China
Africa
Explore chapters and articles related to this topic
Syncope
Published in Henry J. Woodford, Essential Geriatrics, 2022
An accurate diagnosis can be made in most people at this point.4 Additional investigations might be useful if the diagnosis is unknown.5 These are discussed below. A cardiac cause is unlikely (< 1%) if the ECG is normal and there is no clinical evidence of structural heart disease.2 Echocardiography should be considered if structural heart disease is suspected.
Colorado state case study
Published in Edward M. Rafalski, Ross M. Mullner, Healthcare Analytics, 2022
Adom Netsanet, Sera Sempson, William Choe
This mandate also removed the responsibility (and power) of decision-making from physicians regarding whether or not elective procedures should proceed. However, physicians still had to decide whether patients needed a semi-urgent procedure such as pacemaker generator replacements, how long these patients could wait for these life-altering procedures, and what risks hospitalizations posed to these cardiac patients during the dynamic rise of the Coronavirus pandemic. By diminishing elective procedures, this mandate impacted the ability of patients with valvular and structural heart disease to receive treatment, even if the treatment was desired.32
The electrophysiology laboratory
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
A cardiovascular cause of syncope can be identified in a significant number of patients by use of electrophysiologic studies or the head-up tilt test. Tilt testing with or without isoprenaline or nitroglycerine can provoke hypotension and bradycardia in patients with neurocardiogenic mechanisms of syncope. It must be emphasised, however, that syncope can be a sign of more sinister heart disease, particularly in patients with structural heart disease. These patients should be considered for investigation with electrophysiological testing.
The clinical role of invasive hemodynamics in the evaluation and treatment of structural heart disease
Published in Expert Review of Cardiovascular Therapy, 2023
Joshua Rezkalla, Mackram F. Eleid
With the advancement and improvement of therapies for structural heart disease it is of utmost importance to accurately assess disease severity, the predominant etiology of symptoms, and coexisting comorbid conditions in order to predict the likelihood of clinical response prior to exposing patients to surgical or interventional procedural risks. This has led to the resurgence in the use of invasive hemodynamics which has informally been dubbed the ‘table of truth.’ The improvement in surgical techniques coupled with the significantly increased transcatheter therapies that are available to clinicians has inevitably led to increased patient complexity. It is not uncommon to see patients with multivalvular heart disease (such as radiation induced heart disease) or patients with multiple prior surgical valve replacements and sternotomies. Additionally, there is an increase prevalence of associated comorbidities such as atrial fibrillation or diastolic dysfunction that make accurate assessment of the primary disturbance very challenging. Noninvasive imaging and Doppler data in these scenarios are not as reliable. Additionally, imaging faces limitations due to patient’s size, poor imaging windows, and acoustic shadowing from calcification or prior valves/devices. As such we expect invasive hemodynamics to play a larger role in the assessment of structural heart disease in the future both in clinical practice and treatment guidelines.
Association between fragmented QRS and left ventricular dysfunction in acromegaly patients
Published in Acta Cardiologica, 2020
Seçkin Dereli, Hatice Özer, Nurtaç Özer, Adil Bayramoğlu, Ahmet Kaya
We included 60 acromegaly patients in our study. The diagnosis of acromegaly is based on the presence of classical clinical characteristics, increased (age adjusted) serum IGF-I concentration, inadequate suppression of GH concentration during glucose tolerance test and presence of pituitary adenoma in radiological imaging. Patients with previously known diagnosis of structural heart disease (congenital/rheumatic valvular heart disease, arrhythmia, heart failure), coronary artery disease, cancer, renal failure or hepatic failure, acute or chronic infectious disease, autoimmune disease and patients who had undergone major surgery and trauma in the last 3 months were not included in the study, considering that they may complicate the cardiovascular evaluation. Acromegaly patients with complete or incomplete left or right branch block, intraventricular conduction delay (QRS duration >120 ms) in their ECG were also not included in the study. The patients included were separated into two groups: those with (n:23) and without (n:37) fQRS.
Virtual Cardiology
Published in Structural Heart, 2020
Telehealth has, of course, been increasing in prevalence and importance over the last decade. It has enabled sophisticated medical services to be delivered to rural areas and provided specialist consultation for patients, especially in acute conditions. It has, of course, provided interpretation of images from afar for some time. However, the provision of usual initial and follow up outpatient clinic visits is largely a creature of the COVID-19 pandemic. The history and physical are the foundation of diagnosis, and the absence of a physical exam can present a major challenge to care. This is especially true for patients with valvular and other structural heart diseases, for whom the physical exam is often crucial. In addition, virtual meetings eliminate the laying on of hands and the human touch that is so important to the healing arts.