Objective: Minimally invasive multivessel coronary bypass performed through a left anterior minithoracotomy may be associated with early postoperative respiratory events related to thoracotomy, one-lung ventilation, and perioperative ventilatory management. This study aimed to describe the early postoperative pulmonary complication profile in our center and to report the use of selective postoperative non-invasive mechanical ventilation (NIMV) in routine clinical practice. Method: This single-center retrospective descriptive study included 77 consecutive patients who underwent minimally invasive on-pump multivessel coronary bypass surgery through a left anterior mini-thoracotomy between January 2022 and December 2024. Patients were evaluated for early postoperative pulmonary complications documented in the clinical record and chest radiography, including atelectatic changes, pleural effusion, pneumonia, decreased partial oxygen pressure (PaO2), and blunting of the costophrenic angle. Preoperative spirometry was obtained when clinically feasible. Results: Seventy-seven patients (44-79 years; mean age 58.2 years) were included. Preoperative spirometry was available in 51 patients. Five patients required postoperative NIMV because of radiographic and/or oxygenation findings during follow-up; in two of these patients, intermittent ward NIMV was administered for SpO(2) <92% and PaO2 <70 mmHg, with subsequent improvement in oxygen saturation to >94% after NIMV sessions and mobilization. Postoperative pneumonia occurred in one patient and pleural effusion in two patients; no thoracentesis was required. Mean room-air discharge values were acceptable at cohort level (Table 5), with PaO2 99 mmHg, PaCO2 34 mmHg, and SpO(2) 94%. Conclusion: In this selected retrospective cohort, early postoperative pulmonary complications after minimally invasive multivessel bypass surgery were infrequent and were managed predominantly with conservative treatment; selective NIMV was used in a small subset of patients as rescue support. The present data support feasibility reporting only and do not establish NIMV efficacy. Prospective comparative studies with standardized postoperative pulmonary assessments are needed.
Minimally invasive techniques are increasingly being adopted in cardiac surgery. Although thoracotomy-based approaches are well established for selected coronary and mitral operations, median sternotomy remains the standard access for most combined pathologies because of technical complexity and limited evidence. In this case series, we describe two highly selected patients who underwent combined coronary artery bypass grafting and mitral valve repair via bilateral mini-thoracotomy without sternotomy. We report the operative strategy, perioperative course, and early outcomes as a feasibility-focused technical experience. In both patients, the procedures were completed without conversion to sternotomy, mitral repair was confirmed intraoperatively by transesophageal echocardiography, and no major perioperative adverse events listed in Table 1 were observed. In conclusion, bilateral mini-thoracotomy appears technically feasible in carefully selected patients treated by an experienced minimally invasive team; however, this two-patient case series does not permit comparative claims regarding superiority, complication reduction, or long-term effectiveness.
Background: Secondary amenorrhea, defined as the absence of menstruation for three or more consecutive months in women with previously regular cycles, has a broad differential diagnosis that includes endocrine, metabolic, psychosocial, and systemic causes. Heart failure (HF) is a multisystem syndrome that may alter neurohormonal signaling and physiologic stress responses, creating a biologically plausible context for menstrual disturbance. We report a case in which menstrual function resumed after treatment and clinical stabilization of HF. Case Report: A 25-year-old female with a two-year history of secondary amenorrhea presented with exertional dyspnea, orthopnea, and bilateral lower extremity edema. Physical examination showed elevated jugular venous pressure and a systolic murmur. Echocardiography demonstrated mildly reduced left ventricular ejection fraction (44%), dextrocardia, left atrial enlargement, and moderate mitral regurgitation. She was diagnosed with congestive heart failure and treated with intravenous diuretics followed by guideline-directed medical therapy (beta-blocker, angiotensin-converting enzyme inhibitor, and mineralocorticoid receptor antagonist). Her symptoms improved clinically, and by the third month of follow-up she reported return of menstruation, with continued regular cycles during 9 months of follow-up. Conclusion: This case demonstrates a temporal association between HF treatment/clinical improvement and resolution of secondary amenorrhea, but it does not establish causality. The observation is hypothesis-generating and should be interpreted in the context of an incomplete endocrine-gynecologic etiologic evaluation and the absence of serial hormonal measurements. Nevertheless, the case supports clinical awareness of menstrual health in women with HF and motivates prospective studies using standardized reproductive and cardiovascular assessments to clarify mechanisms and determine whether this association is reproducible. (c) 2026 The Author's. Published by Insuficiencia Cardiaca. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)
Background: Radiotherapy (RT) for breast cancer could be associated with subclinical cardiac dysfunction that cannot be identified by conventional echocardiographic parameters. Transthoracic echocardiography (TTE) using Global longitudinal strain (GLS) is a valuable predictor of sub-clinical myocardial dysfunction. Objective: Using transthoracic echocardiography with global longitudinal strain analysis to evaluate whether post-radiotherapy alterations in left ventricular (LV) strain reflect early evidence of cardiac remodeling in breast cancer patients. Study Design: Cohort study. Place and Duration of Study: this prospective cohort study was conducted at Al-Najaf Center for Cardiac Surgery and Transcatheter Therapy, Al-Sader Teaching Hospital in Al-Najaf city from December 2024 to September 2025. Methods: This cohort study was consisted of 40 females with breast cancer between the ages of 20 and 65 years were split into two groups: left sided breast cancer patients (n=18) and right sided breast cancer patients (n=22). Left ventricular global longitudinal strain (LVGLS) Was assessed using standard 2D transthoracic echocardiography pre-radiotherapy and within10 days post-radiotherapy. Independent t-test, paired t-test and ANOVA test were used for statistical comparisons. Results: Compared to pre radiotherapy, post radiotherapy left ventricular global longitudinal strain was significantly decreased (-16.34 +/- 1.44% vs.-18.09%+/- 1.6%, p<0.001). left sided breast cancer patients had a significantly higher reduction in LV GLS compared to right sided (-15.7%+/- 0.9% vs.-16.9%+/- 1.5%, p=0.006). Higher body mass index (BMI) was associated with higher reduction in LV GLS. Conclusion: Even before the presence of obvious clinical symptoms, LVGLS is an early indicator of post radiotherapy sub clinical cardio-toxicity in breast cancer patients. Left side irritation is associated with a higher reduction in LVGLS. The early changes in GLS high light the importance of closer cardiac monitoring in breast cancer patients.
Background: Dextrocardia is a rare congenital anomaly, seen in about 1 in 12,000 births, characterized by abnormal cardiac position and thought to result from early cardiac developmental disturbances. This report presents the unusual coexistence of dextrocardia and a posterior fossa arachnoid cyst, a combination seldom described. Case summary: A 25-year-old woman presented with exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and bilateral peripheral edema. Examination revealed elevated jugular venous pressure, tachycardia, a systolic murmur, ascites, and lower limb edema. Chest X-ray showed dextrocardia and cardiomegaly, while brain CT identified an arachnoid cyst. Laboratory tests demonstrated mild anemia with normal renal function and serum proteins. She was diagnosed with congestive heart failure, started on medical therapy, and chose outpatient follow-up for the cyst without further intervention. Discussion: The coexistence of dextrocardia and an arachnoid cyst suggests a potential genetic link and supports comprehensive genetic evaluation in patients with congenital anomalies. Recognizing such associations may improve understanding of underlying developmental mechanisms and help refine diagnostic and management strategies.
Acute coronary syndrome (ACS) comprises unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), all resulting from acute myocardial ischemia due to abrupt coronary artery obstruction. It is a major global cause of morbidity and mortality and demands rapid diagnosis and treatment. The underlying mechanism involves atherosclerotic plaque disruption, thrombus formation, and myocardial injury, influenced by inflammation and oxidative stress. Diagnosis is based on clinical presentation, ECG changes, and high-sensitivity troponins, supported by imaging such as echocardiography and coronary CT angiography (CCTA). Management focuses on restoring perfusion, limiting myocardial damage, and preventing recurrence, with STEMI requiring urgent reperfusion (primary PCI or fibrinolysis), NSTEMI and UA guided by GRACE or TIMI risk scores, and standard therapy including DAPT, anticoagulants, beta-blockers, statins, ACE inhibitors, and newer P2Y12 and PCSK9 inhibitors. Persistent delays in diagnosis and limited access to specialized care highlight the importance of multidisciplinary management, cardiac rehabilitation, and emerging digital and AI-based tools to improve long-term outcomes.
Acute exacerbations in asthma patients, especially those with underlying cardiovascular disease, pose major clinical challenges due to the complex interaction between the respiratory and cardiovascular systems. This systematic review, conducted according to PRISMA guidelines, examines how different respiratory therapy strategies affect the frequency and outcomes of these exacerbations. We evaluated studies on pharmacologic treatments (such as bronchodilators and corticosteroids) and advanced non-pharmacologic interventions (including non-invasive ventilation, invasive mechanical ventilation, and extracorporeal life support). Evidence from randomized controlled trials and cohort studies suggests that non-invasive ventilation can lower intubation rates in severe exacerbations, while extracorporeal life support (ECLS) may be beneficial in refractory cases. However, the overall evidence remains limited, with considerable methodological variability and frequent reliance on retrospective or post-hoc analyses. There is a clear need for large, high-quality randomized trials focused specifically on asthma patients with cardiovascular comorbidities. Refining therapeutic strategies in this population could improve clinical outcomes and reduce mortality associated with acute exacerbations.
Cardiomyopathies comprise a heterogeneous group of myocardial disorders that lead to structural and functional cardiac abnormalities and are major contributors to heart failure, arrhythmias, and sudden cardiac death worldwide. Their growing clinical and epidemiological impact has driven substantial advances in therapeutic strategies, ranging from optimized pharmacological regimens and device-based interventions to catheter ablation and heart transplantation. In parallel, emerging modalities such as gene therapy, molecularly targeted agents, and disease-modifying treatments for specific etiologies (e.g., sarcomeric, inflammatory, or metabolic forms) are reshaping the therapeutic landscape. This review summarizes current perspectives on the treatment of hypertrophic, dilated, restrictive, and arrhythmogenic right ventricular cardiomyopathies, emphasizing guideline-directed medical therapy, indications for implantable devices, and the role of advanced heart failure therapies. Particular attention is given to the integration of precision medicine, risk stratification tools, and multidisciplinary care pathways, which together are crucial for individualizing management and improving outcomes in patients with these complex myocardial diseases.
Cardiac arrest is a critical, life-threatening event defined by the abrupt cessation of effective cardiac activity, resulting in an immediate interruption of blood flow to vital organs. It remains one of the leading causes of death globally and demands prompt medical intervention to enhance the chances of survival and neurological recovery. The causes of cardiac arrest are varied and include ventricular arrhythmias, acute myocardial infarction, and underlying structural heart disease. This review examines the mechanisms underlying cardiac arrest, the principal diagnostic approaches used to identify its etiology and guide therapy, and current management strategies. Particular emphasis is placed on evidence-based resuscitation practices, comprehensive post-cardiac arrest care, and emerging therapeutic interventions designed to improve clinical outcomes in affected patients.
Introduction. His bundle pacing (HBP) has emerged as an alternative to pacing from the right ventricle in patients with a disturbance in the conduction system.Objective. So far, there are no studies that have shown its efficacy in patients with chagasic cardiopathy. In this report, we studied a group of patients with positive serology for Chagas disease, with structural heart disease and conduction disorders that required the implantation of a pacemaker (PM). Material and method. Cross-sectional study, where HBP was evaluated in patients with Chagas disease through the echocardiographic study before and after the placement of the and implantation of a PM, between June 2020 and June 2021. Patients of both sexes and without age limits were included. Only those who presented positive serology for Chagas disease were selected. Assessing intraventricular synchrony by quantifying the septal-posterior wall delay with M mode and with the use of speckle tracking. Statistical analysis was performed using the Graph Pad Prism 4.0 statistical package.Results. Twenty-two patients with positive serology for Chagas disease who required definitive PM implantation were recruited. 77% of the patients were male, with a mean age of 75 years. Left ventricular end-diastolic diameters (EDD) and end-systolic diameters (ESD) were significantly reduced: pre-EDD: 54.3 mm vs. post-EDD: 50.1 mm (P<0.05). ESD pre: 43.0 mm vs. ESD post: 33.3 mm (p<0.05). LVEF also had a significant improvement with HBP: LVEF pre: 47% vs LVEF post: 52% (p<0.05). All the patients at the beginning of the study were in functional class III (NYHA), and a significant improvement was observed in the follow-up to functional class I-II (NYHA).Conclusion. HBP was feasible, effective, and without complications in patients with chagasic heart disease, achieving a significant shortening of the QRS duration. Also observing a decrease in ventricular volumes, an improvement in the left ventricular ejection fraction, and adequate intraventricular synchrony assessed by M-mode echocardiography and with speckle tracking. These findings could be promising, since, in Chagas disease, there is a risk of heart failure that could be aggravated by conventional pacing from the right ventricle.
Aim. To investigate whether the type of hospital or the volume of patients attended by the emergency department (ED) intervenes in the diagnostic and therapeutic management of acute heart failure (AHF).Method. Thirty-six EDs that had included patients with AHF in the EAHFE 5-6-7 registries participated. Three types of hospital were distinguished (high technology/reference/regional) and three EDs by care volume (high/medium/low). We analyzed 9 parameters related to diagnostic management and 8 to therapeutic management, and investigated whether there was an association with the type of hospital or ED. The associations were adjusted for differences in the baseline characteristics of the patients and the AHF episode, type of hospital and ED, and by center.Results. A total of 10,869 patients were analyzed (median age: 83 years, women: 55%; high-tech/reference/regional hospitals: 68%/16%/16%; ED with high/medium/low volume: 76%/17%/7%). Blood pressure, heart rate, pulse oximetry, chest X-ray, electrocardiogram, and laboratory tests were determined in >95% of patients, but respiratory rate, natriuretic peptide, and troponin were determined in only 71%, 70%, and 54%, respectively. The regional hospitals (as opposed to high technology) determined more vital signs and performed electrocardiograms and blood tests, and less troponin and natriuretic peptide. The EDs with low activity (versus high activity) measured respiratory rate less frequently, performed fewer electrocardiograms and more laboratory tests, although they measured troponin less frequently. The most frequent therapeutic management included IV (intravenous) diuretic (85%), oxygen therapy (68%), and hospitalization (74%), while IV nitroglycerin (8.4%) and non-invasive ventilation (NIV, 6%) were infrequent, morphine (5%) and inotrope/ vasopressor (1%). The district hospitals used more frequently oxygen therapy, NIV, morphine, digoxin and hospitalization, and less frequently nitroglycerin. The low-activity EDs used less NIV, digoxin, and hospitalization, and more IV diuretics.Conclusion. The type of hospital and the volume of activity of the ED are associated with differences in the diagnostic and therapeutic management of AHF in the emergency room.
Acute myocarditis is an inflammatory heart disease that can be caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) capable of inducing heart failure. The case of a 20-year-old male patient diagnosed with COVID-19 pneumonia is presented. In the laboratory, acute renal failure with elevated troponins was found. The Doppler echocardiogram demonstrated severely impaired left ventricular systolic function and global hypokinesia. Cardiac magnetic resonance imaging (CMR) showed a hyperintense transmural zone in the basal and middle segments of the septal face, anterior and apical septal segment, compatible with acute myocarditis. Inotropes, antibiotic therapy and corticosteroid therapy were indicated with good response. In acute myocarditis due to COVID-19, Doppler echocardiography and CMR are mandatory in case of clinical suspicion.
The prevalence of heart failure (HF) is increasing steadily and is the leading cause of hospital admissions in the adult population, affecting both men and women equally and constituting a rapidly growing public health problem. Despite this, there has been a significant underestimation of women in large-scale HF studies. This disparity has led to a deficit in understanding of important gender-based differences in pathophysiology, diagnosis, and treatment strategies. Although HF is an important cause of morbidity and mortality in women, it develops at a later age compared to men. HF with preserved ejection fraction (HFpEF) is more common in women than in men and accounts for at least half of HF cases in women. When men and women with HF with reduced ejection fraction (HFrEF) are compared, women are more symptomatic and have a similarly poor outcome. Primary prevention of HF in women should include targeted and gender-specific strategies to raise awareness, promote a heart-healthy lifestyle, and improve treatments that optimally control risk factors for HFrEF and HFpEF. The epidemiological and pathophysiological differences in both HF subtypes suggest that gender-specific preventive strategies and the reduction of risk factors may be particularly beneficial, based on a biological basis with several variables, including female hormones, which they play an important role in epidemiology and outcome, as well as menopause. In addition, we highlight the singularity of HF during pregnancy and important problems specific to the female sex. However, there are significant gaps in gender-specific knowledge that impede preventive efforts. To overcome these limitations, women need to be adequately assessed in HF studies, gender differences need to be investigated prospectively, and effective female sex-specific interventions need to be incorporated into clinical practice guidelines; highlighting the clear need for greater recruitment of women in clinical studies and more studies exploring the role of gender-based biology in HF treatment, to shed light on the different mechanisms, causes and targeted therapies of HF in the women. This review summarizes the existing evidence supporting the primary prevention of HF in women and identifies potential strategies that are most likely to be effective in reducing the burden of HF among women.
Currently, heart failure (HF) is a syndrome in constant increase due to multiple factors, among them, the longer survival of patients with heart attacks and the longer life expectancy of the general population. Patients with advanced heart failure (AHF) and frailty syndrome (FS) are a particularly vulnerable part of the population, so it is important to keep in mind the different forms of management. The care of older and more frail people with end-stage HF has become challenging, and their evaluation based on current risk scores that focus primarily on subjective symptoms and patient disability is key. For generations, geriatricians have sought to identify the underlying vulnerabilities of the body that characterize frailty. More recently, cardiologists have begun to recognize this entity in their own practice. Several studies have suggested frailty rates of up to 50% in patients with cardiovascular disease. However, despite acknowledging fragility, it remains difficult to define. Like HF, frailty is a biological syndrome that affects multiple organ systems. The objective is to clarify the importance of recognizing the presence of FS in patients with AHF with reduced ejection fraction, guide their management in terms of prevention, treatment and the making of certain decisions that generate concern in terms of cost-benefit. It explains what frailty consists of, what tools there are to assess it, and talks about nutritional management, with physical rehabilitation, decision to implant a cardioverter-defibrillator and cardiac resynchronization therapy, ventricular assist devices, and heart transplantation. The concept and relevance of frailty is also discussed. polypharmacy and palliative care. It is intended to raise awareness in the medical population about the containment of this type of patients who have a greater need for close and continuous care because they are more vulnerable, informing about diagnostic and treatment tools that could improve their quality of life and even in some cases the prognosis of your disease.
Chagas disease is caused by the Trypanosoma cruzi parasite, and has become a widely distributed parasitosis in Latin America. It is estimated that the number of infected people currently amounts to 15 million people, documented in 2006 and that around 100 million inhabitants of this part of the world are exposed to the risk of contracting this infection. Approximately 30% of those infected will suffer from some type of cardiac involvement in a period of between 10 and 30 years from the onset of the disease. The natural history of the disease is still under study, and although it has been clarified in recent years, many questions remain. Various hypotheses have been developed on how it evolves to the stage of fibrosis and replacement of myocardial tissue. One third of cases progress to chronic cardiomyopathy and gastrointestinal disease. The infection is transmitted vertically and by blood/organ donation and can be reactivated with immunosuppression. The identification of cases requires awareness and selection programs aimed at the population at risk (women of reproductive age, donors, immunocompromised patients).Currently, it is known that parasite activity alone is not the cause of the associated histological damage in severe forms of the disease, but is only a pillar. Therefore, in this update we can conclude that autoimmunity through AAB-B1, as well as AAB-M2, play an important role as a consequence of the progression of the disease and that studies should be continued to continue detecting the disease. pathophysiology of this disease and its potential therapeutic forms.In this update we present our vision regarding the evolution of the disease in recent years, advances in pathophysiology and the role of immunity in the development of its forms.
Diseases of the heart muscle are included within the term cardiomyopathy. Among them, the most frequent is dilated cardiomyopathy, which is characterized by dilatation and dysfunction of the left ventricle or both, which is not exclusively explained by abnormal overload or myocardial ischemic damage. Diagnosis is based on clinical history and compatible echocardiographic or cardiac magnetic resonance imaging features. Biomarkers, such as BNP/NT-proBNP, are also useful in the diagnosis and follow-up of these patients. Treatment is based on monitoring the symptoms of heart failure and preventing the progression of the disease and its complications. Depending on each patient, implantable defibrillators with or without resynchronization, ventricular assist devices, and even heart transplantation could be used. In the future, gene therapy and the use of stem cells could play an important role, as currently open lines of research suggest. Also, a descriptive, retrospective cross-sectional study is presented, which included 77 patients who met the inclusion criteria who were hospitalized in the Cardiology Service of the Hospital de Clinicas (Clinic Hospital) of the National University of Asuncion, Paraguay; in a period of 2 years, most patients were diagnosed for the first time within this period, and in turn, most presented a left ventricular ejection fraction <35% and severe systolic dysfunction. With this update we see that patients with dilated cardiomyopathy are complex and require access to a wide range of invasive and non-invasive studies and genetic tests, as well as the participation of multidisciplinary teams and long-term follow-up.
