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Infiltrative Cardiomyopathies
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Arthur Qi, Quynh Nguyen, Haran Yogasundaram, Gavin Y. Oudit
Finally, endomyocardial biopsy provides a definitive assessment of tissue iron levels. However, myocardial iron deposition is heterogeneous, which makes it challenging to evaluate global iron levels.68,69 Endomyocardial biopsy is an invasive procedure with its own inherent risks; therefore, non-invasive approaches (e.g., cardiac MRI) are preferred in clinical practice.
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Dilated cardiomyopathy is diagnosed based on patient history and physical examination, plus excluding other causes of ventricular failure. These include primary valvular disorders, systemic hypertension, and MI. When there is no obvious cause, family history should be taken carefully, identifying anyone related to the patient that have early-onset heart disease or HF. There should be discussion of anyone in the family that suddenly died from a heart-related condition. Many facilities screen first-degree family members for cardiac dysfunction by using echocardiography, chest X-rays, ECG, and cardiac MRI. For some individuals, an endomyocardial biopsy is performed.
Cardiac Emergencies in Obstetrics
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Sanjeewa Rajapakse
In some cases, additional tests may need to be performed in order to arrive at a diagnosis.Cardiac magnetic resonance imaging (MRI) scan – This procedure is used to look for thrombi and exclude infection or inflammation of the heart when findings from the echocardiogram are not clear.Coronary angiogram – This technique is done to look for coronary artery disease.Endomyocardial biopsy – This is not usually required.
Cardiac amyloidosis: a review of the literature
Published in Acta Cardiologica, 2022
Nils de Marneffe, R. Dulgheru, A. Ancion, M. Moonen, P. Lancellotti
Scintigraphy is unable to differentiate senile from hereditary TTR amyloidosis [20].Biopsy: Endomyocardial biopsy remains the gold standard for diagnosis. However, this technique is invasive and of limited accessibility. Therefore, current diagnostic strategies are often based on clinical, laboratory and imaging findings. If this is not sufficient, a non-cardiac biopsy must be performed. This is often used for the diagnosis of AL amyloidosis. Samples are taken from certain tissues, such as the abdominal fat pad, the salivary glands on the inside of the lip (a less invasive procedure), the digestive tract during an endoscopic examination, a kidney biopsy or a bone marrow biopsy. In TTR amyloidosis, endomyocardial biopsy is not necessary if echocardiography and DPD scintigraphy confirm amyloidosis and AL is ruled out by blood and urine electrophoresis with immunofixation [21].
Utilization of cardiac imaging in sarcoidosis
Published in Expert Review of Cardiovascular Therapy, 2022
Mohamed Y. Elwazir, John P. Bois, Panithaya Chareonthaitawee
The diagnosis of CS is complicated by a lack of a reliable gold standard. Contemporary imaging modalities – while sensitive – lack specificity, and the pathological gold standard, endomyocardial biopsy, has a low yield (around 20–30%) [10] owing to the patchy myocardial nature of the disease, with considerable variation in the location of involvement from patient to patient, as well as a predilection for the subepicardium, which is not accessible to an endomyocardial bioptome [11]. This yield can be improved to an extent with electrophysiologic voltage mapping or imaging guidance [12], but requires specialized expertise and the increase in sensitivity comes at the expense of a significant drop in specificity [13]. In addition, while noncaseating granulomas on cardiac histopathology is a relatively uncommon finding in other cardiomyopathies, it is not exclusive to sarcoidosis [14]. Furthermore, endomyocardial biopsy is, after all, an invasive procedure with potential for serious, although uncommon, complications. This has led to the development of a number of societal guidelines to enable establishment of the diagnosis on a probable basis by fulfilling a set of pathological, clinical, and imaging criteria. The two guidelines most often in use are those of the Japanese Circulation Society (JCS) [15] and the Heart Rhythm Society (HRS) [16] (Table 1).
Severe acute respiratory syndrome coronavirus-2-induced flare of systemic sclerosis
Published in Scandinavian Journal of Rheumatology, 2022
C Campochiaro, G De Luca, N Farina, D Vignale, A Palmisano, M Matucci-Cerinic, L Dagna
In the literature, SARS-CoV-2 reinfection has been only anecdotally reported (2). In our patient, the viral clearance was followed, months later, by a reinfection, which may suggest that SARS-CoV-2 immunity may not be long-lasting (3). The following disease flare, characterized by skin progression and inflammatory lung and heart involvement, may be correlated with reinfection, similar to the findings reported with other infectious agents (4). This observation could suggest that the pathogenic inflammatory pathways of SSc reactivation and COVID-19 may share some acute nodal points, but eventually dichotomize into a severe COVID-19 hyperinflammation (5) and a chronic SSc fibrotic progression. It is likely that the repeated exposure to SARS-CoV-2 activated memory B-cells, which are involved in the active worsening of SSc (6). Direct myocardial damage was ruled out with an endomyocardial biopsy.