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1.
Pacing Clin Electrophysiol ; 42(9): 1243-1245, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31390079

RESUMO

We present a case of an 89-year-old man with a left ventricular assist device and cardiac resynchronization therapy device (CRT-D) who presented with multiple presyncopal events. On the night of admission, telemetry revealed a 13-s pause with appropriately timed pacing spikes but with failure to capture, followed by intermittent ventricular contraction with different QRS morphology. What was the mechanism for his ventricular asystole?

3.
World J Pediatr Congenit Heart Surg ; 10(4): 502-503, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307300

RESUMO

Cardiovascular computed tomographic angiography (CCTA) 3-D thoracic reconstruction can serve as a "virtual patient avatar" providing surgical views for approach to complex anomalous coronary artery anatomy. Images demonstrated a single coronary artery ostium arising from the right aortic sinus with trifurcation into a prepulmonic left anterior descending coronary artery (LAD), an interarterial circumflex with a subsequent intraseptal course, and normal course of the right coronary artery. Virtual 3-D CCTA reconstructions were important to planning an incisional plane for surgical correction.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Imagem Tridimensional , Realidade Virtual , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Humanos , Valor Preditivo dos Testes , Seio Aórtico/anormalidades
6.
J Investig Med High Impact Case Rep ; 6: 2324709617749622, 2018 Jan-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29399586

RESUMO

We present a case of a 48-year-old female who developed myocarditis and near fatal arrhythmias during high dose Il-2 therapy for metastatic renal cancer. On day 5 of therapy, the patient developed sudden onset chest pain, elevated cardiac enzymes and ST segment changes on EKG. Coronary angiogram was normal, however echocardiogram showed reduced ejection fraction and hemodynamic measurements showed elevated bilateral elevated filling pressures. The patient then developed episodes of recurrent ventricular arrhythmia, precipitated by bradycardia and PVC, requiring defibrillation and temporary pacemaker placement. Endomycardial biopsy was nonspecific showing fibrosis with subsequent cardiac MRI showed evidence of myocardial edema, consistent with Il-2 induced myocarditis in the setting of no prior cardiac history. After the discontinuation of Il-2 therapy, the patient displayed clinical improvement as well as improved ejection fraction. This case brings attention to the cardiac toxicities associated with high dose Il-2 therapy including potentially lethal arrhythmias and highlights the importance of careful cardiac screening prior to initiation of treatment.

7.
J Cardiovasc Comput Tomogr ; 12(1): 16-27, 2018 Jan - Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29198733

RESUMO

Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Cardiopatias/diagnóstico por imagem , Cardiopatias/terapia , Imagem por Ressonância Magnética/métodos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Terapia Assistida por Computador/métodos , Algoritmos , Projeto Auxiliado por Computador , Humanos , Imagem Tridimensional , Valor Preditivo dos Testes , Impressão Tridimensional , Desenho de Prótese , Interpretação de Imagem Radiográfica Assistida por Computador , Terapia Assistida por Computador/instrumentação
12.
Trends Cardiovasc Med ; 26(8): 722-730, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27373351

RESUMO

Remote digital health monitoring technologies can be synergistically organized to create a virtual medical system providing more continuous care centered on the patient rather than the bricks and mortar medical complex. Utilization of the digitalized patient health monitoring can facilitate diagnosis, treatment plans, physician-patient interaction, and accelerate the progress of medical research, education, and training. The field of cardiac electrophysiology has been an early adopter of this shift in care and serves as a paradigm applicable to all areas of medicine. The overall impact of this remote virtual care model on the quality of medical care and patient experience requires greater study, as well as vigilance as to the differences between technology and care in order to preserve the intangible and immeasurable factors that bring humanity to the art and science of medicine.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Prestação Integrada de Cuidados de Saúde/métodos , Tecnologia de Sensoriamento Remoto/métodos , Telemedicina/métodos , Telemetria/métodos , Algoritmos , Doenças Cardiovasculares/fisiopatologia , Procedimentos Clínicos , Desenho de Equipamento , Humanos , Aplicativos Móveis , Valor Preditivo dos Testes , Prognóstico , Tecnologia de Sensoriamento Remoto/instrumentação , Processamento de Sinais Assistido por Computador , Smartphone , Telemedicina/instrumentação , Telemetria/instrumentação
13.
Front Physiol ; 6: 149, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26074823

RESUMO

Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable "on-body" ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and related digital mobile health technologies are reshaping the clinician-patient interface with important implications for future healthcare delivery.

14.
J Cardiovasc Electrophysiol ; 26(5): 520-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25651872

RESUMO

BACKGROUND: The ubiquitous presence of internet-connected phones and tablets presents a new opportunity for cost-effective and efficient electrocardiogram (ECG) screening and on-demand diagnosis. Wireless, single-lead real-time ECG monitoring supported by iOS and android devices can be obtained quickly and on-demand. ECGs can be immediately downloaded and reviewed using any internet browser. OBJECTIVE: We compared the standard 12-lead ECG to the smartphone ECG in healthy young adults, elite athletes, and cardiology clinic patients. Accuracy for determining baseline ECG intervals and rate and rhythm was assessed. METHODS: In 381 participants, 30-second lead I ECG waveforms were obtained using an iPhone case or iPad. Standard 12-lead ECGs were acquired immediately after the smartphone tracing was obtained. De-identified ECGs were interpreted by automated algorithms and adjudicated by two board-certified electrophysiologists. RESULTS: Both smartphone and standard ECGs detected atrial rate and rhythm, AV block, and QRS delay with equal accuracy. Sensitivities ranged from 72% (QRS delay) to 94% (atrial fibrillation). Specificities were all above 94% for both modalities. CONCLUSION: Smartphone ECG accurately detects baseline intervals, atrial rate, and rhythm and enables screening in diverse populations. Efficient ECG analysis using automated discrimination and an enhanced smartphone application with notification capabilities are features that can be easily incorporated into the acquisition process.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia/métodos , Frequência Cardíaca , Programas de Rastreamento/instrumentação , Aplicativos Móveis , Smartphone , Telemedicina/instrumentação , Telemetria/instrumentação , Tecnologia sem Fio/instrumentação , Adolescente , Adulto , Idoso , Algoritmos , Arritmias Cardíacas/fisiopatologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Atitude Frente aos Computadores , Automação , Estudos de Casos e Controles , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por Computador , Inquéritos e Questionários , Adulto Jovem
15.
Rev Cardiovasc Med ; 16(4): 244-52, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26827746

RESUMO

Takotsubo cardiomyopathy (TC) is a reversible characteristic of left ventricular (LV) ballooning on cardiac imaging without significant coronary artery disease that is precipitated by stress. We performed a retrospective analysis of consecutive patient records to analyze outcomes of patients with TC. Of 100 patients with TC (90% women, mean age 67.7 y, SD = 15.96), 44 patients presented to the emergency room with chest pain, biomarker elevation, and electrocardiographic changes (ST segment elevation in 47%; primary TC) and 56 patients subsequently developed TC after an alternative initial diagnosis (ST segment elevation 27%; secondary TC; P = 0.04). Inciting events differed in those with primary versus secondary TC, with 48% of primary TC patients describing emotional stress; most secondary TC (75%) manifested after a surgical procedure or infection. Average length of hospital stay for primary TC was 6.68 days (SD = 5.32, range 1-28 d) and 18.22 (SD = 20.76, range 3-129 d) for secondary TC (P < .0001). Time to resolution of LV function was equal in both groups. With regard to mortality, eight of nine deaths occurred in secondary TC patients, and all nine deaths were attributable to comorbid medical conditions. Primary TC is frequently related to emotional stress, and carries a benign prognosis. Secondary TC is associated with an acute medical condition and results in a higher death rate.

16.
Curr Probl Diagn Radiol ; 43(5): 294-7, 2014 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25088221

RESUMO

Coronary artery aneurysms are an uncommon manifestation of systemic lupus erythematosus (SLE), with only 14 cases reported previously in the literature. Herein, we report a 29-year-old woman with SLE who developed clinical and serologic evidence of an SLE flare and presented with chest pain and elevated serum troponin-T level. Cardiac computed tomography was performed and demonstrated fusiform aneurysmal enlargement of the proximal and middle portions of the coronary arteries and a beaded appearance of the distal coronary arteries. Extensive intercostal artery aneurysms were also noted. Several areas of abnormal myocardial perfusion were also noted. The patient improved after treatment with steroid pulses and cyclophosphamide. This case report is the first description of the appearance of lupus coronary vasculitis on cardiac computed tomography.


Assuntos
Dor no Peito/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Radiografia Torácica , Tomografia Computadorizada por Raios X , Vasculite/diagnóstico por imagem , Adulto , Dor no Peito/etiologia , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Resultado do Tratamento , Troponina T/sangue , Vasculite/tratamento farmacológico
18.
World J Pediatr Congenit Heart Surg ; 4(2): 142-54, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23799727

RESUMO

Cardiovascular computed tomographic angiography (CCTA) provides an understanding of the three-dimensional (3D) coronary artery anatomy in relation to cardiovascular thoracic structures important to the surgical management of anomalous coronary arteries (ACAs). Although some ACA variants are not clinically significant, others can lead to ischemia/infarction, related acute ventricular dysfunction, ventricular arrhythmias, and sudden cardiac death. The CCTA is important to surgical decision making, as it provides noninvasive visualization of the coronary arteries with (1) assessment of origin, course, and termination of coronary artery anomalies in the context of 3D thoracic anatomy, (2) characterization of anatomy helpful for differentiation of benign versus hemodynamically significant variants, (3) identification of other cardiothoracic anomalies, and (4) detection of coronary artery disease. High-risk ACA anatomy in the appropriate clinical setting can require surgical intervention with decisions including minimally invasive versus open sternotomy approach, correction via reimplantation of a coronary artery, alteration of the ACA course without reimplantation, or bypass of an ACA. Given the rarity of ACA, there is limited data in the literature, and significant controversy related to the management issues. The management of ACA requires comprehensive clinical history, thorough assessment of cardiac function, and detailed anatomic imaging. Future studies will need to address the long-term outcome based on detailed assessment of original anatomy and surgical approach.


Assuntos
Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Imagem Tridimensional/métodos , Tomografia Computadorizada por Raios X/métodos , Procedimentos Cirúrgicos Cardiovasculares , Humanos
19.
Pacing Clin Electrophysiol ; 36(3): e70-3, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22432962

RESUMO

We report identification of a prominent Thebesian valve by cardiovascular computed tomography (CT) angiography impeding cannulation of the coronary sinus, with subsequent successful coronary venous lead placement with cannulation of the coronary sinus ostium via a transvenous femoral vein approach and subsequent cannulation of the ostium with the coronary venous lead with a left subclavian approach. A 57-year-old man with nonischemic dilated cardiomyopathy, New York Heart Association Class III heart failure, left bundle branch block, and an ejection fraction of 15%, underwent an attempted cardiac resynchronization therapy implantable cardiac defibrillator (ICD). As the coronary sinus ostium could not be cannulated, a dual chamber ICD was placed. The patient subsequently underwent cardiovascular CT angiography, which identified a prominent Thebesian valve at the coronary sinus ostium as the anatomic obstacle to cannulation. Reattempted transvenous cardiac resynchronization therapy was accomplished successfully with a double cannulation approach: cannulation of the coronary sinus ostium with a catheter via a transvenous femoral vein approach and subsequent cannulation with the coronary venous lead via a left subclavian approach. When a prominent Thebesian valve is identified as an obstacle to transvenous left ventricular lead placement, cannulation of the coronary sinus by an alternate venous approach may allow for a coronary venous route rather than necessitate an epicardial approach.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Cateterismo/métodos , Seio Coronário/anormalidades , Humanos , Masculino , Pessoa de Meia-Idade
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