Manifestations Of Cardiac Involvement Research Articles

Cardiac repolarization abnormalities in children with familial Mediterranean fever

BackgroundFamilial Mediterranean fever (FMF) is an autoinflammatory disease that can have conduction disturbances and cardiac rhythm disorders as manifestations of cardiac involvement. The aim of the study is to assess the susceptibility of children with FMF to cardiac repolarization abnormalities and therefore arrhythmia in children with FMF.MethodsA cross sectional study conducted on 60 children had FMF and 40 age and sex matched healthy controls. Cardiac repolarization markers, cardiac dimensions and functions were assessed by electrocardiogram (ECG) and conventional echocardiography in patients and controls.ResultsThe mean ± SD age of the patients was 10.43 ± 3.472 years, corrected QT (QTc) and the ratio of peak to end T wave (Tpe) over QTc interval (Tpe /QTc) increased significantly in FMF patients more than healthy control (p value 0.023 and 0.022 respectively). P wave dispersion (Pd) was significantly higher in FMF patients with amyloidosis (p value 0.030). No significant difference was found in cardiac dimensions and functions between the two groups. We found a statistically negative correlation between Pd and age of patients at time of study, age of disease onset and age at diagnosis. On the other hand, we found a statistically significant positive correlation between Pd with number of attacks per year and disease severity score. Furthermore, Tpe/QTc ratio correlated with FMF 50 score, QTc correlated with 24 hours proteinuria. QT, JT intervals correlated with fibrinogen.ConclusionsFMF Patients may have increased risk of arrhythmia and should be monitored on regular basis. Compliance to colchicine therapy and better disease control might play a role in decreasing this risk.

Clinically suspected myocarditis complicating dengue shock syndrome: a case report and literature review of cardiac complication in dengue-affected pediatric patient

We report a case of dengue shock syndrome complicated by clinically suspected acute myocarditis in pediatric patient at a limited-resources hospital in a rural area and review the literature. A 12-year-old boy who experienced dengue shock syndrome developed bradycardia on day 7th of illness. His electrocardiogram during the bradycardia showed sinus bradycardia with a rate of 50 beats per minute. Atropine sulfate and dobutamine, alongside supportive management, were administered. The patient recovered 4 days later. We found a total of seven articles involving pediatric patient with dengue illness and cardiac complications by PubMed search. Clinical manifestations of cardiac involvement in pediatric patient with dengue varied and were mostly transient from tachy-bradyarrhythmia, sinus node dysfunction, low blood pressure, decreased ejection fraction, lower cardiac output, and increased cardiac enzyme. Transient cardiac abnormality can be an important presentation, and physician should have high awareness of cardiac complication in dengue-affected pediatric patients to manage them accordingly.

Cardiac involvement in patients recovered from coronavirus disease-2019 (COVID-19): a systematic review

BackgroundAbout 47.3 million people have recovered from coronavirus disease 2019 (COVID-19). Manifestations of cardiac involvement have been noted in a significant number of patients in the acute phase. There are increasing concerns that some of these cardiac sequels may persist beyond the acute phase. If untreated, the sustained cardiac injury, especially myocarditis and fibrosis, could have severe consequences. Recent studies have assessed the presence of cardiac involvement using cardiac magnetic resonance (CMR) imaging during the post-acute phase.PurposeWe present a systematic review of studies assessing evidence of cardiac involvement in patients recovered from COVID-19 during the post-acute phase using Cardiac Magnetic Resonance (CMR) Imaging.MethodsWe reported this study in accordance with PRISMA. A systematic search was performed on PubMed, Embase (Elsevier), and Google scholar databases using Boolean operators and the relevant key terms covering COVID-19, Cardiac injury, CMR, and follow-up. Retrieved articles were included based on predefined eligibility criteria.ResultsOf 1406 articles retrieved from the initial search, 11 items, 9 cohort, and 2 case series studies met our eligibility criteria. The rate of raised T1 (reported in 6 articles) in patients recovered from COVID-19 varied across studies from 5% to73%. In 4 out of 9 studies, raised T2 was detected in any patients, and in remained studies, its rate ranged from 2% to 60%. In most of the included studies, LGE (myocardial or pericardial) was observed in COVID-19 survivors, ranged from 7.0% to 100%. Myocardial LGE mainly had nonischemic patterns. None of the cohort studies observed myocardial LGE in “healthy” controls. Most studies found that patients who recovered from COVID-19 had significantly a greater mean (SD) T1 and T2 compared to participants in the control group.ConclusionOur systematic review study found evidence of subclinical and clinical myocardial and pericardial involvement in patients recovered from COVID-19.FUNDunding AcknowledgementType of funding sources: None.

Left Atrial Strain in Patients With Systemic Lupus Erythematosus.

In patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. To evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. LAGLS in SLE patients was less than in the controls (41.6% vs. 50.5%; p=.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5s-1 vs. controls 2.75s-1; p=.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. SLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Left atrial strain in patients with systemic lupus erythematosus

BackgroundIn patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. ObjectiveTo evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. MethodsFifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. ResultsLAGLS in SLE patients was less than in the controls (41.6% vs 50.5%; p?=?.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5 s-1 vs controls 2.75 s-1; p?=?.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. ConclusionsSLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Cardiac involvement in patients of dengue fever in reference to ECG and Echocardiography – A tertiary care center study

Introduction: Dengue rarely affects the heart but clinical symptoms of cardiac involvement mayrange greatly from silent illness to severe myocarditis resulting in death. Clinical features areasymptomatic and most are transient among patients with DF/DHF. Material and methods: It wasan observational study conducted at the Department of General Medicine, Peoples College of MedicalSciences and Research Centre, Bhopal. The total duration of the study was One and a half yearsfrom Dec 2018 to May 2020. All dengue patients presenting to People’s Hospital during one and halfyears from which data was collected using as per given proforma. Results: In the present studygroup of 58 patients, it was found that 49 patients (84.5%) have not shown any cardiacabnormalities and 9 patients have abnormal values (15.5%) but are not significant. It is also foundthat the incidence of cardiac manifestations was more common in DHF and dengue shock syndromewhich was 15.5% and 3.4%, respectively. Conclusion: Clinical manifestations of cardiacinvolvement can vary widely from silent disease to severe myocarditis resulting in death. Rhythmabnormalities, hypotension, arrhythmias, myocarditis, myocardial depression with symptoms ofheart failure and shock, and pericarditis have been reported. Involvement of multiple organs, as wellas the presence of metabolic derangement, can further confuse the picture.

PREDICTORS OF SUDDEN CARDIAC DEATH IN CARDIAC SARCOIDOSIS: A NATIONWIDE ANALYSIS

Cardiac sarcoidosis (CS) is highly underdiagnosed due to its often silent course. Sudden cardiac death (SCD) is a devastating and often index manifestation of cardiac involvement. In this study, we analyze the possible predictors of SCD in CS. We queried the National Inpatient Sample between 1999-

Evaluation of P wave dispersion as a predictor of atrial arrhythmias in dystrophinopathies

PURPOSE: Arrhythmias are one of the manifestations of cardiac involvement in dystrophinopathies. P-wave dispersion (PWD) has been known to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we aimed to investigate the role of PWD in patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies. METHODS: It is a retrospective cohort study. The study population consisted of 68 patients with dystrophinopathy and age and sex matched 68 healthy control subjects. Patients with diabetes …

Is there a place for cardiovascular magnetic resonance conditional devices in systemic inflammatory diseases?

ABSTRACTRhythm disturbances and sudden cardiac death (SCD) are important manifestations of cardiac involvement in systemic inflammatory diseases (SID). The commonest events demanding the implantation of a device include ventricular tachycardia and atrioventricular block, mainly diagnosed in sarcoidosis, systemic lupus erythematosus and scleroderma. In SCD, cardiac magnetic resonance (CMR) identified areas of late gadolinium enhancement (LGE) in 71% and provided an arrhythmic substrate in 76%, while during the follow-up, the extent of LGE identified a subgroup at increased risk for future adverse events. CMR has been successfully used for detection of cardiac disease in SID, including myocarditis, coronary, microvascular and valvular disease. Additionally, SIDs have a higher probability to need MRI scanning of other organs, due to their systemic disease. These reasons support the necessity of an MRI conditional device in SIDs. A broad selection of devices, approved for the MRI environment under defined conditions allows the safe and accurate scanning of SID patients.

Fatal Dengue Myocarditis despite the Use of Extracorporeal Membrane Oxygenation.

Dengue is an important mosquitoes-borne viral disease which is endemic in tropics and subtropics region. Rapid spreading of disease to previously unaffected region was found in recent years. Atypical manifestations, such as myocarditis, were reported during large outbreak. There is a wide range of clinical manifestations of cardiac involvement in dengue, but rarely fatal. Here we reported a case of fulminant dengue myocarditis in fatal outcome despite cardiac mechanical support.

Ventricular Tachycardia and Sudden Cardiac Death in Connective Tissue Diseases: Can Cardiovascular Magnetic Resonance Play a Role?

Ventricular tachycardia (VT) and sudden cardiac death (SCD) are deleterious manifestations of cardiac involvement in connective tissue diseases (CTD). In rheumatoid arthritis (RA), the commonest cause of SCD is coronary artery disease that may lead to acute coronary syndrome and VT. In systemic lupus erythematosus (SLE), VT is due either to coronary artery disease or to acute myocarditis. VT/SCD can be also assessed in polymyostis (PM) and dermatomyositis (DM). Finally, VT was described in 7-13%, while SCD in 5-21% of unselected SSc patients. Cardiovascular magnetic resonance (CMR) has been already used as screening tool in CTDs, because of its capability to evaluate noninvasively and without radiation, function, inflammation, perfusion defects and fibrosis. Apart of the impaired ventricular function, which can be by itself a predisposing factor for VT/SCD, the commonest causes that can potentially lead to VT/SCD in CTDs are myocarditis, coronary artery disease with ischemic type fibrosis, microvascular disease, nonischemic type fibrosis and heart failure. The detection of perfusion defects by CMR can be served as a tool to select those patients, who should undergo x ray coronary angiography and/or angioplasty. The location and extent of myocardial scar can guide further electrophysiologic study and/or intervention. On the other hand, in those with myocarditis, microvascular disease and/or heart failure, a modification in both cardiac and rheumatic medication may be recommended after evaluation of CMR findings. CMR in CTDs with VT/SCD may guide risk stratification, rheumatic and cardiac therapeutic decision making and therefore it should be included as a reliable adjunct in the evaluation of these patients.

0274: Cardiac involvement in Behcet’s disease

Behcet’s disease is a multisystem disorder and classified as « vasculitic syndrome with a wide variety of clinical manifestations. » Cardiac involvement is very rare but can occur with different presentations. To analyze the clinical characteristics of Behcet’s disease with cardiac involvement. Patients diagnosed as Behcet’s disease with cardiac involvement in our Hospital from 1998 to 2013 were included in this analysis. The clinical characteristics of these patients were studied retrospectively. Eighteen cardiac manifestations observed in 13 patients with Behçet’s disease are reported. 11 (84.6%) patients were male, with a mean (±SD) age at BD diagnosis of 34.2±9.9 years. Cardiac involvement was the first feature of BD in 9 (69.23%) patients. Cardiac involvement included ST-elevation myocardial infarction (4 cases, 22.22%), stable angina (1case, 5.5%), right heart failure (2 cases 11.1%), pericardial effusion (4 cases, 22.22%), intracardiac thrombus (2 cases, 11.1%), pulmonary artery hypertension (4 cases, 22.22%) (Consecutive to pulmonary embolism in three cases) and valvular disease (mitral insufficiency) (1 case, 5.5%). After a median follow-up of 59.73 (0-180) months, 2 patients had died (directly related to cardiac involvement). The manifestation of cardiac involvement in Behcet’s disease is various. The involvement of pulmonary artery is an independent correlative factor of mortality. Cardiologists should always bear in mind potential threats of (a) symptomatic cardiovascular involvement in BD.

Prevalencia de hipertrofia ventricular izquierda en pacientes hipertensos

Antecedentes: se ha documentado a la hipertrofia ventricular izquierda como una de las manifestaciones tempranas de afectación cardiaca en la enfermedad hipertensiva. Objetivo: evaluar la prevalencia de hipertrofia ventricular izquierda en los pacientes hipertensos que asisten a los programas de control en instituciones de salud de Boyacá. Material y métodos: mediante muestreo secuencial aleatorio se ensambló una muestra de 1275 pacientes a quienes se realizó valoración de la presión arterial y electrocardiograma. Se evaluaron criterios de Cornell, Romhilt-Estest y Rodríguez-Padial para determinar la presencia de hipertrofia ventricular izquierda. Resultados: se encontró prevalencia global de 17.9% de HVI en los pacientes analizados, con marcadas diferencias por municipio. La HVI se encontró asociada con edad mayor de 65 años, sexo femenino, índice de masa corporal aumentado y cifras elevadas de presión sistólica y diastólica. Conclusión: estos resultados sugieren la necesidad de incrementar los programas de tamizaje y control de la presión arterial, así como de incluir capacitación a los agentes de salud en la valoración de evidencia sugestiva de HVI como alteraciones electrocardiográficas y diferencias en las presionesentre las dos extremidades superiores

Prevalence of interatrial block in patients with Friedreich's Ataxia

Interatrial block is a predictor of atrial arrhythmias. Aim of the present study was to estimate the prevalence of interatrial block (IAB) in Friedreich's Ataxia (FA) compared to controls and correlate it with echocardiographic and genetic features. IAB, defined as an electrocardiographic (ECG) derived P-wave duration >120 ms, echocardiographic variables and genetic markers were evaluated in 23 FA patients with no manifestation of cardiac involvement and were compared to 23 sex- and age-matched controls. IAB was significantly more frequent among FA patients compared to controls (11/23 vs 1/23, p<0.005 respectively). However, no correlations with echocardiographic parameters or Guanine-Adenine-Adenine (GAA) trinucleotide repeat lengths could be established. Early recognition of IAB could allow the identification of asymptomatic FA patients who are prone to develop potentially life-threatening arrhythmias.

Atteinte cardiaque de l'hémochromatose

Cardiac involvement in hemochromatosis affects mainly the myocardium: iron overload of the myocytes reduces left ventricular distensibility. Heart failure is the most frequent manifestation of cardiac involvement. Diagnosis of cardiac involvement depends essentially on Doppler echocardiography showing abnormal left ventricular filling and, later, ventricular dilatation with left ventricular systolic dysfunction. Magnetic resonance imaging can quantify intrahepatic and intramyocardial iron levels. Age at onset of symptoms and specific organ involvement in hemochromatosis depend on the type of mutation. The two principal means of treatment by iron depletion are phlebotomy in primary hemochromatosis and excretion of iron by chemical chelation in secondary hemochromatosis. Early diagnosis and iron depletion improve survival by reducing organ iron overload, especially in the liver and the myocardium. Recent guidelines issued by Anaes (national agency for health evaluation) make it possible to identify risk factors for complications early, to determine disease stage, and to provide appropriate management as a function of disease severity.

Churg–Strauss syndrome presenting with massive pericardial effusion

We describe a case of Churg-Strauss syndrome (CSS) presenting with a massive pericardial effusion without overt myocardial dysfunction. A 60-year-old man was referred to our hospital because of exertional dyspnea and fever. Initial chest multidetector-row computed tomography showed a massive pericardial effusion. The presence of eosinophilia, infiltrates of both lungs, pathological evidence of necrotizing vasculitis associated with eosinophilic infiltration, and history of asthma fulfilled the criteria of CSS. Massive pericardial effusion can be the first manifestation of cardiac involvement in CSS.

Early myocardial dysfunction in the diabetic heart: current research and clinical applications

Patients with diabetes mellitus have a high incidence of heart failure, which contributes significantly to their increased cardiovascular morbidity and mortality. One of the major complications of diabetes is the development of cardiomyopathy, a condition characterized by defects of contractile function in the absence of significant coronary artery disease or systemic hypertension. Experimental data in animal models show that contractile depression begins as early as 1 week after induction of diabetes, and the dysfunction is related to an isomyosin distribution shift from V 1 with high adenosine triphosphatase (ATPase) to V 3 with low ATPase activity. Moreover, diabetes is associated with an increased or poorly regulated rate of amino acid catabolism at the cardiac level. Abnormal responses to acute left ventricular (LV) overload induced by exercise (isometric or isotonic) have been demonstrated in patients with diabetes. Impaired augmentation of LV ejection fraction occurs in up to 40% of patients with diabetes. Analysis of the LV afterload-pump function (LV circumferential wall stress-ejection fraction) relationship shows that defective contractile recruitment is the main cause of this anomaly. Exercise-induced LV dysfunction may be the first manifestation of cardiac involvement in patients with diabetes. Increasing the supply of amino acids in addition to conventional therapy significantly attenuates this phenomenon. Although the precise underlying pathophysiologic mechanism is not completely known, these observations may eventually be important in designing an optimal dietary or supplemental approach for patients with diabetes in order to prevent progressive myocardial dysfunction.

Early myocardial dysfunction in the diabetic heart: current research and clinical applications

Patients with diabetes mellitus have a high incidence of heart failure, which contributes significantly to their increased cardiovascular morbidity and mortality. One of the major complications of diabetes is the development of cardiomyopathy, a condition characterized by defects of contractile function in the absence of significant coronary artery disease or systemic hypertension. Experimental data in animal models show that contractile depression begins as early as 1 week after induction of diabetes, and the dysfunction is related to an isomyosin distribution shift from V1 with high adenosine triphosphatase (ATPase) to V3 with low ATPase activity. Moreover, diabetes is associated with an increased or poorly regulated rate of amino acid catabolism at the cardiac level. Abnormal responses to acute left ventricular (LV) overload induced by exercise (isometric or isotonic) have been demonstrated in patients with diabetes. Impaired augmentation of LV ejection fraction occurs in up to 40% of patients with diabetes. Analysis of the LV afterload-pump function (LV circumferential wall stress-ejection fraction) relationship shows that defective contractile recruitment is the main cause of this anomaly. Exercise-induced LV dysfunction may be the first manifestation of cardiac involvement in patients with diabetes. Increasing the supply of amino acids in addition to conventional therapy significantly attenuates this phenomenon. Although the precise underlying pathophysiologic mechanism is not completely known, these observations may eventually be important in designing an optimal dietary or supplemental approach for patients with diabetes in order to prevent progressive myocardial dysfunction.

Early detection of myocardial dysfunction in Chagas disease using novelechocardiographic indices

The first manifestation of cardiac involvement in Chagas disease could be sudden death or rapid deterioration in cardiac function. The aim of this study was to identify a non-invasive method for early detection of cardiac involvement in patients with Chagas disease. During a 6-month period in 2001, 133 people were studied using echocardiography and electrocardiography in Honduras; 88 were seropositive for Trypanosoma cruzi, of which 31 were asymptomatic, and 45 were seronegative controls. The echocardiographic assessment included geometrical and time interval derived indices. Patients with asymptomatic Chagas disease had increased left and right myocardial performance index (MPI) when compared with seronegative controls (P= 0.003 and P= 0.023, respectively) with 36% having a left above the upper limit of the normal range. They also had a reduced diastolic posterior wall thickness (P= 0.005) and lower posterior wall thickness to left ventricular cavity (PWT:LVC) ratio (P= 0.002). Our results show that the MPI, a simple Doppler parameter, and the PWT:LVC ratio are useful in the early detection of myocardial involvement in asymptomatic patients with Chagas disease. These parameters could serve as useful screening tools and monitor the disease progression in these patients.

Overview on the incidence and the characteristics of HIV-related opportunistic infections and neoplasms of the heart: impact of highly active antiretroviral therapy.

The manifestation of cardiac involvement in the course of HIV infection has been significantly changed since the introduction of highly active antiretroviral therapy. While in the pre-highly active antiretroviral therapy era the predominant cardiac pathology was represented by localization of opportunistic infection, now new forms of heart involvement are described. Among infectious agents, viruses and bacteria caused the majority of infections. The 'classic' opportunistic agents, such as Toxoplasma, non-tuberculous mycobacteria, cytomegalovirus and Cryptococcus, have virtually disappeared. Endocarditis is still the most frequent infectious disease of the heart in HIV-infected patients, occurring mainly in drug users, and with the improvement in prognosis, the need for cardiac surgery is increasing. Tuberculosis, the incidence of which is still high in poor resources settings where antiretroviral drugs are not available, is a frequent cause of pericarditis, frequently evolving into cardiac tamponade. Recent studies suggest the direct role of HIV as the cause of myocarditis and heart vessel pathology. This finding points out the need of improving our knowledge about the pathogenesis, diagnosis and treatment of this kind of complication.