Transtorakalna ehokardiografija (TTE) slikovna je metoda koja daje detaljan uvid u morfologiju i funkciju srčanih struktura i velikih krvnih žila. Mogućnost prikupljanja velikog broja važnih ...kliničkih informacija, niska cijena i visoka reproducibilnost čine ju metodom izbora u dijagnostici i praćenju većine kardiovaskularnih bolesti. Široka zastupljenost metode sve jasnije nalaže osnovno poznavanje ehokardiografskih načela i u zdravstvenih djelatnika koji nisu kardiolozi. Da bi pružio jasnu kliničku informaciju, nalaz mora imati jasnu logičku strukturu, biti pisan na razumljiv način i sadržavati sva definirana obavezna standardna mjerenja. Radna skupina za slikovne metode u kardiologiji Europskoga kardiološkog društva izdala je preporuke i smjernice za standardizaciju TTE-postupaka i pisanje nalaza, čiji je cilj unaprijediti kvalitetu informacije koju pruža TTE-izvješće. Uz obavezne opće podatke o bolesniku, kliničko pitanje, obavezna standardna mjerenja i datum pretrage, izvješće mora sadržavati i opisnu interpretaciju mjerenja s kliničkom interpretacijom i naglaskom na mogućim ograničenjima pretrage.
Porast prevalencije debljine postaje ozbiljan globalni javnozdravstveni problem. Osim nezdrave prehrane i smanjene tjelesne aktivnosti, razni kemijski spojevi koji se nalaze svuda oko nas mogu biti ...jedan od etioloških čimbenika razvoja debljine i njezine rastuće prevalencije. Kemijski spojevi koji ometaju rad hormonskog sustava čovjeka nazivaju se endokrini disruptori. U tu skupinu spadaju obezogeni koji ometaju normalan razvoj masnog tkiva i ravnotežu metabolizma lipida. Obezogeni su sastavni dio kozmetike, elektronike, plastike, ali se nalaze i u zraku, vodi i hrani koju svakodnevno konzumiramo. Razdoblje ranog razvoja (in utero, novorođenčad) najosjetljiviji je period pa izloženost ploda obezogenima tijekom njega putem mlijeka ili preko posteljice može biti predisponirajući čimbenik za razvoj debljine u odrasloj dobi. S gledišta suočavanja s epidemijom debljine posebno je važno uspostaviti kontrolu nad obezogenima i pokušati spriječiti ili barem ograničiti izloženost ljudi, posebice djece i trudnica, tim opasnim spojevima.
The heart in Fabry’s disease Skorup, Lea; Grgić Romić, Ivana; Šimić, Jelena ...
Cardiologia Croatica,
05/2019, Letnik:
14, Številka:
3-4
Journal Article, Web Resource
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Introduction: Fabry disease is rare X-linked, recessive lysosomal storage disorder expressed as deficiency in enzyme α-galactosidase A that leads to progressive accumulation of globotriaosylceramide ...and related glycosphingolipids in various tissues. In cardiac tissues, progressive globotriaosylceramide accumulation leads to irreversible cardiac damage.1,2 Males are primarily affected by Fabry disease, but female heterozygotes may also have symptoms.3
Case report: Our patient is 47-years-old who has been suffering from chronic kidney disease since he was 23 years old. Only twelve years later he developed end-stage renal disease and has been undergoing
regular haemodialysis in Dialysis Centre Prijedor (Bosnia and Herzegovina). He started his journey towards kidney transplantation in 2014 in University Hospital Centre Rijeka, which was performed
in May 2018. In 2014, during pretransplantation workup, echocardiography was performed revealing concentric cardiac hypertrophy without left ventricle outflow tract obstruction (Figure 1 and Figure 2) associated with contractility and diastolic filling impairment. Following suspicion on Fabry disease, diagnosis was made by measuring α-galactosidase enzyme activity in leukocytes and molecular genetic testing of GLA gene mutation. Enzyme replacement therapy was started with intravenous infusion of recombinant α-galactosidase A (agalsidase beta).
Conclusion: Renal disease and echocardiographic features of hypertrophic cardiomyopathy combined with electrocardiographic and clinical criteria should be considered as “red flags” for Fabry disease.
Introduction: The differential diagnosis of an intracardiac mass include benign and malignant primary heart tumors, metastatic tumors and thrombi. Primary tumors of the heart consist mainly of ...myxomas, with an incidence of less than 0.5%. Clinical manifestations are consequence of embolic phenomena, intracardiac obstruction or constitutional symptoms. In rare instances, myxomas can cause a mass effect, resulting in mitral valve obstruction1.
Case report: 68-year-old male with a history of ulcerative colitis complained to his gastroenterologist about having exercise intolerance. Undergoing regular colitis evaluation, CT thorax and abdomen scan was performed incidentally revealing a large intracardiac mass. Echocardiogram ordered by the consulting cardiologist demonstrated a large ellipsoid left atrial cyst (50×31 mm), occupying nearly the entire left atrium (Figure 1). The mass was protruding across the mitral valve orifice in diastole causing functional stenosis with an elevated mean diastolic gradient of 10,9 mmHg. Mitral valve area calculated by pressure half-time was 1.0 cm2. Doppler showed moderate tricuspid regurgitation with a systolic pulmonary artery pressure of 50 mmHg. The systolic function was preserved with an estimated left ventricular ejection fraction of 58%. Transesophageal echocardiography described a
cavitating lesion (measuring 15,1 cm2, attached to interatrial septum with 24 mm base), having characteristics consistent with a hemorrhagic cyst (Figure 2). Preoperative coronary angiography displayed coronary artery disease and a rare condition of dual coronary artery supply with left circumflex artery (LCx) providing two (Figure 3) and right coronary artery (RCA) one tumor branch (Figure 4) producing a characteric "tumor blush". CT showed large intracardiac mass (Figure 5 and Figure 6). Patient underwent cardiothoracic surgery with successful excision of the tumor (4,5x3x2 cm), the pathohistology confirmed myxoma. Postoperative course was uneventful, exercise intolerance symptoms improved, and echocardiographic follow up showed no intracardiac mass.
Conclusion: We described a rare case of cystic-appearance cardiac myxoma with dual coronary supply mimicking mitral valve stenosis.
There are not many patients reported with left atrial myxoma being vascularized from both RCA and LCx as seen in our case2. Although more than half of atrial myxomas show obstructive symptoms, severe mitral valve obstruction is rare1. Early echocardiographic examination of patients presenting with exertional dyspnea is advised, as myxomas have an excellent prognosis following surgical excision, preventing complications and improving quality of life.
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