Heart Views最新文献

Primary ovarian carcinoid tumors, an extremely rare subset of ovarian malignancies (<0.1% of cases), typically manifest with abdominal pain and bloating. The occurrence of carcinoid heart disease (CHD) without classic carcinoid syndrome features is exceptionally uncommon. We report a 54-year-old female presenting with dyspnea and edema over months, lacking typical carcinoid syndrome signs. Initial assessments diagnosed heart failure, supported by elevated NT-Pro BNP, echocardiographic right ventricular dilation, and pulmonary/tricuspid valve regurgitation (normal left ventricular function). Right heart catheterization showed normal pulmonary/right ventricular pressures. Subsequent investigations (computed tomography thorax abdomen pelvis, 5-hydroxyindole acetic acid levels) strongly suggested carcinoid disease, confirmed by an octreotide scan revealing an octreotide-secreting ovarian carcinoid tumor. Surgical intervention included tricuspid and pulmonary valve repair, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. Primary ovarian carcinoid tumors, though rare, may lead to unexpected complications like CHD. Timely diagnosis and intervention are pivotal for optimizing patient outcomes in such cases.

Purpose: Here, we describe cardiac magnetic resonance imaging (CMR) findings in patients with proven COVID-19 infection and presenting with cardiac problems both at presentation and in convalescence from a tertiary care center, in North India. A pertinent review of the literature is also discussed.

Materials and methods: Retrospective analysis of patients with real-time reverse transcriptase-polymerase chain reaction proven COVID-19 infection either at presentation or convalescence referred for CMR at our facility from January 2021 to December 2023 was done. CMR was performed on a 3T system (Ingenia, Philips Healthcare, Best, The Netherlands) and examinations were customized according to the clinical indications.

Results: Retrospective analysis yielded 14 patients (4 at presentation; 10 in convalescence). Patients at presentation 4/14 had clinically presented with chest pain with raised troponins and electrographic abnormalities, while 10/14 patients had presented with clinical features of heart failure with two-dimensional transthoracic echocardiography demonstrating systolic dysfunction with reduced left ventricular ejection fraction. Out of 14, 4 patients at presentation, CMR showed features of acute myocarditis in three patients, while one had inferior wall myocardial infarction (MI) (this patient on catheter angiogram had aneurysmally dilated coronary arteries with thrombus and stenosis in the mid right coronary artery which was successfully stented). Out of 14, 10 patients on CMR had features of dilated cardiomyopathy (DCMP).

Conclusion: Cardiac involvement in COVID-19 can have vivid clinicoradiological presentations with features of myocarditis and MI at presentation or DCMP in convalescence. CMR in such cases is a problem-solving tool where myocarditis is candidly differentiated from MI. Moreover, follow-up CMR demonstrates temporal changes in COVID-19-associated myocarditis and evaluation of cardiac structure and function in patients presenting with DCMP.

We report an unusual difficulty in unscrewing and releasing the atrial septal defect device during device closure because of the entrapment of the delivery cable in the prominent Chiari network. We suggest careful pre- and intra-procedure transesophageal guidance in recognizing and managing this rare challenge.

Hypertrophic cardiomyopathy (HCM) is characterized by abnormal thickening of the left ventricular myocardium. Apical HCM is a less common variant of HCM where the hypertrophy is limited to the apical segments and can be challenging to diagnose based on traditional echocardiography alone. Patients with HCM can present with exertional angina. We present a series of four different cases, where patients were advised computed tomography (CT) coronary angiography for the evaluation of coronary artery disease. While CT coronary angiography excluded obstructive coronary artery disease, a detailed evaluation of the retrospective electrocardiogram-gated CT coronary angiography data helped in establishing the diagnosis of apical HCM in these patients. We discuss the importance of a systematic analysis of cardiac CT for diagnosing HCM variants and highlight the utility of reconstructed static and cine CT images which are readily available from the data obtained during retrospective gated CT coronary angiography for diagnosing HCM.

We report a 31-year-old patient with acute fulminant myocarditis, resulting in cardiogenic shock that necessitated mechanical circulatory support, who improved dramatically after treatment with intravenous (IV) pulse steroids. A coordinated multidisciplinary team was the key secret in the cure of this critical patient. In this case study, we focus on the role of IV pulse steroids in the treatment of fulminant lymphocytic myocarditis.

Percutaneous coronary intervention (PCI) is a very rare cause of acute pericarditis. It usually develops after a latent period but can present early in case of procedural complications. A high degree of suspicion is required for diagnosis as most cases can be easily missed. Here, we highlight a case of 54-year-old admitted as a case of non-ST elevated myocardial infarction who in view of ongoing chest pain underwent urgent coronary angiography, followed by the primary PCI to left anterior descending artery after which the patient became pain-free. However, 12 h after the procedure, the patient developed severe persistent chest pain with positional and respiratory variation. He was suspected to have reinfarction and treated accordingly but had no symptomatic improvement and was planned for check angiography. However, based on dynamic electrocardiogram (ECG) changes, new echocardiographic findings aided laboratory parameters, he was diagnosed with acute pericarditis. He was treated with nonsteroidal anti-inflammatory drugs following which his pain resolved and ECG returned to baseline after 4 days. His follow-up echocardiography showed complete resolution of pericardial effusion. This case highlights the importance of keeping acute pericarditis as a differential diagnosis of chest pain in PCI patients. A high degree of suspicion is required, as most cases are easily missed to diagnose.

Computed tomographic (CT) coronary artery angiography with calcium scoring is crucial in suspecting coronary artery disease (CAD). The routine protocol for CAD radiological investigation involves a precontrast series for calcium scoring and a postcontrast series for investigating structural changes in coronary arteries. This review intends to investigate the feasibility of virtual noncontrast images to replace the true noncontrast (TNC) images in coronary artery calcium scoring to decrease the radiation dose. The current review included articles found in the PubMed database. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the further evaluation of the articles for inclusion criteria, 25 articles were finally shortlisted for the final review. It is found that the calcium score of coronary arteries estimated by virtual unenhanced images generated by dual-energy CT (DECT) is comparable with that of TNC images. The virtual unehncanced images has the potential to eliminate the need for the TNC series acquisition, thereby reducing the radiation dose. Especially, photon-counting detector-based DECT has excellent potential in the estimation of calcium scores and the reduction in radiation dose. In addition, contrast dose also can be significantly reduced, which is crucial in patients with renal insufficiency. In conclusion, using DECT for CAD investigations significantly reduces both radiation and contrast doses compared to conventional CT scans. This reduction is particularly crucial for patients who require repeated follow-up scans, as it enhances their safety and minimizes potential risks.

Background: Obstructive sleep apnea (OSA), characterized by recurrent partial or complete upper airway obstructions during sleep, is an established risk factor for cardiovascular diseases in children. This study aims to determine the prevalence of left ventricular hypertrophy (LVH), abnormal left ventricular (LV) geometric patterns, and diastolic dysfunction in children with OSA and compare them with healthy controls.

Materials and methods: This was a cross-sectional comparative study conducted on 75 eligible children with OSA aged 2-14 years and 75 age- and sex-matched healthy children. Transthoracic echocardiography was used to assess the LV structures and diastolic function in all the subjects.

Results: The mean LV mass index was significantly higher in the patients with OSA (36.53 ± 9.1 g/m^2.7) as compared to the control group (32.82 ± 7.9 g/m^2.7) (P = 0.008), and it showed a significant correlation with decreasing peripheral oxygen saturation (r = -0.35, P = 0.002). LVH was present in 8.0% of the patients with OSA and none (0%) of the controls. 29.3% of the patients with OSA and 1.3% of the healthy controls had abnormal LV geometry. LV diastolic dysfunction was present in 6.7% of the patients with OSA and 0% of the controls. LV diastolic dysfunction was significantly higher among the patients with OSA who have abnormal LV geometry compared to those with normal LV geometry (P = 0.002).

Conclusion: LVH, abnormal LV geometry, and diastolic dysfunction are more common in children with OSA than in healthy controls. Children with OSA and abnormal LV geometry are more likely to have LV diastolic dysfunction.

Loeffler first described "fibroplastic parietal endocarditis with blood eosinophilia" in 1936. This we now know refers to the most common cardiac manifestation of an uncommon condition, the so-called hypereosinophilic syndromes. This condition typically results in a restrictive cardiomyopathy affecting the left heart, but here, we present an unusual case of a 65-year-old woman with chronic hypereosinophilia of at least 2 years, who presented with right heart failure as a result of eosinophilic endomyocardial infiltration of her right ventricle. We explore the diagnostic pathway and look at the literature on management.