Hospital Chronicles (E-Journal)
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Early Repolarization: Not Benign Any More- the J-Wave Syndromes
Get PDFAn early repolarization (ER) pattern characterized by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation has been traditionally considered to be totally benign over the past decades. A flurry of data derived from recently published studies demonstrates that an ER pattern in inferior or inferolateral leads, named early repolarization syndrome (ERS), is associated with increased risk for sudden cardiac arrest (SCA), being responsible for some cases of idiopathic ventricular fibrillation (IVF). Current evidence support the notion that although ERS and Brugada syndrome (BrS) show discrete differences, they also share similar clinical, electrocardiographic and pathophysiological features, especially concerning the presence of amplified J-waves; thus, they can be considered to represent a continuous spectrum of phenotypic expression, termed J-wave syndromes. Research has provided us with fascinating insights into the underlying mechanisms responsible for repolarization abnormalities and we presently have more evidence to implement reliable risk stratification methods to patients with ER. However, many unanswered questions remain and still need to be addressed in future studie
Technique of Transcutaneous Aortic Valve Implantation
No full textTranscatheter aortic valve implantation (TAVI) has become an accepted treatment option for high-risk patients with symptomatic severe aortic stenosis (AS). In this article we describe the patient screening procedure and the prosthetic valve implantation technique. Furthermore, common procedural complications and their management are also discussed
Non-Cardiac Sudden Death in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy
Get PDFWe herein present the case of a 70-year old lady with arrhythmogenic right ventricular cardiomyopathy (ARVC) and recurrent episodes of syncope. She was referred to our department due to an episode of sustained ventricular tachycardia (VT) which caused haemodynamic collapse and was converted electrically. During diagnostic investigation, echocardiography revealed evidence of right ventricular dysfunction. She underwent risk stratification and sustained monomorphic VT was easily induced during electrophysiology study. An implantable cardioverter-defibrillator (ICD) device was subsequently implanted, but she died suddenly three months later. ICD device interrogation did not reveal any arrhythmic event and death was attributed to carbon monoxide poisoning
The Pivotal Role of Three-Dimensional Transesophageal Echocardiography in Non-Coronary Intervention Procedures
Get PDFThe recent availability of real-time 3-dimensional (3D) transesophageal echocardiography (TEE) can drive forward the diagnostic capability of ultrasound imaging. Real time 3D TEE has evolved into the imaging modality of choice when it comes to percutaneous interventions, as in many cases it serves as the ‘eyes of the operator’ to evaluate, guide, and assess the results of the procedures in the catheterization laboratory. Moreover, it has been shown to provide additional insight into the anatomical, morphological and hemodynamic status. Up to date, real time 3D TEE has been integrated into the following percutaneous non-coronary procedures: closure of atrial or ventricular defects, aortic valve replacement, paravalvular leak occlusion, mitral valve repair with clips, and more recently left atrial appendage occlusion with use of closure devices. Further technological advancements will lead to more accurate and wider use of this imaging technique
Spot Stenting Preferable in Long Diffuse Coronary Lesions
Get PDFThe treatment of long and diffuse coronary lesions with percutaneous coronary intervention (PCI) has been problematic. Since the era of plain balloon angioplasty,  lesion length  has been a factor related to higher rates of restenosis and target lesion revascularization (TLR). With the advent of bare-metal stents, long and multiple stents were used to completely cover the diseased segments in order to improve outcomes. It has been shown that stenting of long coronary lesions (>20 mm) is related to significantly higher rates of TLR than more discrete lesions and  lesion  length   remained  an independent risk factor for restenosis. The risk was further increased by the multiplicity of implanted stents. Full-cover stenting of long lesions is likely to give rise to diffuse, malignant in-stent restenosis which may necessitate multiple additional PCI procedures and often bypass surgery. Thus, covering the lesion with the least number of non-overlapping stents might reduce the risks of restenosis. This strategy, called spot stenting,... (excerpt
Micro-RNAs: New Biomarkers and Novel Applications for Heart Disease Prevention and Treatment
Get PDFMicroRNAs (MiRNAs) have emerged as pivotal modulators of mammalian cardiovascular development and disease over the past few years. They represent a biological mechanism for regulating gene expression and consequently a broad range of physiological and pathological molecular processes. Importantly, multiple miRNAs have been implicated in heart disease onset and progression, whereas in the case of cardiac hypertrophy and heart failure, recent data are changing our perception of disease pathogenesis and therapeutics. This review presents the concept of miRNAs, mechanisms of generation, and representative examples of associations with cardiovascular disease pathogenesis and therapeutic potential
Significance of Hyponatremia in Heart Failure
Get PDFHyponatremia is a common clinical condition among hospitalized heart failure patients, related with increased morbidity and mortality. The pathophysiological mechanisms that relate heart failure with hyponatremia are complex, involving beyond renal dysfunction, neurohormonal activation, as well as diuretic treatment.The pituitary hormone vasopressin seems to play a central role leading to renal water retention and hyponatremia. Although therapeutic strategies (water restriction, hormone inhibition) have shown to increase serum sodium concentration and improve symptoms, no beneficial effect has been detected on clinical outcome. This fact, urges the need for the conduction of further clinical trials, in order to determine the real causality between short- and long-term outcome and serum sodium concentration in heart failure patients
Renal Angioplasty and Stenting: is it Still Indicated After ASTRAL and STAR Studies?
No full textA renal artery stenosis (RAS) is common among patients with atherosclerosis, up to a third of patients undergoing cardiac catheterization. Fibromuscular dysplasia is the next cause of RAS, commonly found in young women. Atherosclerosis RAS generally progresses overtime and is often associated with loss of renal mass and worsening renal function (RF). Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS according to ACC and AHA guidelines. Several randomized trials have shown the superiority of endovascular procedures to medical therapy alone. However, 2 studies ASTRAL and STAR studies were recently published and did not find any difference between renal stenting and medical therapy. But these studies have a lot of limitations and flaws as we will discuss. (poor indications, poor results, numerous complications, failures, poor technique, inexperienced operators .…
The Clinical Challenge of Predicting and Preventing Sudden Cardiac Death Immediately after Myocardial Infarction
Get PDFDespite many advances in treatment of myocardial infarction (MI) with percutaneous coronary intervention (PCI) and pharmacologic therapies, mortality immediately after MI remains high in patients with impaired left ventricular function. One of the greatest challenges facing the contemporary cardiologist is predicting and preventing sudden cardiac death (SCD) immediately after MI. Unfortunately, the trials assessing the role of the implantable cardioverter defibrillator (ICD) in patients at high risk for SCD immediately post MI have failed to show survival benefit. Current clinical guidelines restrict ICD implants to patients at least 40 days after MI with continued left ventricular dysfunction while on optimal medical therapy. It is evident that additional research is needed to identify strategies to prevent SCD and improve survival immediately after MI. In the meantime, clinicians should optimize and individualize therapy in the immediate post MI patient while carefully considering the risk of SCD and the competing risk of mortality from other causes
Comparing Novel Positron Emission Tomography Myocardial Perfusion Imaging with Conventional Single-Photon Emission Computed Tomography
Get PDFFor myocardial blood flow imaging, single-photon emission computed tomography (SPECT) technology is widely accepted by the cardiological community. It is supported by rich literature and has acceptable diagnostic accuracy. However it does have limitations with false positive studies especially in women and obese patients and underestimates the multivessel coronary disease. Positron emission tomography (PET) technology appears to be able to improve diagnostic accuracy in detecting coronary disease. It offers qualitatively better images with shorter acquisition times and lower radiation burden on patients and personnel. It has the advantage of absolute quantification of myocardial blood flow for multivessel coronary disease diagnosis and is superior in the assessment of myocardial viability. In absolute terms it is an expensive method but avoiding the cost of additional diagnostic tests in equivocal studies makes it cost effective. Its availability is improving and it is expected to help in advancing nuclear cardiology