Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 9 Articles
Background: Left dominant arrhythmogenic cardiomyopathy (LDAC) is a rare condition characterised by progressive\nfibrofatty replacement of the myocardium of the left ventricle (LV) in combination with ventricular arrhythmias of LV\norigin.\nCase presentation: A thirty-five-year-old male was referred for evaluation of recurrent sustained monomorphic\nventricular tachycardia (VT) of 200 bpm and right bundle branch block (RBBB) morphology. Cardiac magnetic resonance\nimaging showed late gadolinium enhancement distributed circumferentially in the epicardial layer of the LV free wall\nmyocardium including the rightward portion of the interventricular septum (IVS). The clinical RBBB VT was reproduced\nduring the EP study. Ablation at an LV septum site with absence of abnormal electrograms and a suboptimum pacemap\nrendered the VT of clinical morphology noninducible. Three other VTs, all of left bundle branch block (LBBB) pattern, were\ninduced by programmed electrical stimulation. The regions corresponding to abnormal electrograms were identified and\nablated at the mid-to-apical RV septum and the anteroseptal portion of the right ventricular outflow tract. No abnormalities\nwere found at the RV free wall including the inferolateral peritricuspid annulus region. Histological examination confirmed\nthe presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both\nthe left and right aspects of the IVS.\nConclusion: LDAC rarely manifests with sustained monomorphic ventricular tachycardia. In this case, several VTs of both\nRBBB and LBBB morphology were amenable to endocardial radiofrequency catheter ablation....
Primary malignant melanomas of uterine cervix are quite rarely seen neoplasms, and long-life prognosis of patients with this\ndisease is poor. Immunohistochemical methods and exclusion of other primary melanoma sites are used to confirm the diagnosis.\nAs with other melanomas, cervix malignant melanomas may also cause cardiac metastases. Cardiac metastases are among rarely\nseen but more commonly encountered cases, compared to primary cardiac tumors. Here, we present a case of biatrial cardiac\nmetastases in a 73-year-old patient with uterine cervix malignant melanomas. The patient underwent echocardiography, cardiac\nmagnetic resonance imaging, and computed tomography. Our report shows the importance of advanced diagnostic techniques,\nsuch as cardiac magnetic resonance, not only for the detection of cardiac masses, but for a better anatomic definition and tissue\ncharacterization. Although the cases ofmalignant melanomas leading tomultiple cardiac metastasis were reported in literature, the\nmetastatic concurrence of malignant melanomas in both right and left atriums is quite rarely encountered as metastatic malignant\nmelanomas. Also, another intriguing point in our case is that the primary lesion of our case was stemmed from uterine cervix, but\nnot skin....
Background: Waist circumference threshold values used in sub-Saharan Africa correspond to those of European\npopulations and are therefore inappropriate. Thus, they may over predict insulin resistance, especially in hypertensive\nAfricans, in whom there is often no association between blood pressure and insulin resistance. Using bioelectrical\nimpedance measurement in sub-Saharan Africa could possibly be advantageous to overcome the shortcomings of waist\ncircumference measurement. The aim of this study was to evaluate the contribution of body composition estimation by\nbioelectrical impedance to predict cardiometabolic risk in Congolese hypertensive subjects.\nMethods: Cardiovascular profiling and body composition analysis by bioelectrical impedance was measured in 400\npatients (men = 40%; age = 51.1 Ã?± 12.6 years). Patients were diagnosed with a metabolic syndrome (MS) according to the\nIDF Criteria with and without the ââ?¬Å?blood pressureââ?¬Â criterion to remove any confounding autocorrelation bias, a visceral\nfat-MS (with and without the ââ?¬Å?blood pressureââ?¬Â criterion) being defined by the presence of ? 2 criteria with the precondition\nof excess visceral fat defined by a bio impedance measurement score >10/30. Total cardiovascular risk was assessed using\nthe criteria of Framingham-2008.\nResults: The frequencies of enlarged waist circumference (71.9% vs 68.9%, p = 0.52) and IDF-MS without blood pressure\ncriterion (24.9% vs 21.9%, p = 0.48) were similar among hypertensive vs. non hypertensive however excess visceral fat\n(57.6% vs 33.8%, p <0.0001) as well as visceral fat-MS without blood pressure criterion (18.9% vs 11.3%, p = 0.04) were more\nprevalent among hypertensive. Finally, total cardiovascular risk as well as arterial hypertension risk were associated with\nvisceral fat, but not with waist circumference (p > 0.05).\nConclusions: Pending the determination of thresholds values for pathological waist circumference adapted to sub-Saharan\npopulations, using bioelectrical impedance measurement may contribute to better characterize the cardiometabolic risk\nand the insulin resistant phenotype of hypertensive sub-Saharan Africans....
A 65-year-old man presented to our hospital due to intermittent claudication and swelling in his left leg. He had Leriche syndrome\nand deep vein thrombosis. We performed endovascular therapy (EVT) for Leriche syndrome, and a temporary filter was inserted\nin the inferior vena cava. He received anticoagulation therapy for deep vein thrombosis. The stenotic lesion in the terminal aorta\nwas stented with an excellent postprocedural angiographic result and dramatic clinical improvement after EVT.This case suggests\nthat EVT can be a treatment for Leriche syndrome....
Background: China is experiencing increasing burden of acute myocardial infarction (AMI) in the face of limited\nmedical resources. Hospital length of stay (LOS) is an important indicator of resource utilization.\nMethods: We used data from the Retrospective AMI Study within the China Patient-centered Evaluative Assessment\nof Cardiac Events, a nationally representative sample of patients hospitalized for AMI during 2001, 2006, and 2011.\nHospital-level variation in risk-standardized LOS (RS-LOS) for AMI, accounting for differences in case mix and year,\nwas examined with two-level generalized linear mixed models. A generalized estimating equation model was used\nto evaluate hospital characteristics associated with LOS. Absolute differences in RS-LOS and 95% confidence\nintervals were reported.\nResults: The weighted median and mean LOS were 13 and 14.6 days, respectively, in 2001 (n = 1,901), 11 and\n12.6 days in 2006 (n = 3,553), and 11 and 11.9 days in 2011 (n = 7,252). There was substantial hospital level\nvariation in RS-LOS across the 160 hospitals, ranging from 9.2 to 18.1 days. Hospitals in the Central regions had on\naverage 1.6 days (p = 0.02) shorter RS-LOS than those in the Eastern regions. All other hospital characteristics\nrelating to capacity for AMI treatment were not associated with LOS.\nConclusions: Despite a marked decline over the past decade, the mean LOS for AMI in China in 2011 remained\nlong compared with international standards. Inter-hospital variation is substantial even after adjusting for case mix.\nFurther improvement of AMI care in Chinese hospitals is critical to further shorten LOS and reduce unnecessary\nhospital variation....
We report a case of a 53-year-oldfemalepresentingwithanew-onsetheart failure thatwas contributedsecondary tononcompaction\ncardiomyopathy. The diagnosis was made by echocardiogram and confirmed by cardiac MRI. Noncompaction cardiomyopathy\n(also known as ventricular hypertrabeculation) is a newly discovered disease. It is considered to be congenital (genetic)\ncardiomyopathy. It is usually associated with genetic disorders and that could explain the genetic pathogenesis of the noncompaction\ncardiomyopathy. Our case had a history of Charcot-Marie-Tooth disease. There is a high incidence of arrhythmia\nand embolic complications. The treatment usually consists of the medical management, defibrillator placement, and lifelong\nanticoagulation. Heart transplantation will be the last resort....
We report the case of a 51-year-oldwoman, treatedwith radiotherapy at the ageof two years, for a pulmonary sarcoma. Subsequently\nshe developed severe aortic stenosis and bilateral ostial coronary artery disease, symptomatic for dyspnea (NYHA III functional\nclass). Due to the prohibitive surgical risk, she underwent successful stenting in the right coronary artery and left main ostia with\ndrug eluting stents and, afterwards, transcatheter aortic valve replacement with transfemoral implantation of a 23mm Edwards\nSAPIEN XT valve. The percutaneous treatment was successful without complications and the patient is in NYHA II functional\nclass at 2 years� follow-up, fully carrying out normal daily activities....
Raghib Syndrome is a rare developmental complex, which consists of persistence of the left superior vena cava (PLSVC) along\nwith coronary sinus ostial atresia and atrial septal defect. This Raghib complex anomaly has also been associated with other\ncongenital malformations including ventricular septal defects, enlargement of the tricuspid annulus, and pulmonary stenosis. Our\ncase demonstrates an isolated PLSVC draining into the left atrium along with coronary sinus atresia in a young patient presenting\nwith cryptogenic stroke without the atrial septal defect. Majority of the cases reported in the literature were found to have the\nlesion during the postmortem evaluation or were characterized at angiography and/or echocardiography.We stress the importance\nof modern day imaging like the computed tomography (CT) angiography and cardiac MRI in diagnosis and surgical management\nof such rare lesions leading to cryptogenic strokes....
Background: Atrial fibrillation (AF) is commonly managed by a variety of specialists. Current guidelines differ in\ntheir recommendations leading to uncertainty regarding important clinical decisions. We sought to document\npractice pattern variation among cardiologists, emergency physicians (EP) and hospitalists at a single academic,\ntertiary-care center.\nMethods: A survey was created containing seven clinical scenarios of patients presenting with AF. We analyzed\nrespondent choices regarding rate vs rhythm control, thromboembolic treatment and hospitalization strategies.\nFinally, we contrasted our findings with a comparable Australasian survey to provide an international reference.\nResults: There was a 78% response rate (124 of 158), 37% hospitalists, 31.5% cardiologists, and 31.5% EP. Most\nrespondents chose rate over rhythm control (92.2%; 95% CI, 89.1% - 94.5%) and thromboembolic treatment (67.8%;\n95% CI, 63.8% - 71.7%). Compared to both hospitalists and EPs, cardiologists were more likely to choose thromboembolic\ntreatment for new and paroxysmal AF (adjusted OR 2.38; 95% CI, 1.05 - 5.41). They were less likely to favor hospital\nadmission across all types of AF (adjusted OR 0.36; 95% CI, 0.17 - 0.79) but thought cardiology consultation was more\nimportant (adjusted OR 1.88, 95% CI, 0.97 - 3.64). Australasian physicians were more aggressive with rhythm control for\nparoxysmal AF with low CHADS2 score compared to US physicians.\nConclusions: Significant variation exists among specialties in the management of acute AF, likely reflecting a lack of\nhigh quality research to direct the provider. Future studies may help to standardize practice leading to decreased rates\nof hospitalization and overall cost....
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