The Significance of Right Ventricle in Young Subjects with Diabetes Mellitus Type 1. An echocardiographyic study.

BACKGROUND: Diabetes mellitus type 1 (DM1) is associated with high risk for cardiovascular disease and early detection of myocardial dysfunction is very important for the prevention of cardiac complications. Although the functionality of right ventricule is important in a lot of disease affecting long time prognosis and progression, in diabetic type 1 patients has not been studied in depth yet. OBJECTIVES: To evaluate the right ventricular function by using both conventional echocardiography as well as speckle tracking echocardiography (STE) in young adults with diabetes mellitus type 1. METHODS: We included 60 young asymptomatic adults diagnosed with diabetes mellitus type 1 (mean interval from diagnosis 9±6 years) and 90 healthy controls. Conventional and STE Echocardiography was acquired using the GE Vivid S60 equipment. The longitudinal right ventricular strain 6 segments (RV GLS global) and 3 segments (RVFW GLS) of right ventricle (RV GLSbazal, RV GLSmid, RV GLSapex) as well were obtained using the EchoPAC BT13 workstation. RESULTS: No significant intergroup differences in EF were noted. Conventional echocardiographic parameters revealed lower tricuspid annular velocities Et, At and Et/At ratio compared to controls suggesting a diastolic disfunction in diabetes group. RV speckle tracking strain measurements showed no significant difference between the groups. CONCLUSIONS: Young adults with type 1 diabetes mellitus and without known heart disease have diastolic right ventricular dysfunction. The subclinical myocardial systolic function is preserved in early stages.

Gender-Related Electrocardiographic Changes in Athletes.

OBJECTIVES: To assess gender differences in training-related electrocardiographic (ECG) patterns of athletes, highlighting the importance of these differences for ECG interpretation used in the cardiovascular screening of athletes. DESIGN: Observational cross-sectional study. METHODS: 315 athletes were enrolled in the study (150 males and 165 females, mean age 23,7±6,6 and 20,7±6,8, respectively). All study participants underwent clinical examination and 12-lead electrocardiogram (12-lead ECG), scored according to 2017 International recommendations for electrocardiographic interpretation in athletes. RESULTS: Males were older (23,7±6,6 years vs. 20,7 years±6,8; p<0,0001) and had more years of training (11,8±6,7 vs. 9,07±6,1; p=0,0003) than female athletes. Female athletes had significantly higher resting heart rates (67/min vs. 61/min; p<0,0001) and QTc intervals (424,5±19,4ms vs. 338,6±22,3ms; p<0,0001). Male athletes were more likely to have isolated QRS voltage criteria for left ventricular hypertrophy (Sokolow-Lyon index) (2,6±0,8mV vs. 2,05±0,5mV; p<0,0001) and QRS duration (96,1±13,1ms vs. 86,9±9,4ms; p<0,0001). Sinus bradycardia <50bpm was more commonly seen in male athletes than in female (14% vs. 5,45%; p=0,009). Sinus arrhythmia occurred more frequently in female athletes (21,8% vs. 12,6%; p=0,03). CONCLUSIONS: This study demonstrates gender-related differences in ECGs of trained athletes that should be considered in their cardiovascular screening.

A Case of Severe Advanced Takayasu Arteritis with Acute Myocardial Infarction as First Manifestation.

We present the case of a 53-year-old female who presented in the emergency room accusing chest pain, dyspnea to moderate physical strain and physical asthenia. The clinical exam highlighted the absence of pulse in the left upper limb, weak pulse at upper right and lower limbs. The angiography revealed severe coronary lesions, bilateral subclavian occlusion, bilateral renal artery occlusion, infrarenal aortic occlusion. The patient was diagnosed with Takayasu's disease. Sequential interventional revascularization was performed. Takayasu arteritis is a rare disease that can easily be overlooked. It can present with severe coronary lesions which require a complex interventional and medical management.

Q-T Interval Prolongation in Patients with Liver Cirrhosis.

Liver cirrhosis (LC) is the end stage of chronic liver disease characterized by the appearance of extensive fibrosis and regeneration nodes associated with hepatocyte necrosis in liver but also by the reshuffling of hepatic architecture. The triad consisting of hepatic parenchymal necrosis, regeneration and scarring is always present regardless of the type of clinical manifestation. The Child-Pugh-Turcotte classification dates back more than 30 years and has been widely used in diagnosing and assessing the severity of liver cirrhosis. This is preferred due to a low degree of complexity and a good predictive value. Prolongation of the QT interval on the electrocardiogram is common, with a prevalence exceeding 60% in patients with advanced stage of cirrhosis. In these cases, beta blockers and antiarrhythmics should be avoided or used with caution and with close QT interval monitoring. Changes in heart rate and Q-T interval are new entities in cirrhosis complications. A prolonged Q-T interval in chronic liver disease could lead to ventricular arrhythmias and sudden death. There is no report on heart rate and Q-T interval disorders in our area.

Marfan Syndrome - Acute Aortic Dissection Due to Giant Aortic Aneurysm.

Marfan syndrome is a genetic disorder with an estimated prevalence of 1/5000 births. Clinical manifestation and disease progress can vary among individuals affected therefore serial follow-up examinations are mandatory in order to prevent serious complications.We report a case of giant proximal aorta aneurysm with associated aortic dissection in a young patient with Marfan syndrome who neglected medical advice to undergo periodic medical evaluation.Given the fact that clinical manifestations may differ among patients making prediction of disease progression very difficult, the patient with Marfan syndrome should be carefully monitored.

Estimation of Oxidative Stress Involvement by Superoxide Dismutase Variation in Cardiac Arrhythmias.

Cardiac arrhythmias, commonly diagnosed in young people, involve multiple etiopathogenic factors, including oxidative stress. PURPOSE: Evaluation of superoxide dismutase (SOD) variations as an antioxidant enzyme (with a physiological role in the dismutation of highly reactive oxygen free radicals into oxygen and water) in young patients with cardiac arrhythmias. MATERIAL AND METHOD: The study was conducted on a group of 40 young patients with a mean age of 34 years old, of both sexes, with non-lesional cardiac dysrhythmias, compared to a control group of 40 healthy subjects, determining for both groups the SOD serum level. Diagnosis of cardiac rhythm disorder was supported by electrocardiogram, imaging and laboratory investigations. RESULTS: SOD recorded a 61% decrease of mean values in patients compared to controls. The decreasing variation was found in all arrhythmia types, as follows: atrial fibrillation (51,54%), sinus bradycardia (54,86%), atrial flutter (55,71%), extrasystolic ventricular arrhythmia (64,20%), extrasystolic atrial arrhythmia (65,27%), combined arrhythmias (65,93%), supraventricular paroxysmal tachycardia (71,32%) and sinus tachycardia (74,24%). SOD deficiency demonstrates the involvement of oxidative stress in cardiac arrhythmic pathogenesis, excess oxygen radicals interfering with multiple mechanisms related to the onset of arrhythmogenesis. The SOD decrease was more important in females (60,57%) than in males (67,06%) and in those with nutrition poor in antioxidants. CONCLUSIONS: SOD estimation represents a biomarker whose decrease and deficiency implies occurrence of oxidative stress and implicitly highlights its role in cardiac arrhythmic pathology in young people, with the possibility of monitoring and correction by pharmacological or non-pharmacological therapeutic means.

Blood Pressure Variability and Left Ventricular Mass in Hypertensive Patients.

Objectives The purpose of the study is to evaluate 24h blood pressure values by automatic ambulatory monitoring (ABPM) in a group of hypertensive patients already on therapy and to find correlations between different blood pressure parameters and the presence of left ventricular hypertrophy (LVH). Design and method: 39 patients diagnosed with essential hypertension grades 1-3 were enrolled in the study; echocardiography was done and left ventricular mass and mass index were calculated. Based on 24 h ABPM we calculated BP variability estimated as standard deviation (SD) and average real variability (ARV), pulse pressure, dipper profile and morning BP surge. We compared these parameters in pts with and without LVH and calculated correlations with LV mass. Results: Nocturnal diastolic BP variability estimated as SD had significantly higher values in pts with LVH (13,2 vs 9,9 mmHg, p=0,015), ARV/24 hour and ARV during nighttime had higher values in pts with LVH vs those with normal LV mass (12,25 vs 9,7 mmHg and 12,35 vs 9,36 mmHg, p=0,03). Nocturnal diastolic BP variability correlated with LV mass index (r=0,325 for ARV and r =0,327 for SD). Other variables did not correlate with LV mass. Conclusions Nocturnal diastolic BP variability correlates with LVH independently of mean BP value. ABPM offers a valueable analysis of BP and enables the calculation of different parameters- as variability- which predict target organ damage.

Incidence of Pulmonary and/or Systemic Thromboembolism in Pregnancy.

Pregnancy associate with thromboembolism is one of leading causes of maternal morbidity and mortality. Worldwide the incidence of pregnancy related venous thromboembolism is approximately 1 in 1500 deliveries. The arterial thromboembolism risk is increased from 3 to 4 fold and the risk of venous thromboembolism is five times higher in a pregnant that in a non-pregnant woman. With an appropriate prophylaxis and therapy, prevention of death from systemic thromboembolism in pregnancy necessitates a high index of clinical suspicion succeeded by a timely and accurate diagnostic approach. In pregnancy the clinical diagnosis of systemic thromboembolism is notoriously difficult due to the overlap of signs and symptoms between the pulmonary embolus with or without deep venous thrombosis. We performed a retrospective study of 86 pregnant women with Pulmonary thromboembolism (PTE) and Deep venous thrombosis (DVT) diagnosed between 2009-2015 in Obstetrics-Gynecology Clinic 1 at Emergency County Hospital of Craiova. Our study evaluated these cases considering frequency, maternal and fetus risk associated with thromboembolism. In 6 years we had 35 women diagnosed as PTE, 8 women diagnosed as DVT and PTE, and 43 patients diagnosed as DVT. The underlying disease in our study was hypertension and the most frequent symptoms reported were dyspnea and limb swelling.(100%).During the third trimester of pregnancy the incidence of PTE was 45% and DVT 57%. 12 cases of DVT were related to thrombophilia. Also we found 25 % of PTE that occurred after cesarean and 8 % of PTE after vaginal delivery. We notice that vaginal delivery is safer than cesarean surgery. Also the importance of third trimester of pregnancy and postpartum it is evident.

Varicella-zoster myocarditis mimicking acute myocardial infarction.

A 23-year-old male was admitted with chest pain. The electrocardiogram showed ST elevation in leads DI, aVL, V2-V6. Troponin T was 1.1ng/mL. Left ventricular systolic function was globally reduced (ejection fraction 45%). The patient was treated with thrombolytic. Twenty-four hours after admission pruriginous vesicles with a clear content and surrounded by a pink halo appeared on his face, head and torso, suggesting varicella-zoster infection. This case illustrates the difficulties of diagnosis in acute myocarditis.