Cardiac symptoms are a survival predictor in sarcoidosis

BACKGROUND: The aim of this study was to evaluate the use of ground-based medical services (GBMS) by the cabin crew of a major South Korean airline for in-flight medical incidents involving passengers.METHODS: We conducted a survey of cabin crew to identify the anticipated use of GBMS in 2017. We compared the anticipated use to actual use as reported in cabin crew records submitted to the GBMS team and cabin crew logs from May 2013 to April 2016.RESULTS: Among 766 team leaders and assistant leaders, 211 individuals answered the questionnaire. A total of 915 instances of GBMS use were reported during the study period. There were no significant differences between anticipated and actual use in terms of the reasons for needing GBMS, with medication prescription being the most common reason. However, there were significant differences in the specific symptoms that triggered contact with GBMS. Pediatric and digestive symptoms were under-predicted, while neuropsychiatric and cardiac symptoms were over-predicted.DISCUSSION: Cabin crew tended to require GBMS to assist with pediatric and digestive conditions more often than anticipated. Furthermore, digestive and pediatric symptoms often require prescription medications.Kim JH, Choi-Kwon S. Ground-based medical services for in-flight emergencies. Aerosp Med Hum Perform. 2020; 91(4):348–351.

Download Full-text

HEART COMPLICATIONS IN HYPERTHYROIDISM

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.2.1 ◽

2011 ◽

pp. 7-17

Author(s):

Hai Thuy Nguyen ◽

Anh Vu Nguyen

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Heart Rate ◽

Heart Diseases ◽

Systolic Dysfunction ◽

Oxygen Demand ◽

Left Ventricular ◽

Cardiac Contraction ◽

Cardiac Complications ◽

Cardiac Symptoms

Thyroid hormone increases the force of the contraction and the amount of the heart muscle oxygen demand. It also increases the heart rate. Due to these reasons, the work of the heart is greatly increased in hyperthyroidism. Hyperthyroidism increases the amount of nitric oxide in the intima, lead them to be dilated and become less stiff. Cardiac symptoms can be seen in anybody with hyperthyroidism, but can be particularly dangerous in whom have underlying heart diseases. Common symptoms include: tachycardia and palpitations. Occult hyperthyroidism is a common cause of an increased heart rate at rest and with mild exertion. Hyperthyroidism can also produce a host of other arrhythmias such as PVCs, ventricular tachycardia and especially atrial fibrillation. Left ventricular diastolic dysfunction and systolic dysfunction, Mitral regurgitation and mitral valve prolapsed are heart complications of hyperthyroism could be detected by echocardiography. The forceful cardiac contraction increases the systolic blood pressure despite the increased relaxation in the blood vessels reduces the diastolic blood pressure. Atrial fibrillation, atrial enlargement and congestive heart failure are important cardiac complications of hyperthyroidism. An increased risks of stroke is common in patients with atrial fibrillation. Graves disease is linked to autoimmune complications, such as cardiac valve involvement, pulmonary arterial hypertension and specific cardiomyopathy. Worsening angina: Patients with coronary artery disease often experience a marked worsening in symptoms with hyperthyroidism. These can include an increase in chest pain (angina) or even a heart attack.

Download Full-text

X-Linked Emery–Dreifuss Muscular Dystrophy: Study Of X-Chromosome Inactivation and Its Relation with Clinical Phenotypes in Female Carriers

Genes ◽

10.3390/genes10110919 ◽

2019 ◽

Vol 10 (11) ◽

pp. 919 ◽

Cited By ~ 1

Author(s):

Viggiano ◽

Madej-Pilarczyk ◽

Carboni ◽

Picillo ◽

Ergoli ◽

...

Keyword(s):

Muscular Dystrophy ◽

X Chromosome ◽

Clinical Symptoms ◽

Fibrous Tissue ◽

X Chromosome Inactivation ◽

Chromosome Inactivation ◽

Cardiac Conduction ◽

Asymptomatic Carriers ◽

Cardiac Symptoms ◽

Female Carriers

X-linked Emery–Dreifuss muscular dystrophy (EDMD1) affects approximately 1:100,000 male births. Female carriers are usually asymptomatic but, in some cases, they may present clinical symptoms after age 50 at cardiac level, especially in the form of conduction tissue anomalies. The aim of this study was to evaluate the relation between heart involvement in symptomatic EDMD1 carriers and the X-chromosome inactivation (XCI) pattern. The XCI pattern was determined on the lymphocytes of 30 symptomatic and asymptomatic EDMD1 female carriers—25 familial and 5 sporadic cases—seeking genetic advice using the androgen receptor (AR) methylation-based assay. Carriers were subdivided according to whether they were above or below 50 years of age. A variance analysis was performed to compare the XCI pattern between symptomatic and asymptomatic carriers. The results show that 20% of EDMD1 carriers had cardiac symptoms, and that 50% of these were ≥50 years of age. The XCI pattern was similar in both symptomatic and asymptomatic carriers. Conclusions: Arrhythmias in EDMD1 carriers poorly correlate on lymphocytes to a skewed XCI, probably due to (a) the different embryological origin of cardiac conduction tissue compared to lymphocytes or (b) the preferential loss of atrial cells replaced by fibrous tissue.

Download Full-text

Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

Netherlands Heart Journal ◽

10.1007/s12471-021-01545-y ◽

2021 ◽

Vol 29 (4) ◽

pp. 224-229 ◽

Cited By ~ 1

Author(s):

E. R. de Koning ◽

M. J. Boogers ◽

J. Bosch ◽

M. de Visser ◽

M. J. Schalij ◽

...

Keyword(s):

Chest Pain ◽

Emergency Medical Services ◽

Medical Services ◽

Cardiac Symptoms ◽

Emergency Medical ◽

Time Period ◽

Number Of Patients ◽

St Elevation ◽

Pain Patients ◽

Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

Download Full-text

Stereotactic Body Radiation Therapy (SBRT) for a Patient with a Myocardial Metastasis: A Case Report

Current Oncology ◽

10.3390/curroncol28010041 ◽

2021 ◽

Vol 28 (1) ◽

pp. 390-395

Author(s):

Aneesh Dhar ◽

Elysia Donovan ◽

Darryl Leong ◽

Sebastien J. Hotte ◽

Anand Swaminath

Keyword(s):

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Mri Scan ◽

Distant Disease ◽

Cardiac Lesion ◽

Stereotactic Body Radiation ◽

Metastatic Lesions ◽

Cardiac Symptoms ◽

Myocardial Metastasis ◽

Magnetic Resonance Imaging Mri

Metastatic lesions of the heart are rare but have the potential to cause significant morbidity. We describe the case of a patient with renal cell carcinoma who presented with shortness of breath and palpitations and was found to have a metastatic myocardial lesion causing arrythmia. He received stereotactic body radiation therapy (SBRT) to alleviate symptoms and provide local control. SBRT planning was executed using a four-dimensional computed tomography (4DCT) scan to account for respiratory and cardiac motion. Images from a planning magnetic resonance imaging (MRI) scan and a gated diagnostic MRI scan of the heart were fused with the 4DCT to assist with delineating the tumour. A dose of 30 Gy in five fractions was delivered without incident. The patient’s cardiac MRI at two months post-treatment showed stability of his cardiac lesion. He subsequently died of distant disease progression, without any recurrence of his cardiac symptoms. SBRT may be considered for patients who present with a symptomatic metastatic cardiac lesion.

Download Full-text

Routine clinical care data from thirteen cardiac outpatient clinics: design of the Cardiology Centers of the Netherlands (CCN) database

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02020-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sophie H. Bots ◽

Klaske R. Siegersma ◽

N. Charlotte Onland-Moret ◽

Folkert W. Asselbergs ◽

G. Aernout Somsen ◽

...

Keyword(s):

Risk Factors ◽

General Practitioner ◽

Data Collection ◽

The Netherlands ◽

Strong Base ◽

Daily Care ◽

Cardiac Symptoms ◽

Number Of Patients ◽

Patient Groups

Abstract Background Despite the increasing availability of clinical data due to the digitalisation of healthcare systems, data often remain inaccessible due to the diversity of data collection systems. In the Netherlands, Cardiology Centers of the Netherlands (CCN) introduced “one-stop shop” diagnostic clinics for patients suspected of cardiac disease by their general practitioner. All CCN clinics use the same data collection system and standardised protocol, creating a large regular care database. This database can be used to describe referral practices, evaluate risk factors for cardiovascular disease (CVD) in important patient subgroups, and develop prediction models for use in daily care. Construction and content The current database contains data on all patients who underwent a cardiac workup in one of the 13 CCN clinics between 2007 and February 2018 (n = 109,151, 51.9% women). Data were pseudonymised and contain information on anthropometrics, cardiac symptoms, risk factors, comorbidities, cardiovascular and family history, standard blood laboratory measurements, transthoracic echocardiography, electrocardiography in rest and during exercise, and medication use. Clinical follow-up is based on medical need and consisted of either a repeat visit at CCN (43.8%) or referral for an external procedure in a hospital (16.5%). Passive follow-up via linkage to national mortality registers is available for 95% of the database. Utility and discussion The CCN database provides a strong base for research into historically underrepresented patient groups due to the large number of patients and the lack of in- and exclusion criteria. It also enables the development of artificial intelligence-based decision support tools. Its contemporary nature allows for comparison of daily care with the current guidelines and protocols. Missing data is an inherent limitation, as the cardiologist could deviate from standardised protocols when clinically indicated. Conclusion The CCN database offers the opportunity to conduct research in a unique population referred from the general practitioner to the cardiologist for diagnostic workup. This, in combination with its large size, the representation of historically underrepresented patient groups and contemporary nature makes it a valuable tool for expanding our knowledge of cardiovascular diseases. Trial registration: Not applicable.

Download Full-text

Silent severe myocardial ischemia in a past illicit drug user imaged with myocardial perfusion scintigraphy

Perfusion ◽

10.1177/02676591211028175 ◽

2021 ◽

pp. 026765912110281

Author(s):

Chrissa Sioka ◽

Georgios Georgiou ◽

Christos Katsouras ◽

Konstantinos Pappas ◽

Dimitris-Nikiforos Kiortsis ◽

...

Keyword(s):

Drug Use ◽

Myocardial Perfusion ◽

Myocardial Ischemia ◽

Illicit Drugs ◽

Illicit Drug ◽

Microvascular Dysfunction ◽

Illicit Drug Use ◽

Coronary Microvascular Dysfunction ◽

Illicit Drug User ◽

Cardiac Symptoms

Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings.

Download Full-text