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Quiz case: a clinical reasoning challenge in the emergency stroke setting
AbstractA right-handed woman in her 80s was admitted to the emergency department 1 h after sudden-onset global aphasia and right-sided hemiparesis. Medical history included arterial hypertension, dyslipidemia, hyperuricemia, aortic stenosis, osteoporosis, and recent pulmonary embolism. Medication consisted of apixaban, bisoprolol, hydrochlorothiazide, allopurinol, fenofibrate, and vitamin D. Vital parameters (blood pressure, heart rate, body temperature, oxygen saturation) and glycemia were all within normal range. Electrocardiogram showed a first-degree atrioventricular block. The patient was promptly transported to the e...
Source: Neurological Sciences - August 5, 2023 Category: Neurology Source Type: research

Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction
CONCLUSION: The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction.PMID:37350345 | DOI:10.1080/0886022X.2023.2224888
Source: Renal Failure - June 23, 2023 Category: Urology & Nephrology Authors: Guy F A Prado Stefano Garzon Jose Mariani Adriano Caixeta Breno O Almeida Felipe O Ramalho Marcelo L C Vieira Claudio H Fischer Gilberto Szarf Walther Ishikawa Pedro A Lemos Source Type: research

Transthyretin cardiac amyloidosis.
Authors: Eicher JC, Audia S, Damy T Abstract Transthyretin (TTR) cardiac amyloidosis results from the dissociation of the tetrameric, liver-synthetized transport protein, either because of a mutation (hereditary CA), or spontaneously due to ageing (wild type CA). Monomers self-associate into amyloid fibrils within the myocardium, causing heart failure, arrhythmias and conduction defects. This overlooked disease must be recognized in case of unexplained increased thickness of the myocardium, particularly in subjects of African descent, in patients with heart failure and preserved ejection fraction, and in those with...
Source: Revue de Medecine Interne - August 23, 2020 Category: Internal Medicine Tags: Rev Med Interne Source Type: research

What Are the Main Acyanotic Congenital Heart Diseases?
Discussion Congenital heart diseases (CHD) are malformations of the heart and great vessels. It occurs in about 5-8/1000 live births. Cyanotic congenital heart disease is often noted perinatally because of cyanosis, respiratory distress and/or poor feeding or other distress type problems. A review can be found here. Acyanotic congenital heart disease (ACHD) can present at birth but often is seen in older children or adults unless the lesions are severe, especially obstructive lesions. Severe lesions may also cause cyanosis and distress type problems in patients also. Shunting lesions cause problems by diverting blood flo...
Source: PediatricEducation.org - August 17, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Light ‐chain and transthyretin cardiac amyloidosis in severe aortic stenosis: prevalence, screening possibilities, and outcome
ConclusionBoth TTR ‐ and AL‐CA can accompany severe AS. Parameters solely based on ECG and echocardiography allow for the identification of the majority of CA‐AS. In the present cohort, CA did not significantly worsen prognosis 15.3 months after TAVR.
Source: European Journal of Heart Failure - March 4, 2020 Category: Cardiology Authors: Christian Nitsche, Stefan Aschauer, Andreas A. Kammerlander, Matthias Schneider, Thomas Poschner, Franz Duca, Christina Binder, Matthias Koschutnik, Julian Stiftinger, Georg Goliasch, Jolanta Siller ‐Matula, Max‐Paul Winter, Anahit Anvari� Tags: Research Article Source Type: research

Left ventricular mechanical dispersion in flow-gradient patterns of severe aortic stenosis with narrow QRS complex
AbstractPatients with severe aortic stenosis are classified according to flow-gradient patterns. We investigated whether left ventricular (LV) mechanical dispersion, a marker of dyssynchrony and predictor of mortality, is associated with low-flow status in aortic stenosis. 316 consecutive patients with aortic stenosis and QRS duration  <  120 ms were included in the retrospective analysis. Patients with severe aortic stenosis (aortic valve area ≤ 1.0 cm2) were classified as normal-flow (NF; stroke volume index  >  35 ml/m2) high-gradient (HG; mean transvalvular gradient  ≥ 40 mmHg) (n = 79...
Source: The International Journal of Cardiovascular Imaging - January 12, 2020 Category: Radiology Source Type: research

Rationale and design of the randomized, controlled early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe aortic stenosis (EVOLVED) trial
ConclusionThe EVOLVED trial is the first multicenter randomized controlled trial to compare early aortic valve replacement to routine care in asymptomatic patients with severe aortic stenosis and mid-wall LGE.
Source: American Heart Journal - March 15, 2019 Category: Cardiology Source Type: research

Could fragmented QRS predict mortality in aortic stenosis patients after transcatheter aortic valve replacement?
ConclusionLike in the case of the other diseases associated with myocardial fibrosis, fragmented QRS could also predict mortality in aortic stenosis patients after TAVR procedure.
Source: Annals of Noninvasive Electrocardiology - November 7, 2018 Category: Cardiology Authors: Kamil Gulsen, Orhan Ince, Gokmen Kum, Flora Ozkalayci, Irfan Sahin, Ertugrul Okuyan Tags: ORIGINAL ARTICLE Source Type: research

Abstract 155: Prevalence and Clinical Correlates of Left Ventricular Hypertrophy by Sokolow-Lyon and Cornell Electrocardiogram Voltage Criteria in Transcatheter Aortic Valve Replacement Patients Session Title: Poster Session II
Conclusion: The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH and critical aortic stenosis in TAVR patients. Women are more likely to have voltage criteria for LVH. Therefore, ECG may not be a suitable method of screening patients with severe aortic stenosis for LVH, especially in men.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Xiao, E., Delago, A., El-Hajjar, M., Bulibek, B., Torosoff, M. Tags: Session Title: Poster Session II Source Type: research

Utility of Duranta, a wireless patch-type electrocardiographic monitoring system developed in Japan, in detecting covert atrial fibrillation in patients with cryptogenic stroke: A case report
Rationale: Subcutaneous implantable electrocardiographs are highly effective in detecting covert atrial fibrillation (AF) in cryptogenic stroke. However, these invasive devices are not indicated for all cryptogenic stroke patients, and noninvasive improvements over conventional Holter-type ambulatory electrocardiography are needed. We evaluated the clinical application and effectiveness of Duranta (ImageONE Co., Ltd.), a wireless patch-type electrocardiographic monitoring system developed in Japan for chronically ill patients or home-based patients at the end of life. A Duranta device was used to detect covert AF in patien...
Source: Medicine - February 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Thirty-day outcomes in patients at intermediate risk for surgery from the SAPIEN 3 European approval trial.
CONCLUSIONS: TF-TAVI using the SAPIEN 3 THV in patients at intermediate risk for surgery is associated with a very low risk of death and complications, including new pacemakers and paravalvular leaks. Although compelling, these initial results are being confirmed in larger global studies before expanding the indications for TAVI in severe aortic stenosis. PMID: 27290682 [PubMed - in process]
Source: EuroIntervention - June 14, 2016 Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research

The Case Files: When a Spade is Not a Spade
Turrin, Danielle DO; Sattler, Steven DO; Amodeo, Dana DO A 25-year-old Hispanic man presented to the emergency department with a complaint of three days of left-sided precordial chest pain. He described the pain as a constant 6/10 with pressure-like discomfort radiating to his left arm and the left side of his neck. He also experienced nausea, but denied any provocative or palliative factors. He said he had not experienced anything similar to this before. He had no family history of heart disease, acute myocardial infarction, or sudden cardiac death. He admitted to a 1.5 pack-per-day smoking history and social alcohol use,...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

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