scholarly journals Management of Rheumatic Heart Diseases in Burundi

2019 ◽  
Vol 23 (3) ◽  
pp. 290-296
Author(s):  
E. Ndirahisha ◽  
E. Baransaka ◽  
J. Nyandwi ◽  
H. Bukuru ◽  
C. Muserebanyi ◽  
...  
Keyword(s):  
New York ◽  
Heart Diseases ◽  
Heart Association ◽  
Operative Management ◽  
Nyha Classification ◽  
New York Heart Association ◽  
Chest X Ray ◽  
Pulmonary Arterial ◽  
Evolutionary Aspects ◽  
Rheumatic Heart

Background: The surgical management of rheumatic heart disease (RHD) in Burundi is almost impossible because of the absence of the technical plateau. Aim: To describe the therapeutic and evolutionary aspects of RHD in Burundi. Patients and methods: This is a retrospective and analytical study of patients' records in surgical indication and/or operated for RHD by facilitation of “Maison du Bon Samaritain du Burundi (MBSB)” from February 2015 to February 2017. Results: Among 89 patients consulting for RHD, 45 (50.56%) were operated. The average age of the patients was 25 years. Females predominated with 64.04% of cases. The age of most of patients was between 4 and 40 years with 74 cases (83.14%). All patients had been received at the heart failure stage including 83 (93.25%) at stage III or IV according to the New York Heart Association (NYHA) classification. The ejection fraction was ≤ 50% in 61 patients (68.53%). Pulmonary arterial hypertension was recorded in 79 patients (88.76%). On chest X-ray, cardiomegaly was found in 85 patients (95.50%). Electrical abnormalities were dominated by dilatation of the left atrium in 48 cases (53.93%). Isolated valvular lesions were the most numerous with 67 cases (75.28%). The operative management was mainly valvular replacement (93.47%) with an operative success of 100% six months after the intervention. Conclusion: The diagnosis of RHD was late. Young people were more vulnerable. The postoperative prognosis at six months was good.

scholarly journals Heart Disease and its Consequence in Pregnancy

2012 ◽  
Vol 7 (1) ◽  
pp. 7-9
Author(s):  
Fatima Wahid ◽  
Firoza Begum ◽  
Umme Kulsum ◽  
Kaniz Fatema ◽  
Farzana Sharmin ◽  
...  
Keyword(s):  
New York ◽  
Heart Disease ◽  
Prospective Observational Study ◽  
Heart Diseases ◽  
Nyha Class ◽  
Heart Association ◽  
Normal Vaginal Delivery ◽  
Class Iii ◽  
New York Heart Association ◽  
Rheumatic Heart

The aim of the study is to evaluate the types of heart disease common in our pregnant woman and to assess its influence on the maternal outcome. This was a prospective observational study. The study was carried out in the department of obstetrics & Gynecology in BSMMU from Jan 2006 to Dec 2006. Thirty-five consecutive cases with heart diseases were included in the study. Out of 35 Cases, 26(74.3%) were suffering from rheumatic heart diseases and only 9 (25.7%) patients were suffering from congenital heart disease. Based on New York heart Association (NYHA) functional classification, 28(80%) belonged to NYHA class I, 5 (71.212%) belonged to NYHA class II and 2(28.57%) belonged to class III heart disease on presentation. The number of caeserian section was 33(94.28%) and normal vaginal delivery (5.71%). In this study only 1 woman of NYHA III disease expired. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10201 UHJ 2011; 7(1): 7-9

scholarly journals An Advanced Protocol-Driven Transition from Parenteral Prostanoids to Inhaled Trepostinil in Pulmonary Arterial Hypertension

2016 ◽  
Vol 6 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Ronald Oudiz ◽  
Manyoo Agarwal ◽  
Franz Rischard ◽  
Teresa De Marco
Keyword(s):  
New York ◽  
Pulmonary Arterial Hypertension ◽  
Adverse Events ◽  
Arterial Hypertension ◽  
Heart Association ◽  
Functional Class ◽  
Inclusion Criteria ◽  
Serious Adverse Events ◽  
New York Heart Association ◽  
Pulmonary Arterial

Patients with pulmonary arterial hypertension (PAH) often require parenteral prostanoids to improve symptoms and signs of PAH. Complications of parenteral prostanoids—such as catheter-related infections and intolerable adverse effects—may develop, prompting transition to inhaled prostanoids. We report a prospective, protocol-driven transition from parenteral prostanoids to inhaled prostanoids with monitoring of exercise gas exchange and acute hemodynamics. Three PAH centers recruited patients transitioning from parenteral prostanoids to inhaled trepostinil. Rigid inclusion criteria were used, including parenteral prostanoid dose < 30 ng/kg/min, New York Heart Association functional class (FC) < 3, and pulmonary vascular resistance (PVR) < 6 Wood units. Of the 9 patients meeting initial inclusion criteria, 3 were excluded. In the remaining patients, the parenteral prostanoid was reduced and the inhaled prostanoid was increased over 24–36 hours with continuous hemodynamic monitoring. Exercise capacity and FC were measured at baseline and weeks 1, 4, and 12. All patients were successfully weaned from parenteral prostanoids. An acute PVR decrease was seen with most inhaled prostanoid doses, but PVR varied throughout the transition. Patients tolerated inhaled prostanoids for 9–12 breaths 4 times a day with no treatment-limiting adverse events. At week 12, FC was unchanged, and all patients continued to receive inhaled prostanoids without serious adverse events or additional PAH therapy. In 5 of 6 patients, 6-minute walk distance and peak V̇O2 were within 10% of baseline. Using a strict transition protocol and rigid patient selection criteria, the parenteral prostanoid to inhaled prostanoid transition appeared safe and well tolerated and did not result in clinical deterioration over 12 weeks. Hemodynamic variability noted acutely during transition in our study did not adversely affect successful transition. (Trial registration: ClinicalTrials.gov identifier: NCT01268553)

scholarly journals Pharmacist- or Nurse Practitioner–Led Assessment and Titration of Sacubitril/Valsartan in a Heart Failure Clinic: A Cohort Study

2020 ◽  
Vol 73 (3) ◽  
Author(s):  
Arden R Barry ◽  
Candy Lee
Keyword(s):  
Heart Failure ◽  
New York ◽  
Nurse Practitioner ◽  
Clinical Pharmacist ◽  
Heart Association ◽  
Effets Secondaires ◽  
Target Dose ◽  
Heart Failure Clinic ◽  
Nyha Classification ◽  
New York Heart Association

ABSTRACTBackground: Sacubitril/valsartan is a first-in-class angiotensin receptor–neprilysin inhibitor indicated in the management of heart failure with reduced ejection fraction, based on the results of the PARADIGM-HF trial. Practice-based studies are needed to validate its effect in real-world settings. Clinical pharmacists are ideally situated to assess and titrate sacubitril/valsartan.Objective: To evaluate the utilization, safety, and tolerability of sacubitril/ valsartan in a multidisciplinary heart failure clinic, with assessment and titration by a clinical pharmacist or a nurse practitioner.Methods: A retrospective cohort study was conducted at a heart failure clinic in Abbotsford, Canada. Included were adult patients with heart failure who were currently or formerly taking sacubitril/valsartan. Data collected for the period October 2015 to February 2019 included patient characteristics, New York Heart Association (NYHA) classification, concurrent medications, sacubitril/valsartan dose, adverse effects, and discontinuation rate.Results: In total, 128 patients were included. Mean age was 70.1 years, 98 (77%) of the patients were men, and 79 (62%) had NYHA class 2 heart failure. The clinical pharmacist managed care for 78 (61%) of the patients, and the nurse practitioner managed care for 50 (39%). Forty-one (32%) of the patients met modified PARADIGM-HF inclusion criteria. Eighty-five (66%) of the patients achieved the target dose of sacubitril/valsartan, with similar proportions for the clinical pharmacist and nurse practitioner groups, over a mean of 2.2 clinic visits. Patients who achieved the sacubitril/valsartan target dose, relative to those who did not, were significantly younger and had higher mean systolic blood pressure at baseline. Twenty-nine percent of patients (35/119) had an improvement in NYHA classification from before initiation of sacubitril/valsartan to achievement of target or maximally tolerated dose. Eighty-five (66%) of the patients experienced an adverse effect, primarily hypotension, and 12 (9%) required a dose reduction. Only 9 (7%) patients discontinued therapy.Conclusions: This study demonstrates the real-world safety and tolerability of sacubitril/valsartan in the treatment of heart failure, and reinforces that clinical pharmacists can effectively assess and titrate medications in a multidisciplinary heart failure clinic.RÉSUMÉContexte : Le sacubitril-valsartan est un inhibiteur novateur des récepteurs de l’angiotensine-néprilysine, indiqué dans la gestion de l’insuffisance cardiaque accompagnée d’une baisse de la fraction d’éjection, selon les résultats de l’essai PARADIGM-HF. Des études fondées sur la pratique sont nécessaires pour valider ses effets en contexte réel. Les pharmaciens cliniciens sont bien placés pour évaluer et titrer le sacubitril-valsartan.Objectif : Évaluer l’utilisation, l’innocuité et le seuil de tolérance du sacubitril-valsartan en clinique multidisciplinaire d’insuffisance cardiaque, l’évaluation et le titrage étant effectués par un pharmacien clinicien ou une infirmière praticienne.Méthodes : Une étude de cohorte rétrospective a été menée au sein d’une clinique d’insuffisance cardiaque à Abbotsford, au Canada. Les patients adultes inclus dans l’étude souffraient d’insuffisance cardiaque, ils prenaient ou avaient pris du sacubitril-valsartan. Les données recueillies entre octobre 2015 et février 2019 comprenaient les caractéristiques des patients, la classification de la New York Heart Association (NYHA), les médicaments pris de façon concomitante, la dose de sacubitril-valsartan, les effets secondaires et le taux d’abandon.Résultats : Au total, 128 patients ont participé à l’étude. L’âge moyen des patients était de 70,1 ans, 98 d’entre eux (77 %) étaient des hommes et 79 (62 %) souffraient d’une insuffisance cardiaque de classe 2 selon la classification de la NYHA. Le pharmacien clinicien gérait les soins de 78 patients (61 %) et la pharmacienne praticienne gérait ceux de 50 patients (39 %). Quarante-et-un patients (32 %) répondaient aux critères d’inclusion modifiés de PARADIGM-HF. Quatre-vingt-cinq (66 %) patients atteignaient le dosage ciblé de sacubitril-valsartan dans des proportions similaires entre le groupe du pharmacien clinicien et celui de l’infirmière praticienne, à raison d’une moyenne de 2,2 visites en clinique. Les patients ayant atteint le dosage ciblé de sacubitril-valsartan, par rapport à ceux ne l’ayant pas atteint, étaient considérablement plus jeunes et leur tension artérielle systolique moyenne de base était plus élevée. Une amélioration de la classification NYHA a été observée chez 29 % des patients (35/119) entre le début de la prise de sacubitril-valsartan et l’atteinte du dosage ciblé ou de la dose maximale tolérée. Des effets secondaires ont été observés chez 85 patients (66 %), principalement une hypotension, et 12 d’entre eux (9 %) ont dû réduire la dose. Seuls 9 patients (7 %) ont dû abandonner la thérapie.Conclusions : Cette étude démontre l’innocuité et le seuil de tolerance en contexte réel du sacubitril-valsartan pour le traitement de l’insuffisance cardiaque. Elle renforce le fait que les pharmaciens cliniciens peuvent efficacement évaluer et titrer des médicaments au sein d’une Clinique d’insuffisance cardiaque multidisciplinaire.

Inhaled Treprostinil for the Treatment of Pulmonary Arterial Hypertension

2011 ◽  
Vol 31 (6) ◽  
pp. e1-e10 ◽  
Author(s):  
Abby Poms ◽  
Martha Kingman
Keyword(s):  
New York ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Severe Disease ◽  
Pulmonary Arteries ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii ◽  
New York Heart Association ◽  
Pulmonary Arterial

Pulmonary arterial hypertension is a progressive disease characterized by vascular proliferation and vasoconstriction of the small pulmonary arteries that eventually leads to right-sided heart failure and death. Patients often initially have symptoms such as shortness of breath, fatigue, and edema; later in the disease, presyncope and syncope are common. Patients with progressive pulmonary arterial hypertension despite oral therapy and/or with severe disease typically require treatment with a prostanoid. Inhaled treprostinil (Tyvaso) is a prostacyclin analog indicated for the treatment of pulmonary arterial hypertension to increase walk distance in patients with symptoms classified as New York Heart Association functional class III. Inhaled treprostinil was approved by the Food and Drug Administration in July 2009. This article provides a brief overview of the pathophysiology of pulmonary arterial hypertension and reviews the mechanism of action, key clinical data, and the practical management of inhaled treprostinil in patients with pulmonary arterial hypertension.

scholarly journals A Pilot Clinical Study of Liquid Ubiquinol Supplementation on Cardiac Function in Pediatric Dilated Cardiomyopathy

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1697 ◽  
Author(s):  
Fong-Lin Chen ◽  
Po-Sheng Chang ◽  
Yi-Chin Lin ◽  
Ping-Ting Lin
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cardiac Function ◽  
Dilated Cardiomyopathy ◽  
Coenzyme Q10 ◽  
Heart Association ◽  
Nyha Classification ◽  
Study Results ◽  
Pilot Clinical Study ◽  
New York Heart Association

Background: Pediatric dilated cardiomyopathy (PDCM) is a life-threatening type of cardiac muscle dysfunction in children. Ubiquinone is a lipid-soluble nutrient that participates in energy synthesis. Recently, a novel hydrophilic ubiquinol supplement was developed. The purpose of this study was to assess the effect of liquid ubiquinol supplementation (10 mg/kg body weight/day) on cardiac function in children with PDCM. Methods: Ten children diagnosed with PDCM were recruited to this study and administered with liquid ubiquinol for 24 weeks. The cardiac function was measured by echocardiography. The New York Heart Association (NYHA) functional classification was used to assess symptoms of heart failure. Plasma coenzyme Q10 levels were measured during the study. Results: Ejection fraction (EF) and fractional shortening (FS) were significantly higher than the baseline values until week 16 of supplementation. Subjects who had higher plasma coenzyme Q10 concentration had significantly better EF and FS values. In addition, 30% of the subjects showed improvement in the NYHA classification after 24 weeks of supplementation. Conclusion: Liquid ubiquinol supplementation is associated with an increase the level of coenzyme Q10 to complementary improve cardiac function (particularly EF and FS) and ameliorate the symptoms of heart failure in children with PDCM.

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