Case Analysis

Mitral valve regurgitation has multiple etiologies. The most common is chronic rheumatic heart disease (see previous chapter) followed by ischemia, congenital valve anomalies (endocardial cushion defects), endocarditis, mitral valve prolapse, fibroelastosis, calcification of the mitral annulus, chamber dilatation and remodeling in myocarditis and dilated cardiomyopathy. In this patient, the diagnosis of chronic rheumatic heart disease is unlikely. Rheumatic valvulopathy usually affects the...

Gross Description

The body measured 160 cm and weighed 55 kg. The external exam was significant for clubbing of fingers and toes. There was no evidence of past thoracic surgery. The heart weighed 460 g and had right ventricular prominence with a double apex. The pericardium was smooth and glistening. There was a moderate amount of subepicardial fat. The right atrium was hypertrophied, but the left was normal in size and free of thrombi. The foramen ovale was closed. The right and left ventricular wall thickness...

Typical vs Atypical Ischemia

Once we consider it more likely than not that this patient had ischemic disease, the question of whether it was typical or atypical is somewhat more difficult to ascertain. First, it is necessary to define these two terms. Typical ischemic heart disease is generally considered secondary to coronary atherosclerosis, with atherosclerotic plaque (s) narrowing the lumen and causing damage to the coronary artery wall. The presence of atherosclerosis may increase the possibility of superimposed...

Case

The death of this middle-aged man several weeks after an interventional catheterization and coronary artery procedure resulted in a suit against the treating cardiologist. The claim against the physicians is based on the performance of an unjustified procedure in lieu of recognized interventions with high clinical success and low morbidity or mortality, such as undertaking a coronary artery bypass or a balloon angioplasty with stenting. It is also suggested that the failure to adequately follow...

Papillary Muscle

There are 2 papillary muscles in the left ventricle, an anterolateral and a posteromedial. They are broad, finger-like projections into the cavity that enlarge with ventricular hypertrophy, and therefore may contribute to a decreased cavity volume in association with conditions such as hypertension. The papillary muscles also have a terminal coronary circulation with little or no collaterals. Ischemia associated with the left anterior descending or circumflex coronary arteries makes them...