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1.
BMJ Case Rep ; 14(9)2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511412

RESUMO

Flash pulmonary oedema can occur as a result of multiple triggers that may act independently or in concert. One such precipitating factor is bilateral renal artery stenosis which can be treated either with revascularisation or with medical therapy. Unilateral renal artery stenosis, however, is a rare cause of flash pulmonary oedema, especially when the contralateral kidney is still functional. We describe a case of an elderly woman with a history of heart failure with preserved ejection fraction and multiple hospitalisations for hypertensive crisis and flash pulmonary oedema who was found to have right, ostial renal artery stenosis that was treated with stent placement.


Assuntos
Insuficiência Cardíaca , Hipertensão , Edema Pulmonar , Obstrução da Artéria Renal , Idoso , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/complicações , Edema Pulmonar/etiologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico por imagem , Stents
3.
Kyobu Geka ; 74(9): 687-691, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446623

RESUMO

The patient was an 81-year-old man. Transcatheter aortic valve implantation( TAVI) was performed for severe aortic stenosis using Evolut R. The patient moved to intensive care unit without an adverse event after the operation. But repeated acute heart failure occurred several times during hospital stay. Mitral regurgitation (MR) was worsened from mild at baseline to moderate or more by transthoracic echocardiography. Various factors that worsened MR after TAVI have been reported, and treatment strategy for severe aortic stenosis patients with MR should be carefully developed.


Assuntos
Estenose da Valva Aórtica , Insuficiência Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Insuficiência Cardíaca/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Desenho de Prótese , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
4.
Int J Mol Sci ; 22(16)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34445662

RESUMO

Acute myocardial infarction (MI) is associated with an intense inflammatory response that is critical for cardiac repair but is also involved in the pathogenesis of adverse cardiac remodeling, i.e., the set of size, geometry, and structure changes that represent the structural substrate for the development of post-MI heart failure. Deciphering the pathophysiological mechanisms underlying cardiac repair after MI is, therefore, critical to favorably regulate cardiac wound repair and to prevent development of heart failure. Catecholamines and estrogen play an active role in regulating the inflammatory response in the infarcted area. For example, stress-induced catecholamines alter recruitment and trafficking of leukocytes to the heart. Additionally, estrogen affects rate of cardiac rupture during the acute phase of MI, as well as infarct size and survival in animal models of MI. In this review, we will summarize the role of ß-adrenergic receptors and estrogen in cardiac repair after infarction in preclinical studies.


Assuntos
Estrogênios/metabolismo , Insuficiência Cardíaca/prevenção & controle , Infarto do Miocárdio/complicações , Receptores Adrenérgicos beta/metabolismo , Remodelação Ventricular , Animais , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/patologia , Humanos
7.
Int J Mol Sci ; 22(16)2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34445301

RESUMO

Angiotensin receptor neprilysin inhibitor (ARNI) treatment reduces functional mitral regurgitation (MR) to a greater extent than angiotensin receptor blocker (ARB) treatment alone, but the mechanism is unclear. We evaluated the mechanisms of how ARNI has an effect on functional MR. After inducing functional MR by left circumflex coronary artery occlusion, male Sprague Dawley rats (n = 31) were randomly assigned to receive the ARNI LCZ696, the ARB valsartan, or corn oil only (MR control). Excised mitral leaflets and left ventricle (LV) were analyzed, and valvular endothelial cells were evaluated focusing on molecular changes. LCZ696 significantly attenuated LV dilatation after 6 weeks when compared with the control group (LV end-diastolic volume, 461.3 ± 13.8 µL versus 525.1 ± 23.6 µL; p < 0.05), while valsartan did not (471.2 ± 8.9 µL; p > 0.05 to control). Histopathological analysis of mitral leaflets showed that LCZ696 strongly reduced fibrotic thickness compared to the control group (28.2 ± 2.7 µm vs. 48.8 ± 7.5 µm; p < 0.05). Transforming growth factor-ß and downstream phosphorylated extracellular-signal regulated kinase were also significantly lower in the LCZ696 group. Consequently, excessive endothelial-to-mesenchymal transition (EndoMT) was mitigated in the LCZ696 group compared to the control group and leaflet area was higher (11%) in the LCZ696 group than in the valsartan group. Finally, the MR extent was significantly lower in the LCZ696 group and functional improvement was observed. In conclusion, neprilysin inhibitor has positive effects on LV reverse remodeling and also attenuates fibrosis in MV leaflets and restores adaptive growth by directly modulating EndoMT.


Assuntos
Aminobutiratos/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Insuficiência da Valva Mitral/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Valsartana/uso terapêutico , Aminobutiratos/farmacologia , Antagonistas de Receptores de Angiotensina/farmacologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Animais , Compostos de Bifenilo/farmacologia , Células Cultivadas , Combinação de Medicamentos , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/fisiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Valva Mitral/efeitos dos fármacos , Valva Mitral/patologia , Valva Mitral/fisiologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Traumatismo por Reperfusão Miocárdica/complicações , Traumatismo por Reperfusão Miocárdica/diagnóstico , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Neprilisina/antagonistas & inibidores , Ratos , Ratos Sprague-Dawley , Valsartana/farmacologia , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos
8.
PLoS One ; 16(8): e0256035, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34398893

RESUMO

BACKGROUND: Chloroquine was promoted as a COVID-19 therapeutic early in the pandemic. Most countries have since discontinued the use of chloroquine due to lack of evidence of any benefit and the risk of severe adverse events. The primary aim of this study was to examine if administering chloroquine during COVID-19 imposed an increased risk of ischemic heart injury or heart failure. METHODS: Medical records, laboratory findings, and electrocardiograms of patients with COVID-19 who were treated with 500 mg chloroquine phosphate daily and controls not treated with chloroquine were reviewed retrospectively. Controls were matched in age and severity of disease. RESULTS: We included 20 patients receiving chloroquine (500 mg twice daily) for an average of five days, and 40 controls. The groups were comparable regarding demographics and biochemical analyses including C-reactive protein, thrombocytes, and creatinine. There were no statistically significant differences in cardiac biomarkers or in electrocardiograms. Median troponin T was 10,8 ng/L in the study group and 17.9 ng/L in the control group, whereas median NT-proBNP was 399 ng/L in patients receiving chloroquine and 349 ng/L in the controls. CONCLUSIONS: We found no increased risk of ischemic heart injury or heart failure as a result of administering chloroquine. However, the use of chloroquine to treat COVID-19 outside of clinical trials is not recommended, considering the lack of evidence of its effectiveness, as well as the elevated risk of fatal arrythmias.


Assuntos
Antivirais/efeitos adversos , Biomarcadores/análise , Cloroquina/análogos & derivados , Insuficiência Cardíaca/etiologia , Traumatismos Cardíacos/etiologia , Idoso , Antivirais/uso terapêutico , Proteína C-Reativa/análise , COVID-19/tratamento farmacológico , COVID-19/patologia , COVID-19/virologia , Estudos de Casos e Controles , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Creatinina/análise , Eletrocardiografia , Feminino , Insuficiência Cardíaca/metabolismo , Traumatismos Cardíacos/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/análise , Fragmentos de Peptídeos/análise , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Troponina T/análise
9.
Acta Biomed ; 92(3): e2021204, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212905

RESUMO

Cardiovascular diseases (CVDs)  have been the most common cause of death worldwide for decades. Until recently the most affected patients were middle-aged and elderly, predominantly men, with more frequent ST elevation myocardial infarction  (STEMI) caused by obstructive coronary artery disease (CAD). However, in the last two decades we have noticed an increased incidence of ischemia with non-obstructive coronary arteries (INOCA), which includes myocardial infarction with non-obstructive coronary arteries (MINOCA) and non-myocardial infarction syndromes, such as microvascular and vasospastic angina, conditions that have been particularly pronounced in women and young adults - the population we considered low-risky till than. Therefore, it has become apparent that for this group of patients conventional methods of assessing the risk of future cardiovascular (CV) events are no longer specific and sensitive enough. Heart failure with preserved ejection fraction (HFpEF) is another disease, the incidence of which has been rising rapidly during last two decades, and predominantly affects elderly population. Although the etiology and pathophysiology of INOCA and HFpEF are complex and not fully understood, there is no doubt that the underlying cause of both conditions is endothelial dysfunction (ED) which further promotes the development of left ventricular diastolic dysfunction (LVDD). Plasma biomarkers of ED, as well as natriuretic peptides (NPs), have been intensively investigated recently, and some of them have great potential for early detection and better assessment of CV risk in the future.


Assuntos
Doença da Artéria Coronariana , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Idoso , Doença da Artéria Coronariana/etiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Esquerda/etiologia
11.
Am J Case Rep ; 22: e933163, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34294675

RESUMO

BACKGROUND We report 4 family members, a 29-year-old son, 54-year-old father, 79-year-old grandmother, and 84-year-old grandfather, with COVID-19 pneumonia. Only the son had heart failure, with reduced ejection fraction and atrial fibrillation. This report aims to show that age and baseline comorbidities are not always predictors of severe COVID-19 disease. CASE REPORT Case 1: The son, a 29-year-old man, presented with dyspnea and palpitation. His nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He required high-flow nasal cannula oxygen therapy and had new-onset atrial fibrillation and reduced ejection fraction. Case 2: The father, a 54-year-old man, presented with dyspnea. Nasopharyngeal swab was positive for SARS-CoV-2. He required regular nasal cannula oxygen therapy. Electrocardiogram showed sinus rhythm. Echocardiogram showed normal ejection fraction. Case 3: The grandfather, an 84-year-old man with a history of atrial flutter, chronic kidney disease, and hypertension, presented with dyspnea and fever. Nasopharyngeal swab was positive for SARS-CoV-2. He required regular nasal cannula oxygen therapy. Electrocardiogram showed sinus rhythm. Echocardiogram showed normal ejection fraction. Case 4: The grandmother, a 79-year-old woman with a history of hypertension, presented with dyspnea. Nasopharyngeal swab was positive for SARS-CoV-2. She required regular nasal cannula oxygen therapy. Electrocardiogram showed sinus rhythm. CONCLUSIONS COVID-19 caused by SARS-CoV-2 is recognized to affect family members and can involve the heart, causing heart failure and cardiac arrhythmia like atrial fibrillation. This report highlights the importance of cardiac monitoring and consideration of cardiac damage, even without previous risk factors, in all hospitalized patients with COVID-19.


Assuntos
Fibrilação Atrial , COVID-19 , Avós , Insuficiência Cardíaca , Adulto , Idoso , Idoso de 80 Anos ou mais , Pai , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Volume Sistólico
12.
BMJ Case Rep ; 14(7)2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34301700

RESUMO

A 74-year-old man with a history of chronic alcohol use presented with progressive exertional dyspnoea and weight gain. On physical examination, he was noted to have wide pulse pressure, elevated jugular venous pressure, and alternating flushing and blanching of the nail beds in concert with the cardiac cycle, known as Quincke's pulse. Transthoracic echocardiography demonstrated normal biventricular systolic function and valvular function, but noted a dilated inferior vena cava. Right heart catheterisation revealed elevated filling pressures, high cardiac output and low systemic vascular resistance, consistent with high-output heart failure. Whole blood concentration of thiamine was low, confirming the diagnosis of wet beriberi. The patient abstained from alcohol use and was started on thiamine replacement therapy, resulting in narrowing of the pulse pressure over time and complete resolution of symptoms without the need for diuretic therapy.


Assuntos
Beriberi , Insuficiência Cardíaca , Idoso , Pressão Sanguínea , Ecocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Tiamina
13.
Expert Rev Cardiovasc Ther ; 19(8): 695-709, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34227916

RESUMO

Introduction: Over the past decade, the number of transcatheter aortic valve replacement (TAVR) procedures has increased exponentially. Despite major improvements in both device and successes, the rate of hospital readmission after TAVR remains high, with heart failure (HF) decompensation being one of the most important causes.Areas covered: This review provides an overview of the current status of HF following TAVR, including details about its incidence, clinical impact, contributing factors, and current and future treatment perspectives.Expert opinion: HF decompensation has been identified as the most common cause of rehospitalization following TAVR, and it has been associated with a negative prognosis. Multiple preexisting factors including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary artery disease, and atrial fibrillation have been associated with an increased risk of HF events. Also, multiple post-procedural factors like the occurrence of significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances have also contributed to increase this risk . Thus, reducing HF events in TAVR recipients would require a multifactorial and multidisciplinary effort including the optimization of the medical treatment and close follow-up and treatment of residual or concomitant valvular disease and conduction disturbance issues. Future studies in this challenging group of patients are warranted.


Assuntos
Estenose da Valva Aórtica , Fibrilação Atrial , Insuficiência Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Insuficiência Cardíaca/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
14.
Thorac Cardiovasc Surg ; 69(S 03): e41-e47, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34327689

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates. MATERIALS AND METHODS: Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. RESULTS: Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500 g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24 hours (p = 0.008 and 0.001, respectively), longer time to lactate normalization (p = 0.001), lactate > 10 mmol/L before ECMO (p = 0.01), lower weight (p = 0.01), longer ECMO duration (p = 0.005), lower platelet count (p = 0.001), more surgical site bleeding (p = 0.001), and surgical residual malformation (p = 0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24 hours (p = 0.003), longer ECMO duration (p = 0.015), and surgical site bleeding (p = 0.025) were independent risk factors. CONCLUSION: ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Oxigenação por Membrana Extracorpórea , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/terapia , Procedimentos Cirúrgicos Cardíacos/mortalidade , China , Oxigenação por Membrana Extracorpórea/efeitos adversos , Cardiopatias Congênitas/mortalidade , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Humanos , Recém-Nascido , Tempo de Internação , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Int Heart J ; 62(4): 811-815, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34234074

RESUMO

Management of constrictive pericarditis is often clinically challenging. Heart rate (HR) modulation using ivabradine is associated with improved clinical outcomes in patients with systolic heart failure, although it remains uninvestigated for other clinical purposes. We aimed to assess the impact of HR control in patients with constrictive pericarditis. In this retrospective study, consecutive patients who were diagnosed with constrictive pericarditis were included. Transthoracic echocardiography was performed at index discharge (day 0). The impact of HR difference between actual HR and ideal HR, which was calculated using a formula consisting of deceleration time, on heart failure readmission rates was investigated. A total of 15 patients (73 years old on median, 11 men) with constrictive pericarditis were included. On median, actual HR was 71 bpm and ideal HR was 81 bpm. Heart failure readmission rates were stratified into three groups by the HR difference: (1) optimal HR group satisfying "-10 bpm ≤ HR difference ≤ 10 bpm" (n = 4, 0.067 events per year); (2) lower HR group satisfying "HR difference < -10 bpm" (n = 7, 0.118 events per year, incidence rate ratio 1.98, 95% confidence interval 0.06-61.6); (3) higher HR group satisfying "HR difference > 10 bpm" (n = 4, 0.231 events per year, incidence rate ratio 9.22, 95% confidence interval 0.36-237.8). In conclusion, non-optimized HR was associated with an increased risk of heart failure recurrence in patients with constrictive pericarditis. Prospective assessment of deceleration time-guided HR optimization in patients with constrictive pericarditis is needed.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Insuficiência Cardíaca/etiologia , Frequência Cardíaca , Ivabradina/uso terapêutico , Pericardite Constritiva/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pericardite Constritiva/complicações , Recidiva , Estudos Retrospectivos
16.
PLoS One ; 16(7): e0255263, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34324524

RESUMO

BACKGROUND: Patients presenting with the coronavirus-2019 disease (COVID-19) may have a high risk of cardiovascular adverse events, including death from cardiovascular causes. The long-term cardiovascular outcomes of these patients are entirely unknown. We aim to perform a registry of patients who have undergone a diagnostic nasopharyngeal swab for SARS-CoV-2 and to determine their long-term cardiovascular outcomes. STUDY AND DESIGN: This is a multicenter, observational, retrospective registry to be conducted at 17 centers in Spain and Italy (ClinicalTrials.gov number: NCT04359927). Consecutive patients older than 18 years, who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 in the participating institutions, will be included since March 2020, to August 2020. Patients will be classified into two groups, according to the results of the RT-PCR: COVID-19 positive or negative. The primary outcome will be cardiovascular mortality at 1 year. The secondary outcomes will be acute myocardial infarction, stroke, heart failure hospitalization, pulmonary embolism, and serious cardiac arrhythmias, at 1 year. Outcomes will be compared between the two groups. Events will be adjudicated by an independent clinical event committee. CONCLUSION: The results of this registry will contribute to a better understanding of the long-term cardiovascular implications of the COVID19.


Assuntos
Arritmias Cardíacas/etiologia , COVID-19/complicações , Sistema Cardiovascular/virologia , Insuficiência Cardíaca/etiologia , Infarto do Miocárdio/etiologia , Acidente Vascular Cerebral/etiologia , Arritmias Cardíacas/virologia , Feminino , Insuficiência Cardíaca/virologia , Humanos , Itália , Masculino , Infarto do Miocárdio/virologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/virologia , Sistema de Registros , Estudos Retrospectivos , Espanha , Acidente Vascular Cerebral/virologia , Fatores de Tempo , Resultado do Tratamento
17.
Curr Cardiol Rep ; 23(8): 101, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196837

RESUMO

PURPOSE OF REVIEW: The contribution of continuous flow left ventricular assist devices (c-LVAD) to vasoplegic syndrome and postoperative outcomes after orthotopic heart transplant (OHT) is contested in the literature. A standardized definition of vasoplegic syndrome (VS) is needed to better recognize and manage vasoplegic shock. RECENT FINDINGS: Vasoplegic syndrome occurs after orthotopic heart transplant more frequently than after other surgeries requiring cardiopulmonary bypass. c-LVADs lead to small vessel endothelial dysfunction and desensitized adrenal receptors; however, their contribution to the development of vasoplegia is debated in clinical studies. Pulsatility may mitigate vascular dysfunction resulting from long-term continuous flow, and should be further explored in the clinical setting when considering risk factors for vasoplegic syndrome. The incidence of vasoplegic syndrome after orthotopic heart transplant is rising with the increasing use of c-LVAD bridge to therapy. Robust clinical studies are needed to advance our understanding and approach to mitigating VS after OHT.


Assuntos
Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Vasoplegia , Ponte Cardiopulmonar , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Transplante de Coração/efeitos adversos , Coração Auxiliar/efeitos adversos , Humanos , Estudos Retrospectivos , Fatores de Risco , Vasoplegia/tratamento farmacológico , Vasoplegia/etiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34300048

RESUMO

Due to the need for continuous work, the heart uses up to 8% of the total energy expenditure. Due to the relatively low adenosine triphosphate (ATP) storage capacity, the heart's work is dependent on its production. This is possible due to the metabolic flexibility of the heart, which allows it to use numerous substrates as a source of energy. Under normal conditions, a healthy heart obtains approximately 95% of its ATP by oxidative phosphorylation in the mitochondria. The primary source of energy is fatty acid oxidation, the rest of the energy comes from the oxidation of pyruvate. A failed heart is characterised by a disturbance in these proportions, with the contribution of individual components as a source of energy depending on the aetiology and stage of heart failure. A unique form of cardiac dysfunction is sepsis-induced cardiomyopathy, characterised by a significant reduction in energy production and impairment of cardiac oxidation of both fatty acids and glucose. Metabolic disorders appear to contribute to the pathogenesis of cardiac dysfunction and therefore are a promising target for future therapies. However, as many aspects of the metabolism of the failing heart remain unexplained, this issue requires further research.


Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Sepse , Trifosfato de Adenosina , Cardiomiopatias/etiologia , Cardiomiopatias/metabolismo , Metabolismo Energético , Ácidos Graxos/metabolismo , Glucose/metabolismo , Coração , Insuficiência Cardíaca/etiologia , Humanos , Miocárdio/metabolismo , Oxirredução
19.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253533

RESUMO

A 58-year-old man presented to the emergency department with recent-onset palpitations and progressive exertional dyspnoea. ECG demonstrated new-onset atrial fibrillation. Transthoracic echocardiogram showed global impairment in left ventricular systolic function with left ventricular ejection fraction of 20%. Cardiac MRI (CMRI) demonstrated generalised severe myocarditis. A SARS-CoV-2 PCR was positive for SARS-CoV-2 RNA. As such, we diagnosed our patient with COVID-19-associated myocarditis based on CMRI appearances and positive SARS-CoV-2 swab. This case highlights that COVID-19-associated myocarditis can present as new atrial fibrillation and heart failure without the classic COVID-19-associated symptoms.


Assuntos
Fibrilação Atrial , COVID-19 , Insuficiência Cardíaca , Miocardite , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico , Miocardite/tratamento farmacológico , RNA Viral , SARS-CoV-2 , Volume Sistólico , Função Ventricular Esquerda
20.
Medicine (Baltimore) ; 100(25): e26308, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160394

RESUMO

INTRODUCTION: Mechanical circulatory support such as the left ventricular assist device (LVAD) has become widely implemented in the treatment of end-stage heart failure, whether as bridge-to-transplant or as destination therapy. The hemodynamic effects of arrhythmia on LVADs and its management are significant in determining the long-term outcome of these patients. Both atrial arrhythmia and ventricular arrhythmia are commonly seen after implantation of the device. There are no strict guidelines, however, on the need for intensive management of arrhythmias in LVAD. In this case report, we present a patient with new onset atrial fibrillation after LVAD implantation which leads to acute decompensating heart failure. The patient was treated with catheter ablation. The intervention demonstrated positive outcomes for this patient. PATIENT CONCERNS: The patient was a Korean male, who presented with dyspnea, fatigue and generalized edema after persistent atrial fibrillation precipitated by implantation of the left ventricular assist device. DIAGNOSIS: The patient was diagnosed with acute decompensating heart failure that was aggravated by recurrent atrial arrhythmia. INTERVENTION: We attempted to relieve symptoms of right ventricular dysfunction by method of strict rhythm control in this patient. The patient underwent radiofrequency catheter ablation for recurrent atrial fibrillation. OUTCOME: The patient showed improved clinical symptoms, BNP levels, and echocardiogram parameters immediately after the procedure as well as during long term outpatient follow up. CONCLUSION: In this case report, we present the first successful case in Korea of atrial fibrillation in LVAD treated with catheter ablation. This case suggests setting catheter ablation as a routine first-line treatment for atrial arrhythmia in LVAD patients, especially when the arrhythmia predisposes the patient at risk for decompensating heart failure.


Assuntos
Fibrilação Atrial/terapia , Cardiomiopatia Dilatada/cirurgia , Ablação por Cateter , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Idoso , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Cardiomiopatia Dilatada/complicações , Resistência a Medicamentos , Ecocardiografia , Eletrocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Recidiva , Resultado do Tratamento
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