scholarly journals Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Paula M. Jaramillo ◽  
Jaime A. Montoya ◽  
David A. Mejia ◽  
Salin Pereira Warr
Keyword(s):  
Ct Scan ◽  
Normal Sinus Rhythm ◽  
Penetrating Trauma ◽  
Cardiac Trauma ◽  
Nonsurgical Management ◽  
Normal Sinus ◽  
Standard Management ◽  
Asymptomatic Patients ◽  
Traumatic Lesions

Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT) scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established. Discussion. Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery. Conclusion. Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies.

Complications of the Mustard Operation

1986 ◽  
Vol 8 (4) ◽  
pp. 106-126
Keyword(s):  
Heart Block ◽  
Normal Sinus Rhythm ◽  
Venous Blood ◽  
Resting Heart Rate ◽  
Normal Sinus ◽  
Mustard Operation ◽  
Mitral Orifice ◽  
The Mean ◽  
Degree Heart Block

Eight pediatric cardiac centers pooled clinical and ECG data from 372 patients who survived the Mustard operation (intraatrial baffle directing pulmonary venous blood to the tricuspid orifice and systemic venous blood to the mitral orifice) for at least 3 months. The follow-up period ranged from 0.4 to 15.9 years, and the mean age at operation was 2 years. The mean resting heart rate for patients who had the Mustard operation was consistently lower than age-matched controls. During the year of operation, 76% of patients had normal sinus rhythm; this percentage declined yearly to 57% by the end of the eighth postoperative year. Active arrhythmias increased after the tenth year. Second or third-degree heart block occurred in 33% of patients during the year of operation and changed very little thereafter. Of the total 372 patients, 39 received pacemakers, 52% during the year of surgery and 48% evenly distributed throughout the follow-up period.

scholarly journals Bucindolol Decreases Atrial Fibrillation Burden in Patients with Heart Failure and the ADRB1 Arg389Arg Genotype

2021 ◽  
Author(s):  
Jonathan P. Piccini ◽  
Christopher Dufton ◽  
Ian A. Carroll ◽  
Jeff S. Healey ◽  
William T. Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Sinus

Background - Bucindolol is a genetically targeted β-blocker/mild vasodilator with the unique pharmacologic properties of sympatholysis and ADRB1 Arg389 receptor inverse agonism. In the GENETIC-AF trial conducted in a genetically defined heart failure (HF) population at high risk for recurrent atrial fibrillation (AF), similar results were observed for bucindolol and metoprolol succinate for the primary endpoint of time to first atrial fibrillation (AF) event; however, AF burden and other rhythm control measures were not analyzed. Methods - The prevalence of ECGs in normal sinus rhythm, AF interventions for rhythm control (cardioversion, ablation and antiarrhythmic drugs), and biomarkers were evaluated in the overall population entering efficacy follow-up (N=257). AF burden was evaluated for 24 weeks in the device substudy (N=67). Results - In 257 patients with HF the mean age was 65.6 ± 10.0 years, 18% were female, mean left ventricular ejection fraction (LVEF) was 36%, and 51% had persistent AF. Cumulative 24-week AF burden was 24.4% (95% CI: 18.5, 30.2) for bucindolol and 36.7% (95% CI: 30.0, 43.5) for metoprolol (33% reduction, p < 0.001). Daily AF burden at the end of follow-up was 15.1% (95% CI: 3.2, 27.0) for bucindolol and 34.7% (95% CI: 17.9, 51.2) for metoprolol (55% reduction, p < 0.001). For the metoprolol and bucindolol respective groups the prevalence of ECGs in normal sinus rhythm was 4.20 and 3.03 events per patient (39% increase in the bucindolol group, p < 0.001), while the rate of AF interventions was 0.56 and 0.82 events per patient (32% reduction for bucindolol, p = 0.011). Reductions in plasma norepinephrine (p = 0.038) and NT-proBNP (p = 0.009) were also observed with bucindolol compared to metoprolol. Conclusions - Compared with metoprolol, bucindolol reduced AF burden, improved maintenance of sinus rhythm, and lowered the need for additional rhythm control interventions in patients with HF and the ADRB1 Arg389Arg genotype.

scholarly journals Atypical chest pain in a young woman with an interatrial bronchogenic cyst

2021 ◽  
Vol 14 (4) ◽  
pp. e241736
Author(s):  
Essam Saad ◽  
Pooja Singh ◽  
Marc Iskandar
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Sinus Rhythm ◽  
Cardiac Mri ◽  
Bronchogenic Cyst ◽  
Normal Sinus Rhythm ◽  
Pathology Report ◽  
Atypical Chest Pain ◽  
Normal Sinus

A 31-year-old woman presented to the emergency department with atypical retrosternal chest pain and dyspnoea. Investigations initially revealed atrial flutter on her electrocardiogram and an interatrial septal mass on CT angiography of the chest. Additional workup with cardiac MRI and transoesophageal echocardiogram were able to delineate the cardiac mass. Electrophysiology and cardiothoracic surgery were consulted. The mass was excised in the same hospitalisation and the pathology report demonstrated a bronchogenic cyst. After mass excision, the patient chest pain has decreased, and she reverted back to normal sinus rhythm. On further follow-up, her flecainide and metoprolol were stopped.

scholarly journals MP08-01 RADIATION DOSE REDUCTION OF UNENHANCED CT SCAN LIMITED TO THE KIDNEYS FOR FOLLOW-UP OF ASYMPTOMATIC PATIENTS WITH KNOWN NEPHROLITHIASIS

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Noah Canvasser* ◽  
Liliya Klimkiv ◽  
Michael Corwin ◽  
Ramit Lamba ◽  
Thomas Loehfelm ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Ct Scan ◽  
Dose Reduction ◽  
Radiation Dose Reduction ◽  
Unenhanced Ct ◽  
Asymptomatic Patients

scholarly journals TO DETERMINE THE ROLE OF RANOLAZINE FOR RHYTHM CONTROL STRATEGY IN PATIENTS WITH NON- VALVULAR ATRIAL FIBRILLATION- AN OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTER. (RANOVA STUDY)

2020 ◽  
pp. 48-53
Author(s):  
Praveen Shukla ◽  
Awadhesh Kumar Sharma ◽  
Biswajit Majumder ◽  
Pritam Kumar Chatterjee ◽  
Vinay Krishna ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Control Strategy ◽  
Normal Sinus Rhythm ◽  
Rhythm Control ◽  
Normal Sinus ◽  
History Of ◽  
Group A ◽  
Group B

Objectives – Non- valvular atrial fibrillation (NVAF) is the most commonly occurring arrhythmia worldwide .Ranolazine is an emerging drug with a ray of hope in the management of NVAF. This is the first large observational study with longer follow up of one year. Methods - It is a hospital based observational prospective study. A total of 100 patients was recruited for the study .The primary objective was to determine the efficacy of ranolazine in converting NVAF to sinus rhythm & the secondary objective was to study epidemiological aspects of NVAF. Results –After 1 month of follow up conversion to normal sinus rhythm was 12% in group A & 6% in group B (6%), it was not significant statistically (Z=1.48p=0.13). After 6 months, conversion to normal sinus rhythm was increased from 12% to 18% in group A which was preserved at 12 months of follow up and statistically significant and higher than that of group B (6.0%) (Z=2.61p=0.009). In predisposing risk factors & other co-morbidities HTN was present in 61%, obesity together with overweight in 37%, smoking in 44%, history of moderate amount of alcohol intake in 35%, history of CVA/TIA in 13%, DM in 11%, CKD in 4%, CAD in 30%, COPD in 20% and congestive heart failure in 15% of the patients. Conclusion- Ranolazine is an effective option when used for rhythm control strategy in NVAF. HTN is the predominant predisposing risk factor.

Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
Y Ancedy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Tricuspid Regurgitation ◽  
Normal Sinus Rhythm ◽  
Integrated Approach ◽  
Pharmacological Therapy ◽  
Normal Sinus ◽  
Direct Current Cardioversion ◽  
Group A

Abstract Background The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed. Purpose Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus. Methods We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M. Results At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p&lt;0.001 for 2D ED TA diameter; ρ=0.34, p&lt;0.005 for 3D ES RA Vi; ρ=0.33, p&lt;0.005 for 3D ED RV Vi; ρ=0.29, p&lt;0.005 for 3D ES RV Vi). Conclusion Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted. TR Evolution Funding Acknowledgement Type of funding source: None

Patterns of Relapse and Value of Follow up Procedures in Patients with Diffuse Large B Cell Lymphoma (DLBCL) Who Achieve a Complete Remission (CR)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5306-5306
Author(s):  
Yasuhiro Oki ◽  
Dai Chihara ◽  
Yoshitoyo Kagami ◽  
Shouji Ine ◽  
Harumi Kato ◽  
...  
Keyword(s):  
Ct Scan ◽  
Median Time ◽  
Optimal Schedule ◽  
Elevated Serum ◽  
B Cell Lymphoma ◽  
Initial Diagnosis ◽  
Ct Scans ◽  
Imaging Studies ◽  
Asymptomatic Patients

Abstract Purpose: Optimal follow up schedule and choice of diagnostic modalities have not been well studied in patients with DLBCL who achieve CR after initial treatment. We analyzed patterns of relapse in patients with DLBCL who were treated with CHOP±R therapy and achieved CR in our institution between 1999 and 2007. We generally follow such patients with physical exam and blood tests including LDH every 3 months and CT scans every 3 to 6 months for the first two years. Follow up schedule varied afterwards. Patients and methods: Thirty-eight patients experienced relapse, in whom we first determined if relapse was detected by symptoms which prompted diagnostic processes such as imaging studies and/or biopsy or by prescheduled follow up blood test or systemic CT scans. Other characteristics of these patients including time from diagnosis to relapse, time from last systemic CT scan that showed no evidence of disease to relapse, and time from relapse to death were analyzed. Results: Twenty-seven patients (71%) presented with symptoms (“symptomatic patients”); 12 with palpable superficial masses, 5 with local pain, 5 with neurological symptoms due to central nervous system (CNS) involvement, 2 with persistent fever, 1 with gastrointestinal bleed, 1 with nasal congestion and 1 with persistent cough. Eleven patients (29%) were asymptomatic when relapse was detected (“asymptomatic patients”). Two showed elevated serum LDH levels which prompted imaging studies leading to the diagnoses. Nine were found to have relapsed diseases by prescheduled systemic CT scans. Among 27 symptomatic patients, 7 (18% of all relapses) had diseases that were not detectable by CT scans (5 isolated CNS relapses, 1 GI relapse, and 1 subcutaneous relapse in upper extremity). Patient characteristics at the time of initial diagnosis were similar in the two groups. Median time from initial diagnosis to relapse in symptomatic and asymptomatic patients were 11.9 months (range 3.8–98.1) and 12.5 months (range 7.2–50.7), respectively (p=0.635). Median time from last systemic CT scan to relapse were 2.9 months (range 0.1–33.0) and 5.2 months (range 1.9–10.8), respectively (p=0.895). Time from relapse to death of any cause were similar in the 2 groups (log-rank p=0.423) but the median time was longer in asymptomatic patients (16.6 months vs 39.8 months). Since late relapses potentially tend to be detected by symptoms due to infrequent CT scans, analyses were next limited only to those who relapsed within 2 years after diagnosis. The results were similar between symptomatic and asymptomatic group. Conclusions: This study showed that more than two thirds of patients were symptomatic at the time of relapse. And up to 18% of relapsed diseases were undetectable by routine CT scans. Half of “symptomatic” patients noticed their symptoms less than three months after last CT scan, suggesting that even every 3 months CT would miss these relapses before patients were symptomatic. Longer median survival (though the overall difference was not significant) in “asymptomatic patient” could be attributed in part to “early detection of relapse and intervention” but in contrast, asymptomatic patients might have had less aggressive diseases allowing prescheduled CT scans to detect the diseases before they are symptomatic. Important question is whether delaying detection of relapse and treatment till patient is symptomatic would be associated with worse clinical outcome. This question is also translated into whether routine CT scan is even necessary, and if so, what is the optimal schedule of imaging studies. Answers to these questions may depend on the estimated risk of relapse based on various prognostic factors. Larger scale studies are needed in this area.

scholarly journals The Association between Blunt Cardiac Injury and Isolated Sternal Fracture

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Anahita Dua ◽  
Jason McMaster ◽  
Pathik J. Desai ◽  
Sapan S. Desai ◽  
SreyRam Kuy ◽  
...  
Keyword(s):  
Normal Sinus Rhythm ◽  
Cardiac Injury ◽  
Sternal Fracture ◽  
Normal Sinus ◽  
Chest X Ray ◽  
Level I ◽  
Clinically Significant ◽  
The Uk ◽  
Sternal Fractures

The treatment of isolated sternal fractures (ISF) throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years) with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77) were admitted to hospital with 66% (58) of them discharged within 48 hours. Two (2%) patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63%) patients with only 2 (2%) having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7%) patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER.

scholarly journals NEW ONSET ATRIAL FIBRILLATION IN AN ELDERLY PATIENT PRESENTING WITH ACUTE DENGUE FEVER- A CASE REPORT

2021 ◽  
Vol 54 (1) ◽  
pp. 116-119
Author(s):  
Syeda Hira Naqvi ◽  
Ghulam Hussain Soomro
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patient ◽  
Dengue Fever ◽  
Normal Sinus Rhythm ◽  
Structural Heart Disease ◽  
Viral Diseases ◽  
Normal Sinus ◽  
Onset Atrial Fibrillation ◽  
New Onset

Dengue fever is a one of the most prevalent viral diseases transmitted by mosquitoes and may cause cardiac abnormalities such as AV blocks and ectopic ventricular beats. Atrial fibrillation, however, is not common. We report a case of an 81 year old female without any structural heart disease or comorbids, who presented with symptoms of atrial fibrillation 2 days after being diagnosed with Dengue fever. Rate controlling agents were given and a normal sinus rhythm was spontaneously achieved, which she maintained even on follow up 2 weeks later.

scholarly journals Non Double-Hit Diffuse Large B Cell Lymphoma Treated with R-CHOP Has Excellent Overall Survival If Interim Scan Shows Partial or Complete Response

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 10-10
Author(s):  
Philip Murphy ◽  
Siobhan Glavey ◽  
Oscar Breathnach ◽  
Philip W Murphy ◽  
Liam Grogan ◽  
...  
Keyword(s):  
Ct Scan ◽  
Stem Cell Transplant ◽  
Complete Response ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Asymptomatic Patients ◽  
Pet Ct ◽  
Pet Ct Scan ◽  
Large B Cell

R-CHOP chemoimmunotherapy is first line therapy for diffuse large B cell non Hodgkin lymphoma (DLBCL), although R-CHOP may be suboptimal treatment for some subtypes of DLBCL, in particular double-hit (DH) or triple-hit (TH) lymphoma. For assessment of response to chemoimmunotherapy, it has been proposed that PET-CT scan may be superior to CT scan and, in particular, demonstration of metabolic complete response (CR) by PET-CT scan at end of treatment (EOT) may be an important indicator of long term survival. However, the usefulness of follow up scans in asymptomatic patients remains debatable. We wished to assess the role of an interim CT or PET-CT scan (after 3-4 courses of chemoimmunotherapy) in predicting overall survival in patients at our centre with stage II- IV DLCBCL (Lugano Modification of Ann Arbor Classification) who received chemoimmunotherapy with curative intent. We also recorded results of scans at EOT and any further follow up scans. Between 1/7/15 and 1/7/19, 43 consecutive patients receiving R-CHOP had an interim CT or PET-CT scan. 3 of 4 patients with DH lymphoma by FISH testing changed to dose adjusted R-EPOCH after one course of R-CHOP. 39 patients had no evidence of DH, with 37 showing either partial response (PR) (N = 11) or CR (N=26) on interim CT or PET-CT scan. Of these 37 cases, one patient died of neutropenic sepsis, whilst 36 remain alive with 35 in complete remission. 30 of these 37 patients had CT scan and/or PET-CT scan at EOT: 27 were in CR, 2 were in stable PR and 1 patient (in CR on interim PET -CT scan) showed relapse on PET-CT scan. 16 patients in CR at EOT had 55 follow up surveillance scans (median 2, range 1-8) -two further relapses were detected on PET-CT scan, both 4 months after EOT. Two of the relapsed cases are in CR following further chemoimmunotherapy and allogeneic stem cell transplant whilst the other relapsed case is currently responding to further chemoimmunotherapy. 2 patients without evidence of DH showed disease progression on interim scan and were refractory to further chemotherapy, dying within 3 months and 18 months of diagnosis. All 4 patients with DH lymphoma had PR or CR at interim scan but relapsed within 5 to 8 months after diagnosis and proved chemotherapy refractory with death in 3. One patient with DH lymphoma remains in CR following local radiation and maintenance therapy with rituximab, lenalidomide and metformin. In our experience, patients with DLBCL, without DH or TH, who have evidence of response to R-CHOP at interim scan have an excellent prognosis. In this patient cohort, 85 EOT and follow up scans detected 3 relapses, suggesting that the detection rate of follow up scans in asymptomatic patients in this good prognosis group is low and of questionable usefulness. The 3 relapsed patients were readily salvageable by further chemoimmunotherapy with or without allogeneic stem cell transplant. In contrast, patients with DH lymphoma or evidence of disease progression on interim scan have very poor prognosis and urgently require alternative therapy approaches. Disclosures No relevant conflicts of interest to declare.

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