1,721,494 research outputs found
Exploring narratives to investigate doctor-patient relationship in the care path for genetic cardiomyopathies
No full textGenetic Cardiomyopathies are chronic diseases involving physical and psycho-social issues which imply the
need to involve the patient in care relationships with their doctors across all the life-span. For the present
study, consultations of 45 adult patients affected by cardiomyopathies (15 at their first consultation, 15 at
their 1-year follow up and 15 at 10-year follow-up) were audio-recorded, transcribed and coded considering
differences in doctors’ and patients’ roles in terms of word-count, type of questions and answers performed.
Results show that doctor narrative is prone to decrease from first consultation to both follow-ups (F(2,42)=
4.631; p=.01), with a lower level of anamnestic dialogue in follow-ups (F(2,42)= 4.055, p=.02). At the same
time, patients increase in follow-ups the number of questions to doctors (F(2,42)= 3.339, p=.04). The first consultation
acquires the meaning of a diagnostic meeting in which doctors narrate and ask more, preferring an
anamnestic script characterized by sequence of new questions. In this scenario, patients don’t find the space
to ask their doctors for explanations or clarifications. Follow-up visits, on the other hand, allow the patient
the opportunity to narrate their illness experience, acquiring an active role in care relationship
Letter regarding the article 'Heart failure with preserved ejection fraction: from mechanisms to therapies' by Lam and colleagues
No full textAntiarrhythmic efficacy of anakinra in a young patient with autoimmune lymphocytic myocarditis
No full textIL-1 inhibition with anakinra suppressed ventricular arrhythmias refractory to conventional therapies in severe myocarditis
Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin'
Full text linkThe implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at high risk of sudden cardiac death. The heterogeneity of clinical scenarios in HCM and the availability of ICDs with distinct characteristics emphasizes the need for selecting the right device for the right patient. There is growing awareness that unnecessarily complex devices can lead to short- and long-term complications without adding significant clinical benefits. Young patients have the greatest potential years of life gained from the ICD but are also most exposed to device-related complications. This increases the complexity of decision-making of ICD prescription in these often otherwise well patients in whom device selection should be tailored to preserve survival benefit without introducing morbidity. In the light of the multiple clinical phenotypes characterizing HCM, the present article offers evidence-based perspectives helpful in predicting the individual impact of the ICD and choosing the most appropriate device
From gene mutations to biomechanical abnormalities and electrophysiological remodeling in hypertrophic cardiomyopathy: exploring the translational approach.
Full text linkAbnormal balance of inward and outward ion currents in HCM ventricular cardiomyocytes determines a reduced lusitropic response to beta-adrenergic stimulation, due to insufficient APD and Ca2+ transient shortening. In HCM patients, this translates into exercise-induced QTc prolongation, TQ shortening and impaired diastolic reserve, contributing to reduced exercise tolerance. MYBPC3-related HCM showed increased long-term prevalence of systolic dysfunction compared to MHY7, in spite of similar outcome. This trend was subtended by an age-related decline in contractile performance in vitro in MYBC3 but not in MHY7 samples. Such observations suggest different pathophysiology of clinical progression in the two subsets and may prove relevant for understanding of genotype-phenotype correlations in HC
Microvascular Dysfunction in Hypertrophic Cardiomyopathy
Full text linkMyocardial ischemia is an established pathophysiological feature of hypertrophic cardiomyopathy (HCM) that impacts various clinical features, including heart failure (HF) and sudden cardiac death (SCD). The major determinant of myocardial ischemia in HCM is coronary microvascular dysfunction (CMD) in the absence of epicardial coronary artery abnormalities. Despite the impossibility to directly visualize microcirculation in vivo, a multimodality approach can allow a detailed assessment of microvascular dysfunction and ischemia. Accordingly, the non-invasive assessment of CMD using transthoracic Doppler echocardiography, positron emission tomography, and cardiac magnetic resonance should now be considered mandatory in any HCM patient. Noteworthy, a complete diagnostic work-up for myocardial ischemia plays a major role in the approach of the patients with HCM and their risk stratification. Chronic and recurrent episodes of ischemia can contribute to fibrosis, culminating in LV remodeling and HF. Ischemia can potentially constitute an arrhythmic substrate and might prove to have an added value in risk stratification for SCD. Accordingly, strategies for the early diagnosis of CMD should now be considered an important challenge for the scientific community
From Atrial Fibrillation Management to Atrial Myopathy Assessment: The Evolving Concept of Left Atrium Disease in Hypertrophic Cardiomyopathy
No full textCompetitive athletes with hypertrophic or dilated cardiomyopathy: sports eligibility according to the current Italian guidelines
No full textThe Italian Cardiological Guidelines (COCIS) for competitive sports eligibility aims to assist physicians in evaluating athletes with cardiovascular conditions. The primary objective is to balance the significant benefits of physical activity with the risks of sudden cardiac death (SCD) in competitive sports. Historically, the COCIS guidelines have adopted a cautious approach, influenced by Italy’s regulatory framework, which mandates a medical certificate for participation in competitive sports. The 2023 COCIS guidelines introduce significant advancements that enhance the evaluation process. These revised guidelines place a strong emphasis on personalized risk stratification. This approach enables physicians in specialized centers to make eligibility decisions based on an athlete’s individual risk profile. Consequently, athletes with a low-risk profile may now be eligible for all types of sports, marking a substantial shift from the 2017 guidelines, which restricted even low-risk patients to low-intensity sports. On the other hand, the 2023 COCIS guidelines further reinforced some traditional concepts of the athlete’s cardiovascular evaluation that have been the basis for an appropriate interpretation of clinical findings and the reduction of SCD in competitive athletes. This review critically examines the 2023 COCIS guidelines, focusing on their advancements compared to the 2017 edition and exploring their alignment with international standards, including the European Society of Cardiology and the American College of Cardiology recommendations
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