scholarly journals Challenges with Takayasu arteritis in pregnancy: a case report

2021 ◽  
Vol 10 (5) ◽  
pp. 2115
Author(s):  
Monika Dalal ◽  
Vani Malhotra ◽  
Smiti Nanda ◽  
Meenakshi Chauhan ◽  
Vandana Rani ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Interdisciplinary Collaboration ◽  
Pulmonary Arteries ◽  
Good Control ◽  
Cardiovascular Complications ◽  
Unknown Etiology ◽  
Chronic Hypertension ◽  
Increased Risk ◽  
Life Threatening ◽  
Female Baby

Takayasu’s arteritis (TA) is a rare, chronic, inflammatory, large vessel vasculitis (LVV) of unknown etiology characterized by narrowing, occlusion, and aneurysms of systemic and pulmonary arteries affecting especially the aorta and its branches. Pregnant patients are at increased risk of cardiovascular complications, including hypertension and congestive heart failure, which may jeopardize both maternal and fetal outcomes, so one should pay special attention to these patients. We present a case of 30-year-old female G5P3L2A1 with 9 months of amenorrhea with previous 2 LSCS with chronic hypertension and superimposed pre-eclampsia with oligohydraminos. She was a known case of Takayasu arteritis, diagnosed since she was 16 years old. Her lower limb pulses were palpable with absent upper limb pulses. On Echocardiography there was dilated aortic root, moderate MR and LVEF was 55%. She proceeded to have emergency LSCS under spinal anesthesia in view of severe pre-eclampsia with previous 2 LSCS at 35 week and delivered alive healthy female baby weight 2.1 kg. A life-threatening maternal cardiovascular complication is observed in more than 5% of pregnant women with TA. Hypertension is present in 90% cases of Takayasu arteritis. A good control of TA disease activity and arterial hypertension before conception and during pregnancy is important to improve feto-maternal outcomes. Pregnancies in the setting of TA should be considered high-risk, requiring a close interdisciplinary collaboration of rheumatologists, nephrologists and obstetrician’s specialists involved in care of TA.

Challenges of Takayasu Arteritis in Pregnancy: A Case Report

2017 ◽  
Vol 51 (4) ◽  
pp. 195-198 ◽  
Author(s):  
Sarah Soo-Hoo ◽  
Jenny Seong ◽  
Brandon R. Porten ◽  
Nedaa Skeik
Keyword(s):  
Heart Failure ◽  
Takayasu Arteritis ◽  
Cardiovascular Complications ◽  
Unknown Etiology ◽  
Optimal Management ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Clinical Challenge ◽  
Increased Risk ◽  
In Pregnancy

Takayasu arteritis is a rare, chronic vasculitis of unknown etiology characterized by inflammation of the aorta and its main branches. Although Takayasu arteritis mostly affects women of childbearing age, there is a paucity in the literature on pregnancy associated with Takayasu arteritis. Pregnant patients are at increased risk of cardiovascular complications, including hypertension and congestive heart failure, which may jeopardize both maternal and fetal outcomes. Furthermore, optimal management has not yet been established for pregnant patients with Takayasu arteritis, posing a clinical challenge. We present a case of a young woman with Takayasu arteritis whose symptoms and disease activity improved during 2 pregnancies. Although her first pregnancy was complicated with preeclampsia, gestational diabetes, and preterm vaginal delivery, her second pregnancy was uneventful. This case provides a rare glimpse of Takayasu arteritis in pregnancy and highlights the challenges of medical management in gravid patients.

scholarly journals Cesarean Section in a COVID-19 Positive Patient with Takayasu Arteritis: A Case Report

2020 ◽  
Vol 3 (2) ◽  
pp. 38-40
Author(s):  
Ritesh Lamsal ◽  
Navindra Raj Bista ◽  
Utsav Acharya ◽  
Pankaj Joshi ◽  
Anil Shrestha
Keyword(s):  
Cesarean Section ◽  
Takayasu Arteritis ◽  
Anesthetic Management ◽  
Cardiovascular Complications ◽  
Elective Cesarean Section ◽  
Chronic Hypertension ◽  
Tissue Hypoperfusion ◽  
Resource Limited ◽  
Elective Cesarean ◽  
Concomitant Hypertension

Takayasu arteritis is an idiopathic, granulomatous aorto-arteritis that usually affcts young or middle-aged women. The anesthetic management of patients with Takayasu arteritis undergoing cesarean section with COVID-19 is challenging. Patients may have concomitant hypertension, tissue hypoperfusion with the potential for major perioperative cardiovascular complications. The challenges increase considerably in resource-limited settings. We report the case of a 27-year-old primigravida at 39 weeks of gestation with concomitant Takayasu arteritis, chronic hypertension, hypothyroidism, and COVID-19, who underwent an elective cesarean section at our hospital. She incidentally tested positive for SARS-CoV-2 after admission to the hospital. The cesarean section was successfully performed under subarachnoid block. We are not aware of any previous publication describing the anesthetic management in patients with Takayasu arteritis and COVID-19 undergoing cesarean section.

scholarly journals The risk of cardiovascular complications in inflammatory bowel disease

2020 ◽  
Vol 20 (4) ◽  
pp. 481-491
Author(s):  
Piotr Czubkowski ◽  
Marcin Osiecki ◽  
Edyta Szymańska ◽  
Jarosław Kierkuś
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Cardiovascular Complications ◽  
Unknown Etiology ◽  
Increased Risk ◽  
Inflammatory Processes ◽  
Inflammatory Bowel ◽  
Atherosclerosis Development ◽  
Physiologic Regulation ◽  
Insight Into

Abstract Inflammatory bowel disease (IBD) is a chronic, relapsing disease of unknown etiology involving gastrointestinal tract. IBD comprises two main entities: ulcerative colitis and Crohn’s disease. Several studies showed increased risk of cardiovascular complications in chronic inflammatory disorders, especially during IBD relapses. Endothelium plays a role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction is associated with increased risk of atherosclerosis development. There are several potential links between chronic IBD-related inflammatory processes and the risk of cardiovascular disease, but insight into pathogenetic pathways remains unclear. We present the current concepts and review of adult and pediatric studies on the risk of CVD in IBD.

scholarly journals Takayasu’s Arteritis in Pregnancy: A Rare Case Report from a Tertiary Care Infirmary in India

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Sheeba Marwah ◽  
Monika Rajput ◽  
Ritin Mohindra ◽  
Harsha S. Gaikwad ◽  
Manjula Sharma ◽  
...  
Keyword(s):  
Late Onset ◽  
Takayasu’S Arteritis ◽  
Interdisciplinary Collaboration ◽  
Tertiary Care ◽  
Pulmonary Arteries ◽  
Reproductive Age ◽  
Chronic Hypertension ◽  
Takayasu's Arteritis ◽  
Rare Case Report ◽  
Reproductive Age Group

Background. Takayasu’s arteritis (TA) is a rare, chronic, inflammatory, progressive, idiopathic arteriopathy, afflicting young women of reproductive age group, causing narrowing, occlusion, and aneurysms of systemic and pulmonary arteries, especially the aorta and its branches. During pregnancy, such patients warrant special attention. An interdisciplinary collaboration of obstetricians, cardiologists, and neurologists is necessary to improve maternal and fetal prognosis. Here a case is reported where a patient with diagnosis of TA, complicated by neurological sequelae, successfully fought the vagaries of the condition twice to deliver uneventfully.Case. 25-year-old G2P1L1 presented at 34 weeks of gestation, with chronic hypertension, with TA, with epilepsy, and with late-onset severe IUGR. Following a multidisciplinary approach, she delivered an alive born low birth weight baby (following induction). Her postpartum course remained uneventful.Conclusion. Pregnancy with TA poses a stringent challenge to an obstetrician. Despite advancements in cardiovascular management and advent of new-fangled drugs, the optimal management for pregnant patients with this disease still remains elusive.

The Role of Revascularisation in Patients Undergoing Non-cardiac Surgery

2010 ◽  
Vol 5 (1) ◽  
pp. 104
Author(s):  
Daniel S Menees ◽  
Eric R Bates ◽  
◽  
Keyword(s):  
Cardiac Surgery ◽  
Prediction Models ◽  
Cardiovascular Complications ◽  
Weight Of Evidence ◽  
Beta Blockade ◽  
Cardiac Morbidity ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Artery Disease ◽  
Risk Reduction Strategies

Coronary artery disease (CAD) affects millions of US citizens. As the population ages, an increasing number of people with CAD are undergoing non-cardiac surgery and face significant peri-operative cardiac morbidity and mortality. Risk-prediction models can be used to help identify those patients at increased risk of peri-operative cardiovascular complications. Risk-reduction strategies utilising pharmacotherapy with beta blockade and statins have shown the most promise. Importantly, the benefit of prophylactic coronary revascularisation has not been demonstrated. The weight of evidence suggests reserving either percutaneous or surgical revascularisation in the pre-operative setting for those patients who would otherwise meet independent revascularisation criteria.

CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

2020 ◽  
Vol 30 (3) ◽  
pp. 56-59
Author(s):  
Jūratė Gudaitytė ◽  
Justina Jermolajevaitė ◽  
Martynas Judickas
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
General Population ◽  
Metabolic Disorders ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Case Presentation ◽  
Increased Risk ◽  
Fluid Regulation ◽  
Class Iv

Background and objectives: Acromegaly is endocri­nal disorder which results in changes involving ge­neral appearance as well as upper airway abnorma­lities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to compli­cations. We aim to discuss the challenges for anesthe­siologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presen­ted the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallam­pati score IV and ASA class IV. The complemen­tary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for furt­her monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthe­sia compared to general population due to difficult intubation, cardiovascular complications , OSA , alte­ration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and as­sessment are necessary to predict and prepare for possible difficulties in the surgery room.

Cardiovascular Complications in Patients with Klinefelter’s Syndrome

2020 ◽  
Vol 26 (43) ◽  
pp. 5556-5563
Author(s):  
Franz Sesti ◽  
Riccardo Pofi ◽  
Carlotta Pozza ◽  
Marianna Minnetti ◽  
Daniele Gianfrilli ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Klinefelter Syndrome ◽  
Subclinical Atherosclerosis ◽  
Cardiovascular Complications ◽  
High Risk Population ◽  
Metabolic Disturbances ◽  
Future Studies ◽  
Increased Risk ◽  
Chromosome Disorder

More than 70 years have passed since the first description of Klinefelter Syndrome (KS), the most frequent chromosome disorder causing male infertility and hypogonadism. KS is associated with increased cardiovascular (CV) mortality due to several comorbidities, including hypogonadism, as well as metabolic syndrome and type 2 diabetes, which are highly prevalent in these patients. Aside from metabolic disturbances, patients with KS suffer from both acquired and congenital CV abnormalities, cerebrovascular thromboembolic disease, subclinical atherosclerosis and endothelial dysfunction, which may all contribute to increased CV mortality. The mechanisms involved in this increased risk of CV morbidity and mortality are not entirely understood. More research is needed to better characterise the CV manifestations, elucidate the pathophysiological mechanisms and define the contribution of testosterone replacement to restoring CV health in KS patients. This review explores the complex association between KS, metabolic syndrome and CV risk in order to plan future studies and improve strategies to reduce mortality in this high-risk population.

Cardiovascular Complications of Sleep Disorders: A Better Night’s Sleep for a Healthier Heart / From Bench to Bedside

2020 ◽  
Vol 19 (2) ◽  
pp. 210-232 ◽  
Author(s):  
Theodora A. Manolis ◽  
Antonis A. Manolis ◽  
Evdoxia J. Apostolopoulos ◽  
Helen Melita ◽  
Antonis S. Manolis
Keyword(s):  
Sleep Disorders ◽  
Disease Risk ◽  
Behavioral Therapy ◽  
Benzodiazepine Receptor ◽  
Cardiovascular Complications ◽  
Gamma Aminobutyric Acid ◽  
Acid Type ◽  
Increased Risk ◽  
Cv Disease ◽  
Meta Analyses

: Sleep is essential to and an integral part of life and when lacking or disrupted, a multitude of mental and physical pathologies ensue, including cardiovascular (CV) disease, which increases health care costs. Several prospective studies and meta-analyses show that insomnia, short (<7h) or long (>9h) sleep and other sleep disorders are associated with an increased risk of hypertension, metabolic syndrome, myocardial infarction, heart failure, arrhythmias, CV disease risk and/or mortality. The mechanisms by which insomnia and other sleep disorders lead to increased CV risk may encompass inflammatory, immunological, neuro-autonomic, endocrinological, genetic and microbiome perturbations. Guidelines are emerging that recommend a target of >7 h of sleep for all adults >18 years for optimal CV health. Treatment of sleep disorders includes cognitive-behavioral therapy considered the mainstay of non-pharmacologic management of chronic insomnia, and drug treatment with benzodiazepine receptor agonists binding to gamma aminobutyric acid type A (benzodiazepine and non-benzodiazepine agents) and some antidepressants. However, observational studies and meta-analyses indicate an increased mortality risk of anxiolytics and hypnotics, although bias may be involved due to confounding and high heterogeneity in these studies. Nevertheless, it seems that the risk incurred by the non-benzodiazepine hypnotic agents (Z drugs) may be relatively less than the risk of anxiolytics, with evidence indicating that at least one of these agents, zolpidem, may even confer a lower risk of mortality in adjusted models. All these issues are herein reviewed.

scholarly journals Incidence, characteristics, determinants and prognostic impact of recurrent syncope

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Zimmermann ◽  
J Du Fay De Lavallaz ◽  
T Nestelberger ◽  
D Gualandro ◽  
P Badertscher ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Coronary Intervention ◽  
Final Diagnosis ◽  
Major Adverse Cardiovascular Events ◽  
Unknown Etiology ◽  
Funding Source ◽  
Prognostic Impact ◽  
Lasso Regression ◽  
Recurrence Rates ◽  
Increased Risk

Abstract Background The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians. Methods We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism. Results Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures. Conclusion Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

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