RESUMO
Thyrotoxic periodic paralysis (TPP) and thyrotoxic cardiomyopathy (TCMP) are potentially lethal complications of thyrotoxicosis that require emergent recognition and management to attenuate significant morbidity and mortality. We present the case of a 23-year-old Asian male with no prior medical history who developed TPP with coincident TCMP, which was successfully managed with antithyroid and heart failure therapies. The clinician should be aware of the diagnosis and treatment of these 2 life-threatening conditions in a hyperthyroid state.
Assuntos
Antitireóideos , Cardiomiopatias , Paralisia Periódica Hipopotassêmica , Tireotoxicose , Humanos , Masculino , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/etiologia , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Adulto Jovem , Cardiomiopatias/etiologia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Antitireóideos/uso terapêutico , EletrocardiografiaAssuntos
Átrios do Coração , Insuficiência Cardíaca , Volume Sistólico , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Volume Sistólico/fisiologia , Átrios do Coração/fisiopatologia , Átrios do Coração/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Cardiomiopatias/diagnóstico , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico por imagem , Masculino , Função do Átrio Esquerdo/fisiologia , Idoso , Função Ventricular Esquerda/fisiologia , FemininoAssuntos
Fibrilação Atrial , Cardiomiopatias , Insuficiência Cardíaca , Humanos , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/etiologia , Cardiomiopatias/complicações , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Fatores de RiscoAssuntos
Disfunção Ventricular Esquerda , Humanos , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico por imagem , Miocárdio Ventricular não Compactado Isolado/complicações , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , SístoleRESUMO
Ventricular tachycardia (VT) is a rare but potentially fatal complication in pregnancy. We present a case of a pregnant woman with cardiomyopathy due to frequent premature ventricular complexes (PVCs) and VT originating from the left ventricular outflow tract. After presenting late in the third trimester, the decision was made to deliver the fetus after 4 days of medication titration due to continued sustained episodes of VT. After delivery, the patient continued to have frequent PVCs and VT several months after discharge, and she ultimately underwent a PVC ablation with dramatic reduction in PVC burden and improvement in cardiomyopathy. Multidisciplinary planning with a pregnancy heart team led to appropriate contingency planning and a successful delivery. This case highlights how multidisciplinary management is best practice in pregnancy complicated by VT and the need for better diagnostic guidelines for PVC-induced cardiomyopathy in the setting of pregnancy.
Assuntos
Cardiomiopatias , Complicações Cardiovasculares na Gravidez , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Humanos , Feminino , Gravidez , Taquicardia Ventricular/terapia , Taquicardia Ventricular/etiologia , Cardiomiopatias/terapia , Cardiomiopatias/complicações , Complicações Cardiovasculares na Gravidez/terapia , Complicações Cardiovasculares na Gravidez/diagnóstico , Adulto , Complexos Ventriculares Prematuros/terapia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Período Periparto , Ablação por Cateter , Eletrocardiografia , Antiarrítmicos/uso terapêutico , Antiarrítmicos/administração & dosagemRESUMO
In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.
Assuntos
Amiloidose , Derrame Pericárdico , Humanos , Amiloidose/complicações , Amiloidose/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/diagnóstico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/diagnóstico , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/etiologia , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Cardiomiopatias/complicações , Cardiomiopatias/terapia , Ecocardiografia , Imagem Cinética por Ressonância Magnética/métodos , Pericárdio/diagnóstico por imagem , Pericárdio/patologiaRESUMO
BACKGROUND: Left bundle branch area pacing (LBBAP) is an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). However, despite the presence of left bundle branch block, whether cardiac substrate may influence the effect between the 2 strategies is unclear. OBJECTIVES: This study aims to assess the association of septal scar on reverse remodeling and clinical outcomes of LBBAP compared with BVP. METHODS: We analyzed patients with nonischemic cardiomyopathy who had CRT indications undergoing preprocedure cardiac magnetic resonance examination. Changes in left ventricular ejection fraction (LVEF) and echocardiographic response (ER) (≥5% absolute LVEF increase) were assessed at 6 months. The clinical outcome was the composite of all-cause mortality, heart failure hospitalization, or major ventricular arrhythmia. RESULTS: There were 147 patients included (51 LBBAP and 96 BVP). Among patients with low septal scar burden (below median 5.7%, range: 0% to 5.3%), LVEF improvement was higher in the LBBAP than the BVP group (17.5% ± 10.9% vs 12.3% ± 11.8%; P = 0.037), with more than 3-fold increased odds of ER (OR: 4.35; P = 0.033). In high sepal scar subgroups (≥5.7%, range: 5.7%-65.9%), BVP trended towards higher LVEF improvement (9.2% ± 9.4% vs 6.4% ± 12.4%; P = 0.085). Interaction between septal scar burden and pacing strategy was significant for ER (P = 0.002) and LVEF improvement (P = 0.011) after propensity score adjustment. During median follow-up of 33.7 (Q1-Q3: 19.8-42.1) months, the composite clinical outcome occurred in 34.7% (n = 51) of patients. The high-burden subgroups had worse clinical outcomes independent of CRT method. CONCLUSIONS: Remodeling response to LBBAP and BVP among nonischemic cardiomyopathy patients is modified by septal scar burden. High septal scar burden was associated with poor clinical prognosis independent of CRT methods.
Assuntos
Terapia de Ressincronização Cardíaca , Cicatriz , Humanos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Cicatriz/fisiopatologia , Cicatriz/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/fisiopatologia , Ecocardiografia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Cardiomiopatias/complicações , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Resultado do Tratamento , Volume Sistólico/fisiologia , Remodelação Ventricular/fisiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapiaRESUMO
BACKGROUND: Catheter ablation of ventricular tachycardia (VT) typically requires radiation exposure with its potential adverse health effects. A completely fluoroless ablation approach is achievable using a combination of electroanatomical mapping and intracardiac echocardiography. Nonetheless, data in patients undergoing VT ablation are limited. OBJECTIVES: This study aimed to determine the feasibility, efficacy, and safety of VT ablation in patients with structural heart disease using a zero-fluoroscopy approach. METHODS: This multicenter study included consecutive patients with ischemic and nonischemic cardiomyopathy undergoing fluoroless VT ablation. Patients requiring epicardial access or coronary angiography were excluded. RESULTS: Between 2017 and 2023 a total of 198 patients (aged 66.4 ± 13.4 years, 76% male, 48% ischemic) were included. Most patients (95.4%) underwent left ventricular (LV) mapping and/or ablation, which was conducted via transseptal route in 54.5% (n = 103), via retrograde aortic route in 43.4% (n = 82), and using a combined approach in 2.1% (n = 4). Two-thirds of patients had a cardiac device, including a biventricular device in 15%; 2 patients had a LV assist device, and 1 patient had a mechanical aortic valve prosthesis. The mean total procedural time was 211 ± 70 minutes, and the total radiofrequency time was 30 ± 22 minutes. During a follow-up period of 22 ± 18 months, the freedom from VT recurrence was 80%, and 7.6% of patients underwent a repeated ablation. Procedural-related complications occurred in 6 patients (3.0%). CONCLUSIONS: Fluoroless ablation of VT in structural heart disease is feasible, effective, and safe when epicardial mapping/ablation is not required.
Assuntos
Ablação por Cateter , Estudos de Viabilidade , Taquicardia Ventricular , Humanos , Masculino , Feminino , Idoso , Ablação por Cateter/métodos , Ablação por Cateter/efeitos adversos , Pessoa de Meia-Idade , Taquicardia Ventricular/cirurgia , Fluoroscopia , Ecocardiografia , Resultado do Tratamento , Cardiomiopatias/cirurgia , Cardiomiopatias/complicaçõesRESUMO
INTRODUCTION: Both atrial fibrillation (AF) and amyloidosis increase stroke risk. We evaluated the best anticoagulation strategy in AF patients with coexistent amyloidosis. METHODS: Consecutive AF patients with concomitant amyloidosis were divided into two groups based on the postablation stroke-prophylaxis approach; group 1: left atrial appendage occlusion (LAAO) in eligible patients and group 2: oral anticoagulation (OAC). Group 1 patients were further divided into Gr. 1A: LAAO + half-does NOAC (HD-NOAC) for 6 months followed by aspirin 81 mg/day and Gr. 1B: LAAO + HD-NOAC. In group 1 patients, with complete occlusion at the 45-day transesophageal echocardiogram, patients were switched to aspirin, 81 mg/day at 6 months. In case of leak, or dense "smoke" in the left atrium (LA) or enlarged LA, they were placed on long-term half-dose (HD) NOAC. Group 2 patients remained on full-dose NOAC during the whole study period. RESULTS: A total of 92 patients were included in the analysis; group 1: 56 and group 2: 36. After the 45-day TEE, 31 patients from group 1 remained on baby-aspirin and 25 on HD NOAC. At 1-year follow-up, four stroke, one TIA and six device-thrombus were reported in group 1A, compared to none in patients in group 1B (5/31 vs. 0/25, p = .03). No bleeding events were reported in group 1, whereas group 2 had five bleeding events (one subdural hematoma, one retinal hemorrhage, and four GI bleedings). Additionally, one stroke was reported in group 2 that happened during brief discontinuation of OAC. CONCLUSION: In patients with coexistent AF and amyloidosis, half-dose NOAC following LAAO was observed to be the safest stroke-prophylaxis strategy.
Assuntos
Amiloidose , Anticoagulantes , Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Acidente Vascular Cerebral , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Masculino , Feminino , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/fisiopatologia , Apêndice Atrial/cirurgia , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/diagnóstico , Ablação por Cateter/efeitos adversos , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fatores de Risco , Fatores de Tempo , Amiloidose/complicações , Amiloidose/diagnóstico , Amiloidose/diagnóstico por imagem , Hemorragia/induzido quimicamente , Administração Oral , Estudos Retrospectivos , Medição de Risco , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Esquema de Medicação , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/complicações , Cardiomiopatias/diagnósticoRESUMO
BACKGROUND: Risk stratification for patients with non-ischemic cardiomyopathy (NICM) remains challenging as previous studies predicting life-threatening ventricular arrhythmia (LTVA) events were conducted before the establishment of the current standard treatment. We investigated the prognostic value of non-sustained ventricular tachycardia (NSVT) in NICM patients among recent studies. METHODS: MEDLINE, Embase were searched from January 2000 to October 2023. The risk of NSVT on LTVA and mortality was assessed using a random-effects model for patients with NICM. A meta-regression analysis was employed to identify sources of heterogeneity. The systematic review and meta-analysis were carried out according to the PRISMA guidelines. RESULTS: A total of 18 studies were identified, including 5238 pooled participants. Meta-analysis demonstrated that the presence of NSVT was considered a significant prognostic indicator for LTVA events [hazard ratio (HR): 2.90; 95â¯% CI; 2.31-3.64] with low heterogeneity (I2: 19â¯%) and for mortality (HR; 2.28; 95%CI; 1.26-4.13) with high heterogeneity (I2: 69â¯%). The prognostic value of NSVT for LTVA was not affected by either ejection fraction or medications at baseline. CONCLUSION: NSVT remained an important predictor of LTVA events even in patients receiving healthcare in contemporary eras. Detection of NSVT helps us to identify the high-risk patients with NICM.
Assuntos
Cardiomiopatias , Taquicardia Ventricular , Humanos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/mortalidade , Cardiomiopatias/complicações , Cardiomiopatias/etiologia , Cardiomiopatias/mortalidade , Prognóstico , Medição de RiscoRESUMO
INTRODUCTION: Septic shock is a severe form of sepsis that has a high mortality rate, and a substantial proportion of these patients will develop cardiac dysfunction, often termed septic cardiomyopathy (SCM). Some SCM patients may develop frank cardiac failure, termed sepsis-related cardiogenic shock (SeRCS). Little is known of SeRCS. This study describes baseline characteristics of patients with SCM and SeRCS compared to patients with septic shock without cardiac dysfunction. We compare clinical outcomes among SCM, SeRCS, and septic shock, and identify risk factors for the development of SCM and SeRCS. METHODS: Septic patients admitted to the ICU with an echocardiogram obtained within 72 hours were included. Left ventricular ejection fraction of ≤55% was used to define SCM, and cardiac index ≤2.1 L/min/m2 among patients with SCM defined SeRCS. Machine learning was used to identify risk factors for development of SCM and SeRCS. Logistic regression was used to compare mortality among groups. RESULTS: Among 1229 patients, 977 patients had septic shock without cardiac dysfunction, 207 had SCM, and 45 had SeRCS. In patients with septic shock, the strongest predictor for developing SCM and SeRCs was a prior history of cardiac dysfunction. Mortality did not significantly differ among the three groups. CONCLUSIONS: SCM and SeRCS affect a minority of patients with septic shock, disproportionately affecting individuals with a history of cardiac disease. We did not identify a mortality difference associated with SCM or SeRCS. Additional work is needed to define further subtypes and treatment options for this patient population.
Assuntos
Cardiomiopatias , Choque Cardiogênico , Choque Séptico , Humanos , Masculino , Feminino , Choque Cardiogênico/mortalidade , Choque Cardiogênico/complicações , Choque Cardiogênico/etiologia , Idoso , Cardiomiopatias/mortalidade , Cardiomiopatias/complicações , Estudos Retrospectivos , Pessoa de Meia-Idade , Choque Séptico/mortalidade , Choque Séptico/complicações , Fatores de Risco , Sepse/mortalidade , Sepse/complicações , Ecocardiografia , Idoso de 80 Anos ou maisAssuntos
Disfunção Ventricular Esquerda , Humanos , Masculino , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Feminino , Miocárdio Ventricular não Compactado Isolado/complicações , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Pessoa de Meia-Idade , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/diagnóstico , SístoleAssuntos
Fibrilação Atrial , Cardiomiopatias , Fibrose , Hipertensão , Serina Endopeptidases , População do Sul da Ásia , Adulto , Feminino , Humanos , Alelos , Arritmias Cardíacas/genética , Fibrilação Atrial/genética , Cardiomiopatias/complicações , Cardiomiopatias/genética , Fibrose/genética , Átrios do Coração/patologia , Átrios do Coração/diagnóstico por imagem , Hipertensão/genética , Mutação com Perda de Função/genética , Serina Endopeptidases/genética , População do Sul da Ásia/genéticaRESUMO
BACKGROUND: Hypocalcaemia is a rare, but reversible, cause of dilated cardiomyopathy causing heart failure. Several case reports have been reported on reversible cardiomyopathy secondary to hypocalcaemia. CASE PRESENTATION: We report a case of 54-year-old female Sri Lankan patient who presented with shortness of breath and was diagnosed with heart failure with reduced ejection fraction due to dilated cardiomyopathy. The etiology for dilated cardiomyopathy was identified as hypocalcemic cardiomyopathy, secondary to primary hypoparathyroidism, which was successfully treated with calcium and vitamin D replacement therapy. CONCLUSION: This adds to literature of this rare cause of reversible cardiomyopathy secondary to hypocalcemia reported from the South Asian region of the world. This case highlights the impact of proper treatment improving the heart failure in patients with hypocalcemic cardiomyopathy.
Assuntos
Cardiomiopatias , Cardiomiopatia Dilatada , Insuficiência Cardíaca , Hipocalcemia , Feminino , Humanos , Pessoa de Meia-Idade , Hipocalcemia/complicações , Hipocalcemia/tratamento farmacológico , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico , Cálcio/uso terapêutico , Cardiomiopatias/complicações , Insuficiência Cardíaca/complicaçõesRESUMO
BACKGROUND: Individuals with diabetes mellitus are at increased risk of cardiovascular diseases, which in turn are the most common cause of morbidity and mortality in the diabetic population. A peculiar feature of cardiovascular diseases in this population is that they can have significant cardiac disease while remaining asymptomatic. There is a paucity of data regarding subclinical cardiac imaging features among diabetic adults in Africa, particularly in Ethiopia. This study was conducted to compare the magnitude and spectrum of left ventricular systolic and diastolic dysfunction among asymptomatic type 2 diabetic adults versus a normotensive, non-diabetic control group and to evaluate the determinants of left ventricular diastolic and systolic dysfunction. METHODS: This was a case-control study conducted at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. A standard transthoracic echocardiography was done for all study participants with type 2 diabetes mellitus and their normotensive and non-diabetic controls. Structured questionnaires were used to collect demographic and clinical characteristics and laboratory test results. Statistical analysis was done using the SPSS 25.0 software. The data was summarized using descriptive statistics. Bivariate and multivariate analysis was performed to determine the association between variables and echocardiographic parameters. The strength of statistical association was measured by adjusted odds ratios and 95% confidence intervals, with significant differences taken at p < 0.05. RESULTS: We analyzed age- and sex-matched 100 participants in the study (diabetic) group and 200 individuals in the control group. Left ventricular systolic and diastolic dysfunction were significantly more prevalent among diabetic adults than their sex and age matched controls. Among diabetic individuals, ages of 60 years and above, dyslipidemia, use of Metformin and Glibenclamide, high serum triglyceride level, presence of neuropathy and use of statins correlated significantly with the presence of left ventricular diastolic dysfunction. Chronic kidney disease and neuropathy were determinants of left ventricular systolic dysfunction. CONCLUSION: Left ventricular systolic and diastolic dysfunction were significantly more prevalent among diabetic patients than their sex- and age-matched controls in our study. We recommend early screening for subclinical left ventricular dysfunction, especially in the elderly and in those with chronic kidney disease, dyslipidemia, and microvascular complications such as neuropathy.
Assuntos
Cardiomiopatias , Diabetes Mellitus Tipo 2 , Dislipidemias , Insuficiência Renal Crônica , Disfunção Ventricular Esquerda , Adulto , Humanos , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Estudos de Casos e Controles , Seguimentos , Etiópia/epidemiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/etiologia , Cardiomiopatias/complicações , Hospitais , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Dislipidemias/complicações , Insuficiência Renal Crônica/complicaçõesRESUMO
AIMS: The ultra-low-temperature cryoablation (ULTC) ablation system using -196°C N2 cryogen has been reported to create lesions with freeze duration-dependent depth titratable to over 10â mm with minimum attenuation by scar. Cryocure-VT (NCT04893317) was a first-in-human clinical trial evaluating the safety and efficacy of a novel, purpose-built ULTC catheter in endocardial ablation of scar-dependent ventricular tachycardias (VTs). METHODS AND RESULTS: This prospective, multi-centre study enrolled patients referred for de novo or second ablations of recurrent monomorphic VT of both ischaemic and non-ischaemic aetiologies. Primary safety and efficacy endpoints of the study were freedom from device- or procedure-related major adverse events (MAEs) up to 30 days post-ablation, acute non-inducibility of clinical VTs at the end of the procedure, and freedom from sustained VT or implantable defibrillator intervention at 6 months. Ultra-low-temperature cryoablation was performed in 64 patients (age 67 ± 11 years, 78% ischaemic, ejection fraction = 35 ± 10%) at 9 centres. The primary acute effectiveness endpoint was achieved in 94% (51/54) of patients in whom post-ablation induction was attempted. There were no protocol-defined MAEs; four procedure-related serious adverse events resolved without clinical sequelae. At 6-month follow-up, 38 patients (60.3%) remained VT-free, and freedom from defibrillator shock was 81.0%, with no significant difference between ischaemic and non-ischaemic cohorts. In 47 patients with defibrillator for at least 6 months prior to the ablation, the VT burden was reduced from median of 4, inter-quartile range (IQR, 1-9) to 0, IQR (0-2). CONCLUSION: In this first-in-human multi-centre experience, endocardial ULTC ablation of monomorphic VT appears safe and effective in patients with both ischaemic-cardiomyopathy and non-ischaemic-cardiomyopathy. CLINICAL TRIAL REGISTRATION: NCT04893317.