Make the Diagnosis: Dizziness Dilemma
(MedPage Today) -- Case Findings: The patient is a 42-year-old African American man who presents with a complaint of dizziness lightheadedness which occurred when he was standing up to go to the rest room 3 days ago. He denies any previous syncopal episodes. He has medically managed hypertension, hypercholesterolemia, cardiomyopathy with last ejection fraction of 35% with defibrillator placement 4 months previous. His ICD did not fire during the episode. His last cardiac catheterization prior to ICD implantation revealed normal coronaries. Patient has been compliant with metoprolol 25 mg twice daily, lisinopril 10 mg daily, atorvastatin 40 mg daily. He denies any new medical regimen. His vital signs are BP 100/80 mm Hg and HR 66/min. His physical examination is normal without any clinical evidence of decompensation. ECG is shown below. What is the next best course of action?
AbstractMany crucial cardiovascular adaptations occur in the body during pregnancy to ensure successful gestation. Maladaptation of the cardiovascular system during pregnancy can lead to complications that promote cardiac dysfunction and may lead to heart failure (HF). About 12% of pregnancy-related deaths in the USA have been attributed to HF and the detrimental effects of cardiovascular complications on the heart can be long-lasting, pre-disposing the mother to HF later in life. Indeed, cardiovascular complications such as gestational diabetes mellitus, preeclampsia, gestational hypertension, and peripartum cardiomyopath...
This report reviews our basic studies and clinical trials using curcumin therapeutically to prevent heart failure, as well as the possibility of clinical applications of curcumin. PMID: 32238626 [PubMed - in process]
This article will provide a comprehensive review and update on this important disease state.
Patients with diabetes have an increased risk for developing clinical heart failure (HF), even in the absence of overt ischemia or hypertension.1 These observations have led to the hypothesis that there is a distinct “diabetic cardiomyopathy.” Numerous potential mechanisms have been proposed to explain the apparent association between diabetes and HF, including inflammation, myocardial fibrosis, altered myocardial energetics or metabolism, lipotoxicity, and microvascular dysfunction.1 Each of these abnormali ties could cause variable degrees of myocardial systolic and/or diastolic mechanical dysfunction.
ConclusionsHalf of the patients with ICD ‐10 code for HF did not have EF data available after a visit at specialty care. In particular, the diagnosis of HFpEF seems challenging, reflected as an increase in procedures and laboratory test preceding diagnosis compared with those in HFrEF patients. Also, a large proportion of patients did no t have HF diagnosis, yet they presented elevated NT‐proBNP concentrations and clinical characteristics resembling those of HFpEF patients.
Abstract Whole exome sequencing (WES) was used in the research of familial pulmonary arterial hypertension (FPAH). CAV1 and KCNK3 were found as two novel candidate genes of FPAH. However, few pathogenic genes were identified in idiopathic pulmonary arterial hypertension (IPAH). We conducted WES in 20 unrelated IPAH patients that did not carry the known PAH-pathogenic variants among BMPR2, CAV1, KCNK3, SMAD9, ALK1 and ENG. We found a total of 4950 variants in 3534 genes including 4444 SNPs and 506 InDels. Through the comprehensive and multi-level analysis, we disclosed several novel signaling cascades significantly...
An asymptomatic 83-year-old man with a history of hypertension, prior stroke with no residual deficits, and bilateral carotid artery stenosis, presented for evaluation prior to cataract surgery. His transthoracic echocardiogram was typical for apical hypertrophic cardiomyopathy (AHCM), and his electrocardiograms (ECG) showed large precordial R-waves and inverted T-waves, previously associated with AHCM, while his ECG 7 years earlier was normal. Mechanistic explanations for the developed ECG abnormalities, and their importance for the detection and monitoring of patients with AHCM are provided.
Ronnie and colleagues reported a case of a 10-year-old female with a history of systemic lupus erythematosus (SLE) complicated by hypertension and cardiomyopathy secondary to lupus who presented to the emergency department with a history of vision loss and headache . The authors diagnosed the patient with posterior reversible encephalopathy syndrome (PRES). Although interesting, the diagnostic criteria for PRES was not met.
Conclusions: The development of a pheochromocytoma from an adrenal non functional adenoma is an extremely rare event, but potentially life-threating because of the catecholamine-associated cardiovascular toxicity. In particular, TTS is a form of cardiomyopathy that has been increasingly described as associated with catecholamine-secreting tumors. The exclusion of pheochromocytoma in a patient with TTS has important therapeutic implications, since the administration of β-blockers may be extremely harmful in patients with catecholamine surge in the absence of adequate α-blockage.
ConclusionsVasodilator challenge with iNO is safe in advanced heart failure patients undergoing RHC prior to HT listing. It produces a reasonably predictable haemodynamic response, which occurs predominantly at the pulmonary circulation level. Clinical implications of iNO ‐induced reversibility may be relevant, but further systematic validation is warranted in larger cohorts.