Tumors of Heart
P. Chopra, R. Ray, A. Saxena in Illustrated Textbook of Cardiovascular Pathology, 2013
Clinical presentation of cardiac myxoma includes constitutional features, obstructive effects and embolic phenomenon. The presenting features in over 90 percent cases are dyspnea on exertion, fever, malaise, arthralgia, rash, clubbing of fingers, etc. Features of mitral valve stenosis, pulmonary hypertension and systemic embolisation may be encountered. Laboratory findings of anemia, increased sedimentation rate, hypergammaglobulinemia, thrombocytosis, polycythemia have been documented in cardiac myxoma. Elevated levels of interleukin-6 (IL-6) have also been reported. Detection and precise anatomical location of cardiac myxomas has been facilitated by several diagnostic techniques namely 2D-echocardiography (Fig. 12.2a), computerised tomography and magnetic resonance imaging. A high degree of clinical suspicion coupled with various investigative modalities have increased the yield of these tumors which are then surgically excised successfully.
Echocardiogram
Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi in Mitral Stenosis, 2018
The diagnosis and management of mitral stenosis (MS) has been revolutionized by the advent of modern echocardiography. Echocardiography is an indispensable component in the assessment of mitral stenosis. While the mechanical obstruction of the left-ventricular inflow by thickened, restricted mitral leaflets is easily discerned on a two-dimensional (2D) scan, its functional consequences in terms of disturbed flow and elevated pressures are evident on doppler echocardiography. Other features influencing management and natural course of MS, like left-atrial (LA) thrombus, pulmonary arterial hypertension, left and right-ventricular (LV and RV) function, co-existing valvular lesions, anatomy of interatrial septum, etc., are also comprehensively evaluated on echocardiography. The backbone of a good echocardiographic evaluation of MS remains a thorough 2D scan and a careful doppler assessment, despite advances in echo-technology.
Practice Paper 8: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Mitral stenosis is nearly always associated with rheumatic fever. On auscultation, there is a low-pitched (rumbling) mid-diastolic murmur, best heard at the apex with the patient lying on their left-hand side. Other features of mitral stenosis include malar flush (mitral facies), dyspnoea, haemoptysis and right heart failure secondary to increased pressures in the pulmonary vasculature. The classic ECG finding in mitral stenosis is P-mitrale, also referred to as bifid (notched) P-waves. P-mitrale is caused by hypertrophy and dilatation of the left atrium secondary to raised intra-atrial pressure. One of the most common complications of mitral stenosis is atrial fibrillation. Since the ECG tracing of atrial fibrillation shows an irregularly irregular rhythm with no P-waves, it is impossible to have P-mitrale and atrial fibrillation simultaneously
Chronic kidney disease predicts atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention
Published in Acta Cardiologica, 2019
Răzvan Constantin Șerban, Ioana Șuș, Eva Katalin Lakatos, Zoltan Demjen, Alexandru Ceamburu, Paul Ciprian Fișcă, Cristina Somkereki, Laszlo Hadadi, Alina Scridon
A number of classic (age, gender, history of hypertension and heart failure, mitral valve disease, previous myocardial infarction, left atrial antero-posterior diameter) and more novel (body mass index [BMI], diabetes mellitus, CKD, COPD) factors predictive of AF in the general population were evaluated. Mitral valve disease was defined as any degree of mitral stenosis or more than minor mitral regurgitation, as evidenced by echocardiography. As in the vast majority of previous studies [13,14] and clinical trials [15] on STEMI patients, CKD was defined as a calculated creatinine clearance at admission <60 mL/min according to the Cockroft–Gault equation. Similarly to previous studies [16–18], patients were considered to have COPD if this diagnosis was reported in their medical records or if they received COPD-specific pharmacologic therapies (e.g. inhaled steroids, beta-agonists, anticholinergics). The severity of coronary artery disease was assessed using the SYNergy between PCI with TAXUS™ and Cardiac Surgery (SYNTAX I) score. The CHA2DS2-VASc score was recorded as a measure of global cardiovascular morbidity.
Refractory isolated pulmonary capillaritis rescued by rituximab
Published in Modern Rheumatology Case Reports, 2018
Stuart Clarence Wiber, Shahin Jamal, Kun Huang
A 47-year-old healthy man presented to hospital with 1-week history of dyspnoea and haemoptysis in 2013 brought on by two massive fine sawdust exposures. His physical examination was entirely unremarkable except for increased work of breathing and decreased oxygen saturation to 90% on room air. The chest computed tomography (CT) revealed bilateral peribronchial consolidation, centrilobular ill-defined pulmonary nodules in the upper lobe and confluent ground glass in the lower lobes, in keeping with alveolar haemorrhage. The differential diagnosis includedHypersensitivity pneumonitis from sawdust exposure.Systemic vasculitis such as anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) and immune complex small vessel vasculitis.Vasculitis-associated systemic diseases including connective tissue diseases and primary antiphospholipid syndrome.Drug associated vasculitis.Pulmonary or systemic infections.Valvular heart disease such as mitral stenosis.
Mitral stenosis in 2019: changing approaches for changing times
Published in Expert Review of Cardiovascular Therapy, 2019
Guy Lloyd, Sveeta Badiani, Marta Costa, Karen Armado, Sanjeev Bhattacharyya
Mitral stenosis is relatively rare, and its management complexity is easy to overlook, often being reduced to a binary decision between balloon valvotomy or surgery. Too often clinicians are faced with a patient with rather modest mitral stenosis but significant symptoms. This may occur in younger patients because of either reduced mitral valve compliance or loss of atrial compliance to buffer atrial pressure changes. In the more elderly patent with more co-morbidities which effect trans valvular flow, the relative contribution of valve stenosis, atrial or ventricular compliance and vascular adaption, as well as other confounders such as atrial fibrillation, become more important. The most extreme examples of this are calcific degenerative mitral stenosis and the increasingly recognized syndrome of low gradient severe mitral stenosis. In these groups, the outcomes of intervention are uncertain at best and hazardous at worst, so very meticulous evaluation of each aspect of the anatomy and physiology is indicated to make best interest clinical decisions. Stress echocardiography plays a pivotal role in establishing changes in trans valvular gradient and pulmonary artery systolic pressure, thus refining the opportunities for therapy. Current guidelines help little with the management of these patients so careful multidisciplinary evaluation is required to achieve the best clinical outcomes.
Related Knowledge Centers
- Atrial Fibrillation
- Rheumatic Fever
- Shortness of Breath
- Stenosis
- Stroke
- Mitral Valve
- Heart
- Orthopnea
- Heart Failure
- Valvular Heart Disease
- Shortness of Breath