Journal of Cardiology & Current Research最新文献

{"title":"Using A 21-Year Real-World Database from a Private Cardiologist's Practice to Test the Hypothesis that Combining Pharmacological Therapies (Carvedilol, Spironolactone and Statins) with Weight Loss May Benefit Patients with HFpEF","authors":"","doi":"10.36879/jcr.20.000133","DOIUrl":"https://doi.org/10.36879/jcr.20.000133","url":null,"abstract":"Heart Failure with preserved Ejection Fraction (HFpEF) is a clinical syndrome in which patients have symptoms of Heart Failure (HF), such as\u0000dyspnea and fatigue, a Left Ventricular Ejection Fraction (LVEF) ≥ 50% and evidence of cardiac dysfunction as a cause of symptoms, such as\u0000abnormal Left Ventricular (LV) diastolic dysfunction with elevated filling pressures. Besides LV diastolic dysfunction, recent investigations\u0000suggest a more complex and heterogeneous pathophysiology, including systolic reserve abnormalities, chronotropic incompetence, stiffening of\u0000ventricular tissue, atrial dysfunction, secondary Pulmonary Arterial Hypertension (PAH), impaired vasodilatation and endothelial dysfunction.\u0000Unlike Heart Failure with Reduced Ejection Fraction (HFrEF), clinical trials over the years have not yet identified effective treatments that\u0000reduce mortality in patients with HFpEF. A database on use of carvedilol in a private cardiologist's practice was begun in 1997 and concluded at\u0000the end of 2018. We used this database to test the hypothesis that combining pharmacological interventions to address diastolic dysfunction\u0000(carvedilol), volume overload (spironolactone/eplerenone) and endothelial dysfunction (statins) with weight loss may benefit patients with\u0000HFpEF. We report analysis of 335 patients with HFpEF comprised of 61% female (mean age 74 ± 8) and 39% males (mean age 72 ± 7). Initial\u0000EF ranged between 50 and 77% with mean EF of 57 ± 6%. Only 15 patients were changed to metoprolol succinate, verapamil or diltiazem\u0000because of adverse side effects. Two hundred and twenty of the patients were in normal sinus rhythm when started on carvedilol,\u0000spironolactone/eplerenone and statin therapy with weight loss counseling. After 5 years, 191 patients were still on combination therapy, and only\u000031 (17%) had developed Atrial Fibrillation (AF). Compared to previous HFpEF trials reporting a 32% risk of developing atrial fibrillation after\u00004 years, our combination therapy significantly (p < 0.05) reduced the risk of developing AF over 5 years. Thus, irrespective of age and sex with\u0000comorbidities of type 2 Diabetes Mellitus (DM) and Chronic Kidney Disease (CKD), patients with HFpEF can be managed successfully with\u0000carvedilol, spironolactone/eplerenone and statins with a clinical benefit being a reduced risk of developing AF. We consider these data\u0000hypothesis-generating and hope these results will be tested further in database analyses and clinical trials.","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"223 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87936306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe acute myocarditis due to scorpion envenoming: unusual presentation in adults","authors":"Glenda Alves de Sá, Cássia Souza F Vale, M. Oliveira","doi":"10.15406/JCCR.2020.13.00480","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00480","url":null,"abstract":"A 21-year-old healthy woman presented to emergency department complaining of severe gluteus pain and progressive dyspnea about one hour after domestic accidental “black scorpion” sting. Despite early scorpion antivenom administration, advanced airway and intensive critical care were promptly required, due to refractory acute respiratory failure (ARF), endorsed by a critical PaO2/ FiO2 of 48. Chest computed tomography revealed diffuse bilateral infiltrates and air bronchograms compatible with acute respiratory distress syndrome. Cardiac troponin levels continuously rose. Initial transthoracic echocardiogram (TTE) revealed diffuse hypokinesia causing moderate left ventricle (LV) systolic dysfunction – rest LV ejection fraction (LVEF) of 0.39 (Simpson ́s method) (Figure 1). Inotrope at low doses (dobutamine 5mcg/kg/min) was then initiated. Follow-up (ninth day) TTE (Figure 2) and cardiac magnetic resonance (CMR) imaging endorsed reversal of initial contractile dysfunction. At eleventh day patient was uneventfully discharged home.","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87972985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erythropoietin role in the therapeutic management of heart failure patients with anemia","authors":"O. Centurión, J. Caceres","doi":"10.15406/JCCR.2020.13.00479","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00479","url":null,"abstract":"The introduction of beta adrenergic blockers associated with angiotensin converting enzyme (ACE) inhibitors in the treatment of HF led to a significant improvement in prognosis.11–13 The benefit obtained with beta-adrenergic blockers encouraged the search for new drugs that not only more completely block the activation of the reninangiotensin and sympathetic systems, but also allow modulating other activated phenomena in heart failure, such as inflammation and endothelial dysfunction.14 However, in recent years we have found that multiple studies analyzing the benefit of new drugs obtained controversial results. From new ACE inhibitors, endothelin and tumor necrosis factor alpha inhibitors, and the same angiotensin receptor antagonists that have brought benefits, but far below the expectations created. This indicates that there is probably no additional benefit to be gained by trying to increase the blockage of circulating neurohormones; in fact, some authors have suggested that this pathway has been exhausted and other therapeutic options must be sought.15 Current guidelines on heart failure recommend the use Sacubitril/ Valsartan (S/V), an angiotensin receptorneprilysin inhibitor, in replacement of the renin–angiotensin–aldosterone system inhibition in ambulatory patients with HF and reduced ejection fraction still symptomatic despite optimal medical therapy.16 This recommendation comes from a single randomized study named PARADIGM-HF trial, which showed the superiority of Sacubitril-Valsartan compared to Enalapril in reducing the incidence of cardiovascular death or hospitalizations for HF.17 Nevertheless, despite the improvements in clinical management and medical therapy of HF, the outcome of these patients still remains poor.18 The persistence of significant ventricular remodeling despite optimized medical treatment has been associated with a poorer prognosis in heart failure. In this sense, possible interventions to cut the signals that activate the mechanisms that mediate progressive ventricular remodeling are being investigated in recent years. Despite the effort made, there is still a long way to go before it can become a reality that allows newer drugs to be generated.19 The lack of effective new treatments has led to a deeper analysis of the factors that affect the prognosis of heart failure, and anemia is one of them. Increasing attention is paid to anemia in patients with HF due to the relationship it has with its prognosis, which, despite all the treatments that have been used in HF, continues to be poor.5,6 This relationship had previously been observed by several authors, both in terms of mortality and the need for new hospital admissions for HF. Furthermore, this association has been observed in hospitalized and outpatients. In fact, anemia is usually frequent in patients with HF in advanced stages of the disease. There is no doubt that correcting anemia can improve symptoms by correcting the oxygen supply to the tissues. Treatm","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81526666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coarctation of the aorta: a misdiagnosed cause of hypertension","authors":"J. B. Oliveira, C. Germano, J. Roda, T. Quinaglia","doi":"10.15406/JCCR.2020.13.00477","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00477","url":null,"abstract":"Clinically, patients may remain asymptomatic for years, although up to half may present lack of lower limbs pulse, typical systolic-diastolic murmur and an increased pressure gradient by echocardiography, which is required for the diagnosis. This method allows measuring the aortic gradient, but eventually a computed tomography angiography (CTA) of the aorta may be also necessary. Treatment involves clinical management of hypertension and heart failure symptoms, followed by surgical or balloon angioplasty for the correction of the narrowed segment. Though the surgical correction is often successful, life-long clinical and echocardiographic follow-up is required as re-coarctation occurs in one-third of patients.","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82012981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and angiographic characteristics of young Egyptian women with acute coronary syndromes","authors":"Timoor Hassan, A. Alaarag, Mahmoud Abuomar","doi":"10.15406/JCCR.2020.13.00476","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00476","url":null,"abstract":"Introduction: Although acute coronary syndrome (ACS) mainly occurs in individuals >50years, younger adults can be affected as well. Young patients represent 2-10% of patients with ACS, most of them are men while women constitute about 25% of this population. Methods : Patients with ACS <45years were included and were subjected to history taking, clinical examination, ECG, echocardiogram, and lab investigations including cardiac enzymes, renal functions, complete blood count, lipid profile, blood sugar, complete liver functions. Invasive management or medical management was determined depending on the diagnosis of the patient, his condition and the decision of the attending physician. For patient who underwent coronary angiography, decision of PCI and stenting and whether culprit lesion or complete revascularization was left for the operator. Results : The study included 306 men and 92 women. There was no significant difference regarding hypertension, dyslipidemia, family history of ischaemic heart disease or chronic kidney disease. Diabetes was significantly higher in women (40.2%) and body mass index was higher in women while smoking was significantly higher in men (66%). STEMI was more in men and unstable angina more in women. Conclusion : In Egyptian women with ACS, they have more incidence of diabetes and higher BMI compared to men with less incidence of smoking. They present more with unstable angina compared to more STEMI in men.","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80290783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial dysfunction in metabolic syndrome patients with and without hypertension","authors":"R. Garcia, C. Bermúdez, Joseph A. Manfredi, M. Gutierrez","doi":"10.15406/JCCR.2020.13.00475","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00475","url":null,"abstract":"","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"1 1","pages":"55-58"},"PeriodicalIF":0.0,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75392218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on the Dynamic Changes in Chest CT Findings of COVID-19 Rehabilitated Patients","authors":"","doi":"10.36879/jcr.20.000132","DOIUrl":"https://doi.org/10.36879/jcr.20.000132","url":null,"abstract":"Objective: To study the dynamic changes in CT findings in COVID-19 (coronavirus disease-19, COVID-19) rehabilitated patients.\u0000Methods: A total of 148 chest CT images of 37 patients with COVID-19 were collected. In the first 21 days of the course of disease, 7 stages were\u0000performed every 3 days, and the eighth stage was performed after 21 days.\u0000Results: In the first chest CT examination, 19 cases were ground glass opacity, and 18 cases were high-density shadows with consolidation. The\u0000lesion shape was flaky and patchy in 33 cases. The percentage of consolidation, air bronchogram, fiber cord, interlobular septal thickening,\u0000subpleural line and pleural thickening were the highest on days 4-6, 7-9, 7-9, 10-12, 19-21 and 19-21, respectively. The highest percentage of\u0000disease progression was 80.00% on days 4-6, and then the percentage of disease progression gradually decreased with the extension of the onset\u0000time. The percentage of patients with improvement gradually increased from days 4-6, reaching 83.33% on days 16-18 and 100.00% on day 21.\u0000The percentage of lesion range enlargement and density increase was the highest on days 4-6, both of which were 60.00%，Then the percentage\u0000of both decreased gradually. The percentage of patients with lesion range reduction and density absorption dilution increased gradually with the\u0000onset time. There was no obvious regularity in the number of lesions.\u0000Conclusion: Patients with COVID-19 have regular changes in their lung conditions.","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83125512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Pandemic: the crisis and the longer-term perspectives","authors":"S. Tabish","doi":"10.15406/JCCR.2020.13.00472","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00472","url":null,"abstract":"The COVID-19 pandemic is exponentially growing. It is the defining global health crisis of our time and the greatest challenge since World War Two. Countries are racing to slow the spread of the virus by testing and treating patients, carrying out contact tracing, limiting travel, quarantining citizens, and cancelling large gatherings such as sporting events, concerts, and schools. The pandemic is moving like a wave. Some countries have effectively contained the pandemic, while others have been slow and the consequences of delay in responding to the challenge are obvious. Every day, people are losing jobs and income, with no way of knowing when normality will return. Nations need to act immediately to prepare, respond, and recover. Nations must focus on the procurement and supply of essential health products, strengthening crisis management and response, and addressing critical social and economic impacts. Researchers are working tirelessly to discover new life-saving medical innovations. The strategy is to develop diagnostic tools to quickly and effectively detect the disease in the first place, alleviating symptoms so that people who have disease experience milder symptoms, and lowering the overall mortality rate. One of the most promising leads on a COVID-19 vaccine is mRNA-1273. This vaccine, is being developed with extreme urgency, skipping straight into human trials before it was even tested in animals. The aftermath is likely to be something we have never witnessed. A new social order will emerge, a new structure of the society, a paradigm shift in human relationships and above all a new economic adjustment.","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"400 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76615638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of hereditary thrombophilia (factor V leiden and protrombine 20210) in a population of women in fertile age who suffered a thromboembolic event studied in the tucumán public health laboratory","authors":"Rios Mariana, Fernández Zenoff, Verónic, Hayward Cecilia, Suarez A Viviana, B. RossiEleonora","doi":"10.15406/JCCR.2020.13.00471","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00471","url":null,"abstract":"to venous thromboembolism. 4 Both dominant abnormalities and milder combinations of defects in others may be clinically apparent with early age of onset, frequent recurrences, or a family history of thrombosis. The family history of first degree thrombosis or gestational complications associated with thrombophilia is also situations to be considered. The recurrence of a thrombotic event at 2years is 17% and increases to 30% at 8years. 5 Defects in the coagulation Factor V molecule have been shown to interfere with the inhibitory regulatory mechanism of activated Protein C, contributing to the pathogenesis of thrombosis. These defects in the Factor V molecule are associated with Abstract The thromboembolic event (TE) is a public health problem associated with significant morbidity and mortality, whose management includes the evaluation of the hypercoagulable state of the patient, especially in young individuals. The most frequent hereditar y thrombophilias are the Factor V Leiden polymorphism (FVL) and the Prothrombin 20210 In the general Caucasian European population, the prevalence of VLF is 3 to 7% and 1-4% for PT20210 and in patients with a first TE it is 20-50% for FVL and 5- 10% for PT20210. Studies performed in our country revealed 2.9% of heterozygous carriers for FVL and 2.6% for PT20210 in the general population, similar to that described for southern Europe, while other authors reported 10% and 6.3% for FVL and PT20210 re spectively in individuals with a first TE. The objective of this study was to investigate FVL and PT20210 in young women, of childbearing age, who suffered a TE without apparent risk factors and were referred to the Public Health Laboratory of Tucumán in 2015 and 2016. A descriptive observational study was conducted cross section in 39 women. It was detected that 2.5% (1/39) were heterozygous for FVL while 5.7% (2/39) for PT20210. Our study includes patients living in the province of Tucumán, where we obs erved that the prevalence of mutations was lower than those described in other regions of the country, possibly reflecting the different ethnic composition; nevertheless, these genetic alterations are present in our province and Scientific societies recomm end the study of these in selected patients. These women could face circumstantial prothrombotic risk factors such as pregnancy, trauma, prolonged immobilization, hormonal treatments that would predispose to a new TE, for which the investigation of these g enetic variants is necessary for their prevention.","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72949981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hughes-Stovin syndrome complicated with fatal pneumothorax in Behçet’s disease: simple bad luck or is there an etiopathogenic link?","authors":"I. Rachdi, M. Jridi, M. Somaï, W. Garbouj, H. Zoubeidi, Wided Hizem, Z. Aydi, B. Dhaou, F. Boussema, F. Daoud","doi":"10.15406/JCCR.2020.13.00470","DOIUrl":"https://doi.org/10.15406/JCCR.2020.13.00470","url":null,"abstract":"Pulmonary involvement in Beh ccedil et rsquo s disease is not usual and the occurrence of spontaneous pneumothorax is evena rarer complication We report the case of a secondary spontaneous pneumothorax occurring in a patient aged diagnosed of Hughes Stovin syndrome treated with colchicine corticosteroids and cyclophosphamide The patient experienced chest pain with acute dyspnea The examination found an increase in the sonority during percussion of the thorax with a decrease in respiratory sounds in auscultation Chest X ray and thoracic CT scan showed the presence of a left medium sized pneumothorax that extended rapidly and became bilateral The patient was transferred to a resuscitation unit undergoing a chest drainage The course was marked by severe respiratory distress requiring intubation The pneumothorax was probably caused by the rupture of pneumatocele in the pleural cavity Several factors have contributed to pneumatocele formation including pulmonary pneumonitis and mechanical ventilation in a lung already weakened by the inflammatory process of Beh ccedil et s vasculitis The patient had died with an unexplained etiology","PeriodicalId":15200,"journal":{"name":"Journal of Cardiology & Current Research","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91162689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}