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Cardiovascular Urgencies and Emergencies in Pregnancy: A Case Based Review of Some Cardiovascular Diseases Affecting Pregnant Females 妊娠期心血管急症和突发事件:一些影响孕妇心血管疾病的病例综述
Pub Date : 2021-07-31 DOI: 10.23937/2643-3966/1710041
Paterick Timothy
This manuscript explores the clinical presentation and physical examination findings in pregnant patients with presumed heart disease. There is a review of the clinical presentation, physical examination, and multi-modality imaging that led to a diagnosis in pregnant patients with coronary artery disease, cardiomyopathies, arrhythmias, valvular heart disease, and pulmonary hypertension. The cases are not exhaustive, but represent a subset of the large number of cardiovascular conditions affecting pregnant patients. For an excellent and exhaustive review, the readership is directed to the 2018 ESC Guidelines for the management of cardiovascular disease during pregnancy.
这篇文章探讨了假定患有心脏病的孕妇的临床表现和体格检查结果。本文综述了冠心病、心肌病、心律失常、瓣膜性心脏病和肺动脉高压孕妇的临床表现、体格检查和多模态影像学诊断。这些病例并不详尽,但代表了影响孕妇的大量心血管疾病的一个子集。为了进行出色而详尽的审查,读者可参考2018年ESC妊娠期心血管疾病管理指南。
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引用次数: 0
Impella Device is Superior to an Intra-Aortic Balloon Pump in Cardiogenic Shock 在心源性休克中,Impella装置优于主动脉内球囊泵
Pub Date : 2021-07-03 DOI: 10.23937/2643-3966/1710040
Khan Muhammad Zubair, F. Sona, Hyman Richard
A Percutaneous assist device is commonly used in cardiogenic shock to improve hemodynamics. The Impella provided superior hemodynamic support in the ISARSHOCK study compared with an intra-aortic balloon pump (IABP), with no change in clinical outcome. In this trial, the IABP was used in one group, and the Impella was placed in a comparator group. We present a case in which the hemodynamics of cardiogenic shock was assessed in the same patient after IABP and after Impella placement. In our case, the hemodynamics improved after Impella placement and removal of IABP. *Corresponding author: Richard Hyman, MD, Department of Medicine, St. Mary Medical Center, 1201 NewtownLanghorne Rd, Langhorne, PA 19047, USA, Tel: +1-215-750-7000 Check for updates
经皮辅助装置常用于心源性休克以改善血流动力学。在ISARSHOCK研究中,与主动脉内球囊泵(IABP)相比,Impella提供了更好的血流动力学支持,临床结果没有变化。在本试验中,IABP作为一组,Impella作为对照组。我们提出了一个病例,在IABP和Impella放置后,对同一患者的心源性休克的血流动力学进行了评估。在我们的病例中,在植入和移除IABP后,血流动力学得到改善。*通讯作者:Richard Hyman,医学博士,圣玛丽医疗中心医学系,1201 NewtownLanghorne Rd, Langhorne, PA 19047, USA, Tel: +1-215-750-7000查看最新情况
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引用次数: 0
Technical Feasibility Does Not Guarantee Clinical Improvement: A Word of Caution for Valve-in-Valve Procedures in Small Surgical Prosthesis 技术可行性并不能保证临床改善:对小型外科假体中瓣内手术的警告
Pub Date : 2021-03-31 DOI: 10.23937/2643-3966/1710038
Stelzmueller Marie-Elisabeth, Mora Bruno, Laufer Guenther, Wisser Wilfried
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引用次数: 0
Complete Heart Block in a Patient with COVID-19 COVID-19患者的完全心脏传导阻滞
Pub Date : 2021-03-31 DOI: 10.23937/2643-3966/1710039
J. VillasmilRicardo, J. LorenzoChristian, K. AbdelalQassem, I. ConteJorge, Lattanzio Natalia, Wiese-Rometsch Wilhelmine, G. ChengHenry
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been reported to cause cardiac complications including myocarditis, acute myocardial infarction (AMI) and various tachyarrhythmias. We present a 63-year-old male who developed nonreversible symptomatic bradycardia due to advanced atrioventricular block (AV) requiring pacemaker placement in the setting of severe SARS-CoV-2 pneumonia.
据报道,严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)大流行可引起心脏并发症,包括心肌炎、急性心肌梗死(AMI)和各种心动过速。我们报告了一名63岁男性,由于晚期房室传导阻滞(AV)而出现不可逆的症状性心动过缓,需要在严重的SARS-CoV-2肺炎背景下放置起搏器。
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引用次数: 4
The Influence of Iterative Reconstruction Technique on the Diagnosis of Coronary Artery Calcification 迭代重建技术对冠状动脉钙化诊断的影响
Pub Date : 2021-01-23 DOI: 10.23937/2643-3966/1710033
AlShamakhi Ahmed Khamis, Jamkhandikar Rakesh Malhari, AlWahshi Yahya Mohammed, P. S. Murthi
Objectives: This study aimed to assess the impact of iterative reconstruction (IR) algorithms for the evaluation of coronary artery calcification (CAC) in terms of image quality and subjective diagnostic performance. Methods: This study was performed in a single center and written informed consent was obtained from all patients. Thirty-one consecutive patients (26 men/5 women) underwent CT calcium score to rule out CAC. Image data were reconstructed with both; filtered back projection (FBP) and different levels of IR algorithms. Both the qualitative and quantitative image quality and subjective diagnostic performance were compared; Agatston scores and calcium density were measured for a total of 100 coronary arteries. Results: Quantitatively; image noise was substantially reduced with high levels of IR reflecting high significances of noise level (p < 0.001). In terms of subjective diagnostic performance, it was observed with increased IR levels; 49% of coronary arteries showed decrease, 14% showed increase, 32% were constant and 5% of coronary arteries showed fluctuation in total Agatston scores. Certain Agatston scores were not detected in coronary arteries in some levels of IR algorithms. Conclusions: IR resulted in substantial noise reduction and improved in both signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Higher levels of IR might lead to disappearance or underestimation of detectable calcium in coronary arteries with low calcium burden. Iterative reconstruction technique should be used with caution for better calcium quantification.
目的:本研究旨在评估迭代重建(IR)算法在图像质量和主观诊断性能方面对冠状动脉钙化(CAC)评估的影响。方法:本研究在单中心进行,所有患者均获得书面知情同意。31例连续患者(26男5女)接受CT钙评分以排除CAC。用两者对图像数据进行重构;滤波后投影(FBP)和不同层次的红外算法。比较定性、定量图像质量和主观诊断性能;测量100条冠状动脉的Agatston评分和钙密度。结果:定量;高水平的IR反映了高显著性的噪声水平,大大降低了图像噪声(p < 0.001)。在主观诊断表现方面,观察到IR水平升高;49%冠状动脉Agatston总分下降,14%升高,32%不变,5%冠状动脉Agatston总分波动。在某些水平的IR算法中,冠状动脉未检测到某些Agatston评分。结论:红外成像显著降低了噪声,提高了信噪比(SNR)和噪声对比比(CNR)。较高的IR水平可能导致低钙负荷冠状动脉中可检测钙的消失或低估。为了更好地定量钙,应谨慎使用迭代重建技术。
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引用次数: 0
Coronary Artery Disease Risk Assessment in Sedentary and Active Patients: Medical Risk, Behavioral Psychology, and the Standard of Care 久坐和活动患者的冠状动脉疾病风险评估:医疗风险、行为心理学和护理标准
Pub Date : 2020-10-12 DOI: 10.23937/2643-3966/1710032
M. Vinay, E. PaterickTimothy
Objective: A practical approach to determining risk in sedentary and active patients for coronary artery disease. Identify how personal/family history, atherogenic risk factors, and coronary calcium are essential to determining and predicting risk potential. Materials/methods: Review of the medical, behavioral psychology, and standard of care literature to identify how human psychology, statistical risk of coronary disease, and coronary calcium shape risk prediction. Results: A comprehensive personal/family history, risk factor assessment and comprehensive physical examination are the foundation of risk assessment. Understanding the cognitive process of risk potential is critical to management strategies. Stress testing and coronary calcium scoring are useful adjuncts when initial screening is suggestive of intermediate atherogenic risk. Conclusion: Comprehensive personal/family history, risk factor assessment, comprehensive physical examination, cognitive processing of risk potential, stress testing and calcium scoring all have a role in risk assessment of sedentary and active patients.
目的:一种确定久坐和活动患者冠状动脉疾病风险的实用方法。确定个人/家族史、动脉粥样硬化危险因素和冠状动脉钙对确定和预测潜在风险的重要性。材料/方法:回顾医学、行为心理学和标准护理文献,以确定人类心理、冠心病的统计风险和冠状动脉钙形态的风险预测。结果:全面的个人/家族史、危险因素评估和全面的体格检查是进行风险评估的基础。了解潜在风险的认知过程对管理策略至关重要。当初始筛查提示中度动脉粥样硬化风险时,压力测试和冠状动脉钙评分是有用的辅助手段。结论:综合个人/家族史、危险因素评估、综合体格检查、风险潜势认知加工、应激测试、钙评分等对久坐和活跃患者的风险评估均有一定作用。
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引用次数: 1
The Usefulness of Long Inflation Balloon Angioplasty Using a Perfusion Balloon for Intracoronary Thrombus 冠状动脉内血栓灌注球囊血管成形术的应用
Pub Date : 2020-06-12 DOI: 10.23937/2643-3966/1710031
Watanabe Shingo, Usui Michio
• Page 1 of 4 • Citation: Watanabe S, Usui M (2020) The Usefulness of Long Inflation Balloon Angioplasty Using a Perfusion Balloon for Intracoronary Thrombus. Int Arch Cardiovasc Dis 4:031. doi.org/10.23937/26433966/1710031 Accepted: June 10, 2020; Published: June 12, 2020 Copyright: © 2020 Watanabe S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
引用本文:Watanabe S, Usui M(2020)使用灌注球囊进行冠状动脉内血栓长期充气球囊成形术的有效性。《心血管病杂志》4:31。doi.org/10.23937/26433966/1710031录用日期:2020年6月10日;出版日期:2020年6月12日版权所有:©2020 Watanabe S, et al。这是一篇根据知识共享署名许可协议发布的开放获取文章,该协议允许在任何媒体上不受限制地使用、分发和复制,前提是要注明原作者和来源。
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引用次数: 0
Pacemaker Lead Associated Superior Vena Cava Syndrome Treated By Veno-Atrial Bypass 静脉-心房搭桥治疗起搏器导联相关上腔静脉综合征
Pub Date : 2020-06-11 DOI: 10.23937/2643-3966/1710030
Gunawardena Thilina, S. Balasubramanium, Bandara Gayan, Cassim Rezni, Wijeyaratne Mandika
• Page 1 of 4 • Citation: Gunawardena T, Saseekaran B, Bandara G, Cassim R, Wijeyaratne M (2020) Pacemaker Lead Associated Superior Vena Cava Syndrome Treated By Veno-Atrial Bypass. Int Arch Cardiovasc Dis 4:030. doi.org/10.23937/2643-3966/1710030 Accepted: June 09, 2020; Published: June 11, 2020 Copyright: © 2020 Gunawardena T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
•引用:Gunawardena T, Saseekaran B, Bandara G, Cassim R, Wijeyaratne M(2020)静脉-心房旁路治疗起搏器导联相关上腔静脉综合征。国际心血管病杂志4:30。doi.org/10.23937/2643-3966/1710030录用日期:2020年6月9日;出版日期:2020年6月11日版权所有:©2020 Gunawardena T, et al。这是一篇根据知识共享署名许可协议发布的开放获取文章,该协议允许在任何媒体上不受限制地使用、分发和复制,前提是要注明原作者和来源。
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引用次数: 0
Two Dimensional Speckle Tracking Echocardiography Assessment of Left Ventricular Remodeling in Patients after Myocardial Infarction 二维斑点跟踪超声心动图评价心肌梗死后左心室重构
Pub Date : 2020-04-11 DOI: 10.23937/2643-3966/1710028
Saad Moustafa Kamal Eldin Ibrahim Khalil, El-khashab Khalid A, Ragab Tamer M
Background: Adverse Left Ventricular Remodelling (LVR), defined as progressive ventricular dilatation, distortion of chamber shape, myocardial hypertrophy and deteriorating function, begins in some patients who suffered from Acute Myocardial Infarction (AMI), sometimes even after successful Percutaneous Coronary Intervention (PCI). If uninterrupted, it could lead to Congestive Heart Failure (CHF) and a poor clinical outcome. Aims: This study aims at evaluating the value of Speckle Tracking Echocardiography (STE) in predicting LVR after successful PCI in AMI patients. Materials and Methods: Eighty-four AMI patients had a complete echocardiographic study, including speckle tracking, performed two days after PCI and then two months afterwards. The patients were then divided into two groups based on the presenceh of remodelling; R+ (remodelling) group and R- (non-remodelling) group. Results: At the baseline study, group R+ showed significantly lower strain parameters than group R-. These included Global Longitudinal Strain (GLS) (-11.14 ± 0.5 VS -16.78 ± 0.4, p˂0.0001), longitudinal strain rate (-1.01 ± 0.05 VS -1.07 ± 0.04, p˂0.0001), Culprit Longitudinal Strain (CulLS) (-9.74 ± 0.59 VS -15.68 ± 0.49, P˂0.0001), and culprit longitudinal strain rate (-0.95 ± 0.05 VS -1.02 ± 0.04, P˂0.0001). In the follow up study, all of the strain parameters studied were again significantly lower in the R+ than the R- group. The most sensitive and specific parameters were the GLS and CulLS (sensitivities of 91.7% and 95.8% respectively and specificities of 95% and 96.7% respectively). Conclusion: Our findings show that impaired indices of LV deformation detected two days after successful PCI for AMI may provide a predictive value in early detection of LV remodelling.
背景:不良左心室重构(LVR),定义为进行性心室扩张,腔室形状扭曲,心肌肥厚和功能恶化,开始于一些急性心肌梗死(AMI)患者,有时甚至在经皮冠状动脉介入治疗(PCI)成功后。如果不间断,它可能导致充血性心力衰竭(CHF)和不良的临床结果。目的:本研究旨在评价斑点追踪超声心动图(STE)对AMI患者PCI术后LVR的预测价值。材料与方法:84例AMI患者在PCI术后2天和术后2个月分别进行了完整的超声心动图研究,包括斑点追踪。然后根据是否存在重构将患者分为两组;R+(重塑)组和R-(非重塑)组。结果:在基线研究中,R+组的应变参数明显低于R-组。其中包括全局纵向应变(GLS)(-11.14±0.5 VS -16.78±0.4,p小于0.0001)、纵向应变率(-1.01±0.05 VS -1.07±0.04,p小于0.0001)、罪魁祸首纵向应变(CulLS)(-9.74±0.59 VS -15.68±0.49,p小于0.0001)和罪魁祸首纵向应变率(-0.95±0.05 VS -1.02±0.04,p小于0.0001)。在后续研究中,R+组的所有应变参数均明显低于R-组。GLS和CulLS是最敏感和特异的参数,灵敏度分别为91.7%和95.8%,特异度分别为95%和96.7%。结论:我们的研究结果表明,在AMI成功PCI后两天检测到的左室变形受损指数可能对早期发现左室重构提供预测价值。
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引用次数: 0
Coronary Artery Involvement Following Kawasaki Disease: A Case Report of a 5 Month Old African Infant 川崎病后冠状动脉受累一例5个月大的非洲婴儿
Pub Date : 2019-11-07 DOI: 10.23937/2643-3966/1710025
Hilda Tumwebaze, Emma Ndagiire, Judith Namuyonga, Aliku Twalib, P. Lwabi, Sulaiman Lubega
Background: Kawasaki disease (KD) is an acute systemic vasculitis which progresses to cause coronary artery abnormalities as a complication. Echocardiographic and cardiac angiographic data indicate that 20-40% of untreated KD patients develop coronary artery abnormalities. However, majority of the lesions regress over time. Timely treatment with high dose intravenous immunoglobulins (IVIG) and high dose of aspirin has been found to reduce the incidence of developing coronary artery aneurysms to 2%-3%. Data on KD in the African region is unavailable. We present a case of a 5 month old infant that presented at the Uganda Heart Institute with KD associated with coronary artery involvement and is currently undergoing follow up. Case presentation: A 5-months-old female infant presented to the pediatric emergency unit with a persistent high grade fever for 7 days with refusal to breast feed, diarrhea and irritability, a generalized maculopapular rash that had started 2 days after onset of fever. Her vaccination status was up to date. She was evaluated and initially managed for gastroenteritis and septicemia with no improvement. A pediatric cardiology review was done at day 22 of illness due to symptoms of difficulty in breathing and palpitations. Significant physical findings were of a very sick infant, febrile with generalized maculopapular rash, peeling of extremities and perineum, hyperemia of the conjunctiva bilaterally and the pharynx, no cervical lymphadenopathy. She had tachypnea, tachycardia with a gallop rhythm but no murmurs, tender hepatomegally, irritability but conscious with no signs of meningeal irritation. A transthoracic echocardiography done significantly showed dilated coronary arteries, moderate pericardial effusion with preserved ejection fraction. Laboratory findings were of leucocytosis predominantly neutrophilia, thrombocytosis, anemia, raised C-reactive protein levels, hypoalbuminemia and raised liver function tests. Blood cultures and blood smear for malaria were unremarkable. A diagnosis of KD with coronary artery involvement was made by the pediatric cardiologist. Treatment for KD was started immediately with high dose intravenous immunoglobulins (IVIG) as a single dose and high dose aspirin with remarkable improvement as the fever subsided with in 24 hours of treatment. Follow up serial transthoracic echocardiography findings showed regression of coronary artery dilatation over time and currently at 3 years of age the coronary arteries are of normal diameter for her body surface area. ISSN: 2643-3966 DOI: 10.23937/2643-3966/1710025 Hilda et al. Int Arch Cardiovasc Dis 2019, 3:025 • Page 2 of 5 • month-old infant with coronary artery involvement in Uganda in Africa.
背景:川崎病(Kawasaki disease, KD)是一种急性全身性血管炎,其发展可导致冠状动脉异常。超声心动图和心脏血管造影数据显示,20-40%未经治疗的KD患者出现冠状动脉异常。然而,随着时间的推移,大多数病变会消退。及时使用高剂量静脉注射免疫球蛋白(IVIG)和高剂量阿司匹林治疗可将冠状动脉瘤的发生率降低至2%-3%。非洲区域的KD数据无法获得。我们提出了一例5个月大的婴儿,在乌干达心脏研究所提出了与冠状动脉受累相关的KD,目前正在进行随访。病例介绍:一名5个月大的女婴因持续高烧7天,拒绝母乳喂养,腹泻和烦躁,发烧2天后开始出现全身性黄斑丘疹而被送到儿科急诊科。她的疫苗接种状况是最新的。对她进行了评估,并初步处理了肠胃炎和败血症,但没有改善。由于呼吸困难和心悸的症状,在发病的第22天进行了儿科心脏病检查。重要的物理发现是一个非常生病的婴儿,发烧,全身性黄斑丘疹,四肢和会阴脱皮,双侧结膜和咽充血,无颈部淋巴结病。她有呼吸急促,心动过速伴快速节奏但无杂音,肝肿大,易怒但意识清醒,无脑膜刺激迹象。经胸超声心动图显示冠状动脉扩张,中度心包积液并保留射血分数。实验室结果是白细胞增多,主要是中性粒细胞增多,血小板增多,贫血,c反应蛋白水平升高,低白蛋白血症和肝功能测试升高。血培养和血涂片检测疟疾无显著差异。儿科心脏病专家诊断为KD伴冠状动脉受累。患者立即给予单剂量高剂量静脉注射免疫球蛋白(IVIG)和高剂量阿司匹林治疗,治疗24小时后发热消退,治疗效果显著。随后的一系列经胸超声心动图显示,随着时间的推移,冠状动脉扩张逐渐消退,目前3岁时,冠状动脉的直径与她的体表面积正常。ISSN: 2643-3966 DOI: 10.23937/2643-3966/1710025 Hilda等。《国际心血管疾病杂志》2019年第3期,第2页,非洲乌干达5个月大婴儿冠状动脉病变。
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引用次数: 0
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International Archives of Cardiovascular Diseases
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