Ten Years of Experience in Treating Patients With Digoxin Toxicity Without Using Digoxin Fab Antibody

Background: Digoxin is extensively prescribed for cardiac diseases, so its chronic or acute toxicity commonly occur. Although digoxin specific antibodies (anti-digoxin Fab) are recommended to be used in patients with cardiac symptoms of digoxin toxicity, there is ongoing controversy about the effectiveness and dose of anti-digoxin Fab. Because our department lacks access to anti-digoxin Fab and the high cost of the antidote, we evaluated 10 years of experience in treating patients with digoxin toxicity without using digoxin Fab antibodies considering outcomes. Methods: A retrospective study was performed in Khorshid Hospital, affiliated with Isfahan University of Medical Sciences, from October 2008 to September 2018. Patients with acute or chronic digoxin toxicity were included in the study. The patients’ data were gathered and analyzed according to their medical documents. Results: Out of 150 cases with digoxin toxicity, 38% (n=57) were acute and 62% (n=93) were chronic. About 64.7% (n=97) were female. The most common non-cardiac manifestations of toxicity were gastrointestinal (67.3%, n=101) and neurological symptoms (52.7%, n=79). Bradyarrhythmia (80.5%, n=33) was the most cardiac manifestation in patients with acute (15.8% n=9) and chronic (25.8%, n=24) toxicity. A total of 144 (96%) cases fully recovered with supportive care, and 6 patients (4%) died. None of the cases received anti-digoxin Fab. Conclusion: The majority of presentations with acute or chronic toxicity recovered with supportive measures without using anti-digoxin Fab.

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Study of cardiac manifestations in hypothyroid patients admitted in tertiary care centre

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20214523 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1852

Author(s):

Parshv P. Shah ◽

Harvy Parikh ◽

Hemant Shah ◽

Nilesh Doctor

Keyword(s):

Early Recognition ◽

Sinus Bradycardia ◽

Tertiary Care ◽

General Medicine ◽

Thyroid Stimulating Hormone ◽

Hormone Deficiency ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Cardiac Manifestation ◽

Cardiac Manifestations

Background: Hypothyroidism is the most common pathological hormone deficiency. To study various cardiac manifestations in overt and subclinical hypothyroidism.Methods: The cross-sectional analytic study is carried out on 60 patients of hypothyroid subjects in indoor facility of general medicine department in SMIMER hospital.Results: This study shows positive correlation between thyroid stimulating hormone (TSH) level, electrocardiogram (ECG) and echocardiographic findings. In this study, there is female predominance, ECG findings most commonly suggestive of sinus bradycardia and ECHO findings are most commonly suggestive of diastolic dysfunction with pericardial effusion.Conclusions: The early recognition and early initiation of treatment of hypothyroidism may helpful to lowering heart changes as hypothyroidism is reversible cause for cardiac manifestation.

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Cardiac arrhythmia in Wilson’s disease: An oversighted and overlooked entity!

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.186982 ◽

2016 ◽

Vol 7 (04) ◽

pp. 587-589 ◽

Cited By ~ 2

Author(s):

Bhupender Kumar Bajaj ◽

Ankur Wadhwa ◽

Richa Singh ◽

Saurabh Gupta

Keyword(s):

Cardiac Arrhythmia ◽

Wilson’S Disease ◽

Blood Pressure Response ◽

Copper Metabolism ◽

Wilson's Disease ◽

Young Female ◽

Multisystem Disorder ◽

Cardiac Symptoms ◽

Cardiac Manifestations

ABSTRACTWilson’s disease is a multisystem disorder which manifests with hepatic, neurological, musculoskeletal, hematological, renal, and cardiac symptoms. The hepatic and neurological manifestations often overshadow the other system involvement including cardiac symptoms and signs, which may prove fatal. We report a case of a young female who presented with progressive parkinsonian features and dystonia for around 4 months followed 2 months later by the complaint of episodes of light-headedness. She was diagnosed to have Wilson’s disease based on the presence of Kayser–Fleischer ring and laboratory parameters of copper metabolism. Electrocardiography of the patient incidentally revealed 2nd degree Mobitz type-1 atrioventricular block explaining her episodes of light-headedness. She was started on penicillamine and trihexyphenidyl. The heart block improved spontaneously. Cardiac autonomic function tests including blood pressure response to standing and heart rate response to standing were observed to be normal. We review the literature on cardiac manifestations of Wilson’s disease and emphasize that patients with Wilson’s disease should be assessed for cardiac arrhythmia and cardiac dysfunction as these may have therapeutic and prognostic implications.

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Acute cardiac complications and subclinical myocardial injuries associated with pheochromocytoma and paraganglioma

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02013-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jing Zhou ◽

He Xuan ◽

Yunxiang Miao ◽

Junting Hu ◽

Yunlang Dai

Keyword(s):

Longitudinal Strain ◽

Wide Spectrum ◽

Comprehensive Analysis ◽

Cardiac Complications ◽

Preserved Ejection Fraction ◽

Cardiac Symptoms ◽

Invasive Behavior ◽

Catecholamine Excess ◽

Cardiac Manifestations ◽

Myocardial Injuries

Abstract Background Catecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations, including acute cardiac complications (ACCs) and subclinical myocardial injuries (SMIs). In this study, we aimed to conduct a comprehensive analysis of ACCs and SMIs in a large cohort of patients with PPGLs. Methods We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2013 and July 2020 (n = 189). The prevalence of ACCs and SMIs and characteristics of patients identified with ACCs and SMIs were investigated. Moreover, comparisons were performed between patients with and without ACCs. Results Fourteen patients (7.4%) fulfilled the criteria for ACCs, including nine (4.8%) who presented with Takotsubo-like cardiomyopathy, four (2.1%) with heart failure with preserved ejection fraction, and finally one (0.5%) with catecholamine-induced cardiomyopathy. Compared to those without ACCs (n = 175), patients with ACCs had a higher prevalence of epinephrine-producing PPGLs (81.8% vs 33.9%, P = 0.006) and were more likely to show invasive behavior (61.5% vs 27.3%, P = 0.022) or hemorrhage/necrosis (53.9% vs 17.4%, P = 0.005) on histology. The apical sparing pattern (5/7, 71.4%) was the dominant impairment pattern of longitudinal strain (LS) for patients displaying Takotsubo-like cardiomyopathy. In patients without cardiac symptoms, a fairly high proportion (21/77, 27.3%) of patients who underwent screening for troponin and/or natriuretic peptide and/or echocardiography had SMIs. Conclusions One in every fourteen PPGL patients presented with ACCs, and in the patients with Takotsubo-like cardiomyopathy, the apical sparing pattern was the primary impairment pattern of LS. Additionally, nearly one-third of patients without symptoms had SMIs. The diagnosis of PPGLs should be considered in patients with acute reversible cardiomyopathy, especially in those exhibiting an apical sparing pattern of LS.

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CARDIAC MANIFESTATIONS OF DENGUE FEVER IN CHILDREN

10.36106/ijsr/3000608 ◽

2021 ◽

pp. 15-18

Author(s):

Gaurav Choudhary ◽

Yograj Khinchi ◽

Chaman R Verma ◽

Bhagwan Sahai Natani ◽

Rakesh Bilwal ◽

...

Keyword(s):

Public Health ◽

Dengue Fever ◽

Public Health Problem ◽

Warning Signs ◽

Severe Dengue ◽

Inclusion Criteria ◽

Medical Sciences ◽

Dengue Virus Serotypes ◽

Dengue With Warning Signs ◽

Cardiac Manifestations

Introduction: Dengue fever represents a signicant public health problem in tropical and subtropical regions. 70% of total cases are from Asia, especially India. Caused by 4 dengue virus serotypes( DENV-1, DENV-2 DENV-3 and DENV-4), DENV-2 being the most prevalent in India. Incidence and range of cardiac manifestations in dengue fever vary widely. Aims & objectives: To study the incidence and range of cardiac manifestations of dengue fever in children. Material & methods:This is an observational study, conducted in department of pediatrics at National Institute of Medical Sciences & Research, Jaipur in study period of 18 months. A total of 94 patients were included in the study fullling the inclusion criteria. Results: The overall incidence of cardiac manifestations was found to be 31.9%. The incidence of cardiac manifestations in dengue without warning signs was 4.4%, in dengue with warning signs was 52.5% and in severe dengue was 77.7%. Conclusion: Incidence of cardiac manifestations increases with increase in disease severity

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The Underrecognized Cardiac Manifestation of Hypereosinophilic Syndrome

General medicine and Clinical Practice ◽

10.31579/2639-4162/002 ◽

2018 ◽

Vol 1 (1) ◽

pp. 01-03

Author(s):

Ashwin Malhotra

Keyword(s):

Systemic Disease ◽

Hypereosinophilic Syndrome ◽

Cost Effective ◽

Coronary Syndrome ◽

Eosinophilic Myocarditis ◽

Cardiac Manifestation ◽

Cardiac Catheterizations ◽

Conclusive Diagnosis ◽

Cardiac Manifestations ◽

Efficient Care

Hypereosinophilic syndrome (HES) is a rare systemic disease in which cardiac manifestations are the leading cause of morbidity and mortality. HES involvement of the heart can often clinically mimic acute coronary syndrome (ACS) with the patient undergoing repeat cardiac catheterizations when no conclusive diagnosis is arrived at, and no effective treatment is suggested to alleviate recurrent symptoms of chest discomfort. Here we present an elusive case of eosinophilic myocarditis (EM) and advocate that a detailed review of history as well as obtaining all medical records be done to avoid unnecessary and repeated invasive investigations in order to provide safe, cost effective, and efficient care for our patients.

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Abstract 14814: By Stanza or Story, the Structure of a Poem

Circulation ◽

10.1161/circ.142.suppl_3.14814 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Timothy F Simpson ◽

Babak Nazer ◽

Punag Divanji

Keyword(s):

Pericardial Effusion ◽

Plasma Cell ◽

Inflammatory Markers ◽

Systemic Disease ◽

Bone Lesion ◽

Whole Body ◽

Pleural Effusions ◽

Lower Extremity Weakness ◽

Cardiac Symptoms ◽

Cardiac Manifestations

A 63-year-old male with recent diagnosis of idiopathic pericarditis presented to the hospital with atrial fibrillation and rapid ventricular rates. He reported one week of palpitations and subacute lower extremity weakness. On exam he was hemodynamically stable with evidence of intra- and extravascular fluid overload. Lab analysis showed elevated creatinine, inflammatory markers, and serum protein gap. Chest radiograph showed bilateral pleural effusions and a focal sclerotic thoracic vertebra. TTE revealed mildly reduced biventricular function, elevated RVSP, and moderate pericardial effusion. The presence of pericardial and pleural effusions with elevated inflammatory markers suggest serositis, and a differential of malignant, autoimmune, and infectious etiologies were considered. Hepatosplenomegaly was noted on CT imaging. Blood, pleural, and pericardial cultures revealed no growth and autoimmune serologies were negative. Given these findings- the differential was narrowed to lymphoma, myeloma with or without amyloidosis, and paraneoplastic syndromes. Electrophoresis revealed presence of an M protein, fat pad biopsy was negative for amyloid fibrils. Bone marrow biopsy revealed an abnormal plasma cell population and biopsy of sclerotic vertebra showed no malignancy. Whole body FDG PET showed no focal uptake in the heart nor elsewhere. VEGF levels were significantly elevated. On the basis of the plasma cell dyscrasia, polyneuropathy, sclerotic bone lesion, elevated VEGF level, hepatosplenomegaly, and pericardial effusion the patient was diagnosed with POEMS syndrome- an extremely rare paraneoplastic syndrome with multisystemic end-organ effects. Cardiac manifestations are infrequent, but include pericardial effusion, myocardial edema and dysfunction, pulmonary hypertension, and volume overload. No specific cardiac therapy exists, but involvement may regress with chemotherapy for treatment of the underlying malignancy. This case demonstrates the importance of recognizing cardiac manifestations as the initial or cardinal presentation of underlying systemic disease, where accurate diagnosis may rely on identification of subtle non-cardiac symptoms, laboratory, and imaging findings as demonstrated here.

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A cardiac manifestation in patients with COVID-19: a case series

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20205484 ◽

2020 ◽

Vol 8 (1) ◽

pp. 124

Author(s):

Archita Ravindranath ◽

Madhumati Ramaiah ◽

Parvaiz Kadloor

Keyword(s):

Case Series ◽

Respiratory Illness ◽

Prior History ◽

Microvascular Damage ◽

Hypoxic Injury ◽

History Of ◽

Artery Disease ◽

Cardiac Manifestation ◽

Cardiac Manifestations ◽

Severe Acute Respiratory Illness

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus or the coronavirus 2019 (COVID-19) infection is a novel viral infection causing the 2020 pandemic affecting primarily the respiratory system in the form of influenza like illness, severe acute respiratory illness or asymptomatic respiratory illness and other systems. The cardiovascular system may also be affected, with or without a prior history of cardiovascular diseases. Myocardial injury is common among patients hospitalized with COVID-19 due to stress cardiomyopathy, hypoxic injury, ischemic injury due to cardiac microvascular damage or epicardial coronary artery disease and cytokine storm, however rhythm abnormalities is affected rarely in a transient or severe manner causing rhythm disturbances. The concerns about COVID‐19 may result in a delay in proper approach and prompt management in many emergent medical conditions, such as cardiovascular problems. Here, we describe our experience with 4 COVID-19 patients with varied cardiac manifestations presenting to our hospital during the months of September- October 2020.

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Cardiac Manifestations in Children with SARS-COV-2 Infection: 1-Year Pediatric Multicenter Experience

Children ◽

10.3390/children8080717 ◽

2021 ◽

Vol 8 (8) ◽

pp. 717

Author(s):

Nicoletta Cantarutti ◽

Virginia Battista ◽

Rachele Adorisio ◽

Marianna Cicenia ◽

Claudia Campanello ◽

...

Keyword(s):

Left Ventricular ◽

Cardiac Biomarkers ◽

Cardiac Anomalies ◽

Cardiac Evaluation ◽

Cardiac Manifestation ◽

Almost All ◽

Cardiac Manifestations ◽

Inflammatory Syndrome ◽

Ecg Abnormalities

Since the spread of COVID-19, pediatric patients were initially considered less affected by SARS-COV-2, but current literature reported subsets of children with multisystem inflammatory syndrome (MIS-C). This study aims to describe the cardiac manifestation of SARS-COV-2 infection in a large cohort of children admitted to two Italian pediatric referral centers. Between March 2020 and March 2021, we performed a cardiac evaluation in 294 children (mean age 9 ± 5.9 years, male 60%) with active or previous SARS-COV-2 infection. Twenty-six showed ECG abnormalities: 63 repolarization anomalies, 13 Long QTc, five premature ventricular beats, two non-sustained ventricular tachycardia, and one atrial fibrillation. In total, 146 patients underwent cardiac biomarkers: NT-proBNP was elevated in 57, troponin in 34. An echocardiogram was performed in 98, showing 54 cardiac anomalies: 27 left-ventricular dysfunction, 42 pericarditis, 16 coronaritis. MIS-C was documented in 46 patients (mean age 9 ± 4.8 years, male 61%) with cardiac manifestations in 97.8%: 27 ventricular dysfunctions, 32 pericarditis, 15 coronaritis, 3 arrhythmias. All patients recovered, and during follow-up, no cardiac anomalies were recorded. Our experience showed that cardiac involvement is not rare in children with SARS-COV-2, and occurred in almost all patients with MIS-C. However, patients’ recovery is satisfactory and no additional events were reported during FU.

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