Cardiac amyloidosis is a serious and progressive infiltrative disease that is caused by the deposition of amyloid fibrils at the cardiac level. It can be due to rare genetic variants in the ...hereditary forms or as a consequence of acquired conditions. Thanks to advances in imaging techniques and the possibility of achieving a non-invasive diagnosis, we now know that cardiac amyloidosis is a more frequent disease than traditionally considered. In this position paper the Working Group on Myocardial and Pericardial Disease proposes an invasive and non-invasive definition of cardiac amyloidosis, addresses clinical scenarios and situations to suspect the condition and proposes a diagnostic algorithm to aid diagnosis. Furthermore, we also review how to monitor and treat cardiac amyloidosis, in an attempt to bridge the gap between the latest advances in the field and clinical practice.
Cardiac amyloidosis is a serious and progressive infiltrative disease that is caused by the deposition of amyloid fibrils at the cardiac level. It can be due to rare genetic variants in the ...hereditary forms or as a consequence of acquired conditions. Thanks to advances in imaging techniques and the possibility of achieving a non‐invasive diagnosis, we now know that cardiac amyloidosis is a more frequent disease than traditionally considered. In this position paper the Working Group on Myocardial and Pericardial Disease proposes an invasive and non‐invasive definition of cardiac amyloidosis, addresses clinical scenarios and situations to suspect the condition and proposes a diagnostic algorithm to aid diagnosis. Furthermore, we also review how to monitor and treat cardiac amyloidosis, in an attempt to bridge the gap between the latest advances in the field and clinical practice.
Diagnosis and treatment of cardiac amyloidosis.
To evaluate the prevalence of metastatic tumors involving the myocardium and study their presentation in order to increase awareness to their existence.
Pathological reports from Sheba Medical Center ...(Israel, January 1, 2010 through December 31, 2015) and medical records from The Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica (Serbia, 23 years period) were screened for cases of metastatic cardiac tumors. Medical, radiological and pathological data of identified cases was retrieved and reviewed.
Out of thousands of registered cardiac surgeries we found less than a dozen cases of metastatic cardiac tumors classified as melanoma, carcinomas of lung, colon and kidney and sarcomas of uterine origin. We found that metastatic cardiac tumors comprised 15.8% of all the cardiac tumors.
Metastatic cardiac tumors are extremely rare. As new diagnostic technologies and improved survival of oncological patients may increase the incidence of metastatic cardiac tumors in the future, awareness to their existence and knowledge of their presentation are key factors in their timely recognition.
ABSTRACT
Primary malignancies of the heart and pericardium are rare. All the available data come from autopsy studies, case reports, and, in recent years, from large, specialized, single‐center ...studies. Nevertheless, if primary malignancy is present, it may have a devastating implication for patients. Malignancies may affect heart function, also causing left‐sided or right‐sided heart failure. In addition, they can be responsible for embolic events or arrhythmias. Today, with the widespread use of noninvasive imaging modalities, heart tumors become evident, even as an incidental finding. A multimodality imaging approach is usually required to establish the final diagnosis. Despite the increased awareness and improved diagnostic techniques, clinical manifestations of primary malignancy of the heart and pericardium are so variable that their occurrence may still come as a surprise during surgery or autopsy. No randomized clinical trials have been carried out to determine the optimal therapy for these primary malignancies. Surgery is performed for small tumors. Chemotherapy and radiation therapy can be of help. Partial resection of large neoplasms is performed to relieve mechanical effects, such as cardiac compression or hemodynamic obstruction. Most patients present with marginally resectable or technically nonresectable disease at the time of diagnosis. It seems that orthotopic cardiac transplantation with subsequent immunosuppressive therapy may represent an option for very carefully selected patients. Early diagnosis and radical exeresis are of great importance for long‐term survival of a primary cardiac malignancy. This can rarely be accomplished, and overall results are very disappointing.
Background. It has been hypothesized that various infective agents may activate immune reactions as part of the atherosclerotic process. We aimed to investigate the interrelationship between chronic ...exposure to oral pathogens and immune-inflammatory response in patients with acute coronary atherothrombosis. Patients and Methods. The study included 200 participants from Serbia: 100 patients with acute myocardial infarction (MI), and 100 age- and sex-matched controls. Antibodies to oral anaerobes and aerobes were determined as well as autoantibodies to endothelial cells, beta-2 glycoprotein I, platelet glycoprotein IIb/IIIa and anticardiolipin. Interleukin-6 (IL-6) and C-reactive protein (CRP) were measured. Results. The mean serum antibodies to oral anaerobes tended to be higher among subjects with MI (0.876 ± 0.303 versus 0.685 ± 0.172 OD, P < 0.001 ). Similarly, antibody levels against oral aerobes in patients were significantly different from controls. Antibodies against endothelial cell, beta-2 glycoprotein I, platelet glycoprotein IIb/IIIa, anticardiolipin along with CRP and IL-6 were highly elevated in patients. The levels of antibodies to oral bacteria showed linear correlation with tissue antibodies, CRP and IL-6. Conclusion. Antibody response to chronic oral bacterial infections and host immune response against them may be responsible for the elevation of tissue antibodies and biomarkers of inflammation which are involved in acute coronary thrombosis development.
OBJECTIVE:After stent or bypass surgery blood pressure (BP) can go up for multiple reasons among which arestress and tense of the patient unsure about the future, the pain of the cut and because some ...of the blood pressure medication, which the patient was receiving preoperatively may get withdrawn post operatively, thereby leading to shooting up the BP. In certain patients, BP actually comes down after surgery and returns back to the pre-operative levels 4 to 6 weeks down the track. We aimed to investigate the incidence of high BP after coronary artery bypass surgery (CABG) in patients referred to our in- house cardiac rehabilitation program.
DESIGN AND METHOD:Out of 2276 patients admitted for in-hospital cardiac rehabilitation, we studied two hundred ten patients with previous CABG or stent (64% males, aged 65.82 ± 10.01 years). Risk factors and medications were noted. Exercise test were performed on admisson and after 21 days of in-hospital rehabilitationn. Patients were selected for exercises programfree walking, cycle and/or Nyllin steps. BP was measured every morning, before and immediately after the exercise, after a break.
RESULTS:High BP was noted in 27% of patients referred to our in house cardiac rehabilitation program with the maximum of 210mmHg for systolic and 110 for diastolic pressure. Most of the patients (86%) were taking preoperative antihypertensive drugs. We optimized the dose in 35% while in 68% ACE inhibitors were change to ARB (irbesartan predominantly) to optimize BP and achieve target levels.None of the patient had severe complicates due to BP arise. All the patients successfully finished in house cardiac rehabilitation program.
CONCLUSIONS:CABG and stent can help to restore blood flow to an area of the heart. However, they do not stop the progression of atherosclerosis. High blood pressure can be successfully detected and treated during in house supervised cardiac rehabilitation program.
Abstract only Background and aims: Atherothrombosis is the major determinant of acute cardiovascular events, such as myocardial infarction. Inflammatory processes have been linked to all phases of ...atherogenesis. Data suggest that atherosclerosis also constitutes an autoimmune disease. We aimed to investigate the presence of anti oxidized LDL (ox-LDL) antibodies (IgG) and anti beta 2 glycoprotein I antibodies in acute coronary atherothrombosis development. Methods: The study included 206 participants of whom 106 were patients with acute coronary syndromes (ACS), (61.2 ± 3.21 years of age, 62% males) and 100 were age and sex matched controls with no known coronary artery disease. Patients with previous infection were excluded from the study. Blood was sampled, frozen and sent on dry ice to Immunosciences Lab. Inc (USA) for analyses. All traditional risk factors were noted. Anti ox-LDL antibodies (IgG), anti beta 2 glycoprotein I (IgG) antibodies were determined as well as anti Chlamydia pneumoniae heat shock protein (HSP) 70 (IgG) antibodies. Interleukin 6 and C- reactive protein were measured. Results: Our data showed significant prevalence of examined antibodies in patients with ACS: 30% of patients had anti Ox-LDL antibodies (IgG) detectable, 25% had anti beta glycoprotein I antibodies compared to 8% of controls. The total of 31% patients versus 13% of controls had anti Chlamydia pneumoniae HSP 70 (IgG) antibodies detectable, RR 2.36, (1.32-4.28 95% CI for RR, p=0.003) The levels of circulating antibodies were significantly higher in patients (p<0.001). Markers of inflammation differed significantly between the groups. Our data indicated linear correlation between examined antibodies and markers of inflammation. In conclusion, the results of our study suggest that antibodies (IgG) against Ox- LDL, beta 2 glycoprotein I and Chlamydia pneumonia HSP 70 can be detected in patients with acute coronary atherothrombosis. The clinical relevance for circulating autoantibodies in cardiovascular outcomes is still debated. We believe that further research will help to assess if those autoantibodies could improve current cardiovascular risk stratification approaches and therapeutic algorithm, both in primary and secondary prevention.
Introduction. Adherence to proposed lifestyle changes and prescribed
medication in patients with stable coronary artery disease (SCAD) is poor.
Objective. We sought to investigate the influence of ...adjusting guideline
proposed medications on relief of angina in a large group of patients with
SCAD in Serbia. Methods. The study included a total of 3,490 patients from 15
cardiology clinics with symptoms of stable angina and at least one of the
following criteria: abnormal electrocardiogram (ECG), history of myocardial
infarction (MI), positive stress test, significant coronary artery disease on
coronary angiogram or previous revascularization. All the patients underwent
comprehensive evaluation at initial visit and after two months. The relief of
angina was study end-point defined as any reduction in Canadian Cardiology
Society (CCS) class, number of angina attacks per week and/or number of
tablets of short-acting nitrates per week. Results. Most patients were
included based on abnormal ECG (48.4%). At Visit 1, the average number of
prescribed classes of medications to a single patient increased from 4.16 ?
1.29 to 4.63 ? 1.57 (p < 0.001). At the follow-up, the patients had
significantly lower blood pressure (141 ? 19 / 85 ? 11 vs. 130 ? 12 / 80 ? 8
mmHg; p < 0.001) and most of them reported CCS class I (63.3%). The average
weekly number of angina attacks was reduced from 2.82 ? 2.50 at Visit 1 to
1.72 0 ? 1.66 at Visit 2, as well as average weekly use of short-acting
nitrates to treat these attacks (2.69 ? 2.53 to 1.74 ? 1.47 tablets; p <
0.001 for all). Conclusion. Adjustment of prescribed medications to guideline
recommendations in a large Serbian patient population with prevalent risk
factors led to significant relief of angina.
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