SUNScholar - Browsing by Author "Przybojewski, J. Z."

Browsing by Author "Przybojewski, J. Z."

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Acute coronary thrombus formation after stress testing following percutaneous transluminal coronary angioplasty : a case report
(Health and Medical Publishing Group -- HMPG, 1985-03) Przybojewski, J. Z.; Weich, H. F. H.
Successful percutaneous transluminal coronary angioplasty (PTCA) was performed on a 37-year-old white man with an isolated 95% right coronary artery stenosis who initially presented with type II unstable angina. Submaximal treadmill stress testing was not carried out before PTCA, but testing 3 days after PTCA was strongly positive without accompanying symptoms of myocardial ischaemia. Some 30 minutes after this test the patient experienced severe precordial pain with features of a hyperacute transmural inferior myocardial infarction. Immediate coronary arteriography delineated fresh thrombus related to the previous PTCA site. Intracoronary thrombolysis with streptokinase was successful, revealing an underlying severe stenosis at the PTCA site. PTCA was not repeated, nor was emergency coronary artery bypass grafting (CABG) performed. This is the second such case documented in the literature; the first patient failed to respond to intracoronary thrombolysis with streptokinase and was submitted to emergency CABG. The possible underlying pathophysiological mechanisms are discussed. We believe that the late thrombus formation was directly related to submaximal stress testing after successful PTCA, and recommend that testing to assess the efficacy of PTCA be deferred until at least 1 month after the procedure to allow for completion of the healing process.
Acute coronary vasospasm secondary to industrial nitroglycerin withdrawal : a case presentation and review
(Health and Medical Publishing Group -- HMPG, 1983-01) Przybojewski, J. Z.; Heyns, M. H.
A Black employee exposed to industrial nitroglycerin (NG) in an explosives factory presented with severe precordial pain. The clinical presentation was that of significant transient anteroseptal and anterolateral transmural myocardial ischaemia which responded promptly to sublingual isosorbide dinitrate. Despite being removed from exposure to industrial NG and receiving therapy with long-acting oral nitrates and calcium antagonists, the patient continued to experience repeated attacks of severe retrosternal pain, although transient myocardial ischemia was not demonstrated electrocardiographically during these episodes. Cardiac catheterization revealed a normal myocardial haemodynamic system and selective coronary arteriography delineated coronary arteries free from any obstructive lesions. An ergonovine (ergometrine) maleate provocative test failed to elicit coronary artery spasm, although this was undertaken while the patient was on nitrate and calcium-blocker therapy. Clinical records of previous significant constrictive pericarditis (probably due to tuberculosis) with resultant abnormalities on the ECG complicated the diagnosis. Evaluation was further hindered by the known 'variant pattern' seen on the ECGs of members of the Black population. We postulate that this patient's clinical features were a direct result of severe vasospasm affecting the left coronary artery; it is also strongly suggested that withdrawal from contact with industrial NG precipitated this potentially lethal coronary vasospasm. The role played by industrial NG in ischaemic heart disease is reviewed, as well as the importance of the 'normal variant pattern' in the assessment of cardiac disease in Black patients. As far as we are aware this is the first time that the use of the ergonovine maleate provocative test has been documented in the industrial NG withdrawal syndrome.
Acute myocardial infarction due to coronary vasospasm secondary to industrial nitroglycerin withdrawal. A case report
(Health & Medical Publishing Group, 1983-07) Przybojewski, J. Z.; Heyns, M.H.
ENGLISH ABSTRACTION: A case of acute transmural anterior myocardial infarction in a 45-year-old Black employee of an explosives factory during a period of withdrawal from industrial nitroglycerin is documented. Angiography revealed that the patient had normal coronary arteries. Coronary vasospasm could not be induced by the ergometrine (ergonovine) maleate provocation test. It is postulated that the infarction was directly attributable to coronary vasospasm provoked by the 'industrial nitroglycerin withdrawal syndrome', since there was no evidence of any other non-atheromatous aetiological factor. The authors believe this to be the first such case in a Black subject reported in the literature.
Acute myocardial infarction with a non-diagnostic electrocardiogram : case presentation and overview
(Health and Medical Publishing Group -- HMPG, 1983-12) Przybojewski, J. Z.; Gilburt, S. G. M.
The clinical presentation of a young hypertensive White man with acute high lateral non-transmural myocardial infarction (MI) is documented. This diagnosis was established on the grounds of a history of chest pain, elevated serial serum enzyme levels, technetium-99m pyrophosphate ('hot-spot') scintigraphy, exercise thallium-201 ('cold-spot') scanning, left ventricular cine angiography and selective coronary arteriography. Daily resting 12-lead ECGs failed to demonstrate unequivocal features of acute non-transmural subendocardial MI. The diagnostic difficulties facing the clinician in a case of acute MI associated with a non-diagnostic ECG are stressed, and the ECG features of acute subendocardial MI are reviewed.
Acute transmural myocardial infarction - coronary vasospasm, thrombosis or coronary embolus? A case report
(Health & Medical Publishing Group, 1984-10) Przybojewski, J. Z.
ENGLISH ABSTRACTION: A very fit 28-year-old Coloured athlete presented with an acute transmural anteroseptal and non-transmural anterolateral myocardial infarction (MI). He had no apart from moderate cigarette smoking. Cardiac catheterization 2 months later demonstrated a significant area of myocardial damage as well as a large mural thrombus, but the coronary arteries appeared normal apart from a large irregular filling defect in the proximal left anterior descending (LAD) branch, apparently due to a thrombus. Cardiac catheterization a further 4 months later documented no further filling defect in the LAD branch and the coronary arteries appeared free of disease. Ergometrine maleate provocation on this occasion failed to demonstrate any coronary vasospasm. Possible pathophysiological mechanisms for the unexpected MI are outlined.
Anterior myocardial infarction with coronary thrombus formation secondary to acute coronary vasospasm: A case report
(Health & Medical Publishing Group, 1986-11) Przybojewski, J. Z.; Vogts, B. C.; Myburgh, D. P.
ENGLISH ABSTRACT: An acute myocardial infarction in a young man when there was no fixed atherosclerotic lesion in the coronary arteries is reported. Soon after the myocardial infarction the patient was shown to have thrombosis in the anterior descending branch of the left coronary artery but this later disappeared. In view of recurrent angina pectoris, provocation tests were undertaken with ergometrine maleate, cold pressor and hyperventilation. Both the drug and the hyperventilation provoked coronary spasm accompanied by angina pectoris but no EGG evidence of ischaemia.
Asymptomatic iatrogenic right coronary artery dissection with spontaneous resolution. A case report
(Health & Medical Publishing Group, 1987-02) Przybojewski, J. Z.
ENGLISH ABSTRACT: A young woman with angiographically normal coronary arteries had asymptomtic iatrogenic catheter-induced dissection of her right coronary artery which was managed conservatively. Because of continuing chest pain despite therapy, over a year later she again underwent selective coronary arteriography; a Softip cardiovascular catheter (Angiomedics Inc., Minneapolis) was used without complication. This may be the first report of use of this catheter after previous iatrogenic coronary artery dissection caused by a more conventional type. It is also the first time that this catheter was employed in the RSA. The use of a Softip cardiovascular catheter may significantly reduce this complication of a common coronary angiography.
Cardiac involvement in mixed connective tissue disease : a fatal case of scleroderma combined with systemic lupus erythematosus
(Health and Medical Publishing Group (HMPG), 1985-10) Przybojewski, J. Z.; Mynhardt, J. H.; Van der Walt, J. J.; Tiedt, F. A. C.
A 27-year-old black woman with cardiac failure, angina pectoris and Raynaud's syndrome is presented. Skin biopsy and barium studies established the diagnosis of scleroderma (progressive systemic sclerosis (PSS)). Systemic lupus erythematosus (SLE) was strongly suggested by the results of immunological studies and increasing severity of renal failure. Because of the possibility of a cardiomyopathy, cardiac catheterization, selective coronary angiography and right ventricular endomyocardial biopsy were carried out but failed to show any histological features of either SLE or PSS. The patient went into progressive renal failure despite immunosuppressive therapy and plasmapheresis and died; consent for autopsy was refused. A final diagnosis of mixed connective tissue disease (MCTD) was made. The salient features of cardiac involvement in SLE, PSS and MCTD are outlined.
Clinical characteristics of and prognosis in acute transmural anterior, transmural inferior and non-transmural myocardial infarction : a comparative retrospective study
(Health & Medical Publishing Group, 1985) Van Rensburg, C. J.; Przybojewski, J. Z.; Soolman, J.
This retrospective study was undertaken to determine whether there was any difference in the clinical characteristics of and prognosis in white patients admitted to the Intensive Coronary Care Unit (ICCU) at Tygerberg Hospital with acute non-transmural, transmural anterior and transmural inferior myocardial infarction (MI). The three groups were carefully matched, taking into consideration the possible influence of previous MI and congestive cardiac failure (CCF). There were 187 patients with nontransmural MI, and 176 with transmural anterior and 209 with transmural inferior MI. Patients with acute transmural anterior MI had the worst prognosis while at the ICCU, at 3-months' follow-up and at long-term follow-up (mean 22,2 months). This group had the greatest frequency of CCF, cardiogenic shock, acute pericarditis, ventricular premature beats, ventricular tachycardia, left anterior hemiblock and complete left bundle-branch block and the highest mortality. Acute transmural inferior MI was responsible for the highest frequency of ventricular fibrillation in the ICCU and had a worse prognosis than non-transmural MI. Acute non-transmural MI resulted in the highest incidence of early and late myocardial re-infarction; although death in the ICCU was least frequent, mortality among this group had increased dramatically by 3 months' follow-up. Hence, acute non-transmural MI is not benign and an unstable period exists for 3 months thereafter. Because of this, more aggressive diagnostic measures should be instituted during this period in order possibly to improve prognosis in this group. It would appear that this is the first such study undertaken in South Africa.
Coronary artery bypass surgery in a patient with symptomatic ventricular arrhythmia : a case presentation and review of the literature
(Health and Medical Publishing Group -- HMPG, 1984-04) Przybojewski, J. Z.
A 42-year-old White man suffered from recurrent symptomatic ventricular tachycardia but not angina pectoris. Cardiac catheterization demonstrated a normally contracting left ventricle and coronary angiography delineated significant atherosclerotic obstructions in the left circumflex (LC) coronary artery and the first diagonal branch of the left anterior descending (LAD) coronary artery. Coronary artery bypass graft (CABG) surgery was carried out on the anterolateral and mid-lateral branches of the LC coronary artery as well as the first diagonal branch of the LAD coronary artery. Frequent postoperative Holter monitoring as well as maximum-exercise stress testing has failed to show any recurrence of the ventricular arrhythmia, and the patient has remained asymptomatic and medical therapy has been discontinued. Some 30 months after operation left ventricular cine angiography demonstrated normal contractility. Selective coronary arteriography indicated that the CABG to the anterolateral branch of the LC coronary artery was occluded at its proximal aortic anastomosis. However, the CABGs to the mid-lateral branch of the LC and LAD coronary arteries were still patent. Repeat serial resting ECGs failed to show any evidence of postoperative myocardial infarction. It is concluded that CABG surgery was responsible for eliminating the episodes of life-threatening ventricular tachycardia, presumably by correcting myocardial ischaemia. The role of CABG surgery in the control of medically unresponsive and dangerous ventricular arrhythmias is reviewed.
'Coronary intimal fibrous stenosis' - early coronary atherosclerosis causing acute myocardial infarction : a case presentation and overview
(Health and Medical Publishing Group -- HMPG, 1982-11) Przybojewski, J. Z.; Van der Walt, J. J.
A 34-year-old Coloured man had typical angina pectoris which was unresponsive to medical therapy. There was no history of factors predisposing to atherosclerosis apart from moderate cigarette smoking. A resting ECG suggested a previous nontransmural anterolateral myocardial infarction, and a submaximal effort test was strongly positive for myocardial ischaemia. Serological investigation for syphilis was positive, and initially the possibility that coronary ostial stenosis was the cause of his symptoms was strongly considered. Cardiac catheterization and selective coronary angiography showed evidence of an anterolateral myocardial infarction and that there was no coronary ostial stenosis, but total occlusion of the left anterior descending coronary artery (LAD) proximally with retrograde filling from the right coronary artery was revealed. The left circumflex coronary artery also showed some insignificant internal luminal irregularities. The patient was subjected to coronary artery bypass graft (CABG) surgery with saphenous grafts to the proximal LAD as well as its first diagonal branch. Proximally the LAD was a firm fibrotic cord; biopsy specimens were taken from this as well as part of the adjacent myocardium and aorta. The artery showed severe fibrous proliferation of the intima without any calcium or lipid deposits, which would have been expected with atherosclerosis, as well as an organized thrombus. There were no signs of cardiovascular syphilis. The patient made quite a dramatic recovery with disappearance of the angina and improved results on submaximal stress testing. A month later cardiac catheterization showed improved segmental anterolateral contractility of the left ventricle as well as patency of both CABGs. Some 3 months postoperatively he again complained of angina, which gradually worsened on treatment. Stress testing again showed significant ischaemia and a second postoperative cardiac catheterization 10 months after surgery showed both CABGs to have occluded. The patient, who is on medication, is being followed up. A pathological diagnosis of early coronary atherosclerosis was made. This lesion has been previously termed 'coronary intimal fibrous stenosis' as the authors concerned did not believe that it was due to coronary atherosclerosis. Ours is the third such case documented in the literature. Reference to earlier literature on coronary atherosclerosis confirms that this histological picture is in keeping with the early phase of this disease. The 'classic' features of coronary atherosclerosis may not have been evident on account of the patient's dietary habits, which may prove to be the important pathological differentiating feature in our White and Coloured population groups.
Effects of nifedipine on the peri-operative ECG, as determined by continuous Holter monitoring : a double-blind study
(Health & Medical Publishing Group, 1986-03) Du Toit, H. J.; Weich, H. F. H.; Weymar, H. W.; Przybojewski, J. Z.
A double-blind study was performed on 50 elderly patients undergoing hip-replacement surgery under general anaesthesia; 26 were given nifedipine and the remaining 24 placebo to determine effects on the continuously monitored (Holter) ECG during the 4 peri-operative days. Drugs were only administered during the latter 3 days of the observation period. Surgery was performed on the morning of the 3rd day. A striking feature was a high incidence of arrhythmias in both groups of patients, a finding previously documented in both 'normal' and elderly people. A decrease in ST-segment changes was expected in the nifedipine-treated patients. An unexpected finding, therefore, was the lack of protection against cardiac ischaemic changes in the nifedipine-treated patients compared with the placebo patients. Interpretation of the ST segment as seen in the Holter-monitored ECG remains controversial. We have no clear explanation for the lack of protection against ischaemic changes. The effects of profound vasodilatation produced by nifedipine in elderly patients subjected to major surgery, general anaesthesia including administration of enflurane, and a variable amount of blood loss in the postoperative period may be important factors. In conclusion, one should perhaps be cautious of nifedipine administration under these circumstances.
Ergometrine-provoked coronary vasospasm on angiography without angina or ischaemia on ECG : a case report
(Health & Medical Publishing Group, 1984) Przybojewski, J. Z.; Ellis, G. C.
A 32-year-old White man suffered a large transmural inferoposterior myocardial infarction (MI). Coronary vasospasm is strongly suspected of having caused this MI since the ergometrine maleate provocation test gave rise to severe coronary vasospasm resulting in total occlusion of the dominant right coronary artery, without angina or ECG or haemodynamic features of myocardial ischaemia. This is a most unusual response to ergometrine maleate. Possible explanations are suggested and the implications are briefly discussed.
Exercise-induced ST-segment elevation possibly caused by coronary artery spasm : a case presentation and review
(Health and Medical Publishing Group (HMPG), 1985-09) Przybojewski, J. Z.; Thorpe, L.
A 36-year-old man with classic angina pectoris had marked ST-segment elevation (STE) in the inferior leads on stress-testing in the absence of chest pain. There was no evidence of previous myocardial infarction (MI). Selective coronary arteriography delineated severe obstructions in the' right coronary artery (RCA) with additional left circumflex coronary artery (LCx) obstruction. Left ventricular cine-angiography established that there was normal contractility and confirmed the absence of past MI. Coronary artery bypass graft surgery to the RCA and LCx was unfortunately complicated by an acute transmural inferoposterolateral MI. Treadmill stress testing 6 weeks after surgery failed to demonstrate the preoperative ST-segment change. The patient may have developed exercise-induced coronary artery spasm superimposed on the severe proximal RCA stenosis; this in turn may have caused the -inferior STE. Exercise- induced STE is reviewed.
Familial dilated (congestive) cardiomyopathy. Occurrence in two brothers and an overview of the literature
(Health and Medical Publishing Group (HMPG), 1984) Przybojewski, J. Z.; Van Der Walt J. J.; Van Eeden P. J.; Tiedt F. A. C.
Two young White brothers had dilated (congestive) cardiomyopathy. The elder came to autopsy after a chronic course of congestive cardiac failure; the younger underwent repeated cardiac catheterization and transvenous right ventricular endomyocardial biopsy specimens demonstrated histopathological features in keeping with a diagnosis of idiopathic dilated cardiomyopathy. These brothers may have the familial form of the disease, although post-viral myocarditis cardiomyopathy cannot be entirely excluded. The literature relating to familial dilated (congestive) cardiomyopathy is reviewed.
Holter monitoring at Tygerberg Hospital, 1979-1983 : an appraisal
(Health & Medical Publishing Group, 1984) Ellis, G. C.; Przybojewski, J. Z.; Weymar, H. W.
Over a period of 4 years Holter monitoring was performed on 607 patients in the Division of Cardiology at Tygerberg Hospital. Indications for monitoring were broadly grouped into four categories: (i) evaluation of symptoms suggestive of disorders of cardiac rhythm (210 patients); (ii) evaluation of arrhythmias associated with a specific underlying cardiac condition (139 patients): (iii) evaluation of a previously documented or suspected arrhythmia (233 patients); and (iv) miscellaneous reasons (25 patients). Findings are presented and aspects of Holter monitoring are discussed. Finally, some recommendations for improving the clinical value of our Holter analyses are made.
Hyperkalaemic complete heart block : a report of 2 unique cases and a review of the literature
(HMPG, 1983-03) Przybojewski, J. Z.; Knott-Craig, C. J.
Two White male patients with temporary complete heart block (CHB) secondary to hyperkalaemia are presented. One, a 40-year-old man, developed CHB with ensuing shock within the first 24 hours of repeat aortic valve replacement for a paraprosthetic leak caused by previous endocarditis. This patient experienced iatrogenic hyperkalaemia. The second was an 81-year-old man who had chronic renal failure and presented with Stokes-Adams attacks. This patient was initially thought to have degenerative CHB and nearly underwent inadvertent permanent pacemaker insertion. Both patients were initially treated with emergency temporary cardiac pacing with subsequent successful management. Temporary CHB secondary to hyperkalaemia, from whatever cause, has very rarely been documented in the literature. A review of this potentially lethal complication is undertaken and the significance of unifascicular and bifascicular conduction block as a consequenc of hyperkalaemia is discussed.
Hypertrophic cardiomyopathy complicated by complete heart block : case report and review of the literature
(Health and Medical Publishing Group -- HMPG, 1984-12) Przybojewski, J. Z.; Van der Walt, J. J.; Ellis, G. C.; Tiedt, F. A. C.
A 48-year-old man with symptoms of presyncope and congestive cardiac failure had hypertrophic cardiomyopathy (HCM) without obstruction. Complete heart block (CHB), a rare complication of this disease, was preceded by complete left bundle-branch block. Right ventricular (RV) heart failure was a dominant clinical feature but improved dramatically after temporary transvenous RV pacing prompting the insertion of a permanent RV inhibited pacemaker. Repeated ventricular fibrillation was successfully controlled by amiodarone. This is the 7th case of HCM complicated by CHB reported in the literature, and the first in which RV endomyocardial biopsies were undertaken. Two other patients reported in the literature had RV inhibited permanent pacemakers implanted, and a further 2 had atrioventricular sequential pacemakers.
Hypertrophic non-obstructive apical cardiomyopathy : a case presentation and review of the literature
(Health & Medical Publishing Group, 1984) Przybojewski, J. Z.; Blake, R. S.
A 20-year-old coloured man gave a history of atypical chest pain, palpitations after strenuous exercise and a single episode of post-exertional presyncope. The diagnosis of hypertrophic non-obstructive apical cardiomyopathy (HNOAC) was established by means of electrocardiography, echocardiography (both M-mode and two-dimensional) and left ventricular cine angiography. This variant of hypertrophic cardiomyopathy is most unusual and has been encountered most frequently in Japan, although a few cases have been diagnosed in the USA. The present case is the second reported from the Republic of South Africa. Important aspects of HNOAC are reviewed.
Hypertrophic obstructive cardiomyopathy with pseudo-myocardial infarction pattern. A case report
(Health & Medical Publishing Group, 1986-6) Przybojewski, J. Z.; Van der Walt, J. J.; Tiedt, F. A. C.
ENGLISH ABSTRACT: A 60-year-old woman with mild hypertension and presumed ischaemic heart disease was followed up over a very long period on account of angina pectoris. Acute myocardial infarction (MI) was suspected on the basis of the history, ECG findings and serum enzyme values, but disproved by radio-isotope investigation. Echocardiography demonstrated features of hypertrophic obstructive cardiomyopathy (HOCM), a diagnosis supported by cardiac catheterization and endomyocardial biopsy (EMB). Histological features of HOCM were absent from left ventricular EMB specimens despite a significant intraventricular gradient, but the right ventricular EMB demonstrated extensive changes of HOCM despite a small intraventricular gradient. Cardiac catheterization excluded previous MI and coronary artery disease. A further interesting feature was the development of congestive cardiac failure, which necessitated modification of her drug therapy).

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