New-onset dilated cardiomyopathy: a cost-effective work-up

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

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Late-gadolinium Enhancement in New-onset Idiopathic Dilated Cardiomyopathy is Associated with Recovery of Systolic Left Ventricular Function

Heart Lung and Circulation ◽

10.1016/j.hlc.2010.06.673 ◽

2010 ◽

Vol 19 ◽

pp. S4

Author(s):

D. Leong ◽

P. Molaee ◽

L. Joerg ◽

N. Shipp ◽

P. Madsen ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Left Ventricular Function ◽

Dilated Cardiomyopathy ◽

Ventricular Function ◽

Left Ventricular ◽

Idiopathic Dilated Cardiomyopathy ◽

Gadolinium Enhancement ◽

Systolic Left Ventricular Function ◽

New Onset

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Addison’s Disease and Dilated Cardiomyopathy: A Case Report and Review of the Literature

Case Reports in Cardiology ◽

10.1155/2016/4362514 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Viktoriya Mozolevska ◽

Anna Schwartz ◽

David Cheung ◽

Bilal Shaikh ◽

Kapil M. Bhagirath ◽

...

Keyword(s):

Case Report ◽

Dilated Cardiomyopathy ◽

Clinical Presentation ◽

Addison’S Disease ◽

Addison's Disease ◽

Review Of The Literature ◽

Cardiac Disorder ◽

New Onset

Addison’s disease is often accompanied by a number of cardiovascular manifestations. We report the case of a 30-year-old man who presented with a new onset dilated cardiomyopathy due to Addison’s disease. The clinical presentation, treatment, and outcomes of this rare hormone mediated cardiac disorder are reviewed.

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A case of atypical systemic primary carnitine deficiency in Saudi Arabia

Pediatric Reports ◽

10.4081/pr.2018.7705 ◽

2018 ◽

Vol 10 (2) ◽

Author(s):

Abdulrahman Alghamdi ◽

Hani Almalki ◽

Aiman Shawli ◽

Rahaf Waggass ◽

Fahad Hakami

Keyword(s):

Dilated Cardiomyopathy ◽

Autosomal Recessive ◽

Acid Metabolism ◽

Age Of Onset ◽

Carnitine Deficiency ◽

Proximal Muscle ◽

Skeletal Myopathy ◽

Primary Carnitine Deficiency ◽

Elevated Transaminases ◽

Work Up

Systemic primary carnitine deficiency (SPCD) is an autosomal recessive inborn error of fatty acid metabolism caused by a defect in the transporter responsible for moving carnitine across plasma membrane. The clinical features of SPCD vary widely based on the age of onset and organs involved. During infancy, patients might show episodes of hypoketotic hypoglycemia, hepatomegaly, elevated transaminases, and hyperammonemia. Skeletal myopathy, elevated creatine kinase, and cardiomyopathy are the main manifestations in children with SPCD, while in adults, the disorder is usually manifested as cardiomyopathy, arrhythmias, or fatigability. Here, we report a 5-year-old boy with SPCD that presented as dilated cardiomyopathy with atypical features, such as anemia, respiratory distress, and proximal muscle weakness. This report supports considering carnitine deficiency treatment in the work-up of unexplained pediatric dilated cardiomyopathy.

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Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Presenting as Recurrent and Migrating Focal Cortical Encephalitis

Child Neurology Open ◽

10.1177/2329048x20966172 ◽

2020 ◽

Vol 7 ◽

pp. 2329048X2096617

Author(s):

Xinran Maria Xiang ◽

Rachel Evans ◽

Jesus Lovera ◽

Rashmi Rao

Keyword(s):

Brain Mri ◽

Occipital Cortex ◽

Myelin Oligodendrocyte Glycoprotein ◽

New Right ◽

High Dose ◽

Antibody Testing ◽

Leptomeningeal Enhancement ◽

The Right ◽

Work Up ◽

New Onset

Although pediatric myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease is increasingly well-recognized, its full clinical spectrum is still being defined. Cortical encephalitis is emerging as a distinct clinico-radiologic syndrome of adult MOG antibody-associated disease. We describe a 12-year-old girl who presented with new onset seizures and left-sided hemiparesis. Brain MRI showed edema of the right temporal-parietal-occipital cortex with associated focal leptomeningeal enhancement. Patient received high-dose corticosteroids and 21 days of acyclovir despite negative infectious work-up due to the focal nature of encephalitis. Patient remained seizure-free for 20 months before presenting with new right hemiclonic seizures with right-sided hemiparesis and edema of the left temporal-parietal cortex with associated leptomeningeal enhancement. Patient’s MOG antibody titer was 1:40. She completed high-dose corticosteroids and intravenous immunoglobulin. Our patient highlights the importance of MOG antibody testing in pediatric focal cortical encephalitis to avoid unnecessary anti-viral agents and provide more appropriate immunotherapy and a more informed prognosis.

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Work disability in gout: a population-based case–control study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212063 ◽

2017 ◽

Vol 77 (3) ◽

pp. 399-404 ◽

Cited By ~ 9

Author(s):

Valgerdur Sigurdardottir ◽

Panagiota Drivelegka ◽

Anna Svärd ◽

Lennart T H Jacobsson ◽

Mats Dehlin

Keyword(s):

Sick Leave ◽

Work Disability ◽

Conditional Logistic Regression ◽

Productivity Loss ◽

Cost Effective ◽

Population Based ◽

Work Absenteeism ◽

Using Data ◽

Population Controls ◽

New Onset

ObjectivesTo examine the extent and cost of work disability among patients with gout compared with matched population controls and to analyse predictors of work disability.MethodsA regional cohort study using data from Swedish national and regional registries from January 2000 through December 2012, including 4571 patients with gout of working age, with a first recorded diagnosis of gout in the years 2003–2009 and 22 482 population controls, matched by age, sex and place of residence. Differences in baseline characteristics (educational level, income, previous employment and comorbidities) and the number of work-loss days (absenteeism) due to sick leave and disability pension for 3 years after identification were calculated. Predictors for new-onset work absenteeism (>90 days/year) in a subset were determined by conditional logistic regression.ResultsPatients with gout (median age 53 years) had significantly more comorbidities, lower income and lower level of education than matched controls. The average work absentee rate during the 3-year follow-up period was higher among patients with gout than controls, 22% and 14%, respectively (P<0.0001). New-onset absenteeism was in multivariate analyses significantly predicted by gout (OR 1.47; 95% CI 1.23 to 1.75). Other variables independently related to new-onset absenteeism were education ≤12 years, previous unemployment and history of sick leave, in addition to several comorbidities (renal disease, cardiovascular disease, alcohol abuse and obesity).ConclusionsGout is associated with substantially higher work absenteeism and costs for society due to productivity loss, after adjusting for associated comorbidities and socioeconomic differences. Whether more intensive treatment of gout is cost-effective needs to be addressed in future studies.

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Pulsus alternans in a child with dilated cardiomyopathy

Cardiology in the Young ◽

10.1017/s1047951117002347 ◽

2017 ◽

Vol 28 (3) ◽

pp. 479-481

Author(s):

Hasti Sanandajifar ◽

Sarosh P. Batlivala

Keyword(s):

Dilated Cardiomyopathy ◽

Pulse Wave ◽

Severe Heart Failure ◽

Clinical Information ◽

Left Ventricular ◽

Warning Sign ◽

Pulse Wave Amplitude ◽

Pulsus Alternans ◽

Myocardial Oxygen Supply ◽

New Onset

AbstractA previously healthy 21-month-old presented with new-onset dilated cardiomyopathy. Evaluation noted pulsus alternans, with beat-to-beat alternations in aortic pulse wave amplitude, both clinically and on diagnostic studies. Pulsus alternans is an infrequent, complex pathophysiologic sign often associated with severe heart failure. The mechanisms are incompletely understood, but theorised aetiologies include beat-to-beat changes in left ventricular loading conditions, variations in myocardial oxygen supply/demand, and alternations in myocardial contractility. Recognition of pulsus alternans is important as it provides significant clinical information, may suggest suboptimal medical management, and may be the first warning sign of severe cardiac dysfunction.

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