Mr. Mohammed Ghouse, a 64-year-old male with hypertension, presented with chest pain and was admitted to the hospital. Tests showed extensive heart ischemia. He underwent coronary angiography which revealed triple vessel disease and atherosclerosis. His condition was stabilized with medications and an IABP device, but he later developed ventricular tachycardia and died despite resuscitative efforts. The cause of death was determined to be an acute myocardial infarction due to reduced blood flow from the blocked coronary arteries.
A woman in her late 40s with a history of hypertension presented to the emergency department after multiple episodes of palpitations with near syncope. While in the
emergency department, she developed monomorphic ventricular tachycardia (VT) with hemodynamic instability and was successfully cardioverted. She continued to have nonsustained monomorphic VT, so intravenous amiodarone and oral metoprolol were initiated. She was admitted for further evaluation. Results of tests of electrolyte levels and coronary angiography were normal. Cardiac magnetic resonance imaging with
gadolinium contrast revealed normal-sized cardiac chambers and normal biventricular
function without delayed enhancement. The presenting electrocardiogram (ECG)
is shown in Figure 1.
This study examined autonomic remodeling in the left atrium and pulmonary veins that contributes to atrial fibrillation (AF) substrate in congestive heart failure (CHF). The following key findings were reported:
1. Autonomic and electrophysiological remodeling was observed in CHF dogs, particularly in the posterior left atrium and pulmonary veins, involving both sympathetic and parasympathetic systems.
2. Sympathetic hyperinnervation was seen with increases in nerve fibers, cardiac ganglia, and beta-adrenergic receptors. Parasympathetic remodeling was more complex with increased acetylcholinesterase activity.
3. Both parasympathetic and sympathetic signaling contributed significantly to AF maintenance in
The document proposes a new research hypothesis to better understand sudden heart pathology through innovative diagnostic methods. It suggests testing the heart's biochemical-metabolic status or pharmacological profile under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events. While many diagnostic strategies currently exist, about 20% of sudden cardiac deaths still lack an identified abnormality. The authors believe new tests analyzing the heart's local performance under varying physiological stresses could provide more useful information to clarify pathological causes, especially in young patients where atherosclerosis is less common. This approach may help explain cases of sudden cardiac arrest in untrained individuals during vigorous exertion.
Biopharmaceutical companies are developing 215 new medicines for heart disease and stroke, the two leading causes of death in Americans. These new treatments have the potential to build on progress made by existing drugs, which have helped reduce heart disease deaths by a third between 2001 and 2011 according to the CDC. Some of the new medicines in development use cutting-edge technologies like gene therapy and target specific aspects of cardiovascular disease such as high cholesterol, heart failure, and stroke. These innovative treatments currently in clinical trials or under FDA review may continue driving down death rates and improving quality of life for patients suffering from heart disease and stroke.
EVALUATING RISK OF HEART FAILURE WITH ERYTHROPOIETIN IN CHRONIC ANEMIAPARUL UNIVERSITY
Erythropoietin (EPO) is the primary regulatory hormone of
erythropoiesis. Hypoxia induces an increase in EPO hormone
production in the kidney which promotes the viability, proliferation,
and terminal differentiation of erythroid precursors, and causing an
increase in red blood cell mass. Any abnormality that reduces the renal
secretion of or bone marrow response to erythropoietin may result in
anemia. The approval of recombinant human erythropoietin
(epoetinalfa) by the US FDA in 1989, epoetinalfa and similar agents
now collectively known as erythropoietin stimulating agents (ESA)
have become the standard of care for the treatment of the
erythropoietin-deficient anemia. Studies suggest that in patients with
high serum erythropoietin is associated with risk of recurrent heart
failure (HF) and mortality. Thromboembolic complications can be
increased in patients receiving erythropoietin. the use of
erythropoiesis-stimulating agents though reduces the need for transfusions it is associated
with increased complications, including higher mortality and increased risk of
thromboembolic and cardiovascular events leading to congestive heart failure.
Heart involvement in systemic lupus erythematosus,dattasrisaila
Cardiac involvement is common in patients with systemic autoimmune diseases like systemic lupus erythematosus (SLE) and anti-phospholipid syndrome (APS). All parts of the heart can be affected through various mechanisms including autoantibodies, immune complexes, and thrombosis. In SLE, pericarditis and myocarditis are most common while APS is associated with valve abnormalities and coronary artery disease. Treatment involves controlling risk factors, immunosuppression, and in APS, anticoagulation or antiplatelet therapy.
This document summarizes a research article that proposes a new hypothesis for studying sudden heart pathology. The authors suggest developing a new diagnostic test that can stress the heart's metabolic processes under normal and abnormal conditions locally within the heart tissue, rather than examining blood plasma. This could help prevent events like heart attacks, arrhythmias, and transplant failure by better understanding the heart's metabolic response under stress. Currently about 20% of sudden cardiac deaths are not explained by autopsy findings, so new testing of the heart's metabolic response directly may provide more insights into these cases. The authors believe translating diagnostic approaches from other medical fields could offer a novel perspective on phenomena in cardiology.
Mr. Mohammed Ghouse, a 64-year-old male with hypertension, presented with chest pain and was admitted to the hospital. Tests showed extensive heart ischemia. He underwent coronary angiography which revealed triple vessel disease and atherosclerosis. His condition was stabilized with medications and an IABP device, but he later developed ventricular tachycardia and died despite resuscitative efforts. The cause of death was determined to be an acute myocardial infarction due to reduced blood flow from the blocked coronary arteries.
A woman in her late 40s with a history of hypertension presented to the emergency department after multiple episodes of palpitations with near syncope. While in the
emergency department, she developed monomorphic ventricular tachycardia (VT) with hemodynamic instability and was successfully cardioverted. She continued to have nonsustained monomorphic VT, so intravenous amiodarone and oral metoprolol were initiated. She was admitted for further evaluation. Results of tests of electrolyte levels and coronary angiography were normal. Cardiac magnetic resonance imaging with
gadolinium contrast revealed normal-sized cardiac chambers and normal biventricular
function without delayed enhancement. The presenting electrocardiogram (ECG)
is shown in Figure 1.
This study examined autonomic remodeling in the left atrium and pulmonary veins that contributes to atrial fibrillation (AF) substrate in congestive heart failure (CHF). The following key findings were reported:
1. Autonomic and electrophysiological remodeling was observed in CHF dogs, particularly in the posterior left atrium and pulmonary veins, involving both sympathetic and parasympathetic systems.
2. Sympathetic hyperinnervation was seen with increases in nerve fibers, cardiac ganglia, and beta-adrenergic receptors. Parasympathetic remodeling was more complex with increased acetylcholinesterase activity.
3. Both parasympathetic and sympathetic signaling contributed significantly to AF maintenance in
The document proposes a new research hypothesis to better understand sudden heart pathology through innovative diagnostic methods. It suggests testing the heart's biochemical-metabolic status or pharmacological profile under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events. While many diagnostic strategies currently exist, about 20% of sudden cardiac deaths still lack an identified abnormality. The authors believe new tests analyzing the heart's local performance under varying physiological stresses could provide more useful information to clarify pathological causes, especially in young patients where atherosclerosis is less common. This approach may help explain cases of sudden cardiac arrest in untrained individuals during vigorous exertion.
Biopharmaceutical companies are developing 215 new medicines for heart disease and stroke, the two leading causes of death in Americans. These new treatments have the potential to build on progress made by existing drugs, which have helped reduce heart disease deaths by a third between 2001 and 2011 according to the CDC. Some of the new medicines in development use cutting-edge technologies like gene therapy and target specific aspects of cardiovascular disease such as high cholesterol, heart failure, and stroke. These innovative treatments currently in clinical trials or under FDA review may continue driving down death rates and improving quality of life for patients suffering from heart disease and stroke.
EVALUATING RISK OF HEART FAILURE WITH ERYTHROPOIETIN IN CHRONIC ANEMIAPARUL UNIVERSITY
Erythropoietin (EPO) is the primary regulatory hormone of
erythropoiesis. Hypoxia induces an increase in EPO hormone
production in the kidney which promotes the viability, proliferation,
and terminal differentiation of erythroid precursors, and causing an
increase in red blood cell mass. Any abnormality that reduces the renal
secretion of or bone marrow response to erythropoietin may result in
anemia. The approval of recombinant human erythropoietin
(epoetinalfa) by the US FDA in 1989, epoetinalfa and similar agents
now collectively known as erythropoietin stimulating agents (ESA)
have become the standard of care for the treatment of the
erythropoietin-deficient anemia. Studies suggest that in patients with
high serum erythropoietin is associated with risk of recurrent heart
failure (HF) and mortality. Thromboembolic complications can be
increased in patients receiving erythropoietin. the use of
erythropoiesis-stimulating agents though reduces the need for transfusions it is associated
with increased complications, including higher mortality and increased risk of
thromboembolic and cardiovascular events leading to congestive heart failure.
Heart involvement in systemic lupus erythematosus,dattasrisaila
Cardiac involvement is common in patients with systemic autoimmune diseases like systemic lupus erythematosus (SLE) and anti-phospholipid syndrome (APS). All parts of the heart can be affected through various mechanisms including autoantibodies, immune complexes, and thrombosis. In SLE, pericarditis and myocarditis are most common while APS is associated with valve abnormalities and coronary artery disease. Treatment involves controlling risk factors, immunosuppression, and in APS, anticoagulation or antiplatelet therapy.
This document summarizes a research article that proposes a new hypothesis for studying sudden heart pathology. The authors suggest developing a new diagnostic test that can stress the heart's metabolic processes under normal and abnormal conditions locally within the heart tissue, rather than examining blood plasma. This could help prevent events like heart attacks, arrhythmias, and transplant failure by better understanding the heart's metabolic response under stress. Currently about 20% of sudden cardiac deaths are not explained by autopsy findings, so new testing of the heart's metabolic response directly may provide more insights into these cases. The authors believe translating diagnostic approaches from other medical fields could offer a novel perspective on phenomena in cardiology.
This document discusses cardioembolic stroke caused by atrial fibrillation. It notes that up to 3 million strokes per year worldwide are caused by AFib. AFib is the most common sustained heart rhythm disorder and increases the risk of stroke 5-fold. The document outlines the prevalence and sources of cardioembolic stroke, how AFib can lead to clots and stroke, and clinical features that help identify potential cardioembolic strokes. It also discusses various cardiac conditions that can cause emboli and stroke like ventricular thrombi, valvular heart disease, congenital heart defects, and arrhythmias.
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2asadsoomro1960
1) This document discusses two cases of chemotherapy-induced cardiomyopathy. The first was a rapidly progressive "tiger heart failure" that led to death before advanced therapies could be applied.
2) The second case involved a man who developed heart failure 17 years ago after chemotherapy for lymphoma but has survived longer through multiple stages of heart failure with guideline-directed medical therapies and devices like CRTD.
3) The author argues that with new treatments like Sacubitril, heart failure may be considered a complex chronic syndrome rather than always a "malignant" condition as was once thought.
Mr. Sajal, age 35, presented with chest pain for 5 hours. His ECG showed signs of myocardial infarction, but his coronary angiogram (CAG) revealed non-obstructive coronary arteries. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA). MINOCA can affect up to 14% of AMI patients, particularly younger patients and women. Cardiac magnetic resonance imaging (CMR) can identify the underlying cause in up to 87% of MINOCA cases. While initially thought to be benign, MINOCA carries similar mortality risks as MI with obstructive coronary artery disease. Identifying the specific cause through tests like CMR is important to determine the proper long-
Ischemic strokes caused by atrial fibrillation are a major health concern in the United States. They account for approximately 69,000 strokes annually. Compared to other causes of ischemic stroke, atrial fibrillation-related strokes tend to be more severe, disabling, and fatal. They are associated with longer hospital stays, higher rates of in-hospital complications, and poorer long-term outcomes. Patients often experience significant physical, emotional, and psychological impacts even years after their stroke. The burden on caregivers is also high. Timely management and treatment are critical to minimize damage from these strokes.
The document summarizes the findings of a CT scan showing extensive pulmonary embolisms in both lungs of a patient. It then reviews risk factors for increased mortality from PE, algorithms for acute care, additional workup and testing to investigate underlying causes, and guidelines for long-term anticoagulation treatment and management of recurrent clots.
1) A study of 900 older adults found that myocardial fibrosis detected by cardiac magnetic resonance (CMR) imaging was common, with myocardial infarction detected in 211 patients, major non-ischemic fibrosis in 54 patients, and minor non-ischemic fibrosis in 238 patients.
2) Patients with major non-ischemic fibrosis detected by CMR had a poorer prognosis than those without late gadolinium enhancement.
3) A study comparing outcomes of unrecognized myocardial infarction detected by CMR versus recognized myocardial infarction found that all-cause mortality was lower in those with unrecognized infarction for at least 5 years.
Atrial fibrillation is associated with an increased risk of heart failure. The relationship between atrial fibrillation and heart failure is bidirectional, as they share common risk factors and atrial fibrillation can lead to heart failure through mechanisms like tachycardiomyopathy or loss of atrial contribution to cardiac filling, while heart failure can also increase the risk of atrial fibrillation. Studies have shown that atrial fibrillation predicts increased risk of death or hospitalization for heart failure. The risk is higher for atrial fibrillation patients compared to those without atrial fibrillation.
This document summarizes a presentation on biomarkers for stroke. It discusses various biomarkers including BNP, NT-proBNP, CRP, and D-dimer. For BNP and NT-proBNP, elevated levels are associated with increased risk of cardioembolic stroke and worse stroke outcomes. CRP levels may help identify atherosclerosis but do not predict stroke risk well. D-dimer is elevated in active clot formation and helps diagnose cerebral venous thrombosis, though normal levels do not rule it out. The document reviews evidence for each biomarker from observational studies and their clinical utility.
1. Patients initially presenting with aborted sudden death have the highest recurrence rate of cardiac events at 69%, while those presenting with syncope have a lower recurrence rate of 19%.
2. Among asymptomatic patients, those with a spontaneously appearing Brugada ECG pattern are at highest risk, while those only showing the pattern after sodium channel blockers appear to be at minimal risk.
3. Implantable cardioverter defibrillators (ICDs) are recommended for symptomatic patients with a Type 1 Brugada ECG pattern to prevent sudden cardiac death, while asymptomatic patients may undergo electrophysiological study to determine risk.
Ischaemic Stroke in the Very Elderly PatientsAde Wijaya
Stroke is common in the very elderly population and presents unique challenges. Risk factors like atrial fibrillation and hypertension are more prevalent. Outcomes are generally poorer with higher mortality rates over 80 and 90 years of age. While intravenous thrombolysis can improve outcomes in those 81-90, it does not for those over 90. Endovascular therapy can allow over a quarter of those over 80 to regain independence, though outcomes are inferior to younger patients. Guidelines support oral anticoagulation for atrial fibrillation in the very elderly, and direct oral anticoagulants are recommended over warfarin with a better safety profile. Treatment is otherwise similar but requires more careful assessment.
This presentation discusses various animal models used to study stroke. It begins with background on stroke, noting that most strokes are ischemic and affect the middle cerebral artery. It then reviews several common animal models, including electrocoagulation, chemically induced, intraluminal filament, embolic, and photochemically induced models in rats and other species. The advantages and disadvantages of each model are discussed. Evaluation methods like infarct volume analysis and cylinder tests are also mentioned. Finally, the presentation calls for continued research to better mimic human post-stroke events in animal models.
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major vascular surgery. In a retrospective case-control study of 2816 patients, statin use was associated with a 78% reduced risk of perioperative mortality. Patients taking statins had over a four-fold lower risk of death compared to non-users. The protective effect of statins was consistent regardless of cardiac risk factors or beta-blocker use.
Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major vascular surgery. In a retrospective case-control study of 2816 patients, statin use was associated with a 78% reduced risk of perioperative mortality. Patients taking statins had over a four-fold lower risk of death compared to non-users. The protective effect of statins was consistent regardless of cardiac risk factors or beta-blocker use.
Aortic Dissection with Hemopericardium and Thrombosed Left Common Iliac Arter...Vinod Namana
#aortic dissection #tamponade #hemopericardium #pericardial effusion #leg ischemia #type a dissection #shock #cardiogenic shock.
An aortic dissection is an uncommon serious condition, which usually presents with chest pain or upper back pain. Symptoms of aortic dissection may mimic those of other diseases, often leading to delay in diagnosis. We report an unusual case of aortic dissection with hemopericardium and thrombosed left common iliac artery presenting as acute limb ischemia. Maintaining a high index of clinical suspicion for aortic pathology could possibly lead to identification and timely management of a greater number of patients who have atypical presentations. This would be especially true for patients who have catastrophic presentations with unexplained symptoms.
Presentatie Prof. dr. Deckers en Prof. dr. BotsCVON
Combining Atherosclerosis Imaging and New and Novel Markers in Asymptomatic Subjects at Intermediate CVD Risk: Implications for Pathophysiology, Prediction and Prevention.
This document discusses cardioembolic stroke caused by atrial fibrillation. It notes that up to 3 million strokes per year worldwide are caused by AFib. AFib is the most common sustained heart rhythm disorder and increases the risk of stroke 5-fold. The document outlines the prevalence and sources of cardioembolic stroke, how AFib can lead to clots and stroke, and clinical features that help identify potential cardioembolic strokes. It also discusses various cardiac conditions that can cause emboli and stroke like ventricular thrombi, valvular heart disease, congenital heart defects, and arrhythmias.
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2asadsoomro1960
1) This document discusses two cases of chemotherapy-induced cardiomyopathy. The first was a rapidly progressive "tiger heart failure" that led to death before advanced therapies could be applied.
2) The second case involved a man who developed heart failure 17 years ago after chemotherapy for lymphoma but has survived longer through multiple stages of heart failure with guideline-directed medical therapies and devices like CRTD.
3) The author argues that with new treatments like Sacubitril, heart failure may be considered a complex chronic syndrome rather than always a "malignant" condition as was once thought.
Mr. Sajal, age 35, presented with chest pain for 5 hours. His ECG showed signs of myocardial infarction, but his coronary angiogram (CAG) revealed non-obstructive coronary arteries. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA). MINOCA can affect up to 14% of AMI patients, particularly younger patients and women. Cardiac magnetic resonance imaging (CMR) can identify the underlying cause in up to 87% of MINOCA cases. While initially thought to be benign, MINOCA carries similar mortality risks as MI with obstructive coronary artery disease. Identifying the specific cause through tests like CMR is important to determine the proper long-
Ischemic strokes caused by atrial fibrillation are a major health concern in the United States. They account for approximately 69,000 strokes annually. Compared to other causes of ischemic stroke, atrial fibrillation-related strokes tend to be more severe, disabling, and fatal. They are associated with longer hospital stays, higher rates of in-hospital complications, and poorer long-term outcomes. Patients often experience significant physical, emotional, and psychological impacts even years after their stroke. The burden on caregivers is also high. Timely management and treatment are critical to minimize damage from these strokes.
The document summarizes the findings of a CT scan showing extensive pulmonary embolisms in both lungs of a patient. It then reviews risk factors for increased mortality from PE, algorithms for acute care, additional workup and testing to investigate underlying causes, and guidelines for long-term anticoagulation treatment and management of recurrent clots.
1) A study of 900 older adults found that myocardial fibrosis detected by cardiac magnetic resonance (CMR) imaging was common, with myocardial infarction detected in 211 patients, major non-ischemic fibrosis in 54 patients, and minor non-ischemic fibrosis in 238 patients.
2) Patients with major non-ischemic fibrosis detected by CMR had a poorer prognosis than those without late gadolinium enhancement.
3) A study comparing outcomes of unrecognized myocardial infarction detected by CMR versus recognized myocardial infarction found that all-cause mortality was lower in those with unrecognized infarction for at least 5 years.
Atrial fibrillation is associated with an increased risk of heart failure. The relationship between atrial fibrillation and heart failure is bidirectional, as they share common risk factors and atrial fibrillation can lead to heart failure through mechanisms like tachycardiomyopathy or loss of atrial contribution to cardiac filling, while heart failure can also increase the risk of atrial fibrillation. Studies have shown that atrial fibrillation predicts increased risk of death or hospitalization for heart failure. The risk is higher for atrial fibrillation patients compared to those without atrial fibrillation.
This document summarizes a presentation on biomarkers for stroke. It discusses various biomarkers including BNP, NT-proBNP, CRP, and D-dimer. For BNP and NT-proBNP, elevated levels are associated with increased risk of cardioembolic stroke and worse stroke outcomes. CRP levels may help identify atherosclerosis but do not predict stroke risk well. D-dimer is elevated in active clot formation and helps diagnose cerebral venous thrombosis, though normal levels do not rule it out. The document reviews evidence for each biomarker from observational studies and their clinical utility.
1. Patients initially presenting with aborted sudden death have the highest recurrence rate of cardiac events at 69%, while those presenting with syncope have a lower recurrence rate of 19%.
2. Among asymptomatic patients, those with a spontaneously appearing Brugada ECG pattern are at highest risk, while those only showing the pattern after sodium channel blockers appear to be at minimal risk.
3. Implantable cardioverter defibrillators (ICDs) are recommended for symptomatic patients with a Type 1 Brugada ECG pattern to prevent sudden cardiac death, while asymptomatic patients may undergo electrophysiological study to determine risk.
Ischaemic Stroke in the Very Elderly PatientsAde Wijaya
Stroke is common in the very elderly population and presents unique challenges. Risk factors like atrial fibrillation and hypertension are more prevalent. Outcomes are generally poorer with higher mortality rates over 80 and 90 years of age. While intravenous thrombolysis can improve outcomes in those 81-90, it does not for those over 90. Endovascular therapy can allow over a quarter of those over 80 to regain independence, though outcomes are inferior to younger patients. Guidelines support oral anticoagulation for atrial fibrillation in the very elderly, and direct oral anticoagulants are recommended over warfarin with a better safety profile. Treatment is otherwise similar but requires more careful assessment.
This presentation discusses various animal models used to study stroke. It begins with background on stroke, noting that most strokes are ischemic and affect the middle cerebral artery. It then reviews several common animal models, including electrocoagulation, chemically induced, intraluminal filament, embolic, and photochemically induced models in rats and other species. The advantages and disadvantages of each model are discussed. Evaluation methods like infarct volume analysis and cylinder tests are also mentioned. Finally, the presentation calls for continued research to better mimic human post-stroke events in animal models.
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major vascular surgery. In a retrospective case-control study of 2816 patients, statin use was associated with a 78% reduced risk of perioperative mortality. Patients taking statins had over a four-fold lower risk of death compared to non-users. The protective effect of statins was consistent regardless of cardiac risk factors or beta-blocker use.
Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major vascular surgery. In a retrospective case-control study of 2816 patients, statin use was associated with a 78% reduced risk of perioperative mortality. Patients taking statins had over a four-fold lower risk of death compared to non-users. The protective effect of statins was consistent regardless of cardiac risk factors or beta-blocker use.
Aortic Dissection with Hemopericardium and Thrombosed Left Common Iliac Arter...Vinod Namana
#aortic dissection #tamponade #hemopericardium #pericardial effusion #leg ischemia #type a dissection #shock #cardiogenic shock.
An aortic dissection is an uncommon serious condition, which usually presents with chest pain or upper back pain. Symptoms of aortic dissection may mimic those of other diseases, often leading to delay in diagnosis. We report an unusual case of aortic dissection with hemopericardium and thrombosed left common iliac artery presenting as acute limb ischemia. Maintaining a high index of clinical suspicion for aortic pathology could possibly lead to identification and timely management of a greater number of patients who have atypical presentations. This would be especially true for patients who have catastrophic presentations with unexplained symptoms.
Presentatie Prof. dr. Deckers en Prof. dr. BotsCVON
Combining Atherosclerosis Imaging and New and Novel Markers in Asymptomatic Subjects at Intermediate CVD Risk: Implications for Pathophysiology, Prediction and Prevention.
Presentatie van Prof. dr.Wilde en Prof. dr. VosCVON
1. The document discusses research into genetic and acquired predictors of sudden cardiac death, with the goal of improving prevention.
2. The research will use large community-based genetic and epidemiological studies in the Netherlands to identify genetic and lifestyle factors that influence risk of sudden cardiac death.
3. Advanced genomic and proteomic techniques will be applied to study the molecular mechanisms and interactions between genetic and acquired factors in modulating sudden cardiac death risk.
Presentatie Prof. dr. Büller en Prof. dr. ReitsmaCVON
The influence of statins on the role of blood coagulation in the maintenance of a healthy macro- and microvasculature and in the prevention of recurrent thrombosis.
1. The document discusses research into genetic and acquired predictors of sudden cardiac death, with the goal of improving prevention strategies.
2. The research will use large community-based genetic and epidemiological studies from the Netherlands, as well as advanced genomic and proteomic techniques, to identify genetic and environmental factors that influence cardiac arrhythmia risk.
3. The research aims to determine how genetic and acquired factors interact to modulate sudden cardiac death risk, as well as the molecular and electrophysiological mechanisms involved. Results may help predict sudden cardiac death risk and identify new therapeutic targets.
Levosimendan is a calcium sensitizer and potassium channel opener developed for treating acute decompensated heart failure. It has been studied for use in acute heart failure (AHF) and cardiogenic shock (CS) complicating acute coronary syndrome (ACS). AHF frequently complicates ACS, especially with large infarctions or arrhythmias, and is associated with worse outcomes than AHF without ACS. Levosimendan enhances contractility without increasing calcium levels, and also causes vasodilation. Studies have found levosimendan reduces myocardial damage from ischemia and improves outcomes in AHF/CS compared to other inotropes. Levosimendan may be preferable to vasopress
ARVC and flecainide case report[EI] Jim.docx.pdfJim Dowling
This case report describes a patient diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC) due to a mutation in the titin gene. Initial treatment with beta-blockers for exercise-induced ventricular arrhythmias was ineffective. Treatment with flecainide dramatically improved the patient's symptoms. After 6 years of flecainide treatment, the patient can engage in low-intensity activities without issues. The report highlights the potential efficacy of flecainide for ARVC patients with exercise-induced arrhythmias and preserved heart function.
This document provides an overview of atrial fibrillation (AF). It begins with the basic electrophysiology of the heart and defines AF. It describes the classification, causes, pathophysiology and epidemiology of AF. It discusses the risks of stroke and methods for assessing stroke risk, including various risk scores. The document outlines the guidelines for managing AF, including treatment options and newer oral anticoagulants. It provides details on evaluating a patient with AF through history, physical exam, ECG and echocardiogram.
Management of Atrial Fibrillation Science:Myths & Fashiontheheartofthematter
This document discusses the management of atrial fibrillation. It notes that AF prevalence is increasing with an aging population and is associated with increased risk of stroke and mortality. Treatment involves rate or rhythm control with medications, electrical cardioversion, or newer options like catheter ablation. Risk stratification tools like CHADS2 are used to determine stroke risk and need for anticoagulation. Newer oral anticoagulants offer alternatives to warfarin by avoiding the need for INR monitoring.
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...pateldrona
LAE related rhythm disturbance that characterize atrial fibrillation is also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte function
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...AnonIshanvi
LAE related rhythm disturbance that characterize atrial fibrillation is also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte function. The role of LAE in acute cerebral infarction patient is not sufficiently described in literature.
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...komalicarol
LAE related rhythm disturbance that characterize atrial fibrillation is
also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte
function. The role of LAE in acute cerebral infarction patient is not sufficiently described in literature.
Hence of this study was undertaken to look for the frequency of left atrial enlargement in acute stroke
subtypes.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
Managing Heart Failure in Patients on Dialysismagdyelmasry3
•
Heart failure and end-stage kidney disease (ESKD) commonly coexist; 1 comorbidity worsens the prognosis of the other.
•
Although patients with ESKD compose an extremely high-risk population, they have been excluded from landmark clinical trials in heart failure, and there is, thus, a paucity of data regarding the management of heart failure in patients on dialysis.
•
Trial-level evidence is warranted in the future to endorse the efficacy and safety of therapeutic interventions in patients with heart failure and on dialysis. Collaborations between cardiologists and nephrologists are needed to devise an optimal treatment strategy for these patients.
Fabry disease affects many parts of the heart and blood vessels. It can cause high blood pressure, an enlarged heart, heart rhythm problems, valve disease, blood vessel damage, heart attack, and sudden cardiac death. These complications are now the leading cause of death in Fabry patients. Advanced imaging techniques like echocardiograms, cardiac MRI, and T1 mapping can detect early heart changes before symptoms appear. Comprehensive screening and treatment of cardiovascular involvement in Fabry disease may allow earlier intervention and reduce morbidity and mortality.
Comparison of the efficacy and safety of new oral anticoagulants with warfari...Khairunnisa Zamri
This document summarizes a meta-analysis comparing the efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) to warfarin for preventing stroke in patients with atrial fibrillation. The analysis pooled data from four randomized controlled trials involving over 100,000 patients. It found that the new oral anticoagulants were as effective or more effective than warfarin at reducing strokes and systemic embolisms, with similar or lower rates of major bleeding. However, they were associated with an increased risk of gastrointestinal bleeding compared to warfarin. The analysis concluded that the new oral anticoagulants provide an improved
This document presents the fourth universal definition of myocardial infarction. Key changes include differentiating myocardial infarction from myocardial injury, highlighting peri-procedural myocardial injury after procedures as distinct from infarction, and considering electrical remodeling in assessing repolarization abnormalities. The definition aims to standardize the diagnosis of infarction for improved patient management and research.
Palpitations In The Young Patients: Another False Alarm?ahvc0858
This document discusses palpitations in young adults. It begins by introducing the speakers and describing the services provided at AHVC, including general cardiology, interventional procedures, and electrophysiology. It then discusses common causes of palpitations like supraventricular tachycardia, outlines four case studies of patients presenting with palpitations, and debunks myths about palpitations always being benign or due to anxiety. The document emphasizes that arrhythmias in young patients should be properly evaluated.
New insights into the predictors of left atrialalatawi2
- 71% (32 of 45) patients developed post-DCCV LAS, defined as LAA emptying velocity <20 cm/s.
- The only significant predictor of post-DCCV LAS was a shorter pre-cardioversion mitral E-wave deceleration time.
- At follow-up of 3.3 years, there was a trend toward a higher arrhythmia recurrence rate in patients with LAS compared to those without LAS.
This document discusses cardioembolic stroke, which occurs when heart issues cause materials to enter the brain's blood vessels. Common causes include atrial fibrillation, heart failure, and mechanical heart valves. Diagnosis involves echocardiography and monitoring for embolic signals. Treatment depends on the specific heart condition but often includes anticoagulants to prevent clots. Anticoagulation reduces stroke risk from atrial fibrillation by 60-90% compared to placebo. Managing cardioembolic stroke risk requires identifying the underlying heart condition and addressing it with medications, surgery, or lifestyle changes.
The EMPHASIS-HF trial studied the effects of adding eplerenone to recommended medical therapy in patients with systolic heart failure and mild symptoms. The trial found that adding eplerenone reduced the primary composite outcome of cardiovascular death or heart failure hospitalization by 37% compared to placebo. Eplerenone also reduced mortality from any cause by 24% and hospitalization from any cause by 23%. The benefits were consistent across subgroups. Safety analysis found eplerenone increased serum potassium similarly to other trials. The study concluded that addition of eplerenone to recommended medical therapy reduces morbidity and mortality for patients with mild systolic heart failure.
This document summarizes key points about atrial fibrillation (AF):
- AF is increasingly prevalent due to aging populations and risk factors like obesity. It reduces quality of life and accounts for a large portion of healthcare costs and strokes.
- Rhythm control strategies like catheter ablation have higher success rates than drug therapies and may slow or prevent progression of AF over time. Ablation also reduces risks of death, stroke, and dementia compared to drug therapy or no treatment.
- Advances in mapping systems and ablation catheters have improved safety and efficacy of catheter ablation procedures for treating AF.
This document discusses cardio-oncology syndromes, specifically chemotherapy-induced cardiomyopathy (CCMP). It presents a case study of a 36-year-old female with no prior heart issues who was diagnosed with acute myeloid leukemia. After receiving chemotherapy, she developed severe heart failure within 2 weeks and died. CCMP can cause heart failure in 1-5% of cancer survivors treated with anthracyclines and risk increases with higher cumulative doses. This was an acute case of CCMP resulting in advanced heart failure and death in a previously healthy young patient.
Atrial fibrillation is the most common type of cardiac arrhythmia. It is the leading cardiac cause of stroke
https://www.youtube.com/watch?v=4pSobW-a6gQ&list=PL2XcrMWxPBLQyEdWnJuO4qSI2m-WTrglH&pp=gAQBiAQB
This document summarizes information on anemia in heart failure patients. Some key points:
1. The prevalence of anemia in heart failure patients ranges from 20-30% for outpatients to 30-40% for inpatients, depending on the definition and study.
2. Anemia is associated with worse prognosis and increased risk of hospitalization and mortality in heart failure patients.
3. Potential treatment options for anemia in heart failure include blood transfusions, erythropoietin-stimulating proteins (ESPs), and iron therapy. However, clinical trials of ESPs like darbepoetin alfa have not shown clear benefits.
4. The FAIR-HF trial found
Similar to Presentatie Prof. Dr. van Gelder en Prof. Dr. Schotten (20)
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This document discusses a research consortium studying human stem cells for cardiac repair. The goals are to reduce patients with symptomatic cardiac failure by unraveling the mechanisms behind stem cell therapy's benefits to improve heart regeneration. Key research questions focus on the roles of neovascularization, microRNAs, and paracrine factors in regeneration. The impact of risk factors like gender, smoking, and diabetes on stem cell behavior and host response will also be examined. Four work packages are outlined studying cardiogenesis, individual variation, preclinical trials, and clinical trials using mesenchymal stem cells, adipose tissue-derived nucleated cells, and cardiac stem cells.
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ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
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Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Presentatie Prof. Dr. van Gelder en Prof. Dr. Schotten
1. Atrial Fibrillation as ElectroVasculopathy Interaction of electrical and vascular factors for the progression of AF I.C. Van Gelder, MD, PhD Prof. of Cardiology Dept. of Cardiology UMCG, Groningen U. Schotten, MD, PhD Prof. of Cardiac Electrophysiology Dept. of Physiology UM, Maastricht
2. Consortium Principal Investigators Van Gelder Cardiology UMCG Schotten Physiology UM, MUMC+ Crijns Cardiology AZM, MUMC+ Rabelink Vascular Physiology LUMC Spronk Biochemistry UM, MUMC+ De Groot Biochemistry UMCU Further Investigators Schalij Cardiology LUMC Ten Cate Biochemistry UM, MUMC+ Van der Worp Neurology UMCU Hillege Epidemiology UMCG Verheule Physiology UM, MUMC+ Maass Cardiology UMCG
3. Health Care problem - AF is not a benign disease, doubles morbidity and mortality in CVD patients Prevalence large (1-2%), 240000 patients with AF in NL - Neither prevention nor therapy of AF satisfactory so far. - AF shows large variability in mechanisms -> need for tailored therapy - AF is both an electrical and a vascular disease Most important manifestation of AF is stroke Risk factors of AF and of stroke in patients with AF are virtually identical 70% of all patients with AF have hypertention - Electrical mechanisms and the role of vascular dysfunction and hypercoagulation have traditionally been explored by different research groups. - Our innovative consortium of vascular and arrhythmia specialists aims to identify pathomechanisms of AF and vascular function in order to find new patient tailored therapies and reduce AF associated complications and costs
4. Research Questions 1. What molecular and cellular mechanisms explain the association between AF and vascular dysfunction? 2. How does AF cause vascular dysfunction and hypercoagulable state? 3. How do vascular dysfunction and hypercoagulable state promote progression of AF? 4. Which risk factors are associated with AF progression (incl. electrical, vascular and coagulation parameters) in a meticulously characterized cohort of patients with uncomplicated AF and hypertension? 5. Does protection of vascular function by direct thrombin inhibition prevent AF progression?
5. WP2: Vascular Dysfunction Causes AF - Hypoxia-induced Signaling Effects on fibroblasts and myocytes - AF substrates in Models of Atrial Ischemia WP1: AF Causes Vascular Dysfunction - Tachycardia-induced Signaling Effects on fibroblasts and endothelial cells - Vascular Dysfunction in models of AF WP3: Common Cause for AF and Vascular Dysfunction - Metabolic Stimuli for signaling in myocytes, fibroblasts and endothelial cells - AF substrates in Models of Metabolic Disorders Atrial Fibrillation Vascular Dysfunction WP5 AF Registry Electrical Versus Vascular Markers for Prediction of AF Progression WP6 Clinical Trial Prevention of AF Progression By Direct Thrombin Inhibitors WP4: AF Promotion by Thrombin generation - Mechanisms of hypercoagulation in AF (extrinsic, intrinsic, role of endothelial cells) - Pro-artherosclerotic and pro-fibrotic effects of thrombin
6. WP5 AF Registry Electrical Versus Vascular Markers for Prediction of AF Progression WP6 Clinical Trial Prevention of AF Progression By Direct Thrombin Inhibitors WP 6: RACE 4 : Prospective, multicenter randomized study of uncomplicated hypertension and AF patients: R andomized study of upstream therapy to prevent A F progression by reducing the hyper C oagulable state by dabigatran and fibrosis forming by E plerenone Hypothesis : Interventions protecting the vascular integrity of the atrium by direct thrombin inhibition with dabigatran reduces vascular remodeling, atrial fibrosis and dilatation in patients with AF and that this can be further reduced by an ARA. Design: Randomization (2 by 2 fashion) to dabigatran or VKA and to and ARA (eplerenone) and placebo. Primary endpoints are progression of AF and thromboembolic events. WP 5: Meticulously prospectively characterized patient cohort with AF and uncomplicated hypertension : Aim 1: to assess differences and risk factors for AF progression (permanent AF, increase in atrial volume and vascular complications). Vascular function will be assessed by sidestream dark field imaging, atrial remodeling by body surface potential maps Aim 2: To study the correlation & predictive value of both electrical and vascular imaging techniques and new coagulation tests for progression of AF
7. Translation Gene Molecule Cell Tissues Organ Animals Patients WP1 WP2 WP3 WP4 WP5 WP6 Thrombin ROS, endothelin, PAI-1, … Microvascular Imaging (SDF) Fibrosis Cognitive Function Hypercoagulation Monocyte recruitment in plaques VSMC proliferation migration Apoptosis Inflammation Microembolism Stroke Body Surface Potential Maps AF Mapping Tissue factor? Factor XII? PAR Dabigatran
8. Focus areas Dutch Heart Foundation Effect of AF on incidence stroke 4x higher in females (Friberg Am J Cardiol 2004) % AF is a disease of the elderly (Heeringa Eur Heart J 2006) yrs Ageing Gender Prevalence of AF Metabolic Disorders Metabolic syndrome components multivariately associated with new onset AF (Watanabe Circ 2008)