Personalized treatment of heart failure with biomarker guidance using a novel disease severity score.

We propose a novel Myocardial Injury Summary Score (MISS) integrating the 4 biomarkers suggested by the 2013 American College of Cardiology/American Heart Association guidelines for management of heart failure. In this case series, we examined 4 heart failure patients who received treatment guided by the biomarker results and 4 patients who received routine clinical management with no information about the biomarkers. Most of the patients receiving biomarker-guided management had medications adjusted based on the biomarker values, while no changes were recommended for patients in the biomarker-blinded category. This case series suggests that biomarker-guided therapy with serial biomarker values leads to timely therapeutic adjustment and that biomarker values as a composite score can be used effectively to measure the severity of heart failure.

Clues to diagnosing carcinoid heart disease as the cause of isolated right-sided heart failure.

Described herein is a 67-year-old woman who underwent replacement of both tricuspid and pulmonic valves because of severe isolated right-sided systolic heart failure. The cause of the heart failure preoperatively was believed to be the result of left breast radiation a year earlier. At operation, however, the pulmonic valve was excised and a biopsy of the stiff-walled right atrium was performed, and histologic examination of each was classic of carcinoid heart disease. She never awoke postoperatively. Postoperatively, computed tomography disclosed numerous masses in the liver. Retrospectively, clues to the presence of carcinoid heart disease include thickening of both the tricuspid and pulmonic valve leaflets by echocardiogram, a pressure gradient, albeit small, across the pulmonic valve, the plastering of the septal tricuspid-valve leaflet to the ventricular septum, the total absence of left-sided heart disease, and the presence of extremely low 12-lead QRS electrocardiographic voltage.

Reverse takotsubo cardiomyopathy: two case reports and review of the literature.

INTRODUCTION: Reverse takotsubo cardiomyopathy is a rare variant of classic takotsubo cardiomyopathy that presents within a different patient profile and with its own hemodynamic considerations. Its recognition is important for prognostic, evaluation and treatment considerations. CASE PRESENTATION: Case 1: A 69-year-old Caucasian woman presented with substernal chest pain following a motor vehicle accident. During her evaluation, she was found to have positive results for cardiac enzymes and underwent left heart cardiac catheterization. The results of the catheterization demonstrated no significant coronary stenosis. However, her ventriculogram showed basal and anterior akinesis.Case 2: A 62-year-old Caucasian woman began having substernal chest pain that radiated to her shoulder blades. She was taken to a local area hospital where she was found to have elevated troponins. A left heart catheterization showed an ejection fraction of 35% with hypokinesis of the anterior and posterobasal walls of her heart, with 30% stenosis of her left anterior descending artery but no other significant coronary artery stenosis. CONCLUSION: The cases in this report illustrate a lesser-known variant of takotsubo cardiomyopathy.