Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 15.108
Filtrar
1.
Int J Mol Sci ; 21(7)2020 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-32276429

RESUMO

Patients with very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) can present with life-threatening cardiac arrhythmias. The pathophysiological mechanism is unknown. We reprogrammed fibroblasts from one mildly and one severely affected VLCADD patient, into human induced pluripotent stem cells (hiPSCs) and differentiated these into cardiomyocytes (VLCADD-CMs). VLCADD-CMs displayed shorter action potentials (APs), more delayed afterdepolarizations (DADs) and higher systolic and diastolic intracellular Ca2+ concentration ([Ca2+]i) than control CMs. The mitochondrial booster resveratrol mitigated the biochemical, electrophysiological and [Ca2+]i changes in the mild but not in the severe VLCADD-CMs. Accumulation of potentially toxic intermediates of fatty acid oxidation was blocked by substrate reduction with etomoxir. Incubation with etomoxir led to marked prolongation of AP duration and reduced DADs and [Ca2+]i in both VLCADD-CMs. These results provide compelling evidence that reduced accumulation of fatty acid oxidation intermediates, either by enhanced fatty acid oxidation flux through increased mitochondria biogenesis (resveratrol) or by inhibition of fatty acid transport into the mitochondria (etomoxir), rescues pro-arrhythmia defects in VLCADD-CMs and open doors for new treatments.


Assuntos
Acil-CoA Desidrogenase de Cadeia Longa/deficiência , Arritmias Cardíacas/prevenção & controle , Síndrome Congênita de Insuficiência da Medula Óssea/fisiopatologia , Compostos de Epóxi/farmacologia , Ácidos Graxos/química , Erros Inatos do Metabolismo Lipídico/fisiopatologia , Mitocôndrias/fisiologia , Doenças Mitocondriais/fisiopatologia , Doenças Musculares/fisiopatologia , Miócitos Cardíacos/fisiologia , Resveratrol/farmacologia , Potenciais de Ação , Arritmias Cardíacas/etiologia , Eletrofisiologia Cardíaca , Síndrome Congênita de Insuficiência da Medula Óssea/complicações , Ácidos Graxos/metabolismo , Humanos , Células-Tronco Pluripotentes Induzidas , Erros Inatos do Metabolismo Lipídico/complicações , Doenças Mitocondriais/complicações , Doenças Musculares/complicações , Miócitos Cardíacos/efeitos dos fármacos , Oxirredução
3.
Orv Hetil ; 161(7): 275-277, 2020 Feb.
Artigo em Húngaro | MEDLINE | ID: mdl-32037871

RESUMO

A 70-year-old male patient presented with acute respiratory failure. ECG at admission showed atrial tachycardia with macro T-wave alternans that disappeared as soon as normal sinus rhythm had returned. This ECG shape was not accompanied by either QT-prolongation or acute ischaemia. This case draws attention to atrial tachycardia (provoked here in a context of respiratory insufficiency) that may be the sole reason for macro T-wave alternans. Orv Hetil. 2020; 161(7): 275-277.


Assuntos
Arritmias Cardíacas/etiologia , Taquicardia Supraventricular/diagnóstico , Idoso , Eletrocardiografia , Humanos , Síndrome do QT Longo , Masculino , Insuficiência Respiratória/etiologia , Taquicardia Supraventricular/complicações
4.
Lancet Haematol ; 7(2): e168-e176, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32004486

RESUMO

Tumour lysis syndrome is a complication of chemotherapy for haematological malignancies; in particular, aggressive leukaemias and lymphomas. For haematological malignancies, targeted therapies, such as small molecule inhibitors and monoclonal antibodies, have a high anti-tumour activity, are well tolerated, and have a low incidence of associated tumour lysis syndrome. The BCL-2 inhibitor venetoclax has a high anti-tumour activity in chronic lymphocytic leukaemia, achieving deep remissions by potently inducing apoptosis and increasing the risk for tumour lysis syndrome. In this Viewpoint, we discuss the pathophysiology, risk factors, monitoring, changes in laboratory parameters, and clinical manifestations of tumour lysis syndrome, and the prophylaxis and treatments available for this complication. Prophylaxis and treatment strategies have been implemented as standard of care in patients receiving venetoclax to minimise the risk of both laboratory and clinical manifestations of tumour lysis syndrome.


Assuntos
Antineoplásicos/efeitos adversos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Terapia de Alvo Molecular/efeitos adversos , Proteínas de Neoplasias/antagonistas & inibidores , Inibidores de Proteínas Quinases/efeitos adversos , Proteínas Proto-Oncogênicas c-bcl-2/antagonistas & inibidores , Síndrome de Lise Tumoral/etiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Alopurinol/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/etiologia , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , Sinergismo Farmacológico , Humanos , Hiperfosfatemia/etiologia , Hiperfosfatemia/terapia , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Leucemia Linfocítica Crônica de Células B/enzimologia , Diálise Renal , Fatores de Risco , Índice de Gravidade de Doença , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Síndrome de Lise Tumoral/diagnóstico , Síndrome de Lise Tumoral/tratamento farmacológico , Síndrome de Lise Tumoral/prevenção & controle , Urato Oxidase/uso terapêutico
6.
J Cardiothorac Surg ; 15(1): 22, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948453

RESUMO

BACKGROUND: Thyroid storm is a rare, life-threatening disease triggered by an acute event or trauma, such as surgery of the thyroid or another area, and infection. However, recent studies have shown that irregular use or discontinuation of antithyroid drugs is the most common cause of thyroid storm. A cardiovascular event caused by thyroid storm following coronary artery bypass graft (CABG) is high output heart failure with extreme tachycardia, which can be fatal. Thyroid storm after nonthyroidal surgery, especially CABG, has been rarely reported, with only one reported case until now. Herein, we present a case of thyroid storm onset in a patient who underwent CABG. CASE PRESENTATION: A 74-year-old woman with a history of antithyroid medication discontinuation against medical advice underwent urgent CABG. The patient exhibited extreme tachycardia postoperatively, which is highly suggestive of thyroid storm. Although a higher infection risk is an important consideration, a high-dose steroid was used to control the intractable tachycardia that did not respond to beta-blocker administration. Despite appropriate antibiotic treatment, the patient's condition was exacerbated, and she developed multiple organ failure resulting from adult respiratory distress syndrome progression, and she died on day 8 after surgery. CONCLUSIONS: Risk factors for thyroid storm after CABG and its treatment outcomes are rarely reported. Patients with a history of inappropriate antithyroid medication prescription should be in a euthyroid state before surgery. If surgery is imminent, anticipating thyroid storm and its treatment as well as a euthyroid state can improve recovery outcomes postoperatively.


Assuntos
Antitireóideos/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias/cirurgia , Hipertireoidismo/tratamento farmacológico , Adesão à Medicação , Crise Tireóidea/etiologia , Idoso , Antitireóideos/efeitos adversos , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Doença das Coronárias/complicações , Evolução Fatal , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Hipertireoidismo/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Fatores de Risco , Crise Tireóidea/terapia , Resultado do Tratamento
7.
Am Heart J ; 220: 213-223, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31864099

RESUMO

BACKGROUND: Cardiogenic syncope in Brugada syndrome (BrS) increases the risk of major events. Nevertheless, clinical differentiation between cardiogenic and vasovagal syncope can be challenging. We characterized the long-term incidence of major events in a large cohort of BrS patients who presented with syncope. METHODS: From a total of 474 patients, syncope was the initial manifestation in 135 (28.5%) individuals (43.9 ±â€¯13.9 years, 71.1% male). The syncope was classified prospectively as cardiogenic, vasovagal, or undefined if unclear characteristics were present. Clinical, electrocardiographic, genetic, and electrophysiologic features were analyzed. Cardiogenic syncope, sustained ventricular arrhythmias, and sudden death were considered major events in follow-up. RESULTS: In 66 patients (48.9%), the syncope was cardiogenic; in 51 (37.8%), vasovagal and in 18 (13.3%); undefined. The electrophysiology study (EPS) inducibility was more frequent in patients with cardiogenic syncope and absent in all patients with undefined syncope (28 [53.8%] vs 5 [12.2%] vs 0 [0%]; P < .01). During follow-up (7.7 ±â€¯5.6 years), only patients with cardiogenic syncope presented major events (16 [11.9%]). Among patients with inducible EPS, 7 (21.2%) presented major events (P = .04). The negative predictive value of the EPS for major events was 92.4%. The incidence rate of major events was 2.6% person-year. Parameters associated with major events included cardiogenic syncope (hazard ratio [HR] 6.3; 95% CI 1.1-10.4; P = .05), spontaneous type 1 electrocardiogram (HR 3.7; 95% CI 1.3-10.5; P = .01), and inducible EPS (HR 2.8; 95% CI 1.1-8.8; P = .05). CONCLUSIONS: An accurate syncope classification is crucial in BrS patients for risk stratification. In patients with syncope of unclear characteristics, the EPS may be helpful to prevent unnecessary implantable cardioverter defibrillators.


Assuntos
Síndrome de Brugada/complicações , Síncope/etiologia , Adulto , Arritmias Cardíacas/etiologia , Síndrome de Brugada/fisiopatologia , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Canal de Sódio Disparado por Voltagem NAV1.5/genética , Valor Preditivo dos Testes , Prevalência , Síncope/classificação , Síncope/epidemiologia , Síncope/fisiopatologia , Síncope Vasovagal/epidemiologia , Síncope Vasovagal/etiologia , Síncope Vasovagal/fisiopatologia , Teste da Mesa Inclinada
8.
Angiology ; 71(5): 389-396, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31876165

RESUMO

The risk of sudden cardiac death (SCD) is high in heart failure (HF) patients. Sudden arrhythmic death (SAD) is a frequent cause of exit in HF patients at the lower end of the HF spectrum, and implantable cardioverter-defibrillators have been recommended to prevent these life-threatening rhythm disturbances in select patients. However, less is known regarding the cause of SCD in patients at the upper end of the HF spectrum, despite the fact that the majority of out-of-hospital SCD victims have unknown or near-normal/normal left ventricular ejection fraction (LVEF). In this review, we report the epidemiology, summarize the mechanisms, discuss the diagnostic challenges, and propose a stepwise approach for the prevention of SAD in HF with near-normal/normal LVEF.


Assuntos
Arritmias Cardíacas/etiologia , Morte Súbita Cardíaca/etiologia , Insuficiência Cardíaca/complicações , Humanos , Medição de Risco
9.
Ann Vasc Surg ; 62: 452-462, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394251

RESUMO

BACKGROUND: Whether remote ischemic preconditioning (RIPC), through several cycles of ischemia-reperfusion, can generate endogenous protective substances to protect patients undergoing elective major vascular surgery remains unclear. The results derived from many randomized controlled trials (RCTs) have been discrepant. METHODS: PubMed (1966 to May 2018) and EMBASE (1966 to May 2018) databases were searched to identify all published RCTs that assessed the effect of RIPC in patients undergoing elective major vascular surgery. Then, we performed a systematic review and meta-analysis to merge the outcomes of RIPC procedures from each RCT, which included all-cause mortality, myocardial infarction (MI), acute kidney injury (AKI), and/or new-onset arrhythmia. RESULTS: A total of 909 patients were enrolled from 10 eligible studies that were conducted from 2007 through 2016. A fixed effect model was utilized in this study to pool each effect size. Pooled analyses of all RCTs showed that RIPC did not reduce the incidence of all-cause mortality (pooled risk ratio [RR] 1.36, 95% confidence interval [CI] 0.63-2.92, P = 0.56), MI (pooled RR 0.77, 95% CI 0.48-1.22, P = 0.38), AKI (pooled RR 0.93, 95% CI 0.68-1.27, P = 0.10), or new-onset arrhythmia (pooled RR 1.47, 95% CI 0.83-2.60, P = 0.52) compared with the control treatment. The publication bias detected by Begg's test was low. CONCLUSIONS: There is no prominent evidence to support the hypothesis that RIPC can provide perioperative protection to patients undergoing elective major vascular surgery. Therefore, the routine use of RIPC to reduce the incidence of perioperative complications of these operations may not be recommended.


Assuntos
Precondicionamento Isquêmico/métodos , Oclusão Terapêutica , Procedimentos Cirúrgicos Vasculares , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/prevenção & controle , Idoso , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Precondicionamento Isquêmico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fluxo Sanguíneo Regional , Fatores de Risco , Oclusão Terapêutica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
10.
Rev Med Liege ; 74(12): 667-671, 2019 12.
Artigo em Francês | MEDLINE | ID: mdl-31833278

RESUMO

INTRODUCTION: Anemia remains one of the main concerns of the day-today life of Internist since it ranks third among the pathologies seen in Internal Medicine Departments. OBJECTIVE: it seemed appropriate for the SiFMI Group (Common Situations in Internal Medicine of the SNFMI) to carry out a study of anemia evaluating the contribution to the diagnosis of the «classical¼ semiology of the anemic syndrome. This work reports the results from the study of 204 patients aged 75 years and more. METHOD: A prospective, non interventional multicenter study was carried out in Internal and Geriatric Departments in the period September 2015-September 2017. Clinical and biological variables were collected. RESULTS: 204 patients from 10 Internal or Geriatric Departments were included in the period September 2015-September 2017. They were assigned into two groups with and without anemia. According to this study, it seems that the following parameters : asthenia, dyspnea (NYHA stages III and IV), palpitations, chest pain, tachycardia, hypotension as well as confusion, falls, depression and MMSE showed no significant statistical difference between both groups in contrast to pallor, edema, albumin and ECG. CONCLUSION: Clinical diagnosis of anemia in elderly individuals remains a challenge. It is difficult to establish a diagnostic protocol in this population.


Assuntos
Anemia , Idoso , Anemia/complicações , Anemia/diagnóstico , Arritmias Cardíacas/etiologia , Dor no Peito/etiologia , França , Humanos , Estudos Prospectivos
11.
Fa Yi Xue Za Zhi ; 35(5): 567-571, 2019 Oct.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31833290

RESUMO

Abstract: Objective To study the effect of overwork stress response on the expression of connexin 43(Cx43) and connexin 45(Cx45) in cardiomyocytes and on cardiac function. Methods The experimental animals were divided into control group, overworked 1-month group and overworked 2-month group. A overworked rat model was established by forcing swimming of overworked group. The expressions of Cx43 and Cx45 in myocardial tissues of experimental animals were detected by Western blotting, while the corresponding myocardial tissues were stained with hematoxylin-eosin (HE) staining and Masson's staining, then histologically observed. Results Western blotting results showed that, compared with the control group, Cx43 expression in myocardial tissues of overworked rats decreased while Cx45 expression increased. HE staining and Masson's staining results showed that hypertrophy, rupture and interstitial fiber tissue hyperplasia were observed in myocardial fibers of overworked rats. Conclusion Overwork stress response may affect cardiac function as an independent factor and may even cause heart failure or arrhythmias and lead to death.


Assuntos
Arritmias Cardíacas/etiologia , Conexina 43/metabolismo , Conexinas/metabolismo , Insuficiência Cardíaca , Miócitos Cardíacos/metabolismo , Animais , Arritmias Cardíacas/metabolismo , Miocárdio , Ratos
12.
Diabetes Res Clin Pract ; 158: 107878, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31669624

RESUMO

BACKGROUND: Sudden nocturnal death is a syndrome that usually affects patients with diabetes mellitus type 1 (DM1), being described mainly due to ventricular arrhythmias in response to nocturnal hypoglycemia. OBJECTIVES: Evaluate the relation between hypoglycemia and ventricular arrhythmias in patients with DM1 and normal structural heart. METHOD: Prospective, observational study with DM1 patients and normal structural heart on echocardiogram aged 18-60 years, of both sexes receiving insulin therapy for at least five years. Intermittent glucose reading device was implanted (iPro2 - Medtronic/USA) and 24hr ambulatory electrocardiographic recording by the Holter system (Cardios Systems - Brazil). Patients were monitored for hypoglycemia without any type of induction (interstitial glucose <70 mg/dl) and cardiac arrhythmias within 24 h. RESULTS: Thirty-two patients were evaluated, with mean-age of 35 years, being 16 men. Eleven patients (34%) did not have hypoglycemia, other 3 (27.3%) also had no arrhythmia, while 8 (72.7%) had arrhythmias interpreted as irrelevant. The other 21 patients (66%) presented some hypoglycemic episodes and 10 (47.6%) did not present arrhythmias, whereas 11 (52.4%) presented arrhythmias considered not clinically significant, as also found in non-diabetic individuals. CONCLUSION: In patients with DM1 without structural heart disease there was no relationship between cardiac arrhythmia and episodes of hypoglycemia.


Assuntos
Arritmias Cardíacas/etiologia , Morte Súbita/etiologia , Diabetes Mellitus Tipo 1/complicações , Eletrocardiografia/métodos , Hipoglicemia/complicações , Adolescente , Adulto , Arritmias Cardíacas/patologia , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/patologia , Feminino , Humanos , Hipoglicemia/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
13.
Heart Surg Forum ; 22(5): E385-E389, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31596717

RESUMO

BACKGROUND: The aim of this study was to evaluate the frequency of postoperative complications in patients who underwent coronary artery bypass grafting (CABG) and simultaneous carotid endarterectomy (CEA) and find predictors of postoperative complications. METHODS: We retrospectively evaluated 86 patients after simultaneous CABG and CEA. Inclusion criteria were: patients with asymptomatic carotid stenosis with a reduction of the carotid lumen diameter of more than 70% detected with Doppler ultrasound and diagnosed with one, two, or three vessel coronary artery disease with coronary stenosis more than 75% and hemodynamic significant stenosis of the left main artery. Exclusion criteria were patients with urgent and previous cardiac surgery and patients with myocardial infarction and stroke in the past one month. We monitored preoperative (ejection fraction, coronarography status), operative (number of grafts, on-pump or off-pump technique) and postoperative (extubation, unit care and hospital stay, bleeding and reoperation) details and complications (myocardial infarction, neurological events, inotropic agents and transfusion requiry, infection, arrhythmic complication, renal failure, mortality). RESULTS: Postoperative complications were observed in 18 (29.9%) patients. Two patients (2.3%) had postoperative stroke and one patient (1.2%) had transient ischemic attack (TIA). Previous stroke was a predictor for increased postoperative neurological events (P < .05). Intrahospital mortality was 8.1%. CONCLUSION: Simultaneous CEA and CABG were performed with low rates of stroke and TIA. Previous stroke was identified as a predictor for increased postoperative neurological complications.


Assuntos
Estenose das Carótidas/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Doenças Assintomáticas , Estenose das Carótidas/complicações , Causas de Morte , Comorbidade , Estenose Coronária/complicações , Feminino , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Masculino , Mediastinite/epidemiologia , Mediastinite/etiologia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
15.
Medicine (Baltimore) ; 98(38): e17212, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567975

RESUMO

RATIONALE: Anomalous Origin of Left Coronary Arteries from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland (BWG), is a rare form of coronary artery anomaly that is usually discovered in the first few months of life. Only rarely can patients with this anomaly reach adulthood without symptoms. PATIENT CONCERNS: A 28-year-old female was witnessed suddenly collapse with a seizure-like episode by her colleagues at work. DIAGNOSIS AND INTERVENTION: Routine cardiopulmonary resuscitation was performed by emergency medical service technologists. The patient was unable to be revived. Postmortem examination revealed the patient had ALCAPA with a focal chronic ischemic injury of the left ventricle. Moreover, a high take-off of the right coronary artery was also discovered. OUTCOMES: The patient passed away due to ALCAPA. The mechanism of death was cardiac arrhythmia being triggered by myocardial ischemic changes. LESSONS: In the rare cases where ALCAPA manifests in an asymptomatic adult, the mortality rate is very high. This case demonstrates the importance of awareness of such patients living under the tremendous risk of sudden cardiac death.


Assuntos
Anomalias dos Vasos Coronários/patologia , Artéria Pulmonar/anormalidades , Adulto , Arritmias Cardíacas/etiologia , Doenças Assintomáticas , Autopsia , Morte Súbita Cardíaca , Feminino , Humanos
16.
Int J Med Inform ; 132: 104011, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31654966

RESUMO

BACKGROUND: Adults with congenital heart disease (ACHD) often suffer from deterioration related to cardiac arrhythmias, hypertension (HT) or heart failure (HF), frequently occurring between planned visits. Mobile health (mHealth) could improve management through remote monitoring by enabling swift therapeutic response and detecting new diagnoses. METHODS: We performed a prospective study employing mHealth in ACHD patients, weekly monitoring heart rhythm, weight and blood pressure. In case of consecutive threshold exceeding measurements or in case of new diagnosis, patients were contacted and if needed the treating physician was consulted. Inclusion criteria were: palpitations within the last three years (with or without arrhythmia diagnosis) or HF NYHA class ≥ II. We evaluated the detection of recurrences and new diagnosis of arrhythmias, HT and HF, adherence and patient experience (Net Promotor Score (NPS)). RESULTS: In total, 109 of the 268 invited ACHD patients were enrolled, 80 with palpitations, 13 with HF, 16 experienced both, mean age 45 (±13) years, 33% male. Median follow-up was 12 (Q1-Q3;9-14) months, 91 patients initiated all measurements (heart rhythm, weight and blood pressure). In 25% of the patients with diagnosed arrhythmias (14/56) recurrences of arrhythmias were detected; 13% of the patients with undiagnosed palpitations (4/32) were diagnosed with novel arrhythmias. In 38% of the patients with HT at baseline (6/16), treatment adjustment was necessary, 4% of the patients without HT (4/76) received novel HT diagnosis. Diuretics were adjusted in 7% of the patients with HF (2/29). Adherence was > 70% in 77% of the patients that started weekly measurements (70/91). Patients that were female, older of age and experienced palpitations at inclusion were more likely to acquire an adherence of > 70%. NPS was completed by 68 patients, 57 patients (84%) were promotors or neutral, and 11 patients (16%) were critics. CONCLUSIONS: mHealth offers advantages in the management of selected ACHD patients; it enabled early detection of recurrences and new diagnosis of arrhythmias, hypertension and heart failure, which lead to swift therapeutic response or remote reassurance. Furthermore, mHealth was well accepted with high adherence and positive patient experience.


Assuntos
Arritmias Cardíacas/prevenção & controle , Cardiopatias Congênitas/complicações , Insuficiência Cardíaca/prevenção & controle , Hipertensão/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Telemedicina/métodos , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Gerenciamento Clínico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Telemedicina/estatística & dados numéricos
17.
Indian J Pathol Microbiol ; 62(4): 599-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31611449

RESUMO

The estimated incidence of primary cardiac tumors is extremely rare. Among it, cardiac myxoma represents the most common benign cardiac tumor constituting about 80% of cases. We are presenting a 30-year-old female with large left atrial myxoma. She was presented with severe dyspnea, palpitations, and systolic murmurs. On 2D echocardiography, left atrial mass obstructing mitral flow was noted. On cardiac magnetic resonance imaging, a single, large, mobile pedunculated mass lesion in left atrium attached to inferior interatrial septum with heterogeneous enhancement was noted, which was likely represented to be myxoma. The mass was surgically excised and valve repairing was done. We received large, solid, lobulated, gray white, soft-to-firm mass measuring 4.5 × 4.1 × 2.5 cm, and on microscopy showed cardiac myxoma with cartilaginous differentiation. We are presenting this case for its clinical, imaging, and uncommon histological features.


Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Mixoma/patologia , Adulto , Arritmias Cardíacas/etiologia , Ecocardiografia , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Humanos , Imagem por Ressonância Magnética
18.
PLoS Comput Biol ; 15(10): e1007421, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31658247

RESUMO

This paper presents a morphological analysis of fibrotic scarring in non-ischemic dilated cardiomyopathy, and its relationship to electrical instabilities which underlie reentrant arrhythmias. Two dimensional electrophysiological simulation models were constructed from a set of 699 late gadolinium enhanced cardiac magnetic resonance images originating from 157 patients. Areas of late gadolinium enhancement (LGE) in each image were assigned one of 10 possible microstructures, which modelled the details of fibrotic scarring an order of magnitude below the MRI scan resolution. A simulated programmed electrical stimulation protocol tested each model for the possibility of generating either a transmural block or a transmural reentry. The outcomes of the simulations were compared against morphological LGE features extracted from the images. Models which blocked or reentered, grouped by microstructure, were significantly different from one another in myocardial-LGE interface length, number of components and entropy, but not in relative area and transmurality. With an unknown microstructure, transmurality alone was the best predictor of block, whereas a combination of interface length, transmurality and number of components was the best predictor of reentry in linear discriminant analysis.


Assuntos
Arritmias Cardíacas/patologia , Cardiomiopatia Dilatada/fisiopatologia , Cicatriz/patologia , Arritmias Cardíacas/etiologia , Estudos de Coortes , Simulação por Computador , Humanos , Interpretação de Imagem Assistida por Computador , Modelos Lineares , Imagem por Ressonância Magnética/métodos , Modelos Teóricos , Infarto do Miocárdio/patologia , Isquemia Miocárdica/patologia , Miocárdio/patologia
19.
Undersea Hyperb Med ; 46(4): 421-427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509898

RESUMO

Introduction: About 26% of diving-related fatalities are caused by cardiac disease, part of which might be associated with fatal arrhythmias. This raises the question as to whether fatal arrhythmias are being provoked by hyperbaric conditions themselves or if exercise or stress provokes the fatal arrhythmias in cases of underlying (ischemic) cardiac disease. Objective: To measure the influence of hyperbaric conditions (50 msw) on cardiac conduction and arrhythmias in professional divers by means of ECG. Methods: This is a prospective study on military divers in a hyperbaric chamber with continuous ECG monitoring using Holter registrations. Supraventricular and ventricular ectopy was registered during hyperbaric conditions. RR, PR, QRS, QT and QTc intervals were calculated at 50 msw and compared with ECGs at rest. Results: Included were 17 male military divers who made 20 dives. A total of 10 PVCs, 45 PACs, four atrial runs and four atrial pairs were seen. Significant prolongation of the PR interval was seen and a decrease of in QRS duration at 50 msw. There was no significant change in the RR, QT and QTc intervals. Conclusion: In these divers, no clinically relevant arrhythmias were observed during wet dives in a recompression chamber at 50 msw. We observed a small prolongation of PR interval that is probably not clinically relevant in divers without any known conduction disorders.


Assuntos
Arritmias Cardíacas/diagnóstico , Mergulho/efeitos adversos , Pressão/efeitos adversos , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Descompressão , Mergulho/fisiologia , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/métodos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Estudos Prospectivos , Água do Mar , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia
20.
Int Heart J ; 60(5): 1196-1200, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484862

RESUMO

Malignant arrhythmia is a fast cardiac arrhythmia that can lead to a hemodynamic abnormality within a short time, most of which is ventricular tachycardia or ventricular fibrillation (VF), which should be managed in time. Both organic and nonorganic cardiac diseases have the potential to cause malignant arrhythmia. We report a noteworthy case of malignant arrhythmia in a teenager during exercise. Transthoracic echocardiography, cardiac magnetic resonance (CMR), electrophysiological study, magnetic resonance imaging of the brain, electroencephalography, chest X-ray, and blood tests were all normal. Twelve-lead electrocardiography showed incomplete right bundle branch block (IRBBB). Two heterozygous missense variants of the desmocollin-2 gene (DSC2, c.G2446A/p.V816M) and desmoplakin gene (DSP, c.G3620A/p.R1207K) were detected in the peripheral blood of this teenager and his father by genetic testing, which encoded a desmosomal protein that was related to arrhythmogenic right ventricular cardiomyopathy (ARVC). In these two rare variants, DSC2 V816M has been reported but uncertain significance, whereas DSP R1207K is never reported. Therefore, the two site variants in DSC2 and DSP genes are likely to become a new research focus for diagnosis and treatment of ARVC in the future. Meanwhile, this report emphasizes that, in addition to a standard set of laboratory tests and examinations, genetic testing may be useful for analyzing the causes of malignant arrhythmia.


Assuntos
Arritmias Cardíacas/etiologia , Bloqueio de Ramo/genética , Desmocolinas/genética , Eletrocardiografia/métodos , Predisposição Genética para Doença , Adolescente , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/genética , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico , Ecocardiografia/métodos , Testes Genéticos/métodos , Humanos , Masculino , Linhagem , Prognóstico , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA