scholarly journals THE PREVALENCE OF THROMBOTIC EVENTS IN CHILDREN WITH HEART FAILURE ON THE BACKGROUND OF THE DILATED CARDIOMYOPATHY PHENOTYPE

2019 ◽  
Vol 21 (2) ◽  
pp. 78-84
Author(s):  
Yuliya V. Derevnina ◽  
E. N. Basargina ◽  
K. V. Savostyanov ◽  
A. A. Pushkov ◽  
O. B. Gordeeva
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Dilated Cardiomyopathy ◽  
Thrombus Formation ◽  
Superior Vena ◽  
Systolic Dysfunction ◽  
Vena Cava ◽  
Mthfr Gene ◽  
Functional Class ◽  
Class Iii

Thrombotic events seem to be one of the most common and severe complications having a direct impact on the course of the disease in patients with cardiomyopathy.There were examined 94 children with dilated cardiomyopathy (DCMP) phenotype [49 children with dilated cardiomyopathy (DCMP), including 45 patients with non-compaction cardiomyopathy (NCMP) and remodeling in dilated phenotype]. Thromboses were diagnosed in 9 patients, including 7 DCMP and 2 NCMP cases. In 4 DCMP children, the thrombus was localized in the cavity of the left ventricle, one in the left atrium, the right ventricle, and the inferior vena cava. In NCMP children, intracardiac thrombus formation was not determined, one patient was diagnosed with an acute ischemic disorder of the cerebral circulation; in the second one, the thrombus was detected in the superior vena cava. Thrombosis in DCMP patients was detected against a background of a severe systolic dysfunction of the left ventricle (LVEF of below 30%), and in NCMP children with a moderate dysfunction. Also, the greatest prevalence rate of thrombotic complications was noted in Functional Class III and IV heart failure cases. At the same time, there was no established any influence of polymorphic markers G1691A of gene F5, G20210A of gene F2, C677T of MTHFR gene on the prevalence of thrombotic events. The authors believe the formation of thrombi with the severe LV dysfunction in children with cMYP should be taken into account in the determination the tactics of the treatment of such patients, as it is necessary to make a decision about administering antithrombotic therapy.

scholarly journals Study of digoxin use in a public health unit

2015 ◽  
Vol 87 (2) ◽  
pp. 1033-1040 ◽  
Author(s):  
Felipe C. Souza ◽  
Emiliana B. Marques ◽  
Rogério B.M. Scaramello ◽  
B.V. Christianne
Keyword(s):  
Public Health ◽  
Heart Failure ◽  
Therapeutic Range ◽  
Systolic Dysfunction ◽  
Functional Class ◽  
Ventricular Rate ◽  
Health Unit ◽  
Class Iii ◽  
Plasma Digoxin ◽  
Public Health Unit

Digoxin is used for heart failure associated to systolic dysfunction and high ventricular rate. It has a narrow therapeutic range and intoxication may occur due to drug interactions or comorbidities. The aim of this work was to study digoxin use in a public health unit delineating the profile of patients susceptible to digitalis intoxication. Medical records belonging to patients admitted to the cardiomyopathy ward of the health unit (2009-2010) and in use of digoxin were analyzed. Among 647 patients admitted, 185 individuals using digoxin and possessed records available. The registration of plasma digoxin concentration was found in 80 records and it was out of the therapeutic range in 42 patients (52.5%). This group of individuals was constituted mainly by males patients (79%), functional class III of heart failure (65%), exhibiting renal failure (33%). The evaluated sample reflects the epidemiology of heart failure in Brazil and, although pharmacotherapy had been according to Brazilian Guidelines, apparently the monitoring was not performed as recommended. This work highlighs the necessity of plasma digoxin constant monitoring during pharmacotherapy and the development of protocols that enable a safer use, especially in male patients, functional class III and with renal dysfunction.

Sustained paradoxical vasodilation during orthostasis in heart failure: a factor in the edema pathogenesis?

1994 ◽  
Vol 267 (2) ◽  
pp. H443-H448 ◽  
Author(s):  
H. Wroblewski
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Dilated Cardiomyopathy ◽  
Regional Blood Flow ◽  
Functional Class ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Pathophysiological Mechanism ◽  
Class Iii ◽  
Control Subjects ◽  
Subcutaneous Blood Flow

Baroreceptor-induced peripheral reflex vasoconstriction during upright posture is an important edema-prevention mechanism in humans. Congestive heart failure (CHF) has been associated with blunted baroreceptor control of regional blood flow during short-term head-up tilt. The effect of prolonged unloading of baroreceptors on subcutaneous blood flow of the calf was investigated in 12 healthy subjects and in 13 patients with severe idiopathic dilated cardiomyopathy (New York Heart Association functional class III or IV). The subjects were studied both supine and sitting for 3-h periods. When sitting, subcutaneous vascular resistance decreased -26 +/- 19% in CHF patients and increased 90 +/- 69% in control subjects (P < 0.0001). The corresponding subcutaneous blood flow increased 43 +/- 29% in patients with CHF compared with the decrease of -42 +/- 17% in control subjects (P < 0.0001). I conclude that patients with CHF secondary to idiopathic dilated cardiomyopathy have an abnormal baroreceptor-mediated peripheral vasodilation during orthostatic stress that is sustained for hours. This extended paradoxical vasodilation may participate as an additional pathophysiological mechanism contributing to lower extremity edema in patients with CHF.

scholarly journals SPECIAL ASPECTS OF IMPLANTATION OF A HEART PUMP SUPPORT SYSTEM AVK-N AS A «BRIDGE» TO HEART TRANSPLANTATION

2018 ◽  
Vol 20 (1) ◽  
pp. 13-22 ◽  
Author(s):  
T. A. Khalilulin ◽  
V. M. Zacharevich ◽  
V. N. Poptsov ◽  
G. P. Itkin ◽  
A. O. Shevchenko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Heart Transplantation ◽  
Systolic Dysfunction ◽  
Functional Class ◽  
Circulatory Support ◽  
Federal State ◽  
National Medical ◽  
Optimal Drug ◽  
Terminal Heart Failure

Aim:to develop an optimal surgical tactic for implantation of “AVK-N” system as a “bridge” to heart transplantation.Materials and methods.17 patients were included. They were operated in the period from 2012 to October 2017 in Federal State Budgetary Institution «V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs». A tiny implantable system «Portable device for assisting cardiac circulation» (AVK-N; Russia) was used for replacing the pumping function of the left ventricle. All patients were examined according to the program of potential recipients for heart transplantation, before the applying of prolonged mechanical circulatory support. Among the operated patients there were 16 (94.1%) men and 1 (5.9%) woman, the average age was 52.64 ± 10.56 (from 33 to 67 years). All patients had congestive heart failure III–IV functional class according to NYHA, refractory to optimal drug therapy. Heart failure was triggered by dilated cardiomyopathy in 12 (70,58%) cases, and by postinfarction systolic dysfunction of the left ventricle in 5 (29,42%). Implantation of «AVK-N» system was performed to potential recipients of the donor heart with terminal stage of CHF with a decrease in LV ejection fraction up to 10%.Results.As a result of this study there were developed several technological aspects facilitating the subsequent heart transplantation.Conclusion.Our experience in optimizing the surgical tactics of the “AVK-N” system implantation as a bridge to heart transplantation, demonstrated the possibility and safety of its active use in both patients with terminal heart failure on the waiting list of heart transplantation and patients having temporary contraindications to HTX.

scholarly journals Evaluation of NT-proBNP in children with heart failure younger than 3 years old

2017 ◽  
Vol 55 (2) ◽  
pp. 69-74
Author(s):  
Daniela Iacob ◽  
Angela Butnariu ◽  
Daniel-Corneliu Leucuţa ◽  
Gabriel Samaşca ◽  
Diana Deleanu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Natriuretic Peptide ◽  
Congenital Heart ◽  
Systolic Function ◽  
Heart Diseases ◽  
Functional Class ◽  
Congenital Heart Diseases

Abstract Introduction. Heart failure (HF) is characterized by neuroendocrine activation. The cardiac natriuretic hormones, including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), together with their related pro-peptides (proANP and proBNP) represent a group of peptide hormones produced by the heart. A normal NT-proBNP level has a high negative predictive value for heart failure. The use of NT-proBNP testing is helpful in diagnosing acute HF in the emergency care setting, allowing an early and optimal treatment. The purpose of this study is to assess the prognostic value of NT-proBNP in heart failure in children younger than 3 years old and to establish whether it correlates with the NYHA/Ross functional class and left ventricle systolic function. Methods. We enrolled 24 consecutive children with HF due to congenital heart diseases and dilated cardiomyopathy. The serum levels of NT-proBNP were measured, all patients underwent echocardiography and left ventricle ejection fraction was calculated. Results. The highest median value of NT-proBNP was recorded in patients with cyanotic heart diseases (248.0 fmol/mL), p = 0.610. NT-proBNP had a negative correlation with the ejection fraction of the left ventricle: Spearman's rank correlation coefficient was −0.165. Conclusions. NT-proBNP levels correlate with the severity of HF in infants and small children younger than 3 years old with heart failure due to congenital heart diseases and dilated cardiomyopathy.

Life-threatening Takotsubo Cardiomyopathy

2011 ◽  
Vol 9 (2) ◽  
pp. 119 ◽  
Author(s):  
Karen Mrejen-Shakin ◽  
Ricardo Lopez ◽  
Mohandas M Shenoy ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Acute Heart Failure ◽  
Takotsubo Cardiomyopathy ◽  
Stress Test ◽  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Assisted Ventilation ◽  
Two Dimensional ◽  
Life Threatening

Objective:To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.Methods:A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.Results:The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.Conclusions:Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.

scholarly journals Sudden Cardiac Death in Hereditary Dilated Cardiomyopathy

2020 ◽  
Author(s):  
Marianna Leopoulou ◽  
Jo Ann LeQuang ◽  
Joseph V. Pergolizzi ◽  
Peter Magnusson
Keyword(s):  
Sudden Cardiac Death ◽  
Left Ventricle ◽  
Sudden Death ◽  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Cardiac Death ◽  
Disease Risk ◽  
Systolic Dysfunction ◽  
Preventive Strategies ◽  
Genetic Origin

Dilated cardiomyopathy (DCM) is characterized by the phenotype of a dilated left ventricle with systolic dysfunction. It is classified as hereditary when it is deemed of genetic origin; more than 50 genes are reported to be related to the condition. Symptoms include, among others, dyspnea, fatigue, arrhythmias, and syncope. Unfortunately, sudden cardiac death may be the first manifestation of the disease. Risk stratification regarding sudden death in hereditary DCM as well as preventive management poses a challenge due to the heterogeneity of the disease. The purpose of this chapter is to present the epidemiology, risk stratification, and preventive strategies of sudden cardiac death in hereditary DCM.

scholarly journals Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

2019 ◽  
Vol 28 (1) ◽  
pp. 3-13 ◽  
Author(s):  
J. F. Veenis ◽  
J. J. Brugts
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Heart Association ◽  
The United States ◽  
Pharmacological Therapy ◽  
Functional Class ◽  
Class Iii ◽  
Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

scholarly journals An Echocardiographic Evaluation of Dilated Cardiomyopathy in a Tertiary Care Hospital

2019 ◽  
Vol 57 (215) ◽  
Author(s):  
Raj Kumar Thapa ◽  
Kanchan K.C ◽  
Rishi Khatri ◽  
Devendra Khatri ◽  
Rajeeb Kumar Deo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Care Hospital ◽  
Echocardiographic Evaluation ◽  
Significant Difference

Introduction: Cardiomyopathies are diseases of heart muscle that may originate from genetic defects, cardiac myocyte injury or infiltration of myocardial tissues. Dilated cardiomyopathy is the most common phenotype and is often a final common pathway of numerous cardiac insults. Mostly it remains unknown in the absence of echocardiography, histopathology and genetic evaluation. Though common it is underdiagnosed with not much of data available in our setup.Methods: This study was analytical cross-sectional study of hospital data on Echocardiographic findings in 65 patients of DCM visiting cardiology unit for Echocardiographic evaluation from 1st of February to 31st July 2018 for the period of six months in Shree Birendra Hospital, a tertiary care military hospital at Chhauni, Kathmandu. Pediatric age group patients and those who refused to give consent were excluded. Data obtained were entered in Microsoft Excel 2010 and analyzed by IBM SPSS 21.Results: Among 65 patients enrolled 40 (61%) were male and 25 (39%) female with male to female ratio of 1.6:1. Elderly people (61-75 years) with an average age of 65 were commonly involved and they presented mostly with congestive heart failure, 32 (49%). Echocardiographic evaluation showed 36 (55%) with mildly dilated Left Ventricle (5.6-6.0cm). Majority had reduced Left ventricular systolic function with an average Ejection fraction (EF) of 39.6%. No significant difference between male and female with the average EF% (P=0.990) and there was no significant relation between age and average EF% (P=0.091).Conclusions: Dilated Cardiomyopathy is the commonest cardiomyopathy phenotype mostly presenting with congestive heart failure. It is often underdiagnosed in our part of the world, however echocardiography will easily detect the condition. Keywords: dilated cardiomyopathy; echocardiography; ejection fraction; left ventricle.

scholarly journals Successful implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava

2013 ◽  
Vol 70 (12) ◽  
pp. 1162-1164
Author(s):  
Mihailo Vukmirovic ◽  
Lazar Angelkov ◽  
Filip Vukmirovic ◽  
Irena Tomasevic-Vukmirovic
Keyword(s):  
Heart Failure ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Biventricular Pacing ◽  
Severe Heart Failure ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Lead Placement ◽  
The Right

Introduction. Persistent left superior vena cava is the most common thoracic venous abnormality which is usually asymptomatic, found incidentally during pacemaker implantation. The main problem is related to reaching the appropriate pacing site and ensuring stable lead placement. Case report. We reported a successful implantation of a biventricular pacing and defibrillator device (CRT-D) via a persistent left superior vena cava in a 55-year-old man with dilated cardiomyopathy and severe heart failure. A persistent left superior vena cava was detected during CRT-D implantation. We managed to position electrodes in the right ventricular outflow tract, a posterior branch of the coronary sinus and in the right atrium. Conclusion. Congenital anomalies of thoracic veins may complicate lead placement on the appropriate and stable position. The presented case demonstrates a successful biventricular pacing and defibrillator therapy device implantation in a patient with dilated cardiomyopathy and severe heart failure.

Superior vena cava stenosis presenting with bendopnea

2021 ◽  
Vol 14 (4) ◽  
pp. e242418
Author(s):  
Mozhu Li ◽  
Seth Toomay ◽  
Mark H Drazner ◽  
Jennifer T Thibodeau
Keyword(s):  
Heart Failure ◽  
Differential Diagnosis ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Ventricular Filling ◽  
Vena Cava Stenosis ◽  
Superior Vena Cava Stenosis

Bendopnea, or dyspnoea with bending forward, is a recently described symptom of heart failure that is associated with elevated ventricular filling pressures. Here, we describe a case of superior vena cava (SVC) stenosis that presented with bendopnea and resolved with SVC recanalisation. We suggest that SVC stenosis be considered in the differential diagnosis of patients who experience bendopnea.

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