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1.
BMC Med Educ ; 21(1): 336, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107936

RESUMO

BACKGROUND: Both simulation-based training and video-based training serve as educational adjuncts for learning TEE among medical students. In the present study, we hypothesized that simulation-based training would better enhance the performance of medical students in the interpretation of 20 cross-sectional views compared to video-based training. METHODS: A total of 120 4th-year undergraduate medical students were enrolled in the present study. The study began with a pre-test of all the participants, followed by a 90-min theoretical lecture and a post-test. Subsequently, the participants were randomly divided into the video-based group (Group V) and simulation-based group (Group S). Next, Group V received 60 min of TEE video learning, while Group S received 60 min of TEE simulator training. After the respective training, both the groups undertook the retention-test 1 and retention-test 2, 1 week and 1 month later, respectively. The performance for each test was evaluated by five views, which were selected randomly and, respectively, from a set of 20 cross-sectional views. The primary outcome was the performance of the retention-test 1. Secondary outcomes included: (1) comparison the performances of the pre-test, post-test, and retention-test 2 between two groups; (2) comparison the performances of pre-test and post-test in the same group; (3) comparison the performances of retention-test 1, and retention-test 2 in the same group. RESULTS: Better performances were observed in Group S in both retention-test 1 (Group V: 63.2 [52.6, 77.6] vs. Group S: 89.5 [68.4, 100.0], P < 0.001) and retention-test 2 (Group V: 58.0 [48.0, 72.0] vs. Group S: 74.0 [64.0, 80.0], P < 0.001) compared to Group V. No statistically significant differences were observed in the performances of pre-test (Group V: 8.3 [4.2, 12.5] vs. Group S: 8.3 [4.2, 12.5], P = 0.825) or post-test (Group V: 46.2 [38.5, 57.7] vs. Group S: 44.2 [38.5, 56.7], P = 0.694) between the two groups. The improvement had been observed in the post-test, compared with pre-test in the same group, respectively (Group V in post-test: 46.2 [38.5, 57.7] vs. Group V in pre-test: 8.3 [4.2, 12.5], P < 0.001; Group S in post-test: 44.2 [38.5, 56.7] vs. Group S in pre-test: 8.3 [4.2, 12.5], P < 0.001). However, the performance in retention-test 2 was significantly reduced, compared with retention-test 1 in the same group, respectively (Group V in retention-test 2: 58.0 [48.0, 72.0] vs. Group V in retention-test 1: 63.2 [52.6, 77.6] P = 0.005; Group S in retention-test 2: 74.0 [64.0, 80.0] vs. Group S in retention-test 1: 89.5 [68.4, 100.0], P < 0.001). CONCLUSIONS: Following a 90-min theoretical lecture, simulation-based training better enhanced the performance of medical students in the interpretation and short-term retention of 20 cross-sectional views compared to video-based training. TRIAL REGISTRATION: http://www.chictr.org.cn ( ChiCTR2000033519 , 3/June/2020).


Assuntos
Treinamento por Simulação , Estudantes de Medicina , Competência Clínica , Estudos Transversais , Ecocardiografia , Avaliação Educacional , Humanos , Estudos Prospectivos
4.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083187

RESUMO

A 60-year-old man was referred to our hospital because of chest tightness. CT scans showed no specific findings except a right ventricular (RV) mass. Echocardiogram revealed that the large cardiac mass was compressing the right ventricular outflow tract, and the patient thus underwent an emergency operation. As the tumour on the inlet side of the right ventricle was tightly adhered to the entire tricuspid chordae, a complete resection was impossible. Pathological findings revealed that the tumour was metastatic squamous cell carcinoma. Four cycles of chemotherapy were administered. Further investigations were conducted to identify the primary cancer focus, but there were no specific findings. Eight months after the operation, the patient returned to the hospital. Echocardiogram showed a severely occupying mass once again, and the patient died as a result. Autopsy revealed no findings relating to the primary origin of the cardiac metastases.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Cardíacas , Obstrução do Fluxo Ventricular Externo , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Ecocardiografia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia
5.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083200

RESUMO

Platypnoea-orthodeoxia syndrome (POS) is a rare condition characterised by the association of dyspnoea and arterial oxygen desaturation induced by standing and relieved by recumbency. The precise mechanism remains poorly understood, but it appears to involve both anatomical and functional components producing a significant right-to-left shunting under certain postural conditions. This syndrome is associated with either intracardiac or extracardiac aetiologies, and the diagnosis depends on high clinical suspicion. Intracardiac shunt is the most common cause of POS and can be identified through echocardiography with bubble study. We report the case of a patient with POS secondary to a paradoxical shunt through the patent foramen oval, whose definitive diagnosis was only possible with contrasted transthoracic echocardiography in the sitting and standing positions.


Assuntos
Forame Oval Patente , Hipóxia , Dispneia/etiologia , Ecocardiografia , Forame Oval Patente/diagnóstico , Forame Oval Patente/diagnóstico por imagem , Humanos , Hipóxia/etiologia , Postura
6.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(6): 610-614, 2021 Jun 24.
Artigo em Chinês | MEDLINE | ID: mdl-34126729

RESUMO

Objective: To observe the changes of parameters derived from transthoracic echocardiography (TTE) before and after left ventricular assist device (LVAD) implantation, and to evaluate the clinical value of TTE in the perioperative period of LVAD implantation. Methods: This is a retrospective study. The data of patients who underwent LVAD implantation in Fuwai Hospital from January 2018 to December 2020 were analyzed retrospectively. The TTE parameters, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and total bilirubin (TBil) before and 1 month after LVAD implantation were collected and analyzed. Results: A total of 12 male patients undergoing LVAD implantation were included in this study. The mean age was (43.3±8.6) years. The left atrial volume index ((41.4±12.8)ml/m2 vs. (74.9±30.7)ml/m2, P<0.001), left ventricular end-diastolic volume index ((152.1±35.3)ml/m2 vs. (205.5±35.7)ml/m2, P<0.001), left ventricular end-systolic volume index ((112.5±27.9)ml/m2 vs. (155.1±29.1)ml/m2, P<0.001), right atrial diameter index ((23.7±3.5)mm/m2 vs. (27.2±5.8)mm/m2, P=0.023), right ventricular internal diameter at end-diastole ((24.6±2.7)mm vs. (30.0±4.8)mm, P<0.001), tricuspid annular plane systolic excursion ((11.5±2.9)mm vs. (14.6±2.8)mm, P=0.007), systolic pulmonary arterial pressure ((29.2±4.8) mmHg vs. (55.1±19.3) mmHg, P<0.001, 1 mmHg=0.133 kPa) were significantly reduced at 1 month post LVAD implantation as compared to before LVAD implantation. The aortic sinus diameter ((33.8±4.7)mm vs. (31.6±5.1)mm, P=0.007), left ventricular ejection fraction ((26.3±3.0)% vs. (23.8±4.4)%, P=0.016), right ventricular fractional area change ((31.0±8.6)% vs. (23.8±5.5)%, P=0.004) at 1 month post LVAD implantation were significantly higher than before LVAD implantation. The degree of mitral and tricuspid regurgitation decreased, and the inspiratory collapse rate of inferior vena cava increased (all P<0.05). NT-proBNP ((1 418.4±812.6)ng/L vs. (5 097.5±3 940.4)ng/L, P=0.004) and TBil ((12.4±5.4)µmol/L vs. (27.5±14.0)µmol/L, P=0.001) decreased significantly at 1 month post LVAD implantation. Conclusions: TTE results show that LVAD could effectively relieve left ventricular load and improve right ventricular function. TTE can monitor the cardiac structural and functional changes during the perioperative period of LVAD implantation, and provide the imaging evidence for clinical evaluation of the therapeutic effect of LVAD.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Adulto , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda
7.
Kardiol Pol ; 79(5): 595-603, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34125943

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic resulted in an urgent need to reorganize the work of echocardiography laboratories in order to ensure the safety of patients and the protection of physicians, technicians, and other staff members. In the previous Expert Opinion of the Working Group on Echocardiography of Polish Cardiac Society we provided recommendations for the echocardiographic services, in order to ensure maximum possible safety and efficiency of imagers facing epidemic threat. Now, with much better knowledge and larger experience in treating COVID-19 patients and with introduction of vaccination programs, we present updated recommendations for performing transthoracic and transesophageal examinations, including information on the potential impact of personnel and the patient vaccination program, and growing numbers of convalescents on performance of echocardiographic laboratories, with the goal of their ultimate reopening.


Assuntos
COVID-19 , Pandemias , Ecocardiografia , Prova Pericial , Humanos , Polônia , SARS-CoV-2 , Vacinação
8.
BMJ Case Rep ; 14(6)2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135074

RESUMO

Bacterial endocarditis remains a challenging condition to manage owing to its variety of different presentations. This report describes a 55-year-old woman with endocarditis who presented confused with shoulder and back pain. Initial diagnosis was made difficult by a negative echocardiogram but aided by striking peripheral stigmata. She was treated for infective endocarditis as she met all five Duke's minor criteria for infective endocarditis. Gallium scan was a useful investigation in identifying lumbar spine and acromioclavicular joint septic foci. This case highlights the challenges of diagnosing endocarditis. It also describes how gallium scans can be useful in identifying occult septic emboli in these patients.


Assuntos
Endocardite Bacteriana , Endocardite , Ecocardiografia , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade
9.
Int J Mol Sci ; 22(11)2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34067440

RESUMO

Myocardial infarction remains the most common cause of heart failure with adverse remodeling. MicroRNA (miR)155 is upregulated following myocardial infarction and represents a relevant regulatory factor for cardiac remodeling by engagement in cardiac inflammation, fibrosis and cardiomyocyte hypertrophy. Here, we investigated the role of miR155 in cardiac remodeling and dysfunction following myocardial infarction in a dyslipidemic mouse model. Myocardial infarction was induced in dyslipidemic apolipoprotein E-deficient (ApoE-/-) mice with and without additional miR155 knockout by ligation of the LAD. Four weeks later, echocardiography was performed to assess left ventricular (LV) dimensions and function, and mice were subsequently sacrificed for histological analysis. Echocardiography revealed no difference in LV ejection fractions, LV mass and LV volumes between ApoE-/- and ApoE-/-/miR155-/- mice. Histology confirmed comparable infarction size and unaltered neoangiogenesis in the myocardial scar. Notably, myofibroblast density was significantly decreased in ApoE-/-/miR155-/- mice compared to the control, but no difference was observed for total collagen deposition. Our findings reveal that genetic depletion of miR155 in a dyslipidemic mouse model of myocardial infarction does not reduce infarction size and consecutive heart failure but does decrease myofibroblast density in the post-ischemic scar.


Assuntos
MicroRNAs/genética , Infarto do Miocárdio/genética , Miofibroblastos/metabolismo , Função Ventricular Esquerda/genética , Animais , Modelos Animais de Doenças , Ecocardiografia/métodos , Fibrose/genética , Fibrose/metabolismo , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/metabolismo , Ventrículos do Coração/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Infarto do Miocárdio/metabolismo , Miocárdio/metabolismo , Volume Sistólico/genética , Remodelação Ventricular/genética
11.
Medicine (Baltimore) ; 100(22): e26171, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087879

RESUMO

ABSTRACT: Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico , Ecocardiografia/métodos , Programas de Rastreamento/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/epidemiologia , Dilatação Patológica/fisiopatologia , Ecocardiografia/estatística & dados numéricos , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Prevalência , Turquia/epidemiologia
12.
Medicine (Baltimore) ; 100(22): e26238, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087909

RESUMO

RATIONALE: Acute acalculous cholecystitis (AAC) is an extremely rare manifestation of systemic lupus erythematous (SLE). In previous reports, most of the patients were already diagnosed cases of SLE upon confirmation of AAC. PATIENT CONCERNS: A 24-year-old female who initially presented with fever and acute right upper quadrant abdominal pain. She had no medical history. DIAGNOSES: Abdominal ultrasonography and computed tomography (CT) showed gallbladder thickening with pericholecystic edema without gallstones or sludge, demonstrating acalculous cholecystitis. She revealed discoid rash on the both shin. Laboratory tests revealed pancytopenia. The titer of antinuclear antibody (ANA) was 1:1280. Anti-dsDNA antibody, anti-phospholipid antibody, anti-Sm antibody test, and proteinuria in 24 hours were positive. Both C3 and C4 were low. Echocardiography and chest CT showed pericardial effusion and pleural effusion. Using the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria, the score was 31. We thought AAC of this case that was one of the initial manifestations of SLE. INTERVENTIONS: The patient was treated with high-dose prednisolone (1 mg/kg) and hydroxychloroquine 400 mg. OUTCOMES: After 4 days of administration of high-dose corticosteroid therapy, symptoms rapidly improved. After 35 days of the treatment, her symptoms and disease activity of SLE were markedly improved. LESSONS: Although AAC being the initial manifestation of SLE is very rare, prompt diagnosis and management with corticosteroids precluded surgical intervention. Physicians need to be cognizant of AAC as a disease flare and as a rare initial manifestation of SLE.


Assuntos
Colecistite Acalculosa/etiologia , Vesícula Biliar/patologia , Lúpus Eritematoso Sistêmico/complicações , Colecistite Acalculosa/diagnóstico , Doença Aguda , Adulto , Idoso , Anticorpos Antinucleares/sangue , Antirreumáticos/administração & dosagem , Antirreumáticos/uso terapêutico , Criança , Quimioterapia Combinada , Ecocardiografia/métodos , Feminino , Vesícula Biliar/diagnóstico por imagem , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Derrame Pericárdico/diagnóstico , Derrame Pleural/diagnóstico , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Proteinúria/diagnóstico , Proteinúria/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos , Adulto Jovem
13.
BMJ Case Rep ; 14(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108155

RESUMO

A 33-year-old man presented with a 3-week history of breathlessness and cough. He disclosed that he was informed regarding a heart defect as a child in his home country but was unaware of its nature and was never followed up. Examination revealed a pansystolic murmur (loudest at the apex), a hyperdynamic, displaced apex, and pulmonary oedema. An ECG showed atrial fibrillation with a regular broad-complex ventricular rhythm. Following electrical cardioversion, the ECG revealed complete heart block, therefore explaining the regular atrial fibrillation. An urgent transthoracic echocardiography (TTE) confirmed the anatomy of congenitally corrected transposition of the great arteries (CCTGA) with torrential tricuspid regurgitation and impaired systemic right ventricle. Cardiac MRI identified a ventricular septal defect which was not visible on TTE. The patient showed a transient improvement following fluid offloading and ACE inhibition, with a more definitive improvement after cardiac resynchronisation therapy (CRT).


Assuntos
Comunicação Interventricular , Transposição dos Grandes Vasos , Adulto , Criança , Transposição Congênita Corrigida de Grandes Artérias , Ecocardiografia , Comunicação Interventricular/diagnóstico por imagem , Ventrículos do Coração , Humanos , Masculino , Transposição dos Grandes Vasos/diagnóstico por imagem
14.
J Med Case Rep ; 15(1): 316, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34099054

RESUMO

BACKGROUND: Left ventricular noncompaction is a rare cardiomyopathy characterized by a thin, compacted epicardial layer and a noncompacted endocardial layer, with trabeculations and recesses that communicate with the left ventricular cavity. In the advanced stage of the disease, the classical triad of heart failure, ventricular arrhythmia, and systemic embolization is common. Segments involved are the apex and mid inferior and lateral walls. The right ventricular apex may be affected as well. CASE PRESENTATION: A 29-year-old Caucasian male was hospitalized with dyspnea and fatigue at minimal exertion during the last months before admission. He also described a history of edema of the legs and abdominal pain in the last weeks. Physical examination revealed dyspnea, pulmonary rales, cardiomegaly, hepatomegaly, and splenomegaly. Electrocardiography showed sinus rhythm with nonspecific repolarization changes. Twenty-four-hour Holter monitoring identified ventricular tachycardia episodes with right bundle branch block morphology. Transthoracic echocardiography at admission revealed dilated left ventricle with trabeculations located predominantly at the apex but also in the apical and mid portion of lateral and inferior wall; end-systolic ratio of noncompacted to compacted layers > 2; moderate mitral regurgitation; and reduced left ventricular ejection fraction. Between apical trabeculations, multiple thrombi were found. The right ventricle had normal morphology and function. Speckle-tracking echocardiography also revealed systolic left ventricle dysfunction and solid body rotation. Abdominal echocardiography showed hepatomegaly and splenomegaly. Abdominal computed tomography was suggestive for hepatic and renal infarctions. Laboratory tests revealed high levels of N-terminal pro-brain natriuretic peptide and liver enzymes. Cardiac magnetic resonance evaluation at 1 month after discharge confirmed the diagnosis. The patient received anticoagulants, antiarrhythmics, and heart failure treatment. After 2 months, before device implantation, he presented clinical improvement, and echocardiographic evaluation did not detect thrombi in the left ventricle. Coronary angiography was within normal range. A cardioverter defibrillator was implanted for prevention of sudden cardiac death. CONCLUSIONS: Left ventricular noncompaction is rare cardiomyopathy, but it should always be considered as a possible diagnosis in a patient hospitalized with heart failure, ventricular arrhythmias, and systemic embolic events. Echocardiography and cardiac magnetic resonance are essential imaging tools for diagnosis and follow-up.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Adulto , Arritmias Cardíacas/etiologia , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Volume Sistólico
15.
Zhonghua Wai Ke Za Zhi ; 59(6): 513-519, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34102737

RESUMO

Objective: To evaluate the safety and effectiveness of a new Chinese-made surgical biopatch for atrial septum under the establishment of atrial septal defect animal model in miniature pigs. Methods: From June 2018 to April 2019, 26 pigs were divided into experimental group (15 pigs) and the control group (11 pigs). Animal models of atrial septal defect were established by traditional surgical methods. The to-be-evaluated and listed surgical biological patches (with a diameter of 10 mm) were implanted in the experimental group and the control group to repair the atrial septal defect. Cardiac ultrasound and blood examination of all animals were performed before and at 7, 30, 90, 180 days after operation, the results were analyzed with repetitive measurement and analysis of variance. At 90 days and 180 days after the operation, tissue samples were taken from animals after euthanasia. Pathological examination of heart and major organs were conducted. The independent sample t test and rank sum test were used to compare the data between the two groups, and the nonparametric was used to compare the patch calcification score between the two groups. Results: In total of 26 animals, 14 animals in the experimental group(6 at 90 days, 8 at 180 days) and 9 animals in the control group(4 at 90 days, 5 at 180 days) reached the end of the experiment. The other 3 animals (1 in the experimental group and 2 in the control group) died of arrhythmia, whole heart failure and right heart failure, the results of pathological examination showed that the causes of death were unrelated to the experimental materials. Cardiac ultrasound showed no patch leakage in all animals. There was no statistically significant difference in cardiac ultrasound and blood examination between the two groups at different time points after operation (all P>0.05). The pathological results showed that all the implants were intact and had good biocompatibility. There was no significant difference in the mean endothelialization rate between the experimental group and the control group at 90 and 180 days after operation ((80.8±29.1)% vs. (82.5±23.6)%, t=0.095, P=0.927; (78.8±36.4)% vs. (82.0±19.2)%, t=0.182, P=0.859) on 90 and 180 days, there was no significant difference in the patch calcification score between the two groups (1.00(1.25) vs. 2.00(0.75), Z=6.500, P=0.214; 0(0.75) vs. 1.00(2.00), Z=12.000, P=0.139). Conclusion: The new Chinese-made surgical biopatch for atrial septum has comparable safety and efficacy to that of the marketable patch in miniature pig atrial septal defect animal model.


Assuntos
Septo Interatrial , Comunicação Interatrial , Animais , China , Ecocardiografia , Comunicação Interatrial/cirurgia , Próteses e Implantes , Suínos
16.
Medicine (Baltimore) ; 100(18): e25775, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950969

RESUMO

RATIONALE: The relationship between spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TTS) remains unclear. Coexistence of SCAD and TTS has been reported in the literature. However, the relationship between these two diseases has not yet been elucidated. PATIENT CONCERNS: A 36-year-old breastfeeding woman was brought to our hospital 52 days after cesarean section because of discomfort in her left arm and convulsions. DIAGNOSES: She was diagnosed of acute myocardial infarction (AMI). The convulsions were attributed to lethal arrhythmia. INTERVENTIONS: An immediate coronary angiography revealed that her left anterior descending artery (LAD) was Type 2a SCAD, but with no flow limitation. In addition, a 12-lead electrocardiogram (ECG) revealed improvement in ST-elevation. We chose the conservative treatment according to the patient's needs. OUTCOMES: Conservative treatment was unsuccessful. She developed another acute myocardial infarction requiring another percutaneous coronary intervention (PCI) during hospitalization. From the course of hospitalization, we suspected the coexistence of SCAD and TTS. LESSONS: When we treat patients with SCAD, we should consider the possibility of coexistence of TTS and confirm left ventricular wall motion. Patients with SCAD may require invasive treatment, hence, should be monitored for a while. An urgent strategy for managing patients with SCAD who require PCI should be established.


Assuntos
Tratamento Conservador , Anomalias dos Vasos Coronários/diagnóstico , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Doenças Vasculares/congênito , Adulto , Aleitamento Materno , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Ecocardiografia , Eletrocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Recidiva , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Prevenção Secundária/métodos , Cardiomiopatia de Takotsubo/complicações , Resultado do Tratamento , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/terapia
17.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(4): 495-503, 2021 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-33963707

RESUMO

OBJECTIVE: To investigate whether anti-hypertrophic memory exists after regression of exercise-induced physiological myocardial hypertrophy (PMH) and explore the contribution of sympathetic activation to hypertrophic memory formation. OBJECTIVE: Seventy-two mice were randomized equally into 6 groups, including sedentary sham-operated group, exercise hypertrophic preconditioning (EHP) + sham operation group, bisoprolol (an adrenergic ß1 receptor blocker) + EHP + sham operation group (biso+Exe+Sham group), sedentary group with transverse aortic constriction (TAC) (Sed+TAC group), EHP+ TAC group (Exe+TAC group), and bisoprolol+EHP+TAC group (biso+Exe+TAC group). The mice in the EHP groups were subjected to 3 weeks of swimming training, and in the bisoprolol groups, bisoprolol was administered by gavage once daily from two days before till the end of the training. One week after the training, TAC or sham surgery was performed. Echocardiography and hemodynamic measurements were performed to evaluate cardiac function of the mice, and the myocardial tissues were examined histologically to detect cardiac remodeling. OBJECTIVE: Compared with the sedentary group, the mice receiving 3 weeks of swimming training had significantly increased heart weight to body weight ratio (HW/BW), HW to tibia length ratio (HW/TL), and the cross-sectional area of the cardiomyocytes (P < 0.05). One week after the training, exercise-induced PMH rapidly diminished and both HW/BW and HW/TL recovered the baseline levels. Treatment with bisoprolol obviously prevented the occurrence of PMH. Four weeks after TAC, the left ventricular posterior wall thickness, HW/BW, HW/TL, left ventricular end diastolic pressure and cross-sectional area of cardiomyocytes were all significantly lower (P < 0.05) while the left ejection fraction and maximal change rate of left ventricular pressure were significantly higher (P < 0.05) in Exe + TAC group than in Sed + TAC group. No significant difference was found in these parameters between biso + Exe + TAC group and Sed + TAC group. OBJECTIVE: Anti-hypertrophic memory exists even after the regression of exercise-induced PMH, which may be attributed to the activation of sympathetic nervous system during exercise.


Assuntos
Miocárdio , Miócitos Cardíacos , Animais , Modelos Animais de Doenças , Ecocardiografia , Ventrículos do Coração , Hipertrofia , Hipertrofia Ventricular Esquerda , Camundongos , Camundongos Endogâmicos C57BL
20.
BMC Infect Dis ; 21(1): 415, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947336

RESUMO

BACKGROUND: Kawasaki disease (KD) is the most common cause of acquired heart disease among children in developed countries, in which the resulting coronary artery (CA) abnormalities cause myocardial ischemia, infarction, and death. Prompt diagnosis was essential, and supplemental information should be used to assist the diagnosis when classical clinical criteria are incomplete. The elevated levels of serum transaminases in most KD patients are mild. Herein, a case of atypical KD child with severely elevated transaminase was reported. CASE PRESENTATION: A child with clinical manifestations of fever, high C-reactive protein (CRP) and severely elevated transaminases was reported. The treatment effect of antibiotic and liver-protecting drugs was not satisfactory. A bilateral diffuse dilation of the CA was detected on echocardiography on day 5 of the illness; thus, atypical KD was diagnosed. Elevated transaminases declined rapidly to normal after the treatment of intravenous immunoglobulin (IVIG). A 1-month follow-up revealed that CA returned to normal, and 2-month, 6-months, and 1-year follow-up revealed the child was in good general health. CONCLUSIONS: This case highlighted that atypical KD clinical symptoms were diverse, and severely elevated transaminases might provide a clue to healthcare providers for the diagnosis and management of atypical KD.


Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/etiologia , Transaminases/sangue , Proteína C-Reativa/análise , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Ecocardiografia , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Lactente , Masculino
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