scholarly journals Small Cell Lymphocytic Lymphoma: An Unexpected Etiology of Pleural Effusion

2021 ◽  
Vol 6 (12) ◽  
pp. 883-887
Author(s):  
Filipa Silva ◽  
Sara Ramos ◽  
Carla Pereira ◽  
Pedro Mesquita ◽  
João Teixeira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pleural Effusion ◽  
Metastatic Disease ◽  
De Novo ◽  
Real Life ◽  
Colon Adenocarcinoma ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Clinical Report ◽  
Ventricular Ejection Fraction

The differential diagnosis of pleural effusion is extensive. Pleural fluid characteristics are helpful in classifying, as transudate or exudate, being this determinant to achieve an accurate diagnosis. The authors present a clinical report of a 74-year-old man with reduced left ventricular ejection fraction heart failure, of ischemic etiology, and multiple cardiovascular risk factors, who develops a pleural effusion. In his medical history it is important to denote a recent diagnosis of colon adenocarcinoma, without evidence of metastatic disease, submitted to hemicolectomy. Four months after this diagnosis, he was admitted in the Emergency Department with dyspnea, type 1 respiratory failure and de novo pleural effusion. The most probable etiologies of pleural effusion were excluded, including heart failure and a metastatic disease. Ultimately, it was reported a difficult (or not so) and unexpected etiology for the pleural effusion, in a patient with multimorbidity and multiple confounders. It is crucial to see beyond the obvious. A real-life challenge for Internal Medicine.

132Imaging criteria for the diagnosis of heart failure with midrange and preserved LVEF in the real life

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Logeart ◽  
E Paven ◽  
T Damy ◽  
R Isnard ◽  
M Salvat ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diagnostic Criteria ◽  
De Novo ◽  
Real Life ◽  
Left Ventricular ◽  
Biological Data ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Multicenter Survey ◽  
Esc Guidelines

Abstract Background According to last ESC guidelines, the diagnosis of heart failure with midrange and preserved left ventricular ejection fraction (HFmrEF-HF and HFpEF) requires at least one of the following imaging criteria: LV hypertrophy with LVMI >115g/m2 in men and 95g/m2 in women, left atria dilation with LAVI >34ml/m2, TDI e' wave average <9cm/s and E/e' average ≥13. Purpose We analyzed the prevalence of these imaging criteria in real life patients who are labeled HFmrEF or HFpEF by using a multicenter survey on HF. Methods Our survey (NCT01956539) was carried out in 32 hospitals between 2015 and 2018 and included 2735 HF patients who gave their consent during consultation or hospitalization. The diagnosis of HF was left to the discretion of investigators. Besides clinical and biological data, echocardiographic data (<1 month before or <3 months after inclusion) was collected in an electronic database. No echographic variable except the LVEF was mandatory to be included. Results Among the 523 and 765 HF patients who were labeled respectively as HFmrEF-HF and HFpEF, the 4 echographic variables required for the diagnosis of HFmrEF or HFpEF were obtained in 512 patients. The median age was 74y [IQR 62–82], HF was de novo in 28%, AF in 34%, median NTproBNP was 1563 pg/mL [IQR 500–4372]. At least one of the 4 diagnostic criteria was present in all patients but 2, and patients had 2, 3 or 4 criteria in 43%, 37% and 1% of cases. The table shows only little differences between HFmrEF and HFpEF or de novo HF regarding the rate of each diagnostic criteria. There was no difference regarding the date of inclusion, i.e. before or after the last ESC guidelines. Table 1 All HF patients De novo HF HFpEF HFmrEF mrEF or pEF (n=143) (n=293) (n=219) LVMI >115g/m2 (men) or 95g/m2 (women) 69.6% 64.3% 68.6% 70.2% LAVI >34ml/m2 74.2% 73.3% 80.4% 68.9% e' average <9cm/s 64.1% 55.3% 55.9% 76.1% E/e' average ≥13 35.4% 38.6% 37.3% 32.8% Conclusion The diagnosis of HFpEF or mrEF may be difficult and requires comprehensive echocardiography including all diagnostic variables because each single diagnostic criteria are present in only 33 to 80% cases.

scholarly journals Wearable Cardioverter-Defibrillator Used as a Telemonitoring System in a Real-Life Heart Failure Unit Setting

2021 ◽  
Vol 10 (22) ◽  
pp. 5435
Author(s):  
Christian Blockhaus ◽  
Stephan List ◽  
Hans-Peter Waibler ◽  
Jan-Erik Gülker ◽  
Heinrich Klues ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Real Life ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Specific Patient ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Heart Failure Unit

Background: In patients with reduced left ventricular ejection fraction (LVEF) who are at risk of sudden cardiac death, a wearable cardioverter-defibrillator (WCD) is recommended as a bridge to the recovery of LVEF or as a bridge to the implantation of a device. In addition to its function to detect and treat malignant arrhythmia, WCD can be used via an online platform as a telemonitoring system to supervise patients’ physical activity, compliance, and heart rate. Methods: We retrospectively analyzed 173 patients with regard to compliance and heart rate after discharge. Results: Mean WCD wearing time was 59.75 ± 35.6 days; the daily wearing time was 21.19 ± 4.65 h. We found significant differences concerning the patients’ compliance. Men showed less compliance than women, and younger patients showed less compliance than patients who were older. Furthermore, we analyzed the heart rate from discharge until the end of WCD prescription and found a significant decrease from discharge to 4, 8, or 12 weeks. Conclusion: WCD can be used as a telemonitoring system to help the involved heart failure unit or physicians attend to and adjust the medical therapy. Furthermore, specific patient groups should be educated more intensively with respect to compliance.

Rapidly progressive heart failure after dual-chamber pacemaker implantation

2021 ◽  
Vol 14 (10) ◽  
pp. e245006
Author(s):  
Claire Seydoux ◽  
Philipp Suter ◽  
Denis Graf ◽  
Hari Vivekanantham
Keyword(s):  
Heart Failure ◽  
De Novo ◽  
Pacemaker Implantation ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Dual Chamber ◽  
Ventricular Ejection Fraction ◽  
Device Implantation ◽  
Resynchronisation Therapy

Pacing-induced cardiomyopathy (PICM) consists of heart failure (HF) associated with a drop in the left ventricular ejection fraction (LVEF) in the setting of high-burden right ventricular pacing, with presentation that may range from subclinical to severe. Time to manifestation can go from weeks to years after device implantation. Treatment typically consists in an upgrade to a cardiac resynchronisation therapy (CRT) or His bundle pacing (HisP). Several risk factors for PICM have been described and should be considered before pacemaker (PM) implantation, as thorough patient selection for de novo CRT or HisP, may preclude its manifestation. We present the case of an 82-year-old patient presenting with acute congestive HF and new severely reduced LVEF, 30 days following dual chamber PM implantation for high-grade atrioventricular block. Treatment with HF medication and upgrade to a CRT permitted rapid resolution of the symptoms and normalisation of the LVEF at 1-month follow-up.

scholarly journals SLE strikes the heart! A rare presentation of SLE myocarditis presenting as cardiogenic shock

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaydeep J. Raval ◽  
Christina Rodriguez Ruiz ◽  
James Heywood ◽  
Jason J. Weiner
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Lupus Erythematosus ◽  
De Novo ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Diagnostic Uncertainty

Abstract Background Although systemic lupus erythematosus (SLE) can affect the cardiovascular system in many ways with diverse presentations, a severe cardiogenic shock secondary to SLE myocarditis is infrequently described in the medical literature. Variable presenting features of SLE myocarditis can also make the diagnosis challenging. This case report will allow learners to consider SLE myocarditis in the differential and appreciate the diagnostic uncertainty. Case presentation A 20-year-old Filipino male presented with acute dyspnea, pleuritic chest pain, fevers, and diffuse rash after being diagnosed with SLE six months ago and treated with hydroxychloroquine. Labs were notable for leukopenia, non-nephrotic range proteinuria, elevated cardiac biomarkers, inflammatory markers, low complements, and serologies suggestive of active SLE. Broad-spectrum IV antibiotics and corticosteroids were initiated for sepsis and SLE activity. Blood cultures were positive for MSSA with likely skin source. An electrocardiogram showed diffuse ST-segment elevations without ischemic changes. CT chest demonstrated bilateral pleural and pericardial effusions with dense consolidations. Transthoracic and transesophageal echocardiogram demonstrated reduced left ventricular ejection fraction (LVEF) 45% with no valvular pathology suggestive of endocarditis. Although MSSA bacteremia resolved, the patient rapidly developed cardiopulmonary decline with a repeat echocardiogram demonstrating LVEF < 10%. A Cardiac MRI was a nondiagnostic study to elucidate an etiology of decompensation given inability to perform late gadolinium enhancement. Later, cardiac catheterization revealed normal cardiac output with non-obstructive coronary artery disease. As there was no clear etiology explaining his dramatic heart failure, endomyocardial biopsy was obtained demonstrating diffuse myofiber degeneration and inflammation. These pathological findings, in addition to skin biopsy demonstrating lichenoid dermatitis with a granular “full house” pattern was most consistent with SLE myocarditis. Furthermore, aggressive SLE-directed therapy demonstrated near full recovery of his heart failure. Conclusion Although myocarditis during SLE flare is a well-described cardiac manifestation, progression to cardiogenic shock is infrequent and fatal. As such, SLE myocarditis should be promptly considered. Given the heterogenous presentation of SLE, combination of serologic evaluation, advanced imaging, and myocardial biopsies can be helpful when diagnostic uncertainty exists. Our case highlights diagnostic methods and clinical course of a de novo presentation of cardiogenic shock from SLE myocarditis, then rapid improvement.

Coexisting Morbidity Burden in Hospitalized Elderly Patients with New-Onset Heart Failure vs Acutely Decompensated Chronic Heart Failure

Angiology ◽  
2022 ◽  
pp. 000331972110626
Author(s):  
Andrew Xanthopoulos ◽  
Konstantinos Tryposkiadis ◽  
Grigorios Giamouzis ◽  
Apostolos Dimos ◽  
Angeliki Bourazana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Endpoint ◽  
De Novo ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Study Population ◽  
Distribution Width ◽  
Ventricular Ejection Fraction ◽  
Morbidity Burden ◽  
New Onset

Coexisting morbidities (CM) are common in patients with heart failure (HF). This study evaluated the CM burden and its clinical significance in elderly hospitalized patients with new-onset (De-novo) HF (n = 84) and acutely decompensated chronic HF (ADCHF) (n = 122). All had HF symptoms associated with: (a) LVEF <50%, or, (b) left ventricular ejection fraction (LVEF) ≥50% and NT-proBNP ≥300 pg/mL. The primary endpoint was the composite of all-cause death/HF rehospitalization at 6 months. Age was similar between patients with new-onset HF and ADCHF [82 (12.5) vs 80 (11) years, respectively; P = .549]. The CM burden was high in both groups. However, the number of CM [3 (2) vs 4 (1.75)] and the prevalence of multimorbidity [CM ≥2; 65 (77.4%) vs 108 (88.5%)] were lower in new-onset HF ( P = .016 and P = .035, respectively). The survival probability without the primary endpoint was higher in new-onset HF than in ADCHF ( P = .001) driven by less rehospitalizations ( P = .001). In the total study population significant primary endpoint predictors were red blood cell distribution width (RDW), urea, and coronary artery disease (CAD) prevalence (AUC of the model =.7685), whereas significant death predictors were RDW, urea, and the number of CM (AUC = .7859), all higher in ADCHF. Thus, the higher CM burden in ADCHF than in new-onset HF most likely contributed to the worse outcome.

scholarly journals Quantification of pleural effusions on thoracic ultrasound in acute heart failure

2020 ◽  
Vol 9 (5) ◽  
pp. 513-521
Author(s):  
Moritz Lindner ◽  
Richard Thomas ◽  
Brian Claggett ◽  
Eldrin F Lewis ◽  
John Groarke ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pleural Effusion ◽  
Acute Heart Failure ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pleural Effusions ◽  
Ventricular Ejection Fraction ◽  
Thoracic Ultrasound ◽  
B Lines

Background: Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically. Methods: In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size. Results: Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score ( P<0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography ( P<0.001), higher NT-pro brain natriuretic peptide values ( P=0.001) and a greater number of B-lines on lung ultrasound ( P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92–1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11–5.37; P=0.027). Conclusion: Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.

P1157Defibrillation threshold with subcutaneous implantable-cardioverter defibrillator implanted using an intermuscular 2-incision approach

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Biffi ◽  
M Ziacchi ◽  
C Martignani ◽  
C Lavalle ◽  
A Piro ◽  
...  
Keyword(s):  
De Novo ◽  
Safety Margin ◽  
Real Life ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
Shock Impedance ◽  
Incision Technique

Abstract Funding Acknowledgements NO FUNDING OnBehalf Rhythm Detect Registry Background Current subcutaneous implantable cardioverter–defibrillators (S-ICD) deliver 80J, and the conversion test is usually conducted by delivering shock energy of 65 J to ensure a safety defibrillation margin of at least 15 J. However, little is known about the real safety margin in real life clinical practice. Purpose To determine the defibrillation threshold (DFT) with S-ICD and to investigate its association with clinical characteristics. Methods De novo S-ICD patients were  consecutively enrolled and DFT was evaluated using a pre-specified step-up protocol at implantation. Results 35 patients, BMI 25 ± 4 kg/m2, left ventricular ejection fraction (LVEF) 48 ± 19%, underwent S-ICD implantation. The generator was positioned in an intermuscular pocket and a 2-incision technique was applied in all patients. The mean DFT was 30 ± 10J and the DFT was &gt;30J in 7 (20%) patients. A single patient had a &gt;40J DFT. The time to shock was 11 ± 3 seconds and the shock impedance was 67 ±21 Ohm at the lowest effective energy. The DFT was comparable in patients with LVEF ≤35% (33 ± 15J) versus &gt;35% (29 ± 5J, p = 0.278), and in patients with BMI ≤25 kg/m2 (30 ± 5J) versus &gt;25kg/m2 (31 ± 14J, p = 0.864). Conclusions We observed low DFT and low shock impedance in patients who received S-ICD with an intermuscular 2-incision approach. The S-ICD defibrillation success rate at ≤30J was 80%, while 97% of patients were defibrillated at ≤ 40J. We found no difference in DFT according to the LVEF or the BMI.

scholarly journals 569 Advanced heart failure patients: insight clinical characteristics and prognosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gaetano Ruocco ◽  
Guido Pastorini ◽  
Arianna Rossi ◽  
Marzia Testa ◽  
Mauro Feola
Keyword(s):  
Heart Failure ◽  
De Novo ◽  
Univariate Analysis ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Emergency Department Admission ◽  
Heart Failure Patients

Abstract Aims The prevalence of patients with advanced heart failure (HF) ranges from 1% to 10% of HF population. A recent position statement of Heart Failure Association (HFA) of European Society of Cardiology (ESC), defined advanced HF according four criteria including LV dysfunction, symptoms severity, and HF hospital admission.1 In this study we would like to evaluate clinical and prognostic characteristics of HF patients in advanced stage. Methods and results This is an observational retrospective study enrolling patients with diagnosis of acute heart failure (AHF) de novo or not, admitted to our department from January 2015 to January 2019 within 12 h from emergency department admission. Patients underwent to clinical examination, laboratory analysis (NTproBNP, renal function haemoglobin) and echocardiography. Advanced heart failure patients were defined on the basis of ESC recent criteria.1 Patients were followed for 1 year after hospital discharge for the composite outcome of HF re-hospitalization and cardiovascular death through 1 year. A total of 601 AHF patients were included in this analysis. Median age was 78 (70–83) years, median of left ventricular ejection fraction (LVEF) was 45 (33–55)% and the median of serum levels of NTproBNP was 7851 (3222–17 543) pg/ml. In our sample we found 122 patients who met the criteria of advanced HF. Comparing patients with advanced HF and without we found that advanced HF patients were more frequent affected by not ischaemic cardiomyopathy with respect to patients not advanced (85% vs. 49%; P &lt; 0.001). Moreover, patients not advanced were more frequent de novo HF with respect to advanced ones (54% vs. 34%; P &lt; 0.001). Advanced heart failure patients showed higher values of NTproBNP [12 375 (5346–26 375) vs. 6652 (2552–13 782) pg/ml; P &lt; 0.001] and creatinine [1.20 (0.88–1.99) vs. 1.07 (0.82–1.50) mg/dL; P = 0.002] and lower values of TAPSE [18 (15–20) vs. 16 (13–19) mm; P &lt; 0.001], eGFR [48 (30–66) vs. 52 (38–38) ml/min/m2; P = 0.05], and serum sodium [140 (138–143) vs. 139 (136–141) mEq/l; P = 0.001] with respect to not advanced HF patients. Univariate analysis showed that advanced HF was related to poor prognosis in terms of one year cardiovascular death or HF re-hospitalization [HR: 1.83 (1.32–2.54); P &lt; 0.001] and in terms of in-hospital mortality [HR: 2.53 (1.01–6.53); P = 0.05]. Conclusions Advanced HF patients showed a worse neuro-hormonal and renal pattern compared to not advanced ones. Similarly, these patients experienced a worse right ventricular function and were more prone no adverse events development at 1 year. Further study are mandatory to better manage these patients improving their outcome.

scholarly journals Characteristics and management of acute heart failure patients in a single university hospital center

Medicina ◽  
2009 ◽  
Vol 45 (11) ◽  
pp. 855 ◽  
Author(s):  
Laura Venskutonytė ◽  
Irena Molytė ◽  
Rūta Ablonskytė-Dūdonienė ◽  
Vaida Mizarienė ◽  
Aušra Kavoliūnienė
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
De Novo ◽  
Systolic Function ◽  
Heart Diseases ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Hospital Center

Objective. To evaluate the causes of acute heart failure, complications, management, and outcomes.Material and methods. A total of 200 patients with diagnosed de novo acute heart failure (27.5%) or worsening chronic heart failure (72.5%) were treated at the Department of Cardiology, Hospital of Kaunas University of Medicine, which was participating in the Euro Heart Failure Survey-II (EHFS-II). The patients were divided into five groups: 1) chronic decompensated heart failure (66.0%); 2) pulmonary edema (13.0%); 3) hypertensive heart failure (7.5%); 4) cardiogenic shock (11.0%); and 5) right heart failure (2.5%). Results. Hypertensive and coronary heart diseases were the most common underlying conditions of acute heart failure. Noncompliance with the prescribed medications was present as the most frequent precipitating factor in more than half of the cases. Left ventricular ejection fraction of >45% was found in 28.64% of cases. Intravenous diuretics (74.5%), nitrates (44.0%), and heparin (71.0%) were the most widely used in the acute phase. At discharge from hospital, 96.69% of patients were given diuretics; 80.11%, angiotensin-converting enzyme inhibitors; and 62.43%, beta-blockers. The mean duration of inhospital stay was 13 days; death rate was 9.5%: after 3 months and 12 months, it was 7.5% and 11.5%, respectively. Conclusion. Preserved systolic function, multiple concomitant diseases, and high mortality rates were observed in a substantial proportion of the patients hospitalized due to acute heart failure. The management of the patients in a university hospital center was performed in accordance with the international guidelines.

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