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REFERENCES 1 Kriwisky M, diagnosis Cardiol 2 Settle EC Clin JVK, overdo>se 5 Lever P 7 Mehta D, and haloperidol. 8 Freed CR. Med JJ, 1980; Lolng QT W. Cardiac arrhythmia Cleve Clin J Med SR. Josephson : 54 Cardiol E, King sudden A case of isolated rupture of the right ventricle to acute MI, presented as cardiac tamponade, The patient underwent successful emergency closure of the right ventricular rupture without Kemper 1978; de pointes. Fowler NO, cardiac J R, Wharton de pointes Am J Med during 1987; Pietro 1983; D, Chou 1976; Mitral tachyar- nosography valve my’xomatotms prolapse TC. in patients mitral valve 67:632-39 JW. DA. administration 98:484-85) left heart with ventricular rupture, while is the since is rare. had emergency cardiac site The to an inferior necessitating and mortality. common the patient secondary aspiration, 5 percent a high most rupture interest ventricle tamponade pericardial wall ventricular right right in approximately MI and carries free is of particular ruptured occurs acute CASE 68-year-old A Electrocardiographic changes psychotropic drugs. Goldschlager of pentamidine N. Torsade isethionate. 83:571-76 white the diagnosis man of acute an isolated wall MI thoracotomy, with surgery successful had dyspnea angina. An echocardiogram tension associated low cardiac admitted wall pericardium of cardiopulmonary Einstein hospital days an episode of syncope . Because arrest, Center 1-Cardiac but the patient possible was Hemodynamic Sarzel Fred *From B. Woldow, G. G. Ablaza, K. Nakhjavan, the Department M.D.; Stevenj Mattleman, M.D., F.C.C.?; and M.D. , FC.C.Pt of Medicine, Division M.D.; of Cardiovascular Disease, Section of Invasive and Interventional Cardiology (Women’s League for Medical Research Laboratory), Albert Einstein Medical Center, Northern Division, Philadelphia. tClinical Professor of Medicine, Temple Medical School, Philadelphia. Reprint requests: Dr. Nakhjavan, Kkin POB 404, 5401 Old York Road, Philadelphia 19141 484 Aorta Left ventricle and technique for no was hype- pressure transferred Data* (mm Hg) 73 (5) 45 (D) 58 (M) 73 26 (LD) “ 23 (ED) Pulmonary wedge 24 (A) 27 (V) 22 (M) Pulmonary artery 29 (S) 23 (D) 25 (M) Right ventricle 30 (5) 21 (ED) 21 (LD) Right atrium 24 (A) 23 (V) 21 (M) Cardiac otmtput, Llmin Cardiac index, 11mm/rn2 Systemic Stroke 0.9 13.5 Vol % rate/mm volume, 85 mi/beat *Abbreviations: late 1 7 arteriovenoums 02 Difference, Heart a and interventional Pressures Isolated Rupture of the Right Ventricle in a Patient with Acute Inferior Wall MI* the but of continuing wedge by thermodilution Medical with previously, unsatisfactory pulmonary as determined to Three technically elevated an episode to a local MI. and was with output Albert was on exertion of thickened stmggestive REPORT inferior patient Table Andrew of present in patients 249:2931-34 PA, of the 52:73-81 37:223-30 J, Demopulous The Thioridazine-induced receiving aortocoro- 1990; outcome. Arrythmias 1975; (Chest ofpatients case 42: 1054-56 mitral The Circulation arrhythmia Cardiol to the 1978; and 1983; Fitzgerald JAMA McCall PR. causing JE. prolapse. bypass. upture Reid 45:715 Edwards nary secondary is reported. surgery for with ventricular an additioln po)intes 1980; J, Mason in patients HL, J Cardiol Am de EN, 89:6-9 de polintes: Dunlap torsade Marcus Med ME, valve AJ, Am Intern 71:63-71 Greene rectmrrent Circulatioln Lopes mitral and RA, death. BA, with and Torsade J Am 1985; AH, aortic pressure. Note the marked pulsus paradisappearance ofthe pulse in inspiration (arrows). without Ann Shen 1. Central with almost FIGURE doxus ME. Circumlation pointes. testing Circulation Torsade KR. F, Electrophysiologic tachycardia. Bennett 16 Winkle de Morady Schaeffer : 0 1987; in patients abnormnalities. torsades WA, Intern CE. E E 1981 ; 17:6-9 136:1468-69 studies Les . syndrome Ann Kossmann and WM BH, J)rolapse (letter). 19 a medication. Spielman or metabolic syndrome. Wei JY, Bulkey 15 Chesler 18 overdoses. AM, Shapiro> ofventricular 17 I treatment: neuroleptic 1979; electrphysiologic MN. rhythmias. 14 drug Smith AK, valve 13 a haloperidol 93:578-84 Bhandari the and J, Shriner Greenspan Schneinman 12 from Halo- 63:1120-28 10 Gallagher IIIl 102: 18 239:48-49 Bull death Petit , pharmacologic 1981; IllIflIIfIlfftflItIlIIllIfIfIfIIIfllII ‘‘‘‘‘‘‘‘ miIIimiiiimiIIIIII miii miii mr I mr IIllIIIII I 141:919-20 SH de po)intes: transient HR. 1985; of netmroleptic Am J Psychiatry’ Treatable Torsades reactions 1978; is a risk Sudden Gibbs Med Psychopharmacol FJ. LN, CHF, Intern Toxic JAMA 1984; Mehta 9 horowitz men. of experience. century’ Seifert Ann WE. controversy. Cairns for old lIIII1U1II11ItlIffllIIIllflflIillf1Hhf-H-’-’-t-tff-f-U}HIH CE, death Psychiatry 18 year miiiimiiiimioiimiiiimiiiimiiiimiiiimiiI IIIIIIlI miii mt a quarter de pointes. children. tW(I 17 and : Usefulness moltion ltft1lffltItlfttlfIIftIffltftf1fttf1ff#{176}#{176}1””’>lfi-f-l-fl-1-f1 Mueller Sudden J, 6 Turbott in B. leaflet 44:440-48 Thornton cN)ntintmiflg J 1983; torsade in mitral 59:1149-51 CHS, 4 Scialli J, Lewis Ribak prolapse FJ Jr. Halidol, Psychiatry and Am valve Jr. Ayd peridol M, determined 1987; 3 Zee-eheng 11 P. Gross mitral (If J Am J Froom echocardiographically (If diastolic; 20 A, “a” wave; M , mean; D, diastolic; 5, systolic; Isolated Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21616/ on 06/18/2017 ED, V-”v”, Rupture early diastolic; LD, wave. of Right Ventricle (Wo!dow et a!) therapy, namely, coronary An emergency ished cardiac (Fig of the anterior Coronary wall. was artery, anterior of a 70 percent the revealed straightening of time the of cardiac suggestive findings, of the cardiac aspirated from consisting the ofdark An was In the pericardial Because bypass a 2.5 x 2 cm area of necrosis a tear myocardium at the was thickness. The junction The detected. posterior wall explored for determination The right ventricular wall elimination of the the and patient tear. the after the was catheterization was and secretarial inferior in be well was BW, 1973; postmortem SC. Rupture after actmte days 5 Schiller 1967, rupture among Cobbs ventricle. cardiac 47 consecutive et al, rupture, developed tesis is a rare Howell,m in one cardiac and autopsy in 1973, and dangerous 1957, reported DA, of the ventricle. right tamponade subsequently three cases The necessitating emergency with patient repair Indeed, most of the salvaged cases right CR, Rohinsoln PH. occlusion to Swan-Ganz MI ofthe right and its subsequent Another referred coronary reported have catheterization. most artery likely In our due pa- to complete lesion due to thrombus is that the patient lysis. interesting to us with was observation the diagnosis of “cardiogenic heart. R. Wallis 1957; for 711-12 Circulation Cardiac 1965; rumpttmre. septum infarction. N, Aust Pae J NZ Pierce T, Kabbani literature. Ann W, rupture JAMA and right Med 1981; 14:75-78 Zelis R. 5, Ellertson report Thorac Surg Pseudomonas Empyema Fibrosis* D, to 1981; J, Crew myocardial shock Surg of two 1983; 71:273-76 Cardio>genic Cardiovasc rupture: ventricular 1984; secondary 1972; J Thorac rupture. of heart Surg right Cardiology ventricumlar Thorac W, J. Isolated Barzilay’ challenge. Hanna cases and due to 82:889-91 E. Surgical review of the 36:209-13 aeruginosa in an Adult with Cystic Hugh Mestitz, M.B.B.S.;t and Glenn was shock.” M.B.B.S. Bowes, , Ph.D.t aeruginosa is frequently grown from the of adults with cystic fibrosis-related bronchiectasis. A rare case of pseudomonal empyema is reported in this clinical setting. Early diagnosis permitted successful treatment with closed needle aspiration and intravenous Pseudomonas sputum (Chest antibiotics. C hronic in infection the with bronchiectatic *From Alfred of Hospital, 1990; Pseud,omonas airways improvement prior Gail interventricular (If myocardial performed inferior Ms. Geriatrics of the adults with cystic fibrosis. Acute infection are often attributed the thank ventricle. been treated only by closure of the rupture site.3’ Perforation of the heart by Swan-Ganz catheterization was ruled out since the echocardiogram in the previous hospital was tient, for the with of the surgery. Left Ann G, salvage 1.5 cm defect at the right ventricular apex. The patient died three years later from noncardiac cause. Higgins et al, in 1981, reported a fatal case with rupture of the ventricle, and in 1984, Antonelli et al reported a patient with isolated right ventricular rupture with fatal outcome. The present case is particularly interesting since the patient had emergency cardiac surgery and survived the operation without any complication. It is also interesting that the patient did not require aortocoronary bypass closure Since used studies. authors Rtmpttmre Katifman FJ. 8 Bashour pericardiocen- surgical is also therapy. might have been treated not been made by cardiac SB. a diagnolstic ventricular of ruptured cases reported case 11:46-47 7 Parr ventricle MI. Hatcher ventricle findings of seven cases with right ventricular five ofwhom died suddenly. London and London,2 reported one case of isolated right ventricular rupture, in right patient had diagnosis This 223:532-35 4 Higgins uneventful, seven ofthe London MI. DISCUSSION acute this The with wall plicated 3 Cohbs infarction. of olfthe in recov- 31:202-08 normal normal RE, 6 Montegut of the and is now often angiographic T. Rupture 2 London infarction: Rupture resulted assistance. 1 Howell postoperatively. complication ventricle parameters of thrombolytic diagnosis pericar- REFERENCES free not was hospital MI, correct surgery of the cases. therapy ACKNOWLEDGMENT: after further and course from ofacute ruptured decompen- establishment setting bleeding could site postoperative discharged treatment ventricular of the the with necessary. infarcted rupture was ifthe right in similar thrombolytic as such the after intravenous patient and ventricle surgery recommended at the completion deemed ventricle left of the extent at The was right of the Emergency or aspiration in hemodynamic usual obstructive Immediate with of the heart hemodynamic tamponade. plication in room, right and improvement have regurgitation, the thus, cardiac of interest the and initiated the mm to not enlarged significant mitral and catheterization is strongly but ofcontinuing in the of ery. 1 L of blood was was the hemo- operating exploration cardiopulmonary at above after exposure, cavity. further diagnosed immediately studies. rapid a 25 difficult, of the due fluid the echocardiogram Because cardiac dial right angiogram and technically room pericardial atrial was after (If disease, septum, sation did an abnormalities, artery ventricular circulation. narrowing border exploration with midportion atrial Therefore, wall in the right tamponade blood, of the right was and part dominant percent 80 silhouette. catheterization sternotomy proximal The to the operating cardiac a median an thickening.” cardiac 54 percent. right a catheterization transferred was shock” namely: contraction coronary heart contractions fraction branch. the of “pericardial dynamic hyperkinetic in the and diagonal from and “cardiogenic findings, marked diastolic a normal the angiographic paradoxus ventricular showed ejection dimin- pulsus right narrowing artery, first separation wall global narrowing descending origin and revealed a 65 percent coronary left inferior The marked However, therapy: a markedly ventriculogram cineangiograms There was hypotension, left thrombolytic revealed elevated 1). The with akinesia size severe a markedly (Table and/or catheterization output, 1) and pressures of the angioplasty cardiac pulmonary of aeruginosa 60 to 90 occurs percent#{176} of exacerbations of pulmonary to this organism. Clinical infection Prahran, 98:485-87) Victoria, and a decrease in Australia. tRegistrar in Respiratory Medicine. tChairman, Department ofRespiratory Medicine, and Head, Adult Cystic Fibrosis Unit. Reprint requests: Dr. Bowes, Respiratory Medicine, Alfred Hospital, Commercial Road, Prahran, V’wtoria 3181, Australia CHEST Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21616/ on 06/18/2017 I 98 I 2 I AUGUST, 1990 485