory failure in children following envenomation by the scorpion Leiurus quinquestriatus: hemodynamic and neurological aspects.

This study describes 18 patients from the University of Cincinnati Hospitals who died of congestive heart failure without clinical or pathologic evidence of a primary cause. Clinical features. Their ages were from 18 months to 68 years at death. Fourteen were male and four female; 11 were white and seven were Negro. Seven patients had heart failure for 5 years or more; three had heart failure for over 10 years. Seven patients were alcoholic and three had nutritional cirrhosis. Transient mitral or tricuspid systolic murmurs and apical protodiastolic gallop rhythms were common. Atrial fibrillation was present in six patients. The electrocardiograms revealed abnormal left axis deviation in three and left bundle-branch block in two. Right heart catheterization was performed in four of these patients and showed low cardiac output, increased arteriovenous oxygen difference, and elevation of pulmonary arterial, pulmonary wedge, right ventricular diastolic, and right atrial pressures. Pathologic features. Heart w...

Primary Myocardial Disease

Five patients with electrocardiographic abnormalities simulating early myocardial infarction after scorpion sting are reported. Pulmonary edema and congestive heart failure accompanied these electrocardiographic changes in 3 patients. Serial recordings revealed an evolution to normalcy. The etiology of the cardiovascular manifestations in severe scorpion sting is related to the venom effects on the sympathetic nervous system and the adrenal secretion of catecholamines as well as to the toxic effects of the venom on the myocardium.

Mosche Gueron

Papers

The cardiovascular system after scorpion envenomation. A review.

Respiratory failure in children following envenomation by the scorpion Leiurus quinquestriatus: hemodynamic and neurological aspects.

Primary Myocardial Disease

Severe myocardial damage and heart failure in scorpion sting: Report of five cases

Interleukin-6 release following scorpion sting in children.