Heart Research Articles

Phantom Shocks Associated With a Wearable Cardioverter Defibrillator

Wearable cardioverter defibrillators (WCDs) are external devices capable of continuous cardiac rhythm monitoring as well as automatic detection and defibrillation of potentially life-threatening arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF). They are an alternative approach for patients when an implantable cardioverter defibrillator (ICD) is not appropriate. Although treatment with ICD is considered highly effective for the primary and secondary prevention of sudden cardiac death (SCD) in high-risk patients susceptible to VT and VF, patients may still experience psychological difficulties such as fear of shock, avoidance of normal behaviors and reduced quality of life. One of these phenomena is phantom shock (PS), which is defined as a perception of having received a shock with no evidence of recorded defibrillation upon device interrogation. While PS has been reported in the ICD literature, to the best of our knowledge, we present the first known case of WCD-related PS. We also present a review of the current literature to explore the prevalence of PS, the factors associated with its pathogenesis and interventional studies aimed at reducing its occurrence. We highlight this case because PS is considered a phenomenon that few recognize, which should be discriminated from real device shocks before clinicians initiate treatment, device reprogramming or device discontinuation. We describe the psychosocial factors associated with PS to emphasize the importance of managing any associated psychiatric disorders and psychosocial factors both before and after initiation of device treatment. J Med Cases. 2021;12(2):49-53 doi: https://doi.org/10.14740/jmc3606

Aerococcus urinae : A Rare Cause of Endocarditis Presenting With Acute Stroke

Aerococcus urinae is a rare organism infrequently isolated from cultures. Mostly known to cause urinary tract infection, it can cause bacteremia leading to severe urosepsis and infective endocarditis. Embolization is frequently reported with Aerococcus urinae endocarditis (AUE); hence, the presentation is highly variable. Sequelae such as various central nervous system manifestations, sepsis, valvular regurgitation with heart failure and even coronary artery involvement have been reported. We report a case of a 58-year-old man with AUE of the aortic valve, severe aortic regurgitation and embolic stroke as a result of embolization from AUE and ultimately required aortic valve replacement. Our case highlights this rare cause of endocarditis and offers insight into the variability of patient presentation and risk factors to consider. J Med Cases. 2021;12(2):65-70 doi: https://doi.org/10.14740/jmc3612

Red Meat and Cardiovascular Risk, Revisited

High consumption of red meat might be associated with excess risk for coronary heart disease (CHD) and cardiac-related mortality, but the evidence has

High-Dose Flu Vaccine in Cardiac Patients

High-dose influenza vaccine contains four times more antigen than do standard preparations and is modestly more effective in preventing influenza and

Clinical and immunological characteristics of myositis complicated with thromboembolism

OBJECTIVE To investigate and analyse the clinical and immunological features of patients with myositis complicated with thromboembolism. METHODS We identified a cohort of 390 myositis patients diagnosed with myositis admitted to People's Hospital of Peking University from 2003 to 2019. The patients were retrospectively enrolled in this investigation. According to the outcome of the color Doppler ultrasound, CT pulmonary angiography, pulmonary ventilation and perfusion scan patients were divided into myositis with and without thromboembolism group. Demographic, clinical (heliotrope rash, Gottron's sign/papules, periungual erythema, skin ulceration, subcutaneous calcinosis, Mechanic's hands, myalgia, interstitial lung disease, pulmonary arterial hypertension), laboratory, immunological [anti-autoantibodies including melanoma differentiation associated gene 5 (anti-MDA5), anti-Mi-2, anti-transcription intermediary factor-1γ (anti-TIF-1γ, anti-nuclear matrix protein 2 (anti-NXP2), anti-small ubiquitin-like modifier activating enzyme (anti-SAE), anti-synthetase], imaging and therapeutic status data of the patients at the diagnosis of myositis with and without thromboembolism were collected and the differences in these data were analyzed. Logistic regressive analysis was used to identify the risk factors of thromboembolism. RESULTS In the retrospective study, 390 myositis patients were investigated. The mean age of onset was (49.6±13.4) years, male to female ratio was 0.31 :1. Thromboembolism was identified in 4.62% (18/390) of the myositis patients, which was lower than the published reports. Out of 18 patients with thromboembolism, 55.6% (10/18) of them were deep venous thrombosis, followed by cerebral infarction (22.2%, 4/18), pulmonary embolism (11.1%, 2/18), renal artery embolism (5.6%, 1/18) and embolism of upper extremity (5.6%, 1/18). Fifty percent of thromboembolism events occurred 6 months after the diagnosis of myositis, 38.9% of thromboembolism events occurred 6 months within the diagnosis of myositis, 11.1% of thromboembolism events occurred 6 months before the diagnosis of myositis. As compared with the myositis patients without thromboembolism, the myositis patients complicated with thromboembolism were older [(58.3±11.7) years vs. (49.3±13.4) years, P=0.006]. C-reaction protein (CRP) (12.2 mg/L vs. 4.1 mg/L, P < 0.001), ferritin (20 085.5 μg/L vs. 216.6 μg/L, P < 0.001) and D-dimer (529.0 μg/L vs. 268.0 μg/L, P=0.002) were significantly higher in thromboembolism group. Diabetes (44.4% vs. 16.4%, P=0.006), coronary heart disease (22.2% vs. 3.0%, P=0.003) and surgery (16.7% vs. 3.5%, P=0.032) were observed more common in thromboembolism group than those without thromboembolism. Activated partial thromboplastin time (APTT) (26.9 s vs. 28.7 s, P=0.049) and albumin (32.4 g/L vs. 36.5 g/L, P=0.002) was lower in thromboembolism group. The risk factors of thromboembolism in the myositis patients were low level of albumin (OR=0.831, 95%CI: 0.736-0.939, P=0.003), diabetes (OR=4.468, 95%CI: 1.382-14.448, P=0.012), and coronary heart disease (OR=22.079, 95%CI: 3.589-135.837, P=0.001) were independent significant risk factors for thromboembolism in the patients with myositis. There was no significant difference in clinical manifestations, myositis-specific antibodies or myositis-associated antibodies between the two groups. CONCLUSION Thromboembolism is a complication of myositis. Lower levels of albumin, diabetes, and coronary heart disease might be risk factors of thromboembolism in myositis patients.

Zooming into the heart

Zooming into the heart

Correction: Optimal paramedic numbers in resuscitation of patients with out-of-hospital cardiac arrest: A randomized controlled study in a simulation setting

[This corrects the article DOI: 10.1371/journal.pone.0235315.].

Update on Performance Measures for Atrial Fibrillation and Flutter

Sponsoring Organizations: American College of Cardiology (ACC) and American Heart Association (AHA), in collaboration with the Heart Rhythm Society

Catharine Randall, A Heart Lost in Wonder: The Life and Faith of Gerard Manley Hopkins

Catharine Randall, A Heart Lost in Wonder: The Life and Faith of Gerard Manley Hopkins

The Life of Ṣaḥābī ʿUrwa b. Masʿūd el-Thaqafī

Hz. Peygamber’in sahâbîlerinden bir tanesi Tâifli Sakîf kabilesinden Urve b. Mes‘ûd’dur. O, kabilesinin en önde gelenlerinden birisidir. O, Sakîf kabilesinin Ahlâf koluna mensuptur ve bu kolun yöneticisidir. Urve Mes‘ûd’un nesebi, Kasî’ye (Sakîf) kadar ihtilafsız bilinmektedir. Onun künyesi Ebû Ya‘fûr bir rivayate göre de Ebû Mes‘ûd’dur. Urve’nin babası da önemli bir şahsiyet-tir. O da kabilesinin reislerindendir ve Ficar savaşlarında Sakîf kabilesinin Ahlâf koluna komu-tanlık yapmıştır. Urve’nin annesi ise Mekkeli Ümeyyeoğullarından Sübey‘a bint Abdüşems’dir. Böylece Urve’nin hem Ümeyyeoğulları ile hem Hz. Peygamber ile akrabalık bağı olmaktadır. Dolayısıyla nesebi, babası ve annesi itibariyle Urve, çok önemli bir konuma sahiptir. Onun Mekke ve Kureyş ile ilgisi de bu konumunu güçlendirmektedir. Kaynaklarımızda Urve b. Mes‘ûd’un doğum tarihi veya vefat yaşı ile ilgili bir bilgi bulunamamıştır. Kabilesinin reisi olu-şuna, vefat ettikten sonra oğlunun Müslüman oluşuna bakıldığında Müslüman olduğunda orta yaşın üzerinde olması muhtemeldir. Urve b. Mes‘ûd’un evlilikleri ile ilgili bilgi de azdır. Onun Müslüman olmadan önce on eşi olduğu rivayet edilmektedir. Müslüman olduktan sonra Hz. Peygamber dört eşini seçmesini istemiştir. Onun dört eşinden bir tanesi Ebû Süfyan’ın kızıdır. Ancak onun eşlerinin isimleri ile ilgili net bilgiler yoktur. Onun erkek çocuklarının isimleri Âsım, Ebû Mürre, Muaviye, Ebû Müleyh, Davud, Hemmâm ve Hişâm; kız çocuklarının isimleri Hz. Ali ile evli olan Ümmü Saîd ve Halime’dir. Hudeybiye Antlaşması öncesinde onun elçilik görevi yaptığını görmekteyiz. Onun elçilik görevi, konumunun üstünlüğünü ortaya koymakta-dır. Ayrıca bu elçilik, barış görüşmelerinde çok etkili olmuştur. Burada Mekkeliler ile olan akrabalık bağını gündeme getirmiştir. Hz. Peygamber ile kendisinin konuşmasının faydalı olacağını söylemiştir. Mekkeliler de ona olan güvenlerini açıklamışlardır. Bu elçilik esnasında iki tarafın da savaştan uzak durması gerektiğini ifade etmiştir. Bu bağlamda Mekkelilere, Hz. Peygamber’in etrafındakilerin ona çok bağlı olduklarını; Hz. Peygamber’e ise etrafındaki insan-ların hemen dağılacağını söylemiştir. Elçiliği, onun herkes tarafından sözü dinlenilen, itibar edilen, zeki ve ikna kabiliyeti yüksek bir kişi olduğunu göstermektedir. Urve, sahâbenin Hz. Peygamber’e olan bağlılığını gözlemlemiştir. Bu bağlılığın hiçbir hükümdar ve çevresindeki-lerde olmayacağını itiraf etmiştir. Bu gözleminin, onun Müslümanlığında etkili olması muhte-meldir. Mekke’nin fethi ve ardından yaşananlar, Tâiflileri endişeye sevk etmiştir. Bu sebeple Tâifliler, Huneyn Savaşı’nda Hevâzinlilerle birlikte Müslümanlara karşı savaşmışlardır. Bu esnada Urve b. Mes‘ûd ile Gaylân b. Seleme’yi bazı savaş araç ve tekniklerini öğrenmeleri için Yemen’in Cüreş şehrine göndermişlerdi. Bu sebeple ikisi de Huneyn ve Tâif gazvelerine katıla-mamışlardı. Hz. Peygamber Tâif kuşatmasına son verip Medine’ye döndü. Bu esnada Urve ve arkadaşı da Yemen’den döndü. Rivayetlere göre Hz. Peygamber Medine’ye dönüş yolunda veya Medine’ye varınca Urve onun yanına gitti ve Müslüman oldu. Bazıları onun İslam’a giriş tarihi ile ilgili Hz. Ebû Bekir’in hac emirliği görevinin öncesi veya sonrasını söylerler. Ancak rivayet-ler incelendiğinde onun Hz. Peygamber’in Tâif muhasarasından 4-5 ay sonra, Tebük seferinden 3-4 ay önce 9/630 yılı Rebîulevvel veya Rebîulâhir (Temmuz veya Ağustos) ayında Müslüman olduğu söylenebilir. Urve’nin Müslüman olmasıyla ilgili temel kaynaklarımız “Allah, Urve’nin kalbine İslâm’ı ilham etti ve üzerinde bulunduğu hali değiştirdi. Bu hali ile Rasûlullah’ın yanına gitti ve Müslüman oldu.” der ve belirli bir sebep belirtmezler. Ancak sonraki dönemde onun Müslüman oluşuyla ilgili Necran’a ticaret için yaptığı yolculukta yaşadıkları sebep gösterilir. Bu yolculukta gizemli iki genç kız ve Necran’daki rahip son peygamberin çıktığını Urve’ye söyler. Onlar, Urve’nin ona tabi olması gerektiğini de belirtirler. Urve de dönüşte Müslüman olur. Bu rivayet hem senet hem metin itibariyle problemlidir. Urve, Müslüman olduktan sonra kavmini İslam’a davet için Hz. Peygamber’den izin istemiştir. İlk etapta Hz. Peygamber, Tâiflilerin İs-lam’a karşı kibirli karşı duruşundan dolayı bunu kabul etmek istememiş ve Urve’ye Sakîflilerin kendisini öldürebileceğini söylemiştir. Nitekim Urve, Hz. Peygamber’in izniyle şehrine gitmiş ve onları İslam’a davet etmiştir. Onlar kabul etmemişler ve kötü sözler söylemişlerdir. Ertesi sabah Urve sabah ezanı okumuş, halkı onu öldürmüştür. Hz. Peygamber tarafından Hz. İsa’ya benzetilen Urve b. Mes‘ûd es-Sekafî’nin Zuhruf suresinde ifade edilen “iki şehrin büyüğünden birisi” olduğu genel olarak kabul edilmiştir. Birkaç gün Müslüman olarak yaşayabilen ve kavmi tarafından şehit edilen Urve’den sadece iki tane zayıf rivayet nakledilmiştir.

Brain MRI for Prognostication After Pediatric Cardiac Arrest

Accurate neuroprognostication after cardiac arrest is important for families and may influence discussions about goals of care; however, this is a

929: Cardiac and IVC Findings Using POC Ultrasound in Hypovolemic Children

929: Cardiac and IVC Findings Using POC Ultrasound in Hypovolemic Children

Physicians' Choice of Implantable Cardiac Device Is Associated with Manufacturer Payments

Financial associations between physicians and industry are common, and payments to physicians have been linked to a higher likelihood of prescribing

Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy

Sponsoring Organizations: American College of Cardiology; American Heart AssociationBackground and ObjectiveOur knowledge of the appropriate diagnostic

Expert consensus on cardiac rehabilitation for chronic heart failure in China

Evidence shows that exercise-based cardiac rehabilitation is benefit to chronic heart failure, which has been strongly recommended by several international guidelines. Thus, cardiac rehabilitation has been actively promoted in domestic clinical practice. In view of the recent research progresses in the theory and methods of cardiac rehabilitation for heart failure in the world, the present updated revision is aimed to provide guidance for cardiac rehabilitation and promote the development of cardiac rehabilitation in chronic heart failure in China.

Is Current Drug Therapy for Heart Failure Sufficient to Control Heart Rate of Patients?

ResumoFundamento Estudos revelam que pacientes com insuficiência cardíaca (IC) e frequência cardíaca (FC) <70 batimentos por minuto (bpm) evoluem melhor e têm menor morbimortalidade em comparação com FC >70. Entretanto, muitos pacientes com IC mantêm FC elevada.Objetivo Avaliar se os pacientes acompanhados em ambulatório de cardiologia têm sua FC controlada e como estava a prescrição dos medicamentos que reduzem a mortalidade na IC.Métodos Foram analisados de forma consecutiva pacientes que passaram em consulta e que já acompanhavam em ambulatório de cardiologia, idade > 18 anos e com diagnóstico de IC e fração de ejeção do ventrículo esquerdo (FEVE) <45%. Os pacientes em ritmo sinusal foram divididos em dois grupos: FC ≤70 bpm (G1) e FC >70 bpm (G2). Na análise estatística, foram utilizados os testes t de Student, Qui-quadrado. Foi considerado significante p <0,05. Utilizamos o programa Statistical Package for the Social Sciences (SPSS) para análise.Resultados Foram avaliados 212 pacientes de forma consecutiva. Destes, 41 (19,3%) apresentavam fibrilação atrial ou eram portadores de marca-passo e foram excluídos desta análise; assim, 171 pacientes foram analisados. Os pacientes em ritmo sinusal tinham idade média de 63,80 anos (±11,77), sendo 59,6% homens e FEVE média de 36,64% (±7,79). Com relação à etiologia, a isquêmica estava presente em 102 pacientes (59,65%), enquanto a cardiopatia chagásica em 17 pacientes (9,9%); 131 pacientes eram hipertensos (76,6%), enquanto 63 pacientes (36,84%) eram diabéticos. Quanto à FC, 101 pacientes apresentaram FC ≤70 bpm (59,06%) G1 e 70 pacientes (40,93%) FC >70 bpm (G2). A FC média no G1 foi de 61,53 bpm (±5,26) e no G2, 81,76 bpm (±9,52), p <0,001. A quase totalidade dos pacientes (98,8%) estava sendo tratada com carvedilol prescrito na dose média de 42,14 mg/dia (±18,55) no G1 versus 42,48 mg/dia (±21,14) no G2, p=0,911. A digoxina foi utilizada em 5,9% dos pacientes no G1 versus 8,5% no G2, p=0,510. A dose média de digoxina no G1 foi de 0,19 mg/dia (±0,06) e no G2 foi de 0,19 mg/dia (±0,06), p=0,999. A maioria dos pacientes (87,72%) utilizou o inibidor da enzima de conversão da angiotensina (IECA) ou bloqueador do receptor da angiotensina (BRA), e 56,72% utilizaram espironolactona. A dose média de enalapril foi de 28,86 mg/dia (±12,68) e de BRA foi de 87,80 mg/dia (±29,80). A maioria dos pacientes utilizou IECA ou BRA e com doses adequadas.Conclusão O estudo revelou que 40,93% dos pacientes estavam com FC acima de 70 bpm, apesar de o betabloqueador ter sido prescrito para praticamente todos os pacientes e em doses elevadas. Outras medidas precisam ser adotadas para manter a FC mais controlada nesse grupo de frequência mais elevada. (Arq Bras Cardiol. 2020; 115(6):1063-1069)

Prognostic values of physical and hematological parameters of dogs naturally infected with parvovirus PVC-2: retrospective study of 103 cases

ABSTRACT Canine parvovirosis is a high mortality disease with acute clinical picture. However, there are few available resources to help stablish prognosis accurately. This study aimed to determine the prognostic threshold values for vital and hematological parameters of dogs naturally infected by the Carnivore protoparvovirus 1 (CPV). A retrospective study of 103 canine parvovirosis cases was carried out. Twenty seven percent of these (28/103) died, 96% (27/28) of which within the first four days of hospitalization. Deceased animals had significantly higher median values for heart (HR) and respiratory (f) rates, as well as significantly lower systolic blood pressure (SBP) than survivors. Severely leukopenic animals (&lt;1,000 cells/μL), had a significantly higher mortality rate (68%, n=13) compared to that of other patients (P&lt;0.0007). Animals with at least two of the following findings: severe hypotension (SBP&lt; 90mmHg), tachycardia (HR &gt; 150 bpm) and leukopenia, represented 34% (34/101) of the cases and had a survival rate of 29% (10/34), while animals with at most one of these parameters represented 66% (67/101) and had a survival rate of 94% (63/67). The presence of two or three abnormal parameters was significantly related to the higher death risk among dogs with parvovirosis (P&lt;0.0001).

Cardiomyopathy in Celiac Disease: Carnitine Behind?

In Volume 8, Issue 2 of the International Journal of Celiac Disease, Shah et al. presented a peculiar celiac disease presenting as cardiomyopathy in an adult female. We would highlight the importance of carnitine deficiency in such cases, both at diagnosis as well as during follow up; carnitine being widely reported as a cause of cardiomyopathy in celiac and non-celiac population, and supplementing these patients by carnitine might reverse this heart dysfunction.

Application of feed forward and recurrent neural networks in simulation of left ventricular mechanics

An understanding of left ventricle (LV) mechanics is fundamental for designing better preventive, diagnostic, and treatment strategies for improved heart function. Because of the costs of clinical and experimental studies to treat and understand heart function, respectively, in-silico models play an important role. Finite element (FE) models, which have been used to create in-silico LV models for different cardiac health and disease conditions, as well as cardiac device design, are time-consuming and require powerful computational resources, which limits their use when real-time results are needed. As an alternative, we sought to use deep learning (DL) for LV in-silico modeling. We used 80 four-chamber heart FE models for feed forward, as well as recurrent neural network (RNN) with long short-term memory (LSTM) models for LV pressure and volume. We used 120 LV-only FE models for training LV stress predictions. The active material properties of the myocardium and time were features for the LV pressure and volume training, and passive material properties and element centroid coordinates were features of the LV stress prediction models. For six test FE models, the DL error for LV volume was 1.599 ± 1.227 ml, and the error for pressure was 1.257 ± 0.488 mmHg; for 20 LV FE test examples, the mean absolute errors were, respectively, 0.179 ± 0.050 for myofiber, 0.049 ± 0.017 for cross-fiber, and 0.039 ± 0.011 kPa for shear stress. After training, the DL runtime was in the order of seconds whereas equivalent FE runtime was in the order of several hours (pressure and volume) or 20 min (stress). We conclude that using DL, LV in-silico simulations can be provided for applications requiring real-time results.

Kardiologiczne, niekardiologiczne powikłania i czynniki predykcyjne przedłużonej hospitalizacji u pacjentów bez cukrzycy z zawałem serca leczonych pierwotną przezskórną angioplastyką wieńcową

Introduction. Prolonged patient stay after acute myocardial infarction (MI) results in higher costs. This study evaluated factors prolonging hospitalization after admission due to MI. Complications which also influence on longer hospital stay: both cardiac (CC) and non-cardiac (NCC), were analysed. Material and methods. The authors included prospectively 131 patients with MI undergoing primary percutaneous intervention. Following factors were collected: demographic and anthropomorphic data, types of infarction, 12-lead electrocardiography (ECG), echocardiography, standard blood tests including admission blood glucose level, fasting glycaemia, oral glucose tolerance test (OGTT) at discharge as well as renal filtration and lipid parameters. Length of hospital stay of Results. The mean age of patients was 62 ± 10.9 years, 71.8% were male. Factors which correlated significantly with longer hospitalisation were: older age (R = 0.47, p = 0.001), higher fasting glycaemia (R = 0.25, p = 0.027), reduced left ventricular ejection fraction (LVEF) (R = –0.36, p = 0.04), occurrence of ST-elevation MI (p = 0.0166), presence of CC (p = 0.0007) and NCC (p = 0.0001). Age, high blood glucose in OGTT and LVEF remained significant in a multivariate model predicting the duration of stay (R2 = 0.32). Factors predicting hospital stay ≥ 6 days in the multivariate model were: older age (p = 0.000), hip circumference (p = 0.014), anterior wall MI (p = 0.026) and usage of glycoprotein IIb/IIIa inhibitors (p = 0.022) with and area under the receiver operating characteristic curve (ROC): 0.792 [95% confidence interval (CI) 0.71–0.87] with specificity 71% and sensitivity 79%. Factors influencing CC occurrence in the multivariate model were: estimated glomerular filtration rate (p = 0.009), LVEF (p = 0.003) with ROC 0.735 (95% CI 0.65–0.82) with specificity 76% and sensitivity 60%. Factors influencing the occurrence of NCC were hyperlipidaemia (p = 0.021), and LVEF (p = 0.004) with an ROC: 0.792 (95% CI 0.71–0.87) with specificity 55% and sensitivity 90%. Conclusions. LVEF, age and blood glucose levels significantly prolonged hospital stay. The major factor associated with an increased risk of both CCs and NCCs was LVEF.