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1.
Curr Opin Anaesthesiol ; 34(3): 218-225, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33935168

RESUMEN

PURPOSE OF REVIEW: The aim of this review of cardiac disease in pregnancy is to delineate current best practices and highlight emerging themes in the literature. RECENT FINDINGS: Cardiovascular disease is the leading cause of death among pregnant women in the United States. Many clinicians and institutions have developed care pathways to approach care in these high-risk patients including highly coordinated multidisciplinary teams. The diagnosis of pulmonary hypertension is the greatest risk factor for an adverse event in pregnant women. Vaginal delivery, with good neuraxial anesthesia, is usually the preferred mode of delivery in women with cardiac disease, although the rate of cesarean delivery is higher among women with heart disease. SUMMARY: The leading cause of morbidity and mortality in pregnant women is cardiac disease. Preconception counseling is useful for optimizing patients for pregnancy and setting appropriate expectations about care and outcomes. Ensuring that women are cared for in centers with appropriate multidisciplinary resources is key for improving outcomes for cardio-obstetric patients.


Asunto(s)
Cardiopatías , Complicaciones Cardiovasculares del Embarazo , Cesárea , Parto Obstétrico , Femenino , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Humanos , Periodo Periparto , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/terapia , Estados Unidos
2.
Curr Hypertens Rep ; 23(4): 22, 2021 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-33881630

RESUMEN

PURPOSE OF REVIEW: This review aims to summarize recent developments in identifying and quantifying both the presence and amount of myocardial fibrosis by imaging and biomarkers. Further, this review seeks to describe in general ways how this information may be used to identify hypertension and the transition to heart failure with preserved ejection fraction. RECENT FINDINGS: Recent studies using cardiac magnetic resonance imaging highlight the progressive nature of fibrosis from normal individuals to those with hypertension to those with clinical heart failure. However, separating hypertensive patients from those with heart failure remains challenging. Recent studies involving echocardiography show the subclinical myocardial strain changes between hypertensive heart disease and heart failure. Lastly, recent studies highlight the potential use of biomarkers to identify those with hypertension at the greatest risk of developing heart failure. In light of the heterogeneous nature between hypertension and heart failure with preserved ejection fraction, an integrated approach with cardiac imaging and biomarker analysis may enable clinicians and investigators to more accurately characterize, prevent, and treat heart failure in those with hypertension.


Asunto(s)
Cardiopatías , Insuficiencia Cardíaca , Hipertensión , Fibrosis , Humanos , Hipertensión/complicaciones , Volumen Sistólico , Función Ventricular Izquierda
3.
Pan Afr Med J ; 38: 101, 2021.
Artículo en Francés | MEDLINE | ID: mdl-33889267

RESUMEN

Dermatomyositis (DM) and polymyositis (PM) are rare but serious conditions. The purpose of this study was to investigate, by a review of hospital cases, their epidemiological, clinical and evolutionary profile. We conducted a retrospective study over a 15-year period, between January 2004 and December 2019. All cases with possible or definite diagnosis according to Bohan and Peter's criteria were retained. A total of 14 patients were enrolled (8 DM and 6 PM), with an average age of 48.7 years. Sex ratio was 13F/ 1H. General signs were reported in 71% of cases. Motor deficit affected the girdle muscles in 71% of cases; 85.7% of patients had arthralgia and 14% arthritis. Erythema and periorbital edema were the predominant skin signs. Patients' assessment showed increased sedimentation rate in all cases and increased muscle enzymes in 80% of cases. Antinuclear antibodies were positive in 63% of cases. Muscle biopsy objectified inflammatory myositis in 75% of cases. Heart disease was reported in 14% of cases and lung disease in 21%. Cancer was found in 21.4% of cases. All patients received corticosteroid therapy. Improvement was reported in 88% of patients, with a relapse in 4 patients. In our context, DM is more frequent than PM, with a clear female predominance. Pulmonary disease is a heavy complication. Its association with cancers occurs commonly, hence the need for a systematic cancer screening at diagnosis and follow-up.


Asunto(s)
Dermatomiositis/epidemiología , Miositis/epidemiología , Polimiositis/epidemiología , Adolescente , Corticoesteroides/administración & dosificación , Adulto , Anciano , Biopsia , Dermatomiositis/diagnóstico , Dermatomiositis/tratamiento farmacológico , Edema/epidemiología , Eritema/epidemiología , Eritema/etiología , Femenino , Cardiopatías/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Miositis/diagnóstico , Miositis/tratamiento farmacológico , Neoplasias/epidemiología , Polimiositis/diagnóstico , Polimiositis/tratamiento farmacológico , Estudios Retrospectivos , Adulto Joven
4.
Artículo en Inglés | MEDLINE | ID: mdl-33802701

RESUMEN

INTRODUCTION: The management of chronic illness assumes a level of demand for permanent care and reaches a priority dimension in the health context. Given the importance of nursing care to post-acute coronary syndrome patients, the objective of this study is to evaluate the impact of an educational intervention program on quality of life in patients after acute coronary syndrome. METHOD: Quasi-experimental study with two groups: an experimental group exposed to the educational intervention program and the control group without exposure to the educational intervention program. RESULTS: The results showed statistically significant differences between both groups (p < 0.001). Although only valid for the specific group of subjects studied, the educational intervention program enabled significant gains in quality of life. CONCLUSIONS: According to the findings of the study, a systematized and structured educational program, integrated into the care organization and based on transition processes, is effective in developing self-care skills and improves the quality of life in patients after acute coronary syndrome.


Asunto(s)
Cardiopatías , Insuficiencia Cardíaca , Enfermedad Crónica , Escolaridad , Humanos , Calidad de Vida
7.
Rev. cuba. anestesiol. reanim ; 20(1): e672, ene.-abr. 2021. tab
Artículo en Español | LILACS, CUMED | ID: biblio-1156363

RESUMEN

Introducción: La cardiopatía isquémica es frecuente, tiene diversas formas de manifestarse y predomina entre las enfermedades que motivan el ingreso de pacientes a unidades de emergencias, y que causan ingresos hospitalarios. Objetivo: Profundizar en el conocimiento de los pacientes con cardiopatía isquémica en una unidad de cuidados intensivos municipal. Método: Se realizó un estudio descriptivo y transversal, de 528 pacientes que ingresaron en la Unidad de Cuidados Intensivos del Hospital General Docente "Orlando Pantoja Tamayo", Contramaestre, Santiago de Cuba, con diagnóstico de cardiopatías isquémicas, desde enero de 2016 hasta junio de 2019. Las variables utilizadas fueron: grupo de edades, sexo, diagnostico al ingreso, antecedentes patológicos personales, estadía y estado al egreso. Se utilizó el porcentaje para resumir la información, así como el test chi cuadrado para identificar asociación estadística. Resultados: Hubo predominio del sexo masculino y edades entre 60-70 y 36-59 años, fueron más frecuentes el infarto agudo de miocardio y la combinación de 3 o más factores de riesgo. El mayor número de fallecimientos se ocurrió en los primeros 3 días de admitidos y en pacientes con ventilación mecánica invasiva. Conclusiones: El comportamiento de las enfermedades cardiovasculares continúa siendo un gran problema de salud, aparece en edades cada vez más tempranas. En casos severos la mortalidad puede ocurrir en las primeras 72 h(AU)


Introduction: Ischemic heart disease is frequent, has different manifestation forms, and predominates among diseases leading to patient admission into emergency units and hospital admissions in general. Objective: To deepen the knowledge of patients with ischemic heart disease in a municipal intensive care unit. Method: A descriptive and cross-sectional study was carried out of 528 patients who were admitted into the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestre Municipality, Santiago de Cuba, with a diagnosis of ischemic heart disease, from January 2016 to June of 2019. The variables used were age group, sex, diagnosis at admission, personal pathological history, hospital stay, and status at discharge. We used percentage to summarize the information, as well as the chi-square test to identify statistical association. Results: There was a predominance of males and ages between 60-70 and 36-59 years. Acute myocardial infarction and the combination of three or more risk factors were more frequent. The highest number of deaths occurred in the first three days after admission and among patients with invasive mechanical ventilation. Conclusions: The characteristics of cardiovascular diseases continues to be a major health concern, as long as they are appearing at increasingly earlier ages. In severe cases, mortality can occur in the first seventy-two hours(AU)


Asunto(s)
Humanos , Cardiopatías/epidemiología , Unidades de Cuidados Intensivos/tendencias , Epidemiología Descriptiva , Estudios Transversales , Factores de Riesgo , Conocimiento
8.
Medicine (Baltimore) ; 100(17): e25702, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907151

RESUMEN

RATIONALE: Diabetic ketoacidosis (DKA) can cause several complications. Among them, cardiac complications are the most fatal and difficult to detect. Cardiac markers are prognostic factors for morbidity and mortality in adult patients with DKA. But, there have been very few discussed cases in pediatrics. We report a case of severe DKA in child with elevated cardiac enzymes and prolonged QT interval. PATIENT CONCERNS: A 12-year-old girl admitted by nausea, vomiting, and lethargy for 1 day. DIAGNOSES: Her blood sugar level was initially undetectable by the capillary blood glucose meter, and blood gas analysis showed severe DKA with elevated cardiac enzymes and prolonged QT interval. INTERVENTIONS: The patient was admitted to hospital and intensive intravenous fluid and regular insulin infusion were administered. OUTCOMES: After 5 days of supportive care, the patient was fully recovered, discharged, and followed up in an outpatient clinic. LESSONS: Since the relationship between DKA and myocardial injury has not been clearly elucidated, pediatricians and emergency physicians should remain careful throughout the recovery time as it can lead to life-threatening conditions in various courses.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Cetoacidosis Diabética , Fluidoterapia/métodos , Insulina/administración & dosificación , Síndrome de QT Prolongado , Troponina I/sangre , Equilibrio Ácido-Base , Administración Intravenosa/métodos , Análisis de los Gases de la Sangre/métodos , Glucemia/análisis , Niño , Cetoacidosis Diabética/sangre , Cetoacidosis Diabética/diagnóstico , Cetoacidosis Diabética/etiología , Cetoacidosis Diabética/terapia , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Cardiopatías/sangre , Cardiopatías/diagnóstico , Cardiopatías/etiología , Humanos , Hipoglucemiantes/administración & dosificación , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/etiología , Péptido Natriurético Encefálico/sangre , Resultado del Tratamiento
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(2): 327-331, 2021 Mar 30.
Artículo en Chino | MEDLINE | ID: mdl-33879906

RESUMEN

OBJECTIVE: To investigate the possibility and feasibility of one-stage cardiac and non-cardiac surgery. METHODS: From July 1999 to August 2018, one hundred and eleven patients suffering from cardiac and non-cardiac diseases were treated by one-stage cardiac and non-cardiac operation in Department of Cardiac Surgery and Thoracic Surgery, General Surgery, Urinary Surgery, and Gynecology, Peking University First Hospital. There were 83 males (74.8%) and 28 females (25.2%), aged 41 to 84 years [mean age: (64.64±8.97) years]. The components of the cardiac disease included coronary heart disease, valvular heart disease, cardiac tumors, chronic constrictive pericarditis and congenital heart disease. The components of the non-cardiac diseases included lung benign and malignant diseases, thymoma and thymic cyst, breast cancer, chest wall giant hemangioma, digestive tract benign and malignant diseases, urinary system carcinoma and gynecological diseases. RESULTS: Two patients died after operations in hospital; thus, the hospital mortality rate was 1.8%. One patient died of multiple organ failure on the 153th days after emergency coronary artery bypass grafting (CABG) combined with radical resection of bladder cancer. The other of pericardium stripping with lung cancer operation died of the multiple organ failure on the tenth day after surgery. The remaining 109 patients recovered and were discharged. There were 13 cases of complications during the days in hospital. The total operative morbidity was 11.7%: postoperative hemorrhage in 2 cases (1.8%), pulmonary infection and hypoxemia in 3 cases (2.7%), hemorrhage of upper digestive tract in 1 case (0.9%), incisional infection in 3 cases (2.7%), subphrenic abscess in 1 case (0.9%), and postoperative acute renal failure and hemofiltration in 3 case (2.7%). Of the 109 patients discharged, 108 patients were followed up. All the patients survived for 6 months, and 21 patients died due to tumor recurrence or metastasis within 1 to 5 years of follow-up, but no cardiogenic death. During the follow-up period, 1 patient developed cardiac dysfunction, 1 patient underwent percutaneous coronary intervention (PCI), 1 patient had cerebral hemorrhage due to excessive postoperative anticoagulation, and 1 patient suffered from incisional hernia. CONCLUSION: One-stage surgeries in patients suffering from both cardiac and non-cardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.


Asunto(s)
Cardiopatías , Intervención Coronaria Percutánea , Adulto , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Infección de la Herida Quirúrgica , Resultado del Tratamiento
10.
BMC Infect Dis ; 21(1): 368, 2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-33874899

RESUMEN

BACKGROUND: Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. METHODS: A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008-2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. RESULTS: Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. CONCLUSION: As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.


Asunto(s)
Enfermedades Gastrointestinales/complicaciones , Inmunoglobulinas Intravenosas/uso terapéutico , Síndrome Mucocutáneo Linfonodular/diagnóstico , Proteína C-Reactiva/análisis , Niño , Preescolar , Aneurisma Coronario/etiología , Estudios Transversales , Exantema/etiología , Femenino , Fiebre/etiología , Cardiopatías/complicaciones , Humanos , Incidencia , Lactante , Irán/epidemiología , Masculino , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Síndrome Mucocutáneo Linfonodular/epidemiología , Recuento de Plaquetas , Estudios Retrospectivos
11.
Pan Afr Med J ; 38: 125, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912295

RESUMEN

In children, coronavirus disease 2019 infection is rarely symptomatic. Severe forms with respiratory distress are rare, thromboembolic complications are exceptional. We report a rare case of a 14 years old girl with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who was admitted to the hospital for bilateral pulmonary embolism with intracardiac thrombus. The girl progressed well on anticoagulation.


Asunto(s)
/complicaciones , Embolia Pulmonar/virología , Trombosis/virología , Enfermedad Aguda , Adolescente , Anticoagulantes/administración & dosificación , Femenino , Cardiopatías/tratamiento farmacológico , Cardiopatías/etiología , Humanos , Embolia Pulmonar/tratamiento farmacológico , Trombosis/tratamiento farmacológico
12.
Cell ; 184(8): 2167-2182.e22, 2021 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-33811809

RESUMEN

Cardiac injury and dysfunction occur in COVID-19 patients and increase the risk of mortality. Causes are ill defined but could be through direct cardiac infection and/or inflammation-induced dysfunction. To identify mechanisms and cardio-protective drugs, we use a state-of-the-art pipeline combining human cardiac organoids with phosphoproteomics and single nuclei RNA sequencing. We identify an inflammatory "cytokine-storm", a cocktail of interferon gamma, interleukin 1ß, and poly(I:C), induced diastolic dysfunction. Bromodomain-containing protein 4 is activated along with a viral response that is consistent in both human cardiac organoids (hCOs) and hearts of SARS-CoV-2-infected K18-hACE2 mice. Bromodomain and extraterminal family inhibitors (BETi) recover dysfunction in hCOs and completely prevent cardiac dysfunction and death in a mouse cytokine-storm model. Additionally, BETi decreases transcription of genes in the viral response, decreases ACE2 expression, and reduces SARS-CoV-2 infection of cardiomyocytes. Together, BETi, including the Food and Drug Administration (FDA) breakthrough designated drug, apabetalone, are promising candidates to prevent COVID-19 mediated cardiac damage.


Asunto(s)
/complicaciones , Cardiotónicos/uso terapéutico , Proteínas de Ciclo Celular/antagonistas & inhibidores , Cardiopatías/tratamiento farmacológico , Quinazolinonas/uso terapéutico , Factores de Transcripción/antagonistas & inhibidores , /metabolismo , Animales , Proteínas de Ciclo Celular/metabolismo , Línea Celular , Citocinas/metabolismo , Femenino , Cardiopatías/etiología , Células Madre Embrionarias Humanas , Humanos , Inflamación/complicaciones , Inflamación/tratamiento farmacológico , Ratones , Ratones Endogámicos C57BL , Factores de Transcripción/metabolismo
14.
Ann Agric Environ Med ; 28(1): 20-26, 2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33775064

RESUMEN

INTRODUCTION: Hiatal hernia (HH) is a condition which refers to the protrusion of an intraabdominal organ in the thorax cavity throughan oesophageal hiatus of the diaphragm. Sliding HH is usually associated with non-specific symptoms, including heartburn, regurgitation or epigastric pain. Importantly, true paraesophageal hernia may lead to cardiac compression. Knowledge of cardiac manifestations of HH is limited. OBJECTIVE: The main aim of the study is to present the rare case of a patient with gastrothorax due to hiatal hernia which caused cardiac arrest, and to provide a literature-based review of the cardiac aspects of hiatal hernia. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: Patients with paraesophageal hernia may experience arrhythmia, including sinus tachycardia, atrial flutter, atrial fibrillation, supraventricular extrasystole and ventricular tachycardia, as well as left bundle branch block, atrioventricular conduction block and electrocardiographic changes in the ST-segment and T-wave. In echocardiograph, HH may appear as an extracardiac posterior mass encroaching on the left atrial cavity, mimicking the left atrial mass. Rarel, HH may be manifested as tension gastrothorax leading cardiac arrest. In such a case, timely diagnosis and instant adequate treatment of the underlying condition are crucial. CONCLUSIONS: Hiatal hernia should be considered as a possible cause of arrhythmia and changes in ST-T pattern, particularly if symptoms occurred after a meal. Differential diagnosis of the posterior mediastinal mass or intracardiac mass should include hiatal hernia. Gastrothorax is a rare condition associated with hiatal hernia which may lead to cardiac arrest. However, even timely recognition and therapy of gastrothorax does not ensure a positive clinical outcome.


Asunto(s)
Cardiopatías/etiología , Hernia Hiatal/complicaciones , Animales , Cardiopatías/fisiopatología , Hernia Hiatal/fisiopatología , Humanos
15.
BMC Geriatr ; 21(1): 184, 2021 03 17.
Artículo en Inglés | MEDLINE | ID: mdl-33731011

RESUMEN

BACKGROUND: Heart disease is a severe health problem among adult populations in China. The prevalence rates of heart disease increase with age. The pathogenic causes of heart disease are often related to conditions in early life. Using a nationally representative sample of adults aged 45 or older in China, we examined the association between childhood conditions and heart disease in later life from a life course perspective. METHODS: The data used in this study were derived from the life history module and 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). Missingness were handled by multiple imputation, generating 20 complete datasets with a final sample of 19,800. Doctor-diagnosed heart disease was the main dependent variable. Respondents' conditions in childhood, adulthood, and older age were the independent variables (e.g., socioeconomic status, health, and health resources). Random-effects logistic regression models were conducted to test the hypotheses. RESULTS: A total of 16.6% respondents reported being diagnosed with heart disease by doctors. Regarding childhood socioeconomic status, 8.2% of the respondents considered that they were (a lot) better off than their neighbors, and 31.1% considered that their health status in childhood was better than their peers. More than 90% of respondents did not have severe illnesses during their childhood, and around 80.3% had access to health resources nearby in childhood. Lower socioeconomic status and poorer health conditions in childhood were associated with a greater likelihood of reporting doctor-diagnosed heart diseases, even after controlling for conditions in adulthood and older age (socioeconomic status: odds ratio (OR) = 0.947; self-rated health: OR = 0.917; severe illnesses: OR = 1.196). CONCLUSIONS: Along with chronic diseases (e.g., hypertension, diabetes, and dyslipidemia), unhealthy behaviors, overweight and obesity, poor childhood conditions should be considered as screening criteria to identify populations at risk of heart disease. Relevant preventive strategies and interventions should be developed from a life course perspective and conducted in communities by providing health education program among older population with low socioeconomic status, and encouraging early detection and treatment.


Asunto(s)
Cardiopatías , Clase Social , Adulto , Anciano , Niño , China/epidemiología , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Jubilación
16.
J Cardiovasc Comput Tomogr ; 15(2): 180-189, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33685845

RESUMEN

The purpose of this review is to highlight the most impactful, educational, and frequently downloaded articles published in the Journal of Cardiovascular Computed Tomography (JCCT) for the year 2020. The JCCT reached new records in 2020 for the number of research submissions, published manuscripts, article downloads and social media impressions. The articles in this review were selected by the Editorial Board of the JCCT and are comprised predominately of original research publications in the following categories: Coronavirus disease 2019 (COVID-19), coronary artery disease, coronary physiology, structural heart disease, and technical advances. The Editorial Board would like to thank each of the authors, peer-reviewers and the readers of JCCT for making 2020 one of the most successful years in its history, despite the challenging circumstances of the global COVID-19 pandemic.


Asunto(s)
Investigación Biomédica , Cardiopatías/virología , Publicaciones Periódicas como Asunto , /patogenicidad , /complicaciones , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/virología , Cardiopatías/diagnóstico por imagen , Cardiopatías/fisiopatología , Interacciones Huésped-Patógeno , Humanos , Pronóstico , Factores de Riesgo
17.
BMJ Case Rep ; 14(3)2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33762277

RESUMEN

Hydroxychloroquine has been widely prescribed to treat patients with COVID-19 pneumonia. A 73-year-0ld woman with COVID-19 pneumonia was treated with dexamethasone and hydroxychloroquine. Her home medications, citalopram and donepezil, were continued. The ECG prior to starting hydroxychloroquine showed normal sinus rhythm with prolonged corrected QT (QTc) of 497 ms, due to citalopram and donepezil therapy. Repeat ECG on days 3 and 4 of hydroxychloroquine therapy showed significantly prolonged QTc of 557 ms and 538 ms, respectively, despite normal serum electrolytes. All QT-prolonging medications including hydroxychloroquine were discontinued on day 4; however, she suffered a transient torsades de pointes lasting for about 15 s, which resolved before any intervention. QTc improved to 477 ms, after discontinuation of QT-prolonging medications. The patient had QTc prolongation and torsades de pointes due to therapy with multiple QT-prolonging medications. Medicine reconciliation and careful monitoring of QTc may help prevent cardiac complications in patients with COVID-19 treated with hydroxychloroquine.


Asunto(s)
/tratamiento farmacológico , Dexametasona/efectos adversos , Hidroxicloroquina/efectos adversos , Torsades de Pointes/inducido químicamente , Anciano , Antiinfecciosos/efectos adversos , Antiinfecciosos/uso terapéutico , Citalopram/efectos adversos , Citalopram/uso terapéutico , Dexametasona/uso terapéutico , Donepezilo/efectos adversos , Donepezilo/uso terapéutico , Quimioterapia Combinada , Electrocardiografía/métodos , Femenino , Cardiopatías/inducido químicamente , Cardiopatías/prevención & control , Humanos , Hidroxicloroquina/uso terapéutico , Síndrome de QT Prolongado/inducido químicamente
18.
Mayo Clin Proc ; 96(4): 932-942, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33714597

RESUMEN

OBJECTIVE: To characterize the clinical and transthoracic echocardiographic features and 30-day outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: Retrospective cohort study that included consecutive inpatients with COVID-19 infection who underwent clinically indicated transthoracic echocardiography at 10 sites in the Mayo Clinic Health System between March 10 and August 5, 2020. Echocardiography was performed at bedside by cardiac sonographers according to an abbreviated protocol. Echocardiographic results, demographic characteristics, laboratory findings, and clinical outcomes were analyzed. RESULTS: There were 179 patients, aged 59.8±16.9 years and 111 (62%) men; events within 30 days occurred in 70 (39%) patients, including prolonged hospitalization in 43 (24%) and death in 27 (15%). Echocardiographic abnormalities included left ventricular ejection fraction less than 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) of 35 or greater mm Hg in 44 (44%) of 101 in whom it was measured. Myocardial injury, defined as the presence of significant troponin level elevation accompanied by new ventricular dysfunction or electrocardiographic abnormalities, was present in 13 (7%). Prior echocardiography was available in 36 (20%) patients and pre-existing abnormalities were seen in 28 (78%) of these. In a multivariable age-adjusted model, area under the curve of 0.81, prior cardiovascular disease, troponin level, D-dimer level, and RVSP were related to events at 30 days. CONCLUSION: Bedside Doppler assessment of RVSP appears promising for short-term risk stratification in hospitalized patients with COVID-19 infection undergoing clinically indicated echocardiography. Pre-existing echocardiographic abnormalities were common; caution should be exercised in attributing such abnormalities to the COVID-19 infection in this comorbid patient population.


Asunto(s)
/complicaciones , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , /terapia , Ecocardiografía , Femenino , Cardiopatías/terapia , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Volumen Sistólico
20.
Life Sci ; 274: 119299, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33675899

RESUMEN

AIMS: Cardiac fibrosis is a pathological hallmark of progressive heart diseases currently lacking effective treatment. Nicotinamide mononucleotide (NMN), a member of the vitamin B3 family, is a defined biosynthetic precursor of nicotinamide adenine dinucleotide (NAD+). Its beneficial effects on cardiac diseases are known, but its effects on cardiac fibrosis and the underlying mechanism remain unclear. We aimed to elucidate the protective effect of NMN against cardiac fibrosis and its underlying mechanisms of action. MATERIALS AND METHODS: Cardiac fibrosis was induced by isoproterenol (ISO) in mice. NMN was administered by intraperitoneal injection. In vitro, cardiac fibroblasts (CFs) were stimulated by transforming growth factor-beta (TGF-ß) with or without NMN and sirtinol, a SIRT1 inhibitor. Levels of cardiac fibrosis, NAD+/SIRT1 alteration, oxidative stress, and Smad3 acetylation were evaluated by real-time polymerase chain reaction, western blots, immunohistochemistry staining, immunoprecipitation, and assay kits. KEY FINDINGS: ISO treatment induced cardiac dysfunction, fibrosis, and hypertrophy in vivo, whereas NMN alleviated these changes. Additionally, NMN suppressed CFs activation stimulated by TGF-ß in vitro. Mechanistically, NMN restored the NAD+/SIRT1 axis and inhibited the oxidative stress and Smad3 acetylation induced by ISO or TGF-ß. However, the protective effects of NMN were partly antagonized by sirtinol in vitro. SIGNIFICANCE: NMN could attenuate cardiac fibrosis in vivo and fibroblast activation in vitro by suppressing oxidative stress and Smad3 acetylation in a NAD+/SIRT1-dependent manner.


Asunto(s)
Fibrosis/tratamiento farmacológico , Cardiopatías/tratamiento farmacológico , Isoproterenol/toxicidad , Mononucleótido de Nicotinamida/farmacología , Estrés Oxidativo/efectos de los fármacos , Proteína smad3/metabolismo , Acetilación , Animales , Cardiotónicos/toxicidad , Fibrosis/inducido químicamente , Fibrosis/metabolismo , Fibrosis/patología , Cardiopatías/inducido químicamente , Cardiopatías/metabolismo , Cardiopatías/patología , Masculino , Ratones , Ratones Endogámicos C57BL , Ratas , Ratas Sprague-Dawley , Proteína smad3/química
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