RESUMO
There is increasing evidence that Takotsubo cardiomyopathy behaves more like a highly variable and dangerous syndrome than an isolated cardiomyopathy. In this case report, we describe a case of Takotsubo cardiomyopathy complicated by complete heart block. We discuss the potential mechanisms for its etiology and examine the need for pacemaker placement.
Assuntos
Cardiomiopatia de Takotsubo , Humanos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/terapia , Eletrocardiografia , Síndrome , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/terapiaRESUMO
BACKGROUND: Trials studying iron repletion in patients with chronic heart failure (CHF) and iron deficiency are underpowered to find consistent hard endpoint (mortality and hospitalization) reductions. We conducted a meta-analysis of controlled trials to examine the effects of iron repletion on these parameters. METHODS AND RESULTS: Pubmed, CENTRAL, EMBASE and NIH Clinical Trials databases were searched for controlled trials utilizing intravenous iron, with or without erythropoietin, in patients with CHF with NYHA class ≥ II, iron deficiency, and left ventricular dysfunction. Data regarding hospitalizations, mortality, adverse events, NYHA class, and ejection fraction were extracted, analyzed for heterogeneity, and pooled using the DerSimonian and Laird random effects model. We identified 5 controlled trials (n = 631 patients). Patients treated with intravenous iron had significant reductions in hospitalizations (OR 0.26, 95% CI 0.08-0.80), adverse events (OR 0.35, 95% CI 0.21-0.60), NYHA class (mean improvement 1.2 classes, 95% CI 0.69-1.78, and LVEF (mean improvement 5.0%, 95% CI 0.13-9.80) but no relationship was found on mortality (OR 0.66, 95% CI 0.30-1.44). CONCLUSION: Treatment of iron deficiency in patients with CHF reduces the risk of hospitalizations without increased adverse events, suggesting its role as a potential therapeutic target in this group of patients.
Assuntos
Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/tratamento farmacológico , Ferro/administração & dosagem , Administração Intravenosa , Anemia Ferropriva/sangue , Eritropoetina/administração & dosagem , Humanos , Resultado do TratamentoAssuntos
Antinematódeos/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/efeitos adversos , Levamisol/efeitos adversos , Neutropenia/induzido quimicamente , Diagnóstico Diferencial , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/diagnóstico , Neutropenia/terapia , Resultado do TratamentoRESUMO
BI's baseline annual risk of stroke was 12.5% by CHADS2 score; her 5-year stroke risk by the Framingham tool was 59%. Risk factors for bleeding included diabetes, aspirin use and ibuprofen use, and a moderate fall risk by physical therapy assessment due to her osteoarthritis and deconditioned state. Given her fall risk, she and her family decided against anticoagulation with warfarin. She was discharged to an acute rehabilitation facility on aspirin alone. The decision to utilize warfarin for anticoagulation in the elderly patient with AF remains an art, involving judicious use of tools to evaluate baseline risk of stroke, careful evaluation for risk factors for bleeding, and diligent consideration of the patient, and his or her comorbidities, medications and ability to comply with treatment and monitoring.
