The percutaneous Impella CP (Cardiac Power; Abiomed, Inc., Danvers, MA) was designed to provide a higher level of cardiac support than Impella 2.5 (Abiomed, Inc.). We present a case of a patient in which we used Impella CP in the setting of refractory cardiogenic shock due to non-ischemic cardiomyopathy. A 33-year-old male patient known to have idiopathic dilated non ischemic cardiomyopathy, presented to King Abdulaziz university Hospital with progressive dyspnea, orthopnea and lower limbs edema, BP was 97/50 with heart rate of 97 bpm, he was admitted initially to medical floor and Lasix infusion. His echocardiogram showed biventricular failure with left ventricular EF of 10%. Over the course of the subsequent three days, the patient's condition deteriorated and became hemodynamically unstable, where he was shifted to ICU and started on inotropes. In the ICU, he became critically ill with severe multiorgan failure. His conscious level started to deteriorate; thus, he was Intubated and mechanically ventilated. His hemodynamic profile shows severe cardiogenic shock, despite the fact that he was on maximum dose of levophid, dopamine and epinephrine, he was taken to cardiac catheterization laboratory, right heart catheterization using swan catheter shows right atrial pressure 28 mmHg, pulmonary capillary wedge pressure 30 mmHg, with cardiac index 1.6 L/min. Impella CP was inserted which can provide up to 3.5 L/min of cardiac output. Over the course of the next 72 hours, the patient showed significant improvement in his hemodynamics profile and cardiac function (LVEF 28% estimated by echocardiogram), with recovery of liver function. The Impella CP was removed with no complications. The Impella CP was shown to be safe and effective for prolonged use in critically ill patients with non-ischemic cardiomyopathy, and may significantly improve their outcome & prognosis.
Abnormal activation of vascular endothelial growth factor (VEGF) plays a role in the increase in the angiogenic process of numerous metastatic malignancies. VEGF-inhibitor (VEGFi) chemotherapy agents are commonly used as indicated in several malignancies, including renal cell, lung, gastric, hepatocellular, colorectal, and ovarian cancer. However, the use of VEGFi chemotherapy agents can lead to an increased incidence of vascular toxicity, particularly when used alone or in patients with a history of prior radiation and chemotherapy toxicities or experiencing rebound hypotension with intermittent dosing. To address these complications, the cardio-oncology task force (COTF) at Northside Hospital created and implemented practical guidelines and algorithms for risk monitoring, adapted from the 2022 ESC guidelines. These guidelines include a cardiovascular risk assessment algorithm for monitoring patients initiating VEGFi and tyrosine kinase inhibitor (TKI) treatments, as well as an algorithm for the acute management of hypertension prior to VEGFi infusion. Moving forward, the COTF aims to develop a research protocol to evaluate the efficacy and reduced cardiovascular toxicity associated with the simplified algorithms. The goal is to minimize treatment interruptions and premature discontinuations while improving treatment outcomes. Overall, the collaboration of various healthcare professionals within the COTF demonstrates a proactive approach in improving cardio-oncology care and patient outcomes.
Objective: To assess the prevalence of atrial fibrillation (AF) and its associated cardiovascular risk factors in the city of Kinshasa, DR Congo. Methods: From August to September 2022, 2641 inhabitants of Kinshasa aged ≥45years were visited at home by trained observers who collected information on lifestyle habits, use of modern or traditional medicine for chronic diseases and measured body weight, height, blood pressure and heart rate. They used Alivecor Kardia Cardia device to screen for AF and a 12lead ECG for confirmation. The likelihood of AF was modelized in a multivariable logistic regression analysis. Results: Suspected in 118 participants (4.6%), AF was confirmed in 108 subjects (4.2%) arguing for intrinsic validity of the Alivecor Kardia Cardia with 100% NPV and sensitivity, and 99.6% specificity compared to standard 12 lead-ECG. AF prevalence was higher (p=0,018) in men (5.2%) than women (3.4%), in participants with higher monthly income (p<0.001) and increased with age (p<0.001). Hypertension (58,2vs39.4%), dyslipidaemia (22.2vs2.9%), heart failure (36.1vs1.9%), stroke (13vs3.3 %), previous myocardial infarction (2.8vs0.6%) and heart palpitations (64.8vs36.3%) predominated whilst diabetes mellitus (11.1vs18.9%) and tobacco consumption (4.6vs9.8%) were less frequent among participants with AF. In multivariable adjusted logistic analysis, the odds (95% CI) for AF were 5,5(2,61-8,25) for heart failure, 4.6(2,67-11,33) for overweight/obesity, 2.1(1,04-4,19) for hypertension and 3.4(1,73-6,89) for age ≥70 years. Conclusion: AF affects a sizable proportion of adult Congolese people with heart failure, palpitations, hypertension, and overweight/obesity as significant correlates. The association with heart failure holds in a dual register with AF as either a culprit or a consequence.
The coronary angiography is the reference diagnostic test for the evaluation of the severity of coronary stenoses and the correspondent treatment. However, to classify an intermediate stenosis angiographically, additional evaluation must be used to confirm or negate its key features and thus the need for coronary revascularization. Therefore, Fractional Flow Reserve (FFR) was developed in order to evaluate the function of these intermediate stenoses, but still underused nowadays considering its invasive character. Computer software took place for this purpose, such as Cardiovascular Angiographic Analysis Systems (CAAS), which is based on the fluid dynamics study and the angiographic reconstruction to calculate an FFR directly derived from the angiographic image called virtual FFR (vFFR). A monocentric retrospective study done at «Grand Hôpital de l'Est Francilien», Marne-La Vallée site in France, to measure the vFFR of patients who had an invasive evaluation by means of the FFR and to compare the 2 evaluation methods of the coronary stenoses in order to determine the diagnostic performance of the vFFR. To be able to maintain vFFR as a necessary tool in the diagnostic arsenal for non-invasive, immediate evaluation, new large scale, multicenter studies using prognostic analyses and ideally randomization protocols are needed.
Despite all current efforts in the field of cerebrovascular disease prevention, stroke remains the leading cause of disability and death worldwide. Animal models are essential tools in stroke research to mitigate its devastating effects. The novelty of this review is the comprehensiveness of the approach and the detailed analysis of progress in the field, translational potential and clinical relevance. Recent research aimed to refine and enhance animal models to better mimic clinical scenario and improve reproducibility. This review provides extensive overview of its classification, underlining their key features, advantages, limitations, and advancements. Additionally, characterization and validation of ischemia models are discussed. Therapeutic strategies such as hypothermia, pharmacological interventions, genetic and molecular approaches, and cell-based therapies are highlighted. This review analyse the challenges and future directions, as well as translational potential and clinical relevance of ischemia models. Incorporating patient-derived cells and genetic modifications in animal models can provide a more personalized and clinically relevant approach. Bridging the gap is challenging and requires careful consideration of multiple factors, including appropriate dose translation, understanding species differences, and aligning protocols. Future studies should focus on optimizing the translational process and conducting well-designed clinical trials to assess the safety and efficacy of promising interventions.
The Medina Classification1, extensively employed in clinical practice and scientific literature, delineates bifurcation lesions (BL) treated with percutaneous coronary interventions (PCIs). When initially introduced, the cases addressed by the PCIs were less intricate, with side branch (SB) lesions predominantly featuring less critical involvement in length compared to the procedures routinely conducted in contemporary catheterization laboratories. The absence of precise quantification pertaining to SB involvement induces interpretative ambiguity in discerning the outcomes and the preferred strategies conveyed by randomized controlled trials dedicated to the treatment of BL. Given the inherent affliction of the main branch in true bifurcation lesions, the pivotal determinant in formulating a 1- or 2-stent strategy and, consequently, influencing procedural outcomes lies in discerning the degree and extension of SB disease from the outset. Consequently, we assert that the integration of a more detailed depiction of SB pathology into the original classification is of paramount importance. We believe that the temporal juncture is ripe for progressive refinement, wherein incorporating the original classification with supplementary descriptive parameters and characteristics as already contemplated in Medina's initial publication. Founded on the revised classification, prospective delineation of a 1- or 2-stent strategy becomes feasible from the outset. Furthermore, through nuanced discrimination among distinct bifurcation populations, the classification facilitates more uniform and dependable comparisons across diverse interventions and techniques. This not only holds relevance for future studies but also ensures retrospective applicability to past publications. Importantly, this iteration preserves the inherent simplicity and user-friendly attributes of the original classification.
Cardiac myosin inhibitors have changed the landscape for therapy in patients with obstructive hypertrophic cardiomyopathy. Mavacamten, as the first-in-class cardiac myosin inhibitor is FDA approved to improve exercise capacity and symptoms in adults with NYHA class II-III oHCM. This class of drugs offers an alternative to septal reduction therapies and have been found to be well tolerated when monitored. New trials currently in progress studying the cardiac myosin inhibitors hold promising opportunities to change the hypertrophic cardiomyopathy management landscape.
Objectives: The pulse wave fluctuations during pregnancy exhibit distinct characteristics that represent both the pregnancy and the fetus. However, these fluctuations, which contain more frequency domain information, have not yet been studied for diagnostic purposes. Our objective was to quantify these pulse waveforms and gather empirical evidence regarding their relationship with both pregnancy and fetal sex. Methods: We collected wrist pulse data from 36 pregnant women (420 datasets) and 50 nonpregnant women using a pressure sensor. We applied Fourier transformation to analyze these pulse waveforms and extract their harmonics in frequency domain. Subsequently, we conducted a statistical analysis to compare these harmonics between pregnant and nonpregnant women to estimate the differences. To validate our findings, we employed machine-learning techniques to assess the utility of these harmonics. Results: We observed a significant increase in the first and second harmonics in the right hand of the pregnant women, with a distinct pattern observed for these harmonics in the left hand. Furthermore, the differences in the top three harmonics between both hands were more evident, particularly in male fetuses, as we analyzed the monthly changes in harmonic differences, revealing stronger magnitudes in the early months. Additionally, our model accurately predicted fetal sex after 12 weeks over 70% accuracy using decision tree techniques. Conclusions: The pulse waveforms of the pregnant women displayed distinct signals, and the observed differences in harmonics between both hands were notable, especially with regard to fetal sex. This evidence could inform prenatal care practices and help research the maternal-fetal relationship.
Introduction: Today there is good evidence that the pulse volume curve (PVC) contains information about the systemic circulation and that the information content is not influenced by peripheral or local conditions at the recording site. In advancing the interpretation of PVC it appears necessary to identify individual wave components that contribute to the pulse wave. Methods and patients: In this study we applied the theory of constructive and destructive addition of forward and reflected arterial pulse waves to PVC recorded from finger pulse oximetry sensors in a group of cardiovascular healthy subjects (n=53) and compared them to those recorded in a group of patients with confirmed cardiovascular diseases (n=46). For this purpose PVC were processed by Fast Fourier transformation (FFT) and isolated sine wave components were used in a sine wave simulation to identify the two major wave components (forward and largest reflected wave) in their phase angle and amplitude. Amplitude amplification was calculated by comparing the identified forward travelling wave to the measured PVC. Results: The cardiological patients had much smaller phase angles between forward and reflected waves (p < 0.01), and much higher wave amplification effects (p < 0.01). This was also true for the subgroups of the cardiological patients (Hypertension, n = 19, Cardiomyopathy, n = 8, Aortic stenosis, n = 6, Coronary artery disease, n = 13). The healthy subjects had phase angles >104° that are associated with decreased systolic pressure, decreased stroke work, and decreased peripheral resistance. The cardiological patients had phase angles < 104° that are associated with a constructive addition of both waves and with negative effects like increased systolic pressure, increased stroke work, and increased peripheral resistance. Discussion: By pulse wave component analysis it was possible to distinguish between cardiovascular healthy participants and patients with different cardiovascular diseases. The new method enables to do a cardiovascular risk assessment by analysing a simple and highly available signal, the PVC. This could contribute to a reduction of cardiovascular mortality when an arterial overload condition is identified in an early stage before organ or tissue damage occurs.
Background: Coronary Artery Disease (CAD) is a common disease with a significant healthcare burden across the globe. Efforts were made to identify therapeutic targets or prophylaxis for high-risk individuals. Method: Here, we used a plasma-proteomewide Mendelian Randomization approach to estimate the causal effect of plasma proteins on the development of CAD by using the pQTL of the proteins as the exposure, and two large-scale GWAS of CAD as the outcome. Results: We identified LPA, PCSK9, PLA2G7, C1S, C1R, ENO2, SNAP25, A1BG, and CA11 as risk proteins casually associated with the onset of CAD. C1S/R and ENO2 were prioritized as the first-tier targets. We further applied pathway enrichment analysis and RNA-seq data to show that aberrant activation of the complement system and glycolysis are casually associated with increased risk for CAD. Conclusion: In short, our study revealed novel therapeutic targets for the treatment of CAD, inviting further investigation into these targets and related pathways.
We present the case of a 72-year-old female with acute chest pain and signs of myocardial ischemia. Cardiac catheterization revealed a bifid left anterior descending (LAD) artery, which was successfully treated with percutaneous intervention (PCI). The procedure involved crossing the lesion using Sion Black wire, followed by balloon dilatation and stent placement. Intravascular ultrasound confirmed adequate stent apposition. Post-dilation of the proximal stent edge was performed, resulting in excellent angiographic outcomes. The patient was discharged on dual antiplatelet therapy and guideline-directed medical therapy. This case highlights the successful management of a complex bifid LAD lesion using PCI.
Diffuse Large B Cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma that metastasizes to the heart. It was considered rare and was detected mainly at autopsy, but the prevalence has risen in recent times. The prognosis is poor if left untreated. Although most cases respond to chemotherapy well, the treatment can be associated with life-threatening complications including ventricular fibrillation, pulmonary embolism, and cardiac rupture early after chemotherapy. Little data is available regarding the optimal approach. A reduced chemotherapy dose was reported in several cases to decrease the risk of complications however, the inadequate treatment of cancer remains a concern. Moreover, chimeric T-cell (CAR-T cell) therapy resulted in significant improvement in other cases. In this manuscript, we intend to explore the symptoms and treatment of DLBCL with cardiac metastasis and the resulting outcomes. Our study includes 29 published cases older than 18 years with DLBCL who were diagnosed with cardiac metastasis. In 50% of cases, cardiac metastasis was detected at the initial presentation and diagnosis of lymphoma. Shortness of breath was the most common manifestation. 80.7 % of the cases underwent isolated chemotherapy and signs of improvement were reported as early as 1 month. Reduced chemotherapy dose was performed just in one case for the first cycle. Five out of 29 patients expired despite treatment. Arrhythmia was the cause of death in one patient. CAR-T cell, which was performed in 3 cases with resistance to chemotherapy, was associated with favorable outcomes.
Coronary artery bypass grafting (CABG) is a common procedure performed for severe coronary artery disease (CAD). Postoperative bleeding requiring a blood transfusion is a common complication. Here, we report a case of a 74-year-old male who underwent CABG for the indication of severe multivessel coronary artery disease. His procedure was complicated by postoperative bleeding requiring one unit of packed red blood cell transfusion. He developed a hematoma around the left lung and a small arterial blood vessel that bled into the pleural fat near the opening made for the mammary pedicle. An electrocardiogram (ECG) was performed prior to the evacuation of the hematoma and was significant for ST depressions and tall T-waves in the precordial leads in the pattern of de Winter syndrome. The de Winter pattern was not present on the repeat ECG after hematoma evacuation. The patient’s hyperacute T waves could have been related to sub-endocardial inflammation or infarction. The rapid resolution of the T-wave abnormalities after evacuation of his hematoma suggested a reversible cause and could have been related to irritation from the hematoma. Ischemia must be considered in the postoperative state when ECG changes are noted but can be difficult to distinguish from ST-T changes that are not ischemic in nature. Therefore, these and similar ECG changes noticed post-operatively should be evaluated carefully.
In the last decades the treatment of peripheral artery disease (PAD) recognizes an impressive rise in the number of endovascular procedures. The most sensitive point of this procedures is a limited patency of the revascularization, due to neointimal hyperplasia (NIH). One of the most important achievements during this years was the implementation of ant proliferative therapy in the daily practice, as drug eluted stents or drug coated balloons, which allowed the doctors to get better and better results.
Background: Despite the numerous studies and medical research that have addressed the relationship between testosterone deficiency & coronary artery disease, most of these studies have overlooked the relationship between testosterone deficiency and the risk factors that contribute to the development of coronary atherosclerosis such as diabetes, hypertension & hyperlipidemia as well as the risk for recurrent hospitalization for acute coronary syndrome. Aim of the study: The study's objective is to clarify the relationship between coronary artery disease, rehospitalisation for acute coronary syndrome, concomitant diseases like hyperlipidemia, hypertension & diabetes mellitus in correlation with testosterone deficiency as an independent variable. Method: The study was conducted on 167 people over the age of 50 years who presented to the emergency room with acute coronary syndrome weather the first time or recurrent acute coronary syndrome. We looked in those patients at the presence of other diseases that are a risk factors for ischemic heart disease. We measured serum testosterone level upon admission.
Diagnosing idiopathic (primary) chylopericardium is an extensive process that involves ruling out all potential secondary causes. Pericardiocentesis and fluid analysis are essential for diagnosis and additionally offer symptomatic relief. Management of idiopathic chylopericardium necessitates pinpointing and surgically correcting the lymphatic anomaly contributing to fluid accumulation. This case describes the diagnosis and management of idiopathic chylopericardium in a previously healthy 7-yearold female. Initial diagnosis was made with chest x-ray (CXR), transthoracic echocardiogram (TTE), and computed tomography (CT), followed by pericardiocentesis and pericardial drain placement. Pericardial fluid analysis revealed high triglycerides. Additional laboratory workup was largely unremarkable except for a positive QuantiFERON-TB Gold test. While disseminated tuberculosis infection can cause pericarditis and pericardial effusion, latent infection is unlikely to result in chylopericardium. Diagnosis of abnormal lymphatic perfusion and leakage into the pericardial sac was eventually established with dynamic contrastenhanced magnetic resonance lymphangiogram (DCMRL). Non-target embolization with lip iodol administered via bilateral inguinal lymph nodes was initially performed, but chylopericardium recurred. The patient subsequently underwent selective lymphatic embolization targeting an abnormally dilated lymphatic channel in the upper mediastinum. Repeat lymphangiogram immediately after selective embolization showed continued abnormal mediastinal lymphatic perfusion through diminutive lymphatic channels, which ultimately necessitated thoracic duct embolization. The patient had diminished pericardial effusion at three weeks post-embolization. She has been monitored with serial echocardiograms, with the most recent showing only a tiny/small amount of pericardial effusion. Continuous surveillance in the coming months and years will be essential to confirm successful embolization.
The global prevalence of MI in individuals < 60 years was found to be 3.8%. Also, following the assessment of 20 eligible investigations with a sample size of 5,071,185 individuals (> 60 years), this value was detected at 9.5% [1]. Cardiac catheterization is an invasive procedure used for both diagnostic as well as therapeutic purpose in patients having myocardial infarction either STEMI OR NSTEMI. It is important to understand that, the chances of having any major complication post coronary angiography occur in less than 2% of the population, with mortality of less than 0.08% [2]. Rupture of large vessels during visualization and stenting needs to be consider, although it is highly unlikely. As a result of any perforation of large vessel leads to pericardial effusion and inflammation of pericardium. Our case study is about a 43- year- old male, who was diagnosed with pericarditis. His presenting symptoms and ECG changes were mimicking inferior wall non-ST elevation myocardial infarction (NSTEMI) or 03 April, 2024infarction changes along with small Q wave, there were no typical findings on ECG indicative of pericarditis. Laboratory findings showed raised cardiac markers (troponin 1, CKMB).Patient underwent for coronary angiography and no acute pathology was seen. Follow up echocardiography revealed mild pericardial fluid accumulation that triggered his recurrent chest pain. On the bases of his recurrent symptoms, a course of anti-inflammatory drug that is colchicine 0.5mg was initiated, which is highly recommended to prevent recurrent pericarditis. Chest pain was relieved and ST segment depression almost returned to normal base line after 3 weeks though it was old infarction it takes usually 4 to 6 weeks return to normal. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.
Introduction: Pancreatic insulinomas are rare, usually benign, small neuroendocrine tumors that occur more frequently in women, with an average age of 47 years. Insulinomas are characterized by chronic hyperinsulinemia leading to recurrent hypoglycaemia. There is evidence that hyperinsulinemia and insulin resistance may be initial events in the genesis of arterial hypertension. The presumed link between hyperinsulinemia and hypertension is more common in individuals of European descent than in those of African descent. On the other hand, sleep apnea is one of the common causes of secondary hypertension. Case presentation: In this study, we present a 61-year-old male of Roma ethnicity with pancreatic insulinoma, hyperinsulinemia, recurrent hypoglycaemia, arterial hypertension, and sleep apnea. The clinical features of insulinoma include hypoglycaemia with neuroglycopenic symptoms, including mental confusion and behavioural changes. In the case of this individual patient, due to the development of resistant hypertension accompanied by headaches and ringing in the ears, intensified antihypertensive drug therapy was implemented. However, despite these measures, blood pressure regulation remained highly challenging. Conclusion: Pancreatic insulinoma in a 61-year-old male of Roma ethnicity with neuroglycopenic symptoms and the development of paroxysmal hypertension is a rare occurrence, despite hypertension typically not being associated with insulinoma. Sleep apnea serves as an additional exacerbating factor for the onset of secondary hypertension, further complicating blood pressure regulation.
A 63-year-old with no remarkable past medical history presented to the emergency room with left-side weakness. The initial lab was significant for eosinophilia and the nasal swab polymerase chain reaction ( PCR ) was positive for SARS-CoV-2. Brain magnetic resonance imaging (MRI) demonstrated multiple foci of infarction. Moreover, she started having chest pain accompanied by elevated troponin and new T-wave inversion in inferior and precordial leads. All infectious, autoimmune, and malignant causes were excluded. Cardiac MRI showed late gadolinium enhancement of the myocardium in the inferior and lateral walls. The patient was started on corticosteroids which resulted in improvement of her eosinophilia. Cardiac involvement in hypereosinophilia has been reported in 5% of patients. It can lead to severe arrhythmias and death. Steroid is the main treatment. However, newer medications have been reported to be effective.
