China
Africa
Explore chapters and articles related to this topic
Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
TR can be tolerated well for a long time. Symptoms occur when low cardiac output and systemic venous congestion ensue. Symptoms of RV failure include fatigue, anorexia, hepatalgia, weight loss, dyspnea, and palpitations. Signs of RV failure are peripheral edema, ascites, cachexia, jaundice, and positive hepatojugular sign. There is holosystolic murmur, best heard left parasternal in the 3rd to 4th intercostal space, which typically increases with inspiration (Carvallo sign). In very severe TR, the murmur is not heard. RV S3 and S4 may be heard and increase with inspiration. The ECG may demonstrate right bundle branch block or AF.11 Chest radiogram may show cardiomegaly due to enlarged right heart chambers.
α1-Antitrypsin deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Pulmonary disease is the most common expression of the PIZZ phenotype [29] (Figure 107.2). As many as 90 percent develop emphysema. It is classically early in onset, occurring at 20–40 years of age in smokers and 55 in nonsmokers [5, 30, 31]. It is referred to as chronic obstructive pulmonary disease or COPD. The earliest symptom is dyspnea on exertion. Cough develops in about half of the patients, and recurrent pulmonary infections are common. On examination, the patient may be thin, but the diameter of the chest is increased. Breath sounds are diminished, and the chest film reveals hyperinflation, especially in the bases. The diaphragms may be flattened. Pulmonary function tests are typical of severe emphysema consistent with a loss of pulmonary elastic recoil. Total lung capacity is impaired, as is residual volume. Air flow is limited, and diffusion capacity and maximum transpulmonary pressure are reduced. Mild hypoxemia at rest may increase with exercise. Hypocarbia and respiratory alkalosis may be associated with mild pulmonary hypertension. Electrocardiograms may show chronic strain on the right heart with right axis deviation and right atrial hypertrophy. There may be a right bundle branch block.
Electrocoagulation Of Vascular Abnormalities Of The Large Bowel
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
This patient is thought to be bleeding from vascular abnormalities outside the large bowel. Because of his age and general medical condition, an attempt at eradicating them will not be made unless his anemia cannot be controlled with iron therapy. Case 11 : This 65-year-old woman was referred because of passing dark-red blood per rectum. The patient had suffered two myocardial infarctions, 6 and 4 years previously. Physical examination of the heart showed it to be enlarged with diminished heart sounds and no murmur. A colon X-ray was nondiagnostic. The electrocardiograph was abnormal because of right bundle-branch block. Colonoscopy showed a 5 mm bright-red lesion just below the ileocecal valve and somewhat lateral. A white fleck at the center suggested that it was eroded (Figure 6). The lesion was biopsied and destroyed in the usual fashion. Microscopic examination showed angiectasis. In addition, the ulcerated surface was confirmed. She has had no bleeding for 2½ years.
Assessment of the QT interval in right bundle branch block
Published in Acta Cardiologica, 2023
Patients with a diagnosis of ‘intermittent right bundle branch block’, that were confirmed by a reading cardiologist, were selected via an electronic search of an ECG data base, MUSE™ version 9.0 SP6 (General Electric, Milwaukee, WI, USA), during an arbitrarily selected 14-year period from 1 January 2004 to 31 March 2018. There were 322, 743 unique individuals in the data base during this time period. The diagnostic criteria for identification of RBBB were those of the algorithm in MUSE™TM version 9.0 SP6 (General Electric, Milwaukee, WI, USA). Inclusion criteria consisted of 12-lead ECGs with both narrow QRS complexes (<120 ms) as well as wide QRS complexes with RBBB morphology. Exclusion criteria consisted of ECGs rendering QT measurement unreliable specifically atrial fibrillation, atrial flutter or atrial tachycardia, artifacts, T-wave changes that rendered QT measurements unreliable, only one complex with normal QRS duration or RBBB morphology, or electronic pacemaker complexes.
Prevalence of cardiac amyloidosis among elderly patients with systolic heart failure or conduction disorders
Published in Amyloid, 2019
Ángela López-Sainz, F. Javier de Haro-del Moral, Fernando Dominguez, Alejandra Restrepo-Cordoba, Almudena Amor-Salamanca, Aitor Hernandez-Hernandez, Luis Ruiz-Guerrero, Isabel Krsnik, Marta Cobo-Marcos, Victor Castro, Jorge Toquero-Ramos, Enrique Lara-Pezzi, Ignacio Fernandez-Lozano, Luis Alonso-Pulpon, Esther González-López, Pablo Garcia-Pavia
Two patients (2%; 95% confidence interval [95% CI] 0–4%) were noninvasively diagnosed with ATTRwt cardiac amyloidosis. 99mTc-DPD scintigraphy revealed an intense cardiac uptake in both cases (Figure 1). Genetic testing of TTR revealed no mutations and a plasma cell dyscrasia was ruled out. Both patients had complete AVB (one of them permanent and the other one intermittent) and were admitted due to a syncopal episode. They were both previously asymptomatic and did not show any extracardiac signs of amyloid deposits. One patient was in atrial fibrillation and both had right bundle branch block (Figure 1). Neither patient showed other classical ECG findings associated with amyloidosis, such as pseudo-infarct pattern or low voltages. Moreover, both patients exhibited normal LVEF (56% and 58%) with mild LV hypertrophy (12 and 14 mm, respectively) and severe left atrium dilatation (indexed left atrium volume of 45 and 48 mL/m2, respectively; Figure 1).
Cardiac sarcoidosis – an expert review for the chest physician
Published in Expert Review of Respiratory Medicine, 2019
Jamie S. Y. Ho, Edwin R. Chilvers, Muhunthan Thillai
Patients may present with first, second or third-degree heart block, or in more distal lesions left or right bundle branch block. In one study from Finland, symptomatic atrioventricular block (AVB) was the first clinical manifestation in 44% of CS [23]. Long-term complete heart block may present with syncope or Adam-Stokes attacks, and at post-mortem of such cases, large granulomas or scarring were seen in the muscular ventricular septum at the cephalic end [7]. AVB can also progress to heart failure and ventricular tachyarrhythmia in CS [24]. One Japanese study found that half of the patients presenting with AVB developed major cardiac adverse events after a mean follow up period of 45 months [25]. AVB associated with CS has been shown to have a higher rate of major cardiac adverse outcomes than idiopathic AVB in patients <55 years old [26].