scholarly journals Cardiac Sarcoidosis Culminating in Severe Biventricular Failure

2009 ◽  
Vol 2009 ◽  
pp. 1-3
Author(s):  
Takefumi Ozaki ◽  
Noritomo Ohnuma ◽  
Norihiro Shimizu ◽  
Atsushi Hasegawa ◽  
Masashi Horimoto
Keyword(s):  
Cardiac Sarcoidosis ◽  
Posterior Wall ◽  
Myocardial Scintigraphy ◽  
Epithelioid Cell ◽  
Right Atrial ◽  
Lv Function ◽  
Exertional Dyspnea ◽  
Epithelioid Cell Granuloma ◽  
Conventional Medical Therapy ◽  
Biventricular Failure

A 59-year-old woman with a history of lung sarcoidosis developed general edema and exertional dyspnea. An electrocardiogram showed first-degree atrioventricular block with complete right bundle branch block. Chest X-ray showed cardiomegaly. Echocardiography showed diffuse and severe hypokinesis of the left ventricle (LV) and biventricular enlargement with severe tricuspid regurgitation. Myocardial scintigraphy disclosed a perfusion defect at the ventricular septum and hypoperfusion at the posterior wall and the apex. On cardiac catheterization, pulmonary capillary wedge pressure, right ventricular, and right atrial pressures were elevated. Coronary angiograms were normal. Myocardial biopsy of the right ventricle histologically revealed epithelioid cell granuloma with infiltration of fibrous cells. The patient's symptom and LV function were improved with conventional medical therapy for heart failure. This is a rare case of cardiac sarcoidosis resulting in biventricular failure.

scholarly journals CMR Features in Cardiac Sarcoidosis

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Sparsh Prasher ◽  
Phong T. Lee ◽  
Marc Dweck ◽  
John R. Payne
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Signs And Symptoms ◽  
Epithelioid Cell ◽  
Unknown Aetiology ◽  
Epithelioid Cell Granuloma ◽  
Organ Systems ◽  
Diagnostic Difficulties ◽  
Life Threatening

Sarcoidosis is a multisystemic disorder of unknown aetiology characterised by the formation of noncaseating epithelioid cell granuloma involving various organ systems. Cardiac involvement has an important prognostic factor as it can present with life-threatening arrythmias and sudden death. Here, we present a case of cardiac sarcoidosis in a 46-year-old gentleman who presented with nonspecific signs and symptoms. We also discuss diagnostic difficulties especially when cardiac involvement is the only clinical sign. In this case, cardiac magnetic resonance (CMR) played an important role in the diagnosis and followup of our patient.

Right Ventricular Assist Device Therapies

2020 ◽  
pp. 215-220
Author(s):  
Adrian Alexis-Ruiz ◽  
Marisa Cevasco
Keyword(s):  
Right Ventricular ◽  
Ventricular Assist Device ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Right Atrial ◽  
Lv Function ◽  
Assist Device ◽  
Ventricular Assist ◽  
Biventricular Failure ◽  
Right Ventricular Assist Device

This chapter discusses right ventricular assist device (RVAD) therapies. Current RVAD options include the Impella Right Peripheral, the Tandem Heart, the Protek Duo system, and a surgically placed CentriMag RVAD. Important considerations when choosing a device include operator familiarity, the need for an oxygenator, the availability of a surgeon, and specific contraindications such as severe tricuspid regurgitation, an occluded internal jugular vein, or the presence of an inferior vena cava filter. It is important to consider the hemodynamic effects on the left ventricle (LV) after placement of an RVAD. Identifying biventricular failure early is critical when RVAD implantation is considered. RVADs reduce right atrial pressure, increase flow through the pulmonary arteries, and increase LV preload and wedge pressure. This change in preload may worsen LV function and cause pulmonary edema in patients with LV failure. LV assist device revolutions per minute may need to increase after placement of an RVAD to manage increased flow to the LV. Ultimately, assessing changes in oxygen saturation, blood pressure, and echocardiographic indices can guide hemodynamic management of RVAD therapy.

scholarly journals The effects of doxorubicin on left and right atrial mechanics in patients with lymphoma

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Vahabi ◽  
E Kharati-Koopaei ◽  
M Stewart ◽  
H Hancock ◽  
M Norouzi ◽  
...  
Keyword(s):  
Strain Rate ◽  
Left Atrial ◽  
Left Ventricular ◽  
Right Atrial ◽  
Lv Function ◽  
Compensatory Mechanism ◽  
Research Association ◽  
Anthracycline Cardiotoxicity ◽  
Diastolic Strain Rate ◽  
Significant Change

Abstract Background Despite the associated dose-dependent cardiotoxicity, anthracyclines continue to form the backbone of modern chemotherapy regimens. Speckle Tracking Echocardiography (STE) has been a popular method of quantifying cardiac function but most studies have focused on left ventricular function. Research into the effects of anthracyclines on left atrial (LA) and right atrial (RA) function continues to be neglected. Purpose To investigate the effects of doxorubicin, a commonly used anthracycline, on both the LA and RA systolic and diastolic strain and strain-rate parameters in two groups of patients with lymphoma: Group 1 (G1) with a conventional drop in ejection fraction (EF <53%), and Group 2 (G2) without. Methods We retrospectively studied 46 patients treated for lymphoma between 2015 and 2018; G1 (n=12) and G2 (n=34). Echocardiograms performed at baseline (T0), mid-chemotherapy (T1), and post-chemotherapy (T2), were analysed by using offline vendor-independent software (TomTec, 2D Cardiac Performance Analysis). Using 2D STE, LA and RA reservoir, conduit and contractile strains, systolic and diastolic strain-rates were measured. Multi-level longitudinal model was used for statistical analysis.This study was ethically approved by the Health Research Association (REC Reference 18/SS/0139). Results Median age was 64 years (IQR 51–74 years) in G1, and 65 years (IQR 57–73 years) in G2. In G1, there was no significant change in LA reservoir strain with time, however a significant decline with an average mean difference of −7.52 was seen between T0 to T2 (p=0.016) in G2. LA conduit strain did not significantly change in either group with incremental doses of doxorubicin. However, LA contraction strain was seen to significantly increase in G1 between T1 to T2 (p=0.045) with an average change of 7.23. LA peak systolic strain rate, and late diastolic strain rate did not show any significant change with time in both groups. Yet, a significant increase was seen in LA early diastolic strain rate between T0 to T2 (p=0.017) in G1 but not G2. No significant changes were seen in the RA strain parameters in both groups. Conclusion In patient with a reduction in LV function, a significant change was noted in the left atrial contraction strain and early diastolic strain rate with incremental doses of doxorubicin. These changes shows the close relationship between the LA and LV, and the importance of LA in providing a compensatory mechanism for a decline in LV function secondary to anthracycline cardiotoxicity. Funding Acknowledgement Type of funding source: None

Abstract 15172: Murf1 Inhibitor Embl205 is a New Approach for Treatment of Heart Failure With Preserved Ejection Fraction in an Animal Model

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anett Jannasch ◽  
Antje Schauer ◽  
Virginia Kirchhoff ◽  
Runa Draskowsi ◽  
Claudia Dittfeld ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Pressure ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Skeletal Muscle Atrophy ◽  
Lv Function ◽  
Preserved Ejection Fraction ◽  
The Impact ◽  
Peak Gradient

Background: The novel MuRF1 inhibitor EMBL205 attenuates effectively developing skeletal muscle atrophy and dysfunction in animals with heart failure with preserved ejection fraction (HFpEF, ZSF1 rat model). The impact of EMBL205 on myocardial function in the HFpEF setting is currently unknown and was evaluated in ZSF1 rats. Methods: 20 wks-old female obese ZSF1 rats received EMBL205 (12 wks, conc. of 0.1% in chow; HFpEF-EMBL205). Age-matched untreated lean (con) and obese (HFpEF) ZSF1 rats served as controls. At 32 wks of age left ventricular (LV)-, aortic valve (AV) function and LV end diastolic pressure (LVEDP) was determined by echocardiography and invasive hemodynamic measurements. LV expression of collagen 1A (Col1A) and 3A (Col3A) was assessed by qRT-PCR, MMP2 expression was obtained by zymography and perivascular fibrosis was quantified in histological sections. Results: Development of HFpEF in ZSF1 obese animals is associated with cardiac enlargement and hypertrophy, as evident by increased myocardial weight, an increase in end diastolic volume (EDV) and LV anterior and posterior wall diameters. Diastolic LV-function is disturbed with elevation of E/é, an increased LVEDP and a preserved LV ejection fraction. AV peak velocity and peak gradient are significantly increased and AV opening area (AVA) significantly decreased. Col1A and Col3A expression are increased in HFpEF animals. EMBL205 treatment results in a significant reduction of myocardial weight and a trend towards lower EDV compared to HFpEF group. EMBL205 attenuates the increase in E/é, LVEDP, AV peak gradient and the decrease of AVA. EMBL205 significantly reduces Col3A expression and a trend for Col1A expression is seen. Increased perivascular fibrosis and MMP2 expression in HFpEF is extenuated by EMBL205 treatment (table 1). Conclusions: Application of EMBL205 attenuated the development of pathological myocardial alterations associated with HFpEF in ZSF1rats due to antifibrotic effects.

P1349 POCUS by general and family physician - advancing physical examination

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Dos Santos ◽  
P Fernandes ◽  
F Rocha Goncalves ◽  
P Pereira Rodrigues ◽  
J Ribeiro ◽  
...  
Keyword(s):  
Image Quality ◽  
Inferior Vena ◽  
Color Doppler ◽  
Interventricular Septum ◽  
Vena Cava ◽  
Posterior Wall ◽  
Aortic Insufficiency ◽  
Lv Function ◽  
Mitral Insufficiency ◽  
Patients With Diabetes

Abstract BACKGROUND Alongside with the development of hand held equipment, echo is becoming more accessible to nontraditional settings. General and family medicine (GPs) are at the forefront of any health system, but the use of cardiac echo by GPs is still unexplored. PURPOSE: This study aims to evaluate the accuracy of echocardiography assessment performed as an extension of the physical exam by GPs. METHODS: Two GPs underwent standard echocardiography training for 6 months. Subsequently, patients with diabetes or arterial hypertension were submitted to an echocardiogram performed by their GPs using a pocket ultrasound. Views obtained (with and without color Doppler) were parasternal long and short axis, apical and subcostal, with measurements of the posterior wall (PW), interventricular septum (IVS), left ventricle (LV), left atrium (LA), aorta and inferior vena cava (IVC). Studies were reviewed at the workstation and measured by two experts who classified the exams according to the image quality. RESULTS: Sixty echocardiograms were analyzed (mean age of 61y, 42% females and 58% males). In 50% the image quality was considered sufficient, 42% considered good and 8% considered bad. There were statistically significant differences between the GPs and expert measurements on the sinus of Valsalva (30.3 ± 3 to 28.8 ± 3.1mm, p = 0.001), LV in systole (p < 0.001, 28[24,31] for 31[29,34]mm), IVS (p = 0.001, 10.9 ± 1.7 for 10.1 ± 1.5mm), PW (p = 0.018, 8.7 ± 1.1 to 9.2 ± 1.6mm) and TAPSE (p = 0.021, 20.9 ± 2.3 to 20.1 ± 2.7mm). There were no significate differences in the measurements of the ascending aorta, LA, LV in diastole and IVC. Agreement between the GPs and the experts was moderate for the evaluation of LVH (k = 0.48). The concordance was substantial for evaluation of LV function (k = 0.66) and excellent for evaluation of pericardial effusion (k = 1) and right ventricular function (k = 1). Concordance was excellent for mitral insufficiency (k = 0.83) and substantial for aortic insufficiency (k = 0.68) and tricuspid insufficiency (k = 0.61). A case of mitral stenosis was identified by both. GPs signalized a case of mild aortic stenosis that the expert did not consider. CONCLUSION: GPs trained in echocardiography, using pocket ultrasound, can obtain cardiac images with sufficient quality for interpretation by experts in the majority of cases. In this study, differences in dimensions might be explained by interobserver variability and/or by the performance of measurements in different environments, mobile vs workstation. Overall the differences were minor and clinically meaningless.

Insight form cardiovascular magnetic resonance on cardiac sarcoidosis: a single centre experience

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Alderighi ◽  
A Baritussio ◽  
O Ozden Tok ◽  
M Perazzolo Marra ◽  
S Iliceto ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
T1 Mapping ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
T2 Mapping ◽  
Left Ventricular ◽  
Lv Function ◽  
Post Contrast ◽  
Lv Volumes

Abstract Background Clinically manifest cardiac sarcoidosis (CS) has a prevalence of 5%, but is more frequent in autoptic series (25%). Diagnosis is multiparametric and relies on clinical criteria and imaging findings, although a certain diagnosis, especially in the case of isolated CS (ICS), can only be based on endomyocardial biopsy. Cardiovascular magnetic resonance (CMR) has a comprehensive role in the assessment of CS: left ventricular (LV) dysfunction and extent of late gadolinium enhancement (LGE)are important predictors of prognosis, T2 mapping provides information on disease activity and global longitudinal strain (GLS) analysis can uncover subclinical LV impairment. Purpose To assess the prevalence of CS by CMR in patients with biopsy-proven extracardiacsarcoidosis (ECS); to describe the imaging characteristics of patients with ECS and those with high clinical suspicionof ICS; to investigate the contribution of more recent techniques to the diagnosis of CS alongside traditional LGE assessment. Methods We retrospectively enrolled 84 patients (66% males, mean age 59±13 years) referred to our centreforsuspected CS (biopsy-proven ECS, n=61; clinical presentation suggestive of CS,, n=23). CMR was performed on a 1.5T scanner, with a protocol comprehensive of biventricular functional assessment and post-contrast images; T2-STIR images (n=30), native myocardial T1 mapping (n=24) and T2 mapping (n=19) were also performed in selected patients. Tissue tracking analysis was perfomed in all patients using a dedicated software. Results Based on CMR findings, 35 patients (42%) with ECS did not show cardiac involvement (SS), 26 (31%) showed both cardiac and systemic involvement (CS-SS) and 23 (27%) had evidence of ICS (ICS). 43% of patients had history of arrhythmias, but life-threatening tachyarrhythmiaswere more frequent in patients with CS (p=0.02).Patients with CS had significantly lower LVEF (p<0,01), larger LV volumes (p<0,01) and greater LV mass (p<0,01). GLS values were impaired in all the groups but significantly more in patients with CS (p<0,01). With regards to LGE distribution, ICS patients showed a higher number of segments involved (p=0,011) as compared to CS patients. T2-STIRimages were positive in 3 out of 30 patients; T2 mapping detected myocardial oedema in 1 patient with negative T2- STIR and was positive in 7 who did not undergo traditional oedema evaluation. T1 mapping mainly confirmed the results provided by LGE, but was altered in 1 patient who could not receive gadolinium. Conclusions CMR findings consistent with CS were found in 49 patients referred for suspected CS. Patients with cardiac involvement, particularly if isolated, had significantly lower LVEF, greater LV volumes and more impaired GLS. Patients with SS, despite a normal LV function, showed mildly impaired GLS, subtending subclinical cardiac involvement. Funding Acknowledgement Type of funding source: None

scholarly journals WCC 2016-112: A case of varied presentation of thrombus

2016 ◽  
Vol 01 (S 01) ◽  
pp. S13-S14
Author(s):  
Ravi Kiran
Keyword(s):  
Antiphospholipid Syndrome ◽  
Pulmonary Thromboembolism ◽  
Lower Limbs ◽  
Histologic Examination ◽  
Right Atrial ◽  
Lv Function ◽  
Shortness Of Breath ◽  
Atrial Mass ◽  
Right Atrial Mass ◽  
History Of

AbstractAntiphospholipid syndrome is a well defined entity that is characterized by spontaneous abortion, thrombocytopenia, and recurrent arterial and venous thromboses. A right atrial thrombus mimicking myxoma with pulmonary thromboembolism in a patient with secondary antiphospholipid syndrome is rare.Herein, we describe the case of a 35 year old woman who was admitted to the hospital with shortness of breath, swelling of both lower limbs. Transthoracic and transesophageal echocardiography showed a right atrial mass suggestive of myxoma, and the patient subsequently underwent surgery. A histologic examination of the mass showed myxoma. In our patient, the preoperative investigations could not differentiate the thrombus from a myxoma, and she was operated in outside hospital. Later she presented with deep vein thrombosis and pulmonary thromboembolism to our hospital and was diagnosed as having secondary antiphospolipid syndrome and the review sides of the right atrial mass showed thrombus. Intracardiac thrombus has been rarely reported as a compication of antiphospholipid syndrome. Case report: In December 2015, a 35 year old woman was admitted to the hospital with swelling of both lower limbs since 15 days, shortness of breath since 15 days. She had a past history of acute left upper limb ischemia in 15/4/2013 for which catheter directed thrombolysis of brachial artery was done with steptokinase, coronary angiogram showed normal coronaries. History of cervical TB lymphadenitis for which she used ATT for 9 months in 2013. History of excision of right atrial myxoma was done on 3/11/15 at outside hospital. Histologic examination showed myxoma. Patient has pallor and bilateral pedal odema on general examination. At admission vitals were stable and systemic examination was normal except for raised jugular venous pressure. ECG showed T inversions in leads V 3-6, II, III, aVF. 2D ECHO showed dilated RA/RV severe TR, moderate PAH, RVSP 50 mm of Hg, TAPSE 1.3, good LV function, mild RV dysfunction, mobile thrombus at the junction of middle hepatic vein & IVC. CTPA showed saddle thrombus in PA extending into RPA, multiple collaterals in anterior & posterior chest wall with non visualisation of part of left subclavian vein.

Case of tuberculosis cutis miliaris with epithelioid cell granuloma

2013 ◽  
Vol 40 (12) ◽  
pp. 1062-1063
Author(s):  
Takayuki Kimura ◽  
Makoto Sugaya ◽  
Hitomi Yokobayashi ◽  
Takeshi Tamaki
Keyword(s):  
Epithelioid Cell ◽  
Epithelioid Cell Granuloma
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