RESUMO
BACKGROUND: Contemporary data regarding the characteristics, treatment and outcomes of patients with atrial fibrillation (AF) are needed. We aimed to assess these data and guideline adherence in the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) long-term general registry. METHODS: We analysed 967 patients from the EORP-AF long-term general registry included in the Netherlands and Belgium from 2013 to 2016. Baseline and 1year follow-up data were gathered. RESULTS: At baseline, 887 patients (92%) received anticoagulant treatment. In 88 (10%) of these patients, no indication for chronic anticoagulant treatment was present. A rhythm intervention was performed or planned in 52 of these patients, meaning that the remaining 36 (41%) were anticoagulated without indication. Forty patients were not anticoagulated, even though they had an indication for chronic anticoagulation. Additionally, 63 of the 371 patients (17%) treated with a non-vitamin K antagonist oral anticoagulant (NOAC) were incorrectly dosed. In total, 50 patients (5%) were overtreated and 89 patients (9%) were undertreated. However, the occurrence of major adverse cardiac and cerebrovascular events (MACCE) was still low with 4.2% (37 patients). CONCLUSIONS: Overtreatment and undertreatment with anticoagulants are still observable in 14% of this contemporary, West-European AF population. Still, MACCE occurred in only 4% of the patients after 1 year of follow-up.
RESUMO
The authors report the very rare case of isolated pulmonary valve endocarditis in the absence of classical predisposing factors and discuss the therapeutic approach. In the absence of large series, a maximum of information is developed from this new case, especially with respect to its unusual context.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Idoso , Ecocardiografia Transesofagiana , Feminino , HumanosAssuntos
Dissecção Aórtica/cirurgia , Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Vasos Coronários , Idoso , Dissecção Aórtica/diagnóstico , Cateterismo Cardíaco , Angiografia Coronária , Doença das Coronárias/diagnóstico , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Sobrevivência de Enxerto , HumanosRESUMO
A patient with unstable angina and known heart failure, and marked U wave alternans on the electrocardiogram is reported. Alternans of the U wave with no change in the QRS complex is extremely rare. The relevant literature is reviewed.
Assuntos
Angina Instável/diagnóstico , Eletrocardiografia , Insuficiência Cardíaca/diagnóstico , Idoso , Angina Instável/fisiopatologia , Evolução Fatal , Feminino , Insuficiência Cardíaca/fisiopatologia , HumanosRESUMO
Anticoagulants, including heparins and antivitamins K are medicines which are largely prescribed in cardiology. Even though the outlines of the treatment have been clearly established for a few decades, new cardiological indications have recently appeared. The long-term treatment of cardiac valvular prosthesis by oral anticoagulants significantly reduces the risk of thrombo-embolic incident among people carrying a cardiac valvular prosthesis. In case of non-operated valvulopathy, treatment indication must be evaluated for each patient; in so doing, the connection benefit/risk must always be taken into account. In case of dilated cardiomyopathy, the treatment prescription must be limited to the patients with a high embolic risk. Other cardiological indications (apart from atrial fibrillation) must be carefully weighed up.
Assuntos
Anticoagulantes/uso terapêutico , Cardiopatias/terapia , Arritmias Cardíacas/terapia , Cardiomiopatia Dilatada/terapia , Doenças das Valvas Cardíacas/terapia , Próteses Valvulares Cardíacas , Heparina/uso terapêutico , Humanos , Medição de Risco , Fatores de Risco , Tromboembolia/prevenção & controle , Vitamina K/antagonistas & inibidoresRESUMO
The authors reports two cases of pulmonary embolism which have, on ECG, an anteroseptal subepicardial ischemia which could indicate a coronary origin. The value and role of electrocardiographic findings in the diagnosis of pulmonary embolism are analysed. Once the diagnosis of pulmonary embolism has been established, the rest-ECG could allow the massive forms to be distinguished from the non-massive ones. The anteroseptal subepicardial ischemia pattern in the precordial leads is the most frequent sign of pulmonary embolism. This parameter is easy to obtain and reflects the severity of pulmonary embolism.
Assuntos
Eletrocardiografia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Idoso , Viés , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
A patient with an obstructive hypertrophic cardiomyopathy and normal epicardial coronary arteries developed myocardial ischemia accompanied by a transitory apical akinesia. This wall motion dysfunction persisted for hours after the relief of myocardial ischemia.
Assuntos
Cardiomiopatia Hipertrófica/complicações , Vasos Coronários , Miocárdio Atordoado/etiologia , Antagonistas Adrenérgicos beta/administração & dosagem , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/tratamento farmacológico , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Miocárdio Atordoado/diagnóstico , Miocárdio Atordoado/tratamento farmacológico , Indução de RemissãoRESUMO
Hypertrophic cardiomyopathy is an uncommon disease, important to recognize. Family screening is mandatory, with physical examination, EKG and echocardiography. Genetic diagnosis will modify our approach in a near future. The different treatments are described: drugs, surgery, pacing. The role of the general practitioner is complementary to the cardiologist's. His task is especially important in the first step of the diagnosis.
Assuntos
Cardiomiopatia Hipertrófica/genética , Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/terapia , Cromossomos Humanos Par 14 , Testes de Função Cardíaca , Septos Cardíacos/cirurgia , Humanos , Mutação PuntualRESUMO
The Doppler indexes of tricuspid porcine bioprosthetic valves were evaluated in twelve patients without clinical and two-dimensional echocardiographic evidence of valve dysfunction. Peak and mean pressure gradients across the prostheses were measured using the simplified Bernoulli equation. All the Doppler measurements were compared during inspiration and expiration. During inspiration peak velocity, peak gradient and mean gradient (1.52 +/- 0.28 m/s; 9.7 +/- 3.05 mmHg; 4.07 +/- 1.16 mmHg) were significantly higher than during expiration (1.28 +/- 0.8 m/s; 6.58 +/- 2.7 mmHg; 2.98 +/- 1.13 mmHg; p < 0.01) but pressure half time was not significantly different (122 +/- 62 ms versus 134 +/- 75 ms; p > 0.05). Inspiratory range of peak velocities, peak gradients, mean gradients and pressure half times were respectively 0.8-2.04 m/s; 4.9-16.6 mmHg; 1.2-7.2 mmHg; 42-340 ms while expiratory range of values was 0.8-1.93 m/s; 2.6-15 mmHg; 1.1-5.7 mmHg; 46-345 ms. These data suggest that even very long pressure half times do not indicate valve dysfunction. This study demonstrates that large variation of Doppler parameters are present during respiration and could produce inaccuracy in the assessment of bioprostheses in tricuspid position if they are not taken in consideration.
Assuntos
Bioprótese , Ecocardiografia Doppler , Próteses Valvulares Cardíacas , Respiração , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Valores de Referência , Valva Tricúspide/fisiologiaRESUMO
We report two cases of tricuspid valve endocarditis with related organisms (Enterococcus faecalis and Gemella morbillorum), some months after colonic operation. This association, without preexistent valvular pathology and without any other classical aetiology of tricuspid endocarditis, has only exceptionally been described.
Assuntos
Colectomia/efeitos adversos , Endocardite Bacteriana/microbiologia , Enterococcus faecalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/isolamento & purificação , Valva Tricúspide , Idoso , Humanos , MasculinoRESUMO
Age does not modify the logical approach of the medical treatment of angina pectoris. Triggering factors have to be searched and treated. Age is not a contra-indication, but the physician has to be familiar with the drugs used in the elderly (side-effects, contra-indications, metabolism, dosages, etc.). The choice based on side-effects and contra-indications favours calcium inhibitors and nitrates. Nevertheless, beta-blocking agents give good results in the elderly, if care is taken to use them correctly. Aspirin is given at reduced dosage. Sublingual nitrates are necessary for the anginal crisis or before stress (prophylaxis). Compliance and safety are favoured by a rational therapy.
Assuntos
Angina Pectoris/tratamento farmacológico , Fármacos Cardiovasculares/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Aspirina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Fármacos Cardiovasculares/efeitos adversos , Contraindicações , Humanos , Nitratos/uso terapêutico , Cooperação do PacienteRESUMO
We describe a case in whom an unusual alteration of the atrial repolarization observed on routine electrocardiogram (Ta segment depression) led to the echocardiographic diagnosis of metastatic involvement of the left atrium by a lung cancer. Electrocardiographic abnormalities in the metastatic involvement of the heart are non specific but observation of new changes may suggest the diagnosis and modify the staging and the treatment.
Assuntos
Carcinoma de Células Escamosas/patologia , Átrios do Coração , Neoplasias Cardíacas/secundário , Neoplasias Pulmonares/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/secundário , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Invasividade NeoplásicaAssuntos
Fibrilação Atrial/etiologia , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/etiologia , Fibrilação Atrial/diagnóstico por imagem , Diástole , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Desenho de PróteseRESUMO
Impaired left ventricular (LV) filling is known to be a major determinant of non-obstructive hypertrophic cardiomyopathy (HCM). Seventeen patients with non-obstructive HCM (mean age 71 years) were investigated by Doppler echocardiography, before and after oral treatment with verapamil (mean daily doses: 335 mg). Diagnosis was based on clinical and echocardiographic data. Mitral regurgitation was absent or mild. Heart rate, PQ interval and mitral regurgitation did not change after treatment. All calculated values of Doppler LV filling improved significantly: corrected relaxation time, ratio of atrial to early velocity, EF slope and pressure half-time (P less than 0.005) showed more significant differences than more sophisticated indices using time-velocity integrals of Doppler LV filling flow (P less than 0.005). Results appear to reflect an effect of verapamil on LV relaxation; a slight effect of a modified load was nevertheless not excluded. We conclude that all parameters of Doppler LV filling show marked improvement in this elderly group with non-obstructive HCM, after oral verapamil. Doppler echocardiography is an easy and useful clinical method to assess the effect of a drug on ventricular relaxation of non-obstructive HCM.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia Doppler , Função Ventricular Esquerda/efeitos dos fármacos , Verapamil/uso terapêutico , Idoso , Cardiomiopatia Hipertrófica/tratamento farmacológico , Feminino , Humanos , MasculinoRESUMO
We describe a case of voluntary intoxication with tricyclic antidepressant drugs: initial electrocardiogram showed alterations of atrial repolarization (Ta segment) which were more pronounced than usual ST-T alterations. Evolution was uneventful (and repolarization normalized). Tricyclic antidepressant drugs absorption can lead to Ta segment alterations, which may be a useful clue in the differential diagnosis of drugs intoxication.