Late diagnosis of coarctation of the aorta in a 44-year-old male: a case report

Abstract Background Coarctation of the aorta is a rare congenital disease. In adults, the main manifestations include hypertension, weak or absent femoral pulses, heart failure, and left ventricular hypertrophy. Case presentation We present a case involving a late diagnosis of coarctation of the aorta detected during aortography in a 44-year-old man. The patient underwent stent implantation and aortoplasty. After 2 years of follow-up, the patient was in good condition. Conclusions This case shows that coarctation of the aorta can be cured and that hypertension caused by the condition can be controlled to some extent with medication. Based on our findings, we recommend a detailed physical examination for all patients suspected of having coarctation of the aorta; the examination should include blood pressure measurements of both the upper and lower extremities. The case of coarctation of the aorta is not common or easy to be found in medium-aged population. Better BP control, earlier repair, and transcatheter intervention may result in a good outcome in that case.

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Long-term effects of balloon angioplasty on left ventricular hypertrophy in adolescent and adult patients with native coarctation of the aorta. Up to 18 years follow-up results

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.21287 ◽

2007 ◽

Vol 70 (6) ◽

pp. 881-886 ◽

Cited By ~ 21

Author(s):

Walid Hassan ◽

Mahmoud Awad ◽

Mohamed Eid Fawzy ◽

Ahmad Al Omrani ◽

Shahid Malik ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Balloon Angioplasty ◽

Ventricular Hypertrophy ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Adult Patients ◽

Long Term Effects

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Cardiac Amyloidosis with Discordant QRS Voltage between Frontal and Precordial Leads

Medicina ◽

10.3390/medicina57070660 ◽

2021 ◽

Vol 57 (7) ◽

pp. 660

Author(s):

Csilla-Andrea Eötvös ◽

Roxana-Daiana Lazar ◽

Iulia-Georgiana Zehan ◽

Erna-Brigitta Lévay-Hail ◽

Giorgia Pastiu ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Cardiac Amyloidosis ◽

Ventricular Hypertrophy ◽

Low Voltage ◽

Disease Process ◽

Left Ventricular ◽

Clinical Suspicion ◽

Immunoglobulin Light Chain ◽

Different Types

Among the different types, immunoglobulin light chain (AL) cardiac amyloidosis is associated with the highest morbidity and mortality. The outcome, however, is significantly better when an early diagnosis is made and treatment initiated promptly. We present a case of cardiac amyloidosis with left ventricular hypertrophy criteria on the electrocardiogram. After 9 months of follow-up, the patient developed low voltage in the limb leads, while still maintaining the Cornell criteria for left ventricular hypertrophy as well. The relative apical sparing by the disease process, as well as decreased cancellation of the opposing left ventricular walls could be responsible for this phenomenon. The discordance between the voltage in the frontal leads and precordial leads, when present in conjunction with other findings, may be helpful in raising the clinical suspicion of cardiac amyloidosis.

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Abstract 15607: Right Atrial Reservoir Strain Predicts Survival in Patients With Cardiac Amyloidosis

Circulation ◽

10.1161/circ.142.suppl_3.15607 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Peter Huntjens ◽

Kathleen Zhang ◽

Yuko Soyama ◽

Maria Karmpalioti ◽

Daniel Lenihan ◽

...

Keyword(s):

Cardiac Amyloidosis ◽

Ventricular Hypertrophy ◽

Cardiac Tissue ◽

Fold Increase ◽

Left Ventricular ◽

Right Atrial ◽

Chamber View ◽

All Cause Mortality ◽

And Function

Introduction: Myofibril deposition in amyloidosis diffusely may affect cardiac structure and function. Right ventricular involvement has been associated with adverse clinical outcome. However, the utility of right atrial (RA) function assessment by echocardiographic strain imaging is unclear. Hypothesis: We hypothesize that right atrial stain has prognostic value in cardiac amyloidosis. Methods: We studied 121 consecutive patients with cardiac amyloidosis: 18% had transthyretin and 79% had light chain amyloidosis. Cardiac amyloidosis was either confirmed by endocardial biopsy (36%) or by a combination of non-cardiac tissue biopsy and proof of left ventricular hypertrophy (64%). Speckle tracking peak RA reservoir strain was assessed based on 6 segments from the apical 4-chamber view. All-cause mortality was tracked over a median of 5 years. Results: Echocardiographic peak longitudinal RA strain was feasible in 109 patients (90%). 60 CA patients died during follow-up period. Peak longitudinal RA strain was reduced in cardiac amyloidosis non-survivors (8.1%) in comparison to survivors (18.3%, p<0.01), showing RA involvement in cardiac amyloidosis. Peak RA strain was significantly associated with survival (using median 12.5%) (p<0.001). Low peak longitudinal RA strain was associated with a 3.3-fold increase in mortality risk (95% confidence interval: 1.83 - 5.96). Conclusions: Reduced peak longitudinal RA strain was significantly associated with survival in patients with cardiac amyloidosis. RA reservoir function assessed by strain appears to be useful as a new means to predict prognosis in cardiac amyloidosis patients and has promise for clinical application.

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Incidental Finding of an Undiagnosed Coarctation of the Aorta Causing Dilated Cardiomyopathy in an Adult

Case Reports in Cardiology ◽

10.1155/2017/6129073 ◽

2017 ◽

Vol 2017 ◽

pp. 1-2

Author(s):

Abdalla Ibrahim ◽

Zahir Satti ◽

Ronan Curtin

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Incidental Finding ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Descending Aorta ◽

Arm Pain ◽

Left Ventricular Dilation ◽

History Of

31-year-old male with no past medical history apart from high blood pressure noted by GP one week prior to admission presented with a three-week history of a flu-like illness and symptoms of heart failure with severe global left ventricular dilation and dysfunction on Transthoracic Echocardiography (TTE). Two weeks following admission he complained of left arm pain and CT upper limb confirmed embolic occlusion of the left brachial artery and incidental severe coarctation of the proximal descending aorta after the origin of the left subclavian artery. Follow-up TTE suggested the presence of coarctation of the aorta on a suprasternal view which was not performed at the time of his first TTE. His heart failure and blood pressure responded very well to medical therapy and he has been referred for surgical correction of his aortic coarctation.

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Electrocardiographic changes in patients with cardiac rhabdomyomas associated with tuberous sclerosis

Cardiology in the Young ◽

10.1017/s1047951103000507 ◽

2003 ◽

Vol 13 (3) ◽

pp. 258-263 ◽

Cited By ~ 12

Author(s):

Junko Shiono ◽

Hitoshi Horigome ◽

Seiyo Yasui ◽

Tomoyuki Miyamoto ◽

Miho Takahashi-Igari ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Left Ventricular Hypertrophy ◽

Tuberous Sclerosis ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Cardiac Rhabdomyoma ◽

Ventricular Cavity ◽

Electrocardiographic Changes

Background:Cardiac rhabdomyomas associated with tuberous sclerosis induce various abnormalities in the electrocardiogram. Electrocardiographic evidence of ventricular hypertrophy may appear if the tumour is electrically active. To our knowledge, electrocardiographic evidence of ventricular hypertrophy has been reported only in association with congestive heart failure. Follow-up studies of changes in electrocardiographic findings are also lacking.Methods:We studied 21 consecutive patients with cardiac rhabdomyoma associated with tuberous sclerosis, 10 males and 11 females, aged from the date of birth to 9 years at diagnosis. The mean period of follow-up was 53 months. None of the patients developed congestive heart failure. We evaluated the electrocardiographic changes during the follow-up, and their association with echocardiographic findings.Results:Of the 21 patients, 12 showed one or more abnormalities on the electrocardiogram at presentation, with five demonstrating right or left ventricular hypertrophy. In all of these five cases, the tumours were mainly located in the respective ventricular cavity. In one patient with a giant tumour expanding exteriorly, there was marked left ventricular hypertrophy on the electrocardiogram. Followup studies showed spontaneous regression of the tumours in 12 of 19 patients, with abnormalities still present in only 7 patients. A gradual disappearance of left ventricular hypertrophy as seen on the electrocardiogram was noted in the patient with marked left ventricular hypertrophy at presentation in parallel with regression of the tumour.Conclusions:The presence of cardiac rhabdomyomas in patients with tuberous sclerosis might explain the ventricular hypertrophy seen on the electrocardiogram through its electrically active tissue without ventricular pressure overload or ventricular enlargement, although pre-excitation might affect the amplitude of the QRS complex. Even in cases with large tumours, nonetheless, the electric potential might not alter the surface electrocardiogram if the direction of growth of the tumour is towards the ventricular cavity. In many cases, electrocardiographic abnormalities tend to disappear, concomitant with regression of the tumours.

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COARCTATION OF THE AORTA WITH CONGESTIVE HEART FAILURE IN INFANCY—MEDICAL TREATMENT

PEDIATRICS ◽

10.1542/peds.17.1.45 ◽

1956 ◽

Vol 17 (1) ◽

pp. 45-57

Author(s):

Henry T. Lang ◽

Alexander S. Nadas

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Medical Treatment ◽

Ventricular Hypertrophy ◽

Failure To Thrive ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Late Childhood ◽

Feeding Problems ◽

Left And Right

Nine infants with uncomplicated coarctation of the aorta in congestive heart failure are presented. The symptomatology was dominated by feeding problems, failure to thrive, dyspnea, and cyanosis. On physical examination, in addition to signs referable to the coarctation, signs of both left and right-sided congestive heart failure were noted. The roentgenographic survey revealed marked generalized cardiomegaly and pulmonary congestion. Electrocardiograms in the infants less than 6 months of age showed left, right, or combined ventricular hypertrophy, whereas those more than 6 months of age all showed left ventricular hypertrophy. Medical treatment, consisting of digitalis, oxygen, mercurial diuretics, diet low in sodium, and antibiotics, was successful in all instances. Digitalization was maintained throughout infancy. Operative intervention can be safely postponed until late childhood unless medical management is not successful. A review of the pertinent literature is presented.

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Paediatric inflammatory multisystem syndrome temporally associated with COVID-19: a new virus and a new case presentation

BMJ Case Reports ◽

10.1136/bcr-2020-238531 ◽

2020 ◽

Vol 13 (12) ◽

pp. e238531

Author(s):

Phoebe Makiello ◽

Sima Svirpliene ◽

Lisa Finlay ◽

Jean McKnight

Keyword(s):

Clinical Symptoms ◽

Late Phase ◽

Upper Airway ◽

Intravenous Immunoglobulins ◽

Left Ventricular ◽

Haemodynamic Instability ◽

Case Presentation ◽

Full Resolution ◽

Inflammatory Syndrome

An 11-year-old boy presented with features resembling those described in health alerts on Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), including persistent fever, haemodynamic instability and abdominal pain. Laboratory tests, including raised inflammatory markers, D-dimer, troponin and a coagulopathy, were consistent with PIMS-TS. Our patient required transfer to the paediatric intensive care unit; an echocardiography revealed left ventricular dysfunction. He was treated with intravenous immunoglobulins (Igs), corticosteroids and aspirin, with full resolution of clinical symptoms. A follow-up echocardiogram 1 month after discharge was unremarkable.Three SARS-CoV-2 PCRs on respiratory samples, taken over the initial 4-day period, were negative, as was a SARS-CoV-2 PCR on faeces 1 month after presentation; titres of IgG were clearly elevated. The negative PCRs in the presence of elevated titres of IgG suggest that the inflammatory syndrome might have developed in a late phase of COVID-19 infection when the virus was no longer detectable in the upper airway.

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