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1.
Cardiovasc Ultrasound ; 19(1): 31, 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429107

RESUMO

BACKGROUND: Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing. CONCLUSION: This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.


Assuntos
COVID-19/epidemiologia , Angiografia Coronária/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Cardiomiopatia de Takotsubo/diagnóstico , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Cardiomiopatia de Takotsubo/epidemiologia
2.
Nutr Metab Cardiovasc Dis ; 31(5): 1501-1508, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33810962

RESUMO

BACKGROUND AND AIMS: Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation. METHODS AND RESULTS: 231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function. CONCLUSIONS: In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.


Assuntos
Doença da Artéria Coronariana/sangue , Hiperuricemia/sangue , Ácido Úrico/sangue , Disfunção Ventricular Esquerda/sangue , Função Ventricular Esquerda , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Diástole , Ecocardiografia , Feminino , Humanos , Hiperuricemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
6.
Radiother Oncol ; 152: 146-150, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32679303

RESUMO

BACKGROUND AND PURPOSE: Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in increasing mortality rate in oncological patients by affecting pericardium, myocardium, valvs and coronaries. Currently, regarding the risk of Coronary Artery Disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5-10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patients without cardiovascular risk factors who sustained radiotherapy, using a cohort of patients presenting with at least one cardiovascular risk factor as control group. DESIGN AND METHODS: A population of 115 patients who sustained chest irradiation (and associated chemotherapy), presenting without classic cardiovascular risk factors or typical symptoms suggesting CAD, was evaluated with exercise stress electrocardiography. 135 patients with at least one risk factor for cardiovascular disease candidate to stress testing for primary prevention or for atypical symptoms served as control group. RESULTS: The cohort of irradiated patients without classical cardiovascular risk factors is younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p < 0.001) and presents a lower percentage of males when compared with the control group. In this latter group 25.9% of subjects has diabetes, 62.9% dyslipidaemia, 67.4% hypertension and 19.2% actively smoke. Despite this important differences regarding classic cardiovascular risk factors, no significant differences were found in the number of positive exercise stress electrocardiography (10.4 vs 5.9%, p = ns). CONCLUSIONS: Chest irradiation represents a strong cardiovascular risk factor. In fact, prevalence of positive ECG-stress test is not different (nor higher and nor lower) in irradiated subjects without cardiovascular risk and not irradiated patients with classic cardiovascular risk.


Assuntos
Doenças Cardiovasculares , Doença da Artéria Coronariana , Isquemia Miocárdica , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Angiografia Coronária , Eletrocardiografia , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Fatores de Risco
7.
Rev Med Chil ; 148(3): 409-413, 2020 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-32730388

RESUMO

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.


Assuntos
Coração Auxiliar , Choque Cardiogênico/terapia , Disfunção Ventricular Esquerda , Diabetes Mellitus Tipo 2 , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Pessoa de Meia-Idade
9.
Rev. méd. Chile ; 148(4): 548-552, abr. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1127095

RESUMO

Transcatheter aortic valve implantation (TAVI) has a lower perioperative risk than traditional surgery mostly when the transfemoral access is used. Some patients have anatomical conditions that contraindicate the use of this route. Lithoplasty is a novel technique that fractures calcium in coronary and peripheral arteries using pulsatile waves transmitted through an angioplasty balloon. We report an 83 year-old male with an aortic stenosis requiring TAVI, with severe calcification of his femoral and aortic arteries. A balloon lithoplasty of the right iliac-femoral tract was carried out, which allowed the use of the transfemoral route to install the aortic prosthesis. The patient had a good subsequent evolution.


Assuntos
Humanos , Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Fluoroscopia , Cateterismo Cardíaco , Resultado do Tratamento
10.
Rev. méd. Chile ; 148(3): 409-413, mar. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1115807

RESUMO

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Choque Cardiogênico/terapia , Coração Auxiliar , Disfunção Ventricular Esquerda , Oxigenação por Membrana Extracorpórea , Diabetes Mellitus Tipo 2
11.
Platelets ; 31(8): 1090-1093, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32090666

RESUMO

Cangrelor is an intravenously administered P2Y12 receptor antagonist, which has been approved for adult patients undergoing percutaneous coronary intervention and, due to its unique pharmacokinetics, it allows effective and controllable peri-procedural platelet inhibition. We report the case of a 6-year-old child with anomalous origin of right coronary artery from aortic left coronary sinus, who underwent elective surgical replacement of stenotic and calcified conduit between the right ventricle and the main pulmonary artery. The surgery was complicated by acute myocardial infarction secondary to coronary extrinsic compression. The patient was successfully treated with urgent percutaneous coronary intervention (simultaneous V-stenting) and cangrelor infusion, subsequently switched to clopidogrel therapy.

12.
Eur Heart J Acute Cardiovasc Care ; 9(7): NP3-NP7, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27221956

RESUMO

We report the case of a 23-year-old man who developed an acute ST-elevation myocardial infarction secondary to acute thrombotic occlusion of the proximal left anterior descending coronary artery five years after undergoing chemotherapy, radiotherapy, haematopoietic stem cell transplantation for acute lymphoblastic leukaemia and bulky mediastinal mass involving the pleura and pericardium. His medical history also included Graft versus Host Disease developed 13 months after transplantation and acute myocarditis three months before the actual hospital admission. To the best of our knowledge, coronary artery disease as a complication of haematopoietic stem cell transplantation and low-dose mediastinal radiation therapy in young patients has been rarely reported in the medical literature. Clinicians should have a high degree of suspicion of coronary artery disease in patients treated with allogeneic haematopoietic stem cell transplantation, especially in patients previously treated with target mediastinal radiotherapy, as a group at risk of premature and significantly accelerated atherosclerosis, in order to make a timely and correct diagnosis.


Assuntos
Aterosclerose/complicações , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirurgia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Aterosclerose/diagnóstico , Angiografia Coronária , Eletrocardiografia , Humanos , Masculino , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Adulto Jovem
13.
Platelets ; 31(6): 820-824, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31607192

RESUMO

Complete blood count should always be considered to tailor diagnosis and appropriate management in patients with acute ischemic heart disease. We present a challenging case of recurrent acute coronary syndrome, in the context of very high thrombotic risk due to concomitant inflammatory disease. Although no general guidelines exist for the switch between antiplatelet agents, particularly in the acute setting, in specific cases, the availability of different orally- and i.v.-acting agents and platelet function tests may allow to discriminate among multiple possible mechanisms of drug failure or side effects in the individual patient.


Assuntos
Síndrome Coronariana Aguda/complicações , Colite Isquêmica/complicações , Trombose Coronária/etiologia , Hemorragia/etiologia , Trombose Coronária/patologia , Feminino , Hemorragia/patologia , Humanos , Pessoa de Meia-Idade
14.
G Ital Cardiol (Rome) ; 20(12): 694-705, 2019 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-31834294

RESUMO

The aim of this review is to explore the available evidence concerning the relationship between the different parameters of the complete blood count, its pathophysiological changes and cardiovascular disease, specifically focusing on the acute ischemic setting. Erythrocytes, leukocytes and platelets undergo significant and more or less durable changes over time in response to conditions of systemic inflammatory, infectious and neoplastic disease. This is the reason why blood cell count parameters can (and should) be implemented in the global assessment of the patient with acute coronary syndrome.From the literature review it emerges that anemia and thrombocytopenia have an independent negative prognostic role in the medium and long term, being markers of the overall frailty of patients with ischemic heart disease. On the other hand, essential thrombocythemia and polycythemia vera, two chronic myeloproliferative neoplasms, are characterized by an important increase in thrombotic risk. Both conditions are given a brief description for the particular importance of the close collaboration between cardiologists and hematologists in the diagnosis and treatment of these diseases in the context of ischemic heart disease.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Doenças Hematológicas/fisiopatologia , Trombose/patologia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/fisiopatologia , Contagem de Células Sanguíneas , Doenças Hematológicas/complicações , Humanos , Prognóstico , Risco , Trombose/epidemiologia
15.
Rev. chil. cardiol ; 38(3): 204-209, dic. 2019. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1058064

RESUMO

Resumen: TAVI transfemoral en una paciente con obesidad extrema y estenosis aórtica severa. Una mujer extremadamente obesa (IMC 62.5 Kg/M2) con estenosis aórtica severa fue descartada para cirugía bariátrica y reemplazo valvular aórtico. Se efectuó una TAVI por vía transfemoral, sin anestesia general. Se describen cuidadosas técnicas para efectuar la punción femoral y su sellado posterior. La paciente se recuperó sin incidentes, la gradiente transvalvular aórtica se redujo significativamente y hubo mínima insuficiencia valvular.


Abstract: An extremely obese woman (BMI 62.5 Kg/M2) with severe symptomatic aortic stenosis was discarded for bariatric surgery or aortic valve replacement. A transfemoral TAVI was performed, without general anesthesia. Careful techniques to perform and seal the transfemoral puncture are described. The patient recovered uneventfully with a significant decrease in aortic valve gradient and minimal aortic insufficiency.

16.
Rev. méd. Chile ; 147(10): 1350-1354, oct. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1058605

RESUMO

We report a 65-years old woman with a history of permanent atrial fibrillation with high risk for ischemic and bleeding events. She developed a heart failure with severely impaired left ventricular ejection fraction and severe secondary mitral regurgitation. Given her high surgical risk, using transesophageal echocardiography guidance, a concomitant deployment of two MitraClip devices using a high-posterior septal puncture and a left atrial appendage closure with an Amplatzer Amulet occluder were performed through the same access.


Assuntos
Humanos , Feminino , Idoso , Fibrilação Atrial/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Apêndice Atrial/cirurgia , Dispositivo para Oclusão Septal , Insuficiência da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Angiografia/métodos , Fatores de Risco , Resultado do Tratamento , Ecocardiografia Transesofagiana
17.
G Ital Cardiol (Rome) ; 20(9): 499-511, 2019 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-31530951

RESUMO

The term MINOCA (myocardial infarction with non-obstructive coronary arteries) defines acute myocardial infarction with angiographic evidence of no significant coronary artery stenosis. Heterogeneous diseases are labelled as MINOCA. Incidence and epidemiological aspects differ on the basis of etiological causes. MINOCA include plaque (causing <50% stenosis) rupture or erosion, coronary embolism and dissection, and coronary artery spasm. Diagnosis may require multiple diagnostic tools, including cardiac imaging or provocative tests, in addition to standard coronary angiography, according to clinical suspicion. Cardiac magnetic resonance plays a key role in confirming the diagnosis and excluding other diseases with similar clinical presentation. Prognosis is not as benign as previously thought, on the opposite it is characterized by morbidity and mortality rates similar to other forms of myocardial infarction. Once the causative mechanism has been identified, appropriate therapy can be delivered.


Assuntos
Infarto do Miocárdio , Vasos Coronários/diagnóstico por imagem , Árvores de Decisões , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Prognóstico
19.
Sci Rep ; 9(1): 1232, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718760

RESUMO

Baroreflex dysfunction is a diffuse chronic condition that is expected to be followed by a profound loss of organization of BP and HR variability. Nevertheless, long-term effects of baroreflex withdrawal are still debated. Aim of our work was to study BP and HR changes long term after sino-aortic denervation (SAD). Inter-beat-interval (IBI) and intra-arterial BP were recorded beat-by-beat in 43 Wistar-Kyoto rats (Controls, n = 33; SAD rats, n = 10). Power spectra were calculated in controls and in SAD rats within three days and at seven months from denervation. Compared to controls, chronic SAD rats showed 1) similar mean BP (control vs SAD: 95 ± 16 vs 87 ± 22 mmHg) and IBI (171 ± 22 vs 181 ± 15 ms) values, 2) dramatically higher values of BP variance (12 ± 2 vs 64 ± 2 mmHg2, p < 0.01) and of ultra- (ULF) and very-low-frequency (VLF) BP oscillations, 3) dramatically higher values of IBI variability (24 ± 2 vs 71 ± 4 ms2, p < 0.01) and of ULF-IBI oscillations that were synchronized with BP oscillations. Chronic SAD rats reveal a marked change in the pattern of cardiovascular variability characterized by the appearance of synchronized slower oscillations of BP and HR. The cardiovascular system, therefore, retains a high level of organization despite the absence of a reflex control mechanism.


Assuntos
Aorta/fisiologia , Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Nó Sinoatrial/fisiologia , Animais , Aorta/inervação , Modelos Animais , Ratos , Ratos Endogâmicos WKY , Nó Sinoatrial/inervação , Simpatectomia , Fatores de Tempo
20.
Rev Med Chil ; 147(10): 1350-1354, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-32186646

RESUMO

We report a 65-years old woman with a history of permanent atrial fibrillation with high risk for ischemic and bleeding events. She developed a heart failure with severely impaired left ventricular ejection fraction and severe secondary mitral regurgitation. Given her high surgical risk, using transesophageal echocardiography guidance, a concomitant deployment of two MitraClip devices using a high-posterior septal puncture and a left atrial appendage closure with an Amplatzer Amulet occluder were performed through the same access.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Dispositivo para Oclusão Septal , Idoso , Angiografia/métodos , Ecocardiografia Transesofagiana , Feminino , Humanos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
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