scholarly journals Acute heart failure due to COVID-19 related myocardial injury and de novo hypertensive cardiomyopathy: a challenging diagnosis

2021 ◽  
Author(s):  
Matteo Pernigo ◽  
Marco Triggiani ◽  
Emanuele Gavazzi ◽  
Ilaria Papa ◽  
Alberto Vaccari ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
De Novo ◽  
Correct Diagnosis ◽  
Young Male ◽  
Organ Damage ◽  
Severe Illness ◽  
Myocardial Inflammation ◽  
Tubular Injury ◽  
Myocardial Thickening ◽  
Left Ventricle Dysfunction

We report a COVID-19 case with acute heart and kidney failure in a healthy young male. Echocardiography showed severe systolic and diastolic left ventricle dysfunction, with diffuse myocardial thickening. Cardiac MRI showed aspects of focal myocarditis, and hypertensive cardiomyopathy. Renal biopsy demonstrated limited acute tubular injury, and hypertensive kidney disease. Coronary angiography excluded critical stenoses. Unlike what we initially suspected, myocardial inflammation had a limited extent in our patient; severe hypertension causing cardiomyopathy and multi-organ damage, not diagnosed before, was primarily responsible for severe illness. Correct diagnosis and guidelines-directed treatment allowed a favorable course.

A case of splenomegaly with RK-39 positivity: A diagnostic pitfall

2021 ◽  
pp. 004947552110206
Author(s):  
Prasad Dange ◽  
Ankesh Gupta ◽  
Richa Juneja ◽  
Renu Saxena
Keyword(s):  
Hereditary Spherocytosis ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Patient Evaluation ◽  
Serological Testing ◽  
Endemic Region ◽  
Careful Patient ◽  
Diagnostic Pitfall ◽  
Marked Splenomegaly

Long-standing moderate to marked splenomegaly suggests several differential diagnoses, both haematological and infectious, particularly leishmaniasis and malaria in endemic areas. Non-infectious causes may be missed in these regions, especially if pitfalls of serological testing are not considered. Careful patient evaluation is necessary to arrive at the correct diagnosis. We report a case of a young male whose hereditary spherocytosis was initially missed because of RK-39 positivity, splenomegaly and the fact that he hailed from an endemic region.

scholarly journals Cardiac MRI and Myocardial Injury in COVID-19: Diagnosis, Risk Stratification and Prognosis

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 130
Author(s):  
Saagar K. Sanghvi ◽  
Logan S. Schwarzman ◽  
Noreen T. Nazir
Keyword(s):  
Risk Stratification ◽  
Myocardial Injury ◽  
Cardiac Tissue ◽  
Contractile Function ◽  
Imaging Modality ◽  
Acute Myocarditis ◽  
Myocardial Inflammation ◽  
Critical Data ◽  
Non Invasive ◽  
Risk Of Exposure

Myocardial injury is a common complication of the COVID-19 illness and is associated with a worsened prognosis. Systemic hyperinflammation seen in the advanced stage of COVID-19 likely contributes to myocardial injury. Cardiac magnetic resonance imaging (CMR) is the preferred imaging modality for non-invasive evaluation in acute myocarditis, enabling risk stratification and prognostication. Modified scanning protocols in the pandemic setting reduce risk of exposure while providing critical data regarding cardiac tissue inflammation and fibrosis, chamber remodeling, and contractile function. The growing use of CMR in clinical practice to assess myocardial injury will improve understanding of the acute and chronic sequelae of myocardial inflammation from various pathological etiologies.

scholarly journals Acute confusional state as a prognostic sign of COVID-19 large-vessel occlusion (LVO)

2021 ◽  
Vol 14 (2) ◽  
pp. e240536
Author(s):  
Smit Sunil Deliwala ◽  
Murtaza Hussain ◽  
Anoosha Ponnapalli ◽  
Dominic Awuah ◽  
Thair Dawood ◽  
...  
Keyword(s):  
De Novo ◽  
Stroke Care ◽  
Organ Damage ◽  
Large Vessel ◽  
Antigenic Structure ◽  
Left Internal Carotid Artery ◽  
Care Pathways ◽  
Acute Confusional State ◽  
Confusional State ◽  
Vessel Occlusion

COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care. We present a unique case of COVID-19 LVO manifesting as an acute confusional state in an elderly man in April 2020. CT angiography revealed 'de novo' occlusions of the left internal carotid artery and proximal right vertebral artery, effectively blocking anterior and posterior circulations. Delirium can lead to inaccurate stroke scale assessments and prolong initiation of COVID-19 stroke care pathways. Future studies are needed to look into the temporal relationship between confusion and neurological manifestations.

MIS-A associated myocardial injury: The art of diagnosis and follow-up

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Bellony Nzemenoh ◽  
◽  
Arianne C Agdamag ◽  
Valmiki Maharaj ◽  
Victoria Charpentier ◽  
...  
Keyword(s):  
Chest Pain ◽  
Early Identification ◽  
Myocardial Injury ◽  
Clinical Course ◽  
Full Recovery ◽  
Myocardial Inflammation ◽  
Severe Condition ◽  
Healthy Female ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe condition in adults with a clinical course similar to that described in children (MIS-C) following infection with the SARS-CoV-2 virus. Here we describe a case of a 21-year-old, otherwise healthy female who presented with chest pain and signs of sepsis six weeks after recovering from coronavirus disease 2019 (COVID-19). Early identification of MIS-A led to a favorable clinical course and full recovery. Given the highly variable disease presentation yet potentially deadly outcome, providers must remain vigilant to recognize and treat MIS-A early Keywords: MIS-A; myocardial inflammation; SARS-CoV-2; COVID-19 disease.

scholarly journals Toll-Like Receptors and Myocardial Inflammation

2011 ◽  
Vol 2011 ◽  
pp. 1-21 ◽  
Author(s):  
Yan Feng ◽  
Wei Chao
Keyword(s):  
Animal Studies ◽  
Myocardial Injury ◽  
Myocardial Inflammation ◽  
Septic Cardiomyopathy ◽  
Toll Like Receptors ◽  
Tlr Signaling ◽  
Animal Data ◽  
Molecular Patterns ◽  
Damage Associated Molecular Patterns

Toll-like receptors (TLRs) are a member of the innate immune system. TLRs detect invading pathogens through the pathogen-associated molecular patterns (PAMPs) recognition and play an essential role in the host defense. TLRs can also sense a large number of endogenous molecules with the damage-associated molecular patterns (DAMPs) that are produced under various injurious conditions. Animal studies of the last decade have demonstrated that TLR signaling contributes to the pathogenesis of the critical cardiac conditions, where myocardial inflammation plays a prominent role, such as ischemic myocardial injury, myocarditis, and septic cardiomyopathy. This paper reviews the animal data on (1) TLRs, TLR ligands, and the signal transduction system and (2) the important role of TLR signaling in these critical cardiac conditions.

scholarly journals De novo angiosarcoma of the pleura in a young male

2016 ◽  
Vol 4 (1) ◽  
pp. 93
Author(s):  
Arjun Khanna ◽  
Pallavi Periwal ◽  
Rajat Saxena ◽  
Deepak Talwar
Keyword(s):  
De Novo ◽  
Young Male

Abstract 258: Pitx2 Promotes Murine Myocardial Regeneration after Myocardial Injury

2014 ◽  
Vol 115 (suppl_1) ◽  
Author(s):  
GE TAO ◽  
Elzbieta Klysik ◽  
Yuka Morikawa ◽  
James F Martin
Keyword(s):  
Myocardial Infarction ◽  
Stem Cells ◽  
Myocardial Injury ◽  
De Novo ◽  
The United States ◽  
Myocardial Regeneration ◽  
Mouse Heart ◽  
Specific Cell ◽  
Regulation Of Transcription ◽  
Regenerative Therapy

Myocardial infarction is the leading cause of morbidity and mortality in the United States. Compromised myocardial function, due to the lack of self-renewal capacity in mature hearts, is a major reason for heart failure. Available therapies can only ameliorate, but not reverse the loss of functional myocardium. With heart transplantation as the only available cure, design of an effective regenerative therapy has become imperative for cardiovascular research. To repopulate the heart with de novo cardiomyocytes, most attempts have been based on the transplantation of cardiac, non-cardiac stem cells or their derivatives, however a more profound knowledge of stem cells is required for achieving significant progress. Meanwhile, triggering endogenous regenerative capacity is a compelling strategy for cardiac repair. It has been reported that proliferation of pre-existing cardiomyocytes strongly contributes to regeneration. Thus, efforts have been made to reintroduce mature cardiomyocytes into mitotic cycle. The mechanisms underlying the proliferation of cardiomyocytes during development and their homeostasis during adulthood are not fully understood, but likely require tight regulation of transcription factors in specific cell types. We have previously shown that the mouse Hippo kinase cascade is a major heart-size control pathway during development. In addition, activation of Yap, a transcriptional cofactor inhibited by Hippo, by genetically disrupting Hippo signaling is sufficient to induce juvenile and adult myocardial regeneration after surgery-induced myocardial infarction. Here we identified the paired-like homeodomain transcription factor 2 (pitx2) as a potential downstream target and cofactor of Yap in mouse heart. Our data indicates that Pitx2 expression is induced by myocardial injury, and is required for neonatal myocardial regeneration in a postnatal day 1 (P1) apex resection model. Further studies show that over-expression of pitx2 in adult cardiomyocytes is sufficient to promote the restoration of myocardial structure and function after myocardial infarction. Together, we show that pitx2 is a new manipulator of myocardial regeneration and could serve as a novel therapeutic target in cardiac regenerative therapy.

Dangerous small B-cell clones

Blood ◽  
2006 ◽  
Vol 108 (8) ◽  
pp. 2520-2530 ◽  
Author(s):  
Giampaolo Merlini ◽  
Marvin J. Stone
Keyword(s):  
B Cell ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Mixed Cryoglobulinemia ◽  
Organ Damage ◽  
Antibody Activity ◽  
Monoclonal Immunoglobulin ◽  
Delay In Diagnosis ◽  
Monoclonal Immunoglobulin Deposition Disease ◽  
Monoclonal Proteins

AbstractThe detection of a monoclonal immunoglobulin in serum or urine usually raises concerns about the size of the underlying B-cell-derived clone and possible systemic effects caused by its expansion. However, a small clone can synthesize a very toxic protein, producing devastating systemic damage and protean clinical presentations. The resulting “monoclonal component-related diseases,” although difficult to diagnose, may be progressive and even fatal. The monoclonal protein can aggregate and deposit systemically as occurs in light-chain amyloidosis, monoclonal immunoglobulin deposition disease, crystal-storing histiocytosis, and monoclonal cryoglobulinemia. Alternatively, some monoclonal proteins possess antibody activity toward autogenous antigens and cause chronic cold agglutinin disease, mixed cryoglobulinemia, and peripheral neuropathies. Other humoral mediators may contribute to neuropathy in variant disorders such as the POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome. The clone synthesizing the noxious monoclonal proteins is often small, and sensitive techniques may be required to detect these immunoglobulins. A delay in diagnosis can allow irreversible organ damage and dramatically shorten survival. Prompt recognition of suggestive signs and symptoms should trigger a thorough diagnostic approach to reach the correct diagnosis quickly, because this is the key to effective therapy. Although the treatment of these conditions is not optimal, significant advances have been made, improving the duration and quality of life.

scholarly journals Aurea diagnosis of pneumomediastinum. A case report

2020 ◽  
Vol 14 (3) ◽  
pp. 179-183
Author(s):  
Lucio Brugioni ◽  
Francesca De Niederhausern ◽  
Chiara Gozzi ◽  
Pietro Martella ◽  
Elisa Romagnoli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Diagnostic Process ◽  
Acute Aortic Syndrome ◽  
X Ray ◽  
Chest X Ray

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.

5035Comparative assessment of diagnostic algorithms of myocardial inflammation by endomyocardial biopsy and tissue mapping by CMR against high-sensitive troponin in viral myocarditis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H A Zainal Abidin ◽  
K Klingel ◽  
A Rolf ◽  
T Keller ◽  
H Zhou ◽  
...  
Keyword(s):  
Endomyocardial Biopsy ◽  
Myocardial Injury ◽  
Research Centre ◽  
Myocardial Inflammation ◽  
Low Grade ◽  
Diagnostic Algorithms ◽  
Native T1 ◽  
T1 And T2 ◽  
Tissue Mapping ◽  
High Sensitive Troponin

Abstract Background Myocarditis is defined by inflammatory involvement of the myocardium, either histologically by evidence of myocardial necrosis and cellular infiltration on endomyocardial biopsy (EMB), or non-invasively by presence of myocardial oedema using tissue mapping with cardiovascular magnetic resonance (CMR). Objective: to undertake intra-individual comparisons of EMB vs. CMR diagnostic algorithms of myocardial inflammation, as well as against an independent gold-standard of myocardial injury, high-sensitive troponin (hs-TropT). Methods Prospective multicentre study of consecutive patients (n=109) with clinical diagnosis of myocarditis. EMBs were analysed by 2 reference centres using the ESC diagnostic and their local algorithms. The CMR criteria used sequence-specific cut-offs for native T1 and T2 (standard deviation, SD); myocardial inflammation T1 ≥2SD, T2 ≥2SD and no inflammation: T1 and T2<2SD, with subcategories for acute/high-grade: T1 ≥5SD, T2 ≥2SD; chronic/low-grade: T1 ≥2SD, T2 ≥2SD; healed: T1 <2SD, T2 <2SD but myocardial impairment and non-inflammatory cardiomyopathy: T1 ≥2SD, T2 <2SD. Results The agreement between ESC criteria and CMR criteria (AUC: 0.56, p=0.381) was poor. There was a significant agreement between myocardial injury (hs-TropT ≥13.9 ng/L) and CMR criteria (AUC: 0.84, p<0.001), but not ESC algorithm. hs-TropT levels had significant associations with native T1 and T2 (r=0.37 and 0.35, p<0.001), but not with immunohistochemical inflammatory markers. Viral presence was similarly proportioned between inflammatory/non-inflammatory subjects, irrespective of the algorithm. AUC of CMR and EMB versus hs-TroponinT Conclusions Poor agreement between CMR and EMB-based diagnostic algorithms suggests non-overlapping definitions of myocardial inflammatory involvement. Excellent agreement between CMR algorithm and hs-TropT reiterates its high sensitivity for inflammatory myocardial injury. Acknowledgement/Funding 1. National Institute for Health Research (NIHR) Biomedical Research Centre 2. German Centre for Cardiovascular Research (DZHK)

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