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1.
BMC Infect Dis ; 20(1): 730, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028242

RESUMO

BACKGROUND: The incidence of Lyme disease (LD) in North America has increased substantially in the past two decades. Concomitant with the increased incidence of infection has been an enhancement in the recognition of LD complications. Here, we report a case of Lyme carditis complicated by heart block in a pediatric patient admitted to our children's hospital. What is unique about this case is that the complaint of chest palpitations is an infrequent presentation of LD, and what it adds to the scientific literature is an improved understanding of LD in the pediatric population. CASE PRESENTATION: The patient was a 16-year-old male who presented with the main concerns of acute onset of palpitations and chest pain. An important clinical finding was Erythema migrans (EM) on physical exam. The primary diagnoses were LD with associated Lyme carditis, based on the finding of 1st degree atrioventricular heart block (AVB) and positive IgM and IgG antibodies to Borrelia burgdorferi. Interventions included echocardiography, electrocardiography (EKG), and intravenous antibiotics. The hospital course was further remarkable for transition to 2nd degree heart block and transient episodes of complete heart block. A normal sinus rhythm and PR interval were restored after antibiotic therapy and the primary outcome was that of an uneventful recovery. CONCLUSIONS: Lyme carditis occurs in < 5% of LD cases, but the "take-away" lesson of this case is that carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients. Any patient with suspected Lyme carditis manifesting cardiac symptoms such as syncope, chest pain, or EKG changes should be admitted for parenteral antibiotic therapy and cardiac monitoring. The most common manifestation of Lyme carditis is AVB. AVB may manifest as first-degree block, or may present as high-grade second or third-degree block. Other manifestations of Lyme carditis may include myopericarditis, left ventricular dysfunction, and cardiomegaly. Resolution of carditis is typically achieved through antibiotic administration, although pacemaker placement should be considered if the PR interval fails to normalize or if higher degrees of heart block, with accompanying symptoms, are encountered. With the rising incidence of LD, providers must maintain a high level of suspicion in order to promptly diagnose and treat Lyme carditis.


Assuntos
Borrelia burgdorferi/isolamento & purificação , Doença de Lyme/diagnóstico , Administração Intravenosa , Adolescente , Antibacterianos/uso terapêutico , Borrelia burgdorferi/imunologia , Eletrocardiografia , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/etiologia , Humanos , Imunoglobulina M/sangue , Doença de Lyme/complicações , Doença de Lyme/tratamento farmacológico , Doença de Lyme/microbiologia , Masculino , Miocardite/diagnóstico
2.
Am J Physiol Heart Circ Physiol ; 319(2): H396-H409, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32678707

RESUMO

Myocardial ischemia leads to conduction slowing, cell-to-cell uncoupling, and arrhythmias. We previously demonstrated that varying perfusate sodium (Na+) and calcium (Ca2+) attenuates conduction slowing and arrhythmias during simulated ischemia with continuous perfusion. Cardioprotection was selectively associated with widening of the perinexus, a gap junction adjacent nanodomain important to ephaptic coupling. It is unknown whether perfusate composition affects the perinexus or ischemic conduction during nonsimulated ischemia, when coronary flow is reduced or halted. We hypothesized that altering preischemic perfusate composition could facilitate perinexal expansion and attenuate conduction slowing during global ischemia. To test this hypothesis, ex vivo guinea pig hearts (n = 49) were Langendorff perfused with 145 or 153 mM Na+ and 1.25 or 2.0 mM Ca2+ and optically mapped during 30 min of no-flow ischemia. Altering Na+ and Ca2+ did not substantially affect baseline conduction. Increasing Na+ and decreasing Ca2+ both lowered pacing thresholds, whereas increasing Ca2+ narrowed perinexal width (Wp). A least squares mean estimate revealed that reduced perfusate Na+ and Ca2+ resulted in the most severe conduction slowing during ischemia. Increasing Na+ alone modestly attenuated conduction slowing, yet significantly delayed the median time to conduction block (10 to 16 min). Increasing both Na+ and Ca2+ selectively widened Wp during ischemia (22.7 vs. 15.7 nm) and attenuated conduction slowing to the greatest extent. Neither repolarization nor levels of total or phosphorylated connexin43 correlated with conduction slowing or block. Thus, perfusate-dependent widening of the perinexus preserved ischemic conduction and may be an adaptive response to ischemic stress.NEW & NOTEWORTHY Conduction slowing during acute ischemia creates an arrhythmogenic substrate. We have shown that extracellular ionic concentrations can alter conduction by modulating ephaptic coupling. Here, we demonstrate increased extracellular sodium and calcium significantly attenuate conduction slowing during no-flow ischemia. This effect was associated with selective widening of the perinexus, an intercalated disc nanodomain and putative cardiac ephapse. These findings suggest that acute changes in ephaptic coupling may serve as an adaptive response to ischemic stress.


Assuntos
Bradicardia/prevenção & controle , Cálcio/metabolismo , Bloqueio Cardíaco/prevenção & controle , Sistema de Condução Cardíaco/metabolismo , Frequência Cardíaca , Isquemia Miocárdica/metabolismo , Sódio/metabolismo , Potenciais de Ação , Animais , Bradicardia/etiologia , Bradicardia/metabolismo , Bradicardia/fisiopatologia , Circulação Coronária , Modelos Animais de Doenças , Cobaias , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/metabolismo , Bloqueio Cardíaco/fisiopatologia , Preparação de Coração Isolado , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Transdução de Sinais , Fatores de Tempo
3.
J Thorac Cardiovasc Surg ; 160(2): 490-496, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32192723

RESUMO

OBJECTIVE: To visualize and quantify the atrioventricular conduction axis in the setting of ventricular septal defect using phase contrast computed tomography. METHODS: We used the SPring-8 synchrotron radiation facility in Hyogo prefecture in Japan, processing and reconstructing the data with 3-dimensional software. RESULTS: We studied 8 hearts obtained from patients known to have had ventricular septal defects, aged from 6 to 150 days, with a median of 24.5 days. None of the individuals, however, had undergone corrective surgery. The penetrating bundle was found at a median of 1.43 mm from the septal crest, with a range of 0.99 to 1.54 mm. The distance to the nonbranching bundle to the right ventricular endocardium was 1.10 mm, with a range from 0.49 to 2.49 mm, to the origin of the left bundle branch was 2.46 mm, with a range from 1.7 to 3.18 mm, and to the origin of the right bundle branch was 2.34 mm, with a range from 0.50 to 2.59 mm. The median distance from the edge of the caudal limb of the septomarginal trabeculation to the right bundle branch was 1.04 mm, with a range from 0.81 to 1.16 mm. CONCLUSIONS: We were able to show the precise location of the axis, with our findings suggesting that longitudinal sutures placed along the posteroinferior rim should be effective in avoiding iatrogenic injury, but sutures should not be placed in the valley between the limbs of the septomarginal trabeculation.


Assuntos
Sistema de Condução Cardíaco/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tomada de Decisão Clínica , Feminino , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/fisiopatologia , Bloqueio Cardíaco/prevenção & controle , Sistema de Condução Cardíaco/fisiopatologia , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Humanos , Doença Iatrogênica , Imageamento Tridimensional , Lactente , Recém-Nascido , Japão , Masculino , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Técnicas de Sutura/efeitos adversos
4.
J Interv Cardiol ; 2020: 8948249, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32161516

RESUMO

Objectives: To demonstrate safety and efficacy of using different generations of softer Amplatzer™ devices for ventricular septal defect (VSD) closure to avoid serious complications at follow-up. Background: Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is a well-established procedure; however, it is associated with unacceptable incidence of complete heart block. Great advantages have been achieved by using softer devices for VSD transcatheter closure. The first and second generation of Amplatzer™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. These devices can be delivered using either an arterial (retrograde) or venous (prograde) approach. Methods and Results: Patients with congenital PmVSD who underwent transcatheter closure using ADO, ADO II, and AVP II devices were included. Primary end point was to determine efficacy and safety of these generations of devices and to determine the incidence of complications at follow-up (complete AV block and aortic/tricuspid/mitral regurgitation). One hundred and nineteen patients underwent VSD closure at a median age of 5 years (8 months-54 years). During the catheterization, there were only minor complications and at follow-up of 36 ± 25.7 months (up to 99 months), the closure rate was high of 98.3% and freedom from AV block was 100%. Conclusions: The use of softer Amplatzer™ devices is a good alternative to achieve PmVSD closure safely with no risk of AVB during the procedure or at midterm follow-up.


Assuntos
Cateterismo Cardíaco , Bloqueio Cardíaco , Comunicação Interventricular , Implantação de Prótese , Dispositivo para Oclusão Septal , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Pré-Escolar , Segurança de Equipamentos , Feminino , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/prevenção & controle , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Humanos , Masculino , México/epidemiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Estudos Retrospectivos , Risco Ajustado , Resultado do Tratamento
8.
Ann Cardiol Angeiol (Paris) ; 68(6): 443-449, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31668339

RESUMO

Transcatheter aortic valve implantation (TAVI) is currently becoming the treatment of choice for patients with calcific aortic stenosis. Despite several technical improvements, the incidence of conduction disturbances has not diminished and remains TAVI's major complication. These disturbances include the occurrence of left bundle branch block and/or high-grade atrioventricular block often requiring pacemaker implantation. The proximity of the aortic valve to the conduction system (conduction pathways) accounts for the occurrence of these complications. Several factors have been identified as carrying a high risk of conduction disturbances like the presence of pre-existing right bundle branch block, the type of valve implanted, the volume of aortic and mitral calcifications, the size of the annulus and the depth of valve implantation. Left bundle branch block is the most frequent post TAVI conduction disturbance. Whereas the therapeutic strategy for persistent complete atrioventricular block is simple, it becomes complex in the presence of fluctuating changes in PR interval and left bundle branch block duration. The QRS width threshold value (150-160 ms) indicative of the need for pacemaker implantation is still being debated. Although there are currently no recommendations regarding the management of these conduction disturbances, the extension of TAVI indications to patient at low surgical risk calls for a standardization of our practice. However, a decision algorithm was recently proposed by a group of experts composed of interventional cardiologists, electrophysiologists and cardiac surgeons. There are still uncertainties about the appropriate timing of pacemaker implantation and the management of new onset left bundle branch block.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Calcinose/cirurgia , Bloqueio Cardíaco/etiologia , Complicações Pós-Operatórias/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Algoritmos , Valva Aórtica/anatomia & histologia , Valva Aórtica/cirurgia , Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/cirurgia , Eletrocardiografia , Bloqueio Cardíaco/cirurgia , Sistema de Condução Cardíaco/anatomia & histologia , Sistema de Condução Cardíaco/fisiopatologia , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/patologia , Marca-Passo Artificial
10.
Heart Surg Forum ; 22(4): E301-E307, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31398097

RESUMO

BACKGROUND: Antiplatelet therapy is critical in the management of coronary artery diseases. For patients undergoing cardiac surgeries, including coronary artery bypass graft (CABG) and valve replacement, controversy remains in preoperative antiplatelet therapy concerning risk of bleeding. For safety concern, aspirin is recommended to be withdrawn 5 to 10 days before a cardiac surgery. Recent studies, however, indicate that preoperative aspirin may have a protective effect on cardiac surgery-associated acute kidney injury (CSA-AKI). OBJECTIVE: To estimate the efficacy of preoperative aspirin in preventing CSA-AKI. METHODS AND RESULTS: Eligible studies included randomized controlled trials (RCTs) and observational studies (OSs) of patients, who had undergone CABG, valve replacement, or combined surgery. These studies compared preoperative aspirin with placebo/no aspirin and reported the least incidence of CSA-AKI. One RCT and five OSs met the inclusion criteria. Data retrieved suggested that aspirin prescribed within five days before cardiac surgery decreased post-operative renal failure [odds ratio (OR), 0.67; 95% confidence interval (CI), 0.50-0.89; P < 0.01] and 30-day mortality (OR, 0.64; 95% CI, 0.53-0.77; P < 0.01). One RCT and three OSs suggested aspirin protected from major adverse cardiocerebral events (MACE) (OR, 0.88; 95% CI, 0.76-1.01; P = 0.07). One RCT and two OSs suggested aspirin did not increase risk of re-exploration for bleeding (OR, 1.01; 95% CI, 0.76-1.34; P = 0.95). CONCLUSION: Preoperative low-dose aspirin decreases post-operative CSA-AKI, mortality, and MACE without increasing the risk of re-exploration. But most of the studies are observational. They lack a uniformed standard on prescription of aspirin and outcomes measurement. No stratification analysis is performed concerning different types of surgical procedures and comorbidities. More randomized controlled trials are necessary to confirm the efficacy and safety of preoperative aspirin prescription.


Assuntos
Lesão Renal Aguda/prevenção & controle , Aspirina/administração & dosagem , Ponte de Artéria Coronária/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Inibidores da Agregação de Plaquetas/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Causas de Morte , Coma/etiologia , Parada Cardíaca/etiologia , Bloqueio Cardíaco/etiologia , Humanos , Ataque Isquêmico Transitório/etiologia , Infarto do Miocárdio/etiologia , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
BMC Ophthalmol ; 19(1): 139, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253129

RESUMO

BACKGROUND: Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibodies (ANCA)-associated necrotizing granulomatous vasculitis that affects small to medium size vessels. While the classical form with renal and respiratory tract involvement is mainly seen, a limited form (i.e., with no renal disease) may also occur. We present an unusual case of GPA manifesting merely as a bilateral ocular involvement and complete heart block. CASE PRESENTATION: We report a case of a 60-year-old male patient with a limited form of GPA who initially presented with bilateral chronic conjunctivitis and complete atrioventricular block. His visual acuity subsequently declined due to progression to bilateral panuveitis with exudative retinal detachment. The laboratory investigation revealed the elevation of acute phase reactants and strongly positive cytoplasmic ANCA (c-ANCA). Despite negative conjunctival and musculocutaneous biopsy results, the positive c-ANCA, and the clinical manifestation, i.e., heart and ocular involvement, led to the diagnosis of GPA. The remission was achieved with cyclophosphamide and methylprednisolone systemic therapy. CONCLUSIONS: A limited form of GPA may be a diagnostic chameleon. Though rare, it is essential to consider even extremely uncommon findings. Our patient is the first case of such a unique demonstration of the limited GPA manifesting as a bilateral ocular involvement and complete heart block.


Assuntos
Conjuntivite/etiologia , Granulomatose com Poliangiite/complicações , Bloqueio Cardíaco/etiologia , Descolamento Retiniano/etiologia , Acuidade Visual , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Biópsia , Doença Crônica , Conjuntivite/diagnóstico , Eletrocardiografia , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/imunologia , Bloqueio Cardíaco/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia
12.
Am J Emerg Med ; 37(8): 1554-1561, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31060863

RESUMO

INTRODUCTION: Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality. OBJECTIVE: This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions. DISCUSSION: Limited evidence exists for ED management of dysrhythmias in AMI due to relatively low prevalence and frequent exclusion of patients with active cardiac ischemia from clinical studies. Management decisions for bradycardia in the setting of AMI are determined by location of infarction, timing of the dysrhythmia, rhythm assessment, and hemodynamic status of the patient. Atrial fibrillation is common in the setting of AMI, and caution is warranted in acute rate control for rapid ventricular rate given the possibility of compensation for decreased ventricular function. Regular wide complex tachycardia in the setting of AMI should be managed as ventricular tachycardia with electrocardioversion in the majority of cases. Management directed towards HF from left ventricular dysfunction in AMI consists of noninvasive positive pressure ventilation, nitroglycerin therapy, and early cardiac catheterization. Norepinephrine is the first line vasopressor for patients with cardiogenic shock and hypoperfusion on clinical examination. Early involvement of a multi-disciplinary team is recommended when caring for patients in cardiogenic shock. CONCLUSIONS: This review discusses considerations of ED management of dysrhythmias and HF associated with AMI.


Assuntos
Fibrilação Atrial/terapia , Bradicardia/tratamento farmacológico , Bloqueio Cardíaco/terapia , Insuficiência Cardíaca/terapia , Infarto do Miocárdio/complicações , Taquicardia Ventricular/terapia , Fibrilação Atrial/etiologia , Bradicardia/etiologia , Medicina de Emergência , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/mortalidade , Insuficiência Cardíaca/etiologia , Humanos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Choque Cardiogênico/complicações , Taquicardia Ventricular/etiologia
13.
BMC Infect Dis ; 19(1): 428, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096922

RESUMO

BACKGROUND: Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest. CASE PRESENTATION: A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120-200 ms). Physical exam was unremarkable. The cardiologist's initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor. CONCLUSIONS: Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.


Assuntos
Teste de Esforço/efeitos adversos , Bloqueio Cardíaco/etiologia , Doença de Lyme/complicações , Miocardite/etiologia , Adulto , Antibacterianos/uso terapêutico , Bradicardia/etiologia , Ceftriaxona/uso terapêutico , Morte Súbita , Doxiciclina/uso terapêutico , Exercício Físico/fisiologia , Frequência Cardíaca , Humanos , Doença de Lyme/tratamento farmacológico , Masculino
15.
J Invasive Cardiol ; 31(4): E64-E65, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30927537
16.
Expert Rev Cardiovasc Ther ; 17(4): 293-304, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30912984

RESUMO

INTRODUCTION: Conduction abnormalities after transcatheter aortic valve replacement (TAVR) account for a high percentage of post-TAVR complications. Areas covered: The etiology of conduction abnormalities is closely tied to cardiac anatomy (length of membranous septum, degree of calcification, location of left bundle within the membranous septum), baseline conduction abnormalities (preprocedure right bundle branch block), and procedural variables (type of valve, depth of implant). Management of new high-grade AV block and new left bundle branch block varies by institution in the absence of consensus guidelines. Expert opinion: Authors describe the incidence, etiology, outcomes, and management of conduction abnormalities related to aortic stenosis and TAVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Cardíaco/terapia , Próteses Valvulares Cardíacas/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Valva Aórtica/cirurgia , Bloqueio Cardíaco/epidemiologia , Bloqueio Cardíaco/etiologia , Humanos , Incidência , Resultado do Tratamento
17.
Clin J Gastroenterol ; 12(4): 296-300, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30904984

RESUMO

Takotsubo cardiomyopathy (TC) describes a reversible left ventricular dysfunction characterized by apical ballooning and basal hyperkinesis, commonly triggered by emotional or physical distress. TC associated with an esophagogastroduodenoscopy (EGD) has rarely been reported. We report a case of TC with complete heart block (CHB) in a patient receiving an EGD, who had no underlying cardiac disease, had previously tolerated both local and general anesthesia, and who had previously undergone similar endoscopic procedures without complications. The concurrence of both TC and CHB is unique in this case pertaining to a patient with no significant risk factors. The incidence, mechanism and prognosis of TC-associated arrhythmias are also reviewed.


Assuntos
Endoscopia do Sistema Digestório/efeitos adversos , Bloqueio Cardíaco/etiologia , Cardiomiopatia de Takotsubo/etiologia , Idoso de 80 Anos ou mais , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Humanos , Cardiomiopatia de Takotsubo/diagnóstico por imagem
18.
BMJ Case Rep ; 12(3)2019 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-30852511

RESUMO

A previously healthy 44-year-old Caucasian man presented with recurrent syncope and was found to have a complete heart block with a ventricular rate of 24 bpm. No biochemical abnormalities were identified. Tick borne illnesses were ruled out. Paced echocardiogram revealed left ventricular systolic dysfunction with septal hypokinesis. Chest radiography and subsequent CT scan did not reveal adenopathy. However, a positron emission tomography scan demonstrated increased fluorodeoxyglucose uptake in the spleen, a right retro-clavicular lymph node, right ventricle and the interventricular septum of the heart. Excision biopsy of the retro-clavicular lymph node revealed non-caseating granulomas consistent with sarcoidosis. Complete heart block persisted despite steroid treatment. A pacemaker/biventricular implantable cardioverter defibrillator was placed for complete heart block and primary prevention of ventricular tachycardia and sudden cardiac death.


Assuntos
Bloqueio Cardíaco/diagnóstico , Sarcoidose/complicações , Baço/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Assistência ao Convalescente , Desfibriladores Implantáveis/provisão & distribução , Diagnóstico Diferencial , Ecocardiografia , Fluordesoxiglucose F18/metabolismo , Glucocorticoides/uso terapêutico , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/prevenção & controle , Bloqueio Cardíaco/terapia , Humanos , Linfonodos/patologia , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Doenças Raras , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Baço/patologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/tratamento farmacológico
19.
Circ Cardiovasc Imaging ; 12(1): e007508, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30636515

RESUMO

BACKGROUND: The risk of conduction system abnormalities (CSA) after transcatheter aortic valve implantation remains high. We aimed to evaluate the impact of mitral annular calcium (MAC) score on the development of CSA after transcatheter aortic valve implantation. METHODS: Consecutive patients (n=168), with severe AoV stenosis, without prior CSA, underwent computed tomography transcatheter AoV implantation followed by device implantation; CoreValve (n=72) and SAPIEN (n=96). MAC, AoV, and left ventricular outflow tract calcium (Ca++) scores were quantitated from noncontrast ECG-gated computed tomography using Agatston method. The primary end point was a combination of complete left bundle branch block or high-degree atrioventricular block. Logistic regression was used to analyze the predictive value of Ca++ scores of different locations. RESULTS: The primary end point was documented in 62% of the fourth quartile MAC score (>2700) patients as compared with 31% of the first quartile (<140); P=0.03. Logistic regression analysis documented MAC score as an independent predictor either of primary end point as a continuous variable (odds ratio: 1.02, 95% [CI]: 1.00 - 1.03, p = 0.021) or as quartile cutoffs, whereas Q4 was a strong and independent predictor (odds ratio: 3.69, 95% [CI]: 1.37 - 9.95, p = 0.010). CONCLUSIONS: MAC score was found to be an independent predictor of CSA in patients undergoing transcatheter aortic valve implantation without preexisting CSA. Therefore, the current study suggests that patients with high MAC score category (fourth MAC score quartile) should be considered at high risk for CSA, warranting closer monitoring. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02023060.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Calcinose/diagnóstico por imagem , Bloqueio Cardíaco/etiologia , Valva Mitral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Calcinose/complicações , Calcinose/fisiopatologia , Bases de Dados Factuais , Eletrocardiografia , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/fisiopatologia , Humanos , Masculino , Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
20.
Pediatr Cardiol ; 40(3): 513-517, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30377753

RESUMO

BACKGROUND: The clinical course of children with advanced heart block secondary to Lyme disease has not been well characterized. OBJECTIVE: To review the presentation, management, and time to resolution of heart block due to Lyme disease in previously healthy children. METHODS: An IRB approved single-center retrospective study was conducted of all patients < 21 years old with confirmed Lyme disease and advanced second or third degree heart block between 2007 and 2017. RESULTS: Twelve patients (100% male) with a mean age of 15.9 years (range 13.2-18.1) were identified. Six patients (50%) had mild to moderate atrioventricular valve regurgitation and all had normal biventricular function. Five patients had advanced second degree heart block and 7 had complete heart block with an escape rate of 20-57 bpm. Isoproterenol was used in 4 patients for 3-4 days and one patient required transvenous pacing for 2 days. Patients were treated with 21 days (n = 6, 50%) or 28 days (n = 6, 50%) of antibiotics. Three patients received steroids for 3-4 days. Advanced heart block resolved in all patients within 2-5 days, and all had a normal PR interval within 3 days to 16 months from hospital discharge. CONCLUSION: Symptomatic children who present with new high-grade heart block from an endemic area should be tested for Lyme disease. Antibiotic therapy provides quick and complete resolution of advanced heart block within 5 days, while steroids did not appear to shorten the time course in this case series. Importantly, no patients required a permanent pacemaker.


Assuntos
Bloqueio Cardíaco/etiologia , Doença de Lyme/complicações , Adolescente , Antiarrítmicos/administração & dosagem , Antibacterianos/administração & dosagem , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Bloqueio Cardíaco/terapia , Humanos , Doença de Lyme/tratamento farmacológico , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Estudos Retrospectivos
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