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?
AbstractPurpose of reviewTransthyretin amyloid cardiomyopathy (ATTR-CM) is a disease with high morbidity and mortality. This disease is significantly underdiagnosed and is more common than previously appreciated, particularly among older adults and people of African descent. This review discusses recent advances in the diagnosis and treatment for ATTR-CM.Recent findingsHistorically, ATTR-CM was diagnosed via endomyocardial biopsy, a resource-intensive and invasive approach. However, in most cases, ATTR-CM can now be diagnosed non-invasively using bone tracer cardiac scintigraphy, which may facilitate earlier diagnosis. In ...
AbstractPurpose of reviewRapid advancements in technology and electronic medical record systems have given rise to massive amounts of cardiac imaging data with the potential to alter medical practices. The rise of machine learning (ML) and radiomics – the concept that images contain invaluable data regarding disease processes beyond what the eyes can see – promises increased precision and accuracy to the current standard of care. Recent advancements in major cardiac imaging modalities, such as echocardiography, cardiac CT and cardiac MRI, h ave uncovered promising diagnostic and prognostic information through t...
Publication date: Available online 9 October 2020Source: The Annals of Thoracic SurgeryAuthor(s): Stijn Vanstraelen, Jeroen Vandenbrande, Alaaddin Yilmaz
Acta Pharmacologica Sinica, Published online: 09 October 2020; doi:10.1038/s41401-020-00538-8Engineered cardiac tissues: a novel in vitro model to investigate the pathophysiology of mouse diabetic cardiomyopathy
AbstractCoronary artery bypass grafting improves survival in patients with ischemic cardiomyopathy, however, these patients are at high risk for morbidity and mortality. The role of viability testing to guide revascularization in these patients is unclear. Cardiac magnetic resonance imaging (CMR) has not been studied adequately in this population despite being considered a reference standard for infarct imaging. We performed a multicenter retrospective analysis of patients (n = 154) with severe left ventricular systolic dysfunction [ejection fraction (EF) 50% viability on CMR had a 47% reduct...
Publication date: Available online 7 October 2020Source: European Journal of RadiologyAuthor(s): Rui Wu, Dong-Aolei An, Ruo-Yang Shi, Bing-hua Chen, Chong-Wen Wu, Meng Jiang, Jian-Rong Xu, Lian-Ming Wu, Jun Pu
Condition: Cardiomyopathy, Hypertrophic Intervention: Other: PET Scan Sponsors: Massachusetts General Hospital; Brigham and Women's Hospital; National Heart, Lung, and Blood Institute (NHLBI) Recruiting
ConclusionMental stress decreased the123I-mIBG HMR, increased mismatch between sympathetic activity and myocardial perfusion, and increased the heterogeneity of123I-mIBG uptake in ICM patients, while there was no significant change in myocardial defect size or the heterogeneity of99mTc-Tetrofosmin perfusion. The changes observed in this proof-of-concept study may provide valuable information about the trigger –substrate interaction and the potential vulnerability for ventricular arrhythmias.