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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
When any of the identified causes are present, cor pulmonale should be suspected. On chest X-rays, there is enlargement of the proximal pulmonary artery with distal arterial attenuation, and enlargement of the RV. On ECG, hypertrophy of the RV is linked to the amount of pulmonary hypertension. This is indicated by a QR wave and a dominant R wave, plus right axis deviation. Since pulmonary hyperinflation and bullae caused by COPD realign the heart, this means that diagnosis may be difficult via physical examination, X-rays, and ECG. To evaluate LV and RV function, echocardiography or radionuclide imaging is performed. Echocardiography assesses the systolic pressure in the RV, but may be limited because of the underlying lung disorder. For some patients, cardiac MRI can assess the heart chambers and their function. Right heart catheterization may be needed to confirm the diagnosis.
Effects of treatment on the thorax
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Dhakshina Moorthy Ganeshan, Herman I Libshitz, Revathy B Iyer
Cardiac MRI is being increasingly used in the evaluation of chemotherapy-induced cardiac dysfunction (124,130–134,136). Cardiac MRI is reported to be more accurate and reproducible compared to echocardiography and does not involve exposure to ionizing radiation, unlike MUGA scans. Calculation of the LVEF is more accurate with cardiac MRI as it is not limited by the geometric assumptions of echocardiography. Typically, LVEF is measured using the Simpson method from the short axis cine steady state free precession images of the left ventricle (136). Since the end-diastolic and end-systolic volumes used to calculate LVEF vary according to age, gender, and body surface area, the values obtained with cardiac MRI should be compared to reference standards normalized for these variables (136). While some authors have reported that a specific pattern of delayed gadolinium enhancement may be seen with chemotherapy-induced cardiac dysfunction in contrast-enhanced cardiac MRI, its value has not been proved in other studies and as such its utility in this condition remains unclear (124). Recent studies indicate that T1 and T2 mapping, and novel sequences for determining myocardial deformation (such as tissue phase mapping, strain encoding, myocardial tagging, and displacement encoding with stimulated echoes) may be helpful in the management of chemotherapy-induced cardiac dysfunction, but further studies are warranted (124,131,132,134). While cardiac MRI holds many advantages over other cardiac imaging techniques, it is significantly more costly and access can be an issue.
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
A cardiac MRI is mainly used for diagnosis of diseases of the aorta and complex congenital heart disease37. Although safety during pregnancy has not yet been totally established, no harmful effects on the fetus have been raised37. However imaging should be avoided during the first trimester if possible2.
Myocarditis following COVID-19 vaccination: incidence, mechanisms, and clinical considerations
Published in Expert Review of Cardiovascular Therapy, 2022
John R. Power, Lucas K. Keyt, Eric D. Adler
The management of patients after recovery from COVID-19 vaccine-associated myocarditis presents several dilemmas. Other forms of AM have been shown to cause persistent cardiomyopathy; the largest registry of children with AM showed that over a 3-year period, 48% had persistent systolic dysfunction, 7% died, and 19% required transplant [122]. Results in adults are quite different, analysis of the Lombardy registry shows that among 429 patients with AM who survived their hospitalization, only 2.8% experienced MACE at the 5-year follow-up, and residual LV dysfunction was seen in 4.5% of patients at a median follow-up of 200 days [123]. Because of potential for long-term consequences, postacute care of myocarditis generally includes electrocardiography, echocardiography, and laboratory testing at annual or semiannual frequency with a low threshold to obtain cardiac MRI if symptoms or testing suggest recurrence [116]. In patients with persistent cardiac dysfunction, guideline-directed medical therapy should be started. With little known about the long-term outcomes after vaccine-associated myocarditis, it is reasonable to adopt these surveillance measures at least for now. Also unknown is whether restricting exercise for 3–6 months after vaccine-associated myocarditis enables recovery and sudden cardiac death prevention as in general myocarditis [124]. Until vaccine-associated myocarditis is better understood, this remains the safest strategy, perhaps with a shorter 3-month exercise restriction.
Initial Experience Assessing the Feasibility of Conscious Sedation in Patients Undergoing Transcatheter Pulmonic Valve Implantation
Published in Structural Heart, 2021
Rajeev Anchan, Diane Weibeler, Joseph M. Venturini, AbdulRahman Dia, Daniel H. Gruenstein, Sajid S. Shahul, Rohan Kalathiya, John Blair, Jonathan D. Paul, Sandeep Nathan, Janet Friant, Stephanie A. Besser, Atman P. Shah
Patients were retrospectively included in this analysis if they had severe pulmonic regurgitation and/or pulmonic stenosis resulting in right ventricular dysfunction in accordance with previous study enrollment criteria.21–23 All relevant demographic and clinical information was obtained from review of electronic medical records. Ventricular function was determined by cardiac MRI, or transthoracic echocardiography, performed no more than 1 year prior to the procedure. Patients were classified based on their cardiac pathology: an RV-PA conduit with or without a prosthetic valve, a prosthetic valve alone, or a native RVOT with or without surgical manipulation. Procedural notes, medication data, laboratory values, and imaging findings were abstracted from medical records. All data were entered into a secure, de-identified database.
Amyloid cardiomyopathy: a hidden heart failure cause that is often misdiagnosed
Published in Acta Clinica Belgica, 2018
Yale Tung-Chen, Miguel-Ángel Arnau
Awareness of Amyloid cardiomyopathy as a cause of CHF requires consideration [1]; essentially when there is a presence of severe wall thickness on echocardiography with inappropriately low limb leads voltage on ECG (an abdnormal ratio of LV thickness and low QRS voltages not seen in hypertensive heart disease, hypertrophic cardiomyopathy, infiltrative cardiomyopathy, or pericardial effusion), particularly if peripheral/autonomic neuropathy, organomegaly, or nephropathy is associated. Cardiac MRI can be used to monitor disease progression and response to therapy. Recently, in some studies, the use of Nuclear scintigraphy (99mTc-3,3-diphosphono-1,2-propanodicarboxylic) seems to help to early recognize ATTRw, with a high specificity that could even avoid the need for histological confirmation [1].