RESUMO
The renin-angiotensin system (RAS) plays a major role in the pathophysiology of cardiovascular disorders. Angiotensin II (Ang-II), the final product of this pathway, is known for its vasoconstrictive and proliferative effects. Angiotensin-converting enzyme 2 (ACE2), a newly discovered homolog of ACE, plays a key role as the central negative regulator of the RAS. It diverts the generation of vasoactive Ang-II into the vasodilatory and growth inhibiting peptide angiotensin(1-7) [Ang(1-7)], thereby providing counter-regulatory responses to neurohormonal activation. There is substantial experimental evidence evaluating the role of ACE2/Ang(1-7) in hypertension, heart failure, and atherosclerosis. In this review, we aim to focus on the conceptual facts of the ACE2-Ang(1-7) axis with regards to clinical implications and therapeutic targets in cardiovascular disorders, with emphasis on the potential therapeutic role in cardiovascular diseases.
Assuntos
Fármacos Cardiovasculares/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Terapia de Alvo Molecular/métodos , Peptidil Dipeptidase A/fisiologia , Angiotensina I/biossíntese , Enzima de Conversão de Angiotensina 2 , Fármacos Cardiovasculares/farmacologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/fisiopatologia , Fragmentos de Peptídeos/biossíntese , Peptidil Dipeptidase A/efeitos dos fármacos , Sistema Renina-Angiotensina/fisiologia , Remodelação Ventricular/fisiologiaRESUMO
Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a reversible form of cardiomyopathy characterized by reduced ejection fraction with regional wall motion abnormalities, elevated cardiac enzyme levels, and signs of ischemia on electrocardiogram despite the absence of obstructive epicardial coronary artery disease. It is often preceded by intense emotional or physical illness stressors. This case describes a 65-year-old female patient who likely developed takotsubo cardiomyopathy precipitated by the stress of diverticulitis.
Assuntos
Cardiomiopatia de Takotsubo , Feminino , Humanos , Idoso , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Ecocardiografia , Coração , Eletrocardiografia , Resultado do TratamentoRESUMO
Intrapericardial organized haematoma secondary to blunt chest trauma is an extremely rare cause of constrictive pericarditis. We report a 30-year-old male who presented with heart failure for 12 months and was found to have an organized intrapericardial haematoma secondary to blunt chest trauma in a road traffic accident 2 years prior. The use of multiple imaging modalities including two-dimensional (transthoracic and transoesophageal) echocardiogram and cardiac magnetic resonance imaging established the diagnosis. Surgical excision of the haematoma and removal of the constricting pericardium relieved his symptoms.
Assuntos
Insuficiência Cardíaca/etiologia , Hematoma/etiologia , Pericardite Constritiva/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Adulto , Diagnóstico Diferencial , Ecocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/cirurgia , Hematoma/diagnóstico , Hematoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgiaRESUMO
A 63-year-old male presented with a 6-month history of worsening exertional dyspnea and was found to have three-vessel coronary artery disease. Transesophageal echocardiography revealed a filamentous structure attached to the anterior mitral valve leaflet, which was confirmed during surgery as filamentous network. To our knowledge, this is the first report to describe such a network attached to the mitral valve.
Assuntos
Ecocardiografia Transesofagiana , Cardiopatias Congênitas/diagnóstico por imagem , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Resultado do TratamentoRESUMO
Hepatocellular carcinoma is the most common primary tumor of the liver accounting for 4.6% of all new human cancers. Cardiac metastasis in hepatocellular carcinoma is an uncommon secondary cardiac malignancy. We described two cases of advanced hepatocellular carcinoma with large masses in the right atrium mimicking atrial myxoma. The RA masses were incidentally detected during two-dimensional echocardiographic examination.
Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/secundário , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/secundário , Neoplasias Hepáticas/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , UltrassonografiaRESUMO
A 40-year-old woman presented with a 1 month history of shortness of breath and easy fatigability. Two-dimensional echocardiography and real-time three-dimensional echocardiography (RT3DE) showed a large right atrial mass protruding into the right ventricle and an atrial septal defect (ASD). Successful excision of the mass, which proved to be a myxoma, and closure of the ASD completely relieved her symptoms. To our knowledge, this is the first report of RT3DE in a patient with right atrial myxoma associated with an ASD.
Assuntos
Ecocardiografia Tridimensional , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Adulto , Feminino , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Comunicação Interatrial/patologia , Comunicação Interatrial/cirurgia , Humanos , Mixoma/patologia , Mixoma/cirurgiaRESUMO
Primary cardiac tumors are rare at all ages, and especially so in childhood, where the most prevalent type of benign cardiac masses are rhabdomyomas followed by fibromas, both of which have a predilection for ventricular septum. We report an unusual case of a tumor involving the ventricular septum in an asymptomatic 17-year-old adolescent who has been known to have this tumor for 10 years. The use of multiple imaging included myocardial contrast two-dimensional echocardiography, real time three-dimensional echocardiography (with and without myocardial contrast), and magnetic resonance imaging supported the diagnosis of cardiac rhabdomyoma.
Assuntos
Diagnóstico por Imagem/métodos , Neoplasias Cardíacas/diagnóstico , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/patologia , Técnica de Subtração , Humanos , Masculino , Radiografia , Ultrassonografia , Adulto JovemRESUMO
Cardiac tuberculosis is rare and usually involves the pericardium. Myocardial tuberculoma is a very rare occurrence and only a few cases were reported. We describe the use of cardiovascular magnetic resonance in the diagnosis of a rare case of cardiac tuberculoma involving the right atrium which was complicated by a bicaval obstruction. The patient made a remarkable improvement with the anti-tuberculous treatment. To our knowledge, this complication has never been reported in relation to cardiac tuberculoma.
Assuntos
Átrios do Coração/patologia , Imageamento por Ressonância Magnética , Síndrome da Veia Cava Superior/etiologia , Tuberculoma/patologia , Tuberculose Cardiovascular/patologia , Veia Cava Inferior/patologia , Trombose Venosa/etiologia , Adulto , Anticoagulantes/uso terapêutico , Antituberculosos/uso terapêutico , Constrição Patológica , Ecocardiografia , Humanos , Masculino , Síndrome da Veia Cava Superior/tratamento farmacológico , Síndrome da Veia Cava Superior/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculoma/complicações , Tuberculoma/tratamento farmacológico , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Trombose Venosa/patologiaRESUMO
Ibn Sina, known in the West as Avicenna, was the most famous and influential of all the Islamic philosopher-scientists. His most important medical works are the Canon of Medicine medical encyclopedia and a treatise on cardiac drugs. His Canon of Medicine remained the standard text in both the East and West until the 16(th) century. Avicenna's description of cardiac diseases was logically presented perhaps for the first time in the history of medicine. Avicenna was the first to describe carotid sinus hypersensitivity, which presents with vasovagal syncope. He was a pioneer in pulsology and the first correct explanation of pulsation was given by Avicenna, after he refined Galen's theory of the pulse. Besides, he discussed the action of available drugs on the heart in details and mentioned their indications and contraindications. In conclusion, Avicenna made important contributions to cardiology. This article describes some of his contributions in this field.
RESUMO
Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome, characterized clinically by fever, splenomegaly, cytopenia, and high ferritin. Infectious causes have been associated with secondary HLH, with viruses being the most common. We report a case of Mycobacterium avium complex-associated HLH in a sickle cell anemia patient. To the best of our knowledge, this association has never been reported in sickle cell anemia.
RESUMO
Cocaine is considered a leading cause of drug-related deaths. This is usually sudden, unwitnessed, and without prodromal features. It has been reported that in-hospital mortality is close to 2%. Cocaine has powerful central nervous system effects(1) and acute cocaine overdose has been associated with hyperthermia, agitation, paranoid ideation, status epilepticus, ventricular fibrillation, ventricular tachycardia, and myocardial infarction (MI). The mechanisms of cocaine-related death remain poorly understood. We report a patient who survived massive cocaine ingestion with psychomotor agitation and generalized seizures followed by asystolic cardiac arrest and transient Brugada pattern on electrocardiogram (ECG).