Hypocalcaemia As A Rare Reversible Cause Of Dilated Cardiomyopathy.

Dilated cardiomyopathy is characterized by dilation and enlargement of one or both ventricles with reduced systolic function. Calcium plays a key role in myocardial contraction. Hypocalcaemia can lead to a decrease in contraction, left ventricular systolic dysfunction, and heart failure with reduced ejection fraction (EF). Hypocalcaemia is a rare reversible cause of dilated cardiomyopathy. The author presents a case who presented with complaints of shortness of breath on exertion, orthopnoea, paroxysmal nocturnal dyspnoea, numbness and crampy muscular pains. He had a high JVP, systolic murmur on auscultation, hepatomegaly, pedal oedema and crackles on chest auscultation. His ECG showed sinus rhythm with prolonged QT interval. His echocardiography showed dilated cardiomyopathy with reduced ejection fraction, moderate mitral regurgitation and mild tricuspid regurgitation. His Calcium levels and PTH levels were both low. He was treated with ionotrophes, diuretics, vitamin D and calcium supplements, including both intravenous and oral. With the correction of calcium levels, he was weaned off the ionotrophic support and his ejection fraction improved. Calcium levels if low should be corrected in patients with dilated cardiomyopathy.

Adverse bioeffects of ultrasound contrast agents used in echocardiography: true safety issue or "much ado about nothing"?

Ultrasound contrast agents, consisting of gas-filled microbubbles, have long been used to enhance ultrasonographic imaging of various organs and in several settings. In echocardiography, after their first use for Doppler signal enhancement, their applications have expanded and several studies, combining a range of stress modalities with myocardial contrast echocardiography have shown the clinical utility of these agents. In experimental isolated heart animal models, the interaction of ultrasound with echo-contrast microbubbles was shown to have significant biologic effects when the acoustic energy of the beam exceeded a threshold, leading them to rupture and causing cavitation phenomena; the observed consequences in the experimental setting included microvascular damage, transient decrease of contractile performance and increased lactate production. From the clinical point of view, the reporting of a number of serious adverse events - whose association with the echo-contrast agents was debated - has led to the addition of warning boxes in the prescribing documentation of these preparations. On the other hand, clinical studies including high numbers of patients have shown good safety and tolerance of contrast use during stress echocardiography, both for left ventricle opacification and myocardial perfusion imaging. The present review aims at presenting a balanced account of the existing data regarding the mechanisms and clinical implications of echo-contrast bioeffects, in order to make an informed assessment of their safety in clinical practice.

Procedural-support music therapy in the healthcare setting: a cost-effectiveness analysis.

This comparative analysis examined the cost-effectiveness of music therapy as a procedural support in the pediatric healthcare setting. Many healthcare organizations are actively attempting to reduce the amount of sedation for pediatric patients undergoing various procedures. Patients receiving music therapy-assisted computerized tomography scans ( n = 57), echocardiograms ( n = 92), and other procedures ( n = 17) were included in the analysis. Results of music therapy-assisted procedures indicate successful elimination of patient sedation, reduction in procedural times, and decrease in the number of staff members present for procedures. Implications for nurses and music therapists in the healthcare setting are discussed.

Intracardiac echocardiography in congenital heart disease: are we ready to begin the fantastic voyage?

Advances in and miniaturization of echocardiographic technology have led to many new methods of examining cardiovascular malformations. Intracardiac echocardiography (ICE) has reached a point where a real impact on clinical medicine can be anticipated. Use of ICE guidance during electrophysiologic and some interventional catheterization procedures will probably become standard clinical practice in the near future. Current results in adults and potential application to and limitations in the pediatric population are discussed.