Cardiovascular Examination Research Articles

ОЦЕНКА РИСКА РАЗВИТИЯ НАРУШЕНИЙ ОБМЕНА ЛИПОПРОТЕИНОВ У ЛИЦ В ВОЗРАСТЕ 18-39 ЛЕТ

Objective. To develop a method for predicting the risk of developing lipoprotein metabolism disorders in persons 18-39 years of age. Material and methods. 137 healthy young people (33.6% (n=46) boys and 66.4 (n=91) girls) aged 20 [20;21] years were examined. Risk factors for the development of cardiovascular diseases (CVD), physical examination, instrumental and laboratory diagnostics were evaluated. The level of total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins, triglycerides in the blood serum was determined. Results. In the course of the study, a logistic regression model with a binary response and a logit communication function was built, which included the following statistically significant predictors: patient's gender, presence of burdened family history, LDL level and the value of the atherogenicity index. The threshold probability for this model (P0=0.43) was selected based on the results of ROC analysis. The area under the ROC curve was AUC=0.784 (95% CI: 0.689-0.878), sensitivity – 73%, specificity – 70%, classification accuracy – 71%. Conclusion. Risk factors of CVD are quite widespread among young people, and occurs with the same frequency, regardless of age. In young people, the incidence of 3 or more risk factors of CVD was 4.4%. The most significant prognostic factors associated with the development of lipoprotein metabolism disorders in people aged 18-39 years are male sex, the presence of burdened family history, LDL levels and the value of atherogenicity index.

Atypical Presentation of Andersen-Tawil Syndrome: Heart Failure with Reduced Ejection without Periodic Paralysis or Dysmorphic Features.

Andersen-Tawil syndrome (ATS) is a rare autosomal dominant disorder caused by variants in the KCNJ2 gene. It is associated with periodic paralysis, dysmorphic features and cardiac arrhythmias. The syndrome exhibits incomplete penetrance, leading to a broad spectrum of clinical manifestations, making diagnosis challenging. A male in his mid-20s with class 3 obesity presented to the emergency department with a week-long history of worsening chest pain, orthopnoea and fatigue. His family history was significant for sudden cardiac death affecting both his mother and brother, with his father having died from complications of Wolff-Parkinson-White syndrome. Cardiovascular examination revealed an S3 heart sound and elevated brain natriuretic peptide levels at 875 pg/ml, with undetectable troponins; potassium level on admission was 3.6 mEq/l. An electrocardiogram showed normal sinus rhythm, first-degree heart block, left atrial enlargement, left bundle branch block and a prolonged QTc of 486 ms. A transthoracic echocardiogram demonstrated a 15-20% reduction in ejection fraction with global left ventricular hypokinesis and left atrial enlargement. Ultimately, he was diagnosed with non-ischaemic dilated cardiomyopathy and referred for genetic testing, which revealed a KCNJ2 variant. Shortly after discharge, he experienced a 55-second run of ventricular tachycardia, necessitating the placement of a single-chamber ICD. Currently, the patient remains on guideline-directed medical therapy and is listed for a heart transplant. Dilated cardiomyopathy, although a rare manifestation in ATS, can profoundly increase the risk of fatal arrythmias, necessitating the need for a low threshold of suspicion, to ensure timely diagnosis and management. Andersen-Tawil syndrome (ATS) can present with heart failure with reduced ejection fraction, even without the typical triad of periodic paralysis, dysmorphic features and arrhythmias. Early genetic testing is essential for confirming ATS, especially in atypical cases with unexplained heart failure or arrhythmias.ATS has incomplete penetrance so it may present without the typical features, making diagnosis challenging and requiring a high suspicion in cases with unexplained arrhythmias or family history of sudden cardiac death.

December 2024 Pulmonary Case of the Month: Two Birds in the Bush Is Better than One in the Hand

No abstract available. Article truncated after 150 words. History of Present Illness A 48-year-old man is referred for dyspnea on exertion and a nonproductive cough. He was well until 6 months prior to this visit. He feels he has had “flu-like symptoms” over the past month. PMH, SH, and FH He has had intermittent atrial fibrillation controlled by digoxin but also clopidogrel as an anticoagulant. He has symptoms of hay fever and had asthma as a child. He has never smoked and rarely drinks. Pets include two dogs and a cat. He is a university English literature professor and his office is an old building but the building is clean and well maintained. Hobbies include playing guitar in a rock-n-roll band. His family history is unremarkable. Physical Examination His physical examination including lungs and cardiovascular examination is unremarkable. Which of the following are indicated for further workup? 1. Chest X-ray 2. Electrocardiogram (ECG) 3. Pulmonary function testing (PFTs) …

Association of prior tuberculosis with cardiovascular status in perinatally HIV-1-infected adolescents

BackgroundWhether, and how, co-occurring HIV-1 infection (HIV) and tuberculosis (TB) impact cardiovascular status, especially in adolescents with perinatally acquired HIV (APHIV), have not been examined. We hypothesised that APHIV with...

Separating Risk Prediction: Myocardial Infarction vs. Ischemic Stroke in 6.2M Screenings.

Traditional cardiovascular disease risk prediction models generate a combined risk assessment for myocardial infarction (MI) and ischemic stroke (IS), which may inadequately reflect the distinct etiologies and disparate risk factors of MI and IS. We aim to develop prediction models that separately estimate the risks of MI and IS. Our analysis included 6,242,404 individuals over 40 years old who participated in a cardiovascular health screening examination in 2009. Potential predictors were selected based on a literature review and the available data. Cox proportional hazards models were used to construct 5-year risk prediction models for MI, and IS. Model performance was assessed through discrimination and calibration. During a follow-up of 39,322,434.39 person-years, 89,140 individuals were diagnosed with MI and 116,259 with IS. Both models included age, sex, body mass index, smoking, alcohol consumption, physical activity, diabetes, hypertension, dyslipidemia, chronic kidney disease, and family history. Statin use was factored into the classification of dyslipidemia. The c-indices for the prediction models were 0.709 (0.707-0.712) for MI, and 0.770 (0.768-0.772) for IS. Age and hypertension exhibited a more pronounced effect on IS risk prediction than MI, whereas smoking, body mass index, dyslipidemia, and chronic kidney disease showed the opposite effect. The models calibrated well for low-risk individuals. Our findings underscore the necessity of tailored risk assessments for MI and IS to facilitate the early detection and accurate identification of heterogeneous at-risk populations for atherosclerotic cardiovascular disease.

Associations between glycated haemoglobin and multi-modal imaging markers of early cardiac aging.

Glycated haemoglobin (HbA1c) is a well-established biomarker for diabetes diagnosis and management and is linked to risk of cardiovascular death. However, among adults without cardiovascular disease (CVD) and diabetes, the value of HbA1c in predicting distinct signatures of myocardial ageing has not been explored. Subjects, from among older adults without CVD, underwent comprehensive cardiovascular and metabolic assessment. Transthoracic echocardiography measured left ventricular structure and function. Longitudinal left atrial (LA) strain comprising reservoir strain (Ɛs), conduit strain (Ɛe) and booster strain (Ɛa) and their corresponding peak strain rates (SRs, SRe, SRa) were measured using cardiac magnetic resonance (CMR). Blood sampling for biomarkers and cardiovascular examinations were performed. 247 subjects (mean age 71years, 44.1% female, mean HbA1c 6.0%) were included. HbA1c was significantly associated with E/A ratio (p < 0.0001), conduit strain (Ɛe) (p < 0.0001), conduit strain rate SRe (p < 0.0001), and conduit strain rate to booster strain rate SRe:SRa ratio (p < 0.0001). Multivariate models adjusting for clinical variables such as body mass index, blood pressure, heart rate, diabetes mellitus, smoking, and associated cardiac parameters, demonstrated a persistent independent association. Each unit increase in HbA1c was associated with lower E/A ratio, lower Ɛe, higher SRe and lower SRe:SRa ratio. These associations remained significant after diabetic subjects were excluded. Distinct associations were found between HbA1c and myocardial functions of interest in the ageing heart. HbA1c may be useful biomarker for stratifying risks associated with myocardial ageing, independent of diabetes status. ClinicalTrials.gov Identifier: NCT02791139.

Beyond the Local Effect: An Examination of Cardiovascular and Other Systemic Complications of Ophthalmologic Drugs.

Ophthalmologic drugs may be delivered to the eye via a number of ways, including topical drops and gels, intraocular injections, and parenteral or oral administration. The inadvertent systemic absorption of these drugs may lead to a myriad of side effects, ranging from benign cosmetic changes to potentially fatal cardiovascular complications. Historically, glaucoma treatment, including β-blockers and α-agonists, have been particularly examined for such events. However, recent studies suggest that the systemic absorption of many drugs commonly used in ophthalmology may lead to acute and serious secondary reactions. The following review examines ocular drugs delivered through various pathways, the mechanisms by which they may be systemically absorbed, and the potential adverse events that may ensue.

Steroid Sensitive Nephrotic Syndrome Associated with Situs Inversus Totalis in a Child : A Case Report with Review of Literature

Abstract Background: Situs inversus (SI) totalis is a rare congenital anomaly characterized by complete inversion of abdominal and thoracic visceral organs. While renal abnormalities have been documented in such cases, the association with nephrotic syndrome (NS) is exceptionally rare. Clinical Description: A 2.5-year-old girl, diagnosed with NS, a year ago, presented with anasarca due to relapse. Routine clinical examination showed normal vital parameters, anthropometry, mild pallor, and pitting edema. While abdominal examination revealed ascites, cardiovascular examination was suggestive of dextrocardia which was confirmed by echocardiogram without structural heart defects. Ultrasound abdomen liver, spleen, and stomach showed lateral inversion. Laboratory investigations were consistent with a relapse of NS. Management and Outcome: The child was managed with corticosteroids along with anti-edema measures, resulting in remission. Conclusion: This case brings out the exceptional rarity of SI totalis coexisting with NS and encourages further research into potential genetic and immunological factors which may explain this coexistence.

Clinically Relevant Extracardiac Findings at Cardiac Imaging: Insights from the European MR/CT Registry.

Purpose To determine the prevalence of clinically relevant extracardiac findings at cardiac CT and MRI examinations from a multicenter, multinational MR/CT registry and the relationship of prevalence with examination indications and patient characteristics. Materials and Methods This was a retrospective analysis of data from the European Society of Cardiovascular Radiology MR/CT Registry. Data from 208 506 cardiac CT examinations (median patient age, 66 years [IQR, 55-77]; 121 617 [58.33%] male patients) and 228 462 cardiac MRI examinations (median patient age, 57 years [IQR, 42-69]; 145 792 [63.81%] male patients) entered into the registry between January 2011 and November 2023 were analyzed. Clinically relevant extracardiac findings were defined as findings requiring follow-up examinations or influencing clinical management. The association of examination indication and patient characteristics, including age, with prevalence of extracardiac findings was evaluated using incidence rate ratios (IRRs) derived from multivariable Poisson regression models. Results The prevalence of clinically relevant extracardiac findings was 3.28% (6832 of 208 506) at cardiac CT and 1.50% (3421 of 228 462) at cardiac MRI examinations. Extracardiac findings were more common at CT examinations performed for transcatheter aortic valve replacement (IRR, 2.07; P < .001) and structural heart disease (IRR, 1.44; P < .001) compared with CT performed for coronary artery disease (IRR, 1; reference). Extracardiac findings were more common at MRI examinations performed for myocarditis (IRR, 1.36; P < .001) and structural heart disease (IRR, 1.16; P < .001) than for coronary artery disease. Older patient age was also significantly associated with higher prevalence of extracardiac findings, with an IRR for both CT and MRI examinations of 1.02 (P < .001). Conclusion Data from the multicenter, multinational MR/CT registry indicate that clinically relevant extracardiac findings are present at cardiovascular CT and MRI examinations, and the prevalence of these findings is associated with examination indication and patient age. Keywords: Cardiac Imaging Techniques, Incidental Findings, MRI, CT Angiography, CT, Heart Disease Supplemental material is available for this article. © RSNA, 2024.

Assessment Outcomes Effect of Apolipoprotein E4 Allele on Cardiovascular Diseases

The apolipoprotein E4 allele is a genetic risk factor that has a negative impact on the quality of life of people with cardiovascular disease. Our current study aimed to evaluate the effect of apolipoprotein E4 allele in cardiovascular patients (n=85). A total of 85 elderly patients with cardiovascular disease were enrolled in the study, which was conducted at hospitals in Baghdad, Iraq, between 18 January 2022 and 27 October 2023. Comprehensive cardiovascular examinations were performed on each patient, including blood pressure, heart rate, and other vital sign measurements. APOE genotype analysis was conducted to evaluate the impact on the patients. Additionally, questionnaires were administered to assess the quality of life of patients with cardiovascular disease. In terms of clinical outcomes, chest pain was identified as the most prevalent symptom among patients, with a total of 38 cases. Additionally, the E3/E4 genotype of the APOE gene was observed in 41.18% of patients, which was associated with an increase in serum lipid-lipoprotein levels in terms of SBP (145.39 ± 27.46) mmHg and DBP (87.89 ± The mean values for the variables were as follows: glucose (3.11 ± 1.12) mg/dL, triglycerides (224 ± 46.25) mg/dL, LDL-C (167.29 ± 12.92) mg/dL, and HDL-C (14.82 ± 3.82) mg/dL. The adverse findings revealed that 23 cases involved heart attacks, and 30 cases involved strokes. Patients with CVD who carried the apolipoprotein E4 allele exhibited negative impacts on their quality of life, as evidenced by the following scores: physical functioning (46.38 ± 14.26), energy/fatigue (53.25 ± 12.29), and emotional problems (62.10 ± 10.29). In general, patients with the apolipoprotein E4 allele exhibit elevated levels of lipid profiles, which signify an elevated risk of severe complications in patients with cardiovascular disease.

Comparison of Thyroid Function Tests Among Type 2 Diabetes Patients With and Without Diabetic Nephropathy and Controls.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with hyperglycemia and impaired insulin function. Diabetic nephropathy (DN) is a common complication of T2DM, characterized by progressive kidney damage. Thyroid dysfunction, particularly hypothyroidism, has been increasingly recognised as a significant factor influencing the progression of DN. To compare thyroid function tests in patients with T2DM with and without diabetic nephropathy and non-diabetic controls, and to assess the role of thyroid dysfunction in DN progression. A hospital-based cross-sectional study was conducted among 225 participants. Patients were divided into three groups: T2DM with DN, T2DM without DN, and controls, with 75 participants in each group. Data collection included demographic details, comorbidities, and clinical assessments such as blood pressure, thyroid function tests, urinary albumin levels, glycated hemoglobin (HbA1c), renal function tests, serum electrolytes, and estimated glomerular filtration rate (eGFR). Statistical analyses were conducted using SPSS version 20.0 (IBM Corp., Armonk, NY, USA). Results:The most common DN stage among T2DM patients was stage 4 (29, 38.7%), followed by stages 2 and 5 (19, 25.3%each). The T2DM with DN (47, 62.7%) group had a higher prevalence of overweight and obesity compared to the T2DM without DN group (38, 51.5%) and controls (24, 32%) (p value<0.001). Abnormal cardiovascular, respiratory, and abdominal examinations were most prevalent in the T2DM with DN group. Hypothyroidism was more prevalent in both T2DM groups (14, 18.7% each) compared to controls (2, 2.7%) (p value<0.004). Conclusion:Our findings strengthen the evidence of an important link between T2DM and thyroid disorders. The high prevalence of thyroid dysfunction among T2DM patients highlights the critical need for routine screening and integrated management of both conditions to enhance patient outcomes.

Mitral valve calcinosis as an important finding during heart examination

BACKGROUND: Mitral valve calcinosis is a chronic degenerative process in the fibrous structures of the mitral valve. Advanced stages increase the risk of endocarditis and cardiac rhythm disturbances and contribute to cardiovascular mortality. The cause of mitral valve calcinosis is still controversial; however, the contribution of atherosclerosis to its development is currently undisputed. The prevalence of mitral valve calcinosis varies in different age groups and on average is higher in people with cardiovascular disease. AIM: To assess the prevalence of mitral valve calcinosis in patients undergoing computed tomography angiography and identify the relationship between aortic and mitral valve calcinosis and coronary calcium index and signs of remodeling. MATERIALS AND METHODS: A retrospective study of 336 patients who underwent computed tomography coronary angiography with intravenous contrast enhancement at the Lomonosov Moscow State University Clinic between November 13, 2020, and May 14, 2022, was conducted. RESULTS: The prevalence of aortic (16.4%) and mitral (11%) valve calcinosis was high in people undergoing cardiovascular examination, and a relationship was noted between valve calcinosis and coronary calcium index. CONCLUSION: The detection of mitral valve calcinosis in patients during routine examination is important in predicting further treatment and outcomes because valve calcinosis is an indirect indicator of coronary heart disease risk. Although valve calcinosis is usually an incidental examination finding, it may indicate a high cardiovascular risk and should prompt further evaluation, if clinically necessary.

Relationship between Ikigai and longitudinal changes in serum HDL cholesterol levels: the Circulatory Risk in Communities Study (CIRCS)

BackgroundHaving positive psychological well-being has been associated with serum high-density lipoprotein cholesterol (HDLC), but no longitudinal study to date has examined the association between Ikigai and serum HDLC. Therefore, we examined the association between Ikigai and change in serum HDLC over time using a cohort dataset spanning 2010–2018.MethodsThe study included 471 men and 776 women aged 40–74 years who underwent a cardiovascular examination in 2010 and were asked their levels of Ikigai. We combined “definitely yes” and “yes” as “with Ikigai” and recorded “a little” as “with a little Ikigai” and “no” as “without Ikigai”. We measured serum HDLC using direct methods. The association between Ikigai and serum HDLC levels at baseline, and changes in this relationship during an eight-year period, were analyzed using linear mixed-effect models.ResultsAt the baseline, relative to those without Ikigai, women with Ikigai had higher serum HDLC (baseline difference in those with a little Ikigai = 7.52 mg/dl, 95% confidence interval [CI]: 1.12 to 13.9 and in those with Ikigai = 8.11 mg/dl, 95% CI: 1.54 to 14.7). The difference in serum HDLC between women with and without Ikigai remained over the eight-year follow-up period. There were no similar Ikigai-associated differences in the serum HDLC of men.ConclusionsWomen with Ikigai showed differences in serum HDLC that were observed at baseline and persisted over time.

A Rare Case of Late Onset-Pompe’s Disease: Presented as Heart Failure

Pompe disease is a hereditary lysosomal storage disorder characterized by a deficiency in the acid alpha-glucosidase (GAA) enzyme, leading to glycogen accumulation in muscle and neurons. Clinical manifestations vary from severe infantile-onset with hypertrophic cardiomyopathy and early mortality due to respiratory insufficiency to late-onset with proximal muscle weakness, gross motor delay, and progressive respiratory insufficiency. A case of an 11-year-old boy who reported to the pediatric emergency department with a nine-year history of progressive muscle weakness and a one-month history of anemia symptoms (easy fatigue, shortness of breath, pale appearance) and heart failure (orthopnea, dyspnea). His family history included consanguineous marriages and similar conditions in his brother and maternal uncle. On examination, he appeared pale, malnourished, and exhibited signs of respiratory distress and tachypnea. His cardiovascular examination revealed apex beat displacement, elevated JVP, bilateral pedal edema, mild ascites, positive hepatojugular reflux, and systolic murmurs. Respiratory examination indicated bilateral crepitation and wheezes. Musculoskeletal examination showed decreased muscle mass and power, especially in proximal muscles. Abdominal examination revealed hepatosplenomegaly and mild ascites. Radiological findings included an enlarged cardiac shadow with pleural effusion and bilateral radio-opaque shadows on chest x-ray, while echocardiography showed impaired left ventricular systolic function with mild to moderate mitral and tricuspid regurgitation. Laboratory tests indicated elevated aspartate aminotransferase, LDH, and creatine kinase levels, along with normocytic, normochromic anemia. Muscle biopsy from the hamstring revealed PAS stain positive granules. These clinical, radiological, and laboratory findings strongly suggest late-onset Pompe disease, marking this as potentially the second reported case in Pakistan.

Cardiovascular risk factors among Roma and non-Roma populations in underprivileged settlements.

The 'Taking the screening tests close to the people' program offers cardiovascular screening to the inhabitants of underprivileged settlements. This study aimed to evaluate the cardiovascular risk factors of underprivileged populations, including individuals who described themselves as belonging to the Roma population. During the program, we collected information about demographic features, lifestyle and current illnesses. A general health assessment (body weight, height, blood pressure and fasting blood glucose) and cardiovascular examination were performed. We analysed data on both Roma and non-Roma groups and used Pearson's chi-squared test and multiple logistic regression models to analyse the factors that contribute to the onset of comorbidities, with a special focus on ethnicity. Data from 6211 participants were processed. Based on self-reports, the non-Roma population consisted of 5352 respondents (1364 men (25.5%) and 3988 women (74.5%)), and the Roma population comprised 859 respondents (200 men (23.3%) and 659 women (76.7%)). A total of 91.2% (4849) of the non-Roma population and 92.5% (788) of the Roma population exercised less than 3h per week (p < 0.001). Of the non-Roma population, 71.7% (3512) had a body mass index above 25kg/m2, while the corresponding figure was 72.4% (609) in the Roma population (p = 0.709). The median body mass index was 28.0 (24.6-31.9) in the non-Roma population and 28.8 (24.5-33.0) in the Roma population (p < 0.001). The prevalence of active smokers was 28.7% (1531) in the non-Roma population and 60.3% (516) in the Roma population (p < 0.001). The prevalence of hypertension was 54.9% (2824) in the non-Roma population and 49.8% (412) in the Roma population (p < 0.001). The prevalence of diabetes was 11.5% (95) in the Roma population and 12.2% (619) in the non-Roma population (p < 0.001). We found a high prevalence of overweight and obesity, a lack of physical activity and an remarkably high smoking rate in the studied underprivileged population. Both type 2 diabetes and hypertension were more common among people living in underprivileged settlements than in the general Hungarian population. People living in underprivileged settlements need more attention in primary care.

Pre - and post- COVID era: how did the pandemic impact the number of cardiovascular examinations?

Abstract Introduction A lot of evidence suggests a close link between COVID-19 and cardiovascular diseases. Recent data indicate that COVID-19 may increase the risk of cardiovascular diseases in the future, to an extent similarly observed in reference to the more traditional cardiovascular risk factors. Health practitioners, nurses, and doctors have a hypothesis that, since COVID began, more and more younger patients seek cardiovascular examinations. The Purpose of this study is to compare the number of cardiovascular examinations before and after the beginning of the COVID pandemic, by gender and age. Materials and Methods We examined the total number of cardiovascular examinations performed at the diagnostic center, Zan Mitrev clinic, Skopje, R. Macedonia, for a period of three years before COVID-19, i.e., from January 2017 to March 2020, and three years after the start of the pandemic, i.e. from March 2020 to March 2023. We structured the comparison by gender and age of the patients before and after COVID. Cardiovascular examination in our hospital comprises electrocardiography, echocardiography and cardiologic consultation. All of the collected data came from the Hospital Information System. Results A total of 24,496 cardiovascular examinations were performed between January 2017 and March 2020. The cohort of patients comprised 13,374 men (55%) and 11,121 (45%) women. The average age was 53±30 years. During the period from March 2020 to March 2023 a total of 33,825 cardiovascular examinations were performed, and the patients comprised 18,137 (54%) men and 15,687 (46%) women. The average age was 55±43 years. Conclusions Although there seems to be an upward trend of the number of cardiovascular examinations after the COVID pandemic started, there is no statistically significant difference between the data categorized by age and gender before and after the COVID era.

Congenital Apical Left Ventricular Aneurysm.

A 17-year-old male was referred for evaluation by Pediatric Cardiology following a pre-sports medical screening, which revealed abnormal ventricular repolarization (negative T wave from V3-V6) on a 12-lead ECG. For 8 years, he has been a competitive football player. There was no relevant personal or family medical history, and he denied any prior cardiovascular symptoms. His cardiovascular physical examination was normal. In the initial assessment, a transthoracic echocardiogram was conducted, revealing an apical aneurysm of the left ventricle (LV) with regional dyskinesia, accompanied by mild mitral regurgitation. The examination also demonstrated globally preserved left ventricular systolic function, with no images suggestive of vegetations or intracardiac thrombi found. For further anatomical and myocardial characterization, a cardiac magnetic resonance (CMR) was performed. The results revealed a wide apical aneurysm of the LV, predominantly lateral, with thin walls, ridges within the outpouching, and local dyskinesia. No areas of late gadolinium enhancement (LGE) were found, suggestive of fibrosis, anomalous infiltration, or scar from a previous infarction. After excluding other etiologies, the diagnosis of a congenital ventricular aneurysm was determined. This is a very rare condition (0.12%) with a wide and variable clinical presentation, ranging from benign arrhythmias to sudden death. Various imaging techniques aid in its diagnosis, with CMR being particularly useful for excluding inflammation and cardiomyopathies, identifying LGE, and evaluating left ventricular volumes and function. There is no standard treatment, and controversy surrounds indications for surgical intervention. If a conservative approach is adopted, measures aimed at preventing endocarditis and embolism must be considered.

Uncommon triggers of insulin autoimmune syndrome: a case report

BackgroundInsulin autoantibody syndrome (IAS), or Hirata disease, is caused by high concentrations of insulin autoantibodies, which result in spontaneous, mainly post-prandial, hypoglycemic episodes. We report a case of a previously healthy 67-year-old man presenting with recurrent fasting hypoglycemia culminating in a diagnosis of insulin autoimmune syndrome linked to omeprazole and probably spices, namely, coriander, and ginger.Case presentationA previously healthy 67-year-old Sinhalese man presented with recurrent syncopal attacks for 3 months, which were found to be hypoglycemic episodes. He experienced mainly fasting hypoglycemic attacks, at a frequency gradually increasing to daily attacks. His cardiovascular, respiratory, abdominal, and neurologic examinations were normal. He was found to have insulin levels > 6000 mU/L and a post-polyethylene glycol insulin recovery of less than 9.5%. Contrast-enhanced computed tomography of the pancreas was normal. The diagnosis of insulin autoantibody syndrome was confirmed by testing for the insulin autoantibody level, yielding a level of > 300 U/mL. With regard to a possible trigger, he had a history of omeprazole intake for 2 weeks, 4 weeks prior to the onset of symptoms. He also consumed an herbal supplement containing coriander and ginger extracts daily for a period of 1 year, approximately 2 years prior to the onset of hypoglycemic attacks. He was commenced on prednisolone 30 mg daily, and hypoglycemic episodes responded dramatically, and thus he was tapered off corticosteroids.ConclusionOmeprazole-induced insulin autoantibody syndrome is likely in this patient; however, the known hypoglycemic effects of coriander and ginger make it worthwhile to consider a possible association with insulin autoantibody syndrome. In addition, this case report highlights the need to consider insulin autoantibody syndrome even in patients presenting with fasting hypoglycemic attacks.

Artificial intelligence in cardiovascular radiology : Image acquisition, image reconstruction and workflow optimization

Artificial intelligence (AI) has the potential to fundamentally change radiology workflow. This review article provides an overview of AI applications in cardiovascular radiology with afocus on image acquisition, image reconstruction, and workflow optimization. First, established applications of AI are presented for cardiovascular computed tomography (CT) and magnetic resonance imaging (MRI). Building on this, we describe the range of applications that are currently being developed and evaluated. The practical benefits, opportunities, and potential risks of artificial intelligence in cardiovascular imaging are critically discussed. The presentation is based on the relevant specialist literature and our own clinical and scientific experience. AI-based techniques for image reconstruction are already commercially available and enable dose reduction in cardiovascular CT and accelerated image acquisition in cardiac MRI. Postprocessing of cardiovascular CT and MRI examinations can already be considerably simplified using established AI-based segmentation algorithms. In contrast, the practical benefits of many AI applications aimed at the diagnosis of cardiovascular diseases are less evident. Potential risks such as automation bias and considerations regarding cost efficiency should also be taken into account. In amarket characterized by great expectations and rapid technical development, it is important to realistically assess the practical benefits of AI applications for your own hospital or practice.

Markedly dilated right atrium in an infant: what is the diagnosis?

An 18-month-old boy presented with recurrent episodes of irritability and documented fast heart rate suggestive of supraventricular tachycardia. Cardiovascular examination revealed significant cardiomegaly, normal heart sounds and no murmurs. The differential diagnosis of marked right atrial dilatation and management principles of idiopathic dilatation of the right atrium are described.