Cardiology
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Comparative Study
Anemia and early mortality in patients with decompensation of chronic heart failure.
The possible independent effect of mild-to-moderate anemia (hemoglobin value not <9 g/dl) on the short-term mortality of patients with decompensation of NYHA class III/IV chronic heart failure has not been investigated yet. ⋯ Mild-to-moderate anemia seems not to contribute independently to short-term mortality in patients with decompensation of NYHA class III/IV chronic heart failure. An adverse concomitant baseline risk profile may have a key role in the induction of mild-to-moderate anemia and in the increased risk of death in these patients.
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Contrast medium administration during imaging and therapeutic procedures can cause renal injury, partly due to ischemia. Therefore, we hypothesized that brief ischemia and reperfusion episodes applied at a distant site - multiple balloon inflations and deflations during angioplasty - may serve as a remote-conditioning (RC) stimulus and thereby protect against contrast-induced kidney injury. To test this hypothesis, we (1) utilized cases from a prior study in which patients undergoing emergent angioplasty for ST segment elevation myocardial infarction received either 1-3 balloon inflations (controls) or were 'conditioned' with multiple (≥4) inflations, and (2) assessed renal function for 3 days in patients with an estimated glomerular filtration rate (eGFR) of <90 ml/min/1.73 m(2) prior to revascularization (mild kidney disease). ⋯ In controls, this improvement was transient: eGFR subsequently decreased to 70 ± 14 ml/min/1.73 m(2) at day 3 (p < 0.05). In contrast, the RC group (despite receiving 25% more contrast volume) showed no functional decline at day 3 (80 ± 14 ml/min/1.73 m(2)). These results are consistent with remote ischemic conditioning providing a novel potential approach to attenuate contrast-associated renal injury.
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Case Reports
Unplanned staged hybrid management of postmyocardial infarction ventricular septal defect.
Ventricular septal defect (VSD) is an uncommon but potentially deadly complication of transmural myocardial infarction (MI). Emergency surgical treatment has traditionally offered the best chance for survival. ⋯ Percutaneous catheter-based closure techniques can be used to treat these critically ill patients, offering a less invasive and less morbid technique. This case demonstrates the successful application of an unplanned, staged hybrid approach utilizing initial percutaneous and subsequent surgical repair after recovery of tissue integrity.
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Takotsubo cardiomyopathy is a phenomenon of transient acute left ventricular dysfunction without obstructive coronary disease seen predominantly in postmenopausal women in the setting of acute emotional or physical stress. Neurocardiogenic injury from acute neurologic events such as intracranial bleeding can precipitate transient left ventricular dysfunction (termed 'neurogenic stunned myocardium') that may be indistinguishable from takotsubo cardiomyopathy. There is controversy about the diagnosis of takotsubo cardiomyopathy in the setting of acute neurologic disorders. ⋯ This case suggests that susceptibility to this disorder is likely due to patient-specific factors rather than etiology, and acute neurologic disorders should be included as precipitants of takotsubo cardiomyopathy. We also theorize that there may be patients with milder forms of stress-related cardiac injury who do not develop left ventricular dysfunction, being similar to the wide range of cardiac manifestations in patients with acute neurologic disorders. We review published literature on neurologic precipitants of takotsubo cardiomyopathy.
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Case Reports
Severe mitral regurgitation and heart failure due to caseous calcification of the mitral annulus.
Caseous calcification is a rare form of mitral annular calcification. Echocardiography reveals an echodense mass in the inferior mitral annulus with smooth borders and an echolucent inner core. We present a case where caseous calcification of the mitral annulus caused severe mitral regurgitation, atrial fibrillation and heart failure. ⋯ The mass was surgically removed and a prosthetic valve was implanted. We conclude that caseous calcification of the mitral annulus should be considered not only in the differential diagnosis of cardiac masses but also in the background of mitral regurgitation, atrial fibrillation and heart failure. This case also represents the usefulness of multimodal imaging in identifying cardiac masses.