scholarly journals Implementation of CT Coronary Angiography as an Alternative to Invasive Coronary Angiography in the Diagnostic Work-Up of Non-Coronary Cardiac Surgery, Cardiomyopathy, Heart Failure and Ventricular Arrhythmias

2021 ◽  
Vol 10 (11) ◽  
pp. 2374
Author(s):  
Thomas P. W. van den Boogert ◽  
Bimmer E. P. M. Claessen ◽  
Adrienne van Randen ◽  
Joost van Schuppen ◽  
S. Matthijs Boekholdt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Coronary Angiography ◽  
Ventricular Arrhythmias ◽  
Imaging Modality ◽  
Invasive Coronary Angiography ◽  
Coronary Lesions ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

To assess the need for additional invasive coronary angiography (CAG) after initial computed tomography coronary angiography (CTCA) in patients awaiting non-coronary cardiac surgery and in patients with cardiomyopathy, heart failure or ventricular arrhythmias, and to determine differences between patients that were referred to initial CTCA or direct CAG, consecutive patients were included between August 2017 and January 2020 and categorized as those referred to initial CTCA (conform protocol), and to direct CAG (non-conform protocol). Out of a total of 415 patients, 78.8% (327 patients, mean age: 57.9 years, 67.3% male) were referred to initial CTCA, of whom 260 patients (79.5%) had no obstructive lesions (<50% DS). A total of 55 patients (16.8%) underwent additional CAG after initial CTCA, which showed coronary lesions of >50% DS in 21 patients (6.3% of 327). Eighty-eight patients (mean age: 66.0 years, 59.1% male) were directly referred to CAG (non-conform protocol). These patients were older and had more cardiovascular risk factors compared to patients that underwent initial CTCA (conform protocol), and coronary lesions of >50% DS were detected in 16 patients (17.2%). Revascularization procedures were infrequently performed in both groups: initial CTCA (3.0%), direct CAG (3.4%). The use of CTCA as a gatekeeper CAG in the diagnostic work-up of non-coronary cardiac surgery, cardiomyopathy, heart failure and ventricular arrhythmias is feasible, and only 17% of these patients required additional CAG after initial CTCA. Therefore, CTCA should be considered as the initial imaging modality to rule out CAD in these patients.

Hypertension in specific conditions/co-morbidities

ESC CardioMed ◽  
2018 ◽  
pp. 2465-2473
Author(s):  
Enrico Agabiti Rosei ◽  
Maria Lorenza Muiesan ◽  
Massimo Salvetti
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Age Groups ◽  
Optimal Management ◽  
Hypertensive Patients ◽  
Accurate Evaluation ◽  
Associated Conditions ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The optimal management of hypertensive patients requires accurate evaluation of cardiovascular risk factors and co-morbidities. The therapeutic approach to hypertension may, in fact, be significantly different according to associated conditions. Among them, the presence of coronary heart disease, heart failure, cerebrovascular disease, chronic kidney disease, and specific age groups deserve special attention. In this chapter, the initial diagnostic work-up, the thresholds and targets for treatment, and the preferred drugs in specific conditions/co-morbidities will be briefly discussed.

Acute heart failure: diagnosis

ESC CardioMed ◽  
2018 ◽  
pp. 1911-1917 ◽  
Author(s):  
Adriaan A. Voors ◽  
Piotr Ponikowski
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Medical Condition ◽  
Specific Treatment ◽  
Length Of Hospital Stay ◽  
Clinical History ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Acute heart failure is a life-threatening medical condition typically leading to urgent hospital admission. Early diagnosis is of great importance, since it will lead to earlier and better targeted treatment, leading to a decrease in length of hospital stay, and most importantly to improved clinical outcome. The initial diagnostic work-up includes a clinical history, evaluation of symptoms and signs, an electrocardiogram, chest X-ray, natriuretic peptide levels, echocardiography and perhaps lung ultrasound. After the initial work-up, a clinical classification according to blood pressure, congestion, and peripheral perfusion should be performed, since it will guide treatment. During the diagnostic work-up, treatable and life-threatening conditions always need to be considered since they need immediate and case-specific treatment.

scholarly journals Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden

2019 ◽  
Vol Volume 11 ◽  
pp. 231-244 ◽  
Author(s):  
Krister Lindmark ◽  
Kurt Boman ◽  
Mona Olofsson ◽  
Michael Törnblom ◽  
Aaron Levine ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Population Based ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris

2007 ◽  
Vol 28 (15) ◽  
pp. 1872-1878 ◽  
Author(s):  
Nico R. Mollet ◽  
Filippo Cademartiri ◽  
Carlos Van Mieghem ◽  
Bob Meijboom ◽  
Francesca Pugliese ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Coronary Angiography ◽  
Ct Coronary Angiography ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 182
Author(s):  
Maria Lucia Narducci ◽  
Michela Cammarano ◽  
Valeria Novelli ◽  
Antonio Bisignani ◽  
Chiara Pavone ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Arrhythmias ◽  
Young Patients ◽  
Structural Heart Disease ◽  
Competitive Athletes ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Apparently Healthy

The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease.

scholarly journals New diagnosed heart failure with renal insufficiency -- Cardiac MRI-guided clinical decision making

2021 ◽  
Author(s):  
Calin Maniu ◽  
Kana Fujikura
Keyword(s):  
Heart Failure ◽  
Coronary Angiography ◽  
Cardiac Mri ◽  
Clinical Decision Making ◽  
Invasive Coronary Angiography ◽  
Clinical Decision ◽  
Newly Diagnosed ◽  
Laboratory Findings ◽  
Initial Work ◽  
Work Up

A 63 year-old female with multiple atherosclerotic risk factors presented with newly diagnosed heart failure. Clinical presentation and initial work-up studies (e.g. laboratory findings, ECG, and echocardiography) were indeterminate for ischemic or non-ischemic etiology. As she developed contrast-induced nephropathy, coronary angiography was deferred and cardiac MRI was performed instead. Cardiac MRI elegantly demonstrated non-ischemic cardiomyopathy that was subsequently confirmed by invasive coronary angiography. This case emphasizes the important role of cardiac MRI in establishing the etiology of cardiomyopathy, ultimately altering the clinical management of the patient with newly diagnosed heart failure.

Hypertension in specific conditions/co-morbidities

ESC CardioMed ◽  
2018 ◽  
pp. 2465-2473
Author(s):  
Enrico Agabiti Rosei ◽  
Maria Lorenza Muiesan ◽  
Massimo Salvetti
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Age Groups ◽  
Optimal Management ◽  
Hypertensive Patients ◽  
Accurate Evaluation ◽  
Associated Conditions ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The optimal management of hypertensive patients requires accurate evaluation of cardiovascular risk factors and co-morbidities. The therapeutic approach to hypertension may, in fact, be significantly different according to associated conditions. Among them, the presence of coronary heart disease, heart failure, cerebrovascular disease, chronic kidney disease, and specific age groups deserve special attention. In this chapter, the initial diagnostic work-up, the thresholds and targets for treatment, and the preferred drugs in specific conditions/co-morbidities will be briefly discussed.

scholarly journals 533 Uncommon ECG presentation in Tako-tsubo syndrome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Lorenzo Acone ◽  
Alonge Stefanoa ◽  
Evelina Toscano ◽  
Andrea Mortara
Keyword(s):  
Coronary Angiography ◽  
Troponin I ◽  
Systolic Function ◽  
Apical Ballooning ◽  
St Depression ◽  
St Segment ◽  
St Elevation ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Aims We present the case of an 80-year-old woman without prior cardiovascular history, recent instrumental diagnosis of peritoneal carcinomatosis and ongoing oncologic diagnostic work up. Methods and results The patient was admitted to our ED for acute-onset worsening dyspnoea. On first clinical evaluation, she denied typical angina, remarkable clinical features were dyspnoea, tachycardia and hypotension. Admission ECG showed sinus rhythm with posterior and inferior ST elevation (leads DII, aVF, V5, V6) with reciprocal ST segment depression in leads V1–V2. Echocardiography confirmed infero-postero-lateral akinesia determining moderate reduction of LVEF (35–40%), normal aortic root, no pericardial effusion. Laboratory tests revealed normal WBC count, mild anaemia (HB 10.7 g/dl), normal renal function, elevated C-reactive protein (139 mg/l, n.v. &lt; 8). Cardiac troponin I (cTnI) was normal on admission, with significant delta on second determination (0.012 &gt; 2.5 ng/ml, nv &lt; 0.023). ST elevation persisted after BP normalization and hypoxia treatment; so, taken into account the increased procedural risk due to patient’s age and comorbidities, however we decided to perform urgent coronary angiography. Surprisingly, coronary angiography revealed absence of any significant stenosis, with TIMI 3 flow in any coronary segment. The patient was then admitted to the ICU with diagnosis of MINOCA. The next day ECG revealed normalization of ST segment and Q wave in V2–V3. On day 2 new ECG showed new ventricular repolarization abnormalities with T wave inversion in precordial leads. Peak hs-cTnI was &gt;15 000 ng/l. Repeat echocardiography on day 2 reported complete akinesia of all the apical segments of the LV with normo-hyperkinesia of the mid-basal segments (apical ballooning pattern) and severely depressed systolic function (FE 32–35%). During the following days patient’s symptoms improved, with rapid weaning from oxygen therapy and stable haemodynamic parameters. After 10 days the patient repeated echocardiography, which revealed improvement of global LVEF and persisting mild apical hypokinesia, suggesting the diagnostic hypothesis of Tako-Tsubo Syndrome (TTS) or TTS-phenocopy (unfortunately cardiac MRI was not performed). The patient was therefore transferred to oncology department to complete the diagnostic work-up; primary mammary neoplasia was identified, moreover associated with metastasis in the liver and the brain. Unfortunately, the patient died a month later due to non-cardiac causes. This is the case report of an uncommon MINOCA, which presented mimicking inferolateral acute STEMI, but subsequent ECG and echocardiographic evolution showed the more typical TTS pattern, with apical ballooning on echo and deep negative T waves in anterior leads. Conclusions The prevalence of MINOCA is estimated to be 6% to 8% among patients diagnosed with MI, especially women, however it is more common in patients with NSTEMI compared with STEMI; moreover in cases of TTS presenting with ST elevation, usually the elevation is found in anterior leads without reciprocal ST depression; in this patient instead ST elevation was inferolateral with reciprocal anterior ST depression. Absence of obstructive CAD and clinical/echocardiographic evolution allowed us to confirm the diagnosis of MINOCA/TTS.

scholarly journals Heart failure in the elderly: A geriatric syndrome. Picture of the modern situation

2019 ◽  
Vol 89 (1) ◽  
Author(s):  
Valentina Fagotto ◽  
Alessandro Cavarape ◽  
Alessandro Boccanelli
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Clinical Presentation ◽  
The Elderly ◽  
Geriatric Syndrome ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up ◽  
Diagnostic Work Up

Among the older patients’ cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient’s history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration.

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