Kristian Galanti, Roberta Magnano, Laura Pezzi, Mario Di Marino, Alberto D’ Alleva, Daniele Forlani, Piergiusto Vitulli, Vincenzo Di Egidio, Gabriele Di Giammarco, Leonardo Paloscia, Sabina Gallina, Massimo Di Marco
Peripartum cardiomyopathy (PPMC) is an infrequent form of cardiomyopathy, whose main presentation is characterized by systolic dysfunction that commonly emerges in the early postpartum period. Acute heart failure symptoms such as congestion and dyspnea are common manifestations of PPMC. Here, we present a case of a 32-year-old female who, after hospitalization, manifested dyspnea and thoracic pain linked to the findings a left endoventricular thrombus. After the admission to the intensive cardiovascular care unit, heart failure and anticoagulant therapies as well as non-steroidal anti-inflammatory drugs were administered, leading to initial improvement of the left ventricular global function. Five days after the treatment, the patient experienced aphasia and right hemiplegia. The cerebral angiography documented an M1 segment occlusion. After treating the occlusion with stent retriever thrombectomy, the symptoms regressed and she attained full recovery. Therefore, surgical thrombectomy should be prioritized as the treatment approach to removing the pedunculated left ventricular thrombus, considering the apical morphology of the pedunculated left ventricular thrombus and if the anticoagulant therapy gives rise to side effects.
{"title":"Pedunculated left endoventricular thrombosis complicated by cerebral stroke in patient with suspected peripartum cardiomyopathy: A case report","authors":"Kristian Galanti, Roberta Magnano, Laura Pezzi, Mario Di Marino, Alberto D’ Alleva, Daniele Forlani, Piergiusto Vitulli, Vincenzo Di Egidio, Gabriele Di Giammarco, Leonardo Paloscia, Sabina Gallina, Massimo Di Marco","doi":"10.36922/bh.1115","DOIUrl":"https://doi.org/10.36922/bh.1115","url":null,"abstract":"Peripartum cardiomyopathy (PPMC) is an infrequent form of cardiomyopathy, whose main presentation is characterized by systolic dysfunction that commonly emerges in the early postpartum period. Acute heart failure symptoms such as congestion and dyspnea are common manifestations of PPMC. Here, we present a case of a 32-year-old female who, after hospitalization, manifested dyspnea and thoracic pain linked to the findings a left endoventricular thrombus. After the admission to the intensive cardiovascular care unit, heart failure and anticoagulant therapies as well as non-steroidal anti-inflammatory drugs were administered, leading to initial improvement of the left ventricular global function. Five days after the treatment, the patient experienced aphasia and right hemiplegia. The cerebral angiography documented an M1 segment occlusion. After treating the occlusion with stent retriever thrombectomy, the symptoms regressed and she attained full recovery. Therefore, surgical thrombectomy should be prioritized as the treatment approach to removing the pedunculated left ventricular thrombus, considering the apical morphology of the pedunculated left ventricular thrombus and if the anticoagulant therapy gives rise to side effects.","PeriodicalId":10091,"journal":{"name":"Chinese Journal of Geriatric Heart Brain and Vessel Diseases","volume":"34 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135873582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Subclinical atrial fibrillation (SAF) is the primary underlying cause of cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS), particularly in patients over 65 years of age. Therefore, it is strongly recommended screening for SAF in these patients. The development of tools designed to determine the priority of SAF screening is essential for optimizing the diagnostic workup. The aim of our study was to investigate the clinical predictive scores available for SAF detection in patients with CS or ESUS. We gathered data from articles published on the PubMed database from January 1, 2000, to January 31, 2023. Our search yielded eight scores for CS and three for ESUS. SAF diagnosis was established using various methods: 12-lead ECG or 24-h ECG monitoring during 1-year follow-up in three scores; 72-h non-implantable ECG monitoring in two scores; 2 or 3-week non-implantable ECG monitoring in three scores; and implantable ECG monitoring in one score. In two scores, ECG monitoring was performed using a non-implantable and/or implantable loop recorder. Overall, the rate of SAF detection was approximately 6% when using devices for monitoring lasting no more than 72 h and increased to nearly 22% employing 2 or 3-week non-implantable or implantable devices. SAF was defined differently in various scores; five scores considered any episode, even if shorter than 30 s, while six scores required episodes to last at least 30 s. Advanced age was included as a variable in 10 of 11 scores, whereas left atrial enlargement, premature atrial beats, and brain computed tomography characteristics were features in four scores. The area under the curve values of these scores ranged from 0.72 to 0.94. In conclusion, it is still challenging to put the currently available clinical scores to use due to a lack of validation. To provide more comprehensive guidance, it is essential to conduct large prospective multicenter trials in the future.
{"title":"Clinical predictive scores for detection of sub-clinical atrial fibrillation after cryptogenic or embolic stroke of undetermined source: A brief systematic review","authors":"Luca Masotti, Elisa Grifoni","doi":"10.36922/bh.0955","DOIUrl":"https://doi.org/10.36922/bh.0955","url":null,"abstract":"Subclinical atrial fibrillation (SAF) is the primary underlying cause of cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS), particularly in patients over 65 years of age. Therefore, it is strongly recommended screening for SAF in these patients. The development of tools designed to determine the priority of SAF screening is essential for optimizing the diagnostic workup. The aim of our study was to investigate the clinical predictive scores available for SAF detection in patients with CS or ESUS. We gathered data from articles published on the PubMed database from January 1, 2000, to January 31, 2023. Our search yielded eight scores for CS and three for ESUS. SAF diagnosis was established using various methods: 12-lead ECG or 24-h ECG monitoring during 1-year follow-up in three scores; 72-h non-implantable ECG monitoring in two scores; 2 or 3-week non-implantable ECG monitoring in three scores; and implantable ECG monitoring in one score. In two scores, ECG monitoring was performed using a non-implantable and/or implantable loop recorder. Overall, the rate of SAF detection was approximately 6% when using devices for monitoring lasting no more than 72 h and increased to nearly 22% employing 2 or 3-week non-implantable or implantable devices. SAF was defined differently in various scores; five scores considered any episode, even if shorter than 30 s, while six scores required episodes to last at least 30 s. Advanced age was included as a variable in 10 of 11 scores, whereas left atrial enlargement, premature atrial beats, and brain computed tomography characteristics were features in four scores. The area under the curve values of these scores ranged from 0.72 to 0.94. In conclusion, it is still challenging to put the currently available clinical scores to use due to a lack of validation. To provide more comprehensive guidance, it is essential to conduct large prospective multicenter trials in the future.","PeriodicalId":10091,"journal":{"name":"Chinese Journal of Geriatric Heart Brain and Vessel Diseases","volume":"36 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135268227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Junlong Hou, Erqing Li, Yichao Duan, Jing Wang, Bin Chen, Chuanmin Fan, Liming Qin, Bo Zhang, Lingping Xu
In this study, we evaluated the potential use of atropine in reducing reperfusion vagal reflex-related events during emergency percutaneous coronary intervention (PCI) for acute inferior ST-elevation myocardial infarction (STEMI). Retrospectively, we included 142 patients with inferior wall STEMI, who were treated between October 2015 and October 2020, in this study. The patients were divided into an experimental group (n = 70) and a control group (n = 72) depending on whether they received prophylactic intracoronary atropine. The experimental group was then subdivided into a low-dose group (0.5 – 1 mg atropine, n = 40) and a high-dose group (2 mg atropine, n = 30). We compared the incidence of reperfusion vagal reflex-related events and the application of temporary pacemakers between these groups. The results showed that the incidence of bradycardia (24.3% vs. 45.8%, P = 0.007), hypotension (18.6% vs. 40.3%, P = 0.005), ventricular tachycardia (4.3% vs. 19.4%, P = 0.005), and ventricular fibrillation (8.6% vs. 20.8%, P = 0.040) as well as the application of temporary pacemakers (14.3% vs. 29.2%, P = 0.032) were all much lower (all P < 0.05) in the experimental group than in the control group. In addition, the incidence of bradycardia (10% vs. 35%, P = 0.016), hypotension (6.7% vs. 27.5%, P = 0.027), ventricular tachycardia (6.7% vs. 25%, P = 0.044), and ventricular fibrillation (0 vs. 15%, P = 0.034) as well as the application of temporary pacemakers (3.3% vs. 22.5%, P = 0.036) were all much lower (all P < 0.05) in the high-dose group than the low-dose group. Our findings demonstrate that atropine pretreatment could prevent reperfusion vagal reflex-related events and reduce the application of temporary pacemakers during emergency PCI for acute inferior STEMI. These effects can be significantly enhanced by high-dose (2 mg) atropine pretreatment.
在这项研究中，我们评估了阿托品在急性下st段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)期间减少再灌注迷走神经反射相关事件的潜在用途。回顾性研究纳入了142例2015年10月至2020年10月间接受治疗的下壁STEMI患者。根据患者是否接受预防性冠状动脉内阿托品治疗分为实验组(n = 70)和对照组(n = 72)。将实验组再分为低剂量组(0.5 ~ 1mg, n = 40)和高剂量组(2mg, n = 30)。我们比较了两组再灌注迷走神经反射相关事件的发生率和临时起搏器的应用。结果显示，两组患者的心动过缓(24.3% vs. 45.8%， P = 0.007)、低血压(18.6% vs. 40.3%， P = 0.005)、室性心动过速(4.3% vs. 19.4%， P = 0.005)、室颤(8.6% vs. 20.8%， P = 0.040)及临时起搏器的使用(14.3% vs. 29.2%， P = 0.032)的发生率均显著降低(P <0.05)，实验组与对照组比较差异有统计学意义。此外，心动过缓(10% vs. 35%， P = 0.016)、低血压(6.7% vs. 27.5%， P = 0.027)、室性心动过速(6.7% vs. 25%， P = 0.044)、室性颤动(0 vs. 15%， P = 0.034)以及临时起搏器的使用(3.3% vs. 22.5%， P = 0.036)的发生率均显著降低(P <高剂量组与低剂量组比较差异无统计学意义(0.05)。我们的研究结果表明，阿托品预处理可以预防迷走神经反射相关的再灌注事件，并减少急诊PCI治疗急性下段STEMI时临时起搏器的应用。高剂量(2mg)阿托品预处理可显著增强这些作用。
{"title":"Potential use of prophylactic intracoronary atropine in reducing reperfusion vagal reflex-related events in ST-elevation myocardial infarction","authors":"Junlong Hou, Erqing Li, Yichao Duan, Jing Wang, Bin Chen, Chuanmin Fan, Liming Qin, Bo Zhang, Lingping Xu","doi":"10.36922/bh.193","DOIUrl":"https://doi.org/10.36922/bh.193","url":null,"abstract":"In this study, we evaluated the potential use of atropine in reducing reperfusion vagal reflex-related events during emergency percutaneous coronary intervention (PCI) for acute inferior ST-elevation myocardial infarction (STEMI). Retrospectively, we included 142 patients with inferior wall STEMI, who were treated between October 2015 and October 2020, in this study. The patients were divided into an experimental group (n = 70) and a control group (n = 72) depending on whether they received prophylactic intracoronary atropine. The experimental group was then subdivided into a low-dose group (0.5 – 1 mg atropine, n = 40) and a high-dose group (2 mg atropine, n = 30). We compared the incidence of reperfusion vagal reflex-related events and the application of temporary pacemakers between these groups. The results showed that the incidence of bradycardia (24.3% vs. 45.8%, P = 0.007), hypotension (18.6% vs. 40.3%, P = 0.005), ventricular tachycardia (4.3% vs. 19.4%, P = 0.005), and ventricular fibrillation (8.6% vs. 20.8%, P = 0.040) as well as the application of temporary pacemakers (14.3% vs. 29.2%, P = 0.032) were all much lower (all P < 0.05) in the experimental group than in the control group. In addition, the incidence of bradycardia (10% vs. 35%, P = 0.016), hypotension (6.7% vs. 27.5%, P = 0.027), ventricular tachycardia (6.7% vs. 25%, P = 0.044), and ventricular fibrillation (0 vs. 15%, P = 0.034) as well as the application of temporary pacemakers (3.3% vs. 22.5%, P = 0.036) were all much lower (all P < 0.05) in the high-dose group than the low-dose group. Our findings demonstrate that atropine pretreatment could prevent reperfusion vagal reflex-related events and reduce the application of temporary pacemakers during emergency PCI for acute inferior STEMI. These effects can be significantly enhanced by high-dose (2 mg) atropine pretreatment.","PeriodicalId":10091,"journal":{"name":"Chinese Journal of Geriatric Heart Brain and Vessel Diseases","volume":"136 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135698647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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