Darren Drittel, Dylan Deyar, Eric Boxer, Hussam Al Hennawi, Margaret Mack
Kounis syndrome, an allergic hypersensitivity coronary disorder, is a rare but potentially life- threatening condition triggered by various allergens, including medications. We present the case of a 41-year-old male with no prior cardiac history, who developed Kounis syndrome following vancomycin administration for suspected cellulitis. The patient initially presented with rash, fever, and malaise, which progressed to chest discomfort associated with diaphoresis and elevated troponin levels. Diagnostic evaluations, including electrocardiographic changes and coronary angiography, confirmed a diagnosis of type I Kounis syndrome. This case adds to the limited literature on vancomycin-induced Kounis syndrome, and underscores the importance of considering this diagnosis in patients with myocardial damage following exposure to potential allergens.
Kounis 综合征是一种过敏性超敏冠状动脉疾病，是由包括药物在内的各种过敏原引发的一种罕见但可能危及生命的疾病。我们介绍了一例 41 岁男性患者的病例，该患者既往无心脏病史，在服用万古霉素治疗疑似蜂窝织炎后出现库尼斯综合征。患者最初表现为皮疹、发热和乏力，随后发展为胸部不适，伴有舒张和肌钙蛋白水平升高。诊断评估（包括心电图变化和冠状动脉造影）确诊为 I 型库尼综合征。本病例补充了有关万古霉素诱发库尼斯综合征的有限文献，并强调了在接触潜在过敏原后出现心肌损害的患者中考虑这一诊断的重要性。
{"title":"The curious case of Kounis syndrome: Exploring clinical manifestations and management in the presence of nonobstructive coronary arteries","authors":"Darren Drittel, Dylan Deyar, Eric Boxer, Hussam Al Hennawi, Margaret Mack","doi":"10.21542/gcsp.2024.14","DOIUrl":"https://doi.org/10.21542/gcsp.2024.14","url":null,"abstract":"\u0000\u0000\u0000Kounis syndrome, an allergic hypersensitivity coronary disorder, is a rare but potentially life- threatening condition triggered by various allergens, including medications. We present the case of a 41-year-old male with no prior cardiac history, who developed Kounis syndrome following vancomycin administration for suspected cellulitis. The patient initially presented with rash, fever, and malaise, which progressed to chest discomfort associated with diaphoresis and elevated troponin levels. Diagnostic evaluations, including electrocardiographic changes and coronary angiography, confirmed a diagnosis of type I Kounis syndrome. This case adds to the limited literature on vancomycin-induced Kounis syndrome, and underscores the importance of considering this diagnosis in patients with myocardial damage following exposure to potential allergens.\u0000\u0000\u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"19 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140432295","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}
A. Elamragy, Ahmad Samir, Ahmed Maher, Hussein Rizk, Marwa Mashaal
Background: COVID-19 caused restrictions and re-allocation of medical resources among all healthcare services. During the peak of the pandemic, several unrelated–yet critical–conditions had silently taken their toll. Infective endocarditis (IE), owing to its non-specific clinical presentation, may have been largely mislabeled as COVID-19 in a number of cases. Results: This retrospective observational study reviewed all IE presentations at an IE unit in a university hospital during the peak of COVID-19. Patient characteristics, courses, and outcomes were compared with historical controls from our IE database published before the COVID era. We identified 30 IE cases [Group A] during the COVID-19 peak in our region (June 2021 to June 2022), with a 25% decrease compared to the usual annual rate. This is in contrast to the expected surge during the pandemic. Compared with group B (398 published IE cases from our database), group A had significantly longer symptoms-to-presentation intervals (60 [31–92] vs. 28 [14–72] days, p = 0.01). Male sex dominated both groups, but group A had significantly less pre-existing structural heart disease. Despite the more liberal use of empirical antibiotics in the COVID-era, group-A had lower rates of culture-negative IE. Compared to group B, group A demonstrated a better response to medical therapy, fewer arterial embolizations, fewer indications for surgery, and fewer overall complications, except for increased acute kidney injury. This can be explained by the abundant use of non-steroidal anti-inflammatory drugs. The data analysis strongly suggests that there might have been a natural selection or selection bias of IE patients with favorable profiles to survive the pandemic to the appropriate diagnosis. Conclusions: The diagnosis of IE and commencing the appropriate workup were significantly undermined during the COVID-19 pandemic. The inexplicable decline in IE referral rate and the favorable outcomes witnessed during the pandemic strongly suggest a referral bias and natural selection of those who survived the pandemic to the appropriate IE diagnosis.
{"title":"Infective endocarditis presentations during the COVID-19 pandemic: Have they paid an untold toll?","authors":"A. Elamragy, Ahmad Samir, Ahmed Maher, Hussein Rizk, Marwa Mashaal","doi":"10.21542/gcsp.2024.11","DOIUrl":"https://doi.org/10.21542/gcsp.2024.11","url":null,"abstract":"\u0000\u0000\u0000Background: COVID-19 caused restrictions and re-allocation of medical resources among all healthcare services. During the peak of the pandemic, several unrelated–yet critical–conditions had silently taken their toll. Infective endocarditis (IE), owing to its non-specific clinical presentation, may have been largely mislabeled as COVID-19 in a number of cases.\u0000Results: This retrospective observational study reviewed all IE presentations at an IE unit in a university hospital during the peak of COVID-19. Patient characteristics, courses, and outcomes were compared with historical controls from our IE database published before the COVID era. We identified 30 IE cases [Group A] during the COVID-19 peak in our region (June 2021 to June 2022), with a 25% decrease compared to the usual annual rate. This is in contrast to the expected surge during the pandemic. Compared with group B (398 published IE cases from our database), group A had significantly longer symptoms-to-presentation intervals (60 [31–92] vs. 28 [14–72] days, p = 0.01). Male sex dominated both groups, but group A had significantly less pre-existing structural heart disease. Despite the more liberal use of empirical antibiotics in the COVID-era, group-A had lower rates of culture-negative IE. Compared to group B, group A demonstrated a better response to medical therapy, fewer arterial embolizations, fewer indications for surgery, and fewer overall complications, except for increased acute kidney injury. This can be explained by the abundant use of non-steroidal anti-inflammatory drugs. The data analysis strongly suggests that there might have been a natural selection or selection bias of IE patients with favorable profiles to survive the pandemic to the appropriate diagnosis.\u0000Conclusions: The diagnosis of IE and commencing the appropriate workup were significantly undermined during the COVID-19 pandemic. The inexplicable decline in IE referral rate and the favorable outcomes witnessed during the pandemic strongly suggest a referral bias and natural selection of those who survived the pandemic to the appropriate IE diagnosis.\u0000\u0000\u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"49 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140433086","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}
Introduction: Iron deficiency (ID) is one of the most frequent comorbidities in patients with heart failure (HF) and is estimated to be present in up to 80% of acute patients regardless of their ejection fraction. Randomized controlled trials have shown that supplementary intravenous iron results in improved clinical outcomes; however, the current understanding of the effects of intravenous iron on morbidity and mortality remains limited. Study and results: The meta-analysis pooled individual participant data from three randomized placebo-controlled trials of ferric carboxymaltose (FCM) in adult patients (n=4,501) with heart failure and iron deficiency (CONFIRM-HF, AFFIRM-AHF, and HEART-FID). FCM therapy significantly reduced the co-primary composite endpoint of total cardiovascular hospitalizations and cardiovascular death, with a rate ratio (RR 0.86; 95% CI 0.75 to 0.98; p=0.029). FCM therapy was associated with a 17% relative rate reduction in total cardiovascular hospitalizations (RR 0.83; 95% CI 0.73 to 0.96; p=0.009) and a 16% relative rate reduction in total heart failure hospitalizations (RR 0.84; 95% CI 0.71 to 0.98; p=0.025). Lessons learned: The meta-analysis shows that in iron-deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, intravenous ferric carboxymaltose (FCM) is associated with a reduced risk of total cardiovascular hospitalization...
导言：缺铁（ID）是心力衰竭（HF）患者最常见的并发症之一，据估计，高达 80% 的急性心力衰竭患者存在缺铁，无论其射血分数如何。随机对照试验表明，静脉补充铁剂可改善临床预后；然而，目前对静脉铁剂对发病率和死亡率影响的了解仍然有限。研究与结果：荟萃分析汇集了三项羧甲基铁（FCM）随机安慰剂对照试验（CONFIRM-HF、AFFIRM-AHF 和 HEART-FID）中的个体参与者数据，这些试验针对心力衰竭和缺铁的成年患者（n=4,501）。FCM疗法大大降低了心血管住院总次数和心血管死亡的共同主要复合终点，比率比（RR 0.86；95% CI 0.75 至 0.98；P=0.029）。FCM疗法可使心血管总住院率相对降低17% (RR 0.83; 95% CI 0.73 to 0.96; p=0.009)，使心力衰竭总住院率相对降低16% (RR 0.84; 95% CI 0.71 to 0.98; p=0.025)。经验教训：荟萃分析表明，对于左心室射血分数降低或轻度降低的缺铁性心力衰竭患者，静脉注射羧甲基铁（FCM）可降低心血管疾病的总住院风险...
{"title":"Benefits of intravenous iron supplementation in heart failure","authors":"S. Kotit","doi":"10.21542/gcsp.2024.10","DOIUrl":"https://doi.org/10.21542/gcsp.2024.10","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 \u0000Introduction: Iron deficiency (ID) is one of the most frequent comorbidities in patients with heart failure (HF) and is estimated to be present in up to 80% of acute patients regardless of their ejection fraction. Randomized controlled trials have shown that supplementary intravenous iron results in improved clinical outcomes; however, the current understanding of the effects of intravenous iron on morbidity and mortality remains limited. \u0000Study and results: The meta-analysis pooled individual participant data from three randomized placebo-controlled trials of ferric carboxymaltose (FCM) in adult patients (n=4,501) with heart failure and iron deficiency (CONFIRM-HF, AFFIRM-AHF, and HEART-FID). FCM therapy significantly reduced the co-primary composite endpoint of total cardiovascular hospitalizations and cardiovascular death, with a rate ratio (RR 0.86; 95% CI 0.75 to 0.98; p=0.029). FCM therapy was associated with a 17% relative rate reduction in total cardiovascular hospitalizations (RR 0.83; 95% CI 0.73 to 0.96; p=0.009) and a 16% relative rate reduction in total heart failure hospitalizations (RR 0.84; 95% CI 0.71 to 0.98; p=0.025). \u0000Lessons learned: The meta-analysis shows that in iron-deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, intravenous ferric carboxymaltose (FCM) is associated with a reduced risk of total cardiovascular hospitalization... \u0000 \u0000 \u0000 \u0000 \u0000 \u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140433140","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}
Summary: The venous inflow of each atrial cortex is asymmetric and coupled to geometry and outflow to produce optimal vortices and flow patterns in each chamber. In the right atrium, fiber orientation is dependent on the crista terminals and pectinate muscles, which produce a circumferential squeezing effect to propel blood into the desired direction. The left atrial fiber orientation is a more complex fiber that suits its its geometry and function. This study demonstrates the structural differences between the right and left atria. Background: The right and left atria play important roles in overall cardiac performance, both at rest and during exercise. Atrial dysfunction due to congenital or acquired heart diseases can result in significant disability or death. The prevalence of such conditions has been rising due to the increasing age of the population as well as the progressively larger number of patients with Grown-up congenital heart disease (GUCH). Methods: Left and right atria were collected from rabbits and juvenile sheep, and pattern recognition and image analysis were used to illustrate the microstructure and orientation of the pectinate muscles. Results: The aim of this study is to observe the differences in the structure of the pectinate muscles in both rabbits and sheep. Through image analysis and pattern recognition, we were able to identify the orientation of the patterns that can help produce off-the-shelf patches that are capable of mimicking and/or reproducing most of the functions of normal atrial tissue. Conclusion: The microstructure of the pectinate muscles is unique and provides remarkable functionality to the atria.
{"title":"Structural variations of pectinate muscles across sheep and rabbit atria","authors":"Mahmoud A Sakr, Magdi H. Yacoub","doi":"10.21542/gcsp.2024.15","DOIUrl":"https://doi.org/10.21542/gcsp.2024.15","url":null,"abstract":"\u0000 \u0000 \u0000Summary: The venous inflow of each atrial cortex is asymmetric and coupled to geometry and outflow to produce optimal vortices and flow patterns in each chamber. In the right atrium, fiber orientation is dependent on the crista terminals and pectinate muscles, which produce a circumferential squeezing effect to propel blood into the desired direction. The left atrial fiber orientation is a more complex fiber that suits its its geometry and function. This study demonstrates the structural differences between the right and left atria. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Background: The right and left atria play important roles in overall cardiac performance, both at rest and during exercise. Atrial dysfunction due to congenital or acquired heart diseases can result in significant disability or death. The prevalence of such conditions has been rising due to the increasing age of the population as well as the progressively larger number of patients with Grown-up congenital heart disease (GUCH). \u0000Methods: Left and right atria were collected from rabbits and juvenile sheep, and pattern recognition and image analysis were used to illustrate the microstructure and orientation of the pectinate muscles. \u0000Results: The aim of this study is to observe the differences in the structure of the pectinate muscles in both rabbits and sheep. Through image analysis and pattern recognition, we were able to identify the orientation of the patterns that can help produce off-the-shelf patches that are capable of mimicking and/or reproducing most of the functions of normal atrial tissue. \u0000Conclusion: The microstructure of the pectinate muscles is unique and provides remarkable functionality to the atria. \u0000 \u0000 \u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"32 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140433378","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}
Mauer A A Gonçalves, J. M. Pedro, Carina Silva, Pedro Magalhães, Miguel Brito
Background: Tobacco use accelerates atherosclerosis and is one of the predictors of death from ischemic heart disease, arrhythmias, heart failure, and sudden death. A new non-invasive parameter, the Index of Cardiac Electrophysiological Balance (iCEB) between depolarization and repolarization of the action potential, was considered a new biomarker for the identification of patients at increased arrhythmic risk. Objectives: We aimed to evaluate the iCEB in apparently healthy Angolans with habitual cigarette smoking compared to non-smokers. Subjects and methods: Data were obtained from the CardioBengo study, a cross-sectional community-based study in which a random sample of individuals aged between 15 and 84 years was selected. In total, 214 apparently healthy subjects, 102 smokers, and 112 non-smokers in the same age group were included in the final analysis. Results: The average age of the participants was 42.17±13.04 years old and 26.6% of the sample was female. Smoking subjects had higher iCEB and corrected Index of Cardiac Electrophysiological Balance (iCEBc) values compared with non-smoking controls (4.39 vs. 4.25; p=0.024, respectively), and (4.74 vs. 4.57; p=0.030, respectively). Conclusions: In summary, iCEB and iCEBc were significantly higher in habitual smokers than in nonsmokers, which represents an increased risk of ventricular arrhythmogenesis in healthy habitual smokers. To the best of our knowledge, this is the first study performed in Africa to evaluate iCEB in smokers, making this type of study very important in low- and middle-income countries in the context of epidemiological transition.
背景:吸烟加速动脉粥样硬化，是缺血性心脏病、心律失常、心力衰竭和猝死死亡的预测因素之一。一种新的无创参数，即动作电位去极化和复极化之间的心脏电生理平衡指数(iCEB)，被认为是识别心律失常风险增加患者的新生物标志物。目的:我们旨在评估明显健康的安哥拉人与非吸烟者相比，习惯性吸烟的iCEB。研究对象和方法:数据来自CardioBengo研究，这是一项基于社区的横断面研究，随机选择年龄在15至84岁之间的个体样本。总共有214名表面健康的受试者，102名吸烟者和112名同年龄组的非吸烟者被纳入最终分析。结果:参与者的平均年龄为42.17±13.04岁，女性占26.6%。与非吸烟对照组相比，吸烟组的iCEB和校正后的心脏电生理平衡指数(icbc)值更高(4.39 vs 4.25;P =0.024)和(4.74 vs. 4.57;分别为p = 0.030)。结论:综上所述，习惯吸烟者的iCEB和iCEBc明显高于非吸烟者，这表明健康习惯吸烟者室性心律失常的风险增加。据我们所知，这是在非洲进行的第一项评估吸烟者的icb的研究，这使得这类研究在流行病学转型背景下对低收入和中等收入国家非常重要。
{"title":"Influence of cigarette smoking on the Index of Cardiac Electrophysiological Balance in apparently healthy Angolans","authors":"Mauer A A Gonçalves, J. M. Pedro, Carina Silva, Pedro Magalhães, Miguel Brito","doi":"10.21542/gcsp.2024.5","DOIUrl":"https://doi.org/10.21542/gcsp.2024.5","url":null,"abstract":"\u0000\u0000\u0000Background: Tobacco use accelerates atherosclerosis and is one of the predictors of death from ischemic heart disease, arrhythmias, heart failure, and sudden death. A new non-invasive parameter, the Index of Cardiac Electrophysiological Balance (iCEB) between depolarization and repolarization of the action potential, was considered a new biomarker for the identification of patients at increased arrhythmic risk.\u0000Objectives: We aimed to evaluate the iCEB in apparently healthy Angolans with habitual cigarette smoking compared to non-smokers.\u0000Subjects and methods: Data were obtained from the CardioBengo study, a cross-sectional community-based study in which a random sample of individuals aged between 15 and 84 years was selected. In total, 214 apparently healthy subjects, 102 smokers, and 112 non-smokers in the same age group were included in the final analysis.\u0000Results: The average age of the participants was 42.17±13.04 years old and 26.6% of the sample was female. Smoking subjects had higher iCEB and corrected Index of Cardiac Electrophysiological Balance (iCEBc) values compared with non-smoking controls (4.39 vs. 4.25; p=0.024, respectively), and (4.74 vs. 4.57; p=0.030, respectively).\u0000\u0000\u0000\u0000\u0000\u0000\u0000Conclusions: In summary, iCEB and iCEBc were significantly higher in habitual smokers than in nonsmokers, which represents an increased risk of ventricular arrhythmogenesis in healthy habitual smokers. To the best of our knowledge, this is the first study performed in Africa to evaluate iCEB in smokers, making this type of study very important in low- and middle-income countries in the context of epidemiological transition.\u0000\u0000\u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"18 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138591558","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}
Cancer and cardiovascular disease are two of the leading causes of death worldwide. Although cancer has historically been viewed as a condition characterized by abnormal cell growth and proliferation, it is now recognized that cancer can lead to a variety of cardiovascular diseases. This is due to the direct impact of cancer on the heart and blood vessels, which can cause myocarditis, pericarditis, and vasculitis. Additionally, cancer patients frequently experience systemic effects such as oxidative stress, inflammation, and metabolic dysregulation, which can contribute to the development of cardiovascular risk factors such as hypertension, dyslipidemia, and insulin resistance. It is important to closely monitor patients with cancer, especially those undergoing chemotherapy or radiation therapy, for cardiovascular risk factors and promptly address them. This article aims to explore the clinical implications of the underlying mechanisms connecting cancer and cardiovascular diseases. Our analysis highlights the need for improved cooperation between oncologists and cardiologists, and specialized treatment for cancer survivors.
{"title":"The cardio-oncology continuum: Bridging the gap between cancer and cardiovascular care","authors":"Tanveer Shaik, Jill Bhavsar, Shreya Garg, Vasundhara Gupta, S. Kanagala, Rohit Jain","doi":"10.21542/gcsp.2024.9","DOIUrl":"https://doi.org/10.21542/gcsp.2024.9","url":null,"abstract":"\u0000\u0000\u0000Cancer and cardiovascular disease are two of the leading causes of death worldwide. Although cancer has historically been viewed as a condition characterized by abnormal cell growth and proliferation, it is now recognized that cancer can lead to a variety of cardiovascular diseases. This is due to the direct impact of cancer on the heart and blood vessels, which can cause myocarditis, pericarditis, and vasculitis. Additionally, cancer patients frequently experience systemic effects such as oxidative stress, inflammation, and metabolic dysregulation, which can contribute to the development of cardiovascular risk factors such as hypertension, dyslipidemia, and insulin resistance. It is important to closely monitor patients with cancer, especially those undergoing chemotherapy or radiation therapy, for cardiovascular risk factors and promptly address them. This article aims to explore the clinical implications of the underlying mechanisms connecting cancer and cardiovascular diseases. Our analysis highlights the need for improved cooperation between oncologists and cardiologists, and specialized treatment for cancer survivors.\u0000\u0000\u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"40 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593543","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}
Anson Lee, Emily Larson, Ifeanyi Chinedozi, Jennifer Lawton, Hamza Aziz
Background: Aortic pseudoaneurysms are particularly dangerous because of the risk of rupture and compression of mediastinal structures, including the trachea, and resultant respiratory distress. If respiratory distress progresses to respiratory failure, extracorporeal membrane oxygenation may be used to provide oxygenation prior to or during pseudoaneurysm repair. Case presentation: A 62-year-old male with a history of emergent aortic ascending and arch replacement for Stanford Type A dissection 10 months prior presented to his primary care physician with dyspnea. Chest radiography revealed a widened mediastinum, and subsequent computed tomography angiogram revealed a pseudoaneurysm at the distal suture line of the aortic arch replacement. Due to the location of the pseudoaneurysm, the patient’s trachea was compressed, and he was emergently placed on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) following unsuccessful intubation for respiratory distress. Two days later, the patient underwent a redo sternotomy and repair of a 2-3 mm defect in the anterior aspect of the distal suture line of the prior aortic arch replacement. The patient progressed well and was discharged on postoperative day 13. What we learned: Using a combination of peripheral bypass, hypothermic circulatory arrest, delayed closure, and respiratory support, this case demonstrates how even complex patients can be successfully treated with multiple strategies.
{"title":"Use of veno-venous extracorporeal membrane oxygenation for stabilization prior to redo sternotomy for aortic pseudoaneurysm repair","authors":"Anson Lee, Emily Larson, Ifeanyi Chinedozi, Jennifer Lawton, Hamza Aziz","doi":"10.21542/gcsp.2024.6","DOIUrl":"https://doi.org/10.21542/gcsp.2024.6","url":null,"abstract":"\u0000\u0000\u0000Background: Aortic pseudoaneurysms are particularly dangerous because of the risk of rupture and compression of mediastinal structures, including the trachea, and resultant respiratory distress. If respiratory distress progresses to respiratory failure, extracorporeal membrane oxygenation may be used to provide oxygenation prior to or during pseudoaneurysm repair.\u0000Case presentation: A 62-year-old male with a history of emergent aortic ascending and arch replacement for Stanford Type A dissection 10 months prior presented to his primary care physician with dyspnea. Chest radiography revealed a widened mediastinum, and subsequent computed tomography angiogram revealed a pseudoaneurysm at the distal suture line of the aortic arch replacement. Due to the location of the pseudoaneurysm, the patient’s trachea was compressed, and he was emergently placed on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) following unsuccessful intubation for respiratory distress. Two days later, the patient underwent a redo sternotomy and repair of a 2-3 mm defect in the anterior aspect of the distal suture line of the prior aortic arch replacement. The patient progressed well and was discharged on postoperative day 13.\u0000\u0000\u0000\u0000\u0000\u0000\u0000What we learned: Using a combination of peripheral bypass, hypothermic circulatory arrest, delayed closure, and respiratory support, this case demonstrates how even complex patients can be successfully treated with multiple strategies.\u0000\u0000\u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"104 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590440","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}
Various transcatheter interventions for the right ventricular outflow tract (RVOT) have been introduced and developed in recent decades. Transcatheter pulmonary valve perforation was first introduced in the 1990s. Radiofrequency wire perforation has been the approach of choice for membranous pulmonary atresia in newborns, with high success rates, although complication rates remain relatively common. Stenting of the RVOT is a novel palliative treatment that may improve hemodynamics in neonatal patients with reduced pulmonary blood flow and RVOT obstruction. Whether this option is superior to other surgical palliative strategies or early primary repair of tetralogy of Fallot remains unclear. Transcatheter pulmonary valve replacement has been one of the biggest innovations in the last two decades. With the success of the Melody and SAPIEN valves, this technique has evolved into the gold standard therapy for RVOT abnormalities with excellent procedural safety and efficacy. Challenges remain in managing the wide heterogeneity of postoperative lesions seen in RVOT, and various technical modifications, such as pre-stenting, valve ring modification, or development of self-expanding systems, have been made. Recent large studies have revealed outcomes comparable to those of surgery, with less morbidity. Further experience and multicenter studies and registries to compare the outcomes of various strategies are necessary, with the ultimate goal of a single-step, minimally invasive approach offering the best longer-term anatomical and physiological results.
{"title":"Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities","authors":"Yoshiyuki Kagiyama, Damien Kenny, Z. Hijazi","doi":"10.21542/gcsp.2024.7","DOIUrl":"https://doi.org/10.21542/gcsp.2024.7","url":null,"abstract":"\u0000\u0000\u0000Various transcatheter interventions for the right ventricular outflow tract (RVOT) have been introduced and developed in recent decades. Transcatheter pulmonary valve perforation was first introduced in the 1990s. Radiofrequency wire perforation has been the approach of choice for membranous pulmonary atresia in newborns, with high success rates, although complication rates remain relatively common. Stenting of the RVOT is a novel palliative treatment that may improve hemodynamics in neonatal patients with reduced pulmonary blood flow and RVOT obstruction. Whether this option is superior to other surgical palliative strategies or early primary repair of tetralogy of Fallot remains unclear. Transcatheter pulmonary valve replacement has been one of the biggest innovations in the last two decades. With the success of the Melody and SAPIEN valves, this technique has evolved into the gold standard therapy for RVOT abnormalities with excellent procedural safety and efficacy. Challenges remain in managing the wide heterogeneity of postoperative lesions seen in RVOT, and various technical modifications, such as pre-stenting, valve ring modification, or development of self-expanding systems, have been made. Recent large studies have revealed outcomes comparable to those of surgery, with less morbidity. Further experience and multicenter studies and registries to compare the outcomes of various strategies are necessary, with the ultimate goal of a single-step, minimally invasive approach offering the best longer-term anatomical and physiological results.\u0000\u0000\u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138591737","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}
Averina Octaxena Aslani, Z. Haryawan, Tania A. Sabrawi, Robin H. Wibowo, Aprilianasry U. Dewi
Background: Infective endocarditis (IE) is a rare, but potentially fatal, infectious disease. One of the common complications of IE is the embolization of endocardial vegetation with subsequent intracerebral artery obstruction that causes acute ischemic stroke. Herein, we present a case report of a patient presenting with a neurological manifestation that turned out to be a complication of IE. Case Illustration: We present the case of a patient with a chief complaint of left- sided hemiplegia. Blood test results revealed signs of infection. Computed tomography (CT) of the head revealed extensive infarction in the right lobe and subarachnoid hemorrhage. Echocardiography revealed vegetation on the aortic valve, suggesting that IE was the source of embolization. The patient was treated with high- dose ampicillin and gentamicin, supportive stroke therapy, and physical rehabilitation. Conclusion: IE can be considered one of the causes of acute ischemic or hemorrhagic stroke. Ruling out other common causes of stroke and noticing signs of infection and vascular phenomena helps define the diagnosis. Echocardiography helps identify valvular vegetation to support the diagnosis. Treatment consists of high-dose penicillin and supportive therapy for stroke.
{"title":"Embolization of infective endocarditis vegetation causes intracranial hemorrhage with hemorrhagic transformation after ischemic stroke","authors":"Averina Octaxena Aslani, Z. Haryawan, Tania A. Sabrawi, Robin H. Wibowo, Aprilianasry U. Dewi","doi":"10.21542/gcsp.2024.2","DOIUrl":"https://doi.org/10.21542/gcsp.2024.2","url":null,"abstract":"\u0000\u0000\u0000Background: Infective endocarditis (IE) is a rare, but potentially fatal, infectious disease. One of the common complications of IE is the embolization of endocardial vegetation with subsequent intracerebral artery obstruction that causes acute ischemic stroke. Herein, we present a case report of a patient presenting with a neurological manifestation that turned out to be a complication of IE.\u0000Case Illustration: We present the case of a patient with a chief complaint of left- sided hemiplegia. Blood test results revealed signs of infection. Computed tomography (CT) of the head revealed extensive infarction in the right lobe and subarachnoid hemorrhage. Echocardiography revealed vegetation on the aortic valve, suggesting that IE was the source of embolization. The patient was treated with high- dose ampicillin and gentamicin, supportive stroke therapy, and physical rehabilitation.\u0000Conclusion: IE can be considered one of the causes of acute ischemic or hemorrhagic stroke. Ruling out other common causes of stroke and noticing signs of infection and vascular phenomena helps define the diagnosis. Echocardiography helps identify valvular vegetation to support the diagnosis. Treatment consists of high-dose penicillin and supportive therapy for stroke.\u0000\u0000\u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"30 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138594253","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}
Introduction: Rural-urban health disparities are apparent in the burden of disease and health outcomes, including cardiovascular disease (CVD), specifically heart failure (HF). However, the factors influencing these disparities are not fully understood. Study and results: Among 27,115 participants in the Southern Community Cohort Study (SCCS) (mean age: 54 years (47-65)), 18,647 (68.8%) were black, 8,468 (32.3%) were white, and 20% resided in rural areas. Over a median 13-year follow-up period, 7,542 HF events occurred (rural=1,865 vs. urban=5,677). The age-adjusted HF incidence was 29.6 (95% CI,28.9-30.5) and 36.5 (95% CI, 34.9-38.3) per 1,000 person-years for urban and rural participants, respectively (P<.001). The risk of HF associated with rurality varied by race and sex. Rural black men had the highest risk across all groups (HR, 1.34; 95% CI, 1.19-1.51) (age-adjusted incidence rate: 40.4/1000 person-years (95% CI, 36.8-44.3)) followed by black women (HR, 1.18; 95% CI, 1.08-1.28) and white women (HR, 1.22; 95% CI, 1.07-1.39). Rurality was not associated with HF risk among white men (HR, 0.97; 95% CI, 0.81-1.16).
{"title":"Rurality and race in heart failure risk: Insights from the Southern Community Cohort Study","authors":"S. Kotit","doi":"10.21542/gcsp.2024.4","DOIUrl":"https://doi.org/10.21542/gcsp.2024.4","url":null,"abstract":"\u0000 \u0000 \u0000Introduction: Rural-urban health disparities are apparent in the burden of disease and health outcomes, including cardiovascular disease (CVD), specifically heart failure (HF). However, the factors influencing these disparities are not fully understood. \u0000Study and results: Among 27,115 participants in the Southern Community Cohort Study (SCCS) (mean age: 54 years (47-65)), 18,647 (68.8%) were black, 8,468 (32.3%) were white, and 20% resided in rural areas. Over a median 13-year follow-up period, 7,542 HF events occurred (rural=1,865 vs. urban=5,677). The age-adjusted HF incidence was 29.6 (95% CI,28.9-30.5) and 36.5 (95% CI, 34.9-38.3) per 1,000 person-years for urban and rural participants, respectively (P<.001). \u0000The risk of HF associated with rurality varied by race and sex. Rural black men had the highest risk across all groups (HR, 1.34; 95% CI, 1.19-1.51) (age-adjusted incidence rate: 40.4/1000 person-years (95% CI, 36.8-44.3)) followed by black women (HR, 1.18; 95% CI, 1.08-1.28) and white women (HR, 1.22; 95% CI, 1.07-1.39). Rurality was not associated with HF risk among white men (HR, 0.97; 95% CI, 0.81-1.16). \u0000 \u0000 \u0000","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"73 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590819","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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