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Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
The prognosis appears to be related to the course following pregnancy. Patients who have persistent cardiomegaly have a poor prognosis (97), whereas a return to normal heart size within 6–12 months postpartum predicts a more favorable outcome (94). Women with persistent LV dysfunction should be advised to avoid pregnancy due to the risk of HF progression and death (98). Successful subsequent pregnancies have been reported in patients who have a return to normal heart size (99,100). For patients who have a refractory downhill course following the diagnosis of peripartum cardiomyopathy, cardiac transplantation should be considered. Case reports of successful completion of pregnancy following cardiac transplantation have been published (101–105). Patients in whom left ventricular dysfunction develops as a result of peripartum cardiomyopathy require echocardio-graphic follow-up of ventricular function. Improvement in systolic function beyond that assessed at 6 months after delivery is uncommon.
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Pulmonary oedema is commonly due to cardiac failure or fluid overload. The earliest feature is upper lobe diversion. Following this, interstitial oedema develops, causing ground glass opacification and interlobular septal thickening. Alveolar oedema will develop if the condition continues to progress and this manifests as consolidation. Cardiomegaly may be present and can be assessed by measuring the cardiothoracic ratio.
Clinical Applications and Protocols of Single Photon Emission Computed Tomography
Published in Bhagwat D. Ahluwalia, Tomographic Methods in Nuclear Medicine: Physical Principles, Instruments, and Clinical Applications, 2020
Only a few patient studies have been published. A study by Donaldson et al. consisted of 84 patients with suspected pulmonary emboli.170 Tomography using 99mTc MAA was compared to planar scintigraphy. Data of angiographically documented pulmonary emboli obtained with cardiac catheterization were available in 12 cases. Excellent correlation was observed between tomograms and angiography. Section scanning yielded higher sensitivity than the two-dimensional planar projections of the lung scans. In eight patients, SPECT revealed the presence of perfusion defects, while planar images were normal. Coronal planes obtained from the transaxial sections offer the best approach to detection of segmental perfusion defects. It appears that the noninvasive SPECT approach may be a good alternative to cardiac catheterization. The SPECT approach also offers the relatively small advantage of increasing the sensitivity for detection of pulmonary emboli by approximately 10%. Similar results were reported by LeJeune’s group.171 According to these investigators, however, a small group of 30 patients did not confirm the superiority of tomography over conventional planar imaging. Nevertheless, the extent and localization of perfusion defects are enhanced due to increased contrast. Applications to cases of cardiomegaly are presently under investigation.
The clinical associations with cardiomegaly in patients undergoing evaluation for pulmonary hypertension
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Benjamin Daines, Sanjana Rao, Omid Hosseini, Sofia Prieto, John Abdelmalek, Mohamed Elmassry, Pooja Sethi, Victor Test, Kenneth Nugent
Information was collected from electronic medical records on patients referred to the Pulmonary Vascular Disease Clinic in the Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock, Texas, who underwent right heart catheterization at University Medical Center in Lubbock between 1 January 2019 and 20 May 2020. This retrospective study included all patients undergoing right heart catheterization during this time interval. There were no exclusions. Demographics, clinical information, laboratory results, chest x-rays, echocardiograms, and right heart catheterization hemodynamic parameters were recorded. Cardiomegaly was defined radiographically as a heart size that exceeded 50% of the internal diameter of the thorax on the posterior-anterior film; these calculations were made by the senior author (KN, a pulmonary physician with more than 40 years of experience in clinical medicine). A hemodynamic composite score based on a recent publication was calculated using right heart catheterization data (Table 1) [8]. All cardiac catheterizations were done by one author (VT, a pulmonary physician with 21 years of experience in performing and interpreting right heart catheterizations).
Low voltage criteria EKG as a harbinger of systemic disease
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Ian Garrahy, Daniel Forman, Sharon Swierczynski
Renal amyloidosis usually manifests as proteinuria, often resulting in nephrotic syndrome, as seen in our case. Development of end-stage renal disease is common [3,5]. Cardiac involvement may lead to cardiomegaly, congestive heart failure, and different rhythm disturbances. The electrocardiographic findings include low voltage and, often, a pattern of myocardial infarction. Echocardiography usually reveals a concentric thickening of the left ventricle [3,5]. Increased myocardial echogenicity with ‘granular sparkling’ appearance is very specific of the disease[5]. In this patient, there was renal amyloidosis present with nephrotic range proteinuria, progressive renal insufficiency, and hypoalbuminemia. Renal amyloidosis was confirmed with the renal biopsy. Two years prior to the diagnosis of renal amyloidosis, low voltage and anterior pseudo-infarct pattern on ECG were clinical clues for cardiac amyloidosis (CA). Cheng et al. concluded that the combination of low voltage on limb leads and pseudo-infarct pattern on ECG has high specificity and positive predictive value for the diagnosis of CA[6]. The results of the Cheng et al. study were similar with previous reports [7–9]. Murtagh et al. [7]. from the Mayo Clinic reported that in 127 patients with biopsy-proven proven CA, 46% had low voltage and 47% had pseudo-infarct pattern. Rahman et al. [8]. reported that the low voltage was in 56% and pseudo-infarct pattern was in 60% of patients. Austin et al. [9]. reported that 45 patients with biopsy-proven CA, the low voltage was seen in 27% of patients.
An unexpected peripheral blood finding: microfilaria
Published in Baylor University Medical Center Proceedings, 2020
John R. Krause, Meleissa Hutcheson, Rebecca Ardoin
A 68-year-old woman presented to the emergency department with an irregular and rapid heartbeat. She had a history of mild hypertension with a blood pressure reading of 155/95 mm Hg. An electrocardiogram revealed atrial fibrillation. Radiologic studies revealed mild cardiomegaly. Her metabolic profile was within normal limits, with a glucose of 87 mg/dL; sodium, 141 mEq/dL; potassium, 3.8 mEq/dL; chloride, 105 mEq/dL; calcium, 9.6 mg/dL; and blood urea nitrogen, 16 mg/dL. Her complete blood count results appear in Table 1. A peripheral smear was examined because of the mild eosinophilia, and a microfilaria was found in the patient’s blood film, which was identified as Mansonella perstans(Figure 1).