Hospital Chronicles (E-Journal)
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Uncommon ultrasound findings due to extensive bicuspid aortic valve endocarditis
No full textWe report the case of a 32-year-old man, who was presented with dyspnoea and diffuse abdominal pain with associated vomiting about two months after surgery for aortic valve replacement due to endocarditis. The echocardiographic examination of the patient revealed uncommon findings such as pseudoaneurysm of the aortic intervalvular fibrosa (MAIVF), perforation of the anterior mitral leaflet, large aneurysm of the perimembranous inlet ventricular septum, Gerboden flow through the perimembranous aneurysm and finally abnormal position of the tricuspid valve towards the ventricular apex
Diabetes Mellitus: Dipeptidyl Peptidase 4 Inhibitors and Cardiovascular Outcomes
Get PDFDipeptidyl peptidase 4 (DPP‑4) inhibitors represent a new pharmacological class of glucose – lowering agents, mainly used as add-on therapy, after metformin or combination of metformin with sulfonylurea or metformin with a thiazolidinedione. Over the last few years, several DPP‑4 inhibitors, also called gliptins, have been approved and introduced into clinical practice such as sitagliptin, linagliptin, saxagliptin, vildagliptin and alogliptin. Their mechanism of action relates to the inhibition of the DPP-4 enzyme which degrades the incretin hormones, e.g. glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), released from the small intestine into the circulation during a meal, potentially capable to stimulate the release of insulin from pancreatic beta cells, thus affording a glucose-lowering action. However, these incretins are swiftly degraded by the DPP-4 enzyme. Gliptins, therefore, inhibit this enzyme, enhancing the bioavailability of GLP-1 and GIP. They have been approved for better glycemic control in type 2 diabetic patients. Although, these new agents have been heralded as safe agents conferring pleiotropic or cardioprotective effects, recent studies showed that the new DPP-4 inhibitors may not have serious adverse cardiovascular effects, but have failed to show any pleiotropic actions or favorable cardiovascular effects. Additional data from ongoing studies may shed further light on this issue
CARTO-Guided Atrial Fibrillation Ablation
Get PDFAtrial Fibrillation (AF) is associated with increased morbidity and mortality and a more severe impairment in quality of life compared with patients with congestive heart failure or myocardial infarction. Left atrial myocardial extensions, known as “myocardial sleevesâ€, are present in almost all pulmonary veins (PVs), and have been recognized as the main source of triggers that initiate and perpetuate AF
The Important Role of FFR Measurement in Everyday Clinical Practice: Two Representative Cases
Get PDFThe measurement of fractional flow reserve (FFR) has been proven useful in evaluating whether or not to perform percutaneous coronary intervention (PCI), especially in the case of “intermediate†stenosis. Nowadays, the indication of its usefulness has been expanded. While coronary angiography remains the cornerstone for assessment of epicardial coronary artery lesions in the catheterization laboratory, FFR-guided coronary treatment has established its usefulness especially after FAME 1 & 2 trials
Serratia Myositis in an Intravenous Drug User
Get PDFSerratia marcescens is a well-known causative agent of hospital-acquired infections, especially in the intensive care unit (ICU), but can also cause community-acquired infections. Infectious myositis due to Serratia is an extremely rare infection. We present a rare case of myositis due to Serratia marcescens in an intravenous drug user. To the best of our knowledge this is the first case of Serratia marcescens infectious myositis in an intravenous drug user. Our report not only reminds us that Serratia marcescens could be a pathogen in the community, but also highlights the fact that drug users are a special population with rare and unusual infections and as a result the clinician must have a high clinical suspicion and vigilance in order to diagnose and treat them
The Ryanodine Receptor Leak: Its Role in the Development of Heart Failure
Get PDFThe cardiac ryanodine receptor-Ca2+ release channel (RyR2) is an essential sarcoplasmic reticulum (SR) transmembrane protein that plays a central role in excitation-contraction coupling in cardiomyocytes. Aberrant spontaneous, diastolic Ca2+ leak from the SR due to dysfunctional RyR2 is the mechanism underlying contractile and relaxation dysfunctions in heart failure. Several potential mechanisms have been proposed to explain the dysfunctional RyR2 in heart failure including overphosphorylation status of RyR2, altered RyR2 regulation and perturbed RyR2 intra/intermolecular interactions. Novel therapeutic strategies that enhance myocyte Ca2+ homeostasis could prevent and reverse adverse cardiac remodeling and improve clinical outcomes in patients with heart failure
The Role of High-Sensitivity Troponin in Diagnosing Acute Coronary Syndromes
Get PDFThe development of assays to detect plasma elevations of cardiac troponins has revolutionized our current clinical practice in the diagnosis and management of acute coronary syndromes. . Recently new highly sensitive assays for troponin measurement have been developed in an effort to detect even minimal elevations suggestive of subclinical injury providing thus the clinicians with additional diagnostic and prognostic information. These assays can facilitate an earlier diagnosis of myocardial ischemia or necrosis and add substantial prognostic information to improve our risk stratification and accordingly our treatment strategy. This increased sensitivity, however, may come in expense to decreased specificity. Nevertheless, accumulating evidence suggests that high sensitive troponins, if used appropriately regarding proper timing and evaluation of serial samples and in conjunction with clinical data can improve clinical care of patients with acute coronary syndrome
Newer Combined (ESC & EASD) 2013 guidelines for Diabetes Mellitus and Cardiovascular Disease
Get PDFIt is estimated that 360 million people were affected by diabetes mellitus (DM) in 2011 with the great majority (namely 95%) being affected by type 2 DM (T2DM). Most importantly, approximately half of these individuals are not aware of this diagnosis. In addition, another 300 million individuals are at future risk of developing T2DM, including people with increased fasting glucose (IFG), impaired glucose tolerance (IGT), gestational DM, and euglycaemic insulin resistance (IR)
Next Generation Transcatheter Aortic Valve Systems: the PorticoTM Valve
Get PDFTranscatheter aortic valve replacement (TAVR) is currently considered a valuable alternative for the treatment of severe symptomatic aortic stenosis patients who are inoperable or at excessively high surgical risk
Transvenous Temporary Cardiac Pacing
Get PDFTransvenous temporary cardiac pacing is a rather old but still contemporary life-saving technique, with a unique value in the treatment of critically ill patients suffering from rhythm disturbances and associated hemodynamic compromise. Physicians involved in the management of such patients should always keep in mind the indications and contraindications of transvenous temporary cardiac pacing, and should be at least familiar with the insertion technique and the post-insertion care