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1.
Cureus ; 16(6): e61857, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38975546

RESUMO

Scimitar syndrome is a congenital disorder characterized by partial anomalous pulmonary venous return to the inferior vena cava (IVC). Clinical manifestation in adulthood is infrequent. The management approach has not been universally accepted and may be challenging. Individually tailored and multidisciplinary team-based decisions are often necessary. We present the case of a symptomatic patient diagnosed with complex congenital heart disease, including scimitar syndrome and atrial septal defect at the age of 50 years. Surgical repair, involving scimitar vein implantation in the left atrium using a pericardial patch, was performed. Despite surgical correction, dyspnea persisted, and hemoptysis developed. A diagnostic workup revealed a critical stenosis of the re-inserted vein. This was successfully treated by percutaneous intervention with stent implantation. The patient has remained asymptomatic since the procedure. Scimitar syndrome can be first diagnosed in adulthood, and clinical manifestations can vary. Diagnostic workup necessitates a CT angiogram, magnetic resonance scan, and catheterization in selected cases. Stenoses of re-implanted pulmonary veins (PVs) can develop years after surgical correction, and hemoptysis may serve as a warning symptom prompting further PV imaging. Percutaneous vascular intervention using a stent is warranted in symptomatic cases and can lead to long-term success.

2.
Cureus ; 16(3): e55971, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38601386

RESUMO

Heart failure with preserved ejection fraction (HFpEF) is considered to be the dominant cause of dyspnea and pulmonary hypertension (PH) in elderly patients with preserved left ventricular systolic function and cardiovascular comorbidities. However, it is important to keep in mind that left ventricular diastolic dysfunction is not the only possible cause of PH in cases of late-onset clinical manifestation. A multiparametric approach is essential for accurate diagnosis and therapeutic decision-making. A 74-year-old patient was admitted due to progressive dyspnea and suspicion of PH. Given the patient's risk profile, HFpEF and concomitant post-capillary PH were anticipated. Despite negative findings on CT angiography and transesophageal echocardiography, right heart catheterization was performed, revealing discrepant oxygen saturations in the superior vena cava and right atrium. A partial anomalous pulmonary venous return and an atrial septal defect were identified through cardiac magnetic resonance imaging.

3.
Bratisl Lek Listy ; 123(12): 859-863, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36342871

RESUMO

OBJECTIVES: This study aims to evaluate the association between prehospital intravenous therapy and clinical outcomes in the patients with acute heart failure. METHODS: We conducted a prospective, multicenter observational study of consecutive AHF patients. Univariate and logistic regression analysis were performed to determine association between prehospital furosemide or nitrates administration and hospital outcome (death, length of stay). RESULTS: Data on a total of 1239 patients were processed. The mean age in the whole cohort was 71 ± 11.8 years with a gender distribution (M/F) of 634/605 patients. By prehospital treatment whole cohort was divided into 4 groups: F+ group with prehospital IV furosemide administration of 602 patients (48.6 %), F- group without prehospital IV furosemide administration of 637 patients (51.4 %), N+ group with prehospital IV nitrates administration of 110 patients (8.9 %) and N- group without IV nitrates administration of 1129 patients (91.1 %). Group of combined F+/N+ was not created. Ninety-four patients (7.6 %) died during the index hospitalization. Hospital mortality (p = 0.138) and length of stay (p = 0.101) did not differ in F+ vs F-. The patients with prehospital nitrates administration did not differ in mortality, but a shorter length of stay in univariate analysis (p = 0.03) was recorded. After adjusting for age, systolic BP and mode of referral to hospitalization, early IV furosemide usage nor nitrates showed no impact on hospital mortality and length of stay. CONCLUSIONS: Prehospital treatment with IV furosemide or nitrates in AHF patients seemed to have no major impact on hospital mortality or length of hospitalization after adjustment for several cofounders (Tab. 2, Ref. 16).


Assuntos
Serviços Médicos de Emergência , Insuficiência Cardíaca , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Furosemida/efeitos adversos , Nitratos/uso terapêutico , Diuréticos/uso terapêutico , Estudos Prospectivos , Hospitais , Doença Aguda , Resultado do Tratamento
4.
Vnitr Lek ; 68(E-1): 22-26, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35459402

RESUMO

The goal of this case report is to describe the young childhood cancer survivor who was treated for nonHodgkin lymphoma with chemotherapy containing anthracycline doxorubicin and who developed symptoms of serious cardiovascular damage 27 years after diagnosis of cancer. The patient is in longterm complete remission of the lymphoma. He started guideline medical therapies for chronic heart failure and had a cardioverter defibrillator implanted for primary prevention of sudden cardiac death. He is currently a candidate for heart transplantation.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca , Neoplasias , Arritmias Cardíacas/complicações , Arritmias Cardíacas/terapia , Criança , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Masculino , Neoplasias/complicações , Sobreviventes , Adulto Jovem
5.
Orphanet J Rare Dis ; 16(1): 196, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933110

RESUMO

BACKGROUND: During the COVID-19 pandemic, most of the health care systems suspended their non-urgent activities. This included the cancellation of consultations for patients with rare diseases, such as severe pulmonary hypertension (PH), resulting in potential medication shortage and loss of follow-up. Thus, the aim of the study was to evaluate PH patient health status evolution, access to health care and mental health experience during the early phase of the pandemic. METHODS: We conducted an online patient survey, available in 16 languages, between 22/05/2020 and 28/06/2020. The survey included questions corresponding to demographic, COVID-19 and PH related information. RESULTS: 1073 patients (or relatives, 27%) from 52 countries all over the world participated in the survey. Seventy-seven percent (77%) of responders reported a diagnosis of pulmonary arterial hypertension and 15% of chronic thromboembolic PH. The COVID-19 related events were few: only 1% of all responders reported a diagnosis of COVID-19. However, 8% of patients reported health deterioration possibly related to PH, and 4% hospitalization for PH. Besides, 11% of the patients reported difficulties to access their PH expert centre, and 3% interruption of treatment due to shortage of medication. Anxiety or depression was reported by 67% of the participants. CONCLUSION: Although COVID-19 incidence in PH patients was low, PH related problems occurred frequently as the pandemic progressed, including difficulties to have access to specialized care. The importance of primary health care was emphasized. Further studies are needed to evaluate the long-term consequences of COVID-related PH care disruption.


Assuntos
COVID-19 , Hipertensão Pulmonar , Ansiedade , Humanos , Hipertensão Pulmonar/epidemiologia , Pandemias , SARS-CoV-2
6.
Artigo em Inglês | MEDLINE | ID: mdl-26498215

RESUMO

AIM: Patients with advanced heart failure (HF) represent a pool of candidates for heart transplantation and long-term mechanical circulatory support devices. The aim of our study was to determine simple and reliable markers of one-year mortality for selection of the most suitable patients for heart replacement therapy. METHODS AND RESULTS: One thousand consecutive patients with HF (mean age 49 ± 10.9 years; 86.8% males) referred to a single tertiary centre from January 1998 to January 2010 in order to assess the indication for heart transplantation were enrolled. Kaplan-Meier survival analysis was performed. Independent mortality predictors were established using logistic regression analysis. The mean follow-up was 4.3 ± 2.7 years (range 1-12 years). Cumulative survival was as follows: 1-year survival 83%, 3-year 63%, 5-year 50%, 7-year 39%, and 10-year 23%. Independent predictors of 1-year mortality included coronary artery disease, left ventricular diastolic diameter >79 mm, plasma sodium <135 mmol/L, the need for intravenous treatment at hospital admission (diuretics and/or inotropes), and furosemide dose at discharge >240 mg/day. CONCLUSIONS: Short-term prognosis of HF patient can be estimated based on simple parameters. Patients with signs of poor prognosis should be referred to tertiary centres to be considered for heart replacement therapy.


Assuntos
Insuficiência Cardíaca/mortalidade , Transplante de Coração/mortalidade , Biomarcadores/metabolismo , Feminino , Coração Auxiliar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Fatores de Risco
7.
Clin Transplant ; 24(1): 36-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19222503

RESUMO

INTRODUCTION: Metabolic syndrome (MS) is a cardiovascular risk predictor. Prevalence of MS after heart transplantation (HTx) is high. Recent data suggest a positive metabolic effect of telmisartan. AIM: To describe the influence of telmisartan on lipid and glycide metabolism in MS after HTx. METHODS: Fifteen patients aged 55+/-12 yr, 88+/-25 months after HTx with MS receiving statins were followed. The reason for telmisartan administration was arterial hypertension with either drug intolerance or poor control. Body mass index (BMI), waist circumference, total cholesterol, low density lipoprotein LDL-cholesterol, high density lipoprotein-cholesterol, triglycerides, C-reactive protein (CRP), fasting glucose, immunoreactive insulin (IRI), C-peptide and the homeostasis model assessment (HOMA) index were determined. Ambulatory blood pressure monitoring was performed. After initial evaluation, telmisartan 80 mg was started. After 20 +/- 5 wk follow-up, identical parameters were measured. Statistical significance was evaluated using Student's t-test. RESULTS: BMI, waist circumference, systolic and diastolic blood pressures, serum lipids and CRP remained unchanged after telmisartan. Significant reduction in fasting glucose (6.7 vs. 5.6 mmol/L, p < 0.02), IRI (8.8 vs. 8.5 U/mL p = 0.05), HOMA (7.3 vs. 5.8 mmol/L x muU/mL, p < 0.05) and C-peptide (4.0 vs. 3.3 ng/mL, p < 0.02) was found. CONCLUSIONS: Telmisartan had a positive impact on insulin sensitivity parameters (fasting glucose, IRI, C-peptide and HOMA) in this population. No effect on obesity, serum lipids and systemic inflammation was observed.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Benzimidazóis/uso terapêutico , Benzoatos/uso terapêutico , Cardiopatias/sangue , Cardiopatias/cirurgia , Transplante de Coração , Síndrome Metabólica/epidemiologia , Adulto , Glicemia/metabolismo , Peptídeo C/sangue , Feminino , Seguimentos , Cardiopatias/complicações , Humanos , Hipertensão/sangue , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Insulina/sangue , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/prevenção & controle , Pessoa de Meia-Idade , Fatores de Risco , Telmisartan
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