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1.
Open Heart ; 7(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33020258

RESUMO

BACKGROUND: Cardiac involvement with COVID-19 is increasingly being recognised. Clinical characteristics and outcomes of patients with COVID-19 complicated by secondary Takotsubo cardiomyopathy (TC) is poorly understood. METHODS: This retrospective case series was conducted between March and April 2020 at four hospitals of Steward Health Care Network of Massachusetts, USA. Seven patients out of 169 who had echocardiogram were identified to have features of TC. Demographic, clinical, laboratory, management and outcome were gathered from their electronic medical records. We also reviewed all the published cases of COVID-19 and TC in the literature to recognise their common clinical characteristics, risk factors and outcomes. RESULTS: In our series of seven patients, three typical, two inverted, one biventricular and one global TC were recognised. Three were females and four were males. The mean age was 71±11 years. In-hospital death was observed in 57% of patients. Patients who belonged to the high-risk group and had high-risk echocardiographic features in our series had a 100% mortality rate. CONCLUSIONS: COVID-19 complicated by TC has a high mortality rate. Early identification of patients with COVID-19 who are at higher risk for developing secondary TC is important for the prevention of complications, and thus improved outcomes.


Assuntos
Causas de Morte , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/epidemiologia , Distribuição por Idade , Idoso , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Coração Auxiliar , Mortalidade Hospitalar/tendências , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Cardiomiopatia de Takotsubo/terapia
2.
Int Heart J ; 61(5): 970-978, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999196

RESUMO

The mechanism of systolic annular expansion in mitral valve prolapse (MVP) is not clarified. Since annular expansion is systolic outward shift of MV leaflet/chorda tissue complex at superior and outer ends, annular expansion could be related to inward (superior) shift of the complex at another inferior and inner end of the papillary muscle (PM) tip and/or systolic lengthening of the tissue complex, especially MV leaflets.MV annulus systolic expansion, PMs' systolic superior shift, and MV leaflets' systolic lengthening were evaluated by echocardiography with a speckle tracking analysis in 25 normal subjects, 25 subjects with holo-systolic MVP and 20 subjects with late-systolic MVP.PMs' superior shift, MV leaflets' lengthening, MV annular area at the onset of systole and subsequent MV annulus expansion were significantly greater in late-systolic MVP than in holo-systolic MVP (4.6 ± 1.6 versus 1.5 ± 0.7 mm/m2, 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m2, 6.8 ± 2.5 versus 5.7 ± 1.0 cm2/m2 and 1.6 ± 0.8 versus 0.1 ± 0.5 cm2/m2, P < 0.001, respectively). Multivariate analysis identified MV leaflets' lengthening and PMs' superior shift as independent factors associated with MV annular expansion.Conclusions: These results suggest that systolic MV annular expansion in MVP is related to abnormal MV leaflets' lengthening and PMs' superior shift.


Assuntos
Ecocardiografia/métodos , Prolapso da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Músculos Papilares/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/diagnóstico por imagem , Músculos Papilares/diagnóstico por imagem , Estudos Retrospectivos , Sístole
6.
Medicine (Baltimore) ; 99(39): e22326, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991443

RESUMO

RATIONALE: The most common cardiac involvement of Fabry disease (FD) is left ventricular hypertrophy (LVH), which usually occurs in male patients over the age of 30. In rare cases, it can progress to ventricular dilation in the late stage of the disease. PATIENT CONCERNS: A 16-year-old boy presenting with recurrent extremity pain and chest distress was admitted to our hospital. Imaging examinations revealed ventricular dilation. DIAGNOSIS: α-Galactosidase A enzyme assay and GLA gene sequencing confirmed the diagnosis of FD and revealed a novel mutation c.76_77insT. INTERVENTIONS: The patient was treated using metoprolol (23.75 mg qd) and angiotensin-converting enzyme inhibitor (fosinopril sodium 5 mg qd). He refused enzyme replacement therapy for financial reasons. OUTCOMES: The echocardiography, electrocardiography, renal function, and routine blood and urine tests performed 20 months after the patients discharge from hospital showed no significant changes. The patient reported a slow and gradual decrease in the frequency and degree of pain and chest distress, starting approximately 24 months after discharge. LESSONS: Cardiac involvement of FD can progress rapidly in some cases. Screening for FD should be considered in patients with unexplained ventricular dilation, especially in those with a history of typical FD manifestations.


Assuntos
Dilatação Patológica/diagnóstico por imagem , Doença de Fabry/complicações , Doença de Fabry/genética , Hipertrofia Ventricular Esquerda/etiologia , alfa-Galactosidase/genética , Adolescente , Assistência ao Convalescente , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Ecocardiografia/métodos , Eletrocardiografia/métodos , Terapia de Reposição de Enzimas/economia , Doença de Fabry/tratamento farmacológico , Fosinopril/uso terapêutico , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Metoprolol/uso terapêutico , Mutação , Simpatolíticos/uso terapêutico , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(37): e22093, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925751

RESUMO

RATIONALE: Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology. PATIENT CONCERNS: Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain. DIAGNOSIS: While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium. INTERVENTIONS: The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital. OUTCOMES: During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion. LESSONS: Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Ecocardiografia/métodos , Pandemias , Derrame Pericárdico , Pericardiocentese/métodos , Pneumonia Viral , Infecções Assintomáticas , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/fisiopatologia , Derrame Pericárdico/cirurgia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Resultado do Tratamento
8.
Rev Med Suisse ; 16(705): 1618-1623, 2020 Sep 09.
Artigo em Francês | MEDLINE | ID: mdl-32914593

RESUMO

Transthoracic echocardiography (TTE) performed by a cardiologist is the first choice for exploring cardiac function and anatomy. Its performance and availability increase the demand for this examination, but this is not always justified. According to criteria published in 2011, the practice of a TTE is classified as appropriate, inappropriate or of uncertain value, depending on the clinical indication. This article explores the frequent indications for which TTE by the cardiologist is considered useful and/or appropriate for patients hospitalized in an internal medicine department.


Assuntos
Ecocardiografia/métodos , Medicina Interna/métodos , Hospitalização , Humanos , Guias de Prática Clínica como Assunto
9.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994595

RESUMO

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Mortalidade Hospitalar/tendências , Hospitais Urbanos/estatística & dados numéricos , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angiografia Coronária/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Alta do Paciente/tendências , Estudos Prospectivos , Recidiva , Estresse Psicológico/epidemiologia , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Centros de Atenção Terciária/estatística & dados numéricos
11.
Pediatr Clin North Am ; 67(5): 821-842, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888684

RESUMO

Left-to-right shunts represent a significant portion of congenital heart disease. Such lesions are common in isolation, but are frequently seen in conjunction with other, often more complex, congenital heart disease. This review covers basic anatomy, physiology, physical examination findings, diagnosis and management for atrial septal defects, ventricular septal defects, and patent ductus arteriosa.


Assuntos
Ecocardiografia/métodos , Forame Oval Patente/diagnóstico , Comunicação Interatrial/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Criança , Humanos
12.
Pediatr Clin North Am ; 67(5): 875-888, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888687

RESUMO

This article presents updates and an overview of pediatric infective endocarditis. It includes a discussion of presentation of illness, diagnosis of this disorder, differential diagnosis, treatment recommendation, and associated morbidity and mortality.


Assuntos
Antibacterianos/uso terapêutico , Gerenciamento Clínico , Ecocardiografia/métodos , Endocardite/diagnóstico , Criança , Endocardite/tratamento farmacológico , Humanos , Prognóstico
14.
J Am Soc Echocardiogr ; 33(10): 1278-1284, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32782131

RESUMO

BACKGROUND: Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease. METHODS: A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. RESULTS: Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = -0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. CONCLUSIONS: This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Ecocardiografia/métodos , Cardiopatias/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Pneumonia Viral/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Feminino , Seguimentos , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Adulto Jovem
15.
Medicine (Baltimore) ; 99(34): e21843, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846832

RESUMO

RATIONALE: Hypertrophic cardiomyopathy (HCM) is an inherited myocardial disease and a common cause of sudden cardiac death, heart failure, atrial fibrillation and stroke. In families affected by HCM, genotyping is useful for identifying susceptible relatives. In the present study, we investigated the disease-causing mutations in a three-generation Chinese family with HCM using whole exome sequencing (WES). PATIENT CONCERNS: The proband, a 50-year-old man, was diagnosed with HCM at the age of 41 years. He presented with an asymmetric hypertrophic interventricular septum and a maximum interventricular septum thickness of 18.04 mm. His third elder sister, niece and daughter were also clinically affected by HCM. DIAGNOSIS: Autosomal dominant HCM. INTERVENTIONS: Seven family members, including 4 affected members, accepted WES. The genetic variants were subsequently called using Genome Analysis Toolkit and annotated using the InterVar program. Following frequency filtration by the Genome Aggregation Database, the variants were evaluated using an in-house bioinformatics analysis pipeline. OUTCOMES: HCM was transmitted as an autosomal dominant trait in the family. An extremely rare stop gained mutation, rs796925245 (g.1:201359630G>A, c.835C>T, p.Gln279Ter) in the troponin T2 (TNNT2) gene was identified as the disease-causing mutation. The stop gained mutation was predicted to result in a truncated troponin T protein in cardiac sarcomere. An adolescent family member who had normal echocardiographic measurements was found to carry the same disease-causing mutation. LESSONS: A novel nonsense TNNT2 mutation was identified as the HCM-causing mutation in this Chinese pedigree. Since HCM shows a low penetrance by clinical criteria in adolescents, the adolescent mutation carrier, who is still clinically unaffected, should be offered routine follow-ups and sport activity recommendations to prevent adverse events including sudden cardiac death in the future.


Assuntos
Cardiomiopatia Hipertrófica Familiar/genética , Troponina T/genética , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Cardiomiopatia Hipertrófica Familiar/complicações , Cardiomiopatia Hipertrófica Familiar/diagnóstico , Códon sem Sentido , Morte Súbita Cardíaca/etiologia , Ecocardiografia/métodos , Feminino , Humanos , Hipertrofia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Septo Interventricular/patologia , Sequenciamento Completo do Exoma/métodos
16.
Medicine (Baltimore) ; 99(34): e21849, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846835

RESUMO

INTRODUCTION: Patent ductus venosus (PDV) is a rare and critical disease, and the majority of patients present with pulmonary arterial hypertension (PAH) or hepatopulmonary syndrome due to congenital portosystemic shunt. We reported that both PAH and hypersplenism were major complications of PDV in this case. This case report can assist the treatment and recovery of the patients with similar symptoms. PATIENT CONCERNS: A 4-year-old male patient presented to our institution with a history of recurrent respiratory infections accompanied by leukocytopenia, thrombocytopenia and presented with tachypnoea. upon mild exertion. DIAGNOSIS: A wide communication, 10 mm in diameter, between the portal vein and inferior vena cava was identified in the subcostal echocardiogram and computed tomography images. Echocardiography showed an estimated systolic pulmonary artery pressure of 106 mm Hg. Right-sided cardiac catheterization indicated a mean pulmonary arterial pressure of 30 mm Hg and a pulmonary vascular resistance of 3 Wood units. Chest X-ray revealed cardiomegaly with a prominent pulmonary segment. INTERVENTIONS: The patient was treated with combination pharmacotherapy of bosentan and tadalafil and PDV ligation. OUTCOMES: A year later, the boy showed normal exercise tolerance and weight gain. Liver and spleen parameters, liver function, blood cells and the general condition of the boy improved. CONCLUSION: Initial combination therapy of bosentan and tadalafil is safe and effective in children with PAH associated with PDV. When PDV banding test shows normal portal pressure, PDV ligation is considered acceptable in children with PAH and hypersplenism associated with PDV.


Assuntos
Hiperesplenismo/etiologia , Ligadura/métodos , Veia Porta/anormalidades , Hipertensão Arterial Pulmonar/etiologia , Malformações Vasculares/cirurgia , Assistência ao Convalescente , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Bosentana/administração & dosagem , Bosentana/uso terapêutico , Cardiomegalia/diagnóstico por imagem , Pré-Escolar , Terapia Combinada/métodos , Ecocardiografia/métodos , Humanos , Masculino , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Hipertensão Arterial Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Tadalafila/administração & dosagem , Tadalafila/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/tratamento farmacológico , Resistência Vascular/fisiologia , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêutico
17.
Medicine (Baltimore) ; 99(34): e21914, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846858

RESUMO

We aimed to evaluate the accuracy and interchangeability of stroke volume and cardiac output measured by electrical velocimetry and transthoracic echocardiography during cesarean delivery.We enrolled 20 parturients in this prospective observational study. We recorded the stroke volume and cardiac output using both methods and compared the values at seven specific time points. We analyzed the data using linear regression analysis for Pearson's correlation coefficients and Bland-Altman analysis to determine percentage errors. We conducted a trending ability analysis based on the four-quadrant plot with the concordance rate and correlation coefficient.We recorded 124 paired datasets during cesarean delivery. The correlation coefficients of the measured cardiac output and stroke volume between the two methods were 0.397 (P < .001) and 0.357 (P < .001). The 95% limits of agreement were -1.0 to 8.1 L min for cardiac output and -10.4 to 90.4 ml for stroke volume. Moreover, the corresponding percentage errors were 62% and 60%. The concordance correlation coefficients were 0.447 (95% CI: 0.313-0.564) for stroke volume and 0.562 (95% CI: 0.442-0.662) for cardiac output. Both methods showed a moderate trending ability for stroke volume (concordance rate: 82% (95% CI: 72-90%)) and cardiac output (concordance rate: 85% (95% CI: 78-93%)).Our findings indicated that electrical velocimetry monitoring has limited accuracy, precision, and interchangeability with transthoracic echocardiography; however, it had a moderate trending ability for stroke volume and cardiac output measurements during cesarean delivery.


Assuntos
Débito Cardíaco , Cesárea/métodos , Ecocardiografia/métodos , Reologia/métodos , Adulto , Algoritmos , China/epidemiologia , Confiabilidade dos Dados , Ecocardiografia/estatística & dados numéricos , Feminino , Hemodinâmica , Humanos , Monitorização Intraoperatória/instrumentação , Gravidez , Estudos Prospectivos , Reologia/estatística & dados numéricos , Volume Sistólico
18.
BMJ Case Rep ; 13(8)2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747596
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