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1.
Front Neurol ; 14: 1221518, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37654428

RESUMO

The COVID-19 pandemic has caused a challenge for our society due to the post-acute sequelae of the disease. Persistent symptoms and long-term multiorgan complications, known as post-acute COVID-19 syndrome, can occur beyond 4 weeks from the onset of the COVID-19 infection. Postural orthostatic tachycardia syndrome (POTS) is considered a variety of dysautonomia, which is characterized by chronic symptoms that occur with standing and a sustained increase in heart rate, without orthostatic hypotension. POTS can lead to debilitating symptoms, significant disability, and impaired quality of life. In this narrative review, the etiopathogenic basis, epidemiology, clinical manifestations, diagnosis, treatment, prognosis, and socioeconomic impact of POTS, as well as other related dysautonomic disorders, after COVID-19 infection and SARS-CoV-2 postvaccination, were discussed. After a search conducted in March 2023, a total of 89 relevant articles were selected from the PubMed, Google Scholar, and Web of Science databases. The review highlights the importance of recognizing and managing POTS after COVID-19 infection and vaccination, and the approach to autonomic disorders should be known by all specialists in different medical areas. The diagnosis of POTS requires a comprehensive clinical assessment, including a detailed medical history, physical examination, orthostatic vital signs, and autonomic function tests. The treatment of POTS after COVID-19 infection or vaccination is mainly focused on lifestyle modifications, such as increased fluid and salt intake, exercise, and graduated compression stockings. Pharmacotherapy, such as beta-blockers, fludrocortisone, midodrine, and ivabradine, may also be used in selected cases. Further research is needed to understand the underlying mechanisms, risk factors, and optimal treatment strategies for this complication.

2.
Eur Heart J Case Rep ; 7(5): ytad228, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37181466

RESUMO

Background: Capnocytophaga canimorsus is a Gram-negative bacillus found in the oral microbiota of dogs. It is a very rare cause of endocarditis. We hereby present a case of aortic valve endocarditis due to this microorganism. Case Summary: A 39-year-old male was admitted to hospital with a history of intermittent fever and exertion dyspnoea and showed signs of heart failure on physical examination. Transthoracic and transoesophageal echocardiography confirmed the presence of a vegetation in the non-coronary cusp of the aortic valve, aortic root pseudoaneurysm, and left ventricle-to-right atrium fistula (Gerbode defect). The patient underwent aortic valve replacement with a biological prosthesis. The fistula was closed with a pericardial patch, although a dehiscence of the patch was detected in post-operative echocardiogram. The post-operative period was complicated by acute mediastinitis and cardiac tamponade secondary to a pericardial abscess, requiring emergent surgery. The patient made a good recovery afterwards and was discharged 2 weeks later. Discussion: Capnocytophaga canimorsus is a very rare cause of endocarditis, although it can be very aggressive, with high degree of valve damage, necessity of surgery, and high mortality. It mainly affects young men with no previous structural heart disease. Due to its slow growth, blood cultures can be negative, so other microbiological techniques such as 16S RNA sequencing or matrix-assisted laser desorption/ionization and time-of-flight (MALDI-TOF) can be helpful for diagnosis.

3.
BMC Nephrol ; 23(1): 293, 2022 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-35999504

RESUMO

BACKGROUND: The association between cardiac complications, such as heart failure (HF), and chronic kidney disease (CKD) is well known. In this study, we examined the effectiveness and safety of treatment with neprilysin inhibition in patients with advanced chronic kidney disease (stage 3b-4). METHODS: This single-centre, longitudinal, retrospective study of 31 months duration involved consecutive patients with CKD and HF with a reduced ejection fraction (HFrEF) who started treatment with sacubitril/valsartan. Glomerular filtration rate (GFR), cardiovascular risk factors, proteinuria, potassium, echocardiographic parameters and admissions for heart failure were analysed. RESULTS: The study comprised 25 patients with a median age of 73.2 ± 5.9 years. The most frequent aetiology of heart failure was ischemic heart disease. The median GFR was 29.4 ± 8.3 ml/min/1.73 m2 and the left ventricular ejection fraction (LVEF) 36.4 ± 8.9%. The GFR improved after initiating the treatment (F = 3.396, p = 0.019), as did the LVEF at one year of follow-up (p = 0.018). The number of visits to the emergency department for heart failure was also reduced. No patients needed to start renal replacement therapy. CONCLUSIONS: This study shows that sacubitril/valsartan may play a beneficial role in patients who have advanced CKD and HFrEF, with a satisfactory safety profile.


Assuntos
Aminobutiratos , Compostos de Bifenilo , Insuficiência Cardíaca , Insuficiência Renal Crônica , Valsartana , Idoso , Aminobutiratos/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Combinação de Medicamentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Estudos Retrospectivos , Volume Sistólico , Valsartana/uso terapêutico , Função Ventricular Esquerda
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