Make the Diagnosis: Puzzling Palpitations

(MedPage Today) -- Case Findings: A 44-year-old male presents with palpitations of 3 months'duration. At first they were occasional and occurred about twice a week. However, they have increased over time with frequency up almost hourly. He has noticed a recent 10-pound weight gain, increased lower extremity swelling, and inability to lie flat. He denies any fevers or chills. His last exercise stress test 5 months ago was normal. His current medications include metoprolol 12.5 mg twice daily, lisinopril 10 mg daily, aspirin 81 mg daily, furosemide 40 mg daily. There have been no recent readjustments in his medical regimen. BP in the clinic on presentation was 110/80 mm Hg, HR 60/min, and the patient was in no acute distress. JVD is elevated, with bilateral basal pulmonary crackles and bilateral lower extremity pitting edema. No heart murmurs are apparent on examination. No baseline is available. Blood work reveals Hemoglobin 14 mg/dl, Creatinine 1.4 mg/dL and BNP 5000. The clinician obtains a Transthoracic Echocardiogram that shows an ejection fraction of 30% with no significant valvular pathology. The patient's ECG is shown below. What is causing the patient's cardiomyopathy?
Source: MedPage Today Cardiovascular - Category: Cardiology Source Type: news

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Purpose of review To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies. Recent findings Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. ...
Source: Current Opinion in Cardiology - Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Conclusion Atrial arrhythmia is common among patients with ARVC with the pooled prevalence of approximately 18%, which is substantially higher than the reported prevalence of atrial arrhythmia in the general population.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Arrhythmias Source Type: research
No abstract available
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Case reports Source Type: research
No abstract available
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Images in cardiovascular medicine Source Type: research
In Reply We agree with Dr Schwartz and colleagues that it would be worthwhile examining the time from the last anthracycline dose on the extent of CRT benefit. However, for CRT to work, there needed to have been concomitant conduction tissue disease because all the patients in our study had an accompanying LBBB contributing to the mechanical dyssynchrony that was corrected with CRT. The temporal relationship of the LBBB to the development of cardiomyopathy could influence the degree of response. We do not have data to examine the relationship between the last dose of anthracycline, the development of LBBB, and the onset of cardiomyopathy.
Source: JAMA - Category: General Medicine Source Type: research
To the Editor Dr Singh and colleagues reported that patients with chemotherapy-induced cardiomyopathy (CHIC) who met class I or II indications for cardiac resynchronization therapy (CRT) showed improvement in left ventricular ejection fraction (LVEF) and heart failure symptoms by 6 months following CRT implantation. We would like to raise a few points for consideration.
Source: JAMA - Category: General Medicine Source Type: research
AbstractTransthyretin amyloid cardiomyopathy (ATTR-CM) continues to be an easily overlooked, life-threatening, yet treatable cause of heart failure. Furthermore, its elusive diagnosis leads to late or misdiagnosis. As therapeutic advancements such as tafamidis usher in a promising new era in the management of ATTR-CM, the need for disease awareness and efficient diagnostic evaluation is crucial. With newer inexpensive imaging modalities and techniques, such as longitudinal strain imaging, T1 mapping on cardiac magnetic resonance imaging, and cardiac scintigraphy, the diagnosis of ATTR-CM no longer requires invasive evaluat...
Source: Cardiology and Therapy - Category: Cardiology Source Type: research
Chronic Chagas disease cardiomyopathy (CCC) is the most frequent and severe form of this parasitic disease. CCC is caused by a progressive inflammation in the heart, resulting in alterations that can culminate in heart failure and death. The use of dendritic cells (DCs) appears as an option for the development of treatments due to their important role in regulating immune responses. Here, we investigated whether tolerogenic cells (tDCs) could interfere with the progression of CCC in an experimental model of Chagas disease. The tDCs were generated and characterized as CD11b+ CD11c+ cells, low expression of MHC-II, CD86, CD8...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
AbstractPercutaneous transluminal septal myocardial ablation (PTSMA) has become a significant treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) despite maximal medical therapy. The target septal arteries usually arise from the left anterior descending artery (LAD). However, when septal perforators do not originate from the LAD, non-LAD septal perforators should be included as candidate-target septal branches that feed the hypertrophic septal myocardium, causing left ventricular outflow tract (LVOT) obstruction. Data pertaining to the procedure remain limited. We aimed to investigate PTS...
Source: Heart and Vessels - Category: Cardiology Source Type: research
AbstractThere are some similarities in clinical features between Takotsubo cardiomyopathy during the peripartum period (PTCM) and peripartum cardiomyopathy (PPCM). Both conditions present as acute heart failure and decreased left ventricular (LV) ejection fraction in the peripartum period in previously heart-healthy women. The present study aimed to evaluate the differences in clinical features and outcomes between PTCM and PPCM. Between January 2004 and December 2016, 37 consecutive patients who demonstrated LV dysfunction during the peripartum period without previous heart disease were recruited retrospectively. The clin...
Source: Heart and Vessels - Category: Cardiology Source Type: research
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