Cardiovascular manifestations of Hutchinson–Gilford progeria syndrome

Cardiovascular complications are the most frequent cause of death in patients with the Hutchinson–Gilford progeria syndrome. However, due to its rarity, studying the course of cardiac abnormalities has been a challenge. The cardiovascular phenotype helps to provide greater insight into the natural history of these abnormalities.

Cardiac assessments of bottlenose dolphins (Tursiops truncatus) in the Northern Gulf of Mexico following exposure to Deepwater Horizon oil

The Deepwater Horizon (DWH) oil spill profoundly impacted the health of bottlenose dolphins (Tursiops truncatus) in Barataria Bay, LA (BB). To comprehensively assess the cardiac health of dolphins living within the DWH oil spill footprint, techniques for in-water cardiac evaluation were refined with dolphins cared for by the U.S. Navy Marine Mammal Program in 2018 and applied to free-ranging bottlenose dolphins in BB (n = 34) and Sarasota Bay, Florida (SB) (n = 19), a non-oiled reference population. Cardiac auscultation detected systolic murmurs in the majority of dolphins from both sites (88% BB, 89% SB) and echocardiography showed most of the murmurs were innocent flow murmurs attributed to elevated blood flow velocity [1]. Telemetric six-lead electrocardiography detected arrhythmias in BB dolphins (43%) and SB dolphins (31%), all of which were considered low to moderate risk for adverse cardiac events. Echocardiography showed BB dolphins had thinner left ventricular walls, with significant differences in intraventricular septum thickness at the end of diastole (p = 0.002), and left ventricular posterior wall thickness at the end of diastole (p = 0.033). BB dolphins also had smaller left atrial size (p = 0.004), higher prevalence of tricuspid valve prolapse (p = 0.003), higher prevalence of tricuspid valve thickening (p = 0.033), and higher prevalence of aortic valve thickening (p = 0.008). Two dolphins in BB were diagnosed with pulmonary arterial hypertension based on Doppler echocardiography-derived estimates and supporting echocardiographic findings. Histopathology of dolphins who stranded within the DWH oil spill footprint showed a significantly higher prevalence of myocardial fibrosis (p = 0.003), regardless of age, compared to dolphins outside the oil spill footprint. In conclusion, there were substantial cardiac abnormalities identified in BB dolphins which may be related to DWH oil exposure, however, future work is needed to rule out other hypotheses and further elucidate the connection between oil exposure, pulmonary disease, and the observed cardiac abnormalities.

Cardiac magnetic resonance imaging in patients with Behçet's disease

Background Behçet’s disease (BD) is a multisystemic vasculitis that may affect the heart. However, the incidence and nature of cardiac involvement in BD have not been clearly documented yet. The aim of this study was to delineate the cardiac magnetic resonance imaging (MRI) appearances of cardiac involvement in BD patients. Methods This cross-sectional observational study was carried out 30 BD patients without known cardiac disease. Patients were subjected to history taking, physical examination, echocardiography and cardiac MRI. Results At least one abnormality on cardiac MRI was observed in 20/30 patients (66.67%). Myocardial oedema was observed in 3 patients (10%) and late gadolinium enhancement in 1 patient (3.3%). Pericardial effusion was found in 3 patients (10.0%), global hypokinesia in 6 patients (20.0%) and intra-cardiac thrombosis in only 1 patient (3.3%). Pulmonary artery was dilated in 4 patients (13.3%). Left ventricular (LV) and right ventricular (RV) end diastolic volume were altered in 4 patients (13.3%) and 7 patients (23.3%) respectively. LV and RV end systolic volume were abnormal in 7 patients (23.3%) and 5 patients (16.7%) respectively. There was aortic valve regurge in 2 patients (6.7%), tricuspid valve regurge in 9 patients (30%), and mitral valve regurge in 9 patients (30%). Dilated left main coronary artery was found in 2 patients (6.7%) and arrhythmogenic right ventricular dysplasia in only one patient 1 patient (3.3%). On logistic regression analysis, BD activity index score was a significant predictor of cardiac abnormalities. Conclusion BD may cause cardiac abnormalities without clinical manifestations and cardiac MRI may represent a tool for early detection of these subtle abnormalities. Higher BD activity index scores are strongly linked to cardiac problems.

A STUDY OF ECHOCARDIOGRAPHIC CHANGES IN PATIENTS WITH CIRRHOSIS OF LIVER

Background/Aims: Cirrhosis is associated with a significant number of cardiac abnormalities but, the information available is scanty about the changes associated with it in India. Which include increased cardiac output, increased wall thickness of cardiac chambers, left ventricular diastolic dysfunction, and PAH. These cardiac abnormalities in patients with Cirrhosis have been termed as Cirrhotic Cardiomyopathy. Cirrhotic Cardiomyopathy may be a significant cause of morbidity and mortality in patients with Cirrhosis. With the advent of increased liver transplantation in India, this entity may have an impact on transplantation success. The present study aims to evaluate the cardiac abnormalities in patients with cirrhosis using 2D Echocardiography to detect the occurrence of LV dysfunction, pulmonary hypertension, pericardial effusion, and to assess the contribution of cardiac dysfunction on mortality, if any. Methodology: Thirty patients with Cirrhosis (alcoholic and non-alcoholic) were enrolled. Thirty age and sex-matched controls without cardiovascular disease were included for comparison. Data collection was done by clinical history taking, examination, and investigations. All subjects underwent Echo study was at 0, 6 and12 months and controls at the start of the study. Observations and Results: 1. The mean age of study group was 54.5 ± 15 yrs among them, males constituted 93 % of the study population, the majority of patients were in Child class B (43.3%), and Child A (40%). None of the study population died during follow up. 2. The salient Echocardiographic abnormalities noted in the study population were a) Interventricular septal thickness showed significant change compared to control (9.80 ± 1.06 vs. 8.00 ± 1.00mm mm). b) Doppler echocardiography detected elevated pulmonary arterial pressure (PAP) in the study population compared to control (20.73 ±2.43mm Hg vs.18.26 ± 2.1mm Hg). c) Diastolic dysfunction occurred in the form of increased Deceleration time (223.17 ± 13.93 ms vs. 190.83 ± 14.0ms) and increased E: A ratio (1.10±0.1 vs. 1.04±0.12) was noted in subjects with Cirrhosis. Two of the study subjects had pericardial effusion. (6.7%) 3. There is no evidence of systolic dysfunction noted in the study population. 4. There is no correlation between the severity of Cirrhosis and echocardiographic changes. 5. There were no differences in echo parameters among patients with alcoholic or non-alcoholic etiology of Cirrhosis. 6. There was no fatality recorded due to cardiac dysfunction Conclusion: 1. This study demonstrates that Indian patients with cirrhosis do have diastolic dysfunction. In the absence of other cardiac disease risk factors, this dysfunction can be attributed only to cirrhotic cardiomyopathy. 2. Echocardiography plays a significant role in detecting early cardiac changes in cirrhosis however, these changes do not seem to be a predictor of increased mortality in cirrhosis patients.

A STUDY OF CARDIAC MANIFESTATIONS IN PATIENTS WITH HIV/AIDS

Introduction:HIV/AIDS pandemic is evolving as a major public concern. Cardiovascular diseases are common in HIV-positive patients. Many patients without any symptoms or signs were found to have a cardiovascular disease on autopsy.It is expected that the risk of cardiovascular disease willrise in the following years due to the cardiovascular risk profile andincreased life expectancy of infected patients. Therefore,diagnosis andtherapy of HIV-associated cardiovascular diseases should be part of the evaluation and management of the HIV-positive patient. Objectives: To find out the frequency of cardiac manifestations on clinical examination, electrocardiography, chest X-ray, and echocardiographic examination. To assess the association of Cardiac abnormality with CD4 Count in patients with HIV/AIDS. Toevaluate the association between cardiac abnormalities with types and duration of antiretroviral therapy regimen (ART). Method:A total of 100 consecutive patients visiting ART OPD and admitted to our institute were examined for signs and symptoms of cardiovascular disease. All patients were evaluated with electrocardiography, chest X-ray, and 2 D echocardiography. CD4 count was measured for all patients using flowcytometry using a BD FACS Count system. Results:Out of 100 patients, 53% were male and 47% were female. Patients were divided into subgroups with CD4 count <200, 200-349, 350-499, and ≥500. The mean CD4 count was 403.62 ± 284.98. Prevalence of the cardiovascular abnormality on ECG, chest X-ray, and echocardiography were 74%, 10%, and 51% respectively. The left ventricular systolic dysfunction was the most common finding in our study with fractional shortening ≤25% in 34% of patients and LVEF <50% in 27% of patients followed by left ventricular diastolic function (26%), dilated cardiomyopathy (6%), pulmonary hypertension (4%), and regional wall motion abnormality (2%).Reduced LV ejection fraction (<50%) and left ventricular diastolic dysfunction were statistically significant in patients with CD4 count less than 200/mm3. Conclusion: In present study electrocardiographic, chest X-ray and echocardiographic abnormalities were present in 74%, 10% and 51% patients respectively. Cardiac abnormalities such as QTc prolongation, LBBB, reduced left ventricular ejection fraction, and left ventricular diastolic dysfunction were more significantly higher in patients with CD4 count less than 200/mm3. We could not find any statistically significant difference in cardiac abnormalities in patients on different ART regimens. Further studies are required with a higher sample size.

Opening the black box: interpretability of machine learning algorithms in electrocardiography

Recent studies have suggested that cardiac abnormalities can be detected from the electrocardiogram (ECG) using deep machine learning (DL) models. However, most DL algorithms lack interpretability, since they do not provide any justification for their decisions. In this study, we designed two new frameworks to interpret the classification results of DL algorithms trained for 12-lead ECG classification. The frameworks allow us to highlight not only the ECG samples that contributed most to the classification, but also which between the P-wave, QRS complex and T-wave, hereafter simply called ‘waves’, were the most relevant for the diagnosis. The frameworks were designed to be compatible with any DL model, including the ones already trained. The frameworks were tested on a selected Deep Neural Network, trained on a publicly available dataset, to automatically classify 24 cardiac abnormalities from 12-lead ECG signals. Experimental results showed that the frameworks were able to detect the most relevant ECG waves contributing to the classification. Often the network relied on portions of the ECG which are also considered by cardiologists to detect the same cardiac abnormalities, but this was not always the case. In conclusion, the proposed frameworks may unveil whether the network relies on features which are clinically significant for the detection of cardiac abnormalities from 12-lead ECG signals, thus increasing the trust in the DL models. This article is part of the theme issue ‘Advanced computation in cardiovascular physiology: new challenges and opportunities’.

Design of a Portable Electrocardiogram (ECG) for the Prevention of Cardiac Anomalies in Health Campaigns in Peru

Cardiac complications are caused by an unbalanced diet, the consumption of alcohol, smoking tobacco, in addition to the excess of polluting gases such as carbon dioxide (CO2), among other gases that are harmful to the human body, due to these types of problems, they arise more frequently in people, which lead to heart problems at an early age. An optimal prevention of these cardiac abnormalities is necessary using an Electrocardiogram (ECG), by using this equipment it is possible to detect the cardiac anomalies that the person may have, thus giving early prevention for cardiac abnormalities that may be occurring in the patient. The design of a low-cost ECG will be considered using the AD8232 module, which allows recording the electrical activities of the heart, obtaining an ECG using the Arduino, in addition the Bluetooth module will send the data collected from the ECG from a patient to a cellphone which will store this information, to be later analyzed by a cardiologist. This paper is intended for use in health campaigns, given that according to the Pan American health organization, 70% of deaths in the world are due to heart problems, due to this figure, it is expected to reduce the rate with early prevention, which consists of the implementation of this biomedical equipment in health campaigns that will have the basic functionalities for the analysis of the electrocardiogram and that is low cost compared to biomedical equipment currently that provide the same functionalities.

Electrolyte Derangements, Hyperlactatemia, and Cardiac Abnormalities Secondary to Refeeding in Three Dogs: Case Report

ABSTRACT Three dogs that presented to the emergency service in severely emaciated body conditions were admitted to the hospital for monitoring and refeeding. During their hospitalization, all three dogs developed electrolyte derangements or required supplementation to prevent hypophosphatemia and hypomagnesemia. Additionally, all dogs developed hyperlactatemia, which was suspected to be secondary to thiamine deficiency. Two dogs were reported to have cardiac abnormalities, including cardiac arrhythmias, systolic dysfunction, and spontaneous echogenic contrast. These cases highlight the complexity of refeeding syndrome and its associated complications that extend beyond electrolyte deficiencies.