Stress-induced/Takotsubo cardiomyopathy (TC) is an increasingly recognized diagnostic entity.
This study was aimed to assess the prevalence and clinical predictors of short and long-term outcome of ...patients (pts) diagnosed with TC.
We included all consecutive pts admitted in our department, from November 2006 to August 2011, who met the Mayo Clinic criteria for TC diagnosis.
We evaluated 37 pts (35 women) with a mean age of 63 ± 13 years. TC was precipitated by a stressful emotional event in the majority (57%) and chest pain was the most common symptom (89%). Twelve pts (32%) had ST-segment elevation and 15 pts (41%) had T-wave inversion on the electrocardiogram at admission. Severe left ventricular (LV) dysfunction was found in 16 pts (43%) and the mean troponin I level was 2.6 ± 1.8 ng/mL. The in-hospital complication rate was 30%, with cardiogenic shock being the most common situation. Physical stress, severe LV systolic dysfunction and peak brain natriuretic peptide (BNP) were predictors of acute complications. On the other hand, we found no association between peak troponin I and electrocardiographic presentation. Thirty-five pts were followed for a mean time of 482 ± 512 days, without clinic recurrence.
In our cohort of pts, TC was associated with a high in-hospital complications rate. Physical stress, LV dysfunction and peak BNP could predict acute adverse outcomes.
ObjectivesPrompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study ...aimed to identify sex differences in presenting symptoms of ACS.DesignData were collected within a prospective cohort study (EPIHeart).SettingPatients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014.ParticipantsPresenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. Outcome measures: Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex.ResultsChest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001).ConclusionsWhile there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.
Stress-induced cardiomyopathy, also known as ‘broken heart syndrome’ or Takotsubo cardiomyopathy, is characterized by transient systolic dysfunction of the apical and/or mid segments of the left ...ventricle, in the absence of significant coronary artery disease. We report the case of a 56-year-old male patient with chronic obstructive pulmonary disease (COPD), with stress-induced cardiomyopathy associated with the use of ipratropium bromide, administered in the context of an acute exacerbation of COPD.
A cardiomiopatia associada ao stress, também conhecida por cardiomiopatia de Takotsubo, é caracterizada por uma disfunção sistólica transitória dos segmentos apicais e/ou médios do ventrículo esquerdo, na ausência de doença coronária significativa. Apresentamos um caso clínico de um doente do sexo masculino, com 56 anos de idade, com doença pulmonar obstrutiva crónica (DPOC), com cardiomiopatia associada ao stress que surgiu após uso de brometo de ipratrópio, administrado no contexto de uma exacerbação de DPOC.
Fundamento: A cardiomiopatia de estresse/Takotsubo (CT) é uma entidade diagnóstica cada vez mais reconhecida. Objetivo: Este estudo teve como objetivo avaliar a prevalência e os preditores clínicos ...de complicações de curto e longo prazo de pacientes (pts) com CT. Métodos: Foram incluídos todos os pts consecutivamente admitidos no nosso centro, entre novembro de 2006 e agosto de 2011, que preenchiam os critérios diagnósticos da Clínica Mayo. Resultados: Analisaram-se 37 pts (35 mulheres), com idade média de 63 ± 13 anos. A CT foi precipitada na maioria dos casos por eventos de estresse emocional (57%) e dor torácica foi o sintoma de apresentação mais frequente (89%). O electrocardiograma na admissão mostrou supradesnivelamento do segmento ST em 12 pts (32%) e inversão da onda T em 15 casos (41%). Verificou-se disfunção sistólica ventricular esquerda (VE) grave em 16 pts (45%) e a elevação média de troponina I foi de 2,6 ± 1,8 ng/mL. A taxa de complicações intra-hospitalares foi de 30%, sendo o choque cardiogênico a situação mais comum. O estresse físico, a disfunção sistólica grave do VE e o valor de pico do peptídeo natriurético cerebral (BNP) foram preditores de complicações agudas. Não foi encontrada associação entre o pico de troponina I e a apresentação eletrocardiográfica. Trinta e cinco pacientes foram acompanhados por um tempo médio de 482 ± 512 dias, sem recorrência clínica. Conclusão: Na nossa série de pacientes, a CT foi associada a uma alta taxa de complicações intra-hospitalares. O estresse físico, a disfunção sistólica do VE e o valor de pico do BNP foram preditores de desfechos adversos agudos.
Conduction disturbances requiring permanent pacemaker (PM) implantation occur in 3–12% of patients after aortic valve replacement (AVR). Our aim was to assess long-term PM dependency and its ...predictors in these patients.
We conducted a retrospective study of all consecutive patients undergoing permanent PM implantation after AVR between January 2004 and December 2010. Absence of sinus rhythm or atrial fibrillation with appropriate ventricular response at a pacing rate of 30 bpm for 10 s was defined as pacemaker dependency.
Ninety-one patients underwent permanent PM implantation and during follow-up (1026.6±732.0 days) 64% of them did not recover rhythm. Age, conduction disorders on the preoperative ECG, negative chronotropic medication before surgery, cardiopulmonary bypass and aortic cross-clamp times did not influence rhythm recovery. In multivariate analysis, valvular disease etiology related to endocarditis, prosthetic dysfunction and bicuspid valve were associated with long-term PM dependency (OR 5.05; CI: 1.43–17.75).
The majority of patients undergoing permanent PM implantation after AVR did not recover from conduction disorders during follow-up. The etiology of valvular disease was an independent predictor of late PM dependence.
Distúrbios da condução que requerem implantação de pacemaker (PM) permanente após a substituição da valva aórtica (SVA) ocorrem em 3-12% dos doentes. O objetivo do estudo foi avaliar a dependência do PM a longo prazo e os seus preditores neste grupo de doentes.
Foi realizado um estudo retrospetivo de todos os doentes submetidos a implantação de PM definitivo após SVA entre janeiro de 2004 e dezembro de 2010. A ausência de ritmo sinusal ou fibrilação auricular com frequência ventricular adequada sob PM a 30 batimentos/min durante um curto período de 10 segundos foi definido como dependência de PM.
Noventa e um pacientes foram submetidos a implantação de PM permanente e durante o período de follow-up (1026,6 ± 732,0 dias) 64% deles não recuperaram o ritmo. A idade, os distúrbios de condução no ECG pré-operatório, uso de medicação cronotrópica negativa antes da cirurgia, o tempo de circulação extracorporal e o tempo de clampagem da aorta não influenciaram a recuperação do ritmo. Na análise multivariada, a etiologia da doença valvular (endocardite, disfunção de prótese ou válvula bicúspide) esteve associada à dependência de PM a longo prazo (OR 5,05; IC: 1,43-17,75).
A maioria dos doentes submetidos a implantação de PM permanente após SVA não recupera dos distúrbios de condução durante o follow-up. A etiologia da doença valvular foi um preditor independente da dependência de PM a longo prazo.
The authors present a case report of successful treatment of pulmonary artery perforation by endovascular stent graft implantation.
Os autores descrevem um caso de sucesso do tratamento da rotura da ...artéria pulmonar com a implantação de um stent endovascular.
Ebstein's anomaly (EA) is a rare congenital malformation of the tricuspid valve, often associated with other cardiac malformations, especially atrial septal defect, which is present in 80–90% of ...patients and predisposes to paradoxical embolization. We describe the case of a 47-year-old male, a drug abuser, with a known but not investigated cardiac murmur. He presented to the emergency department with worsening exertional dyspnea and fatigue associated with recent recurrent transient ischemic attacks. On brain computed tomography there were multiple non-recent ischemic infarctions. Transthoracic echocardiography showed EA with severely dilated right cardiac chambers, right systolic dysfunction and severe tricuspid regurgitation. Contrast and transesophageal echocardiography revealed a patent foramen ovale with right-to-left shunt. After exclusion of other potential causes of the neurologic events, they were assumed to be the consequence of paradoxical embolism.
A anomalia de Ebstein é uma malformação congénita rara da válvula tricúspide, geralmente associada a outras malformações congénitas, particularmente os defeitos do septo auricular, que podem estar presentes em cerca de 80% a 90% dos doentes e favorecer a embolia paradoxal. Descrevemos o caso de um homem de 47 anos de idade, toxicodependente, com história de sopro cardíaco conhecido de longa data, mas não estudado. Recorreu ao Serviço de Urgência por dispneia e fadiga de esforço com agravamento progressivo associados a eventos recorrentes de acidentes isquémicos transitórios. A TC cerebral evidenciou múltiplas lesões isquémicas sequelares não recentes. A ecocardiografia transtorácica revelou a presença de anomalia de Ebstein com dilatação severa das cavidades direitas, disfunção ventricular direita e regurgitação tricúspide severa. O ecocardiograma com contraste e transesofágico permitiram evidenciar a coexistência de foramen oval patente com shunt direita-esquerda. Foram excluídas outras possíveis causas explicativas para o quadro neurológico, que se assumiu na dependência de embolismo paradoxal.
Interpretation of the symptoms of acute coronary syndrome (ACS) can influence the time of hospital admission and negatively affect patients’ prognosis. We decided to explore illness perception and ...its predictors among patients with ACS.
We conducted a retrospective analysis of all consecutive patients with ACS admitted to the cardiology department of a tertiary hospital between January and September 2011. Data were obtained from patients’ medical records and telephone interviews.
One hundred and eighty-six patients with ACS (mean age 64±12 years; 70% male) were included. The majority (62.6%) had no perception of ACS until informed by their doctor. Only 26% of patients with ST-segment elevation myocardial infarction had perception of cardiac disease. Among those who had perception, 82.6% were men and 58% had a previous diagnosis of ischemic heart disease (IHD). Gender and previous diagnosis of IHD were independent predictors of ACS perception, with male gender and patients with previous IHD having greater illness perception. No association was found between ACS perception and age or residence area (rural vs. urban).
The illness perception of ACS patients needs to be improved, independently of sociodemographic factors. An educational program for the general population, but particularly for women and individuals without a past history of IHD, focusing on the alert signs for ACS, may help to improve illness perception in this setting.
A interpretação dos sintomas da síndrome coronária aguda (SCA) pode influenciar o tempo da admissão hospitalar e afetar negativamente o prognóstico. Decidimos explorar a perceção da doença e os seus preditores em doentes com SCA.
Efetuamos uma análise retrospetiva de todos os doentes consecutivamente admitidos no departamento de cardiologia de um hospital terciário com SCA, entre janeiro e setembro de 2011. A informação foi obtida através dos registos clínicos e entrevista telefónica.
Cento e oitenta e seis doentes (idade média de 64±12 anos; 70% homens) com SCA foram incluídos. A maioria (62,6%) dos doentes não tinha perceção da SCA atéàinformação médica. Apenas 26% dos doentes com enfarte agudo do miocárdio com supradesnivelamento do segmento ST tiveram perceção da doença cardíaca. Entre aqueles que tiveram perceção, 82,6% eram homens e 58% tinha um diagnóstico prévio de doença cardíaca isquémica (DCI). O sexo e o diagnóstico prévio de DCI foram preditores independentes da perceção da SCA, tendo o sexo masculino e os doentes com DCI prévia uma perceção superior. Nenhuma associação foi encontrada relativamente à idade e área de residência (rural versus urbana).
A perceção de doença dos pacientes com SCA precisa de ser melhorada, independentemente de fatores sociodemográficos. Um programa educacional que abranja a população geral, particularmente as mulheres e aqueles sem antecedentes de DCI, e que foque os sinais de alerta para a SCA poderá ser útil para melhorar a perceção dos sintomas neste contexto.
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