1,721,156 research outputs found
Cost-effectiveness of transthyretin cardiac amyloidosis screening and treatment: A Dilemma for the clinician
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Safety and Tolerability of Neurohormonal Antagonism in Cardiac Amyloidosis
No full textBackground: Drugs for neurohormonal antagonism are usually denied to patients with cardiac amyloidosis (CA) because of safety concerns. Methods: Patients diagnosed with CA at a tertiary referral centre from 2009 to 2019 were enrolled. In the absence of contraindications, beta-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB), and mineralocorticoid receptor antagonists (MRA) were started or up-titrated. Results: 99 patients were evaluated (72% men, age 80 years [72,83], 33% light-chain and 67% transthyretin amyloidosis); 56% were started on or underwent up-titration of a beta-blocker, 25% of ACEi/ARB, and 39% of MRA; beta-blockers were then prescribed to 87% of patients, ACEi/ARB to 75%, and MRA to 63%, with median bisoprolol, ramipril, valsartan, and spironolactone daily equivalent doses of 2.5 mg, 5 mg, 80 mg, and 25 mg, respectively. Patients starting or starting/up-titrating a beta-blocker did not show a higher frequency of hypotension, fatigue, syncope, symptomatic bradycardia, need for pacemaker implantation, or HF hospitalization. Lower stroke volume and cardiac output (CO) predicted HF hospitalization regardless of amyloidosis type; lower left ventricular ejection fraction predicted hypotension, and lower CO and diastolic blood pressure predicted syncope. Patients who had an ACEi/ARB or MRA being started or up-titrated did not experience more adverse events than other patients. Conclusions: ACEi/ARB and MRA can be safely used in CA, provided that no contraindications are present, treatment is started at a low dose and slowly up-titrated, and patients are monitored quite closely. Beta-blocker therapy is less tolerated in patients with AL amyloidosis and/or worse haemodynamic function
Update sui biomarcatori nello scompenso cardiaco.
No full textHeart failure (HF) represents the final common pathway of cardiovascular diseases. Prognosis of HF remains dismal despite a better understanding of its pathophysiology and advances in diagnostics and therapeutics. HF is a complex syndrome, with an extensive influence on vital organ perfusion and function resulting from hemodynamic alterations and with marked arrhythmogenicity, following the development of structural abnormalities and adrenergic activation. Therefore, current clinical and instrumental approach to the HF syndrome should be complemented by novel decision-making strategies, with potential in early diagnosis as well as in prognostication and therapeutic definition. In this view, there is growing experimental and clinical interest in the use of biomarkers, namely B-type natriuretic peptides, whose role in diagnosis, risk stratification and patients' follow-up is well recognized. A new targeted approach is envisaged in the next future for the management of the heterogeneous clinical phenotype of HF, likely based on biomarker tracking specific pathophysiologic pathways of disease progression
Self-Inserted Needles in the Heart
No full textCardiac injuries due to penetration by sharp foreign bodies usually have a clear clinical presentation. A case of a 38-year-old man with self-inserted cardiac lesions and a misleading presentation is reported. The patient was admitted to the emergency room because of chest pain, with increase in biomarkers of myocardial necrosis, and electrocardiographic and echocardiographic abnormalities inducing initial diagnostic and therapeutic workup of acute coronary syndrome. Once clinical destabilization followed by death had occurred, the suspicion of an alternative diagnosis came from delayed chest radiography, confirmed by autopsy, revealing the presence of multiple metallic objects within the thora
Correction of procedural arterial pseudoaneurysms: Established and novel procedures
No full textPseudoaneurysms are common complications of interventional cardiovascular procedures and represent a significant burden for patients and for health-care systems. Ultrasound-guided thrombin injection is nowadays considered as the treatment of choice for iatrogenic pseudoaneurysms without indication to surgery, but accepted guidelines are currently lacking. In recent years, several novel therapeutic approaches have been suggested, often as limited, single-center experiences. In the present review, the authors focus on promising techniques that may represent an alternative to ultrasound-guided thrombin injection, further reducing the need for surgical treatment. © Informa UK, Ltd
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