This case report describes the diagnosis and management of long QT syndrome in a fetus based on findings from fetal echocardiography. Fetal echocardiography revealed frequent episodes of ventricular tachycardia and intermittent atrioventricular block, leading to a diagnosis of congenital long QT syndrome. Transplacental therapy with propranolol, mexiletine, and magnesium was initiated and helped reduce ventricular arrhythmias. The infant was delivered via cesarean section and required epicardial pacemaker implantation. Genetic testing post-delivery confirmed a mutation associated with long QT syndrome.
Recurrent Third-Trimester Fetal Loss and Maternal Mosaicism for Long-QT SyndromeAsha Reddy
1) A mother experienced recurrent third-trimester fetal loss and her surviving infant was diagnosed with long-QT syndrome (LQTS).
2) Genetic testing found the infant had a mutation in the SCN5A gene known to cause LQTS. Initial testing of the mother found no mutation.
3) A more sensitive test found the mother had low-level (8-10%) mosaicism for the same SCN5A mutation, indicating she transmitted it to her fetuses and infant.
4) This case suggests parental mosaicism can cause recurrent late-term fetal loss or sudden infant death through transmission of LQTS mutations and has implications for genetic counseling.
1) The study evaluated the effectiveness of indomethacin therapy for patent ductus arteriosus (PDA) in 41 full-term infants with birth weights over 2500g.
2) Indomethacin was administered intravenously in doses of 0.2-0.25 mg/kg every 12-24 hours. 25 infants (61%) responded positively to the treatment, either showing complete ductal closure or improved symptoms.
3) The remaining 16 infants (39%) did not respond to indomethacin therapy and most required surgical ligation of the ductus arteriosus. No severe adverse reactions occurred in any infants from the indomethacin treatment.
The document discusses a study analyzing risk factors for cardiac arrhythmias in 402 pediatric patients who underwent cardiac surgery. The study found that arrhythmias occurred in 57 patients (14.2%), with junctional ectopic tachycardia and supraventricular tachycardia being most common. Lower age, lower weight, higher Aristotle Basic Score, longer bypass and clamp times, and use of deep hypothermia were identified as risk factors. Higher score was the only significant independent risk factor based on multivariate analysis.
Abnormal Ductus Venosus Flow With Increased Nuchal TranslucencyTony Terrones
This study evaluated ductus venosus flow velocities in fetuses with increased nuchal translucency (NT) and examined whether flow alterations were related to specific types of cardiac defects. The study included 72 fetuses with normal NT and 137 fetuses with increased NT. Abnormal ductus venosus flow, including higher pulsatility index for veins and lower late diastolic velocity, was seen in fetuses with increased NT, particularly those with cardiac defects. However, ductus venosus flow did not differ between types of cardiac defects. This suggests that altered ductus venosus flow in fetuses with increased NT is not explained by cardiac failure from a specific cardiac anatomy.
Cardiovascular complication of cancer chemotherapyPRAVEEN GUPTA
Cardiovascular complications are an increasing problem for cancer patients due to improved survival rates. Anthracyclines like doxorubicin are highly cardiotoxic and can cause heart failure, especially at cumulative doses over 450 mg/m2. Detection methods include cardiac troponin levels, echocardiography, and cardiac MRI. Risk factors include older age, previous cardiac disease, and concurrent radiation therapy. Prevention strategies involve careful monitoring, risk stratification, limiting cumulative doses, using less toxic agents like epirubicin, and administering cardioprotective drugs.
Anticoagulation of pregnant women with mechanical heart valve prosthesis. a s...escts2012
This document summarizes guidelines and studies on anticoagulation treatment for pregnant women with mechanical heart valve prostheses. It finds that oral anticoagulants (OA) appear safer for mothers but heparin appears safer for fetuses. The guidelines recommend 3 regimens: OA throughout pregnancy, substituting OA with heparin from weeks 6-13, or heparin throughout pregnancy. The document reviews 19 studies comparing outcomes of these regimens. It finds higher rates of fetal complications like embryopathy, prematurity and abortion with OA, but higher rates of maternal complications like thrombosis with heparin. The document aims to determine if fetal embryopathy risk from OA was overstated or decreasing
Recurrent Third-Trimester Fetal Loss and Maternal Mosaicism for Long-QT SyndromeAsha Reddy
1) A mother experienced recurrent third-trimester fetal loss and her surviving infant was diagnosed with long-QT syndrome (LQTS).
2) Genetic testing found the infant had a mutation in the SCN5A gene known to cause LQTS. Initial testing of the mother found no mutation.
3) A more sensitive test found the mother had low-level (8-10%) mosaicism for the same SCN5A mutation, indicating she transmitted it to her fetuses and infant.
4) This case suggests parental mosaicism can cause recurrent late-term fetal loss or sudden infant death through transmission of LQTS mutations and has implications for genetic counseling.
1) The study evaluated the effectiveness of indomethacin therapy for patent ductus arteriosus (PDA) in 41 full-term infants with birth weights over 2500g.
2) Indomethacin was administered intravenously in doses of 0.2-0.25 mg/kg every 12-24 hours. 25 infants (61%) responded positively to the treatment, either showing complete ductal closure or improved symptoms.
3) The remaining 16 infants (39%) did not respond to indomethacin therapy and most required surgical ligation of the ductus arteriosus. No severe adverse reactions occurred in any infants from the indomethacin treatment.
The document discusses a study analyzing risk factors for cardiac arrhythmias in 402 pediatric patients who underwent cardiac surgery. The study found that arrhythmias occurred in 57 patients (14.2%), with junctional ectopic tachycardia and supraventricular tachycardia being most common. Lower age, lower weight, higher Aristotle Basic Score, longer bypass and clamp times, and use of deep hypothermia were identified as risk factors. Higher score was the only significant independent risk factor based on multivariate analysis.
Abnormal Ductus Venosus Flow With Increased Nuchal TranslucencyTony Terrones
This study evaluated ductus venosus flow velocities in fetuses with increased nuchal translucency (NT) and examined whether flow alterations were related to specific types of cardiac defects. The study included 72 fetuses with normal NT and 137 fetuses with increased NT. Abnormal ductus venosus flow, including higher pulsatility index for veins and lower late diastolic velocity, was seen in fetuses with increased NT, particularly those with cardiac defects. However, ductus venosus flow did not differ between types of cardiac defects. This suggests that altered ductus venosus flow in fetuses with increased NT is not explained by cardiac failure from a specific cardiac anatomy.
Cardiovascular complication of cancer chemotherapyPRAVEEN GUPTA
Cardiovascular complications are an increasing problem for cancer patients due to improved survival rates. Anthracyclines like doxorubicin are highly cardiotoxic and can cause heart failure, especially at cumulative doses over 450 mg/m2. Detection methods include cardiac troponin levels, echocardiography, and cardiac MRI. Risk factors include older age, previous cardiac disease, and concurrent radiation therapy. Prevention strategies involve careful monitoring, risk stratification, limiting cumulative doses, using less toxic agents like epirubicin, and administering cardioprotective drugs.
Anticoagulation of pregnant women with mechanical heart valve prosthesis. a s...escts2012
This document summarizes guidelines and studies on anticoagulation treatment for pregnant women with mechanical heart valve prostheses. It finds that oral anticoagulants (OA) appear safer for mothers but heparin appears safer for fetuses. The guidelines recommend 3 regimens: OA throughout pregnancy, substituting OA with heparin from weeks 6-13, or heparin throughout pregnancy. The document reviews 19 studies comparing outcomes of these regimens. It finds higher rates of fetal complications like embryopathy, prematurity and abortion with OA, but higher rates of maternal complications like thrombosis with heparin. The document aims to determine if fetal embryopathy risk from OA was overstated or decreasing
This document defines peripartum cardiomyopathy and discusses its incidence, risk factors, etiology, clinical features, diagnosis, and management. Peripartum cardiomyopathy is defined as heart failure that develops during the last month of pregnancy or within 5 months postpartum without an identifiable cause. It has an incidence of 1 in 2500-4000 live births in the USA and 1 in 300 in Haiti. Risk factors include multi-parity, advanced age, malnutrition, pre-eclampsia, and obesity. Echocardiography is used to diagnose reduced left ventricular ejection fraction. Management involves standard heart failure therapies along with anticoagulation and contraception counseling. Prognosis shows recovery rates of left ventricular function range from
This document discusses catecholaminergic polymorphic ventricular tachycardia (CPVT), a condition characterized by adrenergically mediated polymorphic ventricular arrhythmias without structural heart disease. It has a prevalence of 1 in 10,000 and mortality of up to 50% before age 20 if untreated. The gold standard for diagnosis is exercise stress testing showing exercise-induced bidirectional or polymorphic ventricular tachycardia. Treatment involves lifestyle changes, beta-blockers, flecainide, and an ICD for those with cardiac arrest or recurrent arrhythmias despite medical therapy. Genetic testing identifies mutations in RYR2 or CASQ2 genes in the majority of cases.
Early repolarization (ER) is an ECG pattern characterized by J-point elevation. While historically considered a benign variant, recent studies have linked ER to an increased risk of arrhythmia. ER syndrome describes those with both ER on ECG and symptomatic arrhythmias like ventricular fibrillation. Diagnosis requires excluding other causes through testing of survivors of sudden cardiac death. While the ER pattern itself usually requires no treatment, an implantable cardioverter-defibrillator is recommended for secondary prevention in ER syndrome patients with a history of resuscitated sudden cardiac death.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Broken Heart Syndrome: Cardiovascular Manifestations of Traumatic Brain InjuryAmit Agrawal
This document summarizes cardiovascular complications that can occur following traumatic brain injury (TBI). Up to 15.7% of patients with severe TBI can develop left ventricular dysfunction and wall motion abnormalities due to increased sympathetic activity and catecholamine release after brain injury. This can cause hypotension, hypertension, arrhythmias, and myocardial injury. ECG changes, echocardiogram abnormalities, and elevated biomarkers of cardiac injury have been documented following TBI. While the exact mechanisms are not fully understood, autonomic dysfunction and systemic inflammation following TBI can directly or indirectly impact cardiovascular function. Treatment involves optimizing hemodynamics and treating the underlying brain injury, as the cardiac abnormalities are often transient.
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
This document discusses chemotherapy-induced cardiotoxicity. It notes that cancer patients undergoing chemotherapy have an increased risk of cardiovascular complications, especially those with heart disease. Several chemotherapy agents can cause cardiotoxicity, including anthracyclines like doxorubicin, which can cause arrhythmias, myocardial necrosis, and cardiomyopathy. The risk increases with higher cumulative doses and factors like older age. Monitoring ejection fraction is important to detect toxicity early. While some damage may be permanent, early detection allows modifying treatment to prevent worsening heart failure.
1) Most patients with asymptomatic severe aortic stenosis will develop symptoms within 5 years if not operated on, and the risk of sudden cardiac death is 1% per year.
2) Independent predictors of reduced survival in non-operated patients include advanced age, low left ventricular ejection fraction, heart failure, renal failure, and hypertension.
3) Aortic valve replacement dramatically improves survival outcomes, with 5-year survival rates of 90% for operated patients compared to 38% for non-operated patients.
Peripartum cardiomyopathy is a form of heart failure that develops in the final month of pregnancy or within 5 months after delivery. It is defined as left ventricular systolic dysfunction in the absence of any other cause of heart failure. The causes are still unclear but may involve myocarditis, an abnormal immune response, or latent genetic factors. Prognosis varies but over half of patients experience recovery of left ventricular function, while mortality rates are around 15%. Baseline left ventricular ejection fraction and New York Heart Association functional class can help predict outcomes in patients with peripartum cardiomyopathy.
Peripartum cardiomyopathy (PPCM) is heart failure that develops in the final month of pregnancy or within 5 months after delivery. It is defined by the presence of left ventricular systolic dysfunction without an identifiable cause. The cause is unknown but may involve hormonal and genetic factors. Symptoms include those of heart failure like shortness of breath. Treatment focuses on heart failure management. Prognosis is generally good, with around 70% of patients recovering heart function within 6 months though those with more severe dysfunction have a lower recovery rate.
Austin Journal of Clinical Cardiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of cardiology and angiology. The aim of the journal is to provide a forum for cardiologists, researchers, physicians, and other health professionals to find most recent advances in the areas of cardiology and cardiovascular diseases.
Austin Journal of Clinical Cardiology accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of cardiology and circulatory system.
Austin Journal of Clinical Cardiology strongly supports the scientific upgradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Austin Journal of Clinical Cardiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of cardiology and angiology
This document summarizes the STICH trial which studied the effects of coronary artery bypass grafting (CABG) compared to medical therapy alone in patients with left ventricular dysfunction due to ischemic cardiomyopathy. The randomized trial involved 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG. The primary outcome was all-cause mortality, which was not significantly different between CABG (36%) and medical therapy (41%) with a hazard ratio of 0.86 (p=0.12). Secondary outcomes found CABG was associated with lower rates of cardiovascular death and a composite of death or heart failure hospitalization compared to medical therapy.
This document discusses peripartum cardiomyopathy (PPCM), a type of dilated cardiomyopathy of unknown etiology that occurs near the end of pregnancy or early in the postpartum period. It defines the diagnostic criteria for PPCM. The incidence varies by geography, with higher rates in South Africa and Nigeria. Risk factors include malnutrition and local customs in the postpartum period. While the etiology is unknown, the pathophysiology is likely similar to other forms of dilated cardiomyopathy. Early diagnosis is important for improving outcomes. Management is multidisciplinary, involving heart failure therapies, delivery planning, contraception counseling, and long term monitoring as maternal and fetal complications can be severe without treatment.
RỐI LOẠN NHỊPTHẤT TRONG NHỒI MÁU CƠ TIM CẤP
- Rối loạn nhịp thất là một biến chứng phổ biến của nhồi máu cơ tim cấp, xảy ra ở khoảng 13-50% bệnh nhân.
- Các rối loạn nhịp thất thường gặp b
The STITCH trial evaluated the effect of CABG plus optimal medical therapy (OMT) versus OMT alone on mortality in patients with left ventricular dysfunction and coronary artery disease. A sub-study examined the role of assessing myocardial viability to identify patients who benefit most from CABG. Of 601 patients who underwent viability testing, 487 had viable myocardium and 114 did not. There was no significant interaction between viability status and treatment assignment on mortality or other outcomes. Assessing viability did not identify patients with differential survival benefit from CABG versus OMT alone.
This document discusses several novel biomarkers for acute coronary syndrome (ACS). It describes C-reactive protein (CRP) as a marker of extensive vascular inflammation. High-sensitivity CRP levels above 10 mg/L are more predictive of outcomes in ACS patients. Soluble CD40 ligand and myoglobin are also discussed as inflammation markers. Microalbuminuria is related to endothelial dysfunction and an increased risk of cardiovascular disease. Cystatin C and metalloproteinases are associated with arterial stiffness and plaque degradation. Several microRNAs such as miR-1, miR-133 and miR-208 are described as potential biomarkers for myocardial infarction, cardiac hypertrophy, and arrhythmias.
Early repolarization syndrome is defined by J-point elevation in the ECG. While prevalence is 1-9% depending on factors, the arrhythmic risk is generally low though higher for those with horizontal or downward sloping ST segments. The mechanism involves enhanced outward potassium currents leading to transmural voltage gradients. Genetic variants have been linked to severe cases. Clinical manifestations range from asymptomatic findings to cardiac arrest. Diagnosis requires exclusion of other causes in survivors of sudden cardiac death. Prognosis depends on location and morphology of early repolarization pattern. Therapies include beta-agonists and antiarrhythmic drugs while ICDs are for high-risk patients. Familial inheritance is seen though screening asymptomatic family
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
ARVD is one of important coardiomyopathy in our clinical practice,early diagnosis, risk stratification and early diagnosis of CHF, management of VT will make big difference in patient life
This document discusses the role of ultrasound in diagnosing and monitoring intrauterine growth restriction (IUGR). Key points include: ultrasound is used to diagnose small-for-gestational-age (SGA) babies and classify IUGR cases as symmetric or asymmetric; Doppler of the umbilical artery, uterine arteries, middle cerebral artery and ductus venosus helps assess the fetus and determine the timing of delivery; biophysical profiling and amniotic fluid volume are also monitored; management may involve delivery depending on gestational age and Doppler findings of fetal compromise.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
This document defines peripartum cardiomyopathy and discusses its incidence, risk factors, etiology, clinical features, diagnosis, and management. Peripartum cardiomyopathy is defined as heart failure that develops during the last month of pregnancy or within 5 months postpartum without an identifiable cause. It has an incidence of 1 in 2500-4000 live births in the USA and 1 in 300 in Haiti. Risk factors include multi-parity, advanced age, malnutrition, pre-eclampsia, and obesity. Echocardiography is used to diagnose reduced left ventricular ejection fraction. Management involves standard heart failure therapies along with anticoagulation and contraception counseling. Prognosis shows recovery rates of left ventricular function range from
This document discusses catecholaminergic polymorphic ventricular tachycardia (CPVT), a condition characterized by adrenergically mediated polymorphic ventricular arrhythmias without structural heart disease. It has a prevalence of 1 in 10,000 and mortality of up to 50% before age 20 if untreated. The gold standard for diagnosis is exercise stress testing showing exercise-induced bidirectional or polymorphic ventricular tachycardia. Treatment involves lifestyle changes, beta-blockers, flecainide, and an ICD for those with cardiac arrest or recurrent arrhythmias despite medical therapy. Genetic testing identifies mutations in RYR2 or CASQ2 genes in the majority of cases.
Early repolarization (ER) is an ECG pattern characterized by J-point elevation. While historically considered a benign variant, recent studies have linked ER to an increased risk of arrhythmia. ER syndrome describes those with both ER on ECG and symptomatic arrhythmias like ventricular fibrillation. Diagnosis requires excluding other causes through testing of survivors of sudden cardiac death. While the ER pattern itself usually requires no treatment, an implantable cardioverter-defibrillator is recommended for secondary prevention in ER syndrome patients with a history of resuscitated sudden cardiac death.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Broken Heart Syndrome: Cardiovascular Manifestations of Traumatic Brain InjuryAmit Agrawal
This document summarizes cardiovascular complications that can occur following traumatic brain injury (TBI). Up to 15.7% of patients with severe TBI can develop left ventricular dysfunction and wall motion abnormalities due to increased sympathetic activity and catecholamine release after brain injury. This can cause hypotension, hypertension, arrhythmias, and myocardial injury. ECG changes, echocardiogram abnormalities, and elevated biomarkers of cardiac injury have been documented following TBI. While the exact mechanisms are not fully understood, autonomic dysfunction and systemic inflammation following TBI can directly or indirectly impact cardiovascular function. Treatment involves optimizing hemodynamics and treating the underlying brain injury, as the cardiac abnormalities are often transient.
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
This document discusses chemotherapy-induced cardiotoxicity. It notes that cancer patients undergoing chemotherapy have an increased risk of cardiovascular complications, especially those with heart disease. Several chemotherapy agents can cause cardiotoxicity, including anthracyclines like doxorubicin, which can cause arrhythmias, myocardial necrosis, and cardiomyopathy. The risk increases with higher cumulative doses and factors like older age. Monitoring ejection fraction is important to detect toxicity early. While some damage may be permanent, early detection allows modifying treatment to prevent worsening heart failure.
1) Most patients with asymptomatic severe aortic stenosis will develop symptoms within 5 years if not operated on, and the risk of sudden cardiac death is 1% per year.
2) Independent predictors of reduced survival in non-operated patients include advanced age, low left ventricular ejection fraction, heart failure, renal failure, and hypertension.
3) Aortic valve replacement dramatically improves survival outcomes, with 5-year survival rates of 90% for operated patients compared to 38% for non-operated patients.
Peripartum cardiomyopathy is a form of heart failure that develops in the final month of pregnancy or within 5 months after delivery. It is defined as left ventricular systolic dysfunction in the absence of any other cause of heart failure. The causes are still unclear but may involve myocarditis, an abnormal immune response, or latent genetic factors. Prognosis varies but over half of patients experience recovery of left ventricular function, while mortality rates are around 15%. Baseline left ventricular ejection fraction and New York Heart Association functional class can help predict outcomes in patients with peripartum cardiomyopathy.
Peripartum cardiomyopathy (PPCM) is heart failure that develops in the final month of pregnancy or within 5 months after delivery. It is defined by the presence of left ventricular systolic dysfunction without an identifiable cause. The cause is unknown but may involve hormonal and genetic factors. Symptoms include those of heart failure like shortness of breath. Treatment focuses on heart failure management. Prognosis is generally good, with around 70% of patients recovering heart function within 6 months though those with more severe dysfunction have a lower recovery rate.
Austin Journal of Clinical Cardiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of cardiology and angiology. The aim of the journal is to provide a forum for cardiologists, researchers, physicians, and other health professionals to find most recent advances in the areas of cardiology and cardiovascular diseases.
Austin Journal of Clinical Cardiology accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of cardiology and circulatory system.
Austin Journal of Clinical Cardiology strongly supports the scientific upgradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Austin Journal of Clinical Cardiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of cardiology and angiology
This document summarizes the STICH trial which studied the effects of coronary artery bypass grafting (CABG) compared to medical therapy alone in patients with left ventricular dysfunction due to ischemic cardiomyopathy. The randomized trial involved 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG. The primary outcome was all-cause mortality, which was not significantly different between CABG (36%) and medical therapy (41%) with a hazard ratio of 0.86 (p=0.12). Secondary outcomes found CABG was associated with lower rates of cardiovascular death and a composite of death or heart failure hospitalization compared to medical therapy.
This document discusses peripartum cardiomyopathy (PPCM), a type of dilated cardiomyopathy of unknown etiology that occurs near the end of pregnancy or early in the postpartum period. It defines the diagnostic criteria for PPCM. The incidence varies by geography, with higher rates in South Africa and Nigeria. Risk factors include malnutrition and local customs in the postpartum period. While the etiology is unknown, the pathophysiology is likely similar to other forms of dilated cardiomyopathy. Early diagnosis is important for improving outcomes. Management is multidisciplinary, involving heart failure therapies, delivery planning, contraception counseling, and long term monitoring as maternal and fetal complications can be severe without treatment.
RỐI LOẠN NHỊPTHẤT TRONG NHỒI MÁU CƠ TIM CẤP
- Rối loạn nhịp thất là một biến chứng phổ biến của nhồi máu cơ tim cấp, xảy ra ở khoảng 13-50% bệnh nhân.
- Các rối loạn nhịp thất thường gặp b
The STITCH trial evaluated the effect of CABG plus optimal medical therapy (OMT) versus OMT alone on mortality in patients with left ventricular dysfunction and coronary artery disease. A sub-study examined the role of assessing myocardial viability to identify patients who benefit most from CABG. Of 601 patients who underwent viability testing, 487 had viable myocardium and 114 did not. There was no significant interaction between viability status and treatment assignment on mortality or other outcomes. Assessing viability did not identify patients with differential survival benefit from CABG versus OMT alone.
This document discusses several novel biomarkers for acute coronary syndrome (ACS). It describes C-reactive protein (CRP) as a marker of extensive vascular inflammation. High-sensitivity CRP levels above 10 mg/L are more predictive of outcomes in ACS patients. Soluble CD40 ligand and myoglobin are also discussed as inflammation markers. Microalbuminuria is related to endothelial dysfunction and an increased risk of cardiovascular disease. Cystatin C and metalloproteinases are associated with arterial stiffness and plaque degradation. Several microRNAs such as miR-1, miR-133 and miR-208 are described as potential biomarkers for myocardial infarction, cardiac hypertrophy, and arrhythmias.
Early repolarization syndrome is defined by J-point elevation in the ECG. While prevalence is 1-9% depending on factors, the arrhythmic risk is generally low though higher for those with horizontal or downward sloping ST segments. The mechanism involves enhanced outward potassium currents leading to transmural voltage gradients. Genetic variants have been linked to severe cases. Clinical manifestations range from asymptomatic findings to cardiac arrest. Diagnosis requires exclusion of other causes in survivors of sudden cardiac death. Prognosis depends on location and morphology of early repolarization pattern. Therapies include beta-agonists and antiarrhythmic drugs while ICDs are for high-risk patients. Familial inheritance is seen though screening asymptomatic family
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
ARVD is one of important coardiomyopathy in our clinical practice,early diagnosis, risk stratification and early diagnosis of CHF, management of VT will make big difference in patient life
This document discusses the role of ultrasound in diagnosing and monitoring intrauterine growth restriction (IUGR). Key points include: ultrasound is used to diagnose small-for-gestational-age (SGA) babies and classify IUGR cases as symmetric or asymmetric; Doppler of the umbilical artery, uterine arteries, middle cerebral artery and ductus venosus helps assess the fetus and determine the timing of delivery; biophysical profiling and amniotic fluid volume are also monitored; management may involve delivery depending on gestational age and Doppler findings of fetal compromise.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
This document discusses hyperkalemia (high potassium levels), including its causes, effects on the heart, diagnosis, and treatment. It describes a case report of a 69-year-old woman who experienced hyperkalemia after dialysis. Her symptoms included abdominal pain, fatigue, and arrhythmia. Treatment involved calcium, insulin, glucose, and emergent dialysis to lower her potassium level. The document then provides details on potassium regulation in the body, effects of high potassium on heart function, electrocardiogram changes seen with hyperkalemia, common causes, and approaches for treating acute hyperkalemia including membrane stabilization, promoting potassium influx, and potassium removal methods like dialysis or sodium polystyrene sulfonate.
This study aimed to review the characteristics, management, and outcomes of 153 cases of fetal tachyarrhythmia diagnosed at two Swedish centers from 1990 to 2012. The majority of cases were atrial flutter (28%) or atrioventricular reentrant tachycardia (63%). Transplacental treatment was commenced in 99 cases and resulted in rhythm normalization in two-thirds of treated cases. Non-hydropic fetuses all had favorable outcomes, while hydropic fetuses had a mortality rate of 16%. Sotalol treatment had a higher cardioversion rate than digoxin for AVRT but not for atrial flutter. This study found that transplacental treatment was often insufficient for cardioversion and
This study examined the association between preoperative serum potassium levels and perioperative outcomes in 2402 patients undergoing elective cardiac surgery. The study found that serum potassium levels below 3.5 mmol/L were associated with increased risks of perioperative arrhythmias, intraoperative arrhythmias, and postoperative atrial fibrillation/flutter. Lower potassium levels were also linked to greater needs for cardiopulmonary resuscitation, though this association was not statistically significant after adjusting for confounding factors. The results suggest that screening for and correcting hypokalemia prior to cardiac surgery could help mitigate adverse perioperative events.
Cerebral Venous Sinus Thrombosis
Dr Rajiv Jha, MS
Senior Resident M Ch Neurosurgery
National Neurosurgical Referral Center
National Academy Of Medical Sciences
A 25-year-old female presented with abdominal pain, repeated fits and profuse vaginal bleeding after delivering a dead baby at home. She was diagnosed with HELLP syndrome based on her symptoms and lab results. She was treated aggressively in the intensive care unit with magnesium sulfate to control seizures, blood transfusions, evacuation of retained placenta, antihypertensives, and hemodialysis. Her condition improved over several days and she was discharged after 10 days on oral medications. The case illustrates the importance of early detection and rapid treatment by a multidisciplinary team for successful management of HELLP syndrome.
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.
The document provides information about strokes (cerebrovascular accidents), including signs and symptoms, treatments, and nursing care considerations. It discusses medications and procedures that can stop a stroke from progressing if administered within 3 hours, such as tissue plasminogen activator (TPA). It also outlines nursing diagnoses, goals, and interventions for issues like impaired physical mobility and chronic confusion that may result from a stroke.
This study examined echocardiographic predictors of perinatal mortality in fetuses diagnosed with Ebstein's anomaly or tricuspid valve dysplasia. The study reviewed 21 fetuses between 2000-2008. Smaller right atrial size and absence of hydrops were associated with improved survival. Analysis of left ventricular function showed non-survivors had shorter combined contraction and relaxation times, though ejection times did not differ. Overall perinatal survival was 75% and survival to 3 months was 57-50% depending on whether terminations were included.
The document discusses three topics:
1) A pilot study of an extravascular implantable cardioverter-defibrillator (EV ICD) that showed feasibility of substernal lead placement and effective defibrillation and pacing. No major complications occurred.
2) A study finding that very low-density lipoprotein (VLDL) cholesterol, not triglycerides, explains about half the risk of myocardial infarction from apoB-containing lipoproteins.
3) A presentation by Dr. Sivanand Patel on cardiology topics including the EV ICD and implications of VLDL cholesterol and triglycerides.
1. Acute myocardial infarction can occur during pregnancy with a frequency of 3 to 10 cases per 100,000 deliveries and is a devastating event that can endanger the life of both mother and baby.
2. The heart undergoes anatomical changes during pregnancy including displacement upwards and outwards as well as physiological changes like reduced peripheral resistance and increased blood volume that can affect hemodynamics.
3. Potential causes of acute MI in pregnancy include spontaneous coronary artery dissection (SCAD), coronary spasm, thrombosis, and in rare cases, underlying atherosclerosis. SCAD is thought to be related to hormonal effects on vessel walls.
4. Diagnosis is made using the same criteria as in non-
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1. The diagnosis and management of long QT syndrome
based on fetal echocardiography
Benjamin A. Blais, MD,* Gary Satou, MD,* Mark S. Sklansky, MD,* Himani Madnawat,†
Jeremy P. Moore, MD, MS, FHRS*
From the *Department of Pediatrics, David Geffen School of Medicine at University of California Los
Angeles, and University of California Los Angeles Mattel Children’s Hospital, Los Angeles, California, and
†
College of Physical Sciences, University of California Los Angeles, Los Angeles, California.
Introduction
Long QT syndrome (LQTS) is a disorder of cardiac repolar-
ization that affects approximately 1 in 2500 individuals and is
associated with syncope and sudden cardiac death. Over the
past several decades, advances in clinical diagnosis—
combined with gene-directed antiarrhythmic therapies and
cardiac device management—have improved the outcome
of this life-threatening disorder. Although early detection of
the disorder is paramount, timely diagnosis by fetal echocar-
diography still remains a significant challenge. The present
case characterizes the utility of fetal echocardiography for
the diagnosis and subsequent management of congenital
LQTS.
Case report
A 32-year-old gravid woman was referred for pediatric car-
diologic evaluation at 26 weeks’ gestation for fetal brady-
cardia (atrial rate of 130 beats per minute [bpm];
ventricular rate of 65 bpm) with the referral diagnosis of
congenital atrioventricular (AV) block. The fetal heart rate
(FHR) prior to 26 weeks’ gestation had been reported as
normal by routine prenatal ultrasound (Figure 1). The patient
had given birth previously to 5 children, all of whom were in
good health. She had a known history of gestational diabetes
and was managed with insulin glargine subcutaneous injec-
tions during the current pregnancy. As part of an initial eval-
uation for AV block, laboratory testing for anti-SSA/SSB
antibodies was performed, revealing an elevated anti-SSA
antibody titer equal to 65 units.
Fetal echocardiography demonstrated normal intracardiac
anatomy and preserved biventricular systolic function. There
were frequent salvos of rapid ventricular tachycardia (VT) of
variable cycle length with ventriculoatrial dissociation during
the majority of the initial study (Figure 2) (see also
supplemental video). A small pericardial effusion was also
noted. Based on findings suggestive of polymorphic VT
and intermittent 2:1 AV block, the working diagnosis of
congenital LQTS was established. The patient was admitted
to the inpatient service at 30 weeks’ gestation and transpla-
cental therapy with propranolol of 30 mg/day was initiated.
Follow-up fetal echocardiography obtained 4 hours after
initiation of therapy showed nonsustained VT during 50%–
60% of the study, which was unchanged the following day.
Mexiletine therapy (600 mg/day) was added, and echocardi-
ography obtained 6 hours after first dose showed a modest
reduction in frequency and shorter salvos of VT. Magnesium
was then added approximately 12 hours later and the rhythm
after 24 hours of the above regimen (associated with magne-
sium level of 1.6 mEq/L) showed a noticeable improvement
in VT burden, now totaling approximately 33% of the study.
Given evidence of decreasing ventricular arrhythmia in
response to therapy, the mexiletine and propranolol doses
were optimized (propranolol 80 mg/day and mexiletine 750
mg/day, respectively) and were maintained throughout preg-
nancy. Magnesium levels were checked twice daily and, in
addition to scheduled oral and parenteral magnesium, intra-
venous magnesium sulfate boluses were given 1–3 times a
day in response to the level to maintain a goal of greater
than 2.0 mEq/L. The rhythm was assessed by serial fetal
echocardiography intermittently throughout the rest of the
pregnancy, and the VT burden was noted to decrease progres-
sively, with the final echocardiogram demonstrating near-
absence of ventricular arrhythmia (Figure 1).
A cesarean delivery was planned owing to concerns about
potentially inadequate cardiac monitoring during vaginal
delivery. The infant was delivered at 37 weeks’ gestation,
and immediately upon delivery the rhythm was noted to fluc-
tuate between normal sinus rhythm (110 bpm) and 2:1 AV
block. Central access was obtained and the patient was intu-
bated. A 12-lead surface electrocardiogram confirmed the
diagnosis of significant QT prolongation (corrected QT inter-
val 680 ms) with 2:1 AV block and frequent multiform
KEYWORDS Long QT syndrome; Atrioventricular block; Ventricular
tachycardia; Fetal echocardiography; Sudden death
(Heart Rhythm Case Reports 2017;3:407–410)
Address reprint requests and correspondence: Dr Jeremy P. Moore,
UCLA Medical Center, 200 Medical Plaza Dr, Suite 330, Los Angeles,
CA 90095. E-mail address: jpmoore@mednet.ucla.edu.
2214-0271/Published by Elsevier Inc. on behalf of Heart Rhythm Society. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
http://dx.doi.org/10.1016/j.hrcr.2017.04.007
2. premature ventricular contractions (Figure 3). Lidocaine was
initiated at 20 mcg/kg/min. However, as the rhythm was pre-
dominantly 2:1 AV block, a decision was made to place an
epicardial dual-chamber pacemaker. The infant was started
on a combination of oral propranolol and mexiletine therapy
with dual-chamber pacing.
Subsequent genetic testing revealed a heterozygous muta-
tion in a highly conserved region of the voltage sensor for the
cardiac sodium channel encoded by the SCN5A gene
(R1623Q), consistent with a previously described genetic
form of LQTS.1
Neither of the parents’ electrocardiograms
demonstrated corrected QT interval prolongation. The infant
was discharged to home at 1 month of life without further
ventricular arrhythmia, and was thereafter followed as an
outpatient on mexiletine and propranolol. At 10 months of
age, after a 1-week history of gastroenteritis, the patient expe-
rienced an episode of syncope with documented polymorphic
VT. The mexiletine level at that time was 0.8 mcg/mL. The
patient underwent uneventful surgical upgrade to an epicar-
dial implantable cardioverter-defibrillator and continues to
do well, without further arrhythmia, at 1 year of age.
Discussion
A challenging diagnosis to establish in utero, LQTS requires
the recognition of specific rhythm abnormalities unique to
the fetus. In most cases of fetal LQTS, the only detectable
rhythm abnormality is sinus bradycardia with an FHR , third
percentile for age.2
In approximately 25% of fetuses, however,
the more severe form of LQTS arrhythmia with torsades de
pointes (TdP) and/or second-degree AV block is also
observed. For fetuses with severe LQTS arrhythmia, the diag-
nosis may be unexpected owing to a higher probability of de
novo mutations and, consequently, an unremarkable family
history.3
The inheritance patterns of LQTS is complex and in-
cludes somatic mosaicism,4
autosomal recessive inheritance,
and variable penetrance. Coexistence of common single nucle-
otide polymorphisms with LQTS-causing genes and/or un-
known genes can also affect the phenotypic presentation.
Therefore, although careful history taking for the outcomes
of prior pregnancies and family history is paramount, it is
important to recognize that the absence of family history of
cardiac events should not eliminate suspicion for the disease.
In this case, the prenatal detection of maternal anti-SSA an-
tibodies was misleading, as it suggested the diagnosis of
antibody-related AV block, an entity that was not present.
This patient’s constellation of fetal echocardiographic findings
was more consistent with LQTS. In fact, sinus bradycardia
(FHR , third percentile for age) was observed on 3 occasions
(25% of recordings) prior to the referral (Figure 1) and could
have prompted a more aggressive early approach. Timely
Figure 1 Detailed timeline of fetal and maternal characteristics. The fetal
heart rate is shown at the bottom half of the figure with superimposed 3rd,
50th, and 97th heart rate percentiles in hatched parallel lines (adapted from
Mitchell and colleagues7
). The horizontal dotted line represents the standard
obstetric definition of fetal bradycardia (ie, 110 beats/min). The vertical line
represents admission to the hospital for initiation of transplacental therapy.
There is a marked reduction in fetal arrhythmia associated with therapy prior
to eventual delivery at 37 weeks’ gestation. BP 5 blood pressure; VT 5
ventricular tachycardia.
Figure 2 Fetal echocardiogram M-mode still image demonstrating an
episode of ventricular tachycardia of variable cycle length, with ventriculoa-
trial dissociation and a nonvariable, normal atrial rate. The interval between
each beat is labeled in milliseconds.
KEY TEACHING POINTS
The fetal diagnosis of long QT syndrome may be
challenging, often relying on a constellation of
rhythm abnormalities that may include sinus
bradycardia or torsades de pointes 6 second-
degree atrioventricular block.
Genotype-phenotype correlation is generally not
possible in utero; therefore multidrug therapy is
required prior to delivery.
Aggressive postnatal management with cardiac
pacing therapy and genotype-specific medical
therapy can result in successful treatment of this
possibly fatal condition.
408 Heart Rhythm Case Reports, Vol 3, No 9, September 2017
3. recognition of this syndrome is imperative, as fetal demise
may occur in the absence of appropriate therapy.4,5
The
classic echocardiographic findings demonstrated in the
present report can help the practitioner identify the proper
diagnosis in a timely fashion. Although fetal
magnetocardiography can definitively diagnose prenatal
LQTS, most centers in the country do not have access to this
technology.
An understanding of the most common genotypes impli-
cated in fetal LQTS, along with their previously reported
treatments and outcomes, can be instructive in guiding the
diagnosis and management of such fetal cases of LQTS.
For fetuses that present with the signature LQTS arrhythmias
of TdP and/or second-degree AV block, prior series have
demonstrated a preponderance of de novo SCN5A and
KCNH2 mutations, the former often involving the voltage
sensor of the sodium channel and the latter most often
involving the pore region of the potassium channel.2
SCN5A-R1623Q in particular has been detected frequently
in fetuses with TdP and second-degree AV block, both in
the form of case reports and in case series (as many as 7
unique cases exist in the literature).2,4,6,7
Transplacental therapy generally consists of a combina-
tion of sodium channel and beta-blocker therapy, as well as
aggressive magnesium supplementation. Sodium channel
blockade, whether mexiletine6,8
or lidocaine,9
has been
shown to be effective in suppressing TdP for fetuses affected
by LQTS related to SCN5A mutations. Beta-blocker therapy,
most often in the form of propranolol because of its efficient
transplacental passage, is also administered.2
In the present
case, aggressive mexiletine administration was ultimately
felt to contribute to the observed reduction in ventricular
arrhythmia once therapeutic levels (0.5–2.5 mcg/mL) had
been achieved. Using such an approach, aggressive manage-
ment with complete suppression of fetal arrhythmia should
be pursued in an effort to carry the fetus fully to term. In
the present case, the fetus was ultimately delivered at 37
weeks’ gestation, given concern for the possibility of
arrhythmia recurrence. Although this compares favorably
with reported gestational ages of 35 weeks for fetuses
with similar SCN5A-R1623Q mutations,2,3,7,10
delivery
should always be postponed as long as possible for the
optimal neonatal outcome.
Postnatally, management was guided by additional data ob-
tained shortly after birth and during subsequent follow-up.
Pacemaker implantation was recommended based on the early
postnatal electrocardiographic findings of AV block as well as
a strong suspicion for SCN5A mutation, situations where
Figure 3 Electrocardiogram taken on the first day of life, demonstrating 2:1 atrioventricular block with frequent multiform premature ventricular contractions
and a corrected QT interval of 680 ms. This study was performed before initiation of postnatal medical therapy.
Blais et al Fetal Echocardiography for LQTS 409
4. antibradycardia pacing may be beneficial. In addition, ongoing
therapy with mexiletine and propranolol with verification of
adequate therapeutic levels was prescribed after genetic confir-
mation, ultimately resulting in long-term rhythm control.
Appendix
Supplementary Data
Supplementary data associated with this article can be found
in the online version at http://dx.doi.org/10.1016/j.hrcr.2017.
04.007.
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