Sex and gender affect almost every aspect of heart failure, from epidemiology and risk factors, to pathophysiology, phenotype, response to medical, non-medical and device therapy and ultimate outcomes.
A 27-year-old pregnant woman (29th week) reported palpitations, dizziness and exertional dyspnoea. The heart rate was 130 bpm at rest, up to 180 bpm during mild exertion, without haemodynamic compromise.
A 59-year-old man with a diagnosis of definite ARVC without overt left ventricular involvement presented with recurrent palpitations. The surface 12-lead electrocardiogram raised the suspicion of atrial tachycardia.
Pulmonary hypertension (PH) is a rare disease in newborns, infants, and children that is associated with significant morbidity and mortality. In the majority of pediatric patients, PH is idiopathic or associated with congenital heart disease and rarely is associated with other conditions such as connective tissue or thromboembolic disease. Incidence data from the Netherlands has revealed an annual incidence and point prevalence of 0.7 and 4.4 for idiopathic pulmonary arterial hypertension and 2.2 and 15.6 for pulmonary arterial hypertension, respectively, associated with congenital heart disease (CHD) cases per million children. The updated Nice classification for PH has been enhanced to include a greater depth of CHD and emphasizes persistent PH of the newborn and developmental lung diseases, such as bronchopulmonary dysplasia and congenital diaphragmatic hernia. The management of pediatric PH remains challenging because treatment decisions continue to depend largely on results from evidence based adult studies and the clinical experience of pediatric experts. (J Am Coll Cardiol 2013;62:D117-26) ©2013 by the American College of Cardiology Foundation.
Albrecht von Haller The Swiss scientist Albrecht von Haller (1708–1777) was one of the central figures during the Age of Enlightenment with an impressive range of interests and contributions. Indeed, he was a poet, a scholar, a physician, a botanist and a magistrate at his native city of Bern. He studied at the University of Tübingen, Germany, under Professor Elias Camerius. Afterwards he moved to Leiden in the Netherlands to get further training from Professor Hermann Boerhaave, one of the leading authorities in medicine of his time; visited England and France and ultimately returned to Bern to become the city’s physician and librarian. Based on his seminal contributions to science, botany and medicine, he was nominated as professor of anatomy, botany and surgery at the University of Göttingen in 1736 (fig. 1). In his new position, he published his seminal monograph on Switzerland in 1742 and became one of the leading botanists. As an anatomist, he investigated the vascular system and published his findings in his Icones Anatomicae between 1743 and 1756. The Albrecht von Haller Award To this day, Albrecht von Haller remains a role model due to his restless inquiry and scientific productivity. Therefore the Swiss Heart Foundation decided to create an award named after him dedicated to young and promising scientists. Unlike other scientific awards, the Albrecht von Haller Award, endowed with 25,000 CHF, is not given to recognise a seminal publication, but rather – thanks to a generous donation from Boehringer Ingelheim Switzerland – to support an interesting and promising project of a young cardiologist or cardiovascular scientist. It should be noted that the selection of candidates is made completely independently by the members of the Swiss Heart Foundation’s research committee, without any involvement of the sponsor. In addition, to motivate very young scientists, three awards, each endowed with 2,000 CHF are granted for outstanding dissertations at a Swiss university.
Hypertension is the number one killer for women, with a greater burden for women than men and it is an important risk factor for target organ damage.Women are less frequently affected by arterial hypertension than men during their reproductive life, but their risk catches up and exceeds men's after menopause.There is a knowledge gap about the specificity of arterial hypertension in women due to an under inclusion of women in clinical trials.Hypertensive disorders during pregnancy are a recognised ulterior cardiovascular risk factor and obstetrical history must be part of the evaluation of hypertensive women.Furthermore, efficient cardiovascular prevention must be applied after pregnancies.Both endogenous and exogenous female sex hormones influence the blood pressure (BP) across life course, with specific characteristics relating to pregnancy, lactation, oral contraceptives, menopause, hormones substitution and elderly women.Altogether, effective treatment and control of hypertension ameliorates cardiovascular issues.Concerning medical treatment, due to the lack of data we propose to lower the doses of antihypertensive medications in women, due to increased efficiency and increased risk of secondary effects, most notably for thiazide diuretics and calcium channel blockers.
Both sex, the biological differences between women and men, and gender, the sociologically constructed differences in one of the two sex categories, influence the prevalence of noncommunicable diseases such as obesity and type 2 diabetes.
Cardiovascular disease arises from known cardiac side effects of several anti-cancer therapies, but also cancer itself promotes cardiovascular disease. On the other hand, cardiovascular diseases predispose to future development of cancer.
Valve interventions in left sided valvular heart disease, mainly such as transcatheter aortic valve implantations (TAVI) and transcatheter edge-to-edge repairs (TEER) have emerged as alternative treatments in symptomatic severe aortic stenosis and severe mitral regurgitation.However, stroke remains a serious concern.The two main causes of embolisation after valve intervention are thrombosis and vegetations.This review summarises the role of all the different tools of cardiac imaging including transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT) and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the diagnosis and work-up of potential cardiac or aortal sources of embolism associated with valve interventions.TTE provides a more comprehensive understanding of the implanted valve including its location and function.Contrast enhanced echocardiography offers additional value in order to detect left ventricular thrombus.Increased valve gradients can be attributed to patient-prosthesis mismatch, thrombus or pannus on the leaflets.Therefore, echocardiography performed immediately after the procedure, followed by follow-ups 4 weeks post-intervention and then annually is of major importance.In addition to echocardiography, cardiac CT can be highly beneficial for confirming or ruling out an abscess, pseudoaneurysm, fistulae and thrombosis.Nuclear molecular techniques, such as 18F-FDG-PET is another important advanced imaging technique, particularly in the management of infective endocarditis.
Introduction:The diagnosis and characterisation of intracardiac tumours is challenging.Transoesophageal echocardiographic guided biopsy is an established method to confirm the pathology.Intracardiac echography (ICE) may help to increase the diagnostic outcome of biopsies, particularly in right-sided cardiac masses.Case Report: We report on a 62-year-old patient who presented with recurrent pericardial effusions of unknown origin.Pericardial puncture did not reveal any significant findings.Positron emission tomography-computed tomography revealed a mass in the right atrium.Due to excellent nearfield imaging capacities for right-sided cardiac structures, ICE was used to guide the biopsy.Biopsy was performed safely and demonstrated a primary cardiac angiosarcoma.Conclusion: ICE-guided biopsy can be a reasonable approach, particularly for right-sided structures, allowing a safe, minimally invasive way of diagnosing intracardiac tumours.
Cardiovascular Medicine is one of the most widely read medical journals in Switzerland.In particular, cardiologists, angiologists and general practitioners appreciate the articles on a wide variety of topics in cardiovascular medicine.
Background: The Lund University Cardiopulmonary Assist System-2/-3 was developed for automatic chest compressions during cardiopulmonary resuscitation (mechanical CPR or MCPR) and often allows a patient suffering from cardiac arrest to be taken to the cardiac catheterization room.We report the clinical outcomes of percutaneous coronary interventions (PCI) performed in cardiac arrest patients under automatic MCPR devices.Methods: We retrieved all patients with cardiac arrest who were referred to PCI under MCPR devices from the Cardio-FR database (003-REP-CER-FR) from January 2016 to December 2021.Patients who were hemodynamically stable at the time of coronary examination/intervention (even those who had been resuscitated immediately before) were excluded from the analysis.Baseline patient and procedure characteristics were collected.The primary outcome was the return of spontaneous circulation (ROSC).Results: Of all patients who were on MCPR at the cardiac catheterization room, eleven still required active CPR during coronary examination/intervention and were included in the analysis.Mean age was 67.9 ± 10 years, nine were male.The MCPR device was initiated on average after 8.5 ± 8.1 minutes.All patients had ventricular defibrillation and received an average of 3.4 ± 3.6 shocks and 82% adrenaline boluses.The MCPR was used for an average of 51.1 ± 34.4 minutes.Total resuscitation time was on average 59.6 ± 38.3 minutes.Of the eleven patients, nine underwent ad hoc PCI.ROSC was achieved in four patients after 36.5 ± 49.8 minutes.The survival was 36% (four patients) at 24 hours and 27% (three patients) at three months.Only one of the patients resuscitated for >25 minutes survived.Patients with in-hospital cardiac arrest were associated with shorter ROSC (p <0.01), shorter resuscitation time (p = 0.009) and better survival (p = 0.03) than patients with out-of-hospital cardiac arrest.Conclusions: MCPR allows patients in cardiac arrest to reach the cardiac catheterization room.However, the prognosis is grim with high mortality.Only one patient survived after >25 minutes of mechanical resuscitation.
