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2.
Rev Port Cir Cardiotorac Vasc ; 26(3): 199-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734971

RESUMO

BACKGROUND: Patients under dialysis have a high cardiovascular risk and they are at increased risk when submitted to cardiac surgery. AIM OF THE STUDY: to evaluate morbidity, early and late mortality, and predictive factors of mortality in patients under dialysis who underwent cardiac surgery. METHODS: A retrospective observational study was performed including all dialysis dependent patients who underwent cardiac surgery (coronary, valvular or combined procedures) in our institution between 2007 and 2014. A population of 95 consecutive patients was obtained (no exclusions). Perioperative variables and predictors of mortality were analysed and the endpoints were early and late mortality. Propensity score matching, with a control group of patients with creatinine clearance >90mL/min, was performed by logistic regression, with a 1:1 matching. Kaplan Meier curves were performed for late mortality. RESULTS: Early mortality was 9.4% (EuroSCORE II 4.1%). In univariate analysis, mean time of cardiopulmonary bypass (CPB) (p=0.016) and EuroSCORE II (p=0.02) were related with early mortality. In a multivariate analysis model, combined procedures (OR 138.09; CI95% 1.82-10498.4; p=0.03) and CCS (Canadian Cardiovascular Society) 3-4 (OR 70.951; CI 95% 1.32-3810.11; p=0.037) were predictors of mortality. In multivariable analysis, CPB time >152 min was a predictor of early mortality (p=0.001). After propensity score matching, 30 day, one year and late mortality were higher in the dialysis group. CONCLUSIONS: Early and late mortality were significantly higher in dialysis dependent patients. Predictive factors of mortality were CPB time and EuroSCORE II in univariable analysis, and CCS 3-4 and combined procedures in multivariable analysis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiopatias/cirurgia , Falência Renal Crônica/terapia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/complicações , Humanos , Falência Renal Crônica/complicações , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Undersea Hyperb Med ; 46(5): 581-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683356

RESUMO

Introduction: We aimed to document identified cases of immersion pulmonary edema (IPE) in divers from Oceania (the Indo-Pacific region) from January 2002 to May 2018, inclusive. Method: Cases were identified using various sources, including searches of the Divers Alert Network Asia-Pacific (DAN AP) Fatality Database, published case reports, and interviews with survivors who had reported their incident to DAN AP. Where available, investigations, pathology and autopsy results were obtained. Only incidents diagnosed as IPE by diving physicians or pathologists with experience in the investigation of diving accidents were included. Individual case histories and outcomes, together with brief individual summaries of the associations and possible contributing factors were recorded. Results: Thirty-one IPE incidents in divers from Oceania were documented. There were two surface snorkelers, 22 scuba air divers and seven nitrox divers which included three closed-circuit rebreathers (CCR). The mean (SD) age was 53 (12) years, 58% of victims were females, and the average dive profile was to a maximum depth of 19 meters of seawater for 25 minutes. Six victims (19%) had previous episodes of IPE. There were nine recorded fatalities. Cardiac anomalies dominated the associated or possible contributing factors. These included valvular disease in 29%, transient cardiomyopathies in 26% and dysrhythmias in 16%. Conclusions: Previously reported associations of IPE such as exertion, stress, cold exposure, negative inspiratory pressure, hypertension, overhydration, ascent or surfacing, tight wetsuit, aspiration and certain medications were identified. Cardiac conditions were frequent and included chronic disorders (valvular pathology, coronary artery disease) and transient disorders (dysrhythmias, transient myocardial dysfunction, takotsubo or stress cardiomyopathy). It is likely that the chronic cardiac disorders may have contributed to the IPE, whereas the transient cases could be either sequelae, contributors or coincidental to the IPE.


Assuntos
Mergulho/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Idoso , Autopsia , Doença das Coronárias/patologia , Suscetibilidade a Doenças/etiologia , Suscetibilidade a Doenças/patologia , Evolução Fatal , Feminino , Cardiopatias/complicações , Humanos , Imersão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oceania/epidemiologia , Esforço Físico , Edema Pulmonar/diagnóstico , Edema Pulmonar/epidemiologia , Edema Pulmonar/patologia , Fatores de Risco , Água do Mar , Distribuição por Sexo , Natação , Cardiomiopatia de Takotsubo/complicações , Adulto Jovem
4.
Undersea Hyperb Med ; 46(5): 603-610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683357

RESUMO

Aim: To review incidents of immersion pulmonary edema (IPE) from Oceania, to determine the demographics, diving parameters, and comorbidities that may be related to this disorder. Method: Incidents of IPE, most of which were documented by Divers Alert Network Asia-Pacific (DAN AP) or reported in our medical literature, were analyzed. They included interviews with the survivors and a review of available medical records. Only incidents diagnosed as IPE by specialist diving physicians or pathologists with experience in the investigation of diving accidents were included. Results: Thirty-one IPE incidents in divers from Oceania were documented. There were two surface snorkelers, 22 scuba air divers and seven nitrox divers, which included three closed-circuit rebreathers (CCR). The mean (SD) age was 53 (12) years, 58% of victims were females, and the average dive profile was to a maximum depth of 19 msw for 25 minutes. Six victims (19%) had previous episodes of IPE. There were nine recorded fatalities in this cohort. Medical comorbidities were recorded in 68%, with 42% being cardiac. The latter included valvular disease in 29%, transient cardiomyopathies in 26% and dysrhythmias in 16%. Conclusion: IPE was more likely in middle-aged females, in experienced divers, and during ascent or after surfacing. Commonly reported associations such as exertion, stress, cold exposure, negative inspiratory pressure, hypertension, overhydration, tight wetsuit, aspiration and certain medications were identified. This series supports the hypothesis that the elderly IPE subjects are likely to have comorbidities and be susceptible to IPE recurrences and fatalities unless the contributing factors can be identified and addressed.


Assuntos
Mergulho/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Fatores Etários , Idoso , Autopsia , Temperatura Baixa/efeitos adversos , Comorbidade , Mergulho/estatística & dados numéricos , Feminino , Cardiopatias/complicações , Humanos , Imersão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oceania , Edema Pulmonar/diagnóstico , Edema Pulmonar/mortalidade , Edema Pulmonar/patologia , Fatores de Risco , Água do Mar , Adulto Jovem
6.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 79-85, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630719

RESUMO

Obesity in children has been recognized as a major underlying factor of the pathogenesis of several diseases and a reduced life expectancy. This study aims to verify if clinical parameters, such as waist circumference and/or body mass index and biohumoral and inflammatory parameters can help predict cardiac structural and functional alterations, through an echocardiogram test in obese children and adolescents. Children were prospectively enrolled at the AUOC outpatients' department of Emergency Paediatrics, University Hospital, Messina, from June to December 2017. Clinical, metabolic parameters and an inflammation marker (HMGB1) were evaluated and a transthoracic echocardiogram was carried out. Twenty-two obese subjects were prospectively enrolled.HMGB1 values were 12.6 ± 2ng/ml, significantly higher compared to a previously studied healthy control group. A significant positive correlation was found both between total cholesterol levels and HMGB1 values (r=0.846, p=0.000) and between LDL cholesterol and HMBG1 values (r=0.663, p=0.001). No correlation was found between clinical, biohumoral and echocardiograph parameters. In obese children cardiac parameters obtained from echocardiogram tests may be in the normal range. However, other parameters may be altered in the early phase, showing that infantile obesity can compromise myocardial functions, even in the absence of comorbidities. Furthermore, the evaluation of concentrations of HMBG1 could explain how an initial inflammation can trigger the condition of meta-inflammation.


Assuntos
Cardiopatias/complicações , Obesidade Pediátrica/complicações , Adolescente , Índice de Massa Corporal , Criança , LDL-Colesterol/sangue , Proteína HMGB1/sangue , Humanos , Dados Preliminares , Estudos Prospectivos , Circunferência da Cintura
7.
Vasc Med ; 24(5): 431-438, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31543030

RESUMO

Optimal management of patients with internal carotid artery (ICA) stenosis concurrent with severe cardiac disease remains undefined. The aim of this study is to evaluate the safety and feasibility of the one-day, sequential approach by carotid artery stenting (CAS) immediately followed by cardiac surgery. The study included 70 consecutive patients with symptomatic > 50% or ⩾ 80% asymptomatic ICA stenosis coexisting with severe coronary/valve disease, who underwent one-day, sequential CAS + cardiac surgery. The majority of patients (85.7%) had CSS class III or IV angina and 10% had non-ST elevation myocardial infarction. The EuroSCORE II risk was 2.4% (IQR 1.69-3.19%). All CAS procedures were performed according to the 'tailored' algorithm with a substantial use of proximal neuroprotection devices of 44.3%. Closed-cell (75.7%) and mesh-covered (18.6%) stents were implanted in most cases. The majority of patients underwent isolated coronary artery bypass grafting (88.6%) or isolated valve replacement (7.1%). No major adverse cardiac and cerebrovascular events (MACCE) occurred at the CAS stage. There were three (4.3%) perioperative MACCE: one myocardial infarction and two deaths. All MACCE were related to cardiac surgery and were due to the high surgical risk profile of the patients. Up to 30 days, no further MACCE were observed. No perioperative or 30-day neurological complications occurred. In this patient series, one-day, sequential CAS and cardiac surgery was relatively safe and did not result in neurological complications. Thus, a strategy of preoperative CAS could be considered for patients with severe or symptomatic ICA stenosis who require urgent cardiac surgery.


Assuntos
Artéria Carótida Interna , Estenose das Carótidas/terapia , Ponte de Artéria Coronária , Procedimentos Endovasculares/instrumentação , Cardiopatias/cirurgia , Implante de Prótese de Valva Cardíaca , Stents , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Estudos de Viabilidade , Feminino , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Cardiopatias/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Sistema de Registros , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
8.
Georgian Med News ; (292-293): 26-32, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560658

RESUMO

Cirrhotic cardiomyopathy (CC) is a frequent complication of liver cirrhosis (LC) and characterised by impaired contractile response to stress, altered diastolic relaxation, and QTc prolongation. Symptoms of CC can be masked by edematous ascitic syndrome, high cardiac output, hyperdynamic circulation and preserved left ventricular (LV) ejection fraction at rest. NT-proBNP is a sensitive marker of heart failure in patients with primary heart disease, but its diagnostic value in CC has not been determined. The aim of the study was to evaluate NT-proBNP levels in patients with LC and estimate its relationship with the severity of the main disease, cardiac and hemodynamic dysfunction. The study involved 90 patients with LC (age 49,9±1,92 years). LC decompensation was associated with an increase of end-systolic, end-diastolic volume (ESV, EDV), left ventricular myocardial index (LVMI), cardiac index (CI), decrease E/A and preserve ejection fraction (EF) at rest. Serum NT-proBNP levels in class A, B and C were 109±26.2, 174±17.6, 358±40.1 pg/ml (p˂0.05). The highest NT-proBNP levels were in patients with refractory ascites, severe esophagus varices, hepatorenal syndrome, hypoalbuminemia (374±49.4, 345±33.9, 467±47.4, 323±32.0 pg/ml), the lowest - in pre-ascitics patients (112±23.4 pg/ml). NT-proBNP was correlated with CTP, MELD, serum albumin, portal vein diameter (r= 0.550, 0.429, -0.334, 0.237, p˂0.05), eGFR, CI, EDV, LVMI, E/A (r= 0.419, 0.401, 0.296, 0.233, 0.325, p˂0.05). Thus, elevated levels of NT-proBNP may be an indicator of cardiac dysfunction in patients with LC.


Assuntos
Cardiopatias/complicações , Hipertensão Portal/complicações , Cirrose Hepática/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Biomarcadores/sangue , Humanos , Cirrose Hepática/complicações
10.
Int J Clin Pharmacol Ther ; 57(12): 607-611, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31488241

RESUMO

The anti-programmed cell death-ligand 1 (PD-L1) antibody atezolizumab is a promising agent for various cancers. Although immune-related adverse events (irAEs) induced by atezolizumab are rare, they can be severe. Clinical experience in irAE management is presently insufficient. Herein, we present a case of a patient with non-small cell lung cancer (NSCLC) who developed life-threatening irAEs including pneumonitis, thrombocytopenia, and cardiac dysfunction under immunotherapy with atezolizumab. Under expectant treatment and corticosteroid regimen, pneumonitis was totally resolved. However, thrombocytopenia and cardiac dysfunction did not improve. The patient sadly passed away 28 days after a single dose of atezolizumab. This case alarmed us once more to the importance of irAE management under cancer immunotherapy.
.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/terapia , Cardiopatias/complicações , Neoplasias Pulmonares/terapia , Pneumonia/complicações , Trombocitopenia/complicações , Anticorpos Monoclonais Humanizados , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/complicações , Evolução Fatal , Humanos , Imunoterapia , Neoplasias Pulmonares/complicações
11.
Praxis (Bern 1994) ; 108(11): 741-749, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480954

RESUMO

CME: Nocturnal Dyspnea Abstract. Nocturnal dyspnea has a broad range of differential diagnoses of sometimes serious and even life-threatening illnesses. Systematic assessment starts with taking a detailed medical history to characterize the dyspnea and evaluate possible underlying diseases. The subsequent clinical and complementary evaluation should be targeted to detect possible diseases of the upper and lower respiratory tract, the lungs, disorders of control of breathing, heart diseases as well as neurological and, after exclusion of other causes, mental illnesses.


Assuntos
Dispneia , Cardiopatias , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Cardiopatias/complicações , Cardiopatias/diagnóstico , Humanos
12.
Metas enferm ; 22(7): 65-71, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184101

RESUMO

La función cardiaca y la función renal están íntimamente asociadas, ya que el corazón y los riñones llevan a cabo la regulación hemodinámica del organismo. Cuando se producen alteraciones de forma bidireccional en ambos órganos se activa una serie de mecanismos compensadores que provocan un efecto nocivo de uno de ellos sobre el otro. Es lo que se conoce como síndrome cardiorrenal. Actualmente se dispone de protocolos de Enfermería estandarizados para el manejo de la insuficiencia cardiaca y para la insuficiencia renal; no obstante, es necesario ampliar la información para entender de forma óptima la relación cardiorrenal y aplicar la mejor evidencia científica a los cuidados. Por ello se expone un caso clínico abordado desde Atención Primaria, con el desarrollo de un plan de cuidados elaborado una vez identificados los diagnósticos de Enfermería que se han derivado de la valoración enfermera siguiendo el modelo de las 14 necesidades básicas de Virginia Henderson


Cardiac function and renal function are closely related, because the heart and the kidneys carry out the hemodynamic regulation of the body. When there are bidirectional alterations in both organs, a series of compensating mechanisms are activated, which cause harmful effects of one over the other. This is known as Cardiorenal Syndrome. There are current standard Nursing protocols available for the management of heart failure and renal impairment; however, it is necessary to increase information for an optimal understanding of the cardiorenal interaction, and to apply the best scientific evidence into care. To this aim, we present a case record addressed at Primary Care, with the development of a plan of care prepared after the Nursing diagnoses were identified, derived from nursing assessment following the model of the 14 Basic Needs of Virginia Henderson


Assuntos
Humanos , Feminino , Idoso , Cuidados de Enfermagem , Atenção Primária à Saúde/métodos , Síndrome Cardiorrenal/complicações , Síndrome Cardiorrenal/enfermagem , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/enfermagem , Padrão de Cuidado/normas , Nível de Saúde , Atenção Primária à Saúde , Nefropatias/complicações , Cardiopatias/complicações , Implementação de Plano de Saúde/normas , Insuficiência Cardíaca/enfermagem
13.
Orv Hetil ; 160(35): 1366-1375, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31448646

RESUMO

Cardiac autonomic neuropathy (CAN) is a common complication in type 1 and 2 diabetes and is defined as the impairment of autonomic control of the cardiovascular system. CAN is strongly associated with increased mortality, and in some studies with morbidity of vascular complications, such as stroke, coronary artery disease and myocardial infarction. At the early stages, CAN can be subclinical and it becomes clinically evident as the disease progresses. Subclinically, the disease is defined by cardiovascular reflex testing, which may have prognostic implications. Clinically, the impairment in autonomic function is associated with resting tachycardia, exercise intolerance, orthostatic hypotension, syncope, intraoperative cardiovascular instability, silent myocardial infarction and ischemia, and increased mortality. Although very common and serious, CAN is a frequently overlooked complication of diabetes. Because the progression of cardiovascular denervation is partly reversible or can be slowed down in the early stages of the disease, recent guidelines strongly recommend screening for CAN in patients with diabetes. In this review we summarize the diagnostic tools suggested in the screening for diabetic CAN. Orv Hetil. 2019; 160(35): 1366-1375.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Cardiomiopatias Diabéticas/diagnóstico , Neuropatias Diabéticas/diagnóstico , Cardiopatias/complicações , Doenças do Sistema Nervoso Autônomo/complicações , Neuropatias Diabéticas/complicações , Coração/inervação , Humanos
14.
Kardiologiia ; 59(7S): 23-30, 2019 Aug 23.
Artigo em Russo | MEDLINE | ID: mdl-31441738

RESUMO

AIM: A study of the risk factors for middle-aged and elderly women HER2neu with negative left breast cancer and a normal ejection fraction at the stage of chemoradiotherapy in everyday clinical practice. Matherial and methods. 61 women with left breast cancer without severe cardiovascular pathology were examined at the stage of doxorubicin therapy and 3D conformal radiation therapy. Group 1 comprised 32 patients of middle age (49.8 ± 4.5 years). Group 2 comprised 29 elderly patients (68.3 ± 3.6 years). In addition to Score risk assessment, additional factors, including psychosocial factors, were studied. All patients underwent ECG, echocardiography and 24-hour ECG monitoring. Anxiety levels were assessed using the HADS scale and scale CH. D. Spielberger -Yu.L. Khanin. The study was conducted before the start of treatment, after the completion of the doxorubicin course and after the completion of the course of radiotherapy. Results with discussion. In middle-aged patients, moderate Score risk was found in 21.9%, in the elderly at 58.6% (p = 0.0043, RR 2.68, 95% CI 1.301-5.520). A high Score risk was found in 15.6% of middle-aged patients and 41.4% of elderly patients (p = 0.0438, RR 2.648, 95% CI 1061-6.607). The most common risk factors in the patients studied in addition to age were heredity, overweight, hypercholesterolemia and diabetes mellitus. All examined patients had moderate reactive anxiety. Patients of middle age have moderate personal anxiety, in elderly patients high personal anxiety. After treatment with doxorubicin in a cumulative dose not exceeding 360 mg/m2 , a reduction in the ejection fraction below 50% was found in 6 middle-aged patients and 17.2% in elderly patients. Asymptomatic diastolic dysfunction was detected in 31.3% of middle-aged patients and 55.2% of the elderly. In patients of both groups, after arranging treatment, arrhythmia was detected. CONCLUSIONS: The obtained data indicate to the need for in-depth examination of middle-aged and especially elderly patients with left breast cancer with an assessment of risk factors and conducting an in-depth examination using Echocardiography, 24-hour ECG monitoring and psychological testing to prevent and early detection of cardiovascular complications.


Assuntos
Neoplasias da Mama , Cardiopatias , Idoso , Neoplasias da Mama/complicações , Doxorrubicina , Ecocardiografia , Feminino , Cardiopatias/complicações , Humanos , Pessoa de Meia-Idade , Volume Sistólico
15.
Medicine (Baltimore) ; 98(31): e16640, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374034

RESUMO

RATIONALE: Tumors in the heart are rare. Myxomas, rhabdomyomas, and fibromas are the most common benign cardiac tumors. Hamartoma of mature cardiomyocytes (HMCM) is another benign cardiac tumor, are very rare and have only been reported in a few literatures. PATIENT CONCERNS: We report a case of 41-year-old male who suffered short of breath for 3 years, and lower limbs edema for 2 years. DIAGNOSES: Transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) showed a large amount of pericardial effusion and confirmed a mass of 18 × 14 mm on the superior vena cava near the outer edge of right atrium. The patient was first diagnosed as pleural mesothelioma. Surgery was performed to relieve the symptoms and confirm diagnoses. However, during surgery, we found the right atrium is apparently thicken with rough and uneven surface. Histology of right atrium mass indicated it as hamartoma of mature cardiomyocytes. INTERVENTION: We resected the thicken atrial wall completely, reconstructed right atrium with bovine pericardial patch, and resected the pericardium. OUTCOMES: Patient was discharged 9 days after surgery, and remained asymptomatic during 9 months follow up. LESSONS: Hamartoma of mature cardomyocytes is a rare benign cardiac tumor. There were 26 cases reported until now. The conclusive diagnosis depends on pathological sections. For patients with symptoms, surgery is an effective treatment for HMCM.


Assuntos
Hamartoma/patologia , Átrios do Coração/patologia , Cardiopatias/patologia , Miócitos Cardíacos/patologia , Adulto , Dispneia/etiologia , Ecocardiografia , Edema/etiologia , Hamartoma/complicações , Hamartoma/cirurgia , Cardiopatias/complicações , Cardiopatias/cirurgia , Humanos , Masculino
16.
Adv Exp Med Biol ; 1193: 155-174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31368103

RESUMO

A major pathophysiological mechanism behind the development of diabetic heart diseases is oxidative stress mediated by toxic reactive aldehydes such as 4-hydroxynonenal (4HNE). Aldehyde dehydrogenase (ALDH) 2 is a mitochondrial enzyme that has been found to detoxify these deleterious aldehydes and thereby mitigate cardiac damage. Furthermore, its protective role in cellular signaling reverses aberrations caused by hyperglycemia, thereby protecting cardiac function. This chapter assesses the role of ALDH2 in diabetic heart diseases by examining preclinical studies where ALDH2 activity is perturbed in both decreased and increased directions. In doing so, issues in improving ALDH2 activity in select human populations are elucidated, and further research directions are discussed.


Assuntos
Aldeído-Desidrogenase Mitocondrial/genética , Diabetes Mellitus/genética , Cardiopatias/genética , Aldeídos/efeitos adversos , Cardiopatias/complicações , Humanos , Estresse Oxidativo
18.
Rev Port Cardiol ; 38(6): 457.e1-457.e3, 2019 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31303466

RESUMO

A 24-year-old woman who was 11 weeks pregnant and had a mechanical mitral valve presented at the emergency department with ischemic stroke. Although treatment with aspirin and unfractionated heparin was initially successful, subsequent management was almost impossible, as she eventually suffered a right hemispheric stroke, requiring percutaneous intervention and an emergency cesarian; prosthetic valve thrombosis with hemodynamic instability; and multiple bleeding complications. This case demonstrates how difficult it can be to select the appropriate treatment strategy for prosthetic valve thrombosis.


Assuntos
Isquemia Encefálica/etiologia , Cardiopatias/complicações , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Complicações Cardiovasculares na Gravidez , Trombose/complicações , Isquemia Encefálica/diagnóstico , Ecocardiografia Transesofagiana , Feminino , Cardiopatias/diagnóstico , Humanos , Gravidez , Falha de Prótese , Trombose/diagnóstico , Adulto Jovem
19.
Magn Reson Imaging Clin N Am ; 27(3): 521-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279454

RESUMO

Muscular dystrophy is a group of genetically inherited diseases with irreversible and progressive muscle loss and is associated with cardiac involvement. Particularly in Duchenne and Becker dystrophies, cardiac disorders are the leading causes of mortality. Cardiovascular magnetic resonance imaging (CMR) can detect even incipient myocardial fibrosis (late gadolinium enhancement), which has prognostic significance in patients with preserved left ventricular function by echocardiogram and before the onset of symptoms. Early detection of cardiac abnormalities by CMR enables early cardioprotective treatment, leading to a better prognosis.


Assuntos
Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Distrofias Musculares/complicações , Coração/diagnóstico por imagem , Coração/fisiopatologia , Cardiopatias/fisiopatologia , Humanos
20.
Artigo em Chinês | MEDLINE | ID: mdl-31262110

RESUMO

Objective: To explore the perioperative clinical treatment of thyroid cancer patients with heart disease. Methods: A retrospective analysis was conducted on 39 thyroid cancer patients with heart disease admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital,Capital Medical University from April 2014 to February 2018,including 25 males and 14 females, the age ranged from 59 to 75 years,with an average age of 67.3±6.2 years. Perioperative clinical monitoring indicators included cardiac ultrasound left ventricular ejection fraction (LVEF), degree of vascular stenosis revealed by coronary CT, hypersensitive troponin I (TNI), b-type natriuretic peptide (BNP), fibrinogen degradation products,and coagulation indexes. This panel of patients comprised 26 cases with 50% ≤ LVEF<60%,10 cases with 40% ≤ LVEF<50%, 3 cases with 36% ≤ LVEF<40%, 27 cases with 0≤BNP<100 ng/L, 7 cases with 100≤BNP<400 ng/L, and 5 cases with 400≤BNP<700 ng/L. Coronary CT showed no coronary artery stenosis>75%. The vascular graft was patent and the coronary artery after stenting was unobstructed. For 3 patients with LVEF<40% and 5 patients with BNP>400 ng/L,cardiotonic,diuretic,and nutritional myocardial therapy were used for 1 week. SPSS 17.0 software was used to analyze the data. Results: All 39 patients successfully completed the operation under general anesthesia,including 32 cases of total thyroidectomy,7 cases of glandular lobe and isthmic resection,and 40 cases of lateral neck dissection. One patient developed heart failure three days after surgery and was discharged after two weeks of treatment. No other cardiac related events,cerebrovascular and pulmonary thrombosis occurred during the perioperative period. The anesthesia preparation time was significant different between the group with 0≤BNP<100 ng/L and 50%≤LVEF<60% and the group with 0≤BNP<100 ng/L and 36%≤LVEF<50%. Conclusions: Multi-indicators were utilized to adequately assess cardiac function before surgery. According to the results of cardiac ultrasound and coronary CT examination, the corresponding treatment should be conducted to improve the cardiac function. After the perioperative risk assessment and management of thyroid cancer patients with heart disease,standardized thyroid cancer surgery can be performed safely.


Assuntos
Cardiopatias/terapia , Neoplasias da Glândula Tireoide/cirurgia , Idoso , Feminino , Cardiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia
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