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Heart Failure in Adult Congenital Heart Disease
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Andrew Constantine, Ana Barradas-Pires, Isma Rafiq, Justyna Rybicka, Michael A. Gatzoulis, Konstantinos Dimopoulos
Elevated levels of BNP81 and NT-proBNP82 are strong predictors of mortality in ACHD patients, and normal levels of NT-proBNP (≤14 pmol/L) can reliably predict a low risk of death and HF. The value of measuring natriuretic peptides at regular intervals and lesion-specific cut-offs requires further study.
Cardiovascular Diseases
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
If available,an ECG should be obtained to evaluate for ischaemia, arrhythmia or left ventricular hypertrophy.a chest x-ray can show cardiomegaly and/or pulmonary vascular congestion and/or effusions.blood tests for creatinine, haemoglobin, TSH, electrolytes, glucose and liver function can be useful to evaluate underlying cause.echocardiography is the gold standard to allow classification and assessment of severity by left ventricular systolic function.brain natriuretic peptide levels can be used to guide evaluation if symptoms are of uncertain aetiology; but this test is usually not available in resource-limited settings.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The atrial natriuretic peptide (ANP) and the B-type natriuretic peptide (BNP) are two peptides with natriuretic and diuretic properties [29]. Enhancing the activity of the NPs could help patients presenting with inappropriate salt and water retention. Recent studies with BNP have produced promising results in situations of heart failure [30].
Shotgun recoil causing severe acute aortic regurgitation years after replacement of the aortic valve and ascending aorta
Published in Baylor University Medical Center Proceedings, 2022
Justin Arunthamakun, Ravi Vallabhan, Ramy Ayad, Charles C. Roberts
A 64-year-old man who had undergone a bioprosthetic replacement of his aortic valve and ascending aorta at age 50 developed acute chest pain and dyspnea shortly after shooting his 20-gauge shotgun. Examination 2 days later disclosed a blood pressure of 140/45 mm Hg and a precordial grade 4/6 diastolic murmur with water-hammer pulse. Electrocardiogram showed sinus rhythm with first-degree atrioventricular block, left axis deviation, and a right bundle branch block. A computed tomographic angiogram showed no aortic dissection or pulmonary embolus, but did show mild pulmonary edema. Troponin I assay was 1.12 ng/mL (reference range 0–0.05 ng/mL). B-type natriuretic peptide was 740 pg/mL (reference range 0–100 pg/mL). A transthoracic echocardiogram showed a thickened St. Jude bioprosthetic valve in the aortic valve position and severe aortic regurgitation (Figure 1). A transesophageal echocardiogram confirmed severe transvalvular bioprosthetic aortic regurgitation with no left ventricular systolic dysfunction (Figure 2).
Management of Wolff-Parkinson-White syndrome in a patient with peripartum cardiomyopathy
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Snigdha Bendaram, Sherif Elkattawy, Muhammad Atif Masood Noori, Hardik Fichadiya, Sarah Ayad, Parminder Kaur, Raja Pullatt, Fayez Shamoon
In ED, the patient was found to have a BP of 76/50. EKG (EKG a) showed Narrow complex tachycardia with a nonspecific intraventricular block and a heart rate of 190 beats per minutelikely mechanism being orthodromic AVRT given presence of delta wave in prior resting EKG. Also, a QTc of 533 milliseconds was noted. Serum magnesium was 1.6 mg/dl, which was repleted. She was treated with two doses of 100 mg intravenous procainamide, which reverted the cardiac rhythm to sinus rhythm and raised the patients blood pressure to 110/70 mmHg. A white blood cell count of 12,4004/mm3 (Normal range 4,000–10,000) was noted. Brain natriuretic peptide levels were 916 pg/ml (Normal <100). Chest X-ray showed findings suggestive of a small left pleural effusion; CT angiography was negative for Pulmonary embolism but did show findings concerning left lower lobe bronchopneumonia with trace pericardial and bilateral pleural effusions. The patient was given ceftriaxone and doxycycline, was continued on procainamide infusion and admitted to the Intensive care unit for further management.
Epidemiological, clinical, and echocardiographic features of twenty ‘Takotsubo-like’ reversible myocardial dysfunction cases with normal coronarography following immersion pulmonary oedema
Published in Acta Cardiologica, 2021
Raphaël Demoulin, Raphaël Poyet, Olivier Castagna, Emmanuel Gempp, Arnaud Druelle, Paul Schmitt, Eléonore Capilla, Gwénolé Rohel, Frédéric Pons, Christophe Jégo, François-Xavier Brocq, Gilles R. Cellarier
We have reported 20 cases of patients who showed an IPE from underwater diving complicated by RMD (Table 1). Although these cases were not collected prospectively, we estimate the incidence of this type of RMD in our centre to be three cases per year. To our knowledge, we have had only one case of permanent myocardial dysfunction following a diving accident during this time period (secondary to a myocardial infarction). Nineteen of our patients used an open circuit diving apparatus with gas mixture composed of air while one patient used a semi-closed rebreather circuit with nitrox. The clinical and radiological criteria of IPE were met. The average age of our population was 61.9 years, 7 were men and 13 were women. Half of our patients showed a CVRF other than age. The main CVRF were arterial hypertension (five patients), smoking (five patients), and dyslipidaemia (five patients). Two patients were treated with calcium channel blockers and one with ACE inhibitors. No patient was under β-blocker therapy. None of the patients reported chest pain on admission. Nineteen patients showed elevated troponin levels (Hs-cTnT > 14 ng/L/cTnT > 0.35 μg/L) and 17 patients showed elevated levels of natriuretic peptides (BNP > 100 ng/L and NT-proBNP > 300 ng/L). The average levels of troponin were 334.5 ng/L for Hs-cTnT and 0.82 µg/L for cTnT. The average levels of the natriuretic peptides were 3,187 ng/L for NT-proBNP and 194 µg/L for BNP. ECG anomalies were observed in 95% of the cases over the course of the follow-up (19 patients).