Underlying Heart Disease Research Articles

ECG-iCOVIDNet: Interpretable AI model to identify changes in the ECG signals of post-COVID subjects

ObjectiveStudies showed that many COVID-19 survivors develop sub-clinical to clinical heart damage, even if subjects did not have underlying heart disease before COVID. Since Electrocardiogram (ECG) is a reliable technique for cardiovascular disease diagnosis, this study analyzes the 12-lead ECG recordings of healthy and post-COVID (COVID-recovered) subjects to ascertain ECG changes after suffering from COVID-19. MethodWe propose a shallow 1-D convolutional neural network (CNN) deep learning architecture, namely ECG-iCOVIDNet, to distinguish ECG data of post-COVID subjects and healthy subjects. Further, we employed ShAP technique to interpret ECG segments that are highlighted by the CNN model for the classification of ECG recordings into healthy and post-COVID subjects. ResultsECG data of 427 healthy and 105 post-COVID subjects were analyzed. Results show that the proposed ECG-iCOVIDNet model could classify the ECG recordings of healthy and post-COVID subjects better than the state-of-the-art deep learning models. The proposed model yields an F1-score of 100%. ConclusionSo far, we have not come across any other study with an in-depth ECG signal analysis of the COVID-recovered subjects. In this study, it is shown that the shallow ECG-iCOVIDNet CNN model performed good for distinguishing ECG signals of COVID-recovered subjects from those of healthy subjects. In line with the literature, this study confirms changes in the ECG signals of COVID-recovered patients that could be captured by the proposed CNN model. Successful deployment of such systems can help the doctors identify the changes in the ECG of the post-COVID subjects on time that can save many lives.

Reduction of iron toxicity in the heart of iron-overloaded mice with natural compounds

BackgroundIron-overload is one of the risk factors in susceptible individuals. Iron-overload causes complications such as diastolic dysfunction, arrhythmias, ventricular dilation, and systolic dysfunction in the heart. Therefore, particular care is needed for those who need blood transfusions or patients with underlying heart diseases. Purpose: In this study, we examined the ability of five compounds, hesperidin, coumarin, caffeic acid, ferulic acid, and vanillin, to reduce the effects of iron-overdose in the heart of iron-overloaded mice. Methods: For this purpose, 84 mice were prepared and except for the control group, iron-overload conditions were created in them by injecting iron. The hearts of mice were then harvested and the activities of the antioxidant enzymes catalase and superoxide dismutase were evaluated. Additionally, the amount of lipid peroxidation was measured by assessing the quantity of malondialdehyde. The physiopathology of cardiac tissue was considered by Perl's and H&E staining. Results: According to the results, almost all natural compounds showed better performance than desferal, as an iron chelator chemical. Meanwhile, hesperidin, vanillin, and ferulic acid were the best antioxidant compounds and were able to improve the activity of antioxidant enzymes by reducing the amount of deposited iron. Conclusion: We recommend the use of the above compounds as natural iron chelators after completing additional studies.

Case report of unusual presentation of COVID-19 in a patient with pulmonary hypertension

Objective: COVID-19 has now become a worldwide health problem with many new cases diagnosed every day. people with underlying heart diseases are more likely to get infected and have poor prognosis. Of them, adult patients with congenital heart disease need special attention due to their different symptoms and course of the disease. Case Presentation: Here, we report the unusual presentation and course of COVID-19 disease with rapid progression of right ventricle failure and pulmonary hypertension in patient who was infected with new SARS-CoV-2 virus. She is a 39-year-old woman, known case of ventricular septal defect and pulmonary hypertension with a history of open-heart surgery at the age of seven that arrived to our clinic due to exacerbation of dyspnea; progressive lower extremity edema and mild ascites from 10-days ago. Conclusion: Any changes in the condition of adult patients with congenital heart disease in this epidemic should be considered as a potential infection by this virus and the necessary and accurate evaluation should be done.

Newer Methods for Ventricular Tachycardia Ablation and When to Use Them.

Radiofrequency (RF) catheter ablation has long been an important therapy for ventricular tachycardia and frequent symptomatic premature ventricular beats and nonsustained arrhythmias when antiarrhythmic drugs fail to suppress the arrhythmias. It is increasingly used in preference to antiarrhythmic drugs, sparing the patient adverse effects of drugs. Success of ablation varies with the underlying heart disease and type of arrhythmia: very effective for patients without structural heart disease, less effective in structural heart disease. Failure occurs when a target for ablation cannot be identified or ablation lesions fail to reach and abolish the arrhythmia substrate that may be extensive, intramural, or subepicardial in location. Approaches to improving ablation lesion creation are modifications to RF ablation and emerging investigational techniques. Easily- implemented modifications to RF methods include manipulating the size and location of the cutaneous dispersive electrode, increasing duration of RF delivery, and use of lower-tonicity catheter irrigation (usually 0.45% saline). When catheters can be placed on either side of culprit substrate, RF can be delivered in a bipolar or simultaneous unipolar configuration that can be successful. Catheters with extendable and retractable irrigated needles for delivery of RF are under investigation in clinical trials. Cryoablation is potentially useful with specific situations in which maintaining contact is difficult. Transvascular ethanol ablation and stereotactic radioablation have both shown promise for arrhythmias that fail other ablation strategies. Although substantial clinical progress has been achieved, further improvement is clearly needed. With ability to increase ablation lesion size, continued careful evaluation of safety, which has been excellent for standard RF ablation, remains important.

Impact of sex on clinical, procedural characteristics and outcomes of catheter ablation for ventricular arrhythmias according to underlying heart disease.

Women are under-represented in many key studies and trials examining outcomes of catheter ablation (CA) for ventricular arrhythmias (VA). We compared characteristics between men and women undergoing their first catheter ablation for VA at a single centre over 10years. The clinical, procedural characteristics and outcomes of 287 consecutive patients (male = 182, female = 105), undergoing their first CA at our centre over 10years were compared according to sex and underlying heart disease. In the ablation population, women were younger, had fewer co-morbidities, were less likely to have ischemic cardiomyopathy (ICM) and VA storm and were more likely to have idiopathic VA and premature ventricular complexes as the indication for ablation (P < 0.05 for all). Amongst idiopathic and non-ischemic cardiomyopathy (NICM) subgroups, baseline characteristics were similar; amongst ICM, women were younger and had higher numbers of drug failure pre-ablation (P = 0.05). Women were similar to men in all procedural characteristics, acute procedural success and complications, regardless of underlying heart disease. At median follow-up of 666days, VA-free survival, overall mortality and survival free of death or transplant were comparable in both groups. Sex was not a predictor of these outcomes, after accounting for clinical and procedural characteristics. Women represented 36% of the real-world population at our centre referred for CA of VA. There are key differences in clinical features of women versus men referred for VA ablation. Despite these differences, VA ablation in women can be accomplished with similar success and complication rates to men, regardless of underlying heart disease.

Changing profile of infective endocarditis during 31-year time course in a tertiary care hospital

Aim: Infective endocarditis (IE), infection of the endocardial surface of heart, may cause mortality up to 30% despite advancements in medical care. Epidemiology of IE and profile of causative organism has changed in the last years. We aimed to investigate the changing profile of IE over a 31-year period in a tertiary care hospital &#x0D; Material and Method: Medical records of 290 patients treated with the diagnosis of IE between 1974 and 2005 were re-evaluated according to Modified Duke criteria. Forty seven cases were classified as rejected cases. &#x0D; Results: Of the 243 patients 109 was female (44.8%) and 134 male (55.2%). The mean age of the patients was 38±16.4 years (Table). The mean age of the patients showed an increasing trend throughout the time (p&lt; 0.001) ; it was 29 years between 1974- 1980 but increased to 54 years in 2001-2005 period. Rheumatic valvular disease (RVD) was the most frequent underlying heart disease (60%) but showed a declining trend especially in the last years. S. aureus was the most common pathogen in all the time periods (15.2%). Blood cultures were negative in 90 (43%) patients. But the percentage of blood culture negativitiy decreased significantly from 63% in 1981-1985 periods to 28% in 2001-2005 period. (p: 002). Mitral valve was the most common affected valve (52, 44%). Surgery was performed in 74 of the 243 cases (30.5%). In-hospital mortality rate was 30.6. Mortality rate was significantly lower in patients who underwent surgery compared to ones who did not (19.2% vs. 35.8%, p&lt; 0.005). Mortality rate was also lower in patients with community acquired infection compared to ones with nosocomial infection (27% vs 45%). Embolic events, nosocomial infections and surgery were independent risk factors for mortality. &#x0D; Conclusion: The mean age of IE population is increasing, RVD disesase is less commonly seen as an underlying heart and S. aureus is the most common pathogen. These findings are compatible with the reports from developed countries. Surgery displays a protective effect on the prognosis of IE

Pulmonary Arterial Hypertension and Consecutive Right Heart Failure Lead to Liver Fibrosis.

Hepatic congestion occurs in patients with right heart failure and can ultimately lead to liver fibrosis or cardiac cirrhosis. Elevated pulmonary arterial pressure is found in patients with hepatic congestion. However, whether pulmonary arterial hypertension (PAH) can be a cause of liver fibrosis is unknown. The aim of this study was to investigate whether rats in the SuHx model with severe PAH develop liver fibrosis and to explore the mechanisms of congestive hepatic fibrosis both in rats and humans. To achieve this, PAH was induced in six to eight-week old male Sprague Dawley rats by a single subcutaneous injection of the VEGFR 2 inhibitor SU5416 and subsequent hypoxia for 3 weeks, followed by a 6-week period in room air. SuHx-exposed rats developed severe PAH, right ventricular hypertrophy (RVH), and consecutive right ventricular failure. Cardiac magnetic resonance imaging (MRI) and histological analysis revealed that PAH rats developed both hepatic congestion and liver fibrosis. Gene set enrichment analysis (GSEA) of whole liver RNA sequencing data identified a hepatic stellate cell specific gene signature in PAH rats. Consistently, tissue microarray from liver of patients with histological evidence of hepatic congestion and underlying heart disease revealed similar fibrogenic gene expression patterns and signaling pathways. In conclusion, severe PAH with concomitant right heart failure leads to hepatic congestion and liver fibrosis in the SU5416/hypoxia rat PAH model. Patients with PAH should therefore be screened for unrecognized liver fibrosis.

Common indications and impact on clinical management of overnight, inpatient transthoracic echocardiograms performed by pediatric cardiology fellows

BackgroundOne of the core competencies of pediatric cardiology fellowship training is to perform and interpret transthoracic echocardiograms. Each institution is responsible for developing a curriculum surrounding this skill, yet there is little literature about the most common indications and the utility of these studies. ObjectivesThe aims of this study are to determine the most common indications for overnight, inpatient transthoracic echocardiograms in pediatric patients performed by fellows and to evaluate their impact on clinical management. MethodsRetrospective chart review was completed for all transthoracic echocardiograms performed overnight by pediatric cardiology fellows during a one-year period. Study indication, result, and ordering hospital unit were obtained. Transthoracic echocardiograms impact was classified based on documentation in the medical record. ResultsTwo hundred and twenty-five overnight transthoracic echocardiograms were performed on 186 patients; 46% had underlying structural heart disease. The most common indication was for assessment of left ventricular function (40.9%). The Heart Center (combined cardiac intensive care unit and step-down unit) was the most common ordering unit (40%). Fifty-four percent of studies were documented in the medical record as having impacted clinical decision-making. The indications resulting in the highest clinical impact were evaluation of shunt patency (100%) and confirmation of prenatally diagnosed congenital heart disease (86%). Clinical impact of overnight, inpatient transthoracic echocardiograms was higher in patients with known heart disease compared to those without (67% vs 43%). ConclusionPediatric cardiology fellow education should emphasize early training for assessment of left ventricular function and high impact indications in patients with congenital heart disease. Impact of overnight transthoracic echocardiograms is highest when used in children with underlying heart disease.

Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review.

In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel's triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann's bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard “ready-made” procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.

Lipoprotein profile of pleural and peritoneal transudates in dogs and cats.

BackgroundCurrent diagnostic evaluation of transudative effusions rarely aids in identifying an underlying etiology. Lipoproteins in the fluid might reflect the site or nature of vessel involvement.ObjectivesImprove the classification and diagnostic utility of pleural and peritoneal transudates in dogs and cats by investigating lipoprotein patterns in effusions. Compare these patterns with other peritonaeal and pleural fluid variables and underlying diseases.AnimalsSamples of transudates and serum from 18 cats and 37 dogs with transudative effusion (total nucleated cell count [TNCC] <5000 cells/μL) were analyzed.MethodsLipoprotein fractions, triglyceride, and cholesterol (CHO) concentrations were prospectively determined in paired fluid and serum samples. Standard fluid measurements were retrospectively collected.ResultsTwo distinct fluid lipoprotein patterns were noted. Fluids rich in VLDL+IDL were associated with chronic kidney disease, acquired portosystemic shunts or protein‐losing enteropathy (group I). Fluids rich in denser lipoproteins were associated with underlying heart disease, caudal vena cava syndrome or intracavitary neoplasia (group II). Group I and group II also had significant differences between fluid concentrations of CHO (x̄ = 8 vs 110 mg/dL) and TP (x̄ = 0.6 vs 3.8 g/dL), respectively. Five peritoneal transudates were triglyceride‐rich (>100 mg/dL) and associated with pancreatitis.Conclusions and Clinical ImportanceProtein‐poor (TP <1.5 g/dL) and protein‐rich (TP >2.5 g/dL) transudates were associated with distinct lipoprotein patterns and specific groups of disease. Effusions secondary to pancreatitis might be transudative and rich in triglycerides.

Selection and outcome of implantable cardioverter-defibrillator patients with and without cardiac resynchronization therapy: Comparison of 4384 patients from the German Device Registry to randomized controlled trials.

Registry data add important information to randomized controlled trials (RCT) on real-life aspects of implantable cardioverter-defibrillator (ICD) patients with and without cardiac resynchronization therapy (CRT-D). This analysis of the prospectively conducted German Device Registry aims at comparing mortality rates, comorbidities, complication rates to results from RCT. The German Device registry (DEVICE) prospectively collected data on ICD and CRT-D first implantations from 50 German centres. Demographic data, details on cardiac disease, electrocardiogram (ECG), medication, and data about procedure, complications, and hospital stay were stored in electronic case report forms. One year after device implantation patients were contacted for follow-up. DEVICE included n = 4384 first ICD/CRT-D implantations (29.3% CRT-D devices). We found a strong adherence to guidelines with over 90% of patients being on ß-blocker and ACE-inhibitor medication and adequate QRS width in the majority of CRT-D patients. Patients receiving a CRT-D were older (67.6 ± 11.0 years vs. 63.9 ± 13.4 years, p < .001) and had lower ejection fractions (mean 25% vs. 30%, p < .001) compared to ICD patients. Dilated cardiomyopathy was the predominant underlying heart disease in CRT-D (53.3%), coronary artery disease in ICD patients (64.7%). Compared to RCT our DEVICE patients had more comorbidities (17.9% chronic kidney disease [CKD]) and higher 1-year mortality rates (10.7% ICD group, 12.3% CRT group). In multivariate analysis, CKD patients had an almost 2-fold higher risk of 1-year mortality. Despite relevant limitations of registry data, DEVICE highlights important differences between RCT and real-world registry data and the impact of comorbidities on mortality of ICD and CRT-D recipients.

Penicillin Reactions in Patients With Severe Rheumatic Heart Disease: A Presidential Advisory From the American Heart Association.

Secondary antibiotic prophylaxis with regular intramuscular benzathine penicillin G (BPG) is the cornerstone of rheumatic heart disease management. However, there is a growing body of evidence that patients with rheumatic heart disease who have severe valvular heart disease with or without reduced ventricular function may be dying from cardiovascular compromise following BPG injections. This advisory responds to these concerns and is intended to: (1) raise awareness, (2) provide risk stratification, and (3) provide strategies for risk reduction. Based on available evidence and expert opinion, we have divided patients into low‐ and elevated‐risk groups, based on symptoms and the severity of underlying heart disease. Patients with elevated risk include those with severe mitral stenosis, aortic stenosis, and aortic insuffiency; those with decreased left ventricular systolic dysfunction; and those with no symptoms. For these patients, we believe the risk of adverse reaction to BPG, specifically cardiovascular compromise, may outweigh its theoretical benefit. For patients with elevated risk, we newly advise that oral prophylaxis should be strongly considered. In addition, we advocate for a multifaceted strategy for vasovagal risk reduction in all patients with rheumatic heart disease receiving BPG. As current guidelines recommend, all low‐risk patients without a history of penicillin allergy or anaphylaxis should continue to be prescribed BPG for secondary antibiotic prophylaxis. We publish this advisory in the hopes of saving lives and avoiding events that can have devastating effects on patient and clinician confidence in BPG.

A decade of insertable cardiac monitors with remote monitoring in pediatric patients.

Remote monitoring-enabled insertable cardiac monitors (ICMs) are useful tools for arrhythmias and symptom management. This study sought to evaluate the outcome of ICM implantation in a large, heterogeneous cohort of pediatric and young adult patients. Single centre, retrospective analysis of patients who underwent ICM implantation in 2010-2019. Patients were analysed according to age, symptoms, arrhythmias and underlying heart disease. A total of 200 consecutive patients (58% male), aged 11.5 ± 5.8 years at ICM implantation, were included. Follow-up was 31 ± 18 months. Electrophysiologic study (EPS) was initially performed in 123 patients and was negative in 85%. Patients had no heart disease (57.5%), congenital heart defects (21%), channelopathies (14.5%), cardiomyopathies/heart tumors (8%). The commonest symptoms were syncope/presyncope (45.5%) and palpitations (12.5%). A definite diagnosis was made in 63% of patients (positive diagnosis in 25%, negative in 38%) after 8 (2-19) months of monitoring. EPS results and the presence/absence of an arrhythmia before ICM implantation had no impact on the diagnostic yield. Symptomatic patients as well as patients without structural heart disease showed higher diagnostic yield. Patients with a positive diagnosis underwent pacemaker/implantable cardioverter-defibrillator implantation (13%), pharmacological treatment (10.5%), or catheter ablation (1.5%). In a large cohort of 200 children and young adults, ICMs with remote monitoring showed a high diagnostic yield (63%), especially in symptomatic patients and in patients without structural heart disease.

Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats.

Premature ventricular beats (PVBs) in athletes are not rare. The risk of PVBs depends on the presence of an underlying pathological myocardial substrate predisposing the subject to sudden cardiac death. The standard diagnostic work-up of athletes with PVBs includes an examination of family and personal history, resting electrocardiogram (ECG), 24 h ambulatory ECG (possibly with a 12-lead configuration and including a training session), maximal exercise testing and echocardiography. Despite its fundamental role in the diagnostic assessment of athletes with PVBs, echocardiography has very limited sensitivity in detecting the presence of non-ischemic left ventricular scars, which can be revealed only through more in-depth studies, particularly with the use of contrast-enhanced cardiac magnetic resonance (CMR) imaging. The morphology, complexity and exercise inducibility of PVBs can help estimate the probability of an underlying heart disease. Based on these features, CMR imaging may be indicated even when echocardiography is normal. This review focuses on interpreting PVBs, and on the indication and role of CMR imaging in the diagnostic evaluation of athletes, with a special focus on non-ischemic left ventricular scars that are an emerging substrate of cardiac arrest during sport.

Clinical Characteristics of Cryoglobulinemia With Cardiac Involvement in a Single Center.

Background: Cryoglobulinemia is a syndrome characterized by the presence of cryoglobulins (CGs) in serum, and cardiac involvement is a rare occurrence that can affect treatment and prognosis. This study aimed to explore the clinical characteristics of cryoglobulinemia with cardiac involvement.Methods: 108 patients diagnosed with cryoglobulinemia who were admitted and treated in Peking Union Medical College Hospital (PUMCH) between June 1985 and June 2019 were enrolled in the present study. Clinical characteristics, therapy, and prognosis of patients with cardiac involvement were retrospectively analyzed.Results: The cryoglobulinemia with cardiac involvement was found in 7 patients, thus reaching the incidence of 6.5%. Heart failure was the main cardiac manifestation found in these patients, all with the involvement of external cardiac organs. Laboratory examinations showed significant elevation of N-terminal brain natriuretic peptide precursor (NT-proBNP) and brain natriuretic peptide (BNP) with negative troponin (cTnI). Electrocardiogram (ECG) was generally normal or only showed low-flat and biphasic multi-lead T waves. Echocardiography was performed in 6 patients, all of whom showed enlargement of heart cavity. Five patients had reduced left ventricular myocardial contractible motion with decreased ejection fraction, 3 patients had pericardial effusion, and 1 patient had left ventricular hypertrophy or severe aortic insufficiency. Cardiac magnetic resonance imaging showed delayed myocardial enhancement in 2 patients. One patient underwent a myocardial biopsy, which showed perivasculitis. Condition in 6 patients who received active treatment targeting improved in the early stage. Three patients (3/7, 42.9%) died due to disease progression during follow-up period.Conclusions: Cryoglobulinemia with cardiac involvement is a rare but serious condition that has relatively high risk of death. When patients with cryoglobulinemia without underlying heart disease experience heart failure, chest pain, or elevation of asymptomatic NT-proBNP and BNP, there is a high possibility of cardiac involvement, even if the electrocardiogram and troponin are negative. Further examinations such as echocardiography, cardiac magnetic resonance imaging, and myocardial biopsy examination could contribute to the diagnosis. Cardiac manifestations could be timely reversed after active targeted treatment. NT-proBNP and echocardiography could be used for the monitoring of disease efficacy.

Epidemiological, Clinical and Etiological Profile of Rhythmic Emergencies at the University Hospital of Brazzaville, Republic of Congo

Objectives: To describe the epidemiological, clinical and etiological aspects of rhythmic emergencies at the University Hospital of Brazzaville. Patients and Methods: This was a retrospective descriptive study conducted in the cardiology and internal medicine department of the University Hospital of Brazzaville from January 1, 2014 to June 30, 2016. Were included, all patients admitted for a severe rhythm disorder diagnosed on the surface electrocardiogram. Rhythmic emergency was defined as a severe rhythm disorder of abrupt onset and required rapid management. Data entry and analysis were performed with Epi Info software version 3.5.1. Results: During the study period, 2269 patients were hospitalized, including 138 for a rhythmic emergency. The frequency of rhythmic emergencies was 6.1%. The patients were divided into 76 women and 62 men (sex ratio = 0.81). The mean age of the patients was 63.1 ± 16.9 years (extremes: 17 and 91 years). The socio-economic level was low for 103 patients (74.6%), medium for 26 (17.7%), and high for nine (6.6%). The average time to consultation was 13.7 ± 12.3 days. On admission, the signs were: heart failure (103 cases; 74.6%) including 22 acute cases; dyspnea (94 cases; 68%); palpitations (38 cases; 27.5%); functional impotence (13 cases; 9.4%); collapse (nine cases; 6.5%); chest pain (two cases; 1.4%). The type of rhythmic emergency was: rapid atrial fibrillation (103 cases; 74.6%), ventricular tachycardia (14 cases; 10.1%), junctional tachycardia (10 cases; 7.2%), rapid atrial flutter (10 cases; 7.2%), tachysystole (one case; 0.7%). The context of occurrence was: hypokalemia (8 cases; 5.8%), drunkenness (two cases; 1.4%), acute gastroenteritis (one case; 0.7%). Cardiovascular risk factors were: hypertension (62 cases; 45.2%), smoking (17 cases; 12.1%), dyslipidemia (12 cases; 8.7%), diabetes (11 cases; 8%), obesity (10 cases; 7.2%). Underlying heart disease was: dilated cardiomyopathy (40 cases; 29%), hypertensive cardiomyopathy (26 cases; 18.8%), valvulopathy (24 cases; 17.4%). Ischemic heart disease, chronic pulmonary heart disease, and cardiothyreosis were noted equally (n = 5; 3.6%). No heart disease was noted in 24 patients (17.4%). Conclusion: Rhythmic emergencies are frequent in Brazzaville. They are dominated by atrial fibrillation and often occur on heart disease.

Underlying Heart Diseases and Lesions of the Atrioventricular Conduction System in Dogs with Third-degree Atrioventricular Block

Underlying Heart Diseases and Lesions of the Atrioventricular Conduction System in Dogs with Third-degree Atrioventricular Block

Cardiac Decompensation after Dilatation of an Arteriovenous Fistula Stenosis: A Case Report

The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.

Mechanisms and implications of sex differences in cardiac aging.

Aging promotes structural and functional remodeling of the heart, even in the absence of external factors. There is growing clinical and experimental evidence supporting the existence of sex-specific patterns of cardiac aging, and in some cases, these sex differences emerge early in life. Despite efforts to identify sex-specific differences in cardiac aging, understanding how these differences are established and regulated remains limited. In addition to contributing to sex differences in age-related heart disease, sex differences also appear to underlie differential responses to cardiac stress such as adrenergic activation. Identifying the underlying mechanisms of sex-specific differences may facilitate the characterization of underlying heart disease phenotypes, with the ultimate goal of utilizing sex-specific therapeutic approaches for cardiac disease. The purpose of this review is to discuss the mechanisms and implications of sex-specific cardiac aging, how these changes render the heart more susceptible to disease, and how we can target age- and sex-specific differences to advance therapies for both male and female patients.

Potencial arrítmico de cardiopatias em cães

ABSTRACT: Presently, pet life expectancy is becoming longer and several diseases inherent to age have been diagnosed, with heart disease being a frequent finding. Although various heart diseases have different pathophysiologies, many morphological and hemodynamic changes can predispose patients to arrhythmias. The presence of arrhythmias can worsen the underlying heart disease and predispose patients to develop new alterations, making arrhythmia detection important for establishing adequate therapeutic protocols and a better prognosis. The present study aimed to determine the arrhythmias most frequently found in dogs treated at the Cardiology and Respiratory Diseases Service (SCDR) of the Small Animals Sector of the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (UFRRJ), during the period from January to 2014 to December 2017, relating them to sex, age group, size, and the presence or absence of heart disease. A total of 586 medical records of dogs treated with SCDR-UFRRJ were retrospectively evaluated. Of these, 15.4% had arrhythmias, 95.6% had diagnoses of heart disease, 61.1% (55/90) were diagnosed with mitral valve disease, and 27.8% (25/90) had dilated cardiomyopathies. The most frequent rhythm disturbances were premature ventricular complexes associated with chronic degenerative mitral valve disease or dilated cardiomyopathy. Statistical analysis confirmed the risk of a cardiac patient developing rhythm or conduction alterations (OR, 4.46; p = 0.0003). In conclusion, the pathophysiology of heart failure can lead to the development of rhythm and conduction disorders.