scholarly journals Atrioventricular Conduction Abnormalities in Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Carlos A. Carmona ◽  
Fatma Levent ◽  
Kelvin Lee ◽  
Bhavya Trivedi
Keyword(s):  
Heart Block ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Conduction Abnormalities ◽  
Inflammatory Syndrome ◽  
Degree Heart Block

Cardiac manifestations in multisystem inflammatory syndrome in children (MIS-C) can include coronary artery aneurysms, left ventricular systolic dysfunction, and electrocardiographic disturbances. We report the clinical course of three children with MIS-C while focusing on the unique considerations for managing atrioventricular conduction abnormalities. All initially had normal electrocardiograms but developed bradycardia followed by either PR prolongation or QTc elongation. Two had mild left ventricular ejection fraction dysfunction prior to developing third-degree heart block and/or a junctional escape rhythm; one had moderate left ventricular systolic dysfunction that normalized before developing a prolonged QTc. On average, our patients presented to the hospital 4 days after onset of illness. Common presenting symptoms included fevers, abdominal pain, nausea, and vomiting. Inflammatory and coagulation factors were their highest early on, and troponin peaked the highest within the first two days; meanwhile, peak brain-natriuretic peptide occurred at hospital days 3-4. The patient’s lowest left ventricular ejection fraction occurred at days 5-6 of illness. Initial electrocardiograms were benign with PR intervals below 200 milliseconds (ms); however, collectively the length of time from initial symptom presentation till when electrocardiographic abnormalities began was approximately days 8-9. When comparing the timing of electrocardiogram changes with trends in c-reactive protein and brain-natriuretic peptide, it appeared that the PR and QTc elongation patterns occurred after the initial hyperinflammatory response. This goes in line with the proposed mechanism that such conduction abnormalities occur secondary to inflammation and edema of the conduction tissue as part of a widespread global myocardial injury process. Based on this syndrome being a hyperinflammatory response likely affecting conduction tissue, our group was treated with different regimens of intravenous immunoglobulin, steroids, anakinra, and/or tocilizumab. These medications were successful in treating third-degree heart block, prolonged QTc, and a junctional ectopic rhythm.

scholarly journals Systolic left ventricular dysfunction in patients with clinically suspected myocarditis

2020 ◽  
Vol 17 (4) ◽  
pp. 452-460
Author(s):  
N. P. Mitkovskaya ◽  
E. M. Balysh ◽  
T. V. Statkevich ◽  
N. A. Ladygina ◽  
E. B. Petrova ◽  
...  
Keyword(s):  
Heart Rate ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

The aim of the study was to investigate the features of clinically suspected myocarditis complicated by the left ventricular systolic dysfunction development. 93 patients with clinically suspected myocarditis were examined. The average age was 36.63 ± 1.15 years. In 43.01 % of patients the disease was accompanied by a decrease in left ventricular systolic function. In the group of patients with left ventricular systolic dysfunction in comparison with those with preserved left ventricular ejection fraction, a significantly lower proportion of men (75 % versus 81 %, respectively, χ2 = 9.3, p < 0,01) and a higher average group age (40.7 ± 1.87 versus 33.6 ± 1.3 years, respectively, p <  0,01) were revealed. The course of the disease in patients with left ventricular systolic dysfunction was characterized by a more frequent development of rhythm disturbances (65 % versus 43.3 %, respectively, χ2  = 4.3, p  < 0,05) and a higher heart rate at admission (94.5 (75‒100) and 85 (70‒89) beats per minute, respectively, p = 0.006). The structural and functional state of the heart according to echocardiography in patients with a reduced left ventricular ejection fraction versus comparison group was characterized by larger heart chambers sizes, more pronounced violations of local left ventricular contractility, more frequent involvement of the right ventricle in the pathological process (56.3  % versus 22.2  %, respectively, χ2   =  6.4, p  < 0,05). The relationships between the left ventricular ejection fraction Весці Нацыянальнай акадэміі навук Беларусі. Серыя медыцынскіх навук. 2020. Т. 17, № 4. C. 452–460 453 and the patient’s age (r = ‒0.36), the value of the heart rate at admission (r = ‒0.32), the severity of heart failure at admission, the degree of impaired local contractility of the left ventricle, the degree of right ventricular function (TAPSE, r  =  0.58), the severity of myocardial fibrosis according to cardiovascular magnetic resonance imaging (r = ‒0.32) were revealed.

scholarly journals Cardiac involvement in critically ill patients with leptospirosis: A prospective study using myocardial deformation imaging

2018 ◽  
Vol 9 (8) ◽  
pp. 975-983 ◽  
Author(s):  
Anoop Mathew ◽  
Miriam Shanks ◽  
Eapen Punnoose ◽  
Louie Fischer ◽  
George Koshy ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Cardiac Involvement ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Sepsis Syndrome ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

Background: Myocardial inflammation often complicates leptospirosis, a re-emerging global zoonosis. Leptospirosis associated myocardial dysfunction is equivocal and the pattern of cardiac involvement may not differ from that of sepsis associated myocarditis. Methods: We prospectively compared cardiac involvement in 113 intensive care unit patients with severe leptospirosis to 31 patients with sepsis syndrome using a comprehensive assessment comprising of clinical presentation, electrocardiography, two-dimensional echocardiography (with global longitudinal strain calculation), and cardiac biomarker evaluation. Binomial logistic regression was performed to identify independent predictors of left ventricular systolic dysfunction in leptospirosis. Results: Compared to sepsis syndrome, leptospirosis patients were younger, had higher body mass index measurements and were more likely to be smokers. Electrocardiography abnormalities were common and similar in both groups. Myocardial systolic dysfunction was common in both groups (leptospirosis: 55.86% vs sepsis syndrome: 51.61%, p=0.675) with subclinical left ventricular systolic dysfunction (characterized by abnormal global longitudinal strain and normal left ventricular ejection fraction) being most frequent followed by isolated right ventricular systolic dysfunction, isolated left ventricular systolic dysfunction, and bi-ventricular systolic dysfunction (leptospirosis: 31.43%, 18.42%, 13.16%, 10.53%, respectively; sepsis syndrome: 22.22%, 12.00%, 12.00%, 8.00%, respectively ( p>0.05 for each comparator)). Leptospirosis patients had a trend towards greater troponin-T elevation (61.0% vs 40.0%, p=0.057). ST-segment elevation and elevated troponin were independent predictors of reduced left ventricular ejection fraction in leptospirosis. Conclusions: Cardiac involvement in leptospirosis appears to be similar to that of sepsis syndrome, with myocardial systolic dysfunction being common. As such, clinical vigilance pertaining to cardiac status is paramount in these high-risk patients.

scholarly journals Mid-term outcomes of coronary artery bypass grafting in patients with mild left ventricular systolic dysfunction: a multicentre retrospective cohort study

2021 ◽  
Author(s):  
Hang Zhang ◽  
Ronghui Shi ◽  
Wei Qin ◽  
Wen Chen ◽  
Liangpeng Li ◽  
...  
Keyword(s):  
Adverse Events ◽  
Left Ventricular Systolic Dysfunction ◽  
Artery Bypass ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Repeat Revascularization ◽  
Major Adverse Events

Abstract OBJECTIVES Left ventricular systolic dysfunction (LVSD) is common and associated with adverse events in patients receiving coronary artery bypass grafting (CABG). However, the prognosis of mild LVSD has not been clearly described. We aimed to evaluate the mid-term outcomes of patients with mild LVSD following CABG. METHODS This multicentre cohort study using propensity score matching took place from December 2012 to October 2019 in Jiangsu Province, China, with a mean and maximum follow-up of 3.2 and 7.2 years, respectively. Patients were classified to normal left ventricular systolic function (left ventricular ejection fraction ≥53%) and mild LVSD (left ventricular ejection fraction &gt;40%/&lt;53%). The primary outcomes were death from all causes and death from cardiovascular causes. The secondary outcomes were heart failure, myocardial infarction, repeat revascularization and a composite of all mentioned outcomes, including death from all causes (major adverse events). RESULTS A total of 581 pairs were formed after matching. In-hospital death (1.5% vs 2.1%, P = 0.51) did not differ between 2 cohorts. Throughout 7 years, mild LVSD was associated with higher rates of death from all causes [hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.39–0.89; P = 0.012], death from cardiovascular causes (HR 0.55, 95% CI 0.36–0.90; P = 0.017), heart failure (HR 0.60, 95% CI 0.37–0.93; P = 0.023) and major adverse events (HR 0.66, 95% CI 0.49–0.91; P = 0.009). There was no difference in the rates of myocardial infarction and repeat revascularization. CONCLUSIONS Mild LVSD was associated with a worse mid-term prognosis in patients following CABG.

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