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Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
A cardiomyopathy is a primary myocardial disorder. It is different than structural cardiac disorders, including congenital heart disorders, coronary artery disease, or valvular disorders. There are three main types of cardiomyopathies which include dilated, hypertrophic, and restrictive cardiomyopathies. Dilated cardiomyopathy is myocardial dysfunction that results in HF, with ventricular dilation and systolic dysfunction. Hypertrophic cardiomyopathy is a congenital or acquired disorder, with extreme ventricular hypertrophy and diastolic dysfunction, lacking increased afterload – it may be caused by coarctation of the aorta, systemic hypertension, or valvular aortic stenosis. Restrictive cardiomyopathy involves noncompliant ventricular walls, which resist diastolic filling. When one ventricle is affected it is usually the LV. However, both ventricles can be affected. An ischemic cardiomyopathy can occur with severe CAD, with or without infarction. It is not a primary myocardial disorder. Cardiomyopathies are signified by signs and symptoms of HF, based on systolic, diastolic, or combined dysfunction. Diabetic cardiomyopathy is cardiac dysfunction with structural, functional, and metabolic alterations even though coronary artery disease may be absent.
The Cardiovascular System and its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Auscultation involves listening for sound within the body. It can be as simple as using a stethoscope to detect Korotkoffsounds (the sounds of blood flow through compressed veins when measuring blood pressure with a sphygmomanometer) or more complex such as listening to the heart with a stethoscope to detect unusual sounds and analyze the phases of the cardiac cycle. Variations in the four basic heart sounds, the presence of opening snaps from the valves, ejection sounds, systolic clicks of the mitral valve, or the more prolonged sounds of murmurs can aid the diagnosis of mitral valve disease, valvular regurgitation, and various cardiomyopathies. The use of microphones on the chest wall allows the graphic display of heart sounds and phonocardiography allows further refinement in determining the source of irregular heart sounds and isolating the focus of a disorder.
Cardiomyopathies in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
The cardiomyopathies are a diverse group of disorders characterized by structural abnormalities of the heart muscle, many of which have a genetic component. Abnormalities may be anatomic (dilatation, thickened, or stiff musculature), histologic (manifested by fiber disarray, fibrofatty dysplasia, or fibrosis) or functional (systolic or diastolic dysfunction). Nonischemic cardiomyopathies have several phenotypes that include dilated, hypertrophic, restrictive, arrhythmogenic right ventricular, and unclassified. Each of these types may have familial and non-familial forms [1–3]. Several classificatory schemes exist, but the most recently endorsed is the MOGE(S) system which incorporates morphofunctional phenotype (M), organ involved (O), genetic inheritance (G), etiologic annotation (E), and functional status [1–4]. Examples of major nonischemic cardiomyopathies are shown in Box 12.1.
Perimortem caesarean section in COVID-19 era
Published in Journal of Obstetrics and Gynaecology, 2022
Yudianto Budi Saroyo, Noroyono Wibowo, Damar Prasmusinto, Yuditiya Purwosunu, Rima Irwinda, Mohammad Adya Firmansha Dilmy, Angela Putri, Andrew Wijaya
Maternal physiological changes may worsen the acute decompensation, especially in critically ill pregnant patients. We must made aware that due to progesterone effect to lower oesophageal sphincter, mothers are put on a high risk of aspiration of gastric content. The mortality rate of chemical pneumonitis caused by gastic content have a high mortality rate up to 70%. In an emergency setting, we might not have a detailed history of the patient. We must aware that the patient also might have an underlying cause the cardiac arrest, such as malignant arrhythmia, cardiomyopathies or myocardial infarct (Habek et al. 2021). Prompt oxygenation should be done and while CPR being performed, foetal heart rate monitoring should be postponed as it might disturbs the algorithm (American Heart Association 2020). Attending physicians should be aware to perform perimortem delivery after 4 minutes of resuscitation.
The pre-clinical discovery and development of osimertinib used to treat non-small cell lung cancer
Published in Expert Opinion on Drug Discovery, 2021
Florian Wittlinger, Stefan A. Laufer
Most common adverse events (> 20%) which were observed in clinical trials under treatment with osimertinib were diarrhea, rash, musculoskeletal pain, paronychia, dry skin, stomatitis, fatigue, and cough[94]. Occurrence of Interstitial lung disease (ILD)-like events was reported in 3.7% of patients, and permanent discontinuation of therapy is suggested if symptoms appear. ILD is a collective term for lung diseases affecting the parenchyma, which are triggered by an initial inflammation of the alveoli that expand to the interstitium and usually result in pulmonary fibrosis[95]. QTc interval prolongation was observed, fortunately without any fatal cases. Yet, in patients with a preexisting heart condition, strict monitoring with ECG should be performed. Cardiomyopathies appeared in 3% of patients, and cardiac monitoring should be conducted in patients with cardiac risk factors. Keratitis was reported in 0.7% of patients in clinical trials. An ophthalmologist should be consulted in the presence of typical symptoms. Severe skin reactions such as Stevens-Johnson syndrome and erythema multiforme major have been reported under treatment with osimertinib, which should be discontinued at signs of early symptoms. Osimertinib should be withheld in the case of symptoms of a cutaneous vasculitis, and therapy should be discontinued if coherence between systemic treatment and disease is proven after consultation of a dermatologist[94].
Recommendations and guidance on the diagnosis and management of Danon disease
Published in Expert Opinion on Orphan Drugs, 2021
Kimberly N. Hong, Michela Brambatti, Sonya John, Quan M. Bui, Marzia Rigolli, Matthew Taylor, Eric D. Adler
Guidelines specific to Danon cardiomyopathy exist, but are informed by expert opinion and observational data [9,16]. Treatments are driven by symptoms, with therapeutic decisions extrapolated from guidelines for hypertrophic and dilated cardiomyopathies. Although the disease course may be initially stable, individuals with DD will eventually decline and either die or require advanced therapies. Thus, while the recommended therapies are evidence based for the varying cardiac DD phenotypes, the efficacy of these treatments in DD is unknown, particularly given its early presentation and progressive nature compared to other forms of hypertrophic cardiomyopathy or heart failure. Often patients are made aware of their diagnosis after other family members have been diagnosed or become symptomatic. There are no specific guidelines for the management of asymptomatic patients with known LAMP-2 mutations. Differences in phenotypic expression and disease manifestations by gender should guide when cardiac, muscular, cognitive and ophthalmological screening begins, however, given the morbidity and mortality associated with DD, early surveillance is generally recommended [9].