Population aging represents one of the most significant demographic transitions of the 21st century and is accompanied by a growing burden of cardiovascular disease (CVD). As life expectancy increases, maintaining cardiovascular health and functional independence in older adults has become a major priority for healthcare systems worldwide. Regular physical activity is widely recognized as a cornerstone of cardiovascular prevention and rehabilitation, with strong evidence demonstrating its beneficial effects on cardiorespiratory fitness, endothelial function, blood pressure control, and overall mortality risk. Consequently, international guidelines consistently recommend routine exercise as part of standard cardiovascular care. Despite this robust evidence base, the prescription of exercise in geriatric cardiology often remains limited to generalized recommendations that do not fully account for the heterogeneity of older adults. Variations in functional capacity, frailty status, comorbidities, and physiological reserve can substantially influence both the safety and effectiveness of exercise interventions. As a result, traditional “one-size-fits-all” recommendations may be insufficient for optimizing cardiovascular outcomes in aging populations. Recent advances in digital health technologies, wearable devices, and telemedicine have created new opportunities to move toward more personalized approaches to exercise prescription. Continuous physiological monitoring, combined with functional assessments and cardiopulmonary exercise testing, may allow clinicians to tailor exercise interventions to the specific needs and capabilities of individual patients. In parallel, emerging analytical tools, including artificial intelligence and machine learning, hold promise for integrating multidimensional clinical data to support individualized exercise strategies. This perspective article discusses the evolving role of exercise in geriatric cardiology and argues for a transition from generic activity recommendations toward personalized exercise medicine. We highlight current evidence, limitations in clinical practice, and emerging technological solutions that may enable individualized exercise prescriptions. Ultimately, integrating personalized exercise strategies into cardiovascular care may represent a critical step toward improving health outcomes, functional capacity, and quality of life in older adults.
Unilateral pulmonary artery atresia is a rare condition requiring high index of suspicion for diagnosis. It occurs more frequently on the right side which is usually isolated in contrast to the left sided pulmonary atresia which is commonly associated with other congenital cardiac abnormalities and right aortic arch. Multimodal imaging is often required to make an accurate early diagnosis. Timely management is crucial for preventing complications and improving patient outcomes.
Background and aim: Loeffler endocarditis is a rare complication of eosinophilic granulomatosis with polyangiitis. It is a heart infiltrative disease. Even if echocardiography is not the gold standard for tissue characterization, it can be important for an optimized diagnostic strategy. This report aims to highlight imaging nuances that can be helpful for a better Loeffler endocarditis diagnosis Case summary: This is the case of a Caucasian 67-year-old woman with a history of adult-onset asthma. She complained of increased dyspnea. Physical examination and electrocardiogram were non-specific. hypereosinophilia and immunological tests allowed the diagnosis of eosinophilic granulomatosis. Echocardiography showed a left ventricle apical mass with specific characteristics identified by conventional, 2D, and Doppler modes and further by Tissue Doppler and speckle tracking imaging. Cardiac magnetic resonance identified fibrosis centered by a thrombus. We retained the diagnosis of stage 2 to 3 Loeffler endocarditis, and corticoids and anticoagulants were used for treatment with a short-term favorable outcome and symptom relief. Conclusion: In eosinophilic granulomatosis with polyangiitis patients, echocardiography should actively search for ventricular fibrosis, thrombi, myocardial dysfunction, and valve abnormalities. All of them are highly important and useful for Loeffler endocarditis at time diagnosis and management planning
The Proprotein convertase subtilisin/ kexin type 9 inhibitors (PCSK9i) are a novel class of lipid-lowering agents that effectively reduce low-density lipoprotein (LDL) cholesterol levels. The use of these agents has expanded to involve recipients of solid organ transplants. Method: This case series reports the safety of using PCSK9i in three patients who received heart transplants, followed up for lipid profile, and observed the incidence of coronary artery vasculopathy (CAV) over two years post-treatment. Results: Evolocumab significantly reduced the LDL level without drug interaction with the immune suppression medication. The follow-up evaluation with coronary angiogram or myocardial perfusion images confirms the freedom from CAV incidence or progression. Conclusion: PCSK9i improved the LDL profile without any adverse effect related to the combined use of immune suppressive therapy. A lack of progression of CAV was observed through diagnostic imaging modalities, suggesting a potential preventive effect of evolocumab on CAV. However, large-scale, randomized, controlled trials are needed to confirm the efficacy of PCSK9i in lowering cholesterol levels, preventing CAV, and reducing the risk of graft rejection in heart transplant (HT) recipients.
Background: The predictors of left ventricular thrombus (LVT) formation and resolution, post-acute myocardial infarction (MI), and left ventricular (LV) dysfunction significantly impact management strategies and need updating to reflect contemporary practice. Methods: Transthoracic echocardiography was used to screen and assess post-acute MI patients with LV ejection fraction (LVEF) <35% or <40% with apical akinesis or dyskinesis. Results: We enrolled 979 patients. Of them, 67 (6.84%) patients had an LVT at the baseline. Additionally, 22 and 7 patients developed new LVT at 1 and 3 months. The predictors of LVT formation were the presence of LV aneurysm (HR: 1.45, 95% CI: 1.11-2.07, P=0.024), apical wall motion score index (WMSI) (HR: 1.36, 95% CI: 1.07-2.82, P=0.036), late presentation after MI (HR: 1.32, 95% CI: 1.16-3.16, P=0.042), older age (HR: 1.24, 95% CI: 1.08-3.36, P=0.043), lower baseline LVEF (HR: 1.23, 95% CI: 1.06-2.75, P=0.046) and higher level of low-density lipoprotein-cholesterol (LDL-C) (HR: 1.18, 95% CI: 1.02-2.54, P=0.049). The LVT was resolved in 40 (59.7%) and 32 patients (65.3%) at 1 and 3 months, respectively. The predictors of LVT persistence beyond 3 months were LV aneurysm (HR: 1.55, 95% CI: 1.03-1.87, P=0.024), LVT size at baseline (HR: 1.43, 95% CI: 1.32-2.74, P=0.031), apical WMSI (HR: 1.43, 95% CI: 1.32-2.74, P=0.031), lower LVEF (HR: 1.29, 95% CI: 1.02-2.54, P=0.043) and late presentation after MI (HR: 1.18, 95% CI: 1.07-2.16, P=0.047). Conclusions: The global and apical LV systolic dysfunction, older age, late presentation, and high LDL-C predict LVT formation post-MI. These factors and LVT size predict LVT persistence beyond 3 months. These findings should guide anticoagulation therapy in this high-risk population.
A 77-year-old woman presented to the emergency department with a two-month history of refractory lumbar pain, despite multiple analgesic treatments. She was referred from internal medicine due to constitutional symptoms of weight loss, anorexia, and asthenia. Initial lab tests and plain X-rays were unremarkable, but due to her clinical condition, the patient was admitted. A differential diagnosis of lumbar pain and systemic illness was pursued. During hospitalization, elevated inflammatory markers, hypercalcemia, positive blood cultures for Staphylococcus epidermidis, and a transthoracic echocardiogram showing mitral valve prolapse were noted. Although the initial workup for infective endocarditis (IE) did not fulfill the modified Duke criteria, a subsequent PET-CT revealed intense uptake in the lumbar spine, leading to an MRI-confirmed diagnosis of spondylodiscitis. A transesophageal echocardiogram later demonstrated vegetations on the mitral valve. With repeated positive blood cultures for S. epidermidis and echocardiographic findings, a final diagnosis of infective endocarditis was established. The patient was treated with intravenous vancomycin for three weeks, followed by outpatient dalbavancin therapy for six weeks. This case highlights the complex interplay between spondylodiscitis and infective endocarditis, emphasizing the utility of the Duke criteria and the novel use of dalbavancin in non-surgical patients.
Systemic lupus erythematosus (SLE) is an autoimmune, chronic, and heterogeneous disease. Antimalarial drugs, such as hydroxychloroquine (HCQ) is still an important immunomodulator medicine for the treatment of SLE. Rarely, HCQ toxicity can occur. We report a case of a patient who was admitted to our hospital with clinical symptoms of heart failure with a background of history of SLE and chronic HCQ use. Dilated cardiomyopathy in parallel with increased left ventricular apical trabeculation consistent with left ventricle non-compaction cardiomyopathy (LVNC) was diagnosed. We aim to pinpoint two rare manifestations presenting in the same patient, simultaneously a) the reversible dilated cardiomyopathy after modification of the dose of HCQ and b) the non-reversible left ventricle non compaction cardiomyopathy most likely associated with her underlying disease. HCQ cardiomyopathy is rare but occasionally correlated with undesirable side effects. It is crucial to consider it in any patient taking for prolonged time the medication, who presents with symptoms of heart failure.
Catheter foam treatments guarantee effective and safe administration of medications, avoiding the risks of extravasation. Seldinger catheterization under DUS of the superficial venous trunks offers us a simple and effective technique, with similar results to the direct administration of foam in the IVC. The Arranz technique is a technique developed for the specific treatment of CVI of the saphenous axes, Greater Saphena, Minor Saphena, and Anterior Saphena.
Role of the nurse in the phlebology consultationThe evolution of medicine in recent years and the development of the different specialties require greater training and specialized training in nursing work.The characteristics of the work that a private consultation presents with the specialty of Angiology and vascular Surgery in the development of phlebology, which is the area that includes the study and treatment of venous diseases, requires the nurse to prepare and train specific the techniques and procedures that are not common in the devolpment in the field hospital nursing.We present in this paper, the work characteristics, the functions, attributions and different responsibilities that a nurse has in the Phlebology consultation within the Specialty of Angiology and vascular Surgery.
Objectives: To evaluate the impact of obesity on the incidence and complications of preeclampsia (PE). Material and methods: Database of 19,699 deliveries. The incidence of PE and its complications was analyzed in relation to body mass index (BMI). Qualitative variables are expressed as percentages and were analyzed with Pearson's chi square; the quantitative ones as mean and SD, and were compared with Student's test and Anova. Differences <0.05 were considered significant. SPSS 20 was used. Results: 703 patients had PE (3.6%); BMI: Mean 23.7±5.8; Classification by BMI: Underweight: 9.2%; Normal: 62.9%; Overweight: 17.4%; Obesity:10.6%; Incidence of PE according to BMI: Low weight: 2.5%; Normal: 2.9%; Overweight: 5.1%; Obesity: 6.0% (p<.0001). Incidence in the variables studied in pregnant women without and with PE were: 3rd trimester hemorrhage: 1 vs 1.4%; premature rupture of membranes (PROM) 10.7 vs 5.9%*; intrauterine growth restriction (IUGR) 3.2 vs 10.1%*; anemia 30 vs 31.2%; previous hypertension (HTN) 2.1 vs 7.2%*; intrauterine mortality 1.8 vs 2.6%; Low Apgar 2.5 vs 4.0%*; preterm 8.6 vs 21.7%*; neonatal death 0.5 vs 1.1%; nulliparous 32.6 vs 47.4%*; smoking 12.1 vs 14.4%; multiple pregnancy 1.5 vs 4.6%*; underweight 6.8 vs 22.9%*; age: 25±6 vs 26±7years*; usual weight 57.8±11.5 vs 63±14 kg*; gestational age by Capurro 38.6±2.4 vs 37.6±2.8*; newborn weight 3274±572 vs 2957±793*; feats 2±2.4 vs 1.9±2.5; deliveries 1.8±2.1 vs 1.7±2.3 (0.003) and total days of hospitalization 7±20 vs 9.6±23 (0.007), respectively. (*p<.0001) Incidence in the variables studied according to BMI in patients without PE: comparing low weight, normal weight, overweight and obesity, significant differences were obtained in PROM, IUGR, previous HTN, low Apgar, nulliparity, low weight of the newborn (RN), gestational age , pregnant age, pregnancies and number of births. The obese women were older and had a greater number of births; but except for the incidence of previous HTN and low Apgar that exceeded those of normal weight, in the rest there was improvement in the weight of the RN, in PROM, IUGR and in anemia as the BMI of the pregnant women increased. Incidence in the variables studied according to BMI in patients with PE: comparing low weight, normal weight, overweight and obesity, significant differences were obtained in PROM, IUGR, nulliparity, low birth weight, pregnant age, pregnant weight, pregnancies and number of births. The EPs with obesity were older, heavier, and had a greater number of pregnancies and births. However, it can be seen that as we go from underweight, normal weight, overweight and obesity, the incidence of: RPM is 15.2; 7.3; 3.4 and 1.7, of RCIU 22.2; 8.9; 12 and 6, and the NB's weight increases: 2687± 802; 2903± 740; 2985± 814 and 3174± 858 respectively. Conclusions: Obesity (10% pregnant women) presented an incidence of PE of 6% vs 2.9% in those of normal weight. Patients with PE compared to normal patients had more perinatal complications except for PROM. Obesity, beyond increasing the incidence of PE, in no case worsened the complications of this pathology.
Covid 19 is one of the major infections that primarily attacks the respiratory tract. The most common symptoms at onset of COVID-19 illness are temperature, cough, dyspnea, hemoptysis and diarrhea. In severe cases, patients may develop severe pneumonia - often billateral, acute respiratory distress syndrome (ARDS) and multi-organ failure including perimyocarditis. Hypoxic convulsions is a rare finding, however it is associated with very dangerous disease and poor prognosis. This current report presents severe Covid-19 patient with ARDS and severe hypoxia accompanied with hypoxic seizures after exclusion of meningoencephalitis and other possible etiologies for epileptic attack.
Cardiovascular disease (CVD) remains the leading cause of death globally. In search of advanced techniques for early detection of CVD, recent research has increasingly focused on using machine learning (ML) methods to improve the accuracy and timeliness of diagnosis. A multifactorial machine learning approach offers a comprehensive solution for cardiovascular disease detection, using vast and diverse datasets to develop predictive models that outperform traditional methods. This paper provides a comprehensive examination of various machine learning approaches and their application in the early detection of cardiovascular abnormalities, with special emphasis on their effectiveness compared to traditional diagnostic methods. The research methodology involves the implementation of several ML models trained and tested using large datasets that provide analysis covering various demographic parameters, lifestyle parameters and health status parameters. Key findings show that ML models significantly outperform traditional statistical methods in detecting early signs of CVD. The superior performance of ML models represents a promising tool for healthcare professionals, potentially leading to better strategies for preventive care and reduction of CVD-related mortality. The ongoing development and refinement of these technologies, along with improvements in data collection and interoperability between healthcare systems, will be critical to realizing their full potential in the clinical setting.
resting heart rate (usually 60 beats per minute) using formulas such as Bazett's or others.This adjustment is made to aid in the clinical interpretation of the QT interval, as it allows comparison of values under different heart rate conditions.Therefore, the QT interval is very important in clinical practice, because its prolongation may be associated with an increased risk of serious arrhythmias, including torsades de pointes, which can lead to sudden cardiac death. Changes that can cause a prolonged qt interval on the electrocardiogram includeCongenital Long QT Syndrome: A genetic condition that affects the repolarization of the heart, leading to an increase in the QT interval.According to Krahn AD et al. 1 since its initial description in 1957, our understanding of LQTS has increased dramatically.The prevalence of LQTS is estimated at ∼1:2,000, with a slight female predominance.The diagnosis of LQTS is based on clinical, electrocardiographic and genetic factors.Risk stratification of patients with LQTS aims to identify those at increased risk of cardiac arrest or sudden cardiac death.Factors including age, sex, QTc interval, and genetic background contribute to current risk stratification paradigms.Management of LQTS involves conservative measures such as avoiding medications that prolong the QT interval, pharmacological measures with nonselective β-blockers, and interventional approaches such as device therapy or left cardiac sympathetic denervation. MedicationsAntiarrhythmics: Certain medications used to treat cardiac arrhythmias, such as amiodarone, sotalol, and dofetilide, can prolong the QT interval.Antibiotics: Some antibiotics, such as erythromycin, clarithromycin, azithromycin (especially in high doses) and moxifloxacin, are associated with prolongation of the QT interval.Antidepressants: Some antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), such as citalopram, escitalopram, sertraline, venlafaxine and duloxetine, may prolong the interval QT.Antipsychotics: Some antipsychotics, especially second-generation antipsychotics (atypical antipsychotics), such as ziprasidone, quetiapine, olanzapine, and clozapine, have been associated with QT prolongation.Antihistamines: Some second-generation antihistamines, such as terfenadine and astemizole, have been withdrawn from the market due to the risk of QT prolongation and cardiac arrhythmias.Antiemetics: Certain medications used to prevent nausea and vomiting, such as ondansetron, granisetron, and dolasetron, can prolong the QT interval.
Background: Hypertension (HTN) is one of the major risk factors of coronary artery disease, stroke, heart failure, and chronic kidney disease. The aim of this study was to assess common complications, awareness hypertension complications (HTNC) and associated factors in hypertensive patients. Method: Cross-sectional survey was done on four hundred study participants at selected public hospitals in Arsi Zone (PHAZ) from March 10, 2019 to April 8, 2019. EpiData version 4.2.0.0 was used for data entry and Statistical Package for the Social Sciences (SPSS) version 21.0 was used for statistical analysis. Results: The level of good awareness towards HTNC in study participants was 32.5% [95% confidence interval (CI); 28.3, 37.0]). Secondary education (adjusted odds ratio (AOR)=3.95, 95% CI [2.33, 14.92]), higher education (AOR=4.37, 95% CI [2.57, 15.16]), employed (AOR=3.59, 95% CI [1.76, 17.77]), urban residents (AOR=1.68, 95% CI [1.47, 4.24]), monthly income of ≥ 3000 ETB (AOR=3.76, 95% CI [1.36, 10.43]), positive family history of HTN (AOR=2.14, 95% CI [1.92, 8.93]), duration of HTN > 10 years (AOR=2.41, 95% CI [1.81, 10.73]), health insurance (AOR=3.35, 95% CI [1.81, 10.48]), having comorbidities (AOR=1.73, 95% CI [1.55, 8.93]), non-smoker (AOR=1.72, 95% CI [1.35, 10.85]) and having regular health professional visit (AOR=8.20, 95% CI [5.31, 17.59]) were factors significantly associated with awareness of HTNC. Conclusion: Awareness of HTNC among the study participants was low. There is a need to initiate programs that could create public awareness about HTNC. Educational level, occupation, residency, monthly income, family history of hypertension, duration of hypertension, health insurance, presence of comorbidities, current smoking status, and regular healthcare professional visits were factors significantly associated with awareness of HTNC.
Introduction: Cardiovascular diseases cause almost 4 million deaths per year in Europe, most of them due to coronary heart disease, which corresponds to 47 % of all deaths. Objective: To characterize the quality of care indicators proposed by ACC/AHA and ESC in patients admitted for Acute Myocardial Infarction in the Coronary Care Unit according to sex of the Sancti Spíritus Camilo Cienfuegos Provincial General Hospital in the period January 2019 to January 2022. Method: A descriptive, cross-sectional investigation was carried out. The population and sample were made up of 341 patients with Acute Myocardial Infarction, diagnosed, treated and registered in the Registry of Acute Myocardial Infarction (RESCUE) corresponding to the province of Sancti-Spíritus, in the aforementioned period. Results: The affected patients were more frequently male, with a mean age of 67,5 years prevailing, with hypertension as the most prevalent comorbidity, the Killip-Kimball I class obtained the highest report in the study, prevailing of the electrocardiogram before arrival at the reperfusion center, with reperfusion therapy being performed in the hospital in the majority of patients. The 89.44% reported having received very good care in the treatments they received. Conclusions: The patients admitted for Acute Myocardial Infarction in the Coronary Care Unit were characterized according to sex, highlighting that the majority of patients were between 50 and 59 years old, were male had high blood pressure, a functional class II and good adherence therapy.
Background: Cardiovascular diseases are a leading cause of death worldwide. Multiple meta-analysis have demonstrated the benefit of exercise based cardiac rehabilitation. However, the effect of exercise training on left ventricular (LV) systolic function in patients with ischemic cardiomyopathy has been controversial in the literature. Objective: To study the effect of exercise-based cardiac rehabilitation (EBCR) on left ventricular (LV) systolic function and exercise stress parameters (METs achieved, HR recovery and HR reserve) in post anterior STEMI patients with ischemic cardiomyopathy (EF≤45%). Patients and methods: The study included 50 patients with ischemic cardiomyopathy (Post anterior STEMI successfully treated by 1ry PCI) referred for cardiac rehabilitation unit at Ain Shams University Hospitals. The patients were subjected to 3 months of formal exercise based cardiac rehabilitation. Before the CR program, they were subjected to a symptom-limited exercise test (modified Bruce protocol) to exclude any remaining ischemia and calculate enrolment HR reserve, baseline heart rate recovery in 1st minute and 2nd minute (HRR1 and HRR2). Another symptom-limited exercise test was done post CR program to assess the forementioned exercise parameters after completion of the program. Echocardiography was done at baseline and after completion of the CR program for assessment of LV systolic function by ejection fraction (assessed by 2D Simpson’s method) and peak longitudinal strain of the left ventricle (measured using speckle tracking echocardiography). Results: Exercise-based cardiac rehabilitation was associated with significant improvement in LV systolic function as reflected by significant improvement in Global longitudinal strain (GLS) (P-value = 0.0001) in patients with ischemic heart failure. CR was also associated with improvement in the functional capacity as reflected by the improvement in METs as well as in the HRR and HR reserve (P-value = 0.0001). However, there was no significant change regarding EF before and after cardiac rehabilitation (P-value= 0.4582).
