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Cardiology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
MI – late complications:1 Recurrent arrhythmias.2 Heart failure.3 Dressler’s syndrome.114 Ventricular aneurysm.
CardiacTransplantation
Published in P. Chopra, R. Ray, A. Saxena, Illustrated Textbook of Cardiovascular Pathology, 2013
Fig. 10.8a: Explanted heart from a case of ischemic heart disease. Left ventricular aneurysm was present. The picture shows marked thinning and attenuation of the surviving myofibers (M) with dense replacement fibrosis (F) of the myocardium. Endocardium (E) is also thickened (MassonTrichrome stain)
HeartMate 3 left ventricular assist device implant after excision of a large apical aneurysm
Published in Baylor University Medical Center Proceedings, 2020
Themistokles Chamogeorgakis, Konstantinos Kostopanagiotou, Allison Behler, Dimitrios Apostolou
The left ventricular opening was larger than the LVAD sewing ring. We compensated for the size mismatch with the two Fontan stitches that were tied snug when the ring was sutured and the pump secured. A similar technique has been described for a HeartWare LVAD (Medtronic, Minneapolis, MN) implant in a patient with a left ventricular aneurysm.3 Alternatively, a Dor procedure has been described with patch ventriculoplasty and HeartMate II LVAD implant with interposition tube graft in more complex anatomy, when the inflow cannula is anticipated to be in close proximity to the mitral valve annulus.4 The shorter inflow cannula of the two centrifugal LVADs most commonly used in the USA (HeartMate III and HeartWare) avoids this problem. Small apical aneurysms during LVAD implant can be incorporated in the left ventricular apical coring.5
Naxos disease – a narrative review
Published in Expert Review of Cardiovascular Therapy, 2020
Marianna Leopoulou, Gustav Mattsson, Jo Ann LeQuang, Joseph V Pergolizzi, Giustino Varrassi, Marita Wallhagen, Peter Magnusson
Expert consensus for patients with ACMs suggests that patients with either left or right ventricular dysfunction should be considered for treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, mineral corticosteroids and, in the case of fluid overload, also diuretics. However, unlike heart failure with left ventricular deterioration, less is known about efficacy of pharmacological therapy in right ventricular dysfunction [35,43]. The combination of sacubitril/valsartan is indicated in heart failure with left ventricular ejection fraction ≤35% [44]. Dapagliflozine and empagliflozine, both reduce the risk of worsening heart failure as well, even in non-diabetic patients [45,46]. The use of isosorbide nitrate has also been suggested (Class of Recommendation IIb), while anticoagulant therapy is recommended in the case of atrial flutter/fibrillation or in the event of intracardiac thrombi. Anticoagulation therapy can also be considered in patients with right or left ventricular aneurysm [35,47]. In end-stage disease, a heart transplant or assist devices may be the only life-saving choices. Patients with advanced left ventricular assist device (LVAD) heart failure may benefit from cardiac resynchronization therapy (CRT), often combined with an ICD (CRT-D), now recognized as a cornerstone in HF treatment [44]. LVADs are also available for patients with advanced LV heart failure [44]. Assist devices for the right ventricle (RVAD or BiVAD) may be considered in the setting of LVAD implantation and must be considered as a bridge to transplant rather than destination therapy [44].
A contemporary 16-year review of Coxiella burnetii infective endocarditis in a tertiary cardiac center in Queensland, Australia
Published in Infectious Diseases, 2018
Mark R. Armstrong, Kate L. McCarthy, Robert L. Horvath
All confirmed cases with clear documentation (12/13) were treated with doxycycline and hydroxychloroquine. Other administered antibiotics were ciprofloxacin (N = 3), sulfamethoxazole/trimethoprim (N = 1), and rifampicin/rifabutin (N = 1). Treatment was interrupted in 3 cases due to side effects including photosensitive rashes on doxycycline (N = 4), visual symptoms (N = 1) and nausea (N = 1) associated with hydroxychloroquine, diarrhoea (N = 1) and continued symptoms of Q fever while on treatment (N = 1). Complications during the initial hospital admission included acute kidney injury in three cases (one requiring dialysis), respiratory failure in three cases requiring extended mechanical ventilation and haemolytic anaemia in two cases. One patient died within 30 days after diagnosis. One patient was admitted two years after diagnosis for left ventricular aneurysm repair, and was recommenced on doxycycline and hydroxychloroquine. Probable cases were treated with the combination of doxycycline and hydroxychloroquine (N = 3), with additional rifampicin in two of these cases. Doxycycline was given as the only antibiotic in two cases. Documented side effects were photosensitivity in two cases, and nausea/vomiting in one case (due to hydroxychloroquine). All probable cases survived to 30 days after diagnosis. One patient had a splenic infarct on presentation and another had a documented relapse of likely Q fever endocarditis on echocardiography two years after initial diagnosis requiring recommencement of treatment. Another patient had a cerebral vascular accident after commencing treatment for presumed Q fever endocarditis.