Pericardial Diseases in Pregnancy.

Pericardial effusion is the most common manifestation of pericardial diseases during pregnancy. This effusion is benign, mild, or moderate, well tolerated, with spontaneous resolution after delivery; no specific treatment is required. Acute pericarditis is the second most common condition, usually requiring medical therapy during pregnancy. Cardiac tamponade and constrictive pericarditis are rare in pregnancy. Pre-pregnancy counselling is essential in women of childbearing age with recurrent pericarditis to plan pregnancy in a phase of disease quiescence and to review therapy. High-dose aspirin or nonselective nonsteroidal anti-inflammatory drugs, such as ibuprofen and indomethacin, can be used up to the 20th week of gestation. Low-dose prednisone (2.5-10 mg/d) can be administered throughout pregnancy. All of these medications, apart from high-dose aspirin, may be used during lactation. Colchicine is compatible with pregnancy and breastfeeding, and it can be continued throughout pregnancy to prevent recurrences. Appropriate follow-up with a multidisciplinary team with experience in the field is recommended throughout pregnancy to ensure good maternal and fetal outcomes.

Effects of losartan and valsartan on left ventricular hypertrophy and function in essential hypertension.

This study compared the effect of losartan and valsartan on left ventricular mass (LVM) and function in patients with untreated essential hypertension and concentric left ventricular hypertrophy (LVH). Thirty patients (17 men and 13 women; mean age, 48+/-8 years) with untreated essential hypertension and concentric LVH, as determined by echocardiographic assessment, were randomly assigned in equal numbers and double-blind fashion to receive either losartan 50 to 100 mg/d or valsartan 80 to 160 mg/d. Doppler echocardiograms were obtained from each patient before treatment, at the time of initial blood pressure control, and then after 6 months. A significant reduction (P<.01) in LVM index was observed in both the losartan group (from 57.1+/-7.2 g/m2.7 to 51.5+/-6.1 g/m2.7) and the valsartan group (from 58.1+/-8.4 g/m2.7 to 48.2+/-6.2 g/m27), but the reduction was higher (P<.05) in the valsartan group. The predicted midwall fractional shortening improved significantly in both the losartan group (from 81+/-8% to 89+/-9%, P<.05) and the valsartan group (from 78+/-7% to 91+/-9%, P<.01). Similarly, the early peak/peak atrial velocity ratio improved significantly both in the losartan group (from 0.78+/-0.4 to 0.88+/-0.3, P<.05) and the valsartan group (from 0.84+/-0.3 to 0.94+/-0.4, P<.01). These results indicate that valsartan is more effective than losartan in reducing LVM index in hypertensive patients with concentric LVH. This effect is associated with improvement in midwall systolic performance and left ventricular diastolic function.

Influence of microalbuminuria on left ventricular geometry and function in hypertensive patients with type 2 diabetes mellitus.

BACKGROUND: An increased urinary albumin excretion (UAE) is associated with an augmented risk of cardiovascular disease in diabetic patients and in non-diabetic subjects. Left ventricular hypertrophy has been demonstrated to be a powerful predictor of cardiovascular morbidity and mortality in arterial hypertension and when the ventricular geometry is concentric the relation is even stronger. This echocardiographic and Doppler study was designed to evaluate the influence of microalbuminuria on the left ventricular geometry and function in hypertensive patients with type 2 diabetes melitus. METHODS: Forty-two patients (16 males, 26 females, mean age 59.6 +/- 6.7 years) with mild-to-moderate essential hypertension and type 2 diabetes mellitus were enrolled in the study. Twenty-one patients had an elevated UAE (group 1) and 21 a normal UAE (group 2). M-mode (under two-dimensional control) and Doppler echocardiography were performed after a 4-week washout period off antihypertensive therapy. RESULTS: The left ventricular mass index was found to be greater than the partition value of 51 g/m2.7 in both groups but was significantly higher (p < 0.001) in group 1. The midwall fractional shortening was significantly lower (p < 0.001) in group 1 in comparison with group 2. The E/A ratio was impaired in both groups but was more significantly reduced (p < 0.02) in group 1. There was a significantly higher prevalence of a left ventricular concentric hypertrophy pattern (19/21 patients, p < 0.001) in group 1. CONCLUSIONS: In hypertensive patients with type 2 diabetes mellitus, an elevated UAE is associated with an increased left ventricular mass index, a higher prevalence of a concentric left ventricular hypertrophy pattern, a depressed midwall systolic performance and a markedly impaired diastolic function...

Acute hepatitis complicating intravenous amiodarone treatment.

We describe a case of acute hepatitis after a loading dose of intravenous amiodarone. An 83-year-old woman was admitted in emergency for recent-onset atrial fibrillation associated with left ventricular failure. Twenty-four hours after having started parenteral amiodarone, she developed biochemical alterations indicative of severe hepatic cytolysis associated with impairment of the synthetic capacity which rapidly reverted after suspension of the drug. No clinical sign or symptom of hepatopathy was noted except for mild icterus. A review of the literature regarding amiodarone-related hepatotoxicity is reported.