Sample records for cardiac index due

  1. Cardiac arrest due to lymphocytic colitis: a case report

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    Groth Kristian A


    Full Text Available Abstract Introduction We present a case of cardiac arrest due to hypokalemia caused by lymphocytic colitis. Case presentation A 69-year-old Caucasian man presented four months prior to a cardiac arrest with watery diarrhea and was diagnosed with lymphocytic colitis. Our patient experienced a witnessed cardiac arrest at his general practitioner's surgery. Two physicians and the emergency medical services resuscitated our patient for one hour and four minutes before arriving at our university hospital. Our patient was defibrillated 16 times due to the recurrence of ventricular tachyarrhythmias. An arterial blood sample revealed a potassium level of 2.0 mmol/L (reference range: 3.5 to 4.6 mmol/L and pH 6.86 (reference range: pH 7.37 to 7.45. As the potassium level was corrected, the propensity for ventricular tachyarrhythmias ceased. Our patient recovered from his cardiac arrest without any neurological deficit. Further tests and examinations revealed no other reason for the cardiac arrest. Conclusion Diarrhea can cause life-threatening situations due to the excretion of potassium, ultimately causing cardiac arrest due to hypokalemia. Physicians treating patients with severe diarrhea should consider monitoring their electrolyte levels.

  2. A Case of Cardiac Arrest Due to Late Diaphragm Hernia

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    Duygu Mergan Ižliklerden


    Full Text Available Traumatic diaphragm hernias are seen in 0.5-6% of blunt traumas and early diagnosis of these cases is difficult. Traumatic diaphragm hernias can produce symptoms and be diagnosed in weeks, months, and sometimes in years. A 20-year-old male patient had a history of a fall from a tree eight years prior. He had complaints of postprandial pain in the epigastrium continuing for several years. Over the previous two weeks, the patient%u2019s complaints of chest pain and difficulty in breathing increased. On PA chest graphy, increased air fluid levels were seen in left lower zone. The patient that hospitalized for examination had a mediastinal shift suddenly and caused cardiac arrest on the second day. By performing anterolateral thoracotomy, the patient received cardiac by manual cardiac massage. Following a response to resuscitation, during exploration of the patient, it was observed that the stomach was perforated towards the thorax. The stomach and the diaphragm were primary repaired and he was discharged on the postoperative seventh day. It is difficult to diagnose diaphragm ruptures in early periods following trauma and thus causes a delay in treatment. This study presents a case that was diagnosed eight years after blunt trauma and had cardiac arrest due to mediastinal shift preoperatively.

  3. Context indexing of digital cardiac ultrasound records in PACS (United States)

    Lobodzinski, S. Suave; Meszaros, Georg N.


    Recent wide adoption of the DICOM 3.0 standard by ultrasound equipment vendors created a need for practical clinical implementations of cardiac imaging study visualization, management and archiving, DICOM 3.0 defines only a logical and physical format for exchanging image data (still images, video, patient and study demographics). All DICOM compliant imaging studies must presently be archived on a 650 Mb recordable compact disk. This is a severe limitation for ultrasound applications where studies of 3 to 10 minutes long are a common practice. In addition, DICOM digital echocardiography objects require physiological signal indexing, content segmentation and characterization. Since DICOM 3.0 is an interchange standard only, it does not define how to database composite video objects. The goal of this research was therefore to address the issues of efficient storage, retrieval and management of DICOM compliant cardiac video studies in a distributed PACS environment. Our Web based implementation has the advantage of accommodating both DICOM defined entity-relation modules (equipment data, patient data, video format, etc.) in standard relational database tables and digital indexed video with its attributes in an object relational database. Object relational data model facilitates content indexing of full motion cardiac imaging studies through bi-directional hyperlink generation that tie searchable video attributes and related objects to individual video frames in the temporal domain. Benefits realized from use of bi-directionally hyperlinked data models in an object relational database include: (1) real time video indexing during image acquisition, (2) random access and frame accurate instant playback of previously recorded full motion imaging data, and (3) time savings from faster and more accurate access to data through multiple navigation mechanisms such as multidimensional queries on an index, queries on a hyperlink attribute, free search and browsing.

  4. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

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    Ersin Kasım Ulusoy


    Full Text Available Emery-Dreifuss muscular dystrophy (EDMD is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t have regular cardiac follow-up was reported and the importance of the treatment of cardiac diseases which could play a role in ischemic stroke etiology and the implantation of pace-maker was mentioned.

  5. Influence of preoperative propranolol on cardiac index during the anhepatic phase of liver transplantation

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    Emerson Seiberlich


    Full Text Available INTRODUCTION: Liver transplantation is the best therapeutic option for end-stage liver disease. Non-selective beta-blocker medications such as propranolol act directly on the cardiovascular system and are often used in the prevention of gastrointestinal bleeding resulting from HP. The effects of propranolol on cardiovascular system of cirrhotic patients during liver transplantation are not known. OBJECTIVE: Evaluate the influence of propranolol used preoperatively on cardiac index during the anhepatic phase of liver transplantation. METHOD: 101 adult patients (73 male [72.2%] who underwent cadaveric donor orthotopic liver transplantation by piggyback technique with preservation of the retrohepatic inferior vena cava performed at Hospital das Clinicas, Federal University of Minas Gerais were evaluated. There was no difference in severity between groups by the MELD system, p = 0.70. The preoperative use of propranolol and the cardiac index outcome were compared during the anhepatic phase of liver transplantation in 5 groups (I: increased cardiac index, II: cardiac index reduction lower than 16%, III: cardiac index reduction equal to or greater than 16% and less than 31%, IV: cardiac index reduction equal to or greater than 31% and less than 46%, V: cardiac index reduction equal to or greater than 46%. RESULTS: Patients in group I (46.4% who received propranolol preoperatively were statistically similar to groups II (60%, III (72.7%, IV (50% and V (30.8%, p = 0.57. CONCLUSION: The use of propranolol before transplantation as prophylaxis for gastrointestinal bleeding may be considered safe, as it was not associated with worsening of cardiac index in anhepatic phase of liver transplantation.

  6. Sudden death due to an unrecognized cardiac hydatid cyst: three medicolegal autopsy cases. (United States)

    Pakis, Isil; Akyildiz, Elif Ulker; Karayel, Ferah; Turan, Arzu Akcay; Senel, Berna; Ozbay, Mehmet; Cetin, Gursel


    Echinococcosis is a human infection caused by the larval stage of Echinococcocus granulosus. The most common sites of infection are the liver and the lungs. Cardiac hydatid cysts are very rare, even in regions where hydatic cysts are endemic (the Mediterranean, South America, Africa, and Australia). It has been reported that cardiac involvement is seen in about 0.5-3% of human echinococcosis cases. Three cases of cardiac hydatid disease that caused sudden death and which were histopathologically diagnosed are reported. Cardiac echinococcosis is rare, but due to its insidious presentation and affinity to cause sudden death, it is important that it be identified in the histopathological examination.

  7. Acute Cardiac Failure in a Pregnant Woman due to Thyrotoxic Crisis

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    Nao Okuda


    Full Text Available Introduction. Cardiac failure during pregnancy is usually related to preeclampsia/eclampsia, rarely to hyperthyroidism. While hyperthyroidism can easily lead to hypertensive cardiac failure and may harm the fetus, it is sometimes difficult to distinguish hyperthyroidism from normal pregnancy. Case Presentation. We encountered a case of 41-year-old pregnant woman with hypertensive cardiac failure. Because we initially diagnosed as pre-eclampsia/eclampsia, Caesarian section was performed. However, her symptoms still persisted after delivery. After thyroid function test results taken on the day of admission were obtained on the fourth day, we could diagnose that her cardiac failure was caused by thyrotoxic crisis. Conclusions. Hypertensive cardiac failure due to hyperthyroidism during pregnancy is rare and difficult to diagnose because of similar presentation of normal pregnancy. However, physicians should be aware of the risks posed by hyperthyroidism during pregnancy.

  8. Therapeutic Efficacy Observation on Acupoint Sticking for Edema Due to Chronic Cardiac Failure

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    Xu Jia-li


    Objective: To evaluate the therapeutic effect of acupoint sticking with Chinese herbs for edema due to chronic cardiac failure. Methods: One hundred and seventy patients in conformity with the diagnostic criteria of edema due to chronic cardiac failure were randomly divided into two groups, 85 cases in each group. The observation group was treated by oral administration of diuretics plus acupoint sticking with Chinese herbs. The control group was treated just by oral administration of diuretics same as the observation group. The therapeutic effects were evaluated after continuous intervention for 14 d. Results: The total effective rate was 90.6% in the observation group, remarkably higher than 67.1% in the control group. The difference of overall therapeutic effect between the two groups was statistically significant (P Conclusion: The therapeutic effect of acupoint sticking with Chinese herbs plus oral administration of diuretics is better than simple oral administration of diuretics in treatment of edema due to chronic cardiac failure.


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    Full Text Available AIM : It was thought previously that morbidity and mortality are directly related to both Systolic and Diastolic blood pressure . However evidences from different studies suggest that systolic hypertension deserves more importance especially due to its profound effect on cardiovascular disease progression. Isolated systolic hypertension (ISH has now increased amongst the elderly population due to inc reased longevity. METHOD : Total 240 patients of 65 – 89 years age group were taken as study group at the out - patient and in - door department of CNMC Kolkata and NBMC , Siliguri. All patients were divided into three groups based on systolic blood pressure : Gr A=SBP - 140 — 159 mmHg , Gr B=SBP - 160 - 179 mmHg & Gr C=SBP>180 mmHg with each group having age and sex matched 100 healthy normotensive control subjects. History , Clinical examination , ECG and Echocardiographic studies were done in the selected patients . Sop histicated tests were not done due to nonavailability. RESULTS : Major Electrocardiogram changes are left atrial enlargement , left ventricular hypertrophy with systolic strain , Inferior wall ischemia , both bundle branch blocks , bifascicular block , left axis deviation. Other minor changes were : antero - septal ischemia , septal wall ischemia , lateral wallischemia , right axis deviation , arrhythmia , and low voltage were also noted. Echocardiography in 2 - D and M - ModeandEcho - Doppler assessment showed incre ased Intraventricular septal thickness (IVST , Left ventricular posterior wall Thickness (LVPWT and Left ventricular mass index were the major changes. Left ventricular functional abnormality like diastolic dysfunction was another significant abnormality. CONCLUSION : Different anatomical & functional changes in ISH are more prevalent in higher SBP group , and strong risk factor for future catastrophic cardiac events. It is an independent risk factor for CVS morbidity and mortality. Early therapeutic interve ntion

  10. Changes in cardiac index and blood pressure on positioning children prone for scoliosis surgery. (United States)

    Brown, Z E; Görges, M; Cooke, E; Malherbe, S; Dumont, G A; Ansermino, J M


    In this prospective observational study we investigated the changes in cardiac index and mean arterial pressure in children when positioned prone for scoliosis correction surgery. Thirty children (ASA 1-2, aged 13-18 years) undergoing primary, idiopathic scoliosis repair were recruited. The cardiac index and mean arterial blood pressure (median (IQR [range])) were 2.7 (2.3-3.1 [1.4-3.7]) l.min(-1).m(-2) and 73 (66-80 [54-91]) mmHg, respectively, at baseline; 2.9 (2.5-3.2 [1.7-4.4]) l.min(-1).m(-2) and 73 (63-81 [51-96]) mmHg following a fluid bolus; and 2.5 (2.2-2.7 [1.4-4.8]) l.min(-1).m(-2) and 69 (62-73 [46-85]) mmHg immediately after turning prone. Turning prone resulted in a median reduction in cardiac index of 0.5 l.min(-1).m(-2) (95% CI 0.3-0.7 l.min(-1).m(-2), p=0.001), or 18.5%, with a large degree of inter-subject variability (+10.3% to -40.9%). The changes in mean arterial blood pressure were not significant. Strategies to predict, prevent and treat decreases in cardiac index need to be developed.

  11. Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after cerebrovascular stroke

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    Dirk Vogelgesang


    Full Text Available Dirk Vogelgesang1, Johannes B Dahm2, Holm Großmann3, Andre Hippe4, Astrid Hummel5, Christian Lotze6, Silke Vogelgesang71Practice of Cardiology, Greifswald, 2Practice of Cardiology, Goettingen, 3Department of Cardiovascular Surgery, Herzzentrum Karlsburg, 4Department of Neurology, 5Department of Cardiology, 6Department of Haematology and Oncology, 7Department of Pathology, University of Greifswald, Greifswald, GermanyAbstract: Primary malignant cardiac tumors (cardiac angiosarcomas are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease.Keywords: cardiac angiosarcoma, stroke, embolism

  12. Evaluation of changes in paraclinical indexes due to intermaxillary fixation

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    Javad Yazdani


    Full Text Available Introduction: One of the treatment techniques for mandibular and midface fractures is intermaxillary fixation (IMF, but treatment with IMF interferes with normal nutrition, and malnutrition can affect the result of the treatment and patient’s recovery. Methods: Paraclinical factors including lipid profile and protein profile indexes which are diagnostic for malnutrition were evaluated in this study to point out how treatment with IMF changes these indexes. In this study, 60 patients were treated with 4 weeks of IMF, the lipid profile and protein profile indexes for these patients were measured before and after the treatment. Results: The albumin (Alb decreased during this period, but a slight increase was shown in the hemoglobin (Hb level. All lipid profile indexes such as low-density lipoprotein (LDL, high-density lipoprotein (HDL, triglyceride (TG, and total cholesterol (TC decreased during this period but not statistically significant.Conclusion: Treatment with IMF could cause a malnutrition situation although not severe, which makes using nutrition supplements considerable in these cases.

  13. Tei index in determination of fetal cardiac function in pregnant women with gestational diabetes mellitus

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    Guo-Dong Li; Jia-Yuan Yi; Shu-Yu Gao; Hong-Ping Liang; Yan-Qing Liu


    Objective:To explore the application value of Tei index in determination of fetal cardiac function in pregnant women with gestational diabetes mellitus (GDM).Methods: A total of 60 gestational diabetes mellitus pregnant women with single birth were included in the study and served as GDM group, while 60 healthy pregnant women with single birth were served as the control group. The fetal echocardiography was performed. The cardiac structure, function, and other related indicators were detected and compared.Results:IVSs, LVWT, RVWT, LVEF, LVFS, and RVFS in GDM group were significantly greater than those in the control group (P<0.05). E/A MV and E/A TV in GDM group were significantly lower than those in the control group (P<0.05). The left and right ventricular Tei index in GDM group was significantly higher than that in the control group (P<0.05).Conclusions:The fetal cardiac structure and function in GDM pregnant women can cause damage to a different degree. Tei index is an important indicator to evaluate the fetal cardiac function in GDM pregnant women, and can be applied in the early diagnosis and treatment; therefore, it deserved to be widely recommended in the clinic.

  14. Risk factors and risk index of cardiac events in pregnant women with heart disease

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    LIU Hua; HUANG Tao-tao; LIN Jian-hua


    Background Pregnant women with heart disease are at high risk.Studies of risk factors of these patients are of great significance to improve maternal and fetal outcomes.In this paper,we try to discuss the main risk factors of cardiac events in pregnant women with heart disease and to establish a risk assessment system.Methods A retrospective analysis was carried out for pregnancies in 1741 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between January 1993 and September 2010.A Logistic regression model was used to identify independent risk factors of cardiac events and calculate the risk index in pregnant women with heart disease.Results The composition of heart disease in pregnant women was arrhythmia (n=662,38.00%),congenital heart disease (CHD; n=529,30.40%),cardiomyopathy (n=327,18.80%),rheumatic heart disease (RHD; n=151,8.70%),and cardiopathy induced by pre-eclampsia (n=53,3.00%).Main cardiac events were heart failure (n=110,6.32%),symptomatic arrhythmia needing medication (n=43,2.47%),cardiac arrest (n=2,0.11%),syncope (n=3,0.17%),and maternal death (n=10,0.57%).Six independent risk factors to predict cardiac events in pregnant women with heart disease were cardiac events before pregnancy (heart failure,severe arrhythmia,cardiac shock,etc.,P=0.000),New York Heart Association (NYHA) class >ll (P=0.000),oxygen saturation <90% (P=0.018),pulmonary artery hypertention (PAH)>50 mmHg (P=0.025),cyanotic heart disease without surgical correction (P=0.015),and reduced left ventricular systolic function (ejection fraction <40%,P=0.003).Every risk factor was calculated as 1 score.The incidence of cardiac events in patients with scores 0,1,2,3,and ≥4 was 2.10%,31.61%,61.25%,68.97%,and 100.00% respectively.Conclusions Pregnancy with heart disease could lead to undesirable pregnancy outcomes.The risk of cardiac events in pregnant women with heart disease could be assessed by risk

  15. Cardiac Function Evaluation Analyzing Spectral Components due to the Consumption of Energy Drinks

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    Md. Bashir Uddin


    Full Text Available The aim of this study is to investigate the effect of energy drinks consumption on cardiac function of human being by analyzing the spectral components of pulse and ECG of several healthy people. Using pulse transducer connected with MP36 (Biopac, USA data acquisition unit, pulse recordings were performed. With electrode lead set connected to the same MP36 data acquisition unit, ECG recordings were also performed. At before and after the consumption of energy drinks available in Bangladesh, pulse and ECG recordings as well as analysis were performed with Biopac software. After having energy drinks, the spectral components such as power of spectral density and amplitude of fast Fourier transform of pulse signal decreased about 47.5 and 37%, respectively. In case of ECG signal, the spectral components such as power of spectral density and amplitude of fast Fourier transform increased about 17 and 7.5% within a short interval about 0-20 min, then effective decrements about 10 and 18.5%, respectively started for long duration. Analyzing spectral parameters, the findings highlight the adverse impacts on cardiac function which may cause cardiac abnormality as well as severe cardiac disease due to the regular consumption of energy drinks.

  16. Nitroglycerin reduces augmentation index and central blood pressure independent of effects on cardiac preload

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    Mike; Saddon; Karen; McNeil; Philip; Chowienczyk


    Objective To determine whether reduction in central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-load or is due to arterial dilation. Methods We compared effects of NTG with those of lower body negative pressure (LBNP). Hemodynamic measurements were made at rest,during LBNP (10,20 and 30 mmHg,each for 15 min) and after NTG (10,30 and 100 μg/min,each dose for 15 min) in ten healthy volunteers. Cardiac pre-load,stroke volume and cardiac output w...

  17. Cardiac arrest due to hyperkalemia following irradiated packed red cells transfusion

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    Miyazawa, Kazuharu [Yamamoto-kumiai General Hospital, Noshiro, Akita (Japan); Ohta, Sukejuurou; Kojima, Yukiko; Mizunuma, Takahide; Nishikawa, Toshiaki


    We describe two cases of cardiac arrest due to hyperkalemia following transfusion of irradiated packed red cells. Case 1: Because sudden, rapid and massive hemorrage occurred in a 69-year-old male patient undergoing the left lobectomy of the liver, 8 units of irradiated packed red cells were rapidly transfused, the patient developed cardiac arrest. Serum kalium concentration after transfusion was 7.6 mEq/l. Case 2: A 7-month-old girl scheduled for closure of a ventricular septal defect, developed cardiac arrest due to hyperkalemia at the start of cardiopulmonary bypass. The extracorporeal circuit was primed with 6 units of irradiated packed red blood cells. Serum kalium concentration immediately after the start of cardiopulmonary bypass was 10.6 mEq/l. Analysis of kalium concentration in the pilot tubes of the same packs revealed 56-61 mEq/l. These case reports suggest that fresh irradiated packed red cells should be transfused during massive bleeding and for pediatric patients to prevent severe hyperkalemia. (author)

  18. Sudden Cardiac Death of a Body Packer Due to Cocaine Cardiotoxicity


    Parthasarathi Pramanik; Raghvendra Kumar Vidua


    This article presents a case of sudden cardiac death due to the effects of cocaine concealed in the body of a male drug smuggler in his 40s, a so-called body packer. A total of 57 body packets filled with cocaine powder were discovered in his body cavities. The detailed autopsy examination, including histopathology and toxicology findings, is discussed with the aim of describing the mechanism of cocaine intoxication in the body packer and an analysis of cocaine-induced cardiotoxicity and sudd...

  19. Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma. (United States)

    Liang, Huai-min; Chen, Qiu-lin; Zhang, Er-yong; Hu, Jia


    Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.

  20. Renal Doppler Resistive Index as a Marker of Oxygen Supply and Demand Mismatch in Postoperative Cardiac Surgery Patients

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    Francesco Corradi


    Full Text Available Background and Objective. Renal Doppler resistive index (RDRI is a noninvasive index considered to reflect renal vascular perfusion. The aim of this study was to identify the independent hemodynamic determinants of RDRI in mechanically ventilated patients after cardiac surgery. Methods. RDRI was determined in 61 patients by color and pulse Doppler ultrasonography of the interlobar renal arteries. Intermittent thermodilution cardiac output measurements were obtained and blood samples taken from the tip of pulmonary artery catheter to measure hemodynamics and mixed venous oxygen saturation (SvO2. Results. By univariate analysis, RDRI was significantly correlated with SvO2, oxygen extraction ratio, left ventricular stroke work index, and cardiac index, but not heart rate, central venous pressure, mean artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, oxygen delivery index, oxygen consumption index, arterial lactate concentration, and age. However, by multivariate analysis RDRI was significantly correlated with SvO2 only. Conclusions. The present data suggests that, in mechanically ventilated patients after cardiac surgery, RDRI increases proportionally to the decrease in SvO2, thus reflecting an early vascular response to tissue hypoxia.

  1. Mechanisms of the refractive index change in DO11/PMMA due to photodegradation

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    Anderson, Benjamin R


    Using a white light interferometric microscope (WLIM) we measure the photodamage induced change in the complex index of refraction of disperse orange 11 (DO11) dye-doped (poly)methyl-methacrylate. We find that the change in the imaginary part of the refractive index is consistent with previous measurements of photodamage-induced absorbance change. Additionally, we find that the change in the real refractive index can be separated into a component due to damage to the dye molecules and a component due to irreversible damage to the polymer.

  2. Correlation of mixed venous and central venous oxygen saturation and its relation to cardiac index

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    Ramakrishna M


    Full Text Available Background and Aim: The clinical applicability of substitution of central venous oxygen saturation for mixed venous oxygen saturations in monitoring global tissue hypoxia is still a matter of controversy. Hence aim of the study is comparison of paired samples of mixed venous and central venous oxygen saturation and comparison in relation to cardiac index in varying hemodynamic conditions. Materials and Methods: Prospective clinical observation: Postoperative cardiac surgical ITU: 60 adult patients,> 18 years of age of either sex: A PAC was inserted through ® IJV, triple lumen catheter was inserted through ® IJV. Blood samples were taken from distal tip of PAC and central venous catheters. An arterial blood sample was drawn from either radial or femoral arterial line. Measurements: Continuous cardiac output monitoring. Analysis of blood samples for hemoglobin concentration and oxygen saturation. Mixed venous oxygen saturations and central venous oxygen saturations were compared. The study was carried over a period of 30h in the postoperative period and samples were taken at 6h intervals. Patients were classified into three groups as follows depending on the CI: Low (< 2.5 L/m 2, medium (2.5-4 L/m 2, high (> 4 L/m2 and correlated with Svo 2 and Scvo 2 . Results: 298 Comparative sets of samples were obtained. Svo2 was consistently lower than Scvo2 throughout the study period. The difference was statistically significant. By using Bland - Altman plot, the mean difference between Svo 2 and Scvo 2 (Svo 2 -Scvo 2 was - 2.9% ± 5.14 and confidence limits are + 7.17% and - 12.97%. The co-efficient r is > 0.7 throughout the study period for all paired samples. The correlation Svo 2 and Scvo 2 with cardiac index in all the three groups were> 0.7. Conclusion: Scvo 2 and Svo 2 are closely related and are interchangeable. Even though individual values differ trends in Scvo 2 may be substituted for trend in Svo 2

  3. Acute Liver Failure Due to Budd-Chiari Syndrome in the Setting of Cardiac Synovial Sarcoma


    Stine, Jonathan G.; Newton, Kelly; Vinayak, Ajeet G


    Primary malignant tumors of the heart, specifically cardiac sarcomas, are rare and mainly diagnosed at autopsy. Acute Budd-Chiari syndrome is a recognized cause of acute liver failure and has been associated with several rare cardiac tumors: atrial myxoma, caval rhabdomyosarcoma, and primary cardiac adenocarcinoma. We present the first case of a fatal, highly differentiated cardiac synovial sarcoma that presented as acute liver failure from Budd-Chiari syndrome.

  4. Nitroglycerin reduces augmentation index and central blood pressure independent of effects on cardiac preload

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    Bao-min Liu; Xiao-lin Niu; Ben-yu Jiang; Mike Saddon; Karen McNeil; Philip Chowienczyk


    Objective To determine whether reduction In central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-lead or is due to arterial dilation. Methods We compared effects of NTG with these of lower body negative pressure (LBNP). Hemodyunmic measurements were made at rest, during LBNP (10, 20 and 30 mmHg, each for 15 min) and after NTG (10, 30 and 100μg/min, each dose for 15 min) in ten healthy volunteers. Cardiac pre-lead, stroke volume and cardiac output were assessed by echacardiography. Central pressure an mnentation and central systolic pressure were obtained by radial tonometry using a transfer function. Results LBNP (20 mmHg) and NTG (30μg/min) reduced pre-lead (as measured by the peak velocity of the S wave in the superior vena eava) to a similar degree [by (26. 8 ± 3.8) % and (23.9 ± 3. 4) %, respectively]. Compared to LBNP, NTG reduced systemic vascular resistance [by (32. 9 ± 7.5) %, p< 0. 01], decreased peripheral and central pressure augmentation [by (20. 8 ± 3. 4)% units and (12. 9±2. 9)% units, respectively, each P< 0. 01]. Conclusion These results suggest that a reduction in pre-load does not explain reduction in pressure augmentation and central systolic blood pressure by NTG and that these effects are mediated through arterial dilation.

  5. Giant Purulent Pericarditis with Cardiac Tamponade Due to Streptococcus intermedius Rapidly Progressing to Constriction. (United States)

    Tigen, Elif T; Sari, Ibrahim; Ak, Koray; Sert, Sena; Tigen, Kursat; Korten, Volkan


    Purulent pericardial effusion, although rare, is a life-threatening condition usually produced by the extension of a nearby bacterial infection locus or by blood dissemination in the immune-suppressed subjects or in the course of cardiothoracic surgery. Because clinical features of purulent pericardial effusion are often nonspecific, it can cause delay in diagnosis. Therefore, a high index of suspicion is required for timely diagnosis and management. Herein, we describe a case of giant purulent pericardial effusion due to Streptococcus intermedius with the history of bronchiectasis and pneumonia, which was successfully treated with pericardiocentesis via parasternal approach, appropriate antibiotics, and pericardiectomy.

  6. Validation of the severity index by cardiac catheterization and Doppler echocardiography in patients with aortic sclerosis and stenosis

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    Rosales Joseph


    Full Text Available Abstract The severity index is a new echocardiographic measure that is thought to be an accurate indicator of aortic leaflet pathology in patients with AS. However, it has not been validated against cardiac catheterization or Doppler echocardiographic measures of AS severity nor has it been applied to patients with aortic sclerosis. The purposes of this study were to compare the severity index to invasive hemodynamics and Doppler echocardiography across the spectrum of calcific aortic valve disease, including aortic sclerosis and AS. 48 patients with aortic sclerosis and AS undergoing echocardiography and cardiac catheterization comprised the study population. The aortic valve leaflets were assessed for mobility (scale 1 to 6 and calcification (scale 1 to 4 and the severity index was calculated as the sum of the mobility and calcification scores according to the methods of Bahler et al. The severity index increased with increasing severity of aortic valve disease; the severity indices for patients with aortic sclerosis, mild to moderate AS and severe AS were 3.38 ± 1.06, 6.45 ± 2.16 and 8.38 ± 1.41, respectively. The aortic jet velocity by echocardiography and the square root of the maximum aortic valve gradient by cardiac catheterization correlated well with the severity index (r = 0.84, p

  7. Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

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    Andersson, Charlotte; Wissenberg, Mads; Jørgensen, Mads Emil;


    BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship......%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups. CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1...

  8. Genetic Polymorphisms in Endothelin-1 as Predictors for Long-Term Survival and the Cardiac Index in Patients Undergoing On-Pump Cardiac Surgery.

    Directory of Open Access Journals (Sweden)

    Ashham Mansur

    Full Text Available Genetic variants within the endothelin-1 gene (EDN1 have been associated with several cardiovascular diseases and may act as genetic prognostic markers. Here, we explored the overall relevance of EDN1 polymorphisms for long-term survival in patients undergoing on-pump cardiac surgery. A prospectively collected cohort of 455 Caucasian patients who underwent cardiac surgery with cardiopulmonary bypass was followed up for 5 years. The obtained genotypes and inferred haplotypes were analyzed for their associations with the five-year mortality rate (primary endpoint. The EDN1 T-1370G and K198N genotype distributions did not deviate from Hardy-Weinberg equilibrium and the major allele frequencies were 83% and 77%, respectively. The cardiovascular risk factors were equally distributed in terms of the different genotypes and haplotypes associated with the two polymorphisms. The five-year mortality rate did not differ among the different EDN1 T-1370G and K198N genotypes and haplotypes. Haplotype analysis revealed that carriers of the G-T (compound EDN1 T-1370G G/K198N T haplotype had a higher cardiac index than did non-carriers (p = 0.0008; however, this difference did not reach significance after adjusting for multiple testing. The results indicate that common variations in EDN1 do not act as prognostic markers for long-term survival in patients undergoing on-pump cardiac surgery.

  9. Coronary artery stent mimicking intracardiac thrombus on cardiac magnetic resonance imaging due to signal loss

    DEFF Research Database (Denmark)

    Qayyum, Abbas Ali; Vejlstrup, Niels Grove; Ahtarovski, Kiril Aleksov;


    Since the introduction of percutaneous coronary intervention for coronary artery disease, thousands of patients have been treated with the implantation of coronary stents. Moreover, several of the patients with coronary stent undergo cardiac magnetic resonance (CMR) imaging every year. This case...... report is of a 77-year-old man who was previously treated with the implantation of a coronary stent in the left circumflex artery. He underwent CMR imaging, which revealed a process 14×21 mm in the left atrium. Cardiac contrast computed tomography did not demonstrate any cardiac pathology. While...

  10. Effects of Blood Flow on the Heating of Cardiac Stents Due to Radio Frequency Fields


    Elder, Nate Ian


    A safety concern during MRI scans with implanted medical devices is heating induced by the incident RF field. This research was performed to better understand the heating of cardiac stents during MRI. Heating of cardiac stents tends to occur at their ends. The temperature rise will be affected by blood flow through the lumen of the stent. In this work, an experiment was performed to simulate heating of a cardiac stent in the presence of blood flow during exposure to the electric field induced...

  11. Exercise capacity in the Bidirectional Glenn physiology: Coupling cardiac index, ventricular function and oxygen extraction ratio. (United States)

    Vallecilla, Carolina; Khiabani, Reza H; Trusty, Phillip; Sandoval, Néstor; Fogel, Mark; Briceño, Juan Carlos; Yoganathan, Ajit P


    In Bi-directional Glenn (BDG) physiology, the superior systemic circulation and pulmonary circulation are in series. Consequently, only blood from the superior vena cava is oxygenated in the lungs. Oxygenated blood then travels to the ventricle where it is mixed with blood returning from the lower body. Therefore, incremental changes in oxygen extraction ratio (OER) could compromise exercise tolerance. In this study, the effect of exercise on the hemodynamic and ventricular performance of BDG physiology was investigated using clinical patient data as inputs for a lumped parameter model coupled with oxygenation equations. Changes in cardiac index, Qp/Qs, systemic pressure, oxygen extraction ratio and ventricular/vascular coupling ratio were calculated for three different exercise levels. The patient cohort (n=29) was sub-grouped by age and pulmonary vascular resistance (PVR) at rest. It was observed that the changes in exercise tolerance are significant in both comparisons, but most significant when sub-grouped by PVR at rest. Results showed that patients over 2 years old with high PVR are above or close to the upper tolerable limit of OER (0.32) at baseline. Patients with high PVR at rest had very poor exercise tolerance while patients with low PVR at rest could tolerate low exercise conditions. In general, ventricular function of SV patients is too poor to increase CI and fulfill exercise requirements. The presented mathematical model provides a framework to estimate the hemodynamic performance of BDG patients at different exercise levels according to patient specific data.

  12. Predictive Value of Beat-to-Beat QT Variability Index across the Continuum of Left Ventricular Dysfunction: Competing Risks of Non-cardiac or Cardiovascular Death, and Sudden or Non-Sudden Cardiac Death (United States)

    Tereshchenko, Larisa G.; Cygankiewicz, Iwona; McNitt, Scott; Vazquez, Rafael; Bayes-Genis, Antoni; Han, Lichy; Sur, Sanjoli; Couderc, Jean-Philippe; Berger, Ronald D.; de Luna, Antoni Bayes; Zareba, Wojciech


    Background The goal of this study was to determine the predictive value of beat-to-beat QT variability in heart failure (HF) patients across the continuum of left ventricular dysfunction. Methods and Results Beat-to-beat QT variability index (QTVI), heart rate variance (LogHRV), normalized QT variance (QTVN), and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca (MUSIC) HF study (mean age 63.1±11.7; males 70.6%; LVEF >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance (IDEAL) database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death [hazard ratio (HR) 1.67(95%CI 1.14-2.47), P=0.009] and in particular with non-sudden cardiac death [HR 2.91(1.69-5.01), P<0.001]. Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular [HR 1.57(1.04-2.35), P=0.031], and non-sudden cardiac death in multivariate competing risk model [HR 2.58(1.13-3.78), P=0.001]. No interaction between QTVI and LVEF was found. QTVI predicted neither non-cardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability (HRV) rather than increased QT variability was the reason for increased QTVI in this study. Conclusions Increased QTVI due to depressed HRV predicts cardiovascular mortality and non-sudden cardiac death, but neither SCD nor excracardiac mortality in HF across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from HF patients at risk. PMID:22730411

  13. Sudden Cardiac Arrest due to Brugada Syndrome: a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    R Soleimanirad


    Full Text Available Brugada Syndrome is a rare cause of sudden cardiac arrest and has a unique ECG pattern. In fact, with ST-segment elevation down sloping in the right precordial leads (v1-v3, RBBB pattern in lateral leads and J-point elevation is revealed. We must notice and avoid trigger factors of this syndrome during general anesthesia. Patient is a 39 old man who attended to emergency department with sudden cardiac arrest and resuscitate. He was transferred to ICU for management of hypoxic ischemic encephalopathy. Complementary studies concluded the diagnosis of Brugada syndrome. We must consider Brugada syndrome within patients with family history of sudden cardiac arrest. Moreover, we must avoid trigger factors of this syndrome such as fever, bradicardia and electrolyte abnormality (specialy Na, Ca abnormalities during general anesthesia and if they appear, we should treat them.

  14. Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

    Directory of Open Access Journals (Sweden)

    Krisztián Tánczos


    Full Text Available The aim of this study was to compare stroke volume (SVI to cardiac index (CI guided resuscitation in a bleeding-resuscitation experiment. Twenty six pigs were randomized and bled in both groups till baseline SVI (Tbsl dropped by 50% (T0, followed by resuscitation with crystalloid solution until initial SVI or CI was reached (T4. Similar amount of blood was shed but animals received significantly less fluid in the CI-group as in the SVI-group: median = 900 (interquartile range: 850–1780 versus 1965 (1584–2165 mL, p=0.02, respectively. In the SVI-group all variables returned to their baseline values, but in the CI-group animals remained underresuscitated as indicated by SVI, heart rate (HR and stroke volume variation (SVV, and central venous oxygen saturation (ScvO2 at T4 as compared to Tbsl: SVI = 23.8 ± 5.9 versus 31.4 ± 4.7 mL, HR: 117 ± 35 versus 89 ± 11/min SVV: 17.4 ± 7.6 versus 11.5 ± 5.3%, and ScvO2: 64.1 ± 11.6 versus 79.2 ± 8.1%, p<0.05, respectively. Our results indicate that CI-based goal-directed resuscitation may result in residual hypovolaemia, as bleeding caused stress induced tachycardia “normalizes” CI, without restoring adequate SVI. As the SVI-guided approach normalized most hemodynamic variables, we recommend using SVI instead of CI as the primary goal of resuscitation during acute bleeding.

  15. Successful emergency splenectomy during cardiac arrest due to cytomegalovirus-induced atraumatic splenic rupture

    DEFF Research Database (Denmark)

    Glesner, Matilde Kanstrup; Madsen, Kristian Rørbæk; Nielsen, Jesper Meng Rahn;


    A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma...

  16. Dysautonomia due to reduced cholinergic neurotransmission causes cardiac remodeling and heart failure. (United States)

    Lara, Aline; Damasceno, Denis D; Pires, Rita; Gros, Robert; Gomes, Enéas R; Gavioli, Mariana; Lima, Ricardo F; Guimarães, Diogo; Lima, Patricia; Bueno, Carlos Roberto; Vasconcelos, Anilton; Roman-Campos, Danilo; Menezes, Cristiane A S; Sirvente, Raquel A; Salemi, Vera M; Mady, Charles; Caron, Marc G; Ferreira, Anderson J; Brum, Patricia C; Resende, Rodrigo R; Cruz, Jader S; Gomez, Marcus Vinicius; Prado, Vania F; de Almeida, Alvair P; Prado, Marco A M; Guatimosim, Silvia


    Overwhelming evidence supports the importance of the sympathetic nervous system in heart failure. In contrast, much less is known about the role of failing cholinergic neurotransmission in cardiac disease. By using a unique genetically modified mouse line with reduced expression of the vesicular acetylcholine transporter (VAChT) and consequently decreased release of acetylcholine, we investigated the consequences of altered cholinergic tone for cardiac function. M-mode echocardiography, hemodynamic experiments, analysis of isolated perfused hearts, and measurements of cardiomyocyte contraction indicated that VAChT mutant mice have decreased left ventricle function associated with altered calcium handling. Gene expression was analyzed by quantitative reverse transcriptase PCR and Western blotting, and the results indicated that VAChT mutant mice have profound cardiac remodeling and reactivation of the fetal gene program. This phenotype was attributable to reduced cholinergic tone, since administration of the cholinesterase inhibitor pyridostigmine for 2 weeks reversed the cardiac phenotype in mutant mice. Our findings provide direct evidence that decreased cholinergic neurotransmission and underlying autonomic imbalance cause plastic alterations that contribute to heart dysfunction.

  17. Evidence of a wide spectrum of cardiac involvement due to ACAD9 mutations: Report on nine patients. (United States)

    Dewulf, Joseph P; Barrea, Catherine; Vincent, Marie-Françoise; De Laet, Corinne; Van Coster, Rudy; Seneca, Sara; Marie, Sandrine; Nassogne, Marie-Cécile


    Acyl-CoA dehydrogenase 9 (ACAD9) is a mitochondrial protein involved in oxidative phosphorylation complex I biogenesis. This protein also exhibits acyl-CoA dehydrogenase (ACAD) activity. ACAD9-mutated patients have been reported to suffer from primarily heart, muscle, liver, and nervous system disorders. ACAD9 mutation is suspected in cases of elevated lactic acid levels combined with complex I deficiency, and confirmed by ACAD9 gene analysis. At least 18 ACAD9-mutated patients have previously been reported, usually displaying severe cardiac involvement. We retrospectively studied nine additional patients from three unrelated families with a wide spectrum of cardiac involvement between the families as well as the patients from the same families. All patients exhibited elevated lactate levels. Deleterious ACAD9 mutations were identified in all patients except one for whom it was not possible to recover DNA. To our knowledge, this is one of the first reports on isolated mild ventricular hypertrophy due to ACAD9 mutation in a family with moderate symptoms during adolescence. This report also confirms that dilated cardiomyopathy may occur in conjunction with ACAD9 mutation and that some patients may respond clinically to riboflavin treatment. Of note, several patients suffered from patent ductus arteriosus (PDA), with one exhibiting a complex congenital heart defect. It is yet unknown whether these cardiac manifestations were related to ACAD9 mutation. In conclusion, this disorder should be suspected in the presence of lactic acidosis, complex I deficiency, and any cardiac involvement, even mild.

  18. Variability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery disease. (United States)

    Cohn, K; Selzer, A; Kersh, E S; Karpman, L S; Goldschlager, N


    Eight patients with chronic congestive heart failure (four with cardiomyopathy and four with ischemic heart disease) underwent hemodynamic studies during acute administration of digoxin, given intravenously in two 0-5 mg doses 2 hours apart. Observations were made before administration of digitalis (control period) and serially therafter for 4 hours after the first dose. Resting mean cardiac index and pulmonary arterial wedge pressure were as follows: 2.0 liters/min per m2 and 23 mm Hg (control period); 2.1 and 24 (at 1 hour); 2.0 and 23 (at 2 hours); 2.7 and 19 (at 3 hours); and 2.3 and 20 (at 4 hours). Exercise responses of mean cardiac index and pulmonary arterial wedge pressure in five patients were: 3.1 liters/min per m2 and 36 mm Hg (control period); 3.2 and 33 (at 1 hour); 3.2 and 28 (at 2 hours); 3.1 and 27 (at.3 hours); and 3.4 and 31 (at 4 hours). The pulmonary arterial wedge pressure remained elevated during exercise in all cases. Arrhythmias were seen in five patients after administration of 0.5 mg of digoxin. Hemodynamic improvement at 4 hours involving both reduced filling pressure and increased blood flow was observed in only two patients at rest and in one additional patient during exercise. Acute deterioration of cardiac function (elevated pulmonary arterial wedge pressure of decreased cardiac index) occurred 30 minutes after administration of digoxin in four patients, concomitantly with increased systemic resistance. In six patients, a peak hemodynamic effect appeared 1 to 1 1/2 hours after administration of digoxin, with partial or total loss of initial benefit by 2 and 4 hours. In previously performed studies observations have seldom exceeded 1 hour; the results of this 4 hour study suggest that, in patients with cardiomyopathy or coronary artery disease and chronic congestive heart failure, acute digitalization does not necessarily lead to consistent, marked or lasting hemodynamic improvement. Thus, current concepts of the use of digitalis is

  19. Rate-dependent activation failure in isolated cardiac cells and tissue due to Na+ channel block. (United States)

    Varghese, Anthony; Spindler, Anthony J; Paterson, David; Noble, Denis


    While it is well established that class-I antiarrhythmics block cardiac sodium channels, the mechanism of action of therapeutic levels of these drugs is not well understood. Using a combination of mathematical modeling and in vitro experiments, we studied the failure of activation of action potentials in single ventricular cells and in tissue caused by Na(+) channel block. Our computations of block and unblock of sodium channels by a theoretical class-Ib antiarrhythmic agent predict differences in the concentrations required to cause activation failure in single cells as opposed to multicellular preparations. We tested and confirmed these in silico predictions with in vitro experiments on isolated guinea-pig ventricular cells and papillary muscles stimulated at various rates (2-6.67 Hz) and exposed to various concentrations (5 × 10(-6) to 500 × 10(-6) mol/l) of lidocaine. The most salient result was that whereas large doses (5 × 10(-4) mol/l or higher) of lidocaine were required to inhibit action potentials temporarily in single cells, much lower doses (5 × 10(-6) mol/l), i.e., therapeutic levels, were sufficient to have the same effect in papillary muscles: a hundredfold difference. Our experimental results and mathematical analysis indicate that the syncytial nature of cardiac tissue explains the effects of clinically relevant doses of Na(+) channel blockers.

  20. Calcium Alternans is Due to an Order-Disorder Phase Transition in Cardiac Cells (United States)

    Alvarez-Lacalle, Enrique; Echebarria, Blas; Spalding, Jon; Shiferaw, Yohannes


    Electromechanical alternans is a beat-to-beat alternation in the strength of contraction of a cardiac cell, which can be caused by an instability of calcium cycling. Using a distributed model of subcellular calcium we show that alternans occurs via an order-disorder phase transition which exhibits critical slowing down and a diverging correlation length. We apply finite size scaling along with a mapping to a stochastic coupled map model, to show that this transition in two dimensions is characterized by critical exponents consistent with the Ising universality class. These findings highlight the important role of cooperativity in biological cells, and suggest novel approaches to investigate the onset of the alternans instability in the heart.

  1. Hyperthemia after cardiac surgery due to ascariasis in a child: report of a case. (United States)

    Maekawa, Yoshiyuki; Sakamoto, Takahiko; Umezu, Kentaroh; Ohashi, Noburoh; Harada, Yorikazu; Matsui, Hikoroh


    Ascaris lumbricoides is the most common parasite affecting humans, especially in countries and regions with lower socio-economic conditions. A 2-year-old female child underwent right pulmonary angioplasty using cardiopulmonary bypass. Serious hyperthermia continued after surgery, and, therefore, a re-exploration of the mediastinum was performed because mediastinitis was suspected. No evidence of wound infection was revealed. Ascaris lumbricoides was subsequently isolated from her stool. The patient had no further hyperthermia throughout her hospitalization and was discharged uneventfully on post-operative day 12. The probable origin of the fever was an A. lumbricoides infection and ascariasis may cause the occurrence of serious hyperthermia during the perioperative period. Ascaris lumbricoides infection may, therefore, cause high-grade fever after cardiac surgery.

  2. The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet's disease. (United States)

    Tavil, Yusuf; Ozturk, Mehmet Akif; Sen, Nihat; Kaya, Mehmet Gungor; Hizal, Fatma; Poyraz, Fatih; Turfan, Murat; Onder, Meltem; Gurer, Mehmet Ali; Cengel, Atiye


    Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 +/- 10 years, mean disease duration, 2.7 +/- 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 +/- 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 +/- 13 vs 63 +/- 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 +/- 0.072 vs 0.416 +/- 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.

  3. Clinicopathological study of cardiac tamponade due to pericardial metastasis originating from gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Michiya Kobayashi; Takehiro Okabayashi; Ken Okamoto; Tsutomu Namikawa; Keijiro Araki


    AIM: To review the cases reported in the literature,examined their clinicopathological features, and evaluated the efficacy of different therapeutic modalities for this rare condition.METHODS: A search of the MEDLINE database revealed 16 cases of pericarditis carcinomatosa (PC)originating from GC reported in the literature between1982 and 2005. Additional detailed data were obtained from the authors of these studies for subsequent clinicopathological investigation. We have also described about a case study from our own clinic.RESULTS: The mean age of cases with pericarditis carcinomatosa originating from GC was 54 years.Females were diagnosed at a younger age (46.3 years)compared to males (58 years). The mean survival period after diagnosis was 4.5 mo. No statistical differences in the length of survival time were found between different therapeutic modalities, such as drainage, and local and/or systemic chemotherapy after drainage. However,three cases who underwent systemic chemotherapy survived for more than 10 mo. Cases that developed metachronous cardiac tamponade for more than 2years after the diagnosis of GC generally survived for a longer period of time, although this was not statistically significant. Multivariate analysis revealed that low levels of carcinoembryonic antigen (CEA), and CEA and/or cancer antigen 19-9 (CA 19-9) were associated with longer survival.CONCLUSION: Cases with low levels of CEA, and CEA and/or CA 19-9 should undergo systemic chemotherapy with or without local chemotherapy after drainage.

  4. Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case. (United States)

    Finsterer, Josef; Stöllberger, Claudia


    Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

  5. The influence of body mass index on outcomes in patients undergoing cardiac surgery: does the obesity paradox really exist?

    Directory of Open Access Journals (Sweden)

    Juan Carlos Lopez-Delgado

    Full Text Available Obesity influences risk stratification in cardiac surgery in everyday practice. However, some studies have reported better outcomes in patients with a high body mass index (BMI: this is known as the obesity paradox. The aim of this study was to quantify the effect of diverse degrees of high BMI on clinical outcomes after cardiac surgery, and to assess the existence of an obesity paradox in our patients.A total of 2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 were prospectively studied at our institution. Patients were divided into four groups based on BMI: normal weight (18.5-24.9 kg∙m-2; n = 523; 21.4%, overweight (25-29.9 kg∙m-2; n = 1150; 47%, obese (≥ 30-≤ 34.9 kg∙m-2; n = 624; 25.5% and morbidly obese (≥ 35kg∙m-2; n = 152; 6.2%. Follow-up was performed in 2,379 patients during the first year.After adjusting for confounding factors, patients with higher BMI presented worse oxygenation and better nutritional status, reflected by lower PaO2/FiO2 at 24h and higher albumin levels 48 h after admission respectively. Obese patients showed a higher risk for Perioperative Myocardial Infarction (OR: 1.768; 95% CI: 1.035-3.022; p = 0.037 and septicaemia (OR: 1.489; 95% CI: 1.282-1.997; p = 0.005. In-hospital mortality was 4.8% (n = 118 and 1-year mortality was 10.1% (n = 252. No differences were found regarding in-hospital mortality between BMI groups. The overweight group showed better 1-year survival than normal weight patients (91.2% vs. 87.6%; Log Rank: p = 0.029. HR: 1.496; 95% CI: 1.062-2.108; p = 0.021.In our population, obesity increases Perioperative Myocardial Infarction and septicaemia after cardiac surgery, but does not influence in-hospital mortality. Although we found better 1-year survival in overweight patients, our results do not support any protective effect of obesity in patients undergoing cardiac surgery.

  6. Influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    Shu-Tian Song; Ming Yang; Kun-Peng Li; Juan Xu; Chuan-Ming Bai; Ji-Wu Zhou


    Objective:To investigate and analyze the influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass.Methods:A total of 42 patients with open heart surgery with cardiopulmonary bypass during the period of June 2014 to January 2016 were randomly divided into the control group of 21 cases and the observation group of 21 cases. The control group was treated with routine postoperative treatment, and the observation group was treated with recombinant human brain natriuretic peptide on the basic treatment of control group, then the myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes of the two groups before the surgery and at 2 h, 12 h and 24 h after the surgery were respectively detected and compared.Results: There were no significant difference in myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes between two groups before the surgery (allP>0.05), while the myocardial enzymes and serum cardiac function indexes of the observation group at 2 h ,12 h and 24 h after the surgery were all significantly lower than those of control group, the oxygen metabolism indexes were significantly better than the levels of control group (allP<0.05).Conclusions:The recombinant human brain natriuretic peptide can effectively improve the myocardial enzymes, serum cardiac function indexes and oxygen metabolism state of patients with open heart surgery with cardiopulmonary bypass, and it has application value for the patients with the surgery is higher.

  7. Embryonic Lethality Due to Arrested Cardiac Development in Psip1/Hdgfrp2 Double-Deficient Mice.

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    Hao Wang

    Full Text Available Hepatoma-derived growth factor (HDGF related protein 2 (HRP2 and lens epithelium-derived growth factor (LEDGF/p75 are closely related members of the HRP2 protein family. LEDGF/p75 has been implicated in numerous human pathologies including cancer, autoimmunity, and infectious disease. Knockout of the Psip1 gene, which encodes for LEDGF/p75 and the shorter LEDGF/p52 isoform, was previously shown to cause perinatal lethality in mice. The function of HRP2 was by contrast largely unknown. To learn about the role of HRP2 in development, we knocked out the Hdgfrp2 gene, which encodes for HRP2, in both normal and Psip1 knockout mice. Hdgfrp2 knockout mice developed normally and were fertile. By contrast, the double deficient mice died at approximate embryonic day (E 13.5. Histological examination revealed ventricular septal defect (VSD associated with E14.5 double knockout embryos. To investigate the underlying molecular mechanism(s, RNA recovered from ventricular tissue was subjected to RNA-sequencing on the Illumina platform. Bioinformatic analysis revealed several genes and biological pathways that were significantly deregulated by the Psip1 knockout and/or Psip1/Hdgfrp2 double knockout. Among the dozen genes known to encode for LEDGF/p75 binding factors, only the expression of Nova1, which encodes an RNA splicing factor, was significantly deregulated by the knockouts. However the expression of other RNA splicing factors, including the LEDGF/p52-interacting protein ASF/SF2, was not significantly altered, indicating that deregulation of global RNA splicing was not a driving factor in the pathology of the VSD. Tumor growth factor (Tgf β-signaling, which plays a key role in cardiac morphogenesis during development, was the only pathway significantly deregulated by the double knockout as compared to control and Psip1 knockout samples. We accordingly speculate that deregulated Tgf-β signaling was a contributing factor to the VSD and prenatal lethality

  8. Cardiac tamponade due to low-volume effusive constrictive pericarditis in a patient with uncontrolled type II autoimmune polyglandular syndrome. (United States)

    Palmer, William C; Kurklinsky, Andrew; Lane, Gary; Ussavarungsi, Kamonpun; Blackshear, Joseph L


    Type II autoimmune polyglandular syndrome (APS), a relatively common endocrine disorder, includes primary adrenal insufficiency coupled with type 1 diabetes mellitus and/or autoimmune primary hypothyroidism. Autoimmune serositis, an associated disease, may present as symptomatic pericardial effusion. We present a case of a 54-year old male with APS who developed pericarditis leading to cardiac tamponade with a subacute loculated effusion. After urgent pericardiocentesis intrapericardial pressure dropped to 0, while central venous pressures remain elevated, consistent with acute effusive constrictive pericarditis. Contrast computerized tomography confirmed increased pericardial contrast enhancement. The patient recovered after prolonged inotropic support and glucocorticoid administration. He re-accumulated the effusion 16 days later, requiring repeat pericardiocentesis. Effusive-constrictive pericarditis, an uncommon pericardial syndrome, is characterized by simultaneous pericardial inflammation and tamponade. Prior cases of APS associated with cardiac tamponade despite low volumes of effusion have been reported, albeit without good demonstration of hemodynamic findings. We report a case of APS with recurrent pericardial effusion due to pericarditis and marked hypotension with comprehensive clinical and hemodynamic assessment. These patients may require aggressive support with pericardiocentesis, inotropes, and hormone replacement therapy. They should be followed closely for recurrent tamponade.

  9. Utility of comprehensive assessment of strain dyssynchrony index by speckle tracking imaging for predicting response to cardiac resynchronization therapy. (United States)

    Tatsumi, Kazuhiro; Tanaka, Hidekazu; Yamawaki, Kouhei; Ryo, Keiko; Omar, Alaa Mabrouk Salem; Fukuda, Yuko; Norisada, Kazuko; Matsumoto, Kensuke; Onishi, Tetsuari; Gorcsan, John; Yoshida, Akihiro; Kawai, Hiroya; Hirata, Ken-ichi


    The strain delay index is reportedly a marker of dyssynchrony and residual myocardial contractility. The aim of this study was to test the hypothesis that a relatively simple version of the strain dyssynchrony index (SDI) can predict response to cardiac resynchronization therapy (CRT) and that combining assessment of radial, circumferential, and longitudinal SDI can further improve the prediction of responders. A total of 52 patients who underwent CRT were studied. The SDI was calculated as the average difference between peak and end-systolic strain from 6 segments for radial and circumferential SDI and 18 segments for longitudinal SDI. Conventional dyssynchrony measures were assessed by interventricular mechanical delay, the Yu index, and radial dyssynchrony by speckle tracking strain. Response was defined as a ≥15% decrease in end-systolic volume after 3 months. Of the individual parameters, radial SDI ≥6.5% was the best predictor of response to CRT, with sensitivity of 81%, specificity of 81%, and an area under the curve of 0.87 (p SDIs was 100%. In contrast, rates in patients with either 1 or no positive SDIs were 42% and 22%, respectively (p SDIs). In conclusion, the SDI can successfully predict response to CRT, and the combined approach leads to more accurate prediction than using individual parameters.

  10. Strain dyssynchrony index determined by three-dimensional speckle area tracking can predict response to cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Onishi Tetsuari


    Full Text Available Abstract Background We have previously reported strain dyssynchrony index assessed by two-dimensional speckle tracking strain, and a marker of both dyssynchrony and residual myocardial contractility, can predict response to cardiac resynchronization therapy (CRT. A newly developed three-dimensional (3-D speckle tracking system can quantify endocardial area change ratio (area strain, which coupled with the factors of both longitudinal and circumferential strain, from all 16 standard left ventricular (LV segments using complete 3-D pyramidal datasets. Our objective was to test the hypothesis that strain dyssynchrony index using area tracking (ASDI can quantify dyssynchrony and predict response to CRT. Methods We studied 14 heart failure patients with ejection fraction of 27 ± 7% (all≤35% and QRS duration of 172 ± 30 ms (all≥120 ms who underwent CRT. Echocardiography was performed before and 6-month after CRT. ASDI was calculated as the average difference between peak and end-systolic area strain of LV endocardium obtained from 3-D speckle tracking imaging using 16 segments. Conventional dyssynchrony measures were assessed by interventricular mechanical delay, Yu Index, and two-dimensional radial dyssynchrony by speckle-tracking strain. Response was defined as a ≥15% decrease in LV end-systolic volume 6-month after CRT. Results ASDI ≥ 3.8% was the best predictor of response to CRT with a sensitivity of 78%, specificity of 100% and area under the curve (AUC of 0.93 (p Conclusions ASDI can predict responders and LV reverse remodeling following CRT. This novel index using the 3-D speckle tracking system, which shows circumferential and longitudinal LV dyssynchrony and residual endocardial contractility, may thus have clinical significance for CRT patients.

  11. Mapping Uncertainty Due to Missing Data in the Global Ocean Health Index. (United States)

    Frazier, Melanie; Longo, Catherine; Halpern, Benjamin S


    Indicators are increasingly used to measure environmental systems; however, they are often criticized for failing to measure and describe uncertainty. Uncertainty is particularly difficult to evaluate and communicate in the case of composite indicators which aggregate many indicators of ecosystem condition. One of the ongoing goals of the Ocean Health Index (OHI) has been to improve our approach to dealing with missing data, which is a major source of uncertainty. Here we: (1) quantify the potential influence of gapfilled data on index scores from the 2015 global OHI assessment; (2) develop effective methods of tracking, quantifying, and communicating this information; and (3) provide general guidance for implementing gapfilling procedures for existing and emerging indicators, including regional OHI assessments. For the overall OHI global index score, the percent contribution of gapfilled data was relatively small (18.5%); however, it varied substantially among regions and goals. In general, smaller territorial jurisdictions and the food provision and tourism and recreation goals required the most gapfilling. We found the best approach for managing gapfilled data was to mirror the general framework used to organize, calculate, and communicate the Index data and scores. Quantifying gapfilling provides a measure of the reliability of the scores for different regions and components of an indicator. Importantly, this information highlights the importance of the underlying datasets used to calculate composite indicators and can inform and incentivize future data collection.

  12. Mapping Uncertainty Due to Missing Data in the Global Ocean Health Index (United States)

    Longo, Catherine; Halpern, Benjamin S.


    Indicators are increasingly used to measure environmental systems; however, they are often criticized for failing to measure and describe uncertainty. Uncertainty is particularly difficult to evaluate and communicate in the case of composite indicators which aggregate many indicators of ecosystem condition. One of the ongoing goals of the Ocean Health Index (OHI) has been to improve our approach to dealing with missing data, which is a major source of uncertainty. Here we: (1) quantify the potential influence of gapfilled data on index scores from the 2015 global OHI assessment; (2) develop effective methods of tracking, quantifying, and communicating this information; and (3) provide general guidance for implementing gapfilling procedures for existing and emerging indicators, including regional OHI assessments. For the overall OHI global index score, the percent contribution of gapfilled data was relatively small (18.5%); however, it varied substantially among regions and goals. In general, smaller territorial jurisdictions and the food provision and tourism and recreation goals required the most gapfilling. We found the best approach for managing gapfilled data was to mirror the general framework used to organize, calculate, and communicate the Index data and scores. Quantifying gapfilling provides a measure of the reliability of the scores for different regions and components of an indicator. Importantly, this information highlights the importance of the underlying datasets used to calculate composite indicators and can inform and incentivize future data collection. PMID:27483378

  13. Wave intensity analysis in mice: age-related changes in WIA peaks and correlation with cardiac indexes. (United States)

    Di Lascio, Nicole; Kusmic, Claudia; Stea, Francesco; Faita, Francesco


    Mouse models are increasingly employed in the comprehension of cardiovascular disease. Wave Intensity Analysis (WIA) can provide information about the interaction between the vascular and the cardiac system. We investigate age-associated changes in WIA-derived parameters in mice and correlate them with biomarkers of cardiac function. Sixteen wild-type male mice were imaged with high-resolution ultrasound (US) at 8 weeks (T 0) and 25 weeks (T 1) of age. Carotid pulse wave velocity (PWV) was calculated from US images using the diameter-velocity loop and employed to evaluate WIA. Amplitudes of the first (W 1) and the second (W 2) local maxima, local minimum (W b) and the reflection index (RI = W b/W 1) were assessed. Cardiac output (CO), ejection fraction (EF), fractional shortening (FS) and stroke volume (SV) were evaluated; longitudinal, radial and circumferential strain and strain rate values (LS, LSR, RS, RSR, CS, CSR) were obtained through strain analysis. W 1 (T 0: 4.42e-07 ± 2.32e-07 m(2)/s; T 1: 2.21e-07 ± 9.77 m(2)/s), W 2 (T 0: 2.45e-08 ± 9.63e-09 m(2)/s; T 1: 1.78e-08 ± 7.82 m(2)/s), W b (T 0: -8.75e-08 ± 5.45e-08 m(2)/s; T 1: -4.28e-08 ± 2.22e-08 m(2)/s), CO (T 0: 19.27 ± 4.33 ml/min; T 1: 16.71 ± 2.88 ml/min), LS (T 0: 17.55 ± 3.67%; T 1: 15.05 ± 2.89%), LSR (T 0: 6.02 ± 1.39 s(-1); T 1: 5.02 ± 1.25 s(-1)), CS (T 0: 27.5 ± 5.18%; T 1: 22.66 ± 3.09%) and CSR (T 0: 10.03 ± 2.55 s(-1); T 1: 7.50 ± 1.84 s(-1)) significantly reduced with age. W 1 was significantly correlated with CO (R = 0.58), EF (R = 0.72), LS (R = 0.65), LSR (R = 0.89), CS (R = 0.61), CSR (R = 0.70) at T 0; correlations were lost at T 1. The decrease in W 1 and W 2 suggests a cardiac performance reduction, while that in Wb, considering unchanged RI, might indicate a wave energy decrease. The loss of correlation between WIA-derived and cardiac parameters might reflect an alteration in cardiovascular interaction.

  14. Evaluation of Cardiac Function Index as Measured by Transpulmonary Thermodilution as an Indicator of Left Ventricular Ejection Fraction in Cardiogenic Shock

    Directory of Open Access Journals (Sweden)

    Jessica Perny


    Full Text Available Introduction. The PiCCO transpulmonary thermodilution technique provides two indices of cardiac systolic function, the cardiac function index (CFI and the global ejection fraction (GEF. Both appear to be correlated with left ventricular ejection fraction (LVEF measured by echocardiography in patients with circulatory failure, especially in septic shock. The aim of the present study was to test the reliability of CFI as an indicator of LVEF in patients with cardiogenic shock. Methods. In thirty-five patients with cardiogenic shock, we performed (i simultaneous measurements of echocardiography LVEF and cardiac function index assessed by transpulmonary thermodilution (n=72 and (ii transpulmonary thermodilution before/after increasing inotropic agents (n=18. Results. Mean LVEF was 31% (+/−11.7, CFI 3/min (+/−1, and GEF 14.2% (+/−6. CFI and GEF were both positively correlated with LVEF (P<0.0001, r2=0.27. CFI and GEF were significantly increased with inotropic infusion (resp., P=0.005, P=0.007. A cardiac function index <3.47/min predicted a left ventricular ejection fraction ≤35% (sensitivity 81.1% and specificity 63%. In patients with right ventricular dysfunction, CFI was not correlated with LVEF. Conclusion. CFI is correlated with LVEF provided that patient does not present severe right ventricular dysfunction. Thus, the PiCCO transpulmonary thermodilution technique is useful for the monitoring of inotropic therapy during cardiogenic shock.

  15. Bragg grating induced cladding mode coupling due to asymmetrical index modulation in depressed cladding fibers

    DEFF Research Database (Denmark)

    Berendt, Martin Ole; Grüne-Nielsen, Lars; Soccolich, C.F.


    to reduce this problem. None of these designs seems to give complete solutions. In particular, the otherwise promising depressed cladding design gives a pronounced coupling to one LP01 mode, this has been referred to as a Ghost grating. To find the modes of the fiber we have established a numerical mode......-solver based on the staircase-approximation method. The Bragg grating causes coupling between the fundamental LP01 mode and higher order LP1p modes that satisfy phase-matching. The coupling strength is determined by the overlap integral of the LP01, the LP1p mode, and the UV-induced index perturbation. For LP0...

  16. Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients. (United States)

    Kramer, Philip A; Chacko, Balu K; George, David J; Zhi, Degui; Wei, Chih-Cheng; Dell'Italia, Louis J; Melby, Spencer J; George, James F; Darley-Usmar, Victor M


    Monitoring the bioenergetics of leucocytes is now emerging as an important approach in translational research to detect mitochondrial dysfunction in blood or other patient samples. Using the mitochondrial stress test, which involves the sequential addition of mitochondrial inhibitors to adherent leucocytes, we have calculated a single value, the Bioenergetic Health Index (BHI), which represents the mitochondrial function in cells isolated from patients. In the present report, we assess the BHI of monocytes isolated from the post-operative blood and post-operative pericardial fluid (PO-PCF) from patients undergoing cardiac surgery. Analysis of the bioenergetics of monocytes isolated from patients' PO-PCF revealed a profound decrease in mitochondrial function compared with monocytes isolated from their blood or from healthy controls. Further, patient blood monocytes showed no significant difference in the individual energetic parameters from the mitochondrial stress test but, when integrated into the BHI evaluation, there was a significant decrease in BHI compared with healthy control monocytes. These data support the utility of BHI measurements in integrating the individual parameters from the mitochondrial stress test into a single value. Supporting our previous finding that the PO-PCF is pro-oxidant, we found that exposure of rat cardiomyocytes to PO-PCF caused a significant loss of mitochondrial membrane potential and increased reactive oxygen species (ROS). These findings support the hypothesis that integrated measures of bioenergetic health could have prognostic and diagnostic value in translational bioenergetics.

  17. Exacerbated cardiac fibrosis induced by β-adrenergic activation in old mice due to decreased AMPK activity. (United States)

    Wang, Jingjing; Song, Yao; Li, Hao; Shen, Qiang; Shen, Jing; An, Xiangbo; Wu, Jimin; Zhang, Jianshu; Wu, Yunong; Xiao, Han; Zhang, Youyi


    Senescent hearts exhibit defective responses to β-adrenergic receptor (β-AR) over-activation upon stress, leading to more severe pathological cardiac remodelling. However, the underlying mechanisms remain unclear. Here, we investigated the role of adenosine monophosphate-activated protein kinase (AMPK) in protecting against ageing-associated cardiac remodelling in mice upon β-AR over-activation. 10-week-old (young) and 18-month-old (old) mice were subcutaneously injected with the β-AR agonist isoproterenol (ISO; 5 mg/kg). More extensive cardiac fibrosis was found in old mice upon ISO exposure than in young mice. Meanwhile, ISO treatment decreased AMPK activity and increased β-arrestin 1, but not β-arrestin 2, expression, and the effects of ISO on AMPK and β-arrestin 1 were greater in old mice than in young mice. Similarly, young AMPKα2-knockout (KO) mice showed more extensive cardiac fibrosis upon ISO exposure than that was observed in age-matched wild-type (WT) littermates. The extent of cardiac fibrosis in WT old mice was similar to that in young KO mice. Additionally, AMPK activities were decreased and β-arrestin 1 expression increased in KO mice. In contrast, the AMPK activator metformin decreased β-arrestin 1 expression and attenuated cardiac fibrosis in both young and old mice upon ISO exposure. In conclusion, more severe cardiac fibrosis is induced by ISO in old mice than in young mice. A decrease in AMPK activity, which further increases β-arrestin 1 expression, is the central mechanism underlying the ageing-related cardiac fibrosis induced by ISO. The AMPK activator metformin is a promising therapeutic agent for treating ageing-related cardiac remodelling upon β-AR over-activation.

  18. Indexed

    CERN Document Server

    Hagy, Jessica


    Jessica Hagy is a different kind of thinker. She has an astonishing talent for visualizing relationships, capturing in pictures what is difficult for most of us to express in words. At, she posts charts, graphs, and Venn diagrams drawn on index cards that reveal in a simple and intuitive way the large and small truths of modern life. Praised throughout the blogosphere as “brilliant,” “incredibly creative,” and “comic genius,” Jessica turns her incisive, deadpan sense of humor on everything from office politics to relationships to religion. With new material along with some of Jessica’s greatest hits, this utterly unique book will thrill readers who demand humor that makes them both laugh and think.

  19. Using Lorenz plot and Cardiac Sympathetic Index of heart rate variability for detecting seizures for patients with epilepsy. (United States)

    Jeppesen, Jesper; Beniczky, Sandor; Johansen, Peter; Sidenius, Per; Fuglsang-Frederiksen, Anders


    Tachycardia is often seen during epileptic seizures, but it also occurs during physical exercise. In order to assess whether focal epileptic seizures can be detected by short term moving window Heart Rate Variability (HRV) analysis, we modified the geometric HRV method, Lorenz plot, to consist of only 30, 50 or 100 R-R intervals per analyzed window. From each window we calculated the longitudinal (L) and transverse (T) variability of Lorenz plot to retrieve the Cardiac Sympathetic Index (CSI) as (L/T) and "Modified CSI" (described in methods), and compared the maximum during the patient's epileptic seizures with that during the patient's own exercise and non-seizure sessions as control. All five analyzed patients had complex partial seizures (CPS) originating in the temporal lobe (11 seizures) during their 1-5 days long term video-EEG monitoring. All CPS with electroencephalographic correlation were selected for the HRV analysis. The CSI and Modified CSI were correspondently calculated after each heart beat depicting the prior 30, 50 and 100 R-R intervals at the time. CSI (30, 50 and 100) and Modified CSI (100) showed a higher maximum peak during seizures than exercise/non-seizure (121-296%) for 4 of the 5 patients within 4 seconds before till 60 seconds after seizure onset time even though exercise maximum HR exceeded that of the seizures. The results indicate a detectable, sudden and inordinate shift towards sympathetic overdrive in the sympathovagal balance of the autonomic nervous system just around seizure-onset for certain patients. This new modified moving window Lorenz plot method seems promising way of constructing a portable ECG-based epilepsy alarm for certain patients with epilepsy who needs aid during seizure.

  20. Two cases of delayed cardiac tamponade due to pericarditis after pulmonary vein (PV) isolation for atrial fibrillation. (United States)

    Torihashi, Sadayoshi; Shiraishi, Hirokazu; Hamaoka, Tetsuro; Imai, Mikimasa; Kuroyanagi, Akira; Nakanishi, Naohiko; Nakamura, Takeshi; Yamano, Tetsuhiro; Matsumuro, Akiyoshi; Shirayama, Takeshi


    Catheter ablation is an established treatment for atrial fibrillation (AF). The incidence of major complications related to the procedure is reported to be 4.5%, and delayed cardiac tamponade (DCT) is a rare, although recently recognized, complication. However, the mechanisms underlying the development of DCT remain unclear. We herein report the cases of two men, both 49 years of age, who developed cardiac tamponade requiring pericardiocentesis a few weeks after undergoing pulmonary vein isolation for persistent AF. Physicians should explain to the patient the potential for DCT as a complication prior to performing catheter ablation and provide careful follow-up for at least a few weeks after the session.

  1. Analysis of Errors Involved in the Estimation of Leachate Pollution Index Due to Nonavailability of Leachate Parameter

    Directory of Open Access Journals (Sweden)

    Islam M. Rafizul


    Full Text Available An important part of maintaining a solid waste landfill is managing the leachate through proper treatment to prevent pollution into the surrounding ground and surface water. Any assessment of potential impact of a landfill on groundwater quality requires consideration of the component of leachate most likely to cause an envionental impact as well as the source of concentration of those components. Leachate pollution index (LPI is an environmental index used to quantify and compare the leachate contamination potential of solid waste landfill. This index is based on concentration of 18 pollutants in leachate and their corresponding significance. That means, for calculating the LPI of a landfill, concentration of these 18 parameters are to be known. However, sometimes the data for all the 18 pollutants included in the LPI may not be available to calculate the LPI. In this study, the possible errors involved in calculating the LPI due to nonavailability of data are reported by the author. The leachate characteristic data for solid waste landfill at Chittagong in Bangladesh have been used to estimate these errors. Based on this study, it can be concluded that the errors may be high if the data for the pollutants having significantly high or low concentration are not available. However, LPI can be reported with a marginal error if the concentrations of the nonavailable pollutants are not completely biased.

  2. Progression of Mortality due to Diseases of the Circulatory System and Human Development Index in Rio de Janeiro Municipalities (United States)

    Soares, Gabriel Porto; Klein, Carlos Henrique; Silva, Nelson Albuquerque de Souza e; de Oliveira, Glaucia Maria Moraes


    Background Diseases of the circulatory system (DCS) are the major cause of death in Brazil and worldwide. Objective To correlate the compensated and adjusted mortality rates due to DCS in the Rio de Janeiro State municipalities between 1979 and 2010 with the Human Development Index (HDI) from 1970 onwards. Methods Population and death data were obtained in DATASUS/MS database. Mortality rates due to ischemic heart diseases (IHD), cerebrovascular diseases (CBVD) and DCS adjusted by using the direct method and compensated for ill-defined causes. The HDI data were obtained at the Brazilian Institute of Applied Research in Economics. The mortality rates and HDI values were correlated by estimating Pearson linear coefficients. The correlation coefficients between the mortality rates of census years 1991, 2000 and 2010 and HDI data of census years 1970, 1980 and 1991 were calculated with discrepancy of two demographic censuses. The linear regression coefficients were estimated with disease as the dependent variable and HDI as the independent variable. Results In recent decades, there was a reduction in mortality due to DCS in all Rio de Janeiro State municipalities, mainly because of the decline in mortality due to CBVD, which was preceded by an elevation in HDI. There was a strong correlation between the socioeconomic indicator and mortality rates. Conclusion The HDI progression showed a strong correlation with the decline in mortality due to DCS, signaling to the relevance of improvements in life conditions. PMID:27849263

  3. Comparison of {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) in corticosteroid-naive patients with conduction system disease due to cardiac sarcoidosis

    Energy Technology Data Exchange (ETDEWEB)

    Ohira, Hiroshi; Birnie, David H.; Mc Ardle, Brian; Dick, Alexander; Klein, Ran; Renaud, Jennifer; DeKemp, Robert A.; Davies, Ross; Hessian, Renee; Liu, Peter; Nery, Pablo B. [University of Ottawa Heart Institute, Molecular Function and Imaging Program, National Cardiac PET Centre, Ottawa, ON (Canada); University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON (Canada); Pena, Elena; Dennie, Carole [The Ottawa Hospital, Medical Imaging Department, Ottawa, ON (Canada); University of Ottawa, Department of Radiology, Ottawa, ON (Canada); Bernick, Jordan; Wells, George A. [University of Ottawa Heart Institute, Cardiovascular Research Methods Center, Ottawa, ON (Canada); Leung, Eugene [The Ottawa Hospital, Division of Nuclear Medicine, Department of Medicine, Ottawa, Ontario (Canada); Yoshinaga, Keiichiro [Hokkaido University School of Medicine, Department of Molecular Imaging, Hokkaido (Japan); Tsujino, Ichizo; Sato, Takahiro; Nishimura, Masaharu [Hokkaido University School of Medicine, First Department of Medicine, Hokkaido (Japan); Manabe, Osamu; Tamaki, Nagara [Hokkaido University School of Medicine, Department of Nuclear Medicine, Hokkaido (Japan); Oyama-Manabe, Noriko [Hokkaido University Hospital, Diagnostic and Interventional Radiology, Hokkaido (Japan); Ruddy, Terrence D.; Beanlands, Rob S.B. [University of Ottawa Heart Institute, Molecular Function and Imaging Program, National Cardiac PET Centre, Ottawa, ON (Canada); University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON (Canada); The Ottawa Hospital, Medical Imaging Department, Ottawa, ON (Canada); University of Ottawa, Department of Radiology, Ottawa, ON (Canada); The Ottawa Hospital, Division of Nuclear Medicine, Department of Medicine, Ottawa, Ontario (Canada); Chow, Benjamin J.W. [University of Ottawa Heart Institute, Molecular Function and Imaging Program, National Cardiac PET Centre, Ottawa, ON (Canada); University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON (Canada); The Ottawa Hospital, Medical Imaging Department, Ottawa, ON (Canada); University of Ottawa, Department of Radiology, Ottawa, ON (Canada)


    Cardiac sarcoidosis (CS) is a cause of conduction system disease (CSD). {sup 18}F-Fluorodeoxyglucose-positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) are used for detection of CS. The relative diagnostic value of these has not been well studied. The aim was to compare these imaging modalities in this population. We recruited steroid-naive patients with newly diagnosed CSD due to CS. All CS patients underwent both imaging studies within 12 weeks of each other. Patients were classified into two groups: group A with chronic mild CSD (right bundle branch block and/or axis deviation), and group B with new-onset atrioventricular block (AVB, Mobitz type II or third-degree AVB). Thirty patients were included. Positive findings on both imaging studies were seen in 72 % of patients (13/18) in group A and in 58 % of patients (7/12) in group B. The remainder (28 %) of the patients in group A were positive only on CMR. Of the patients in group B, 8 % were positive only on CMR and 33 % were positive only on FDG PET. Patients in group A were more likely to be positive only on CMR, and patients in group B were more likely to be positive only on FDG PET (p = 0.02). Patients in group B positive only on FDG PET underwent CMR earlier relative to their symptomatology than patients positive only on CMR (median 7.0, IQR 1.5 - 34.3, vs. 72.0, IQR 25.0 - 79.5 days; p = 0.03). The number of positive FDG PET and CMR studies was different in patients with CSD depending on their clinical presentation. This study demonstrated that CMR can adequately detect cardiac involvement associated with chronic mild CSD. In patients presenting with new-onset AVB and a negative CMR study, FDG PET may be useful for detecting cardiac involvement due to CS. (orig.)

  4. Difficulties with neurological prognostication in a young woman with delayed-onset generalised status myoclonus after cardiac arrest due to acute severe asthma

    Directory of Open Access Journals (Sweden)

    Arvind Rajamani


    Full Text Available Neurological prognostication in cardiac arrest survivors is difficult, especially when the primary etiology is respiratory arrest. Prognostic factors designed to have zero false-positive rates to robustly confirm poor outcome are usually inadequate to rule out poor outcomes (i.e., high specificity and low sensitivity. One of the least understood prognosticators is generalised status myoclonus (GSM, with case reports confusing GSM, isolated myoclonic jerks and post-hypoxic intention myoclonus (Lance Adams syndrome [LAS]. With several prognostic indicators (including status myoclonus having been validated in the pre-hypothermia era, their current relevance is debatable. New modalities such as brain magnetic resonance imaging (MRI and continuous electroencephalography are being evaluated. We describe here a pregnant woman resuscitated from a cardiac arrest due to acute severe asthma, and an inability to reach a consensus based on published guidelines, with a brief overview of myoclonus, LAS and the role of MRI brain in assisting prognostication.

  5. [A case of cardiac tamponade due to malignant pericarditis with lung adenocarcinoma, effectively treated with pericardial drainage and pemetrexed plus cisplatin chemotherapy]. (United States)

    Yoshida, Kazufumi; Teramoto, Shinji


    A 68-year-old man was diagnosed with non small cell lung cancer in May 2013. Although the patient was negative for EGFR mutation, he wished to undergo treatment with gefitinib and erlotinib as first-line therapy. However, one year later, he was admitted to our hospital because of cardiac tamponade due to malignant pericarditis. He received pericardial drainage, after which his condition was stabilized. He was diagnosed with lung adenocarcinoma by cytology of pericardial effusion and treated with pemetrexed plus cisplatin as second-line therapy. Thereafter, the malignant effusion was decreased and the primary lesion was regressed. He received six courses of chemotherapy, however, brain metastases and bone metastases appeared. The brain metastases were controlled with gamma knife radiosurgery and he received carboptatin-paclitaxel plus bevacizumab as third-line therapy. The patient is currently receiving chemotherapy without any recurrence of malignant pericarditis or cardiac tamponade.

  6. Is transition zone index useful in assessing bladder outflow obstruction due to benign prostatic hyperplasia?: A prospective study

    Directory of Open Access Journals (Sweden)

    S L Sailo


    Full Text Available BACKGROUND: Benign prostatic enlargement (BPE is the commonest cause of bladder outlet obstruction in men above 50 years of age. Though pressure-flow study is the gold standard in establishing outlet obstruction, it is associated with definite morbidity. Several noninvasive parameters are described to diagnose outlet obstruction due to BPE and evaluate treatment efficacy. AIM: We studied the role of transitional zone index (TZI in assessing bladder outlet obstruction (BOO due to BPE. SETTING AND DESIGN: Prospective hospital-based cross-sectional diagnostic study. MATERIALS AND METHODS: Thirty-five men aged between 50 and 77 years with untreated lower urinary tract symptoms due to BPE were studied. Patients with prostate cancer, prostatitis, active UTI urethral stricture, neurovesical dysfunction and diabetes mellitus were excluded. All patients underwent a standard assessment using the American Urological Association (AUA symptom score, uroflow, pressure-flow (PF study and transrectal ultrasound (TRUS estimation of TZI. Investigators undertaking PF studies and TRUS were blinded to the investigation of others. From the PF studies, Abrams Griffith (AG number was calculated. Based on this, patients were grouped into obstructed (AG>40 and unobstructed (AG< 40 groups. STATISTICAL ANALYSIS: TZI was calculated and compared with PF studies using Mann-Whitney U test, logistic regression analysis and receiver operator characteristic curve (ROC. RESULTS: The mean age was 63.2 years (SD. The mean AUA scores and peak flow rate were 16.7 and 7.5 ml/sec, respectively. Of the 35 men, 21 were obstructed and 14 were unobstructed. TZI was not significantly different between the two groups, while the differences in age, AUA symptom score, prostate volume and TZ volume were statistically significant. Logistic regression model did not show any independent effect of TZI in predicting obstruction. ROC curve showed a poor overall accuracy in diagnosing obstruction due

  7. An Obesity Paradox of Asian Body Mass Index after Cardiac Surgery: Arterial Oxygenations in Duration of Mechanic Ventilation

    Directory of Open Access Journals (Sweden)

    Chiu-Hsia Chang


    Full Text Available Background. Numerous studies have documented an obesity paradox that overweight of Caucasian patients has better prognosis after cardiac surgery. This study is to examine Asian patients’ BMI to see whether an obesity paradox exists in DMV after cardiac surgery. Methods. A retrospective study consisted of 428 patients after cardiac surgery from January 2006 to December 2010 in the medical center of Taiwan. The Asian BMI was divided into 3 groups: under-normal weight patients (; , overweight patients (BMI 24 to <27; , and obese patients (; . Multivariable analysis and paired were used to compare all variables. Results. Overweight patients were significantly associated with the shortest DMV. Under-normal weight patients had significantly better oxygenations of AaDO2 and P/F ratio in the DMV; however, they correlated with the longest DMV, older age, more female, lower LVSV, higher BUN, more dialysis-dependent, and poorer outcomes, namely, 1-year mortality, HAP, reintubation, tracheotomy, and LOS. Conclusions. Asian overweight patients after cardiac surgery have better prognosis. Under-normal weight patients have higher risk factors, longer DMV, and poorer outcomes; even though they have better arterial oxygenations, they seem to need better arterial oxygenations for successful weaning ventilator.

  8. Cardiac power index, mean arterial pressure, and Simplified Acute Physiology Score II are strong predictors of survival and response to revascularization in cardiogenic shock. (United States)

    Popovic, Batric; Fay, Renaud; Cravoisy-Popovic, Aurelie; Levy, Bruno


    Short-term prognostic factors in patients with cardiogenic shock (CS) have previously been established using only hemodynamic parameters without taking into account classic intensive care unit (ICU) severity score or organ failure/support. The aim of this study was to assess early predictors of in-hospital mortality of a monocentric cohort of patients with ST-elevation myocardial infarction complicated by early CS. We retrospectively studied 85 consecutive patients with CS complicating acute myocardial infarction and Thrombolysis in Myocardial Infarction flow grade 3 after percutaneous coronary revascularization. All patients were managed according to the following algorithm: initial resuscitation by a mobile medical unit or in-hospital critical care physician unit followed by percutaneous coronary revascularization and CS management in the ICU. Prehospital CS was diagnosed in 69% of cases, initially complicated by an out-of-hospital cardiac arrest in 64% of cases. All patients were treated with vasopressors, 82% were ventilated, and 22% underwent extrarenal epuration. The 28-day mortality rate was 39%. Under multivariate analysis, initial cardiac power index, mean arterial pressure of less than 75 mmHg at hour 6 of ICU management, and Simplified Acute Physiology Score II were independent predictive factors of in-hospital mortality. In conclusion, parameters directly related to cardiac performance and vascular response to vasopressors and admission Simplified Acute Physiology Score II are strong predictors of in-hospital mortality.

  9. Point-of-care pleural and lung ultrasound in a newborn suffering from cardiac arrest due to tension pneumothorax after cardiac surgery. (United States)

    Polito, Angelo; Biasucci, Daniele G; Cogo, Paola


    We report the case of a 12-day-old newborn affected by coarctation of the aorta and intraventricular defect who underwent coarctectomy and pulmonary artery banding. On post-operative day 7, the patient suffered from pulseless electric activity due to tension pneumothorax. Point-of-care ultrasound was performed during cardiopulmonary resuscitation in an attempt to diagnose pneumothorax. The diagnosis was made without delaying or interrupting chest compressions, and the pneumothorax was promptly treated.

  10. Clinical impact of left ventricular eccentricity index using cardiac MRI in assessment of right ventricular hemodynamics and myocardial fibrosis in congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, Yuzo; Kamitani, Takeshi; Yamanouchi, Torahiko; Honda, Hiroshi [Kyushu University, Departments of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan); Nagao, Michinobu; Kawanami, Satoshi [Kyushu University, Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Fukuoka (Japan); Yamamura, Kenichiro [Kyushu University, Pediatrics, Graduate School of Medical Sciences, Fukuoka (Japan); Sakamoto, Ichiro [Kyushu University, Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka (Japan); Yabuuchi, Hidetake [Kyushu University, Health SciencesGraduate School of Medical Sciences, Fukuoka (Japan)


    To investigate the utility of eccentricity index (EI) using cardiac cine MRI for the assessment of right ventricular (RV) hemodynamics in congenital heart disease (CHD). Fifty-five patients with CHD (32 women; mean age, 40.7 ± 20.9 years) underwent both cardiac MRI and right heart catheterization. EI was defined as the ratio of the distance between the anterior-posterior wall and the septal-lateral wall measured in the short-axis of mid-ventricular cine MRI. Correlations between EIs and RV hemodynamic parameters were analyzed. EIs were compared between patients with and without late gadolinium enhancement (LGE). A strong correlation between mean pulmonary artery pressure (PAP) and systolic EI (r = 0.81, p < 0.0001) and a moderate negative correlation between diastolic EI and RV ejection fraction (EF) (r = -0.62, p < 0.0001) were observed. Receiver operating characteristic analysis revealed optimal EI thresholds for detecting patients with mean PAP ≥40 mmHg with C-statistics of 0.90 and patients with RVEF <40 % with C-statistics of 0.78. Systolic EIs were significantly greater for patients with LGE (1.45 ± 0.05) than for those without LGE (1.15 ± 0.07; p < 0.001). EI offers a simple, comprehensive index that can predict pulmonary hypertension and RV dysfunction in CHD. (orig.)

  11. Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest. (United States)

    Xing, Jingjun; Li, Shangxun; Zhang, Lin; Yang, Yi; Duan, Yijie; Li, Wenhe; Zhou, Yiwu


    Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.

  12. Asystole due to trigemino-cardiac reflex: a rare complication of trans-sphenoidal surgery for pituitary adenoma. (United States)

    Seker, Askin; Toktas, Zafer Orkun; Peker, Selcuk; Batirel, Halit Abbas; Necmettin Pamir, M


    The trigemino-cardiac reflex (TCR) is a well-known reflexive response in which bradycardia, hypotension, and gastric hypermotility are induced by stimulation of a peripheral or central portion of the trigeminal nerve. This reflex occurs during craniofacial surgery and other operations on or near the cerebellopontine angle, petrosal sinus, orbit and trigeminal ganglion. TCR is a well-known, although not well documented, phenomenon commonly observed during trans-sphenoidal surgery for resection of pituitary adenomas. We report a case in which asystole occurred during trans-sphenoidal surgery on a pituitary adenoma that was infiltrating the right cavernous sinus. When the anesthesiologist reported asystole, the team stopped manipulation and administered intravenous atropine. Intra-operative MRI showed a small tumour remnant in the right cavernous sinus. The operation was terminated but subsequent radiosurgery was planned for the residual tumor. Although TCR is rare and usually self-limiting, this case led us to change our treatment strategy. Surgeons who perform trans-sphenoidal surgery should be aware of this potential problem. Invasive pituitary adenomas should be removed gently and the risk of triggering TCR should be kept in mind.

  13. Recurrent Muscle Weakness with Rhabdomyolysis, Metabolic Crises, and Cardiac Arrhythmia Due to Bi-allelic TANGO2 Mutations. (United States)

    Lalani, Seema R; Liu, Pengfei; Rosenfeld, Jill A; Watkin, Levi B; Chiang, Theodore; Leduc, Magalie S; Zhu, Wenmiao; Ding, Yan; Pan, Shujuan; Vetrini, Francesco; Miyake, Christina Y; Shinawi, Marwan; Gambin, Tomasz; Eldomery, Mohammad K; Akdemir, Zeynep Hande Coban; Emrick, Lisa; Wilnai, Yael; Schelley, Susan; Koenig, Mary Kay; Memon, Nada; Farach, Laura S; Coe, Bradley P; Azamian, Mahshid; Hernandez, Patricia; Zapata, Gladys; Jhangiani, Shalini N; Muzny, Donna M; Lotze, Timothy; Clark, Gary; Wilfong, Angus; Northrup, Hope; Adesina, Adekunle; Bacino, Carlos A; Scaglia, Fernando; Bonnen, Penelope E; Crosson, Jane; Duis, Jessica; Maegawa, Gustavo H B; Coman, David; Inwood, Anita; McGill, Jim; Boerwinkle, Eric; Graham, Brett; Beaudet, Art; Eng, Christine M; Hanchard, Neil A; Xia, Fan; Orange, Jordan S; Gibbs, Richard A; Lupski, James R; Yang, Yaping


    The underlying genetic etiology of rhabdomyolysis remains elusive in a significant fraction of individuals presenting with recurrent metabolic crises and muscle weakness. Using exome sequencing, we identified bi-allelic mutations in TANGO2 encoding transport and Golgi organization 2 homolog (Drosophila) in 12 subjects with episodic rhabdomyolysis, hypoglycemia, hyperammonemia, and susceptibility to life-threatening cardiac tachyarrhythmias. A recurrent homozygous c.460G>A (p.Gly154Arg) mutation was found in four unrelated individuals of Hispanic/Latino origin, and a homozygous ∼34 kb deletion affecting exons 3-9 was observed in two families of European ancestry. One individual of mixed Hispanic/European descent was found to be compound heterozygous for c.460G>A (p.Gly154Arg) and the deletion of exons 3-9. Additionally, a homozygous exons 4-6 deletion was identified in a consanguineous Middle Eastern Arab family. No homozygotes have been reported for these changes in control databases. Fibroblasts derived from a subject with the recurrent c.460G>A (p.Gly154Arg) mutation showed evidence of increased endoplasmic reticulum stress and a reduction in Golgi volume density in comparison to control. Our results show that the c.460G>A (p.Gly154Arg) mutation and the exons 3-9 heterozygous deletion in TANGO2 are recurrent pathogenic alleles present in the Latino/Hispanic and European populations, respectively, causing considerable morbidity in the homozygotes in these populations.

  14. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

    Directory of Open Access Journals (Sweden)

    Jian Zhang


    Full Text Available OBJECTIVES: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting in thoracic surgery patients requiring one-lung ventilation.

  15. Chronic murine myocarditis due to Trypanosoma cruzi: an ultrastructural study and immunochemical characterization of cardiac interstitial matrix

    Directory of Open Access Journals (Sweden)

    Sonia G. Andrade


    Full Text Available In an attempt to define the mouse-model for chronic Chagas' disease, a serological, histopathological and ultrastructural study as well as immunotyping of myocardium collagenic matrix were performed on Swiss mice, chronically infected with Trypanosoma cruzi strains: 21 SF and mambaí (Type II; PMN and Bolivia (Type III, spontaneously surviving after 154 to 468 days of infection. Haemagglutination and indirect immunofluorescence tests showed high titres of specific antibodies. The ultrastructural study disclosed the cellular constitution of the inflammatory infiltrate showing the predominance of monocytes, macrophages with intense phagocytic activity, fibroblasts, myofibroblasts and abundant collagen matrix suggesting the association of the inflammatory process with fibrogenesis in chronic chagasic cardiomyopathy. Artertolar and blood capillary alterations together with dissociation of cardiac cells from the capillary wall by edema and inflammation were related to ultrastructural lesions of myocardial cells. Rupture of parasitized cardiac myocells contribute to intensify the inflammatory process in focal areas. Collagen immunotyping showed the predominance of Types III and IV collagen. Collagen degradation and phagocytosis were present suggesting a reversibility of the fibrous process. The mouse model seems to be valuable in the study of the pathogenetic mechanisms in Chagas cardiomyopathy, providing that T. cruzi strains of low virulence and high pathogenecity are used.Utilizando o modelo experimental do camundongo, foi realizado um estudo sorológico, histopatológico e ultraestrutural bem como a imunotipagem do colágeno na matriz conjuntiva do miocárdio em camundongos suiços cronicamente infectados com as cepas 21 SF e Mambaí (Tipo II PMN e Bolívia (Tipo III por períodos de 154 a 468 dias. Os testes sorológicos e de imunofluorescência indireta mostraram altos títulos de anticorpos específicos. O estudo estrutural definiu melhor a

  16. Alterations in intracellular ionic calcium levels in isolated adult rat cardiac myocytes due to the generation of free radicals

    Energy Technology Data Exchange (ETDEWEB)

    Burton, K.P.; Nazeran, H.; Hagler, H.K. (Univ. of Texas, Dallas, TX (United States))


    Oxygen-derived free radical production has been documented to occur on reperfusion of the ischemic myocardium. Intracellular ionic calcium ((Ca{sup ++}){sub i}) levels in isolated adult rat cardiac myocytes (M) exposed to free radicals were evaluated using the fluorescent calcium indicator, fura-2. The effect of different time periods of free radical exposure and the level of extracellular Ca{sup ++} concentration on altering (Ca{sup ++}){sub i} was examined. The free radical generating system (FRGS) utilized consisted of a HEPES buffered physiological salt solution containing 2.3 mM purine, 2.4. {mu}M iron-loaded transferrin and 0.01 U/ml xanthine oxidase. M maintained in HEPES buffer or the HEPES buffer containing purine and iron-loaded transferrin continued to stimulate, exhibited relatively uniform 340/380 ratios and maintained a rod shape for extended time periods. M continuously exposed to the FRGS showed a significant increase in (Ca{sup ++}){sub i}, became unresponsive to stimulation at 31 {plus minus} 7 (SE) min and eventually exhibited contracture. Exposure to the FRGS for 10 min resulted in a response similar to continuous exposure. M exposed to the FRGS for 5 min exhibited regular Ca{sup ++} transients for 55{plus minus}5 min. M exposed to the FRGS for 10 min and maintained in 2.5 mM Ca{sup ++} versus 1.25 mM Ca{sup ++}, accumulated significantly higher (CA{sup ++}){sub i}. Quiescent myocytes continuously exposed to the FRGS also exhibited a significant increase in (Ca{sup ++}){sub i} over time. Thus, a brief period of free radical exposure may induce subsequent damage. Alterations in Ca{sup ++} flux resulting from the generation of free radicals may possibly contribute to the development of Ca{sup ++} overload and myocardial arrhythmias.

  17. Cardiac ryanodine receptor gene (hRyR2) mutation underlying catecholaminergic polymorphic ventricular tachycardia in a Chinese adolescent presenting with sudden cardiac arrest and cardiac syncope

    Institute of Scientific and Technical Information of China (English)

    Ngai-Shing Mok; Ching-Wan Lam; Nai-Chung Fong; Yim-Wo Hui; Yuen-Choi Choi; Kwok-Yin Chan


    @@ Sudden cardiac death (SCD) in children and adolescents is uncommon and yet it is devastating for both victim's family and the society.Recently, it was increasingly recognized that SCD in young patients with structurally normal heart may be caused by inheritable primary electrical diseases due to the malfunction of cardiac ion channels, a disease entity known as the ion channelopathies.Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a specific form of ion channelopathy which can cause cardiac syncope or SCD in young patients by producing catecholamine-induced bi-directional ventricular tachycardia (BiVT), polymorphic VT and ventricular fibrillation (VF) during physical exertion or emotion.1-7 We reported here an index case of CPVT caused by cardiac ryanodine receptor gene (hRyR2)mutation which presented as cardiac syncope and sudden cardiac arrest in a Chinese adolescent female.

  18. 静脉输注氨茶碱治疗严重脓毒症的可行性%Effects of aminophylline on cardiac index,oxygenation index, urine output and APACHEⅡ in patients with sepsis

    Institute of Scientific and Technical Information of China (English)

    代冬梅; 王飞; 许汪斌; 杨磊; 谢翠英


    Objective To investigate the effects of aminophylline on cardiac index, oxygenation index and urine output in patients with sepsis. Methods Sixty APACHE Ⅱ score > 16 points patients with spesis of both sexes, aged 22 -76yr, were randomly divided into 2 groups( n = 30 each ) : aminophylline group ( group A ) and control group( group C ). Mechanical ventilation, antibiotics according to susceptibility or the sites of infection, early goal - directed therapy and low - dose steroids were administered for septic shock in both groups. Aminophylline 3mg/kg was infused iv over 30 min and followed by an infusion at 0. 4 mg/( kg·h ) for 4 days. Cardiac index, stroke volume variation and invasive arterial blood pressure were continuously monitored. Blood samples were drawn for blood gas analysis calculating oxygenation index and for determination of aminophylline serum concentration before aminophylline infusion( T0) and at 24h( T1), 48h( T2 ) and 72 h( T3 ) following aminophylline infusion. Urine output and total daily infusion were recorded at T0- T3. Results There were no significant differences in age, gender ratios, height, weight, APACHE Ⅱ scores, and total daily infusion between two groups ( P>0. 05 ). Compared with group C, there were no significant differences in the total daily infusion, cardiac index, oxygenation index and urine output before intravenous infusion of aminophylline ( P >0. 05 ). Compared with the values before intravenous infusion of aminophylline ( T0), oxygenation index and urine output increased in two groups ( P 0. 05 ), but it increased at T1 and T3( P 0. 05 ). Conclusion Intravenous infusion of aminophylline can increase urine output, oxygenation index and cardiac index in patients with sepsis.%目的 观察静脉输注氨茶碱对严重脓毒症患者氧合指数、尿量、心脏指数和APACHEII评分的影响,探讨静脉输注氨茶碱治疗脓毒症的可行性.方法 将60例APACHE 评分>16分的脓毒症患者随机分为氨茶

  19. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanović-Krstić Branislava A.


    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  20. Average years of life lost due to breast and cervical cancer and the association with the marginalization index in Mexico in 2000 and 2010

    Directory of Open Access Journals (Sweden)

    Claudio Alberto Dávila Cervantes


    Full Text Available The objective of this study was to calculate average years of life lost due to breast and cervical cancer in Mexico in 2000 and 2010. Data on mortality in women aged between 20 and 84 years was obtained from the National Institute for Statistics and Geography. Age-specific mortality rates and average years of life lost, which is an estimate of the number of years that a person would have lived if he or she had not died prematurely, were estimated for both diseases. Data was disaggregated into five-year age groups and socioeconomic status based on the 2010 marginalization index obtained from the National Population Council. A decrease in average years of life lost due to cervical cancer (37.4% and an increase in average years of life lost due breast cancer (8.9% was observed during the period studied. Average years of life lost due to cervical cancer was greater among women living in areas with a high marginalization index, while average years of life lost due to breast cancer was greater in women from areas with a low marginalization index.

  1. Average years of life lost due to breast and cervical cancer and the association with the marginalization index in Mexico in 2000 and 2010. (United States)

    Cervantes, Claudio Alberto Dávila; Botero, Marcela Agudelo


    The objective of this study was to calculate average years of life lost due to breast and cervical cancer in Mexico in 2000 and 2010. Data on mortality in women aged between 20 and 84 years was obtained from the National Institute for Statistics and Geography. Age-specific mortality rates and average years of life lost, which is an estimate of the number of years that a person would have lived if he or she had not died prematurely, were estimated for both diseases. Data was disaggregated into five-year age groups and socioeconomic status based on the 2010 marginalization index obtained from the National Population Council. A decrease in average years of life lost due to cervical cancer (37.4%) and an increase in average years of life lost due breast cancer (8.9%) was observed during the period studied. Average years of life lost due to cervical cancer was greater among women living in areas with a high marginalization index, while average years of life lost due to breast cancer was greater in women from areas with a low marginalization index.

  2. Neonatal multiorgan failure due to ACAD9 mutation and complex I deficiency with mitochondrial hyperplasia in liver, cardiac myocytes, skeletal muscle, and renal tubules. (United States)

    Leslie, Nancy; Wang, Xinjian; Peng, Yanyan; Valencia, C Alexander; Khuchua, Zaza; Hata, Jessica; Witte, David; Huang, Taosheng; Bove, Kevin E


    Complex I deficiency causes Leigh syndrome, fatal infant lactic acidosis, and neonatal cardiomyopathy. Mutations in more than 100 nuclear DNA and mitochondrial DNA genes miscode for complex I subunits or assembly factors. ACAD9 is an acyl-CoA dehydrogenase with a novel function in assembly of complex I; biallelic mutations cause progressive encephalomyopathy, recurrent Reye syndrome, and fatal cardiomyopathy. We describe the first autopsy in fatal neonatal lethal lactic acidosis due to mutations in ACAD9 that reduced complex I activity. We identified mitochondrial hyperplasia in cardiac myocytes, diaphragm muscle, and liver and renal tubules in formalin-fixed, paraffin-embedded tissue using immunohistochemistry for mitochondrial antigens. Whole-exome sequencing revealed compound heterozygous variants in the ACAD9 gene: c.187G>T (p.E63*) and c.941T>C (p.L314P). The nonsense mutation causes late infantile lethality; the missense variant is novel. Autopsy-derived fibroblasts had reduced complex I activity (53% of control) with normal activity in complexes II to IV, similar to reported cases of ACAD9 deficiency.

  3. An Erosion Aggressiveness Index (EAI) Based on Pressure Load Estimation Due to Bubble Collapse in Cavitating Flows Within the RANS Solvers


    Bergeles, G.; Koukouvinis, P.; Gavaises, M.; Li, J; Wang, L.


    Despite numerous research efforts, there is no reliable and widely accepted tool for the prediction of erosion prone material surfaces due to collapse of cavitation bubbles. In the present paper an Erosion Aggressiveness Index (EAI) is proposed, based on the pressure loads which develop on the material surface and the material yield stress. EAI depends on parameters of the liquid quality and includes the fourth power of the maximum bubble radius and the bubble size number density distribution...

  4. Heart Failure Due to Age-Related Cardiac Amyloid Disease Associated With Wild-Type Transthyretin: A Prospective, Observational Cohort Study (United States)

    Connors, Lawreen H.; Sam, Flora; Skinner, Martha; Salinaro, Francesco; Sun, Fangui; Ruberg, Frederick L.; Berk, John L.; Seldin, David C.


    Background Heart failure due to wild-type transthyretin amyloidosis (ATTRwt) is an under-appreciated cause of morbidity and mortality in the aging population. The aims of this study were to examine features of disease and characterize outcomes in a large ATTRwt cohort. Methods and Results Over 20 years, 121 patients with ATTRwt were enrolled in a prospective observational study. Median age at enrollment was 75.6 years (range, 62.6–87.8); 97% of patients were Caucasian. The median survival, measured from biopsy diagnosis, was 46.69 months (95% CI, 41.95–56.77); 78% of deaths were due to cardiac causes. By Kaplan-Meier analysis, 5-year survival was 35.7% (95% CI, 25–46). Impaired functional capacity (mean VO2 max of 13.5 mL/kg/min) and atrial fibrillation (67%) were common clinical features. Multivariate predictors of reduced survival were elevated serum brain natriuretic peptide (BNP, 482 ± 337 pg/mL) and uric acid (8.2 ± 2.6 mg/dL), decreased left ventricular ejection fraction (LVEF, 50% median ranging 10-70%), and increased relative wall thickness (RWT, 0.75 ± 0.19). Conclusions In this series of patients with biopsy-proven ATTRwt amyloidosis, poor functional capacity and atrial arrhythmias were common clinical features. Elevated BNP and uric acid, decreased LVEF, and increased RWT were associated with limited survival of only 35.7% at 5 years for the group as a whole. These data establish the natural history of ATTRwt, provide statistical basis for the design of future interventional clinical trials, and highlight the need for more sensitive diagnostic tests and disease-specific treatments for this disease. PMID:26660282

  5. Relation between strain dyssynchrony index determined by comprehensive assessment using speckle-tracking imaging and long-term outcome after cardiac resynchronization therapy for patients with heart failure. (United States)

    Tatsumi, Kazuhiro; Tanaka, Hidekazu; Matsumoto, Kensuke; Kaneko, Akihiro; Tsuji, Takayuki; Ryo, Keiko; Fukuda, Yuko; Norisada, Kazuko; Onishi, Tetsuari; Yoshida, Akihiro; Kawai, Hiroya; Hirata, Ken-Ichi


    Strain dyssynchrony index (SDI), which was a marker of dyssynchrony and residual myocardial contractility, can predict left ventricular reverse remodeling short-term after cardiac resynchronization therapy (CRT). We investigated SDI-predicted long-term outcome after CRT in patients with heart failure (HF). We studied 74 patients with HF who underwent CRT. SDI was calculated as the average difference between peak and end-systolic strain from 6 segments for radial and circumferential SDIs and 18 segments for longitudinal SDI using 2-dimensional speckle-tracking strain. Based on our previous findings, the predefined cutoff for significant dyssynchrony and residual myocardial contractility was a radial SDI ≥6.5%, a circumferential SDI ≥3.2%, and a longitudinal SDI ≥3.6%. The predefined principal outcome variable was the combined end point of death or hospitalization owing to deteriorating HF. Long-term follow-up after CRT was tracked over 4 years. The primary end point of prespecified events occurred in 14 patients (19%). An association with a favorable long-term outcome after CRT was observed in patients with significant radial, circumferential, and longitudinal SDIs (p SDIs, respectively). Furthermore, cardiovascular event-free rate after CRT in patients with positivity of 3 for the 3 SDIs was 100% better than that in patients with positivity of 1 (52%, p SDIs. In conclusion, SDIs can successfully predict long-term outcome after CRT in patients with HF. Moreover, the approach combining the 3 types of SDI leads to a more accurate prediction than the use of individual parameters. These findings may have clinical implications in patients with CRT.

  6. Discordant diagnoses of acute myocardial infarction due to the different use of assays and cut-off points of cardiac troponins

    DEFF Research Database (Denmark)

    Lyck Hansen, Maria; Saaby, Lotte; Nybo, Mads


    Objectives: Several assays for the measurement of cardiac troponin (cTn) are available, but differences in their analytical performances may affect the diagnosis of acute myocardial infarction (MI). Methods: A survey was conducted at all Danish departments of clinical biochemistry at hospitals...

  7. Evolution from increased cardiac mechanical function towards cardiomyopathy in the obese rat due to unbalanced high fat and abundant equilibrated diets

    Directory of Open Access Journals (Sweden)

    Mourmoura Evangelia


    Full Text Available The aim of our study was to know whether high dietary energy intake (HDEI with equilibrated and unbalanced diets in term of lipid composition modify the fatty acid profile of cardiac phospholipids and function of various cardiac cells and to know if the changes in membrane lipid composition can explain the modifications of cellular activity. Wistar rats were fed either a control or high-fat (HF diet for 12 weeks and Zucker diabetic fatty (ZDF rats as well as their lean littermate (ZL a control diet between week 7 to 11 of their life. Energy intake and abdominal obesity was increased in HF-fed and ZDF rats. Circulating lipids were also augmented in both strains although hyperglycemia was noticed only in ZDF rats. HDEI induced a decrease in linoleate and increase in arachidonate in membrane phospholipids which was more pronounced in the ZDF rats compared to the HF-fed rats. In vivo cardiac function (CF was improved in HF-fed rats whereas ex vivo cardiac function was unchanged, suggesting that environmental factors such as catecholamines stimulated the in vivo CF. The unchanged ex vivo CF was associated with an increased cardiac mass which indicated development of fibrosis and/or hypertrophy. The increased in vivo CF was sustained by an augmented coronary reserve which was related to the cyclooxygenase pathway and accumulation of arachidonate in membrane phospholipids. In conclusion, before triggering a diabetic cardiomyopathy, HDEI stimulated the CF. The development of cardiomyopathy seems to result from fibrosis and/or hypertrophy which augments myocardial stiffness and decreases contractility.

  8. Molecular Basis of Cardiac Myxomas

    Directory of Open Access Journals (Sweden)

    Pooja Singhal


    Full Text Available Cardiac tumors are rare, and of these, primary cardiac tumors are even rarer. Metastatic cardiac tumors are about 100 times more common than the primary tumors. About 90% of primary cardiac tumors are benign, and of these the most common are cardiac myxomas. Approximately 12% of primary cardiac tumors are completely asymptomatic while others present with one or more signs and symptoms of the classical triad of hemodynamic changes due to intracardiac obstruction, embolism and nonspecific constitutional symptoms. Echocardiography is highly sensitive and specific in detecting cardiac tumors. Other helpful investigations are chest X-rays, magnetic resonance imaging and computerized tomography scan. Surgical excision is the treatment of choice for primary cardiac tumors and is usually associated with a good prognosis. This review article will focus on the general features of benign cardiac tumors with an emphasis on cardiac myxomas and their molecular basis.

  9. Mechanisms of cardiac pain. (United States)

    Foreman, Robert D; Garrett, Kennon M; Blair, Robert W


    Angina pectoris is cardiac pain that typically is manifested as referred pain to the chest and upper left arm. Atypical pain to describe localization of the perception, generally experienced more by women, is referred to the back, neck, and/or jaw. This article summarizes the neurophysiological and pharmacological mechanisms for referred cardiac pain. Spinal cardiac afferent fibers mediate typical anginal pain via pathways from the spinal cord to the thalamus and ultimately cerebral cortex. Spinal neurotransmission involves substance P, glutamate, and transient receptor potential vanilloid-1 (TRPV1) receptors; release of neurokinins such as nuclear factor kappa b (NF-kb) in the spinal cord can modulate neurotransmission. Vagal cardiac afferent fibers likely mediate atypical anginal pain and contribute to cardiac ischemia without accompanying pain via relays through the nucleus of the solitary tract and the C1-C2 spinal segments. The psychological state of an individual can modulate cardiac nociception via pathways involving the amygdala. Descending pathways originating from nucleus raphe magnus and the pons also can modulate cardiac nociception. Sensory input from other visceral organs can mimic cardiac pain due to convergence of this input with cardiac input onto spinothalamic tract neurons. Reduction of converging nociceptive input from the gallbladder and gastrointestinal tract can diminish cardiac pain. Much work remains to be performed to discern the interactions among complex neural pathways that ultimately produce or do not produce the sensations associated with cardiac pain.

  10. Non-ischemic perfusion defects due to delayed arrival of contrast material on stress perfusion cardiac magnetic resonance imaging after coronary artery bypass graft surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeo Koon; Park, Eun Ah; Park, Sang Joon; Cheon, Gi Jeong; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of)


    Herein we report about the adenosine stress perfusion MR imaging findings of a 50-year-old man who exhibited two different perfusion defects resulting from two different mechanisms after a coronary artery bypass surgery. An invasive coronary angiography confirmed that one perfusion defect at the mid-anterior wall resulted from an ischemia due to graft stenosis. However, no stenosis was detected on the graft responsible for the mid-inferior wall showing the other perfusion defect. It was assumed that the perfusion defect at the mid-inferior wall resulted from delayed perfusion owing to the long pathway of the bypass graft. The semiquantitative analysis of corrected signal-time curves supported our speculation, demonstrating that the rest-to-stress ratio index of the maximal slope of the myocardial territory in question was similar to those of normal myocardium, whereas that of myocardium with the stenotic graft showed a typical ischemic pattern. A delayed perfusion during long graft pathway in a post-bypass graft patient can mimick a true perfusion defect on myocardial stress MR imaging. Radiologists should be aware of this knowledge to avoid misinterpretation of graft and myocardial status in post bypass surgery patients.

  11. Early cardiac failure in a child with Becker muscular dystrophy is due to an abnormally low amount of dystrophin transcript lacking exon 13. (United States)

    Ishigaki, C; Patria, S Y; Nishio, H; Yoshioka, A; Matsuo, M


    Two Japanese brothers with Becker muscular dystrophy were shown by polymerase chain reaction (PCR) and cDNA sequence analysis to produce a dystrophin gene transcript lacking a single exon: that is, number 13. Despite having the same deletion mutation, the brothers showed clearly different clinical phenotypes: the younger brother developed cardiac failure at the age of nine, while the elder brother was asymptomatic. As alternative splicing was not responsible for this clinical difference, the amount of dystrophin transcript was examined by using reverse transcription semi-nested and parallel PCR. The results showed that the amount of the dystrophin transcript in the younger brother was 20% of that of the elder brother. This finding suggested that lesser amount of dystrophin transcript in the younger brother was responsible for the early onset of cardiac failure. This would represent a novel molecular mechanism for dystrophinopathy.

  12. Effect of polysaccharides extract of rhizoma atractylodis macrocephalae on thymus, spleen and cardiac indexes, caspase-3 activity ratio, Smac/DIABLO and HtrA2/Omi protein and mRNA expression levels in aged rats. (United States)

    Guo, Ling; Sun, Yong Le; Wang, Ai Hong; Xu, Chong En; Zhang, Meng Yuan


    This study was designed to determine the possible protective effect of polysaccharides extract of rhizoma atractylodis macrocephalae on heart function in aged rats. Polysaccharides extract of rhizoma atractylodis macrocephalae was administered to aged rats. Results showed that thymus, spleen and cardiac indexs were significantly increased, whereas caspase-3 activity ratio, Smac/DIABLO and HtrA2/Omi protein expression, Smac/DIABLO and HtrA2/Omi mRNA expression levels were markedly reduced. It can be concluded that polysaccharides extract of rhizoma atractylodis macrocephalae may enhance immunity and improve heart function in aged rats.

  13. Embryonic lethality in mice lacking the nuclear factor of activated T cells 5 protein due to impaired cardiac development and function.

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    Man Chi Mak

    Full Text Available Nuclear factor of activated T cells 5 protein (NFAT5 is thought to be important for cellular adaptation to osmotic stress by regulating the transcription of genes responsible for the synthesis or transport of organic osmolytes. It is also thought to play a role in immune function, myogenesis and cancer invasion. To better understand the function of NFAT5, we developed NFAT5 gene knockout mice. Homozygous NFAT5 null (NFAT5(-/- mouse embryos failed to develop normally and died after 14.5 days of embryonic development (E14.5. The embryos showed peripheral edema, and abnormal heart development as indicated by thinner ventricular wall and reduced cell density at the compact and trabecular areas of myocardium. This is associated with reduced level of proliferating cell nuclear antigen and increased caspase-3 in these tissues. Cardiomyocytes from E14.5 NFAT5(-/- embryos showed a significant reduction of beating rate and abnormal Ca(2+ signaling profile as a consequence of reduced sarco(endoplasmic reticulum Ca(2+-ATPase (SERCA and ryanodine receptor (RyR expressions. Expression of NFAT5 target genes, such as HSP 70 and SMIT were reduced in NFAT5(-/- cardiomyocytes. Our findings demonstrated an essential role of NFAT5 in cardiac development and Ca(2+ signaling. Cardiac failure is most likely responsible for the peripheral edema and death of NFAT5(-/- embryos at E14.5 days.

  14. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

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    Michael Mazzeffi


    Full Text Available Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

  15. Application of pulse index continuous cardiac output monitoring to improve efficiency of acute heart failure care%应用脉搏指数连续心输出量监测提升急性心力衰竭护理效果

    Institute of Scientific and Technical Information of China (English)

    孙秀月; 张领; 赵书琴


    Objective To ihvestigate the effect of pulse index continuous cardiac output (PiCCO) monitoring to nursing care of acute heart failure care.Methods The clinical data of 43 acute heart failure patients were retrospectively analyzed,patients were given pulse index continuous cardiac output monitoring and care,the patient' s nursing outcomes were observed,and the intrathoracic blood volume,cardiac output and oxygen consumption before and after the intervention were compared.Results After the implementation of PiCCO and nursing intervention,43 patients had no serious complications,improved 42 cases discharged,the other 1 patient in critical condition due to old age and heart function improvement sustained no automatic discharge.Oxygen consumption,cardiac output and intrathoracic blood volume were improved after the intervention,there was a significant difference (P < 0.05) compared to the previous indicators and intervention after intervention.Conclusions Application of pulse index continuous cardiac output can effectively improve patient's clinical parameters such as cardiac output,through the implementation of appropriate care can improve symptoms and reduce complications.%目的 探讨急性心力衰竭患者护理中应用脉搏指数连续心输出量监测(PiCCO)的效果.方法 选取平顶山市第二人民医院收治的43例急性心力衰竭患者作为研究对象,收集患者的临床资料并对其做回顾性分析,对患者实施脉搏指数连续心输出量监测和护理,对患者的护理效果进行观察,并对其干预前后的胸腔内血容量、心排血量与氧耗量进行对比观察.结果 实施PiCCO和护理干预,本研究43例患者均无严重并发症产生,42例好转出院,1例由于病情危重、高龄及心功能持续无改善自动出院.患者干预后的氧耗量、心排血量与胸腔内血容量均有所改善,干预后各项指标与干预前比较差异有统计学意义(P<0.05).结论 应用脉搏指数连续心

  16. Correlação entre gasometria atrial direita e índice cardíaco no pós-operatório de cirurgia cardíaca Correlation between right atrial venous blood gasometry and cardiac index in cardiac surgery postoperative period

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    João Jackson Duarte


    Full Text Available OBJETIVO: Determinar a confiabilidade em se correlacionar o índice cardíaco com os dados fornecidos pela gasometria do sangue venoso atrial direito em pacientes submetidos à cirurgia cardíaca, durante o período pós-operatório. MÉTODOS: A partir das amostras de sangue arterial e venoso do átrio direito, colhidas no pós-operatório de cirurgia cardíaca, foram determinados os parâmetros de oxigênio do sangue venoso do átrio direito. Estes parâmetros foram então comparados com o índice cardíaco determinado pela termodiluição. RESULTADOS: Houve boa correlação entre a saturação de oxigênio do sangue venoso do átrio direito (SvO2, diferença artério-venosa do conteúdo de oxigênio do sangue colhido no átrio direito e o índice cardíaco aferido pela termodiluição, com boa sensibilidade e especificidade e alto valor preditivo positivo e negativo. A pressão do sangue do átrio direito (PvO2 apresentou baixa sensibilidade na estimativa de baixo débito cardíaco. CONCLUSÃO: No pós-operatório de cirurgia cardíaca, a SvO2e a diferença artério-venosa do conteúdo de oxigênio (C(avO2 apresentaram-se como parâmetros confiáveis correlacionados a baixo débito cardíaco. A PvO2 foi pouco sensível no diagnóstico de baixo débito no pós-operatório de cirurgia cardíaca.OBJECTIVE: To determine, even during postoperative period, the confiability of the cardiac index correlate with the data data given by a central atrial venous blood gasometry in patients who underwent cardiac surgery. METHODS: From the sample of arterial and venous blood of right atrium gathered in postoperative of cardiac surgery, it was determinated the hemoglobin concentration and the gasometric study through what was observed of the venous oxygen saturation (SvO2 and the partial pressure of oxygen from venous blood gathered in right atrium (PvO2, add to the calculation of artery-venous difference of the oxygen content - radial artery / right atrium (C

  17. Cardiac arrest (United States)

    ... Article.jsp. Accessed June 16, 2014. Myerburg RJ, Castellanos A. Approach to cardiac arrest and life-threatening ... PA: Elsevier Saunders; 2011:chap 63. Myerburg RJ, Castellanos A. Cardiac arrest and audden aardiac death. In: ...

  18. Recovery of the cardiac frequency to the minute post effort as early indicator of myocardial ischemia; Recuperacion de la frecuencia cardiaca al minuto postesfuerzo como indicador temprano de isquemia miocardica

    Energy Technology Data Exchange (ETDEWEB)

    Jimenez M, L. [Centro Medico Nacional 20 de Noviembre, Mexico D.F. (Mexico)


    The objective of the work was to evaluate the recovery cardiac frequency like ischemia indicator, due to the immediate reactivity of the parasympathetic nervous system in the post-effort. It is obtained as conclusion that a slow descent of the cardiac frequency to the first minute of the post-effort is a predictor ischemia index when correlating it with the risk evaluated by cardiac SPECT with a high specificity; being this a marker of simple calculating in the daily practice. (Author)

  19. Left ventricular hypertrophy index based on a combination of frontal and transverse planes in the ECG and VCG: Diagnostic utility of cardiac vectors (United States)

    Bonomini, Maria Paula; Juan Ingallina, Fernando; Barone, Valeria; Antonucci, Ricardo; Valentinuzzi, Max; Arini, Pedro David


    The changes that left ventricular hypertrophy (LVH) induces in depolarization and repolarization vectors are well known. We analyzed the performance of the electrocardiographic and vectorcardiographic transverse planes (TP in the ECG and XZ in the VCG) and frontal planes (FP in the ECG and XY in the VCG) to discriminate LVH patients from control subjects. In an age-balanced set of 58 patients, the directions and amplitudes of QRS-complexes and T-wave vectors were studied. The repolarization vector significantly decreased in modulus from controls to LVH in the transverse plane (TP: 0.45±0.17mV vs. 0.24±0.13mV, p<0.0005 XZ: 0.43±0.16mV vs. 0.26±0.11mV, p<0.005) while the depolarization vector significantly changed in angle in the electrocardiographic frontal plane (Controls vs. LVH, FP: 48.24±33.66° vs. 46.84±35.44°, p<0.005, XY: 20.28±35.20° vs. 19.35±12.31°, NS). Several LVH indexes were proposed combining such information in both ECG and VCG spaces. A subset of all those indexes with AUC values greater than 0.7 was further studied. This subset comprised four indexes, with three of them belonging to the ECG space. Two out of the four indexes presented the best ROC curves (AUC values: 0.78 and 0.75, respectively). One index belonged to the ECG space and the other one to the VCG space. Both indexes showed a sensitivity of 86% and a specificity of 70%. In conclusion, the proposed indexes can favorably complement LVH diagnosis

  20. Fatal cardiac arrhythmia and long-QT syndrome in a new form of congenital generalized lipodystrophy with muscle rippling (CGL4 due to PTRF-CAVIN mutations.

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    Anna Rajab


    Full Text Available We investigated eight families with a novel subtype of congenital generalized lipodystrophy (CGL4 of whom five members had died from sudden cardiac death during their teenage years. ECG studies revealed features of long-QT syndrome, bradycardia, as well as supraventricular and ventricular tachycardias. Further symptoms comprised myopathy with muscle rippling, skeletal as well as smooth-muscle hypertrophy, leading to impaired gastrointestinal motility and hypertrophic pyloric stenosis in some children. Additionally, we found impaired bone formation with osteopenia, osteoporosis, and atlanto-axial instability. Homozygosity mapping located the gene within 2 Mbp on chromosome 17. Prioritization of 74 candidate genes with GeneDistiller for high expression in muscle and adipocytes suggested PTRF-CAVIN (Polymerase I and transcript release factor/Cavin as the most probable candidate leading to the detection of homozygous mutations (c.160delG, c.362dupT. PTRF-CAVIN is essential for caveolae biogenesis. These cholesterol-rich plasmalemmal vesicles are involved in signal-transduction and vesicular trafficking and reside primarily on adipocytes, myocytes, and osteoblasts. Absence of PTRF-CAVIN did not influence abundance of its binding partner caveolin-1 and caveolin-3. In patient fibroblasts, however, caveolin-1 failed to localize toward the cell surface and electron microscopy revealed reduction of caveolae to less than 3%. Transfection of full-length PTRF-CAVIN reestablished the presence of caveolae. The loss of caveolae was confirmed by Atomic Force Microscopy (AFM in combination with fluorescent imaging. PTRF-CAVIN deficiency thus presents the phenotypic spectrum caused by a quintessential lack of functional caveolae.

  1. Invasive hemodynamic monitoring in the postoperative period of cardiac surgery

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    Desanka Dragosavac


    Full Text Available OBJETIVE: To assess the hemodynamic profile of cardiac surgery patients with circulatory instability in the early postoperative period (POP. METHODS: Over a two-year period, 306 patients underwent cardiac surgery. Thirty had hemodynamic instability in the early POP and were monitored with the Swan-Ganz catheter. The following parameters were evaluated: cardiac index (CI, systemic and pulmonary vascular resistance, pulmonary shunt, central venous pressure (CVP, pulmonary capillary wedge pressure (PCWP, oxygen delivery and consumption, use of vasoactive drugs and of circulatory support. RESULTS: Twenty patients had low cardiac index (CI, and 10 had normal or high CI. Systemic vascular resistance was decreased in 11 patients. There was no correlation between oxygen delivery (DO2 and consumption (VO2, p=0.42, and no correlation between CVP and PCWP, p=0.065. Pulmonary vascular resistance was decreased in 15 patients and the pulmonary shunt was increased in 19. Two patients with CI < 2L/min/m² received circulatory support. CONCLUSION: Patients in the POP of cardiac surgery frequently have a mixed shock due to the systemic inflammatory response syndrome (SIRS. Therefore, invasive hemodynamic monitoring is useful in handling blood volume, choice of vasoactive drugs, and indication for circulatory support.

  2. Proposta de escore de risco para predição de fibrilação atrial após cirurgia cardíaca Risk index proposal to predict atrial fibrillation after cardiac surgery

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    Rogério Gomes da Silva


    Full Text Available OBJETIVO: A fibrilação atrial (FA é uma complicação frequente após cirurgia cardíaca e está associada ao aumento na morbidade e mortalidade dos pacientes. O objetivo deste estudo foi desenvolver uma proposta de escore de risco para FA após cirurgia cardíaca. MÉTODOS: Estudo prospectivo observacional, no qual 452 pacientes foram selecionados para avaliação da incidência e fatores de risco associados com FA pós-operatória. Foram selecionados somente pacientes submetidos à cirurgia cardíaca. A avaliação utilizou monitoramento cardíaco contínuo e eletrocardiograma diário. Os fatores com maior associação em modelo de regressão logística multivariável foram selecionados para o escore de risco. RESULTADOS: A incidência média de FA foi de 22,1%. Os fatores mais associados com FA foram: pacientes com mais de 75 anos de idade, doença valvar mitral, não utilização de betabloqueador, interrupção do uso de betabloqueador e balanço hídrico positivo. A ausência fator de risco determinou 4,6% de chance de FA pós-operatória e para um, dois e três ou mais fatores de risco a chance foi, respectivamente, de 16,6%, 25,9% e 46,3%. CONCLUSÃO: Em modelo de regressão logística multivariada foi possível estabelecer uma proposta para escore de risco para predição de FA pós-operatória, com um risco máximo de 46,3% na presença de três ou mais fatores de risco.OBJECTIVE: Atrial fibrillation (AF is a common complication following cardiac surgery and is associated with an increased patient morbidity and mortality. The objective of this study was to develop a risk index proposal to predict AF after cardiac surgery. METHODS: A prospective observational study in that 452 patients were selected to assess the incidence and risk factors associated with postoperative AF. Only patients following cardiac surgery were selected. Continuous cardiac monitor and daily electrocardiogram were assessed. The most associated in a multivariable

  3. Late cardiac sodium current can be assessed using automated patch-clamp [v1; ref status: indexed,

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    Morgan Chevalier


    Full Text Available The cardiac late Na+ current is generated by a small fraction of voltage-dependent Na+ channels that undergo a conformational change to a burst-gating mode, with repeated openings and closures during the action potential (AP plateau. Its magnitude can be augmented by inactivation-defective mutations, myocardial ischemia, or prolonged exposure to chemical compounds leading to drug-induced (di-long QT syndrome, and results in an increased susceptibility to cardiac arrhythmias. Using CytoPatch™ 2 automated patch-clamp equipment, we performed whole-cell recordings in HEK293 cells stably expressing human Nav1.5, and measured the late Na+ component as average current over the last 100 ms of 300 ms depolarizing pulses to -10 mV from a holding potential of -100 mV, with a repetition frequency of 0.33 Hz. Averaged values in different steady-state experimental conditions were further corrected by the subtraction of current average during the application of tetrodotoxin (TTX 30 μM. We show that ranolazine at 10 and 30 μM in 3 min applications reduced the late Na+ current to 75.0 ± 2.7% (mean ± SEM, n = 17 and 58.4 ± 3.5% (n = 18 of initial levels, respectively, while a 5 min application of veratridine 1 μM resulted in a reversible current increase to 269.1 ± 16.1% (n = 28 of initial values. Using fluctuation analysis, we observed that ranolazine 30 μM decreased mean open probability p from 0.6 to 0.38 without modifying the number of active channels n, while veratridine 1 μM increased n 2.5-fold without changing p. In human iPSC-derived cardiomyocytes, veratridine 1 μM reversibly increased APD90 2.12 ± 0.41-fold (mean ± SEM, n = 6. This effect is attributable to inactivation removal in Nav1.5 channels, since significant inhibitory effects on hERG current were detected at higher concentrations in hERG-expressing HEK293 cells, with a 28.9 ± 6.0% inhibition (mean ± SD, n = 10 with 50 μM veratridine.      

  4. Cardiac Sarcoidosis. (United States)

    Birnie, David; Ha, Andrew C T; Gula, Lorne J; Chakrabarti, Santabhanu; Beanlands, Rob S B; Nery, Pablo


    Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic (clinically silent) cardiac involvement. An international guideline for the diagnosis and management of CS recommends that patients be screened for cardiac involvement. Most studies suggest a benign prognosis for patients with clinically silent CS. Immunosuppression therapy is advocated for clinically manifest CS. Device therapy, with implantable cardioverter defibrillators, is recommended for some patients.

  5. A novel index based on fractional calculus to assess the dynamics of heart rate variability: changes due to chi or yoga meditations


    García González, Miguel Ángel; Ramos Castro, Juan José; Fernández Chimeno, Mireya


    The study aims to present and interpret a novel index based on fractional calculus ( αc) and to assess differences in RR time series dynamics in subjects during meditation. Fractional differintegration (FDI) of a RR time series provides a new time series.αc is defined as the order of the FDI operator that provides the time series with minimum variance. Analyzed time series were obtained from the Exaggerated Heart Rate Oscillations During Two Meditation Techniques database. This da...

  6. Differential effects of propofol and isoflurane on the relationship between EEG Narcotrend index and clinical stages of anaesthetic depth in sheep undergoing experimental cardiac surgery. (United States)

    Otto, Klaus A


    The electroencephalogram (EEG) Narcotrend index (NI) has been shown to improve anaesthetic depth monitoring in isoflurane-anaesthetised sheep. Data obtained from 13 anaesthetised juvenile female sheep were analysed retrospectively in order to assess the relationship between clinical stages of anaesthesia (CS) and NI during both propofol and isoflurane anaesthesia. Polynomial regression analysis revealed no significant association between CS and NI for propofol (R = 0.374, R(2) = 0.140, P = 0.403) but for isoflurane anaesthesia (R = 0.548, R(2) = 0.301, P = 0.010) there was a significant relationship. Furthermore, a strong correlation existed between end-tidal isoflurane concentration (ISOET) and CS (r = -0.463, P = 0.008). A combination of assessment of clinical signs and analogous EEG patterns is recommended during propofol anaesthesia.

  7. Cardiac Malpositions

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Shi Joon; Im, Chung Gie; Yeon, Kyung Mo; Hasn, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Cardiac Malposition refers to any position of the heart other than a left-sided heart in a situs solitus individual. Associated cardiac malformations are so complex that even angiocardiographic and autopsy studies may not afford an accurate information. Although the terms and classifications used to describe the internal cardiac anatomy and their arterial connections in cardiac malpositions differ and tend to be confusing, common agreement exists on the need for a segmental approach to diagnosis. Authors present 18 cases of cardiac malpositions in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between 1971 and 1979. Authors analyzed the clinical, radiographic, operative and autopsy findings with the emphasis on the angiocardiographic findings. The results are as follows: 1. Among 18 cases with cardiac malpositions, 6 cases had dextrocardia with situs inversus, 9 cases had dextrocardia with situs solitus and 3 cases had levocardia with situs inversus. 2. There was no genuine exception to visceroatrial concordance rule. 3. Associated cardiac malpositions were variable and complex with a tendency of high association of transposition and double outlet varieties with dextrocardia in situs solitus and levocardia in situs inversus. Only one in 6 cases of dextrocardia with situs inversus had pure transposition. 4. In two cases associated pulmonary atresia was found at surgery which was not predicted by angiocardiography. 5. Because many of the associated complex lesions can be corrected surgically provided the diagnosis is accurate, the selective biplane angiocardiography with or without cineradiography is essential.

  8. The environmental vegetation index: A tool potentially useful for arid land management. [Texas and Mexico, plant growth stress due to water deficits (United States)

    Gray, T. I., Jr.; Mccrary, D. G. (Principal Investigator)


    The NOAA-6 AVHRR data sets acquired over South Texas and Mexico during the spring of 1980 and after Hurricane Allen passed inland are analyzed. These data were processed to produce the Gray-McCrary Index (GMI's) for each pixel location over the selected area, which area contained rangeland and cropland, both irrigated and nonirrigated. The variations in the GMI's appear to reflect well the availability of water for vegetation. The GMI area maps are shown to delineate and to aid in defining the duration of drought; suggesting the possibility that time changes over a selected area could be useful for irrigation management.

  9. Tei指数定量评价妊娠期高血压疾病对胎儿心功能的影响%Quantitative Evaluation of Fetuses Cardiac Function in Hypertensive Disorders Complicating Pregnancy by Using Tei Index

    Institute of Scientific and Technical Information of China (English)

    夏永升; 赵雅萍; 许崇永


    目的 探讨Tei指数(TI)在评估妊娠期高血压疾病(HDCP)胎儿心功能的临床价值.方法 HDCP孕妇根据高血压严重程度分为妊娠期高血压组、子痫前期轻度组及子痫前期重度组,正常孕妇为对照组;通过测量胎儿左、右心室相应的时间间期,计算胎儿左、右心室TI;采用方差分析比较各组间胎儿左、右心室TI的差异性.结果 子痫前期轻度组胎儿右心室TI高于对照组,差异有统计学意义(P<0.05);子痫前期重度组胎儿左、右心室TI分别高于对照组,差异具统计学意义(分别为P<0.05与P<0.01);将各组中宫内生长受限(IUGR)胎儿剔除后,仅子痫前期重度组胎儿右心室TI高于对照组(P<0.05).结论 子痫前期可引起胎儿心功能异常,IUGR的出现提示胎儿心功能异常发展到严重阶段,是预后不良的标志.%Objective To evaluate the clinical value of Tei index in assessment of the cardiac function of fetuses in hypertensive disorders complicating pregnancy. Methods According to the severity the hypertension, hypertensive disorders complicating pregnancy women were divided into gestational hypertension group, mild pre-eclampisa group and severe pre-eclampsia group. The corresponding time intervals of fetuses ventricular were measured, and Tei index were calculated. Analysis of variance was used to compare the difference of fetuses TI among four groups and in the four groups, intrauterine growth restriction (IUGR) fetuses were eliminated. Results Left ventricular Tei index (LV-TI) and right ventricular Tei index (RV-TI) in severely pre-eclampsia group were obviously higher than those in control group (P<0.05 and P<0. 01,respectively). RV-TI in mild pre-eclampsia group were higher than those in control group (P <0.05), And in the four groups, (IUGR fetuses were eliminated) only RV-TI in severely pre-eclampsia group were higher than those in control group (P<0. 05) . Conclusion Pre-eclampsia can endanger

  10. Application of the soil-ecological multiplicative index to assess suitability of Cis-Ural chernozems for cultivation with due account for economic parameters (United States)

    Levykin, S. V.; Chibilev, A. A.; Kazachkov, G. V.; Petrishchev, V. P.


    The evolution of Russian concepts concerning the assessment of soil suitability for cultivation in relation to several campaigns on large-scale plowing of virgin steppe soils is examined. The major problems of agricultural land use in steppe areas—preservation of rainfed farming in the regions with increasing climatic risks, underestimation of the potential of arable lands in land cadaster assessments, and much lower factual yields in comparison with potential yields—are considered. It is suggested that the assessments of arable lands should be performed on the basis of the soil-ecological index (SEI) developed by I. Karmanov with further conversion of SEI values into nominal monetary values. Under conditions of land reforms and economic reforms, it is important to determine suitability of steppe chernozems for plowing and economic feasibility of their use for crop growing in dependence on macroeconomic parameters. This should support decisions on optimization of land use in the steppe zone on the basis of the principles suggested by V. Dokuchaev. The developed approach for assessing soil suitability for cultivation was tested in the subzone of herbaceous-fescue-feather grass steppes in the Cis-Ural part of Orenburg oblast and used for the assessment of soil suitability for cultivation in the southern and southeastern regions of Orenburg oblast.

  11. Cardiac cameras. (United States)

    Travin, Mark I


    Cardiac imaging with radiotracers plays an important role in patient evaluation, and the development of suitable imaging instruments has been crucial. While initially performed with the rectilinear scanner that slowly transmitted, in a row-by-row fashion, cardiac count distributions onto various printing media, the Anger scintillation camera allowed electronic determination of tracer energies and of the distribution of radioactive counts in 2D space. Increased sophistication of cardiac cameras and development of powerful computers to analyze, display, and quantify data has been essential to making radionuclide cardiac imaging a key component of the cardiac work-up. Newer processing algorithms and solid state cameras, fundamentally different from the Anger camera, show promise to provide higher counting efficiency and resolution, leading to better image quality, more patient comfort and potentially lower radiation exposure. While the focus has been on myocardial perfusion imaging with single-photon emission computed tomography, increased use of positron emission tomography is broadening the field to include molecular imaging of the myocardium and of the coronary vasculature. Further advances may require integrating cardiac nuclear cameras with other imaging devices, ie, hybrid imaging cameras. The goal is to image the heart and its physiological processes as accurately as possible, to prevent and cure disease processes.

  12. Pediatric cardiac postoperative care

    Directory of Open Access Journals (Sweden)

    Auler Jr. José Otávio Costa


    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  13. Comprehensive cardiac rehabilitation

    DEFF Research Database (Denmark)

    Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O;


    OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed...... for the situation at hand. Due to challenging circumstances, the cost assessment turned out to be ex-post and top-down. RESULTS: Cost per treatment sequence is estimated to be approximately euro 976, whereas the incremental cost (compared with usual care) is approximately euro 682. The cost estimate is uncertain...... and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective....

  14. Prevalence of sleep-disordered breathing in elderly patients with cardiac pacemaker: a case-control study

    Institute of Scientific and Technical Information of China (English)

    Haiyun WU; Shiwen WANG; Jianping JIA; Wenli ZHANG; Qiang XU


    Objective To investigate the prevalence of sleep-disordered breathing in elderly patients with permanent cardiac pacemaker implantation due to bradyarrhythmias, and the relationship between pacing mode and patients' sleep apnea-hypopnea index.Methods Forty-four elderly patients (>60 years) with cardiac pacemaker and their 44 controls matched for gender, age, body mass index and cardiovascular morbidity were studied using polysomnography or portable sleep monitoring device. Results Prevalence of sleep-disordered breathing (apnea-hypopnea index ≥5/h) was 44.7% and the mean apnea-hypopnea index was 8.2 ±4.1/h in the cardiac pacemaker group, which were significantly higher than those in control subjects (25% and 4.6±2.4/h, respectively, P<0.01 and P<0.05). The mean apnea-hypopnea index of patients with DDD or AAI pacemaker was significantly lower than that of patients with VVI pacemaker. Conclusions Sleep-disordered breathing was more common in patients who had their cardiac pacemaker implanted due to bradyarrhythmias than in their matched controls. Compared with VVI pacing, DDD or AAI pacing may be more beneficial to patients with bradyarrhythmias and sleep-disordered breathing.

  15. Cardiac Rehabilitation (United States)

    ... your risk of future heart problems, and to improve your health and quality of life. Cardiac rehabilitation programs increase ... exercise routine at home or at a local gym. You may also continue to ... health concerns. Education about nutrition, lifestyle and weight loss ...

  16. Hepato-cardiac disorders

    Institute of Scientific and Technical Information of China (English)

    Yasser; Mahrous; Fouad; Reem; Yehia


    Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato-cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. Differential diagnoses of liver injury are extremely important in a cardiologist’s clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic congestive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplantation may lead to the improvement of all cardiac changes and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases

  17. Severe Left Ventricular Hypertrophy, Small Pericardial Effusion, and Diffuse Late Gadolinium Enhancement by Cardiac Magnetic Resonance Suspecting Cardiac Amyloidosis: Endomyocardial Biopsy Reveals an Unexpected Diagnosis

    Directory of Open Access Journals (Sweden)

    Nina P. Hofmann


    Full Text Available Left ventricular (LV hypertrophy can be related to a multitude of cardiac disorders, such as hypertrophic cardiomyopathy (HCM, cardiac amyloidosis, and hypertensive heart disease. Although the presence of LV hypertrophy is generally associated with poorer cardiac outcomes, the early differentiation between these pathologies is crucial due to the presence of specific treatment options. The diagnostic process with LV hypertrophy requires the integration of clinical evaluation, electrocardiography (ECG, echocardiography, biochemical markers, and if required CMR and endomyocardial biopsy in order to reach the correct diagnosis. Here, we present a case of a patient with severe LV hypertrophy (septal wall thickness of 23 mm, LV mass of 264 g, and LV mass index of 147 g/m2, severely impaired longitudinal function, and preserved radial contractility (ejection fraction = 55%, accompanied by small pericardial effusion and diffuse late gadolinium enhancement (LGE by cardiac magnetic resonance (CMR. Due to the imaging findings, an infiltrative cardiomyopathy, such as cardiac amyloidosis, was suspected. However, amyloid accumulation was excluded by endomyocardial biopsy, which revealed the presence of diffuse myocardial fibrosis in an advanced hypertensive heart disease.

  18. Cardiac Function in Long-Term Survivors of Childhood Lymphoma

    Directory of Open Access Journals (Sweden)

    Mark K. Friedberg


    Full Text Available Objectives. We studied long-term effects of therapy for childhood lymphoma on cardiac function. Design and patients. We prospectively evaluated 45 survivors of childhood lymphoma, using clinical parameters, electrocardiography and echocardiography. Further comparisons were made between lymphoma subgroups and between males and females. Results. Mean age at diagnosis was 9.1 years. Mean followup duration was 10.9 years. The NYHA functional class was I in 43 patients and II in 2 patients. A prolonged QTc interval (>0.44 msec was found in 8 patients. Left ventricular (LV systolic function and compliance were normal (LV shortening fraction 40±5.6%; cardiac index 2.84±1.13 L/min/m2; E/A wave ratio 2.5±1.3; mean ± S.D., LV mass was normal (97±40 grams/m2, mean ± S.D.. Mitral regurgitation was observed in 7/45 patients (16%. Asymptomatic pericardial effusions were found in 3/45 (7% patients. Conclusions. Long-term follow-up shows that most parameters of cardiac function are normal in survivors of childhood lymphoma. This is likely due to relatively low doses of anthracyclines in modern protocol modalities. Abnormalities in mitral valve flow, QTc prolongation and in a small proportion of survivors, and functional capacity necessitate long-term cardiac follow-up of these patients.

  19. Cardiac Calcification

    Directory of Open Access Journals (Sweden)

    Morteza Joorabian


    Full Text Available There is a spectrum of different types of cardiac"ncalcifications with the importance and significance"nof each type of cardiac calcification, especially"ncoronary artery calcification. Radiologic detection of"ncalcifications within the heart is quite common. The"namount of coronary artery calcification correlates"nwith the severity of coronary artery disease (CAD."nCalcification of the aortic or mitral valve may indicate"nhemodynamically significant valvular stenosis."nMyocardial calcification is a sign of prior infarction,"nwhile pericardial calcification is strongly associated"nwith constrictive pericarditis. A spectrum of different"ntypes of cardiac calcifications (linear, annular,"ncurvilinear,... could be seen in chest radiography and"nother imaging modalities. So a carful inspection for"ndetection and reorganization of these calcifications"nshould be necessary. Numerous modalities exist for"nidentifying coronary calcification, including plain"nradiography, fluoroscopy, intravascular ultrasound,"nMRI, echocardiography, and conventional, helical and"nelectron-beam CT (EBCT. Coronary calcifications"ndetected on EBCT or helical CT can be quantifie,"nand a total calcification score (Cardiac Calcification"nScoring may be calculated. In an asymptomatic"npopulation and/or patients with concomitant risk"nfactors like diabetes mellitus, determination of the"npresence of coronary calcifications identifies the"npatients at risk for future myocardial infarction and"ncoronary artery disease. In patients without coronary"ncalcifications, future cardiovascular events could"nbe excluded. Therefore, detecting and recognizing"ncalcification related to the heart on chest radiography"nand other imaging modalities such as fluoroscopy, CT"nand echocardiography may have important clinical"nimplications.

  20. On the Automated Segmentation of Epicardial and Mediastinal Cardiac Adipose Tissues Using Classification Algorithms. (United States)

    Rodrigues, Érick Oliveira; Cordeiro de Morais, Felipe Fernandes; Conci, Aura


    The quantification of fat depots on the surroundings of the heart is an accurate procedure for evaluating health risk factors correlated with several diseases. However, this type of evaluation is not widely employed in clinical practice due to the required human workload. This work proposes a novel technique for the automatic segmentation of cardiac fat pads. The technique is based on applying classification algorithms to the segmentation of cardiac CT images. Furthermore, we extensively evaluate the performance of several algorithms on this task and discuss which provided better predictive models. Experimental results have shown that the mean accuracy for the classification of epicardial and mediastinal fats has been 98.4% with a mean true positive rate of 96.2%. On average, the Dice similarity index, regarding the segmented patients and the ground truth, was equal to 96.8%. Therfore, our technique has achieved the most accurate results for the automatic segmentation of cardiac fats, to date.

  1. Sudden Cardiac Death

    Directory of Open Access Journals (Sweden)

    Yipsy María Gutiérrez Báez


    Full Text Available Since the second half of the twentieth century, dying suddenly due to heart-related problems has become the main health issue in all countries where infectious diseases are not prevalent. Sudden death from cardiac causes is an important global health problem. Major databases were searched for the leading causes of sudden cardiac death. It has been demonstrated that there is a group of hereditary diseases with structural alterations or without apparent organic cause that explains many cases of sudden death in young people, whether related or not to physical exertion. Certain population groups are at higher risk for this disease. They are relatively easy to identify and can be the target of primary prevention measures.

  2. Postoperative hypoxia and length of intensive care unit stay after cardiac surgery: the underweight paradox?

    Directory of Open Access Journals (Sweden)

    Marco Ranucci

    Full Text Available OBJECTIVE: Cardiac operations with cardiopulmonary bypass can be associated with postoperative lung dysfunction. The present study investigates the incidence of postoperative hypoxia after cardiac surgery, its relationship with the length of intensive care unit stay, and the role of body mass index in determining postoperative hypoxia and intensive care unit length of stay. DESIGN: Single-center, retrospective study. SETTING: University Hospital. Patients. Adult patients (N = 5,023 who underwent cardiac surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: According to the body mass index, patients were attributed to six classes, and obesity was defined as a body mass index >30. POH was defined as a PaO2/FiO2 ratio <200 at the arrival in the intensive care unit. Postoperative hypoxia was detected in 1,536 patients (30.6%. Obesity was an independent risk factor for postoperative hypoxia (odds ratio 2.4, 95% confidence interval 2.05-2.78, P = 0.001 and postoperative hypoxia was a determinant of intensive care unit length of stay. There is a significant inverse correlation between body mass index and PaO2/FiO2 ratio, with the risk of postoperative hypoxia increasing by 1.7 folds per each incremental body mass index class. The relationship between body mass index and intensive care unit length of stay is U-shaped, with longer intensive care unit stay in underweight patients and moderate-morbid obese patients. CONCLUSIONS: Obese patients are at higher risk for postoperative hypoxia, but this leads to a prolonged intensive care unit stay only for moderate-morbid obese patients. Obese patients are partially protected against the deleterious effects of hemodilution and transfusions. Underweight patients present the "paradox" of a better lung gas exchange but a longer intensive care unit stay. This is probably due to a higher severity of their cardiac disease.

  3. Relationship between cardiac function and resting cerebral blood flow

    DEFF Research Database (Denmark)

    Henriksen, Otto M; Jensen, Lars T; Krabbe, Katja;


    Although both impaired cardiac function and reduced cerebral blood flow are associated with ageing, current knowledge of the influence of cardiac function on resting cerebral blood flow (CBF) is limited. The aim of this study was to investigate the potential effects of cardiac function on CBF. CBF...... and cardiac output were measured in 31 healthy subjects 50-75 years old using magnetic resonance imaging techniques. Mean values of CBF, cardiac output and cardiac index were 43.6 ml per 100 g min(-1), 5.5 l min(-1) and 2.7 l min(-1) m(-2), respectively, in males, and 53.4 ml per 100 g min(-1), 4.3 l min(-1......) and 2.4 l min(-1) m(-2), respectively, in females. No effects of cardiac output or cardiac index on CBF or structural signs of brain ageing were observed. However, fractional brain flow defined as the ratio of total brain flow to cardiac output was inversely correlated with cardiac index (r(2) = 0.22, P...

  4. Cardiac manifestations in systemic sclerosis

    Institute of Scientific and Technical Information of China (English)

    Sevdalina; Lambova


    Primary cardiac involvement, which develops as a direct consequence of systemic sclerosis(SSc), may manifest as myocardial damage, fibrosis of the conduction system, pericardial and, less frequently, as valvular disease. In addition, cardiac complications in SSc may develop as a secondary phenomenon due to pulmonary arterial hypertension and kidney pathology. The prevalence of primary cardiac involvement in SSc is variable and difficult to determine because of the diversity of cardiac manifestations, the presence of subclinical periods, the type of diagnostic tools applied, and the diversity of patient populations. When clinically manifested, cardiac involvement is thought to be an important prognostic factor. Profound microvascular disease is a pathognomonic feature of SSc, as both vasospasm and structural alterations are present. Such alterations are thought to predict macrovascular atherosclerosis over time. There are contradictory reports regarding the prevalence of atherosclerosis in SSc. According to some authors, the prevalence of atherosclerosis of the large epicardial coronary arteries is similar to that of the general population, in contrast with other rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, the level of inflammation in SSc is inferior. Thus, the atherosclerotic process may not be as aggressive and not easily detectable in smaller studies. Echocardiography(especially tissue Doppler imaging), single-photon emission computed tomography, magnetic resonance imaging and cardiac computed tomography are sensitive techniques for earlier detection of both structural and functional scleroderma-related cardiac pathologies. Screening for subclinical cardiac involvement via modern, sensitive tools provides an opportunity for early diagnosis and treatment, which is of crucial importance for a positive outcome.

  5. Torsadogenic index for prevention of acute death

    Directory of Open Access Journals (Sweden)

    Adrián Ángel Inchauspe


    Full Text Available This risk management project aims to apply a global preventive and predictive measure in potential victims of acute death and heart failure. Among the main causes are identified sub-diagnosed genetic mutations; prescription, interaction, self-medication or abuse of suspected drugs due to internet prospect's consult; and a parasitic pandemia, the Chagas disease (over 100000000 population is potentially infected worldwide. Promoting a global extensive determination of the torsadogenic index which was successfully published in Frontiers of Pharmacology Journal, will allow to monitor general population, set security patterns to categorize silent high risk groups of serious prognosis of tachyarrhythmias. For this purpose, applications of known QT determinations are proposed, recommending Dr. Rautaharju's formula, actually improved with gender adult versions. Torsadogenic index will allow to establish an individual traceability, obtain comparative samples that are alert to possible QT enlargements. Thus, torsadogenic index results a valuable, simple and costless resource to consider in the fight against acute death and cardiac arrest. Torsadogenic index represents a global indicator capable of predicting and preventing acute death and heart failure for most relevant reasons.

  6. Torsadogenic index for prevention of acute death

    Institute of Scientific and Technical Information of China (English)

    Adrián Ángel Inchauspe


    This risk management project aims to apply a global preventive and predictive measure in potential victims of acute death and heart failure. Among the main causes are identified sub-diagnosed genetic mutations; prescription, interaction, self-medication or abuse of suspected drugs due to internet prospect's consult; and a parasitic pandemia, the Chagas disease (over 100 000 000 population is potentially infected worldwide). Promoting a global extensive determination of the torsadogenic index which was successfully published in Frontiers of Pharmacology Journal, will allow to monitor general population, set security patterns to categorize silent high risk groups of serious prognosis of tachyarhythmias. For this purpose, applications of known QT determinations are proposed, recommending Dr. Rautaharju's formula, actually improved with gender adult versions. Torsadogenic index will allow to establish an individual traceability, obtain comparative samples that are alert to possible QT enlargements. Thus, torsadogenic index results a valuable, simple and costless resource to consider in the fight against acute death and cardiac arrest. Torsadogenic index represents a global indicator capable of predicting and preventing acute death and heart failure for most relevant reasons.

  7. A severe penetrating cardiac injury in the absence of cardiac tamponade. (United States)

    Connelly, Tara M; Kolcow, Walenty; Veerasingam, Dave; DaCosta, Mark


    Penetrating cardiac injury is rare and frequently not survivable. Significant haemorrhage resulting in cardiac tamponade commonly ensues. Such cardiac tamponade is a clear clinical, radiological and sonographic indicator of significant underlying injury. In the absence of cardiac tamponade, diagnosis can be more challenging. In this case of a 26-year old sailor stabbed at sea, a significant pericardial effusion and cardiac tamponade did not occur despite an injury transversing the pericardium. Instead, the pericardial haemorrhage drained into the left pleural cavity resulting in a haemothorax. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion, a concomitant cerebrovascular event and a long delay from injury to appropriate medical treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate a primary chordae of the anterior mitral leaflet.

  8. Indexing Images. (United States)

    Rasmussen, Edie M.


    Focuses on access to digital image collections by means of manual and automatic indexing. Contains six sections: (1) Studies of Image Systems and their Use; (2) Approaches to Indexing Images; (3) Image Attributes; (4) Concept-Based Indexing; (5) Content-Based Indexing; and (6) Browsing in Image Retrieval. Contains 105 references. (AEF)

  9. Cardiac MRI in Athletes

    NARCIS (Netherlands)

    Luijkx, T.


    Cardiac magnetic resonance imaging (CMR) is often used in athletes to image cardiac anatomy and function and is increasingly requested in the context of screening for pathology that can cause sudden cardiac death (SCD). In this thesis, patterns of cardiac adaptation to sports are investigated with C

  10. Pseudothrombocytopenia in cardiac surgical practice. (United States)

    Nair, Sukumaran K; Shah, Roma; Petko, Matus; Keogh, Bruce E


    Pseudothrombocytopenia is observed occasionally in post-cardiac surgical patients. It is commonly due to EDTA-mediated immunological mechanisms, which lead to agglutination of functionally intact platelets. This condition is harmless and does not warrant platelet transfusion. We describe an instance of pseudothrombocytopenia in our practice and discuss its clinical relevance.

  11. Reninoma presenting as cardiac syncope

    Directory of Open Access Journals (Sweden)

    Tak Shahid


    Full Text Available Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia.

  12. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Emília Nozawa


    Full Text Available OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23, airway resistance (p=0.21, and the dead space/tidal volume ratio (p=0.54. No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86, rapid and superficial respiration index (p=0.48, and carbon dioxide arterial pressure (p=0.86. Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation.

  13. Nuclear imaging in cardiac amyloidosis

    Energy Technology Data Exchange (ETDEWEB)

    Glaudemans, A.W.J.M.; Slart, R.H.J.A.; Veltman, N.C.; Dierckx, R.A.J.O. [University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, P.O. Box 30001, Groningen (Netherlands); Zeebregts, C.J. [University Medical Center Groningen, Department of Surgery (Division of Vascular Surgery), Groningen (Netherlands); Tio, R.A. [University Medical Center Groningen, Department of Cardiology, Groningen (Netherlands); Hazenberg, B.P.C. [University Medical Center Groningen, Department of Rheumatology and Clinical Immunology, Groningen (Netherlands)


    Amyloidosis is a disease characterized by depositions of amyloid in organs and tissues. It can be localized (in just one organ) or systemic. Cardiac amyloidosis is a debilitating disease and can lead to arrhythmias, deterioration of heart function and even sudden death. We reviewed PubMed/Medline, without time constraints, on the different nuclear imaging modalities that are used to visualize myocardial amyloid involvement. Several SPECT tracers have been used for this purpose. The results with these tracers in the evaluation of myocardial amyloidosis and their mechanisms of action are described. Most clinical evidence was found for the use of {sup 123}I-MIBG. Myocardial defects in MIBG activity seem to correlate well with impaired cardiac sympathetic nerve endings due to amyloid deposits. {sup 123}I-MIBG is an attractive option for objective evaluation of cardiac sympathetic level and may play an important role in the indirect measurement of the effect of amyloid myocardial infiltration. Other, less sensitive, options are {sup 99m}Tc-aprotinin for imaging amyloid deposits and perhaps {sup 99m}Tc-labelled phosphate derivatives, especially in the differential diagnosis of the aetiology of cardiac amyloidosis. PET tracers, despite the advantage of absolute quantification and higher resolution, are not yet well evaluated for the study of cardiac amyloidosis. Because of these advantages, there is still the need for further research in this field. (orig.)

  14. Cardiac, Skeletal, and smooth muscle mitochondrial respiration

    DEFF Research Database (Denmark)

    Park, Song-Young; Gifford, Jayson R; Andtbacka, Robert H I


    Unlike cardiac and skeletal muscle, little is known about vascular smooth muscle mitochondrial function. Therefore, this study examined mitochondrial respiratory rates in the smooth muscle of healthy human feed arteries and compared with that of healthy cardiac and skeletal muscle. Cardiac......, skeletal, and smooth muscle was harvested from a total of 22 subjects (53±6 yrs) and mitochondrial respiration assessed in permeabilized fibers. Complex I+II, state 3 respiration, an index of oxidative phosphorylation capacity, fell progressively from cardiac, skeletal, to smooth muscle (54±1; 39±4; 15......±1 pmol•s(-1)•mg (-1), psmooth muscle (222±13; 115±2; 48±2 umol•g(-1)•min(-1), p

  15. Application of bispectrai index monitoring inpatients with coma due to massive cerebral infarction%脑电双频指数在大面积脑梗死昏迷患者中的临床应用

    Institute of Scientific and Technical Information of China (English)

    牛世芹; 袁俊亮; 李海英; 王姝梅; 李淑娟; 刘芳; 李向红; 岳云; 胡文立


    Objective To study the application of bispectrai index monitoring(BIS) in patients with coma due to massive cerebral infarction and its relation with the prognosis of such patients. Methods Thirty patients with coma due to massive cerebral infarction were divided into survival group (n=20)and death group(n = 10). Their BISmin, BIS?, and BISm.,n were recorded, and their vital signs,clinical symptoms and signs,Glasgow outcome scale(GOS)-based coma score were monitored. The patients were followed up for 3 months,during which their coma was scored according to the GOS. Whether death occurred within 3 months after the patients were discharged was used as the end assessment indication. Results The average hospital stay time was significantly longer in death group than in survival group<41. 0?. 3 d vs 30. 2?. 1 d,P<0. 01). The BIS?BISmx and BISmean were significantly lower in death group than in survival group(45. 1 + 19. 2 vs 69. 1?13. 6,51. l?0. 0 vs 74. 5 + 13. 0,48. 1?9. 5 vs 71. 8+13. 1 ,P<0. 01). The BIS? was positively related with the GOSbased coma score in death group(r=0. 486,P = 0. 03). Conclusion BIS can directly and objectively show the severity of cerebral injury in patients with coma due to massive cerebral infarction,accurately and reliably predict their prognosis,and is thus of a potential application value in clinical practice.%目的 探讨应用脑电双频指数(BIS)评估大面积脑梗死导致昏迷患者病情严重程度的可靠性及其与预后的关系.方法 选择大面积脑梗死导致昏迷的患者30例,分为生存组20例和死亡组10例,记录BISmin、BISmax,计算BISmean.同时动态监测生命体征、临床症状体征、评价格拉斯哥昏迷评分.随访3个月,评估格拉斯哥结局和格拉斯哥昏迷评分,以出院后3个月内有无死亡为终点评价指标.结果 与生存组住院时间(30.2±5.1)d比较,死亡组住院时间(41.0±7.3)d明显延长(P<0.01);死亡组BISmin、BISmax、BISmean分别为45.1±19

  16. Cardiac tamponade (image) (United States)

    Cardiac tamponade is a condition involving compression of the heart caused by blood or fluid accumulation in the space ... they cannot adequately fill or pump blood. Cardiac tamponade is an emergency condition that requires hospitalization.

  17. What Is Cardiac Rehabilitation? (United States)

    ANSWERS by heart Treatments + Tests What Is Cardiac Rehabilitation? A cardiac rehabilitation (rehab) program takes place in a hospital or ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ...

  18. Cross-cultural adaptation of the Neck Disability Index and Copenhagen Neck Functional Disability Scale for patients with neck pain due to degenerative and discopathic disorders. Psychometric properties of the Polish versions

    Directory of Open Access Journals (Sweden)

    Glowacki Maciej


    Full Text Available Abstract Background Even though there are several region-specific functional outcome questionnaires measuring neck disorders that have been developed in English-speaking countries, no Polish version has ever been validated. The purpose of our study was to translate, culturally adapt and validate the Neck Disability Index (NDI and Copenhagen Neck Functional Disability Scale (CDS for Polish-speaking patients with neck pain. Methods The translation was carried out according to the International Quality of Life Association (IQOLA Project. Sixty patients were treated due to degenerative and discopathic disorders in the cervical spine filled out the NDI-PL and the CDS-PL. The pain level was evaluated using the Visual Analog Scale. The mean age of the assessed group was 47.1 years (SD 8.9. We used Cronbach's alpha to assess internal consistency. We assessed the test-retest reliability using the Intraclass Correlation Coefficients (ICCs. The Spearman's rank correlation coefficient (rS was used to determine dependency between quantitative characteristics. The Mann-Whitney test was applied to determine dependency between quantitative and qualitative characteristics. Results The Cronbach's alpha values were excellent for the NDI-PL in the test and in the retest (0.84, 0.85, respectively, and for the CDS-PL (0.90 in the test and in the retest. Intraclass Correlation Coefficients were excellent for the CDS-PL and NDI-PL and equalled 0.93 (95% CI from 0.89 to 0.95 and 0.87 (95% CI from 0.80 to 0.92, respectively The concurrent validity was good in the test and in the retest (rs = 0.42 p Conclusions The present versions of the NDI-PL and CDS-PL, the first to be published in Polish, have proven to be reliable and valid for patients with degenerative changes in the cervical spine. The NDI-PL and CDS-PL have excellent internal consistency and test-retest reliability, and good concurrent validity. The adapted questionnaires showed a strong inter-correlation both

  19. Cardiac sodium channelopathies

    NARCIS (Netherlands)

    Amin, A.S.; Asghari-Roodsari, A.; Tan, H.L.


    Cardiac sodium channel are protein complexes that are expressed in the sarcolemma of cardiomyocytes to carry a large inward depolarizing current (I-Na) during phase 0 of the cardiac action potential. The importance of I-Na for normal cardiac electrical activity is reflected by the high incidence of

  20. Apigenin ameliorates hypertension-induced cardiac hypertrophy and down-regulates cardiac hypoxia inducible factor-lα in rats. (United States)

    Zhu, Zeng-Yan; Gao, Tian; Huang, Yan; Xue, Jie; Xie, Mei-Lin


    Apigenin is a natural flavonoid compound that can inhibit hypoxia-inducible factor (HIF)-1α expression in cultured tumor cells under hypoxic conditions. Hypertension-induced cardiac hypertrophy is always accompanied by abnormal myocardial glucolipid metabolism due to an increase of HIF-1α. However, whether or not apigenin may ameliorate the cardiac hypertrophy and abnormal myocardial glucolipid metabolism remains unknown. This study aimed to examine the effects of apigenin. Rats with cardiac hypertrophy induced by renovascular hypertension were treated with apigenin 50-100 mg kg(-1) (the doses can be achieved by pharmacological or dietary supplementation for an adult person) by gavage for 4 weeks. The results showed that after treatment with apigenin, the blood pressure, heart weight, heart weight index, cardiomyocyte cross-sectional area, serum angiotensin II, and serum and myocardial free fatty acids were reduced. It is important to note that apigenin decreased the expression level of myocardial HIF-1α protein. Moreover, apigenin simultaneously increased the expression levels of myocardial peroxisome proliferator-activated receptor (PPAR) α, carnitine palmitoyltransferase (CPT)-1, and pyruvate dehydrogenase kinase (PDK)-4 proteins and decreased the expression levels of myocardial PPARγ, glycerol-3-phosphate acyltransferase genes (GPAT), and glucose transporter (GLUT)-4 proteins. These findings demonstrated that apigenin could improve hypertensive cardiac hypertrophy and abnormal myocardial glucolipid metabolism in rats, and its mechanisms might be associated with the down-regulation of myocardial HIF-1α expression and, subsequently increasing the expressions of myocardial PPARα and its target genes CPT-1 and PDK-4, and decreasing the expressions of myocardial PPARγ and its target genes GPAT and GLUT-4.

  1. Clinical research on cardiac preioad with right ventricular end-diastolic volume index assessment during coronary artery bypass grafting%右心室舒张末期容积指数评价冠状动脉搭桥术中心室前负荷的研究

    Institute of Scientific and Technical Information of China (English)

    徐娜; 王天龙


    目的 比较中心静脉压(CVP)、肺动脉闭合压(PAOP) 右心室舒张末期容积指数(RVEDVI)用于监测冠状动脉搭桥术(CABG)中心脏前负荷的准确性.方法 选择择期行冠状动脉搭桥术患者56例,于切皮前5 min(T0)、劈胸骨后5 min(T1)、转机前5 min(T2)、停机后5 min(T3)、停机后1 h(T4)和术毕(T5)记录CVP、PAOP、RVEDVI、每搏量指数(SVI)等血流动力学指标,并计算各时点SVI、CVP、PAOP、RVEDVI之间的相关性,以筛选能够准确反映CABG患者前负荷的优选参数.结果 所有患者均顺利完成CABG手术.各时点SVI与RVEDVI呈正相关(r=0.269-0.575,P0.05),RVEDVI与CVP、PAOP无显著相关性(r=-0.178--0.200,P>0.05).结论 RVEDVI较CVP、PAOP更适于评价冠状动脉搭桥术中患者的心脏前负荷.%Objective To evaluate the suitability of CVP, PAOP, RVEDVI for predicting changes in the cardiac preload state. Methods Fifty six patients who underwent elective coronary artery bypass grafting (CABG) were selected. The hemodynamic parameters were taken in six time points: 5 min before operation (To), 5 min following sternotomy (T1), 5 min before CPB(T2), 5 min after the end of CPB(T3), 1 h after CPB (T4) and the end of surgery(T5). The liner regression analyses of SVI, CVP, PAOP, RVEDVI in each points were calculated, and the best monitored index of cardiac preload during CABG was monitored. Results All patients were successfully underwent CABG. Linear regression analyses showed a significant correlation between RVEDVI and SVI in each points (r = 0.269~0.575, P < 0.05). But linear regression analysis among CVP, PAOP and SVI did not identify any significant correlations, and no statistical relationships were found among PAOP, CVP and RVEDVI. Conclusion The RVEDVI may be the best hemodynamic index for optimal evaluation of cardiac preload during CABG.


    Institute of Scientific and Technical Information of China (English)


    αadrenergic receptor, autoantibodies, cardiac remodeling, hypertension, 2006464β-catenin, tyrosine phosphorylation, cadherin ,2006495β-adrenergic receptor antagonist, apoptosis, myocardial infarction , oncogene,2006353β-catenin, pancreatic carcinoma, prognosis ,2006391β-cell function,diabetes mellitus,non insulin dependent,2006443β-defensin-2, nuclear factor-kappa B, Helicobacter pylori, peptic ulcer,2006150β-lactamases, plasmid, K pneumonia, gene,2006161 10-23 DNAzymes,hepatitis B virus,S gene,C gene,2006153

  3. Cerebral oximetry in cardiac anesthesia (United States)

    Vretzakis, George; Georgopoulou, Stauroula; Stamoulis, Konstantinos; Stamatiou, Georgia; Tsakiridis, Kosmas; Katsikogianis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Mpakas, Andreas; Beleveslis, Thomas; Koletas, Alexander; Siminelakis, Stavros N.; Zarogoulidis, Konstantinos


    Cerebral oximetry based on near-infrared spectroscopy (NIRS) is increasingly used during the perioperative period of cardiovascular operations. It is a noninvasive technology that can monitor the regional oxygen saturation of the frontal cortex. Current literature indicates that it can stratify patients preoperatively according their risk. Intraoperatively, it provides continuous information about brain oxygenation and allows the use of brain as sentinel organ indexing overall organ perfusion and injury. This review focuses on the clinical validity and applicability of this monitor for cardiac surgical patients. PMID:24672700

  4. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    LENUS (Irish Health Repository)

    Hogan, T S


    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient\\'s cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  5. External cardiac compression may be harmful in some scenarios of pulseless electrical activity. (United States)

    Hogan, T S


    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  6. The obesity paradox in cardiac arrest patients. (United States)

    Chalkias, Athanasios; Xanthos, Theodoros


    Evidence from clinical cohorts indicates an obesity paradox in overweight and obese patients who seem to have a more favorable short-term and long-term prognosis than leaner patients. Although obese cardiac arrest victims are theoretically more difficult to be resuscitated due to difficulties in providing adequate chest compressions, ventilation, and oxygenation, research so far has shown that there is an obesity paradox in cardiac arrest.

  7. AP Index (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Planetary Amplitude index - Bartels 1951. The a-index ranges from 0 to 400 and represents a K-value converted to a linear scale in gammas (nanoTeslas)--a scale that...

  8. Speech Indexing

    NARCIS (Netherlands)

    Ordelman, R.J.F.; Jong, de F.M.G.; Leeuwen, van D.A.; Blanken, H.M.; de Vries, A.P.; Blok, H.E.; Feng, L.


    This chapter will focus on the automatic extraction of information from the speech in multimedia documents. This approach is often referred to as speech indexing and it can be regarded as a subfield of audio indexing that also incorporates for example the analysis of music and sounds. If the objecti

  9. Fiberoptic monitoring of central venous oxygen saturation (PediaSat in small children undergoing cardiac surgery: continuous is not continuous [v3; ref status: indexed,

    Directory of Open Access Journals (Sweden)

    Francesca G. Iodice


    Full Text Available Background: Monitoring of superior vena cava saturation (ScvO2 has become routine in the management of pediatric patients undergoing cardiac surgery. The objective of our study was to evaluate the correlation between continuous ScvO2 by the application of a fiber-optic oximetry catheter (PediaSat and intermittent ScvO2 by using standard blood gas measurements. These results were compared to those obtained by cerebral near infrared spectroscopy (cNIRS. Setting: Tertiary pediatric cardiac intensive care unit (PCICU. Methods and main results: A retrospective study was conducted in consecutive patients who were monitored with a 4.5 or 5.5 F PediaSat catheter into the right internal jugular vein. An in vivo calibration was performed once the patient was transferred to the PCICU and re-calibration took place every 24 hours thereafter. Each patient had a NIRS placed on the forehead. Saturations were collected every 4 hours until extubation. Ten patients with a median age of 2.2 (0.13-8.5 years and a weight of 12.4 (3.9-24 kg were enrolled. Median sampling time was 32 (19-44 hours: 64 pairs of PediaSat and ScVO2 saturations showed a poor correlation (r=0.62, 95% CI 44-75; p<0.0001 and Bland Altman analysis for repeated measures showed an average difference of 0.34 with a standard deviation of 7,9 and 95% limits of agreement from -15 to 16. Thirty-six pairs of cNIRS and ScVO2 saturations showed a fair correlation (r=0.79, 95% CI 0.60-0.89; p<0.0001 an average difference of -1.4 with a standard deviation of 6 and 95% limits of agreement from -13 to 10. Analysis of median percentage differences between PediaSat and ScvO2 saturation over time revealed that, although not statistically significant, the change in percentage saturation differences was clinically relevant after the 8th hour from calibration (from -100 to +100%. Conclusion: PediaSat catheters showed unreliable performance in our cohort. It should be further investigated whether repeating

  10. Exercise-induced arterial hypertension - an independent factor for hypertrophy and a ticking clock for cardiac fatigue or atrial fibrillation in athletes? [v1; ref status: indexed,

    Directory of Open Access Journals (Sweden)

    Roman Leischik


    Full Text Available Background: Exercise-induced arterial hypertension (EIAH leads to myocardial hypertrophy and is associated with a poor prognosis. EIAH might be related to the “cardiac fatigue” caused by endurance training. The goal of this study was to examine whether there is any relationship between EIAH and left ventricular hypertrophy in Ironman-triathletes. Methods: We used echocardiography and spiroergometry to determine the left ventricular mass (LVM, the aerobic/anaerobic thresholds and the steady-state blood pressure of 51 healthy male triathletes. The main inclusion criterion was the participation in at least one middle or long distance triathlon. Results: When comparing triathletes with LVM 220g there was a significant difference between blood pressure values (BP at the anaerobic threshold (185.2± 21.5 mmHg vs. 198.8 ±22.3 mmHg, p=0.037. The spiroergometric results were: maximum oxygen uptake (relative VO2max 57.3 ±7.5ml/min/kg vs. 59.8±9.5ml/min/kg (p=ns. Cut-point analysis for the relationship of BP >170 mmHg at the aerobic threshold and the probability of LVM >220g showed a sensitivity of 95.8%, a specificity of 33.3%, with a positive predictive value of 56.8 %, a good negative predictive value of 90%. The probability of LVM >220g increased with higher BP during exercise (OR: 1.027, 95% CI 1.002-1.052, p= 0.034 or with higher training volume (OR: 1.23, 95% CI 1.04 -1.47, p = 0.019. Echocardiography showed predominantly concentric remodelling, followed by concentric hypertrophy. Conclusion: Significant left ventricular hypertrophy with LVM >220g is associated with higher arterial blood pressure at the aerobic or anaerobic threshold. The endurance athletes with EIAH may require a therapeutic intervention to at least prevent extensive stiffening of the heart muscle and exercise-induced cardiac fatigue.

  11. Neurologic management following cardiac arrest. (United States)

    Bircher, N G


    Optimal neurologic outcome after cardiac arrest requires careful attention to the details of both intracranial and extracranial homeostasis. A high index of suspicion regarding the potential causes and complications of cardiac arrest facilitates discovery and treatment of problems before they adversely affect neurologic outcome. The future is bright for resuscitation research: Our fundamental understanding of cerebral ischemia and its consequences has dramatically improved, and this knowledge can hopefully be transferred to clinical useful modes of therapy. However, the transition from a promising, therapeutically effective intervention in animals to the demonstration that treatment is effective following cardiac arrest in humans is an important and difficult step. The patient population is heterogeneous before the insult, the duration and severity of the insult are variable, and the effectiveness of cardiopulmonary resuscitation varies among institutions. Therefore, the only means of demonstrating clinical efficacy is the performance of a large clinical trial. The Resuscitation Research Center at the University of Pittsburgh has developed and coordinated a multicenter, multinational team of investigators who have completed one definitive trial of postarrest barbiturate therapy and are currently completing a similar trial using a calcium entry blocker. Despite the formidable obstacles posed by such comprehensive efforts, they provide the mechanism for determining whether the cost of a new treatment modality is justified by the likelihood of improved mortality or morbidity.

  12. [Cardiopulmonary resuscitation in cardiac arrest following trauma]. (United States)

    Leidel, B A; Kanz, K-G


    For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade. Treatment of reversible causes should be simultaneous. Chest compression is inferior following traumatic cardiac arrest and should never delay treatment of reversible causes of the traumatic cardiac arrest. In massive bleeding, bleeding control has priority. Damage control resuscitation with permissive hypotension, aggressive coagulation therapy, and damage control surgery represent the pillars of initial treatment. Cardiac arrest due to hypoxia should be resolved by airway management and ventilation. Tension pneumothorax should be decompressed by finger thoracostomy, pericardial tamponade by resuscitative thoracotomy. In addition, resuscitative thoracotomy allows direct and indirect bleeding control. Untreated impact brain apnea may rapidly lead to cardiac arrest and requires quick opening of the airway and effective oxygenation. Established algorithms for treatment of cardiac arrest following trauma enable a safe, structured, and effective management.

  13. Reoperation for bleeding in cardiac surgery

    DEFF Research Database (Denmark)

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik;


    At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperati...

  14. Stimulating endogenous cardiac regeneration

    Directory of Open Access Journals (Sweden)

    Amanda eFinan


    Full Text Available The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration,a combination of these approaches couldameliorate the overall repair process to incorporate the participation ofmultiple cell players.

  15. AA Index (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The geomagnetic aa index provides a long climatology of global geomagnetic activity using 2 antipodal observatories at Greenwich and Melbourne- IAGA Bulletin 37,...

  16. Walkability Index (United States)

    U.S. Environmental Protection Agency — The Walkabiliy Index dataset characterizes every Census 2010 block group in the U.S. based on its relative walkability. Walkability depends upon characteristics of...

  17. Electrophysiological properties of mouse and epitope-tagged human cardiac sodium channel Nav1.5 expressed in HEK293 cells [v2; ref status: indexed,

    Directory of Open Access Journals (Sweden)

    Katja Reinhard


    Full Text Available Background: The pore-forming subunit of the cardiac sodium channel, Nav1.5, has been previously found to be mutated in genetically determined arrhythmias. Nav1.5 associates with many proteins that regulate its function and cellular localisation. In order to identify more in situ Nav1.5 interacting proteins, genetically-modified mice with a high-affinity epitope in the sequence of Nav1.5 can be generated. Methods: In this short study, we (1 compared the biophysical properties of the sodium current (INa generated by the mouse Nav1.5 (mNav1.5 and human Nav1.5 (hNav1.5 constructs that were expressed in HEK293 cells, and (2 investigated the possible alterations of the biophysical properties of the human Nav1.5 construct that was modified with specific epitopes. Results: The biophysical properties of mNav1.5 were similar to the human homolog. Addition of epitopes either up-stream of the N-terminus of hNav1.5 or in the extracellular loop between the S5 and S6 transmembrane segments of domain 1, significantly decreased the amount of INa and slightly altered its biophysical properties. Adding green fluorescent protein (GFP to the N-terminus did not modify any of the measured biophysical properties of hNav1.5. Conclusions: These findings have to be taken into account when planning to generate genetically-modified mouse models that harbour specific epitopes in the gene encoding mNav1.5.

  18. Platelets and cardiac arrhythmia

    Directory of Open Access Journals (Sweden)

    Jonas S De Jong


    Full Text Available Sudden cardiac death remains one of the most prevalent modes of death in industrialized countries, and myocardial ischemia due to thrombotic coronary occlusion is its primary cause. The role of platelets in the occurrence of SCD extends beyond coronary flow impairment by clot formation. Here we review the substances released by platelets during clot formation and their arrhythmic properties. Platelet products are released from three types of platelet granules: dense core granules, alpha-granules, and platelet lysosomes. The physiologic properties of dense granule products are of special interest as a potential source of arrhythmic substances. They are released readily upon activation and contain high concentrations of serotonin, histamine, purines, pyrimidines, and ions such as calcium and magnesium. Potential arrhythmic mechanisms of these substances, e.g. serotonin and high energy phosphates, include induction of coronary constriction, calcium overloading, and induction of delayed after-depolarizations. Alpha-granules produce thromboxanes and other arachidonic acid products with many potential arrhythmic effects mediated by interference with cardiac sodium, calcium and potassium channels. Alpha-granules also contain hundreds of proteins that could potentially serve as ligands to receptors on cardiomyocytes. Lysosomal products probably do not have an important arrhythmic effect. Platelet products and ischemia can induce coronary permeability, thereby enhancing interaction with surrounding cardiomyocytes. Antiplatelet therapy is known to improve survival after myocardial infarction. Although an important part of this effect results from prevention of coronary clot formation, there is evidence to suggest that antiplatelet therapy also induces anti-arrhythmic effects during ischemia by preventing the release of platelet activation products.

  19. 心率对左心功能指数、主动脉强化 CT 值及延迟时间的影响%The effect of heart rate on left cardiac function index,enhanced CT value of aorta and delay time

    Institute of Scientific and Technical Information of China (English)

    李剑; 印弘; 石明国; 张劲松; 赵宏亮; 郑敏文


    目的:探讨心率对左心功能指数、主动脉强化 CT 值和延迟时间的影响。方法:连续选择进行冠状动脉 CTA的患者74例,在对比剂注射参数相同的情况下,按照心率分为低心率组(≤75次/分)和高心率组(>75次/分)。所得数据在0%~90% R-R 间期以10%为间隔进行重组,分析心输出量、每搏输出量和射血分数,测量两组主动脉强化 CT 值和延迟时间。并对两组间的差异进行统计学分析。结果:在对比剂注射参数相同的情况下,高心率组心输出量高于低心率组(t=3.908,P <0.05),但高心率组主动脉强化 CT 值和延迟时间均低于低心率组(t =2.536,3.454,P 均<0.05)。结论:掌握不同心率下心功能指数、主动脉强化 CT 值及延迟时间的变化有助于冠状动脉 CTA 扫描中对比剂注射参数的设定,获得优良的图像质量。%Objective:The purpose of this study was to evaluate the effect of heart rate (HR)on left cardiac function index,enhanced CT value of aorta and delay time.Methods:Seventy-four consecutive patients underwent dual-source CT an-giography using the same parameters for contrast administration.Patients were divided into slow HR groups (≤75bpm) and fast HR groups (>75bpm).All of the original data were reconstructed at 0%~90% R-R interval with 10% interval and the cardiac output,stroke volume and ejection fraction were analyzed.The enhanced CT value of aorta and delay time were measured.Statistical analyses were performed between the two groups.Results:Using the same parameters for contrast administration,the cardiac output of the fast HR group was higher than that of slow HR group,with significant difference (t=3.908,P <0.05).Yet the enhanced CT value of aorta and delay time were lower in fast HR group compared with that of slow HR group (t=2.536,3.454;P <0.05).Conclusion:Well knowledge about the variation of cardiac function index

  20. 心电图参数和心肌酶峰与前壁 STEMI 患者短期心功能的相关性%Correlation among electrocardiogram indexes,myocardial enzyme peak and short term cardiac function in patients with anterior STEMI

    Institute of Scientific and Technical Information of China (English)

    董彬; 赵娜; 陈东芳


    目的:探讨心电图和心肌酶峰与急性前壁 ST 段抬高型心肌梗死(STEMI)患者短期心功能的相关性。方法:选择我院收治的150例急性前壁 STEMI 患者,根据3个月的左室射血分数(3m LVEF),分为心功能不良组(LVEF<50%,78例)和心功能正常组(LVEF≥50%,72例)。比较两组患者梗死相关导联心电图的 ST 段抬高幅度之和(ΣST)、R 波振幅之和(ΣR)、Q 波之和(ΣQ)、ST 段抬高最大值(STm)、Q 波最大值(Qm),以及CK 的峰值(CKm)、CK-MB 的峰值(CK-MBm)、cTnT 的峰值(cTnTm)等指标。结果:与心功能正常组比较,心功能不良组ΣST、ΣQ、STm、Qm、CKm、CK-MBm、cTnTm,左室舒张末期内径(LVEDd),3mLVEDd 均显著增大,ΣR、LVEF、3mLVEF 均显著减小(P <0.05或<0.01);Spearman 相关分析显示,ΣST、ΣQ、STm、Qm、CKm、CK-MBm、cTnTm 与3m LVEDd 均呈正相关(r =0.18~0.63,P <0.05或<0.01),与3m LVEF均呈负相关(r =-0.88~-0.42,P 均<0.01)。ΣR 与 LVEDd,3m LVEDd 呈负相关(r =-0.46、-0.51,P<0.01),与 LVEF,3m LVEF 呈正相关(r =0.81、0.71,P 均<0.01)。结论:前壁 STEMI 患者的 ST 段抬高越多,Q 波越大,R 波越小,心肌酶峰越高,患者短期的心功能越差。%Objective:To explore the correlation among ECG indexes,myocardial enzyme peak and short term cardi-ac function in patients with acute anterior ST elevation myocardial infarction (STEMI).Methods:A total of 150 pa-tients with acute anterior STEMI were selected from our hospital.According to left ventricular ejection fraction af-ter three months (3m LVEF),they were divided into cardiac dysfunction group (n=78,LVEF<50%)and normal cardiac function group (n= 72,LVEF≥ 50%).Following indexes were compared between two groups,including sum of ST elevation extent (ΣST),R wave (ΣR),Q wave (ΣQ),maximum value of ST elevation

  1. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence

    Directory of Open Access Journals (Sweden)

    Francisco Javier eGimeno-Blanes


    Full Text Available Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indexes, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indexes in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indexes which are tackled from the aforementioned viewpoints, namely, heart rate turbulence, heart rate variability, and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future.

  2. Louisiana ESI: INDEX (Index Polygons) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains vector polygons representing the boundaries of all the hardcopy cartographic products produced as part of the Environmental Sensitivity Index...

  3. Virginia ESI: INDEX (Index Polygons) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains vector polygons representing the boundaries of all hardcopy cartographic products produced as part of the Environmental Sensitivity Index...

  4. Maryland ESI: INDEX (Index Polygons) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains vector polygons representing the boundaries of all hardcopy cartographic products produced as part of the Environmental Sensitivity Index...

  5. Fractal fluctuations in cardiac time series (United States)

    West, B. J.; Zhang, R.; Sanders, A. W.; Miniyar, S.; Zuckerman, J. H.; Levine, B. D.; Blomqvist, C. G. (Principal Investigator)


    Human heart rate, controlled by complex feedback mechanisms, is a vital index of systematic circulation. However, it has been shown that beat-to-beat values of heart rate fluctuate continually over a wide range of time scales. Herein we use the relative dispersion, the ratio of the standard deviation to the mean, to show, by systematically aggregating the data, that the correlation in the beat-to-beat cardiac time series is a modulated inverse power law. This scaling property indicates the existence of long-time memory in the underlying cardiac control process and supports the conclusion that heart rate variability is a temporal fractal. We argue that the cardiac control system has allometric properties that enable it to respond to a dynamical environment through scaling.

  6. Respiratory gating in cardiac PET

    DEFF Research Database (Denmark)

    Lassen, Martin Lyngby; Rasmussen, Thomas; Christensen, Thomas E


    of our study was to compare the resulting imaging quality by the use of a time-based respiratory gating system in two groups administered either adenosine or dipyridamole as the pharmacological stress agent. METHODS AND RESULTS: Forty-eight patients were randomized to adenosine or dipyridamole cardiac...... stress (82)RB-PET. Respiratory rates and depths were measured by a respiratory gating system in addition to registering actual respiratory rates. Patients undergoing adenosine stress showed a decrease in measured respiratory rate from initial to later scan phase measurements [12.4 (±5.7) vs 5.6 (±4......BACKGROUND: Respiratory motion due to breathing during cardiac positron emission tomography (PET) results in spatial blurring and erroneous tracer quantification. Respiratory gating might represent a solution by dividing the PET coincidence dataset into smaller respiratory phase subsets. The aim...

  7. Marketing cardiac CT programs. (United States)

    Scott, Jason


    There are two components of cardiac CT discussed in this article: coronary artery calcium scoring (CACS) and coronary computed tomography angiography (CCTA).The distinctive advantages of each CT examination are outlined. In order to ensure a successful cardiac CT program, it is imperative that imaging facilities market their cardiac CT practices effectively in order to gain a competitive advantage in this valuable market share. If patients receive quality care by competent individuals, they are more likely to recommend the facility's cardiac CT program. Satisfied patients will also be more willing to come back for any further testing.

  8. Supravalvular aortic stenosis with sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Pradeep Vaideeswar


    Full Text Available Sudden cardiac death (SCD most commonly results from previously undiagnosed congenital, acquired, or hereditary cardiac diseases. Congenital aortic valvular, subvalvular, and supravalvular disease with left ventricular outflow tract obstruction is an important preventable cause of sudden death. This report documents sudden death presumably due to acute myocardial ischemia in a young male with an undiagnosed supravalvular aortic stenosis (SVAS due to a rare association of isolation of coronary sinuses of Valsalva. Congenital supravalvular pulmonary stenosis and mitral valvular dysplasia were also present.

  9. Comparison of cardiac magnetic resonance imaging features of isolated left ventricular non-compaction in adults versus dilated cardiomyopathy in adults

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, H. [Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Zhao, S., E-mail: [Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Jiang, S.; Lu, M.; Yan, C.; Ling, J.; Zhang, Y.; Liu, Q.; Ma, N.; Yin, G.; Wan, J. [Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Yang, Y. [Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Li, L. [Department of Pathology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China); Jerecic, R. [MR Research and Development, Siemens Medical Solutions, Chicago, IL (United States); He, Z. [Department of Nuclear Medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037 (China)


    Aim: To compare cardiac magnetic resonance imaging (MRI) features between isolated left ventricular non-compaction (IVNC) and dilated cardiomyopathy (DCM) in adults. Materials and methods: A consecutive series of 50 patients with IVNC from a single institution were reviewed. During the same period, 50 patients with DCM who had prominent trabeculations, who were matched for age, gender, and body surface area, were prospectively included. Left ventricular (LV) morphology and function were assessed using cardiac MRI. Results: Compared with patients with DCM, patients with IVNC had a significantly lower LV sphericity index and end-diastolic volume index (LVEDVI) and a greater LV ejection fraction (LVEF), number of trabeculated segments, and ratio of non-compacted to compacted myocardium (NC/C ratio). There were no significant differences in stroke volume index, cardiac output, and cardiac index between the two patient groups. In patients with IVNC, the number of trabeculated segments and the NC/C ratio correlated positively with LVEDVI (r = 0.626 and r = 0.559, respectively) and negatively with LVEF (r = -0.647 and r = -0.521, respectively, p < 0.001 for all). In patients with DCM, the number of non-compacted segments and the NC/C ratio had no correlation with either the LVEDVI (r = -0.082 and r = -0.135, respectively) or the LVEF (r = 0.097 and r = 0.205, respectively). Conclusion: There are demonstrable morphological and functional differences between IVNC and DCM at LV assessment using cardiac MRI. The occurrence of trabeculated myocardium might be due to a different pathophysiological mechanism.

  10. Cardiac troponin: an emerging cardiac biomarker in animal health

    Directory of Open Access Journals (Sweden)

    Vishal V. Undhad

    Full Text Available Analysis of cardiac troponin I (cTn I and T (cTnT are considered the “gold standard” for the non-invasive diagnosis of myocardial injury in human and animals. It has replaced traditionally used cardiac biomarkers such as myoglobin, lactate dehydrogenase (LDH, creatine kinase (CK and CK-MB due to its high sensitivity and specificity for the detection of myocardial injury. Cardiac troponins are proteins that control the calcium-mediated interaction between actin and myosin, allowing contraction at the sarcomere level. Concentration of the cTn can be correlated microscopic lesion and loss of immunolabeling in myocardium damage. Troponin concentration remains elevated in blood for 1-2wks so that wide window is available for diagnosis of myocardial damage. The cTn test has >95% specificity and sensitivity and test is less time consuming (10 to 15 minutes and less costly (INR 200 to INR 500. [Vet. World 2012; 5(8.000: 508-511

  11. Sublingual Microcirculation is Impaired in Post-cardiac Arrest Patients

    DEFF Research Database (Denmark)

    G. Omar, Yasser; Massey, Michael; Wiuff Andersen, Lars;


    AIM: We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory...... markers in the post-cardiac arrest state. METHODS: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using...... the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients. RESULTS: We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual...

  12. INDEXING MECHANISM (United States)

    Kock, L.J.


    A device is presented for loading and unloading fuel elements containing material fissionable by neutrons of thermal energy. The device comprises a combination of mechanical features Including a base, a lever pivotally attached to the base, an Indexing plate on the base parallel to the plane of lever rotation and having a plurality of apertures, the apertures being disposed In rows, each aperture having a keyway, an Index pin movably disposed to the plane of lever rotation and having a plurality of apertures, the apertures being disposed in rows, each aperture having a keyway, an index pin movably disposed on the lever normal to the plane rotation, a key on the pin, a sleeve on the lever spaced from and parallel to the index pin, a pair of pulleys and a cable disposed between them, an open collar rotatably attached to the sleeve and linked to one of the pulleys, a pin extending from the collar, and a bearing movably mounted in the sleeve and having at least two longitudinal grooves in the outside surface.

  13. Sudden cardiac arrest in sports - need for uniform registration

    DEFF Research Database (Denmark)

    Solberg, E E; Borjesson, M; Sharma, S;


    There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities....

  14. Advances in cardiac magnetic resonance imaging of congenital heart disease

    NARCIS (Netherlands)

    Driessen, Mieke M P; Breur, Johannes M. P. J.; Budde, Ricardo P J; van Oorschot, Joep W M; van Kimmenade, Roland R J; Sieswerda, Gertjan Tj.; Meijboom, Folkert J; Leiner, Tim


    Due to advances in cardiac surgery, survival of patients with congenital heart disease has increased considerably during the past decades. Many of these patients require repeated cardiovascular magnetic resonance imaging to assess cardiac anatomy and function. In the past decade, technological advan

  15. Understanding cardiac electrical phenotypes in the genomic era

    NARCIS (Netherlands)

    A. Milano


    Sudden cardiac death (SCD) is defined as unexpected death due to a cardiac cause. It most often results from life-threatening ventricular fibrillation (VF) and ranks among the most common causes of death worldwide, with an incidence in the community varying between 0.6 and >1.4 per 1,000 individuals

  16. Cardiac thrombi mistaken for metastasis in recurrent melanoma. (United States)

    Galiuto, Leonarda; Locorotondo, Gabriella; Fedele, Elisa; Danza, Maria L; De Vito, Elena; Masi, Ambra; Favoccia, Carla; Rebuzzi, Antonio G; Crea, Filippo


    Intra-cardiac thrombi can be incidentally found in recurrent melanoma and need careful assessment. An 81-year-old woman, with a history of malignant nasopharyngeal melanoma, was evaluated by echocardiography and cardiac magnetic resonance due to the detection of undefined masses localized both in right atrium and ventricle during contrast-enhanced thoraco-abdominal computed tomography.

  17. Cardiac Procedures and Surgeries (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Cardiac Procedures and Surgeries Updated:Sep 16,2016 If you've had ... degree of coronary artery disease (CAD) you have. Cardiac Procedures and Surgeries Angioplasty Also known as Percutaneous Coronary Interventions [PCI], ...

  18. [Advances in cardiac pacing]. (United States)

    de Carranza, María-José Sancho-Tello; Fidalgo-Andrés, María Luisa; Ferrer, José Martínez; Mateas, Francisco Ruiz


    This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed.

  19. Dying from cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Powari Manish


    Full Text Available Abstract Background To determine the causes of cardiac tamponade (CT, focussing especially on haemopericardium (HP, as a terminal mode of death, within a 430,000 rural English population. Methods Our hospital mortuary register and, all postmortem reports between 1995 and 2004 inclusive, were interrogated for patients dying of CT or HP. The causes of CT/HP and selected morphological characteristics were then determined. Results 14,368 postmortems were performed in this period: of these, 461 patients died of CT. Three cases were due to non-haemorrhagic pericardial effusion. HP accounted for the remaining 458 cases of which, five were post-traumatic, 311 followed rupture of an acute myocardial infarction (RAMI, 138 after intra-pericardial rupture of dissecting ascending aortic aneurysms (RD3A and four were due to miscellaneous causes. HP was more commonly due to RAMI. Men tended to die from RAMI or RD3A earlier than women. RAMI or RD3A were commoner in men Two thirds of RAMI were associated with coronary artery thrombosis. Anterior free wall rupture was commonest overall, and in women, but posterior free wall rupture was commoner in men. The volume of intrapericardial blood in RAMI (mean = 440 ml and RD3A (mean = 498 ml varied between 150 and 1000 ml: intrapericardial blood volume was greater in men than in women dying from either RAMI or RD3A. Conclusion At postmortem, CT is most often related to HP, attributable to either RAMI or intrapericardial RD3A. Post-traumatic and other causes of CT are infrequent.

  20. Biomaterials for cardiac regeneration

    CERN Document Server

    Ruel, Marc


    This book offers readers a comprehensive biomaterials-based approach to achieving clinically successful, functionally integrated vasculogenesis and myogenesis in the heart. Coverage is multidisciplinary, including the role of extracellular matrices in cardiac development, whole-heart tissue engineering, imaging the mechanisms and effects of biomaterial-based cardiac regeneration, and autologous bioengineered heart valves. Bringing current knowledge together into a single volume, this book provides a compendium to students and new researchers in the field and constitutes a platform to allow for future developments and collaborative approaches in biomaterials-based regenerative medicine, even beyond cardiac applications. This book also: Provides a valuable overview of the engineering of biomaterials for cardiac regeneration, including coverage of combined biomaterials and stem cells, as well as extracellular matrices Presents readers with multidisciplinary coverage of biomaterials for cardiac repair, including ...

  1. Mathematical cardiac electrophysiology

    CERN Document Server

    Colli Franzone, Piero; Scacchi, Simone


    This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

  2. Ultrasound assessment of fetal cardiac function (United States)

    Crispi, Fàtima; Valenzuela‐Alcaraz, Brenda; Cruz‐Lemini, Monica


    Abstract Introduction: Fetal heart evaluation with US is feasible and reproducible, although challenging due to the smallness of the heart, the high heart rate and limited access to the fetus. However, some cardiac parameters have already shown a strong correlation with outcomes and may soon be incorporated into clinical practice. Materials and Methods: Cardiac function assessment has proven utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. In addition, some cardiac parameters with high sensitivity such as MPI or annular peak velocities have shown promising results in monitoring and predicting outcome in intrauterine growth restriction or congenital diaphragmatic hernia. Conclusion: Cardiac function can be adequately evaluated in most fetuses when appropriate expertise, equipment and time are available. Fetal cardiac function assessment is a promising tool that may soon be incorporated into clinical practice to diagnose, monitor or predict outcome in some fetal conditions. Thus, more research is warranted to further define specific protocols for each fetal condition that may affect cardiac function. PMID:28191192

  3. Stem cell sources for cardiac regeneration. (United States)

    Roccio, M; Goumans, M J; Sluijter, J P G; Doevendans, P A


    Cell-based cardiac repair has the ambitious aim to replace the malfunctioning cardiac muscle developed after myocardial infarction, with new contractile cardiomyocytes and vessels. Different stem cell populations have been intensively studied in the last decade as a potential source of new cardiomyocytes to ameliorate the injured myocardium, compensate for the loss of ventricular mass and contractility and eventually restore cardiac function. An array of cell types has been explored in this respect, including skeletal muscle, bone marrow derived stem cells, embryonic stem cells (ESC) and more recently cardiac progenitor cells. The best-studied cell types are mouse and human ESC cells, which have undisputedly been demonstrated to differentiate into cardiomyocyte and vascular lineages and have been of great help to understand the differentiation process of pluripotent cells. However, due to their immunogenicity, risk of tumor development and the ethical challenge arising from their embryonic origin, they do not provide a suitable cell source for a regenerative therapy approach. A better option, overcoming ethical and allogenicity problems, seems to be provided by bone marrow derived cells and by the recently identified cardiac precursors. This report will overview current knowledge on these different cell types and their application in cardiac regeneration and address issues like implementation of delivery methods, including tissue engineering approaches that need to be developed alongside.

  4. Cardiac risk of coronary patients after reintegration into occupations with heavy physical exertion. (United States)

    Wolf, R; Habel, F; Heiermann, M; Jäkel, R; Sinn, R


    The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion ("hazard period"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected ("basal") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing

  5. Agreement between cardiac index measured with FloTrac-Vigileo system and pulmonary artery catheter in patients undergoing off-pump coronary artery bypass grafting%非体外循环冠状动脉旁路移植术患者FloTrac-Vigileo系统与肺动脉导管技术监测心指数的一致性

    Institute of Scientific and Technical Information of China (English)

    杜伯祥; 史宏伟; 宋杰


    Objective To determine if the cardiac index (Cl) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midazolam,sufentanil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.Cl was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:Cl (2.8 ± 0.6) L·min-1 ·m-2,bias was 0.23 L·min-1 ·m-2 and limit of agreement was (-0.57,1.02) L·min-1 ·m-2,resulting in κ =0.546 and an overall percentage error of 28.6%.Conclusion Cl values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.

  6. Afghanistan Index

    DEFF Research Database (Denmark)

    Linnet, Poul Martin


    The Afghanistan index is a compilation of quantitative and qualitative data on the reconstruction and security effort in Afghanistan. The index aims at providing data for benchmarking of the international performance and thus provides the reader with a quick possibility to retrieve valid...... basis. The data are divided into different indicators such as security, polls, drug, social, economic, refugees etc. This represents a practical division and does not indicate that a picture as to for instance security can be obtained by solely looking at the data under security. In order to obtain...... a more valid picture on security this must incorporate an integrated look on all data meaning that for instance the economic data provides an element as to the whole picture of security....


    Institute of Scientific and Technical Information of China (English)


    2, 4, 6-trinitrobenzenesulphonic acid, zinc sulfate, experimental colitis, 2003328AC133 antigen, hematopoietic stem cells, fetal blood, immunophe-notyping, 2003138ALR2 gene, eNOS gene, PON1 gene, RAGE gene, 2003179 ATN-ISI, prognosis, acute renal failure, acute tubular necrosis-individual severity index, acute physiology and chronic health evaluation, 2003118 Alzheimer disease, interleukin-1 beta, tumor necrosis factor alpha,

  8. Cardiac tumors: echo assessment. (United States)

    Mankad, Rekha; Herrmann, Joerg


    Cardiac tumors are exceedingly rare (0.001-0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

  9. [Morgagni hernia causing cardiac tamponade]. (United States)

    S Breinig; Paranon, S; Le Mandat, A; Galinier, P; Dulac, Y; Acar, P


    Morgagni hernia is a rare malformation (3% of diaphragmatic hernias). This hernia is usually asymptomatic in children. We report on a case revealed by an unusual complication. Severe cyanosis was due to right-to-left atrial shunt through the foramen ovale assessed by 2D echocardiography. Diagnosis of the Morgagni hernia was made with CT scan. The intrathoracic liver compressed the right chambers of the heart causing tamponade. Cardiac compression was reversed after surgery and replacement of the liver in the abdomen. Six months after the surgery, the infant was symptom-free with normal size right chambers of the heart.

  10. 酒精所致震颤谵妄患者血液相关指标的对照研究%The measurement of blood related indexes in the patients with delirium tremens due to alcohol dependence

    Institute of Scientific and Technical Information of China (English)

    庞良俊; 尹良爽; 朱春燕; 董文文; 戴兢; 王晓玲


    Objective: To investigate the blood related indexes in the patients with delirium tremens dueto alcohol dependence and explore the high risk factors for delirium tremens. Method; 142 male inpatients with alcohol dependence were divided into two groups ( delirium tremens and non delirium tremens) in terms of delirium tremens occurrence. The blood related indexes were measured and compared between the two groups. Results; Compared non delirium tremens group, delirium tremens group showed higher levels on AST (aspartate aminotransferase) [ (183.53 ± 174. 55 ) U/L vs. (95. 83 ± 118. 38 ) U/L] , GGT ( glutamate transaminase) [(647.26 ±618. 27) U/L vs. (250.48 ±313. 91) U/L] ,CK(creatine kinase) [ (738. 85 ± 1023. 72)U/L vs. (330.59 ±433.42)U/L] and Ca [(2.34 ±0.91) mmol/1 vs. (2.22 ±0. 14)mmol/l] ,and lower levels in HGB (hemoglobin) [ (126.00 ± 17.77)g/l vs. (135.38 ± 17.85)g/l] ,RBC(red blood cell) [ (3.55 ±0.64) x 1012/L vs. (3.93 ±0.60) ×10'2/L],PLT (platelet count) [ (86.41 ±31.56) x 109/L vs. ( 173.78 ±79.44) x 109/L],K[(3.45±0.75)mmol/L vs. (3.88 ±0.55)mmol/L] and Cl [(100.94 ±5.02)mmol/L vs (104.46 ± 6.64)mmol/L]. The above index differences between the two groups were statistically significant (P<0.05 or P < 0.01). Logistic regression analysis indicated that thrombocytopenia and low serum potassium were risk factors fro delirium tremens. Conclusion;The blood related indexes in patients with alcohol dependence to some degree can predict delirium tremens onset.%目的:对酒依赖患者进行血液相关指标的观察与分析,探讨慢性酒精中毒患者发生震颤谵妄(delirium tremens,DT)的高危因素. 方法:对近4年142例首次住院的男性酒依赖住院患者按照是否出现DT分组进行血液相关指标比较. 结果:出现震颤谵妄(DT)的17例酒依赖患者与非震颤谵妄组相比,在谷草转氨酶[(183.53±174.55) U/L;(95.83±118.38) U/L]、谷氨酸转氨酶[(647.26±618.27)U/L; (250.48±313.91) U

  11. Cardiac Arrest due to Pneumoperitoneum After PEG Insertion in ALSPatient

    Directory of Open Access Journals (Sweden)

    Berit Ceylan


    Full Text Available Amyotrophic lateral sclerosis (ALS, the most common motor neuron disease, is characterized by motor neuron degeneration in the primary cortex, brainstem, and spinal cord. Percutaneous endoscopic gastrostomy (PEG is a preferable method of nutritional support in patients with normal gastrointestinal function who cannot be fed orally for various reasons. PEG tube placement is recommended in amyotrophic lateral sclerosis (ALS patients with dysphagia to provide reliable access for medications and nutrition. We report a case of a 63-year-old man with amyotrophic lateral sclerosis presenting with dysphagia and pneumoperitoneum following percutaneous endoscopic gastrostomy (PEG placement. We also report on the intensive care period of this patient. PEG is a widely used nutrition therapy in these cases but complications such as pneumoperitoneum result in long term ICU stays and higher mortality rates.

  12. Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization (United States)

    Wang, Chu

    Patients undergoing cardiac catheterization are potentially at risk of radiation-induced health effects from the interventional fluoroscopic X-ray imaging used throughout the clinical procedure. The amount of radiation exposure is highly dependent on the complexity of the procedure and the level of optimization in imaging parameters applied by the clinician. For cardiac catheterization, patient radiation dosimetry, for key organs as well as whole-body effective, is challenging due to the lack of fixed imaging protocols, unlike other common X-ray based imaging modalities. Pediatric patients are at a greater risk compared to adults due to their greater cellular radio-sensitivities as well as longer remaining life-expectancy following the radiation exposure. In terms of radiation dosimetry, they are often more challenging due to greater variation in body size, which often triggers a wider range of imaging parameters in modern imaging systems with automatic dose rate modulation. The overall objective of this dissertation was to develop a comprehensive method of radiation dose estimation for pediatric patients undergoing cardiac catheterization. In this dissertation, the research is divided into two main parts: the Physics Component and the Clinical Component. A proof-of-principle study focused on two patient age groups (Newborn and Five-year-old), one popular biplane imaging system, and the clinical practice of two pediatric cardiologists at one large academic medical center. The Physics Component includes experiments relevant to the physical measurement of patient organ dose using high-sensitivity MOSFET dosimeters placed in anthropomorphic pediatric phantoms. First, the three-dimensional angular dependence of MOSFET detectors in scatter medium under fluoroscopic irradiation was characterized. A custom-made spherical scatter phantom was used to measure response variations in three-dimensional angular orientations. The results were to be used as angular dependence

  13. [Berberine inhibits cardiac fibrosis of diabetic rats]. (United States)

    Lu, Kun; Shen, Yongjie; He, Jinfeng; Liu, Guoling; Song, Wei


    Objective To explore the effect of berberine on cardiac fibrosis of diabetic rats by observing the expressions of serum transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF) , collagen type 1 (Col1) and collagen type 3 (Col3) in myocardial tissues of diabetic rats after berberine treatment. Methods The diabetic model was induced by intraperitoneal injection of streptococci (STZ). Forty-three diabetic rats were randomly divided into diabetic model group (n=9), berberine treated groups of different doses [50, 100, 150 mg/(kg.d), gavage administration for 12 weeks; n=9, 9, 8 respectively], and metformin group as positive control (n=8); other 8 normal rats served as a negative control group. After the last administration, fasting blood glucose, left ventricular systolic pressure (LVSP) and left ventricular end diastolic pressure (LVEDP) were measured; rats' heart were taken to calculate the heart mass index (HMI); ELISA was used to detect the serum levels of TGF-β1 and CTGF; collagenous fibers in cardiac tissues were tested by Masson staining; collagen volume fraction (CVF) was measured by image analysis; Col1 and Col3 in cardiac tissues were determined by Western blotting. Results Compared with the normal control group, the fasting blood glucose, LVSP, LVEDP absolute value, HMI, the degree of cardiac fibrosis, the expressions of TGF-β1, CTGF, Col1 and Col3 significantly increased in the model group. All indexes mentioned above were reduced obviously in berberine treated groups of 100 and 150 mg/(kg.d). Conclusion Berberine improves cardiac fibrosis in diabetic rats through down-regulating the expressions of TGF-β1 and CTGF and reducing the synthesis and deposition of Col1 and Col3.

  14. Complete cardiac rupture associated with closed chest cardiac massage: case report and review of the literature. (United States)

    Tattoli, Lucia; Maselli, Eloisa; Romanelli, Maria Carolina; Di Vella, Giancarlo; Solarino, Biagio


    Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35-year-old workman who collapsed and underwent ECM by his co-workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre-existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.

  15. Cardiac Tissue Characterization with Ultrasound and : a very early index of diabetic cardiomyopathy? Caracterización tisular miocárdica por ultrasonidos: ¿un índice precoz de miocardiopatía diabética?

    Directory of Open Access Journals (Sweden)

    Nicolás A Hernández

    Full Text Available

    Introduction: There is an intrinsec myocardiopaty related with the diabetes and probably produced for the increment of collagen in the myocardium. Objective: To value the paper of the tissular myocardial characterization by ultrasound and the detection of diastolic dysfunction by pulsated Doppler as precocious indexes of diabetic miocardiopaty. Methods: Transverse, prospective,and controlled study that analyzed the diastolic function with pulsated Doppler in 60 diabetic patients and a control group of 15 healthy individuals; all with a normal pressure, with a negative ergometric test and normal systolic function; 40 presented microvascular complications. The securities of magnitude of recurrent variation were determined at the level of the septum and the posterior wall. The echocardiograms were carried out with the equipment ALOKA 5500 with a multiband transducer of 2.5 MHZ using the beta digital handling program (DMS and the power Doppler in ecocardiografic views. Results: Reduction of the recurrent variation was obtained in diabetics with respect to the control group at the level of the septum 2D (3.4 ±1.3 vs. 4.4 ± 0.4 dB; p < 0.003 and the posterior wall PP2D (3.4 ± 1.3 vs. 6.2 ± 0.4 dB; p < 0.000001. Was found a correlation between the presence of diastolic dysfunction and the low magnitudes of ciclic variation (p < 0.001. The tissular characterization was more sensitive to detect precocious changes of the myocardium in diabetic patients (p < 0.001. Conclusions: The diabetes mellitus is cause of myocardiopaties that originate very precocious alterations in the myocardium of these patients; these changes can be discovered in very early phases by the pulsated Doppler detecting diastolic dysfunction and the tissular characterization by ultrasounds. This last one is more sensitive for the diagnosis of this entity

  16. Cardiac catheterization in children with pulmonary hypertensive vascular disease. (United States)

    Bobhate, Prashant; Guo, Long; Jain, Shreepal; Haugen, Richard; Coe, James Y; Cave, Dominic; Rutledge, Jennifer; Adatia, Ian


    The risks associated with cardiac catheterization in children with pulmonary hypertension (PH) are increased compared with adults. We reviewed retrospectively all clinical data in children with PH [mean pulmonary artery pressure (mean PAp) ≥25 mmHg and pulmonary vascular resistance index (PVRI) ≥3 Wood units m(2)] undergoing cardiac catheterization between 2009 and 2014. Our strategy included a team approach, minimal catheter manipulation and sildenafil administration prior to extubation. Adverse events occurring within 48 h were noted. Seventy-five patients (36 males), median age 4 years (0.3-17) and median weight 14.6 kg (2.6-77 kg), underwent 97 cardiac catheterizations. Diagnoses included idiopathic or heritable pulmonary arterial hypertension (PAH) (29 %), PAH associated with congenital heart disease (52 %), left heart disease (5 %) and lung disease (14 %). Mean PAp was 43 ± 19 mmHg; mean PVRI was 9.7 ± 6 Wood units m(2). There were no deaths or serious arrhythmias. No patient required cardiac massage. Three patients who suffered adverse events had suprasystemic PAp (3/3), heritable PAH (2/3), decreased right ventricular function (3/3), and pulmonary artery capacitance index <1 ml/mmHg/m(2) (3/3) and were treatment naïve (3/3). No patient undergoing follow-up cardiac catheterization suffered a complication. In 45 % of cases, the data acquired from the follow-up cardiac catheterization resulted in an alteration of therapy. Three percent of children with PH undergoing cardiac catheterization suffered adverse events. However, there were no intra or post procedural deaths and no one required cardiac massage or cardioversion. Follow-up cardiac catheterization in patients receiving pulmonary hypertensive targeted therapy is safe and provides useful information.

  17. Cardiac Tumors; Tumeurs cardiaques

    Energy Technology Data Exchange (ETDEWEB)

    Laissy, J.P.; Fernandez, P. [Centre Hospitalier Universitaire Bichat Claude Bernard, Service d' Imagerie, 76 - Rouen (France); Mousseaux, E. [Hopital Europeen Georges Pompidou (HEGP), Service de Radiologie Cardio Vasculaire et Interventionnelle, 75 - Paris (France); Dacher, J.N. [Centre Hospitalier Universitaire Charles Nicolle, 75 - Rouen (France); Crochet, D. [Centre Hospitalier Universitaire, Hopital Laennec, Centre Hemodynamique, Radiologie Thoracique et Vasculaire, 44 - Nantes (France)


    Metastases are the most frequent tumors of the heart even though they seldom are recognized. Most primary cardiac tumors are benign. The main role of imaging is to differentiate a cardiac tumor from thrombus and rare pseudo-tumors: tuberculoma, hydatid cyst. Echocardiography is the fist line imaging technique to detect cardiac tumors, but CT and MRl arc useful for further characterization and differential diagnosis. Myxoma of the left atrium is the most frequent benign cardiac tumor. It usually is pedunculated and sometimes calcified. Sarcoma is the most frequent primary malignant tumor and usually presents as a sessile infiltrative tumor. Lymphoma and metastases are usually recognized by the presence of known tumor elsewhere of by characteristic direct contiguous involvement. Diagnosing primary and secondary pericardial tumors often is difficult. Imaging is valuable for diagnosis, characterization, pre-surgical evaluation and follow-up. (author)

  18. Socially differentiated cardiac rehabilitation

    DEFF Research Database (Denmark)

    Meillier, Lucette Kirsten; Nielsen, Kirsten Melgaard; Larsen, Finn Breinholt;


    to a standard rehabilitation programme (SRP). If patients were identified as socially vulnerable, they were offered an extended version of the rehabilitation programme (ERP). Excluded patients were offered home visits by a cardiac nurse. Concordance principles were used in the individualised programme elements......%. Patients were equally distributed to the SRP and the ERP. No inequality was found in attendance and adherence among referred patients. Conclusions: It seems possible to overcome unequal referral, attendance, and adherence in cardiac rehabilitation by organisation of systematic screening and social......Aim: The comprehensive cardiac rehabilitation (CR) programme after myocardial infarction (MI) improves quality of life and results in reduced cardiac mortality and recurrence of MI. Hospitals worldwide face problems with low participation rates in rehabilitation programmes. Inequality...

  19. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi


    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  20. Speckle Tracking Based Strain Analysis Is Sensitive for Early Detection of Pathological Cardiac Hypertrophy. (United States)

    An, Xiangbo; Wang, Jingjing; Li, Hao; Lu, Zhizhen; Bai, Yan; Xiao, Han; Zhang, Youyi; Song, Yao


    Cardiac hypertrophy is a key pathological process of many cardiac diseases. However, early detection of cardiac hypertrophy is difficult by the currently used non-invasive method and new approaches are in urgent need for efficient diagnosis of cardiac malfunction. Here we report that speckle tracking-based strain analysis is more sensitive than conventional echocardiography for early detection of pathological cardiac hypertrophy in the isoproterenol (ISO) mouse model. Pathological hypertrophy was induced by a single subcutaneous injection of ISO. Physiological cardiac hypertrophy was established by daily treadmill exercise for six weeks. Strain analysis, including radial strain (RS), radial strain rate (RSR) and longitudinal strain (LS), showed marked decrease as early as 3 days after ISO injection. Moreover, unlike the regional changes in cardiac infarction, strain analysis revealed global cardiac dysfunction that affects the entire heart in ISO-induced hypertrophy. In contrast, conventional echocardiography, only detected altered E/E', an index reflecting cardiac diastolic function, at 7 days after ISO injection. No change was detected on fractional shortening (FS), E/A and E'/A' at 3 days or 7 days after ISO injection. Interestingly, strain analysis revealed cardiac dysfunction only in ISO-induced pathological hypertrophy but not the physiological hypertrophy induced by exercise. Taken together, our study indicates that strain analysis offers a more sensitive approach for early detection of cardiac dysfunction than conventional echocardiography. Moreover, multiple strain readouts distinguish pathological cardiac hypertrophy from physiological hypertrophy.

  1. Cardiac imaging in adults

    Energy Technology Data Exchange (ETDEWEB)

    Jaffe, C.C.


    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.

  2. Port Access Cardiac Surgery. (United States)

    Viganó, Mario; Minzioni, Gaetano; Spreafico, Patrizio; Rinaldi, Mauro; Pasquino, Stefano; Ceriana, Piero; Locatelli, Alessandro


    The port-access technique for cardiac surgery was recently developed at Stanford University in California as a less invasive method to perform some cardiac operations. The port-access system has been described in detail elsewhere. It is based on femoral arterial and venous access for cardiopulmonary bypass (CPB) and on the adoption of a specially designed triple-lumen catheter described originally by Peters, and subsequently modified and developed in the definitive configuration called the endoaortic clamp.

  3. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon


    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  4. Post cardiac injury syndrome

    DEFF Research Database (Denmark)

    Nielsen, S L; Nielsen, F E


    The post-pericardiotomy syndrome is a symptom complex which is similar in many respects to the post-myocardial infarction syndrome and these are summarized under the diagnosis of the Post Cardiac Injury Syndrome (PCIS). This condition, which is observed most frequently after open heart surgery, i...... on the coronary vessels, with cardiac tamponade and chronic pericardial exudate. In the lighter cases, PCIS may be treated with NSAID and, in the more severe cases, with systemic glucocorticoid which has a prompt effect....

  5. Autonomic cardiac innervation


    Hasan, Wohaib


    Autonomic cardiac neurons have a common origin in the neural crest but undergo distinct developmental differentiation as they mature toward their adult phenotype. Progenitor cells respond to repulsive cues during migration, followed by differentiation cues from paracrine sources that promote neurochemistry and differentiation. When autonomic axons start to innervate cardiac tissue, neurotrophic factors from vascular tissue are essential for maintenance of neurons before they reach their targe...

  6. Infected cardiac hydatid cyst


    Ceviz, M; Becit, N; Kocak, H.


    A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass—an echinococcal cyst or tumour—in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp.

Keywords: cardiac hydatid cyst; infected cardiac hydatid cyst

  7. Strategies for the prevention of sudden cardiac death during sports. (United States)

    Corrado, Domenico; Drezner, Jonathan; Basso, Cristina; Pelliccia, Antonio; Thiene, Gaetano


    Sudden cardiac death of a young athlete is the most tragic event in sports and devastates the family, the sports medicine team, and the local community. Such a fatality represents the first manifestation of cardiac disease in up to 80% of young athletes who remain asymptomatic before sudden cardiac arrest occurs; this explains the limited power of screening modalities based solely on history and physical examination. The long-running Italian experience showed that electrocardiogram (ECG) screening definitively improves the sensitivity of pre-participation evaluation for heart diseases and substantially reduces the risk of death in the athletic field (primary prevention). However, some cardiac conditions, such as coronary artery diseases, present no abnormalities on 12-lead ECG. Moreover, cardiac arrest due to non-penetrating chest injury (commotio cordis) cannot be prevented by screening. This justifies the efforts for implementing programmes of early external defibrillation of unpredictable arrhythmic cardiac arrest. This article reviews the epidemiology of sudden cardiac arrest in the athlete in terms of incidence, sport-related risk, underlying causes, and the currently available prevention programmes such as pre-participation screening and early external defibrillation by using automated external defibrillators. The best strategy is to combine synergistically primary prevention of sudden cardiac death by pre-participation identification of athletes affected by at-risk cardiomyopathies and secondary prevention with back-up defibrillation of unpredictable sudden cardiac arrest on the athletic field.

  8. Selective quantification of the cardiac sympathetic and parasympathetic nervous systems by multisignal analysis of cardiorespiratory variability. (United States)

    Chen, Xiaoxiao; Mukkamala, Ramakrishna


    Heart rate (HR) power spectral indexes are limited as measures of the cardiac autonomic nervous systems (CANS) in that they neither offer an effective marker of the beta-sympathetic nervous system (SNS) due to its overlap with the parasympathetic nervous system (PNS) in the low-frequency (LF) band nor afford specific measures of the CANS due to input contributions to HR [e.g., arterial blood pressure (ABP) and instantaneous lung volume (ILV)]. We derived new PNS and SNS indexes by multisignal analysis of cardiorespiratory variability. The basic idea was to identify the autonomically mediated transfer functions relating fluctuations in ILV to HR (ILV-->HR) and fluctuations in ABP to HR (ABP-->HR) so as to eliminate the input contributions to HR and then separate each estimated transfer function in the time domain into PNS and SNS indexes using physiological knowledge. We evaluated these indexes with respect to selective pharmacological autonomic nervous blockade in 14 humans. Our results showed that the PNS index derived from the ABP-->HR transfer function was correctly decreased after vagal and double (vagal + beta-sympathetic) blockade (P < 0.01) and did not change after beta-sympathetic blockade, whereas the SNS index derived from the same transfer function was correctly reduced after beta-sympathetic blockade in the standing posture and double blockade (P < 0.05) and remained the same after vagal blockade. However, this SNS index did not significantly decrease after beta-sympathetic blockade in the supine posture. Overall, these predictions were better than those provided by the traditional high-frequency (HF) power, LF-to-HF ratio, and normalized LF power of HR variability.

  9. Cardiac applications of optogenetics. (United States)

    Ambrosi, Christina M; Klimas, Aleksandra; Yu, Jinzhu; Entcheva, Emilia


    In complex multicellular systems, such as the brain or the heart, the ability to selectively perturb and observe the response of individual components at the cellular level and with millisecond resolution in time, is essential for mechanistic understanding of function. Optogenetics uses genetic encoding of light sensitivity (by the expression of microbial opsins) to provide such capabilities for manipulation, recording, and control by light with cell specificity and high spatiotemporal resolution. As an optical approach, it is inherently scalable for remote and parallel interrogation of biological function at the tissue level; with implantable miniaturized devices, the technique is uniquely suitable for in vivo tracking of function, as illustrated by numerous applications in the brain. Its expansion into the cardiac area has been slow. Here, using examples from published research and original data, we focus on optogenetics applications to cardiac electrophysiology, specifically dealing with the ability to manipulate membrane voltage by light with implications for cardiac pacing, cardioversion, cell communication, and arrhythmia research, in general. We discuss gene and cell delivery methods of inscribing light sensitivity in cardiac tissue, functionality of the light-sensitive ion channels within different types of cardiac cells, utility in probing electrical coupling between different cell types, approaches and design solutions to all-optical electrophysiology by the combination of optogenetic sensors and actuators, and specific challenges in moving towards in vivo cardiac optogenetics.

  10. Habitual traffic noise at home reduces cardiac parasympathetic tone during sleep. (United States)

    Graham, Jamie M A; Janssen, Sabine A; Vos, Henk; Miedema, Henk M E


    The relationships between road and rail traffic noise with pre-ejection period (PEP) and with respiratory sinus arrhythmia (RSA) during sleep, as indices of cardiac sympathetic and parasympathetic nervous system tone, were investigated in the field (36 subjects, with 188 and 192 valid subject nights for PEP and RSA, respectively). Two analyses were conducted. The first analysis investigated the overall relationships across the entire sleep period. A second analysis investigated differences in the relationships between the first and second halves of the sleep period. Separate multilevel linear regression models for PEP and RSA were employed. Potential covariates for each model were selected from the same pool of variables, which included: gender, age, body-mass index, education level, traffic noise source type, intake of medication, caffeine, alcohol and cigarette smoke, and hindrance during sleep due to the ambulatory recordings. RSA models were adjusted for respiration rate. Mean indoor traffic noise exposure was negatively related to mean RSA during the sleep period, specifically during the second half of the sleep period. Both respiration rate and age were negatively associated with RSA. No significant relationships were observed for PEP. The results indicate that higher indoor traffic noise exposure levels may lead to cardiac parasympathetic withdrawal during sleep, specifically during the second half of the sleep period. No effect of indoor traffic noise on cardiac sympathetic tone was observed.

  11. Disturbance of intracardiac hemodynamics in children with chronic rheumatic cardiac disease

    Directory of Open Access Journals (Sweden)

    Kondratiev V.A.


    Full Text Available By means of Doppler echocardiography there have been studied disturbances of intracardiac hemodynamics in 44 children aged 8-17 years with chronic rheumatic cardiac disease and developed mitral aortal and combined heart defects, as well as in chronic rheumatic cardiac disease without developed valvar defect. Differential approach has been defined to administration of inhibitors of angiotensin-converting factor in rheumatic heart defects: developed insufficiency of mitral and/or aortal valves II-III stage leads to remodeling of the left heart portions with developing chronic insufficiency of blood circulation, being an index for prolonged, not less than a year usage of the angiotensin-converting factor. In the presence of isolated mitral regurgitation, I stage in children with chronic rheumatic cardiac disease usage of the angiotensin-converting factor may be cancelled due to insignificant disturbances of valvar hemodynamics and a small risk of developing blood circulation insufficiency. Timely sanation of chronic infection foci in nasopharynx (conservative and surgical treatment of chronic tonsillitis, adenoid vegetations, therapy of hemolytic streptococcus presence decreases risk of developing rheumatic heart defect in children suffered acute rheumatic fever.

  12. Renal-sparing strategies in cardiac transplantation

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Ross, Heather J


    PURPOSE OF REVIEW: Renal dysfunction due to calcineurin inhibitor (CNI) toxicity is a major clinical problem in cardiac transplantation. The aim of the article is to review the efficacy and safety of various renal sparing strategies in cardiac transplantation. RECENT FINDINGS: Small studies have...... documented that late initiation of CNI is safe in patients treated with induction therapy at the time of transplantation. Use of mycophenolate is superior when compared with azathioprine to allow for CNI reduction. More substantial reduction in CNI levels is safe and effective with the introduction...... of sirolimus or everolimus. However, studies that use very early CNI discontinuation have found an increased risk of allograft rejection, and this strategy requires further study before it can be routinely recommended. CNI discontinuation late after cardiac transplantation seems more effective than CNI...

  13. Assessment Indexes of Cardiac Function in Elderly Patients with Nosocomial Pneumonia and Heart Failure%医院获得性肺炎伴心力衰竭老年患者的心功能评价指标研究

    Institute of Scientific and Technical Information of China (English)



    Objective To detect and analyze the biochemical indexes of elderly patients with nosocomial pneumonia complicated by heart failure so as to find out the sensitive indexes to assess the cardiac functions. Methods Totally 80 elderly patients with nosocomial pneumonia who were definitely diagnosed as having chronic heart failure were recruited as the trial group, and another 80 with no chronic hear failure were chosen as controls. The bidirectional lateral flow immunoassay was used to detect the concentration of serum N - terminal - pro - brain natriuretic peptide ( NT - proBNP ); and AIA360 Automatic Enzyme Immunoassay System was taken to determine the contests of aspartate aminotransferase ( AST ), lactate dehydrogenase ( LDH ), crea-tine phosphate kinase - MB ( CK - MB ) and cardiac troponin I ( cTnl). The heart function classification was performed according to criteria of New York Heart Association ( NYHA ). Results The logNT - proBNP in the trial group was ( 3. 42 ± 0. 19 ) pg/ml, being significantly higher than ( 2. 65 ± 0. 16 ) pg/ml in the control group ( P ( 3. 36 ±0. 14 ) pg/ml of patients at NYHAⅢ grade > ( 2. 88 ±0. 12 ) pg/ml of patients at NYHA Ⅱ grade ( F = 183. 36, P = 0. 00 ) . Conclusion The level of serum NT - proBNP in elderly patients with nosocomial pneumonia complicated by heart failure increases with the severity of the heart failure, which is a sensitive biomarker to evaluate heart function.%目的 检测医院获得性肺炎(HAP)伴心力衰竭(心衰)老年患者的生化指标并进行分析,以寻找评价心功能的敏感性指标.方法 选择明确诊断为慢性心衰的HAP老年患者80例作为观察组,不伴心衰者80例作为对照组.利用双向侧流免疫法检测血清氨基末端脑钠肽前体(NT-proBNP)浓度,血清天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白I(cTnI)用AIA360全自动荧光磁微粒酶免疫分析仪检测.心功能按照纽约心

  14. Cardiac involvement in canine babesiosis : review article

    Directory of Open Access Journals (Sweden)

    R.G. Lobetti


    Full Text Available Cardiac dysfunction in canine babesiosis has traditionally been regarded as a rare complication, with the majority of lesions reported as incidental findings at post-mortem examination. Recent studies have, however, demonstrated cardiac lesions in canine babesiosis. Cardiac troponins, especially troponin I, are sensitive markers of myocardial injury in canine babesiosis, and the magnitude of elevation of plasma troponin I concentrations appears to be proportional to the severity of the disease. ECG changes in babesiosis are similar to the pattern described for myocarditis and myocardial ischaemia and together with histopathological findings indicate that the heart suffers from the same pathological processes described in other organs in canine babesiosis, namely inflammation and hypoxia. The clinical application of the ECG appears to be limited and thus cardiovascular assessment should be based on functional monitoring rather than an ECG tracing. On cardiac histopathology from dogs that succumbed to babesiosis, haemorrhage, necrosis, inflammation and fibrin microthrombi in the myocardium were documented, all of which would have resulted in ECG changes and elevations in cardiac troponin. Myocardial damage causes left ventricular failure, which will result in hypotension and an expansion of the plasma volume due to homeostatic mechanisms.

  15. Does organophosphate poisoning cause cardiac injury? (United States)

    Aghabiklooei, Abbas; Mostafazadeh, Babak; Farzaneh, Esmaeil; Morteza, Afsaneh


    Organophosphates are insecticides which are widely used as a suicidal agent in Iran. They are associated with different types of cardiac complications including cardiac arrest and arrhythmia, however their role in cardiac injury is not known yet. The aim of this study was to investigate the presence of myocardial damage in patients with cholinesterase poisoning.It was a prospective study conducted from January 2008 to March 2010. Cohorts of patients with cholinesterase poisoning due to suicidal attempt who have been referred to Loghman hospital were selected. Patients who have taken more than one poison or were used concomitant drugs were excluded. Physical examination was performed on admission to discover warning sign. Peripheral arterial blood gases, creatine kinase, creatine kinase-myocardial band, troponin-T measurements were performed in all cases. There were 24 patients, 7 of them women, with the mean age of 41.2±15.05 who were included in this study. Non-survivors had significantly higher levels of systolic blood pressure, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide, bicarbonate Glasgow Coma Scale scoring and longer duration of mechanical ventilation. Our findings showed that cardiac injury is an important cause of death in organophosphate poisoning. It could be hypothesized that cardiac injury is a strong predictor of death in patients with organophosphate poisoning.

  16. [Psychosomatic aspects of cardiac arrhythmias]. (United States)

    Siepmann, Martin; Kirch, Wilhelm


    Emotional stress facilitates the occurrence of cardiac arrhythmias including sudden cardiac death. The prevalence of anxiety and depression is increased in cardiac patients as compared to the normal population. The risk of cardiovascular mortality is enhanced in patients suffering from depression. Comorbid anxiety disorders worsen the course of cardiac arrhythmias. Disturbance of neurocardiac regulation with predominance of the sympathetic tone is hypothesized to be causative for this. The emotional reaction to cardiac arrhythmias is differing to a large extent between individuals. Emotional stress may result from coping with treatment of cardiac arrhythmias. Emotional stress and cardiac arrhythmias may influence each other in the sense of a vicious circle. Somatoform cardiac arrhythmias are predominantly of psychogenic origin. Instrumental measures and frequent contacts between physicians and patients may facilitate disease chronification. The present review is dealing with the multifaceted relationships between cardiac arrhythmias and emotional stress. The underlying mechanisms and corresponding treatment modalities are discussed.

  17. Cardiac Contractile Reserve Parameters Are Related to Prognosis in Septic Shock

    Directory of Open Access Journals (Sweden)

    Antoine Kimmoun


    Full Text Available Introduction. Cardiac reserve could be defined as the spontaneous magnitude from basal to maximal cardiac power under stress conditions. The aim of this study was to evaluate the prognostic value of cardiac reserve parameters in resuscitated septic shock patients. Methods. Seventy patients with septic shock were included in a prospective and observational study. Prior to inclusion, patients were resuscitated to reach a mean arterial pressure of 65–75 mmHg with an euvolemic status. General, hemodynamic, and cardiac reserve-related parameters (cardiac index, double product, and cardiac power index were collected at inclusion and at day 1. Results. Seventy patients were included with 28-day mortality at 38.5%. Ten of the 70 patients died during the first day. In multivariate analysis, independent predictors of death were SAPS II ≥58 (OR: 3.36 [1.11–10.17]; , a high double product at inclusion (OR [95% IC]: 1.20 [1.00–1.45] per 103 mmHg·min; , and at day 1, a decrease in cardiac index (1.30 [1.08–1.56] per 0.5 L/min/m2; or cardiac power index (1.84 [1.18–2.87] per 0.1 W/m2, . Conclusion. In the first 24 hours, parameters related to cardiac reserve, such as double product and cardiac index evolution, provide crucial and easy to achieve hemodynamic physiological information, which may impact the outcome.

  18. Cardiac radiology: centenary review. (United States)

    de Roos, Albert; Higgins, Charles B


    During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

  19. Out-of-Hospital Cardiac Arrest in Denmark

    DEFF Research Database (Denmark)

    Wissenberg Jørgensen, Mads

    challenges, due to the victim’s physical location, which brings an inherent risk of delay (or altogether absence) of recognition and treatment of cardiac arrest. A low frequency of bystander cardiopulmonary resuscitation and low 30-day survival after out-of-hospital cardiac arrest were identified nearly ten......BACK COVER TEXT Cardiac arrest is an emergency medical condition characterized by the cessation of cardiac mechanical activity; without immediate and decisive treatment, a victim’s chances of survival are minimal. Out-of-hospital cardiac arrest is a particular arrest subgroup that poses additional...... years ago in Denmark. These findings led to several national initiatives to strengthen bystander resuscitation attempts and advance care. Despite these nationwide efforts, it was unknown prior to this project whether these efforts resulted in changes in resuscitation attempts by bystanders and changes...

  20. [Sudden cardiac death in individuals with normal hearts: an update]. (United States)

    González-Melchor, Laila; Villarreal-Molina, Teresa; Iturralde-Torres, Pedro; Medeiros-Domingo, Argelia


    Sudden death (SD) is a tragic event and a world-wide health problem. Every year, near 4-5 million people experience SD. SD is defined as the death occurred in 1h after the onset of symptoms in a person without previous signs of fatality. It can be named "recovered SD" when the case received medical attention, cardiac reanimation effective defibrillation or both, surviving the fatal arrhythmia. Cardiac channelopathies are a group of diseases characterized by abnormal ion channel function due to genetic mutations in ion channel genes, providing increased susceptibility to develop cardiac arrhythmias and SD. Usually the death occurs before 40 years of age and in the autopsy the heart is normal. In this review we discuss the main cardiac channelopathies involved in sudden cardiac death along with current management of cases and family members that have experienced such tragic event.

  1. Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An Overview

    Directory of Open Access Journals (Sweden)

    Zima Endre


    Full Text Available A satisfactory neurologic outcome is the key factor for survival in patients with sudden cardiac death (SCD, however this is highly dependent on the haemodynamic status. Short term cardiopulmonary resuscitation and regained consciousness on the return of spontaneous circulation (ROSC is indicative of a better prognosis. The evaluation and treatment of SCD triggering factors and of underlying acute and chronic diseases will facilitate prevention and lower the risk of cardiac arrest. Long term CPR and a prolonged unconscious status after ROSC, in the Intensive Care Units or Coronary Care Units, indicates the need for specific treatment and supportive therapy including efforts to prevent hyperthermia. The prognosis of these patients is unpredictable within the first seventy two hours, due to unknown responses to therapeutic management and the lack of specific prognostic factors. Patients in these circumstances require the highest level of intensive care and aetiology driven treatment without any delay, independently of their coma state. Current guidelines sugest the use of multiple procedures in arriving at a diagnosis and prognosis of these critical cases.

  2. Toothache of cardiac origin. (United States)

    Kreiner, M; Okeson, J P


    Pain referred to the orofacial structures can sometimes be a diagnostic challenge for the clinician. In some instances, a patient may complain of tooth pain that is completely unrelated to any dental source. This poses a diagnostic and therapeutic problem for the dentist. Cardiac pain most commonly radiates to the left arm, shoulder, neck, and face. In rare instances, angina pectoris may present as dental pain. When this occurs, an improper diagnosis frequently leads to unnecessary dental treatment or, more significantly, a delay of proper treatment. This delay may result in the patient experiencing an acute myocardial infarction. It is the dentist's responsibility to establish a proper diagnosis so that the treatment will be directed toward the source of pain and not to the site of pain. This article reviews the literature concerning referred pain of cardiac origin and presents a case report of toothache of cardiac origin.

  3. The cardiac anxiety questionnaire: cross-validation among cardiac inpatients

    NARCIS (Netherlands)

    Beek, M.H. van; Oude Voshaar, R.C.; Deelen, F.M. van; Balkom, A.J. van; Pop, G.A.; Speckens, A.E.


    OBJECTIVE: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the D


    NARCIS (Netherlands)

    van Beek, M. H. C. T.; Voshaar, R. C. Oude; van Deelen, F. M.; van Balkom, A. J. L. M.; Pop, G.; Speckens, A. E. M.


    Objective: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the D

  5. Cardiac involvement in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    V. De Gennaro Colonna


    Full Text Available Rheumatoid arthritis (RA is a systemic disease of unknown etiology characterized by a chronic inflammatory process mainly leading to destruction of synovial membrane of small and major diarthrodial joints. The prevalence of RA within the general adult population is about 1% and female subjects in fertile age result mostly involved. It’s an invalidating disease, associated with changes in life quality and a reduced life expectancy. Moreover, we can observe an increased mortality rate in this population early after the onset of the disease. The mortality excess can be partially due to infective, gastrointestinal, renal or pulmonary complications and malignancy (mainly lung cancer and non- Hodgkin lymphoma. Among extra-articular complications, cardiovascular (CV involvement represents one of the leading causes of morbidity and mortality. Every cardiac structure can be affected by different pathogenic pathways: heart valves, conduction system, myocardium, endocardium, pericardium and coronary arteries. Consequently, different clinical manifestations can be detected, including: pericarditis, myocarditis, myocardial fibrosis, arrhythmias, alterations of conduction system, coronaropathies and ischemic cardiopathy, valvular disease, pulmonary hypertension and heart failure. Considering that early cardiac involvement negatively affects the prognosis, it is mandatory to identify high CV risk RA patients to better define long-term management of this population.

  6. Pravastatin ameliorates placental vascular defects, fetal growth, and cardiac function in a model of glucocorticoid excess. (United States)

    Wyrwoll, Caitlin S; Noble, June; Thomson, Adrian; Tesic, Dijana; Miller, Mark R; Rog-Zielinska, Eva A; Moran, Carmel M; Seckl, Jonathan R; Chapman, Karen E; Holmes, Megan C


    Fetoplacental glucocorticoid overexposure is a significant mechanism underlying fetal growth restriction and the programming of adverse health outcomes in the adult. Placental glucocorticoid inactivation by 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) plays a key role. We previously discovered that Hsd11b2(-/-) mice, lacking 11β-HSD2, show marked underdevelopment of the placental vasculature. We now explore the consequences for fetal cardiovascular development and whether this is reversible. We studied Hsd11b2(+/+), Hsd11b2(+/-), and Hsd11b2(-/-) littermates from heterozygous (Hsd11b(+/-)) matings at embryonic day (E)14.5 and E17.5, where all three genotypes were present to control for maternal effects. Using high-resolution ultrasound, we found that umbilical vein blood velocity in Hsd11b2(-/-) fetuses did not undergo the normal gestational increase seen in Hsd11b2(+/+) littermates. Similarly, the resistance index in the umbilical artery did not show the normal gestational decline. Surprisingly, given that 11β-HSD2 absence is predicted to initiate early maturation, the E/A wave ratio was reduced at E17.5 in Hsd11b2(-/-) fetuses, suggesting impaired cardiac function. Pravastatin administration from E6.5, which increases placental vascular endothelial growth factor A and, thus, vascularization, increased placental fetal capillary volume, ameliorated the aberrant umbilical cord velocity, normalized fetal weight, and improved the cardiac function of Hsd11b2(-/-) fetuses. This improved cardiac function occurred despite persisting indications of increased glucocorticoid exposure in the Hsd11b2(-/-) fetal heart. Thus, the pravastatin-induced enhancement of fetal capillaries within the placenta and the resultant hemodynamic changes correspond with restored fetal cardiac function. Statins may represent a useful therapeutic approach to intrauterine growth retardation due to placental vascular hypofunction.

  7. Perioperative management of cardiac disease. (United States)

    Aresti, N A; Malik, A A; Ihsan, K M; Aftab, S M E; Khan, W S


    Pre-existing cardiac disease contributes significantly to morbidity and mortality amongst patients undergoing non cardiac surgery. Patients with pre-existing cardiac disease or with risk factors for it, have as much as a 3.9% risk of suffering a major perioperative cardiac event (Lee et al 1999, Devereaux 2005). Furthermore, the incidence of perioperative myocardial infarction (MI) is increased 10 to 50 fold in patients with previous coronary events (Jassal 2008).

  8. Data analysis in cardiac arrhythmias. (United States)

    Rodrigo, Miguel; Pedrón-Torecilla, Jorge; Hernández, Ismael; Liberos, Alejandro; Climent, Andreu M; Guillem, María S


    Cardiac arrhythmias are an increasingly present in developed countries and represent a major health and economic burden. The occurrence of cardiac arrhythmias is closely linked to the electrical function of the heart. Consequently, the analysis of the electrical signal generated by the heart tissue, either recorded invasively or noninvasively, provides valuable information for the study of cardiac arrhythmias. In this chapter, novel cardiac signal analysis techniques that allow the study and diagnosis of cardiac arrhythmias are described, with emphasis on cardiac mapping which allows for spatiotemporal analysis of cardiac signals.Cardiac mapping can serve as a diagnostic tool by recording cardiac signals either in close contact to the heart tissue or noninvasively from the body surface, and allows the identification of cardiac sites responsible of the development or maintenance of arrhythmias. Cardiac mapping can also be used for research in cardiac arrhythmias in order to understand their mechanisms. For this purpose, both synthetic signals generated by computer simulations and animal experimental models allow for more controlled physiological conditions and complete access to the organ.

  9. Biosynthesis of cardiac natriuretic peptides

    DEFF Research Database (Denmark)

    Goetze, Jens Peter


    Cardiac-derived peptide hormones were identified more than 25 years ago. An astonishing amount of clinical studies have established cardiac natriuretic peptides and their molecular precursors as useful markers of heart disease. In contrast to the clinical applications, the biogenesis of cardiac...

  10. Cardiac troponins and high-sensitivity cardiac troponin assays. (United States)

    Conrad, Michael J; Jarolim, Petr


    Measurement of circulating cardiac troponins I and T has become integral to the diagnosis of myocardial infarction. This article discusses the structure and function of the troponin complex and the release of cardiac troponin molecules from the injured cardiomyocyte into the circulation. An overview of current cardiac troponin assays and their classification according to sensitivity is presented. The diagnostic criteria, role, and usefulness of cardiac troponin for myocardial infarction are discussed. In addition, several examples are given of the usefulness of high-sensitivity cardiac troponin assays for short-term and long-term prediction of adverse events.

  11. [Cardiac tamponade as the first symptom of lung cancer]. (United States)

    Gromadziński, Leszek; Przelaskowski, Piotr; Januszko-Giergielewicz, Beata; Górny, Jerzy; Stankiewicz, Aleksander; Każarnowicz, Andrzej; Pruszczyk, Piotr


    Pericardial effusion is a relatively common clinical problem. It is, however, rarely the first symptom of cancer. Cardiac tamponade testifies to an advanced stage of cancer and is a negative prognostic factor. This paper presents a patient in whom cardiac tamponade was the first symptom of lung cancer. A 63-year-old male, habitual smoker, was admitted to hospital due to progressive symptoms of exertional dyspnoea lasting for a few days and chest pain. Echocardiographic examination revealed a large amount of fluid in the pericardium with echocardiographic signs of a life-threatening cardiac tamponade. The patient underwent pericardial puncture and additional imaging examinations. Lung adenocarcinoma was recognized as the underlying disease. Due to the recurrence of the life-threatening cardiac tamponade, video-assisted thoracoscopic pericardial fenestration was performed and systemic chemotherapy was introduced with good results.

  12. Cardiac potassium channel subtypes

    DEFF Research Database (Denmark)

    Schmitt, Nicole; Grunnet, Morten; Olesen, Søren-Peter


    About 10 distinct potassium channels in the heart are involved in shaping the action potential. Some of the K(+) channels are primarily responsible for early repolarization, whereas others drive late repolarization and still others are open throughout the cardiac cycle. Three main K(+) channels...

  13. Cardiac Risk Assessment (United States)

    ... Risk Assessment Related tests: Lipid Profile , VLDL Cholesterol , hs-CRP , Lp(a) Overview | Common Questions | Related Pages What ... cardiac risk include: High-sensitivity C-reactive protein (hs-CRP) : Studies have shown that measuring CRP with a ...

  14. The cardiac malpositions. (United States)

    Perloff, Joseph K


    Dextrocardia was known in the 17th century and was 1 of the first congenital malformations of the heart to be recognized. Fifty years elapsed before Matthew Baillie published his account of complete transposition in a human of the thoracic and abdominal viscera to the opposite side from what is natural. In 1858, Thomas Peacock stated that "the heart may be congenitally misplaced in various ways, occupying either an unusual position within the thorax, or being situated external to that cavity." In 1915, Maude Abbott described ectopia cordis, and Richard Paltauf's remarkable illustrations distinguished the various types of dextrocardia. In 1928, the first useful classification of the cardiac malpositions was proposed, and in 1966, Elliott et al's radiologic classification set the stage for clinical recognition. The first section of this review deals with the 3 basic cardiac malpositions in the presence of bilateral asymmetry. The second section deals with cardiac malpositions in the presence of bilateral left-sidedness or right-sidedness. Previous publications on cardiac malpositions are replete with an arcane vocabulary that confounds rather than clarifies. Even if the terms themselves are understood, inherent complexity weighs against clarity. This review was designed as a guided tour of an unfamiliar subject.

  15. Spatial repolarization heterogeneity detected by magnetocardiography correlates with cardiac iron overload and adverse cardiac events in beta-thalassemia major.

    Directory of Open Access Journals (Sweden)

    Chun-An Chen

    Full Text Available BACKGROUND: Patients with transfusion-dependent beta-thalassemia major (TM are at risk for myocardial iron overload and cardiac complications. Spatial repolarization heterogeneity is known to be elevated in patients with certain cardiac diseases, but little is known in TM patients. The purpose of this study was to evaluate spatial repolarization heterogeneity in patients with TM, and to investigate the relationships between spatial repolarization heterogeneity, cardiac iron load, and adverse cardiac events. METHODS AND RESULTS: Fifty patients with TM and 55 control subjects received 64-channel magnetocardiography (MCG to determine spatial repolarization heterogeneity, which was evaluated by a smoothness index of QTc (SI-QTc, a standard deviation of QTc (SD-QTc, and a QTc dispersion. Left ventricular function and myocardial T2* values were assessed by cardiac magnetic resonance. Patients with TM had significantly greater SI-QTc, SD-QTc, and QTc dispersion compared to the control subjects (all p values<0.001. Spatial repolarization heterogeneity was even more pronounced in patients with significant iron overload (T2*<20 ms, n = 20 compared to those with normal T2* (all p values<0.001. Loge cardiac T2* correlated with SI-QTc (r = -0.609, p<0.001, SD-QTc (r = -0.572, p<0.001, and QTc dispersion (r = -0.622, p<0.001, while all these indices had no relationship with measurements of the left ventricular geometry or function. At the time of study, 10 patients had either heart failure or arrhythmia. All 3 indices of repolarization heterogeneity were related to the presence of adverse cardiac events, with areas under the receiver operating characteristic curves (ranged between 0.79 and 0.86, similar to that of cardiac T2*. CONCLUSIONS: Multichannel MCG demonstrated that patients with TM had increased spatial repolarization heterogeneity, which is related to myocardial iron load and adverse cardiac events.

  16. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites

    DEFF Research Database (Denmark)

    Krag, A; Bendtsen, F; Henriksen, J H;


    OBJECTIVES: Recent studies suggest that cardiac dysfunction precedes development of the hepatorenal syndrome. In this follow-up study, we aimed to investigate the relation between cardiac and renal function in patients with cirrhosis and ascites and the impact of cardiac systolic function...... on survival. Patients and DESIGN: Twenty-four patients with cirrhosis and ascites were included. Cardiac function was investigated by gated myocardial perfusion imaging (MPI) for assessment of cardiac index (CI) and cardiac volumes. The renal function was assessed by determination of glomerular filtration...... (130 (SD 46) vs 78 (SD 29) mumol/l, pdeveloped hepatorenal syndrome type 1 within 3 months was higher in the group with low CI than in the high CI group (43% vs 5%, p = 0.04). Patients with the lowest CI (N = 8) had significantly poorer survival at 3, 9, and 12 months...

  17. Chest pain of cardiac and noncardiac origin. (United States)

    Lenfant, Claude


    Chest pain is one of the most common symptoms driving patients to a physician's office or the hospital's emergency department. In approximately half of the cases, chest pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease. The other half is due to noncardiac causes, primarily esophageal disorder. Pain from either origin may occur in the same patient. In addition, psychological and psychiatric factors play a significant role in the perception and severity of the chest pain, irrespective of its cause. Chest pain of ischemic cardiac disease is called angina pectoris. Stable angina may be the prelude of ischemic cardiac disease; and for this reason, it is essential to ensure a correct diagnosis. In most cases, further testing, such as exercise testing and angiography, should be considered. The more severe form of chest pain, unstable angina, also requires a firm diagnosis because it indicates severe coronary disease and is the earliest manifestation of acute myocardial infarction. Once a diagnosis of stable or unstable angina is established, and if a decision is made not to use invasive therapy, such as coronary bypass, percutaneous transluminal coronary angioplasty, or stent insertion, effective medical treatment of associated cardiac risk factors is a must. Acute myocardial infarction occurring after a diagnosis of angina greatly increases the risk of subsequent death. Chest pain in women warrants added attention because women underestimate their likelihood to have coronary heart disease. A factor that complicates the clinical assessment of patients with chest pain (both cardiac and noncardiac in origin) is the relatively common presence of psychological and psychiatric conditions such as depression or panic disorder. These factors have been found to cause or worsen chest pain; but unfortunately, they may not be easily detected. Noncardiac chest pain represents the remaining half of all cases of chest pain. Although there are a number of

  18. Cardiac rhabdomyomas and tuberous sclerosis: two case reports in neonates


    Arango Posada, César Augusto; Docente pediatría, programa de medicina, universidad de manizales


    Rhabdomyomas are the most common cardiac tumours in children. They are strongly associated with tuberous sclerosis disease. They usually regress spontaneously but sometimes they need surgical intervention because the children symptoms due to tumour location. We described here two neonates with tuberous sclerosis diagnosisand big cardiac rhabdomyomas in unusual situation. Los rabdomiomas son el tipo de tumor cardíaco más común de la infancia. Su presencia obliga a descartar esclerosis tuber...

  19. Chylopericardium presenting as cardiac tamponade secondary to mediastinal lymphangioma. (United States)

    Alsmady, M M; Aladaileh, M A; Al-Zaben, K; Saleem, M M; Alimoglu, O


    Mediastinal lymphangioma is a rare entity and chylopericardium is a rare form of pericardial effusion. We report a case of acute chylous cardiac tamponade due to a cervicomediastinal lymphangioma in a one-year-old boy. A chest x-ray revealed marked cardiac enlargement and echocardiography showed massive pericardial effusion. Emergency surgery was performed whereby a pericardial window was created, followed by excision of the lymphangioma.

  20. Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study

    Directory of Open Access Journals (Sweden)

    Fatima Dumas Cintra


    Full Text Available Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart® system. Results: A total of 767 participants (461 men with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001. After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.

  1. Effects of Lifestyle Modification Programs on Cardiac Risk Factors (United States)

    Razavi, Moaven; Fournier, Stephen; Shepard, Donald S.; Ritter, Grant; Strickler, Gail K.; Stason, William B.


    Medicare conducted a payment demonstration to evaluate the effectiveness of two intensive lifestyle modification programs in patients with symptomatic coronary artery disease: the Dr. Dean Ornish Program for Reversing Heart Disease (Ornish) and Cardiac Wellness Program of the Benson-Henry Mind Body Institute. This report describes the changes in cardiac risk factors achieved by each program during the active intervention year and subsequent year of follow-up. The demonstration enrolled 580 participants who had had an acute myocardial infarction, had undergone coronary artery bypass graft surgery or percutaneous coronary intervention within 12 months, or had documented stable angina pectoris. Of these, 98% completed the intense 3-month intervention, 71% the 12-month intervention, and 56% an additional follow-up year. Most cardiac risk factors improved significantly during the intense intervention period in both programs. Favorable changes in cardiac risk factors and functional cardiac capacity were maintained or improved further at 12 and 24 months in participants with active follow-up. Multivariable regressions found that risk-factor improvements were positively associated with abnormal baseline values, Ornish program participation for body mass index and systolic blood pressure, and with coronary artery bypass graft surgery. Expressed levels of motivation to lose weight and maintain weight loss were significant independent predictors of sustained weight loss (p = 0.006). Both lifestyle modification programs achieved well-sustained reductions in cardiac risk factors. PMID:25490202

  2. Effects of lifestyle modification programs on cardiac risk factors.

    Directory of Open Access Journals (Sweden)

    Moaven Razavi

    Full Text Available Medicare conducted a payment demonstration to evaluate the effectiveness of two intensive lifestyle modification programs in patients with symptomatic coronary artery disease: the Dr. Dean Ornish Program for Reversing Heart Disease (Ornish and Cardiac Wellness Program of the Benson-Henry Mind Body Institute. This report describes the changes in cardiac risk factors achieved by each program during the active intervention year and subsequent year of follow-up. The demonstration enrolled 580 participants who had had an acute myocardial infarction, had undergone coronary artery bypass graft surgery or percutaneous coronary intervention within 12 months, or had documented stable angina pectoris. Of these, 98% completed the intense 3-month intervention, 71% the 12-month intervention, and 56% an additional follow-up year. Most cardiac risk factors improved significantly during the intense intervention period in both programs. Favorable changes in cardiac risk factors and functional cardiac capacity were maintained or improved further at 12 and 24 months in participants with active follow-up. Multivariable regressions found that risk-factor improvements were positively associated with abnormal baseline values, Ornish program participation for body mass index and systolic blood pressure, and with coronary artery bypass graft surgery. Expressed levels of motivation to lose weight and maintain weight loss were significant independent predictors of sustained weight loss (p = 0.006. Both lifestyle modification programs achieved well-sustained reductions in cardiac risk factors.

  3. Cardiac arrest secondary to type 2 Kounis syndrome resulting from urticaria and angioedema. (United States)

    Connor, Suzy; Child, Nick; Burdon-Jones, David; Connor, Andrew


    A 43-year-old man with no cardiac history presented with chest pain followed by cardiac arrest. He was successfully defibrillated and underwent primary percutaneous coronary angioplasty to a culprit coronary artery lesion. He later re-presented with a diffuse urticarial rash and lip swelling, reporting that these symptoms had been present for 4 weeks before his cardiac arrest and voicing concern that a further cardiac arrest may be imminent. A diagnosis of post-viral or idiopathic autoimmune urticaria and angioedema was made. Given the absence of cardiac symptoms before the development of the rash, it was hypothesised that coronary artery spasm precipitated by histamine release due to his dermatological condition contributed to his myocardial infarction and cardiac arrest. The final diagnosis was therefore cardiac arrest secondary to type II Kounis syndrome, resulting from idiopathic autoimmune or post-viral urticaria and angioedema.

  4. Depth Attenuation Degree Based Visualization for Cardiac Ischemic Electrophysiological Feature Exploration (United States)

    Liu, Lei; Zuo, Wangmeng; Zhang, Henggui


    Although heart researches and acquirement of clinical and experimental data are progressively open to public use, cardiac biophysical functions are still not well understood. Due to the complex and fine structures of the heart, cardiac electrophysiological features of interest may be occluded when there is a necessity to demonstrate cardiac electrophysiological behaviors. To investigate cardiac abnormal electrophysiological features under the pathological condition, in this paper, we implement a human cardiac ischemic model and acquire the electrophysiological data of excitation propagation. A visualization framework is then proposed which integrates a novel depth weighted optic attenuation model into the pathological electrophysiological model. The hidden feature of interest in pathological tissue can be revealed from sophisticated overlapping biophysical information. Experiment results verify the effectiveness of the proposed method for intuitively exploring and inspecting cardiac electrophysiological activities, which is fundamental in analyzing and explaining biophysical mechanisms of cardiac functions for doctors and medical staff. PMID:28004002

  5. Ubiquitous health monitoring and real-time cardiac arrhythmias detection: a case study. (United States)

    Li, Jian; Zhou, Haiying; Zuo, Decheng; Hou, Kun-Mean; De Vaulx, Christophe


    As the symptoms and signs of heart diseases that cause sudden cardiac death, cardiac arrhythmia has attracted great attention. Due to limitations in time and space, traditional approaches to cardiac arrhythmias detection fail to provide a real-time continuous monitoring and testing service applicable in different environmental conditions. Integrated with the latest technologies in ECG (electrocardiograph) analysis and medical care, the pervasive computing technology makes possible the ubiquitous cardiac care services, and thus brings about new technical challenges, especially in the formation of cardiac care architecture and realization of the real-time automatic ECG detection algorithm dedicated to care devices. In this paper, a ubiquitous cardiac care prototype system is presented with its architecture framework well elaborated. This prototype system has been tested and evaluated in all the clinical-/home-/outdoor-care modes with a satisfactory performance in providing real-time continuous cardiac arrhythmias monitoring service unlimitedly adaptable in time and space.

  6. Penetrating Cardiac and Hepatic Injury; Polytrauma of a Child After Bombing

    Directory of Open Access Journals (Sweden)

    Baris Akca


    Full Text Available After a bombing attack, patients were brought into hospital suffering from a combination of injuries caused by the blast, penetrating injuries and burns which as a case of polytrauma. In penetrating thoracoabdominal injuries due to bombing possibility of cardiac injury should be kept in mind. Penetrating cardiac injuries in children are rare but has a high mortality and morbidity. In some cases there may be difficulty in diagnosis of penetrating cardiac injury. In this case we want to share the diagnosis, treatment and follow-up processes of penetrating cardiac and hepatic injury with burns of a politrauma child due to bombing.

  7. Is it time for cardiac innervation imaging?

    Energy Technology Data Exchange (ETDEWEB)

    Knuuti, J. [Turku Univ., Turku (Finland) Turku PET Center; Sipola, P. [Kuopio Univ., Kuopio (Finland)


    The autonomic nervous system plays an important role in the regulation of cardiac function and the regional distribution of cardiac nerve terminals can be visualized using scintigraphic techniques. The most commonly used tracer is iodine-123-metaiodobenzylguanidine (MIBG) but C-11-hydroxyephedrine has also been used with PET. When imaging with MIBG, the ratio of heart-to-mediastinal counts is used as an index of tracer uptake, and regional distribution is also assessed from tomographic images. The rate of clearance of the tracer can also be measured and indicates the function of the adrenergic system. Innervation imaging has been applied in patients with susceptibility to arrythmias, coronary artery disease, hypertrophic and dilated cardiomyopathy and anthracycline induced cardiotoxicity. Abnormal adrenergic innervation or function appear to exist in many pathophysiological conditions indicating that sympathetic neurons are very susceptible to damage. Abnormal findings in innervation imaging also appear to have significant prognostic value especially in patients with cardiomyopathy. Recently, it has also been shown that innervation imaging can monitor drug-induced changes in cardiac adrenergic activity. Although innervation imaging holds great promise for clinical use, the method has not received wider clinical acceptance. Larger randomized studies are required to confirm the value of innervation imaging in various specific indications.

  8. Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Park, Jeong-Jun [University of Ulsan College of Medicine, Asan Medical Center, Department of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Kim, Ellen Ai-Rhan [University of Ulsan College of Medicine, Asan Medical Center, Division of Neonatology, Department of Pediatrics, Seoul (Korea, Republic of); Won, Hye-Sung [University of Ulsan College of Medicine, Asan Medical Center, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of)


    Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects. (orig.)

  9. Cardiac Time Intervals by Tissue Doppler Imaging M-Mode

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Mogelvang, Rasmus; de Knegt, Martina Chantal;


    PURPOSE: To define normal values of the cardiac time intervals obtained by tissue Doppler imaging (TDI) M-mode through the mitral valve (MV). Furthermore, to evaluate the association of the myocardial performance index (MPI) obtained by TDI M-mode (MPITDI) and the conventional method of obtaining...... MPI (MPIConv), with established echocardiographic and invasive measures of systolic and diastolic function. METHODS: In a large community based population study (n = 974), where all are free of any cardiovascular disease and cardiovascular risk factors, cardiac time intervals, including isovolumic...... the MPITDI and MPIConv measured. RESULTS: IVRT, IVRT/ET and MPI all increased significantly with increasing age in both genders (pcardiac function. MPITDI...

  10. Index and Indexing Assessment: Criteria and Standards

    Directory of Open Access Journals (Sweden)

    Hassan Ashrafi


    Full Text Available Indexing is one of the most important methods of content representation where by assigning descriptors to the documents, their subject content are made known. Since index and indexing are remarkably significant in information retrieval, its quality and evaluation and provision of criteria and standards had always been the mainstay of researchers in this field. Given the fact that Indexing is a complex process, offering definitions, principles and methods could be step towards optimal use of the information. The present study, while offering a capsule definition of index, will investigate the indexing evaluation criteria and would follow it up with a definition of indexing. Finally a number of standards in the field of indexing are presented and would make its conclusions.

  11. Cardiac Dysfunction in a Porcine Model of Pediatric Malnutrition.

    Directory of Open Access Journals (Sweden)

    Christian Fabiansen

    Full Text Available Half a million children die annually of severe acute malnutrition and cardiac dysfunction may contribute to the mortality. However, cardiac function remains poorly examined in cases of severe acute malnutrition.To determine malnutrition-induced echocardiographic disturbances and longitudinal changes in plasma pro-atrial natriuretic peptide and cardiac troponin-T in a pediatric porcine model.Five-week old piglets (Duroc-x-Danish Landrace-x-Yorkshire were fed a nutritionally inadequate maize-flour diet to induce malnutrition (MAIZE, n = 12 or a reference diet (AGE-REF, n = 12 for 7 weeks. Outcomes were compared to a weight-matched reference group (WEIGHT-REF, n = 8. Pro-atrial natriuretic peptide and cardiac troponin-T were measured weekly. Plasma pro-atrial natriuretic peptide decreased in both MAIZE and AGE-REF during the first 3 weeks but increased markedly in MAIZE relative to AGE-REF during week 5-7 (p ≤ 0.001. There was overall no difference in plasma cardiac troponin-T between groups. However, further analysis revealed that release of cardiac troponin-T in plasma was more frequent in AGE-REF compared with MAIZE (OR: 4.8; 95%CI: 1.2-19.7; p = 0.03. However, when release occurred, cardiac troponin-T concentration was 6.9-fold higher (95%CI: 3.0-15.9; p < 0.001 in MAIZE compared to AGE-REF. At week 7, the mean body weight in MAIZE was lower than AGE-REF (8.3 vs 32.4 kg, p < 0.001, whereas heart-weight relative to body-weight was similar across the three groups. The myocardial performance index was 86% higher in MAIZE vs AGE-REF (p < 0.001 and 27% higher in MAIZE vs WEIGHT-REF (p = 0.025.Malnutrition associates with cardiac dysfunction in a pediatric porcine model by increased myocardial performance index and pro-atrial natriuretic peptide and it associates with cardiac injury by elevated cardiac troponin-T. Clinical studies are needed to see if the same applies for children suffering from malnutrition.

  12. Cardiac nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Gerson, M.C.


    The book begins with a review of the radionuclide methods available for evaluating cardiac perfusion and function. The authors discuss planar and tomographic thallium myocardial imaging, first-pass and equilibrium radionuclide angiography, and imaging with infarct-avid tracers. Several common but more specialized procedures are then reviewed: nonogemetric measurement of left ventricular volume, phase (Fourier) analysis, stroke volume ratio, right ventricular function, and diastolic function. A separate chapter is devoted to drug interventions and in particular the use of radionuclide ventriculography to monitor doxorubicin toxicity and therapy of congestive heart failure. The subsequent chapters provide a comprehensive guide to test selection, accuracy, and results in acute myocardial infarction, in postmyocardial infarction, in chronic coronary artery disease, before and after medical or surgical revascularization, in valvular heart disease, in cardiomyopathies, and in cardiac trauma.

  13. Cardiac arrhythmias in pregnancy. (United States)

    Knotts, Robert J; Garan, Hasan


    As more women with repaired congenital heart disease survive to their reproductive years and many other women are delaying pregnancy until later in life, a rising concern is the risk of cardiac arrhythmias during pregnancy. Naturally occurring cardiovascular changes during pregnancy increase the likelihood that a recurrence of a previously experienced cardiac arrhythmia or a de novo arrhythmia will occur. Arrhythmias should be thoroughly investigated to determine if there is a reversible etiology, and risks/benefits of treatment options should be fully explored. We discuss the approach to working up and treating various arrhythmias during pregnancy with attention to fetal and maternal risks as well as treatment of fetal arrhythmias. Acute management in stable patients includes close monitoring and intravenous pharmacologic therapy, while DC cardioversion should be used to terminate arrhythmias in hemodynamically unstable patients. Long-term management may require continued oral antiarrhythmic therapy, with particular attention to fetal safety, to prevent complications associated with arrhythmias.

  14. Cardiac tamponade - unusual clinical manifestation of undiagnosed malignant neoplasm. (United States)

    Perek, B; Tomaszewska, I; Stefaniak, S; Katynska, I; Jemielity, M


    Cardiac tamponade may be the first or predominant symptom of some pathologies but its etiology is not uncommonly unknown on admission to hospital. The purpose of this study was to evaluate the predominant causes of cardiac tamponade in previously healthy patients treated emergently in a single cardiac surgical center. The study involved 81 patients with the mean age of 58.1±16.0 years who underwent emergent subxyphoid pericardiotomy due to cardiac tamponade. Pericardial effusion was analyzed macro- and microscopically. Examinations done in the cardiac surgical department revealed pericarditis secondary to infection (n=17) or autoimmunologic processes (n=2) and malignancy in 18 patients (predominantly of the lungs (n=11)). Pericardial effusion obtained from patients with viral and autoimmunologic-induced pericarditis was straw-color and odorless while with bacterial infections dark yellow, iridescent and usually malodorous. Additional workup in the regional hospitals enabled to reveal malignant tumors in 29 patients, leukemia or lymphoma in 5 subjects. In all but one of the neoplastic cases, pericardial fluid was turbid and dark red or plummy. In 10 patients etiology of tamponade remained unknown. In conclusion, cardiac tamponade in previously healthy patients may be occasionally the predominant symptom of cancer, especially of the lungs. Macroscopic intraoperative appearance of pericardial fluid may be helpful in identification of causative condition of cardiac tamponade.

  15. Cause and Long-Term Outcome of Cardiac Tamponade. (United States)

    Sánchez-Enrique, Cristina; Nuñez-Gil, Iván J; Viana-Tejedor, Ana; De Agustín, Alberto; Vivas, David; Palacios-Rubio, Julián; Vilchez, Jean Paul; Cecconi, Alberto; Macaya, Carlos; Fernández-Ortiz, Antonio


    Cardiac tamponade is a life-threatening condition, whose current specific cause and outcome are unknown. Our purpose was to analyze it. We performed a retrospective observational study with prospective follow-up data including 136 consecutive patients admitted with diagnosis of cardiac tamponade, from 2003 to 2013. We thoroughly recorded variables as clinical features, drainage/pericardiocentesis, fluid characteristics, and long-term events (new cardiac tamponade ± death). The median age was 65 ± 17 years (55% men). In the baseline characteristics, 70% were no smokers, 12% were on anticoagulation, and 13 had suffered a previous myocardial infarction. In the preceding month, 15 patients had undergone a cardiac catheterization, 5 cardiac surgery, and 5 pacemaker insertion. Fever was observed in 16% of patients and 21% displayed other inflammatory symptoms. In 81% of patients, pericardiocentesis was needed. The fluid was hemorrhagic or a transudate in the majority, with positive cytology in 15% and bacteria in 3.7%. Main causes were malignancy (32%), infection (24%), idiopathic (16%), iatrogenic (15%), postmyocardial infarction (7%), uremic (4%), and other causes (2%). After a maximum follow-up of 10.4 years, cardiac tamponade recurred in 10% of the cases (62% in the neoplastic group) and the 48% of patients died (89% in the neoplastic cohort). In conclusion, most cardiac tamponades are due to malignancy, having this specific cause a poorer outcome, probably as a manifestation of an advanced disease. The rest of causes, after an aggressive intensive management, have a good prognosis, especially the iatrogenic.

  16. Lean heart: Role of leptin in cardiac hypertrophy and metabolism

    Institute of Scientific and Technical Information of China (English)

    Michael; E; Hall; Romain; Harmancey; David; E; Stec


    Leptin is an adipokine that has been linked with the cardiovascular complications resulting from obesity such as hypertension and heart disease. Obese patients have high levels of circulating leptin due to increased fat mass. Clinical and population studies have correlated high levels of circulating leptin with the development of cardiac hypertrophy in obesity. Leptin has also been demonstrated to increase the growth of cultured cardiomyocytes. However, several animal studies of obese leptin deficient mice have not supported a role for leptin in promoting cardiac hypertrophy so the role of leptin in this pathological process remains unclear. Leptin is also an important hormone in the regulation of cardiac metabolism where it supports oxidation of glucose and fatty acids. In addition, leptin plays a critical role in protecting the heart from excess lipid accumulation and the formation of toxic lipids in obesity a condition known as cardiac lipotoxicity. This paper focuses on the data supporting and refuting leptin’s role in promoting cardiac hypertrophy as well as its important role in the regulation of cardiac metabolism and protection against cardiac lipotoxicity.

  17. Spatiotemporal control to eliminate cardiac alternans using isostable reduction (United States)

    Wilson, Dan; Moehlis, Jeff


    Cardiac alternans, an arrhythmia characterized by a beat-to-beat alternation of cardiac action potential durations, is widely believed to facilitate the transition from normal cardiac function to ventricular fibrillation and sudden cardiac death. Alternans arises due to an instability of a healthy period-1 rhythm, and most dynamical control strategies either require extensive knowledge of the cardiac system, making experimental validation difficult, or are model independent and sacrifice important information about the specific system under study. Isostable reduction provides an alternative approach, in which the response of a system to external perturbations can be used to reduce the complexity of a cardiac system, making it easier to work with from an analytical perspective while retaining many of its important features. Here, we use isostable reduction strategies to reduce the complexity of partial differential equation models of cardiac systems in order to develop energy optimal strategies for the elimination of alternans. Resulting control strategies require significantly less energy to terminate alternans than comparable strategies and do not require continuous state feedback.

  18. Cardiac surgery 2015 reviewed. (United States)

    Doenst, Torsten; Strüning, Constanze; Moschovas, Alexandros; Gonzalez-Lopez, David; Essa, Yasin; Kirov, Hristo; Diab, Mahmoud; Faerber, Gloria


    For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term "cardiac surgery". The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.

  19. Cardiac hybrid imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); University Hospital Zurich, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)


    Hybrid cardiac single photon emission computed tomography (SPECT)/CT imaging allows combined assessment of anatomical and functional aspects of cardiac disease. In coronary artery disease (CAD), hybrid SPECT/CT imaging allows detection of coronary artery stenosis and myocardial perfusion abnormalities. The clinical value of hybrid imaging has been documented in several subsets of patients. In selected groups of patients, hybrid imaging improves the diagnostic accuracy to detect CAD compared to the single imaging techniques. Additionally, this approach facilitates functional interrogation of coronary stenoses and guidance with regard to revascularization procedures. Moreover, the anatomical information obtained from CT coronary angiography or coronary artery calcium scores (CACS) adds prognostic information over perfusion data from SPECT. The use of cardiac hybrid imaging has been favoured by the dissemination of dedicated hybrid systems and the release of dedicated image fusion software, which allow simple patient throughput for hybrid SPECT/CT studies. Further technological improvements such as more efficient detector technology to allow for low-radiation protocols, ultra-fast image acquisition and improved low-noise image reconstruction algorithms will be instrumental to further promote hybrid SPECT/CT in research and clinical practice. (orig.)

  20. Cardiac tissue engineering

    Directory of Open Access Journals (Sweden)



    Full Text Available We hypothesized that clinically sized (1-5 mm thick,compact cardiac constructs containing physiologically high density of viable cells (~108 cells/cm3 can be engineered in vitro by using biomimetic culture systems capable of providing oxygen transport and electrical stimulation, designed to mimic those in native heart. This hypothesis was tested by culturing rat heart cells on polymer scaffolds, either with perfusion of culture medium (physiologic interstitial velocity, supplementation of perfluorocarbons, or with electrical stimulation (continuous application of biphasic pulses, 2 ms, 5 V, 1 Hz. Tissue constructs cultured without perfusion or electrical stimulation served as controls. Medium perfusion and addition of perfluorocarbons resulted in compact, thick constructs containing physiologic density of viable, electromechanically coupled cells, in contrast to control constructs which had only a ~100 mm thick peripheral region with functionally connected cells. Electrical stimulation of cultured constructs resulted in markedly improved contractile properties, increased amounts of cardiac proteins, and remarkably well developed ultrastructure (similar to that of native heart as compared to non-stimulated controls. We discuss here the state of the art of cardiac tissue engineering, in light of the biomimetic approach that reproduces in vitro some of the conditions present during normal tissue development.

  1. Cardiogenic shock due to acute tramadol intoxication. (United States)

    Perdreau, Elodie; Iriart, Xavier; Mouton, Jean-Baptiste; Jalal, Zakaria; Thambo, Jean-Benoît


    Tramadol is a common analgesic, widely prescribed because of its efficiency and safety. We report the case of a 7-year-old child admitted in cardiac intensive care unit for cardiogenic shock due to tramadol intoxication. Without any past history, the child was admitted at emergency room for generalised convulsion, followed by respiratory distress. Cardiogenic shock was suspected after clinical examination and chest X-ray and confirmed by transthoracic echocardiography showing low left ventricular ejection fraction (1 mg/L) and O-desmethyltramadol (>1.5 mg/L). Hemodynamic support by inotropic drug infusion and diuretics was necessary. Left ventricular function normalised after 2 days of treatment allowing drug infusion weaning. Cardiac magnetic resonance imaging performed 3 days after admission confirmed normal left ventricular ejection fraction and volumes without evidence of late gadolinium enhancement. Cardiogenic shock due to tramadol intoxication is rare but exists. Negative inotropic effect of high doses of tramadol has been suspected. Quick recovery is possible.

  2. The pathogenesis and treatment of cardiac atrophy in cancer cachexia. (United States)

    Murphy, Kate T


    Cancer cachexia is a multifactorial syndrome characterized by a progressive loss of skeletal muscle mass associated with significant functional impairment. In addition to a loss of skeletal muscle mass and function, many patients with cancer cachexia also experience cardiac atrophy, remodeling, and dysfunction, which in the field of cancer cachexia is described as cardiac cachexia. The cardiac alterations may be due to underlying heart disease, the cancer itself, or problems initiated by the cancer treatment and, unfortunately, remains largely underappreciated by clinicians and basic scientists. Despite recent major advances in the treatment of cancer, little progress has been made in the treatment of cardiac cachexia in cancer, and much of this is due to lack of information regarding the mechanisms. This review focuses on the cardiac atrophy associated with cancer cachexia, describing some of the known mechanisms and discussing the current and future therapeutic strategies to treat this condition. Above all else, improved awareness of the condition and an increased focus on identification of mechanisms and therapeutic targets will facilitate the eventual development of an effective treatment for cardiac atrophy in cancer cachexia.

  3. EJSCREEN Indexes 2015 Public (United States)

    U.S. Environmental Protection Agency — There is an EJ Index for each environmental indicator. There are eight EJ Indexes in EJSCREEN reflecting the 8 environmental indicators. The EJ Index names are:...

  4. EJSCREEN Indexes 2016 Public (United States)

    U.S. Environmental Protection Agency — There is an EJ Index for each environmental indicator. There are eleven EJ Indexes in EJSCREEN reflecting the 11 environmental indicators. The EJ Index names are:...

  5. EJSCREEN Indexes 2015 Internal (United States)

    U.S. Environmental Protection Agency — There is an EJ Index for each environmental indicator. There are 12 EJ Indexes in EJSCREEN reflecting the 12 environmental indicators. The EJ Index names are:...

  6. Cardiac amyloidosis detection with pyrophosphate-99mTc scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Souza, D.S.F.; Ichiki, W.A.; Coura Filho, G.B.; Izaki, M.; Giorgi, M.C.P.; Soares Junior, J; Meneghetti, J.C. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Fac. de Medicina. Instituto do Coracao. Servico de Medicina Nuclear e Imagem Molecular


    Full text: Introduction: Amyloidosis is a rare disease, characterized by extracellular deposition of insoluble amyloid fibrils in organs and tissues. It may affect virtually any system, preferably heart, kidneys and liver. The cardiac involvement produces a spectrum of clinical features, usually with progressive dysfunction. Early diagnosis is important for institution of appropriate therapy. Case report: Male patient, 75 years old, with diagnosed congestive heart failure functional class III and Mobitz II second-degree atrial-ventricular block, was hospitalized for implantation of definitive cardiac pacemaker. Patient mentioned history of worsening effort dyspnoea over a one-month period, progressing to minimum effort, orthopnea, paroxysmal nocturnal dyspnoea and paroxysms of dry cough, and swelling of lower limbs. Echocardiography showed diffuse hypertrophy of left ventricle (LV), with systolic dysfunction due to diffuse hypokinesia and hyperrefringent aspect in the septum. It was questioned a cardiac infiltrating process. Cardiac amyloidosis was considered as a diagnostic hypothesis. The patient underwent a pyrophosphate-{sup 99m}Tc scintigraphy, which showed abnormal tracer uptake in the heart projection, with diffuse pattern on the left ventricle walls, compatible with the clinical suspicion cardiac amyloidosis, which was later confirmed by endomyocardial biopsy. Discussion: In this case report, the patient had clinical and other auxiliary examinations, such as electrocardiography and Doppler echocardiography, compatible with cardiac amyloidosis, which led to implementation with pyrophosphate-{sup 99m}Tc scintigraphy and later endomyocardial biopsy. Cardiac amyloidosis occurs in about half the cases of primary amyloidosis (AL) and is rare in secondary amyloidosis (AA). Its clinical presentation is polymorphic and it can be classified into four distinctive types: restrictive cardiomyopathy, systolic dysfunction, postural hypotension and conduction disorders

  7. Indeterminacy of Spatiotemporal Cardiac Alternans

    CERN Document Server

    Zhao, Xiaopeng


    Cardiac alternans, a beat-to-beat alternation in action potential duration (at the cellular level) or in ECG morphology (at the whole heart level), is a marker of ventricular fibrillation, a fatal heart rhythm that kills hundreds of thousands of people in the US each year. Investigating cardiac alternans may lead to a better understanding of the mechanisms of cardiac arrhythmias and eventually better algorithms for the prediction and prevention of such dreadful diseases. In paced cardiac tissue, alternans develops under increasingly shorter pacing period. Existing experimental and theoretical studies adopt the assumption that alternans in homogeneous cardiac tissue is exclusively determined by the pacing period. In contrast, we find that, when calcium-driven alternans develops in cardiac fibers, it may take different spatiotemporal patterns depending on the pacing history. Because there coexist multiple alternans solutions for a given pacing period, the alternans pattern on a fiber becomes unpredictable. Usin...

  8. Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Weeke, P; Jensen, Aksel Karl Georg; Folke, F;


    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were.......17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs....

  9. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign


    Sankalp Dwivedi; Fayez Siddiqui; Milan Patel; Shaun Cardozo


    Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside ...

  10. Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA)

    DEFF Research Database (Denmark)

    Meyer, Anna Sina P; Ostrowski, Sisse R; Kjaergaard, Jesper;


    BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients...... resuscitated from cardiac arrest display evidence of endothelial injury and coagulopathy (hypocoagulability, hyperfibrinolysis), which in associated with poor outcome. Recent randomized controlled trials have revealed that treatment with infusion of prostacyclin reduces endothelial damage after major surgery...... and AMI. Thus, a study is pertinent to investigate if prostacyclin infusion as a therapeutic intervention reduces endothelial damage without compromising, or even improving, the hemostatic competence in resuscitated cardiac arrest patients. Post-cardiac arrest patients frequently have a need...

  11. Anesthesia Maintenance During Mini-Invasive Cardiac Valve Surgery

    Directory of Open Access Journals (Sweden)

    L. A. Krichevsky


    Full Text Available Based on own experience and published data the authors analyze the features and specific components of anesthesia maintenance during mini-invasive cardiac valve surgery. The following clinically relevant aspects of anesthesia and perioperative intensive care were identified: preoperative patient selection and surgical and anesthesia risk prediction; one-lung ventilation; peripheral connection of circulation and specific features of its performance; control of oxygen delivery in the bed of aortic arch branches; and echocardiographic monitoring. The main risks and probable complications due to these interventions, such as cerebral hypoxia, respiratory failure, pulmonary hypertension, etc., are described. The mechanisms of their development and the modes of prevention and treatment are shown. Key words: anesthesia in cardiac surgery, mini-invasive cardiac surgery, one-lung ventilation, anesthesia during cardiac valve surgery.

  12. Right ventricular dysfunction after cardiac surgery - diagnostic options

    DEFF Research Database (Denmark)

    Grønlykke, Lars; Ravn, Hanne Berg; Gustafsson, Finn;


    Right ventricular (RV) failure after cardiac surgery is associated with an ominous prognosis. The etiology of RV failure is multifaceted and the ability to recognize RV failure early is paramount in order to initiate timely treatment. The present review focuses on different diagnostic modalities......, reproducibility and comparability of the next generation of diagnostic modalities we propose to use simple, but obtainable echocardiographic measurements and ultimately the insertion of a pulmonary artery catheter (PAC) in order to diagnose RV failure after cardiac surgery....... for RV function and discusses the normal versus abnormal findings in RV monitoring after cardiac surgery and the limitations of the applicable diagnostic modalities. There are specific challenges in RV assessment after cardiac surgery due to a loss of longitudinal contraction and a concomitant gain...

  13. Cardiac abnormalities in children with hyperthyroidism. (United States)

    Lester, L A; Sodt, P C; Rich, B H; Lucky, A W; Hutcheon, N; Arcilla, R A


    The cardiac status of 18 hyperthyroid (HT) children (9 black and 9 white) was evaluated by echocardiography. Mitral regurgitation (MR) was diagnosed clinically in 33% (6 of the 9 blacks). None of the 9 white children had MR. Left ventricular end-diastolic diameter (LVEDD) and volume (LVEDV) did not differ from the predicted normal (PN) based on body surface area and heart rate, except in those with MR where increased LVEDD and LVEDV were noted (p less than 0.02). LV mass was +1.75 standard deviations (sigma) of the PN (p less than 0.01), due to increased wall thickness of LVEDV. Left ventricular output (LVO) was +0.35 sigma PN (p = ns); however, when compared to that of normal children, LVO of HT was higher (p less than 0.001) due to the increased heart rate. Enhanced left ventricular contractility was suggested by increased rate of dimensional change during ejection (peak dD/dt-syst), with a mean value of -11.39 cm/sec as compared to the normal of -9.54 cm/sec (p less than 0.01). A linear multivariate regression equation differentiated the cardiac status of HT from that of normal children. Following treatment to euthyroid state, MR disappeared in 2 and became less in 4 patients. LVO, LV mass, and peak dD/dt-syst also became less. Significant cardiac changes occur in children with hyperthyroidism, which may be reversible in part after euthyroidism is restored.

  14. Cardiac autonomic nervous system activity in obesity. (United States)

    Liatis, Stavros; Tentolouris, Nikolaos; Katsilambros, Nikolaos


    The development of obesity is caused by a disturbance of energy balance, with energy intake exceeding energy expenditure. As the autonomic nervous system (ANS) has a role in the regulation of both these variables, it has become a major focus of investigation in the fields of obesity pathogenesis. The enhanced cardiac sympathetic drive shown in most of the studies in obese persons might be due to an increase in their levels of circulating insulin. The role of leptin needs further investigation with studies in humans. There is a blunted response of the cardiac sympathetic nervous system (SNS) activity in obese subjects after consumption of a carbohydrate-rich meal as well as after insulin administration. This might be due to insulin resistance. It is speculated that increased SNS activity in obesity may contribute to the development of hypertension in genetically susceptible individuals. It is also speculated that the increase in cardiac SNS activity under fasting conditions in obesity may be associated with high cardiovascular morbidity and mortality.

  15. Case Report: Penetrating Cardiac Injury

    Directory of Open Access Journals (Sweden)

    Adem Grbolar


    Full Text Available Summary: Penetrating cardiac injurys caused by gunshots and penetrating tools have high mortality rates. The way of injury, how the cardiac area is effected and the presence of cardiac tamponadecauses mortality in different rates. However the better treatment quality of hospitals, increasingoperative techniques, and internel care unit quality has not been change during the years. Searching the literature, we want to present a 42 years old male patient whowas injured by knife and had a 1 cm skin wound on chest with cardiac tamponade. After sternotomy a 7 cm laseration was observed in heart. Cardioraphy was performed.

  16. Cardiac surgery for Kartagener syndrome. (United States)

    Tkebuchava, T; von Segesser, L K; Niederhäuser, U; Bauersfeld, U; Turina, M


    Two patients (one girl, one boy) with Kartagener syndrome (situs inversus, bronchiectasis, sinusitis), despite pulmonary problems and associated congenital cardiac anomalies, were operated on at the ages of 4 years and 7 years, respectively. They had had previous palliative treatment at the age of 3 months and 1.3 years, respectively. Both postoperative periods after total correction were without significant complications. Long-term follow-up was available for 9 and 19 years, respectively, with no manifestations of heart insufficiency. Both patients are physically active, and neither requires cardiac medication. Patients with Kartagener syndrome and associated congenital cardiac anomalies can successfully undergo multiple cardiac operations with good long-term outcome.

  17. Effects of strain dyssynchrony index on response evaluations in patients with cardiac resyn-chronization therapy postoperatively%应变延迟指数对心脏再同步治疗患者术后反应的评估

    Institute of Scientific and Technical Information of China (English)

    陆娟; 戴敏; 钱大钧; 高怡; 王如兴


    目的:探讨斑点追踪成像应变延迟指数(strain dyssynchrony index,SDI)对心脏再同步治疗(cardiac resynchronization therapy,CRT)患者术后反应的评估价值。方法采用常规超声心动图、组织多普勒成像和斑点追踪成像测定25例CRT治疗患者术前及术后6个月左室同步性和左室收缩功能。长轴SDI、径向SDI和圆周SDI分别通过左室长轴、径向和圆周应变峰值与收缩末期峰值差值之和的平均值计算得出;同时评估术前及术后6个月患者心功能的变化,C RT临床有反应定义为术后6个月心功能分级改善1级以上,C RT超声心动图有反应定义为术后6个月左室收缩末期容积减少≥15%。结果在评估C RT患者术后反应的3种SDI中,径向SDI≥6.6%时,预测CRT有反应的敏感性为82%,特异性为83%,曲线下面积0.88(P<0.001);圆周SDI≥3.2%和长轴SDI≥3.5%时,预测CRT有反应的曲线下面积分别为0.78和0.76(P<0.05)。3种SDI均阳性预测CRT有反应率为100%,且它们均与左室收缩末期容积减少相关。结论径向SDI 能较好地预测CRT患者术后反应,而联合使用3种SDI更能准确评估CRT患者术后的反应。%Objective To investigate the effects of strain dyssynchrony index(SDI)on response evaluations in patients with cardiac resynchronization therapy(CRT)postoperatively.Methods The synchrony and systolic function of left ventricle of 25 patients with CRT were evaluated with conven-tional echocardiography,tissue Doppler imaging and speckle tracking imaging before and 6 months after CRT procedure respectively.The longitudinal,radial and circumferential SDI was calculated as the average sum of difference between the corresponding peak strain and end-systolic peak respectively.Meanwhile,changes in patients’heart function before and 6 months after CRT proce-dure were also assessed according to clinical and echocardiographic

  18. Comparação do índice de respiração rápida e superficial (IRRS calculado de forma direta e indireta no pós-operatório de cirurgia cardíaca Comparison of the rapid shallow breathing index (RSBI calculated under direct and indirect form on the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Fernando A. M. Lessa


    Full Text Available OBJETIVOS: Comparar e analisar a correlação entre o índice de respiração rápida e superficial (IRRS determinado com os valores fornecidos pelo software do ventilador mecânico Raphael® e pelo ventilômetro digital. MÉTODOS: Participaram do estudo 22 indivíduos adultos (17 homens e 5 mulheres, intubados, no pós-operatório de cirurgia cardíaca. Antes da coleta de dados, cada indivíduo foi avaliado, recebeu atendimento fisioterapêutico a fim de promover higiene brônquica e reexpansão pulmonar e foi posicionado em decúbito dorsal elevado em 45º, e depois foram registrados os valores de volume minuto (VM e frequência respiratória (FR obtidos pelo ventilador e pelo ventilômetro. O IRRS foi calculado pela relação FR/volume corrente (VC. Aplicou-se o teste t-pareado para comparação das variáveis relacionadas. Utilizou-se o coeficiente de correlação intraclasse (CCI para mensuração da replicabilidade dos escores. RESULTADOS: Observou-se diferença significativa entre o IRRS obtido pelo ventilador mecânico e o obtido pelo ventilômetro (p-valor=0,011 e concordância moderada para VM (CCI=0,74, alta concordância para FR (CCI=0,80, VC (CCI=0,79 e IRRS (CCI=0,86. Para todas as variáveis, o p-valor foi menor que 0,05. CONCLUSÕES: Houve concordância estatisticamente significativa entre o IRRS calculado pelos valores registrados no ventilador mecânico e pela ventilometria Artigo registrado no Australian New Zealand Clinical Trials Registry (ANZCTR sob o número ACTRN12610000756022.OBJECTIVES: To compare and to analyze whether the values of rapid shallow breathing index (RSBI determined by a ventilator display and a digital ventilometer were correlated. METHODS: Twenty-two adult patients (17 males and 5 females in the postoperative period of cardiac surgery and in mechanical ventilation were studied. Prior to the data collection, each patient was evaluated, received physical therapy, in order to promote bronchial hygiene and

  19. Imaging cardiac amyloidosis: a pilot study using {sup 18}F-florbetapir positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Dorbala, Sharmila [Brigham and Women' s Hospital, Harvard Medical School, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Center, Departments of Radiology and Medicine (Cardiology), Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, Cardiovascular Division and the Cardiac Amyloidosis Program, Department of Medicine, Boston, MA (United States); Brigham and Women' s Hospital, Boston, MA (United States); Vangala, Divya; Semer, James; Strader, Christopher; Bruyere, John R.; Moore, Stephen C. [Brigham and Women' s Hospital, Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Boston, MA (United States); Di Carli, Marcelo F. [Brigham and Women' s Hospital, Harvard Medical School, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Center, Departments of Radiology and Medicine (Cardiology), Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Boston, MA (United States); Falk, Rodney H. [Brigham and Women' s Hospital, Harvard Medical School, Cardiovascular Division and the Cardiac Amyloidosis Program, Department of Medicine, Boston, MA (United States); Brigham and Women' s Hospital, Boston, MA (United States)


    Cardiac amyloidosis, a restrictive heart disease with high mortality and morbidity, is underdiagnosed due to limited targeted diagnostic imaging. The primary aim of this study was to evaluate the utility of {sup 18}F-florbetapir for imaging cardiac amyloidosis. We performed a pilot study of cardiac {sup 18}F-florbetapir PET in 14 subjects: 5 control subjects without amyloidosis and 9 subjects with documented cardiac amyloidosis. Standardized uptake values (SUV) of {sup 18}F-florbetapir in the left ventricular (LV) myocardium, blood pool, liver, and vertebral bone were determined. A {sup 18}F-florbetapir retention index (RI) was computed. Mean LV myocardial SUVs, target-to-background ratio (TBR, myocardial/blood pool SUV ratio) and myocardial-to-liver SUV ratio between 0 and 30 min were calculated. Left and right ventricular myocardial uptake of {sup 18}F-florbetapir were noted in all the amyloid subjects and in none of the control subjects. The RI, TBR, LV myocardial SUV and LV myocardial to liver SUV ratio were all significantly higher in the amyloidosis subjects than in the control subjects (RI median 0.043 min{sup -1}, IQR 0.034 - 0.051 min{sup -1}, vs. 0.023 min{sup -1}, IQR 0.015 - 0.025 min{sup -1}, P = 0.002; TBR 1.84, 1.64 - 2.50, vs. 1.26, IQR 0.91 - 1.36, P = 0.001; LV myocardial SUV 3.84, IQR 1.87 - 5.65, vs. 1.35, IQR 1.17 - 2.28, P = 0.029; ratio of LV myocardial to liver SUV 0.67, IQR 0.44 - 1.64, vs. 0.18, IQR 0.15 - 0.35, P = 0.004). The myocardial RI, TBR and myocardial to liver SUV ratio also distinguished the control subjects from subjects with transthyretin and those with light chain amyloid. {sup 18}F-Florbetapir PET may be a promising technique to image light chain and transthyretin cardiac amyloidosis. Its role in diagnosing amyloid in other organ systems and in assessing response to therapy needs to be further studied. (orig.)

  20. Nucleic acid indexing (United States)

    Guilfoyle, Richard A.; Guo, Zhen


    A restriction site indexing method for selectively amplifying any fragment generated by a Class II restriction enzyme includes adaptors specific to fragment ends containing adaptor indexing sequences complementary to fragment indexing sequences near the termini of fragments generated by Class II enzyme cleavage. A method for combinatorial indexing facilitates amplification of restriction fragments whose sequence is not known.

  1. Exposure to occupational air pollution and cardiac function in workers of the Esfahan Steel Industry, Iran. (United States)

    Golshahi, Jafar; Sadeghi, Masoumeh; Saqira, Mohammad; Zavar, Reihaneh; Sadeghifar, Mostafa; Roohafza, Hamidreza


    Air pollution is recognized as an important risk factor for cardiovascular disease. We investigated association of exposure to occupational air pollution and cardiac function in the workers of the steel industry. Fifty male workers of the agglomeration and coke-making parts of the Esfahan Steel Company were randomly selected (n = 50). Workers in the administrative parts were studied as controls (n = 50). Those with known history of hypertension, dyslipidemia, or diabetes, and active smokers were not included. Data of age, body mass index, employment duration, blood pressure, fasting blood sugar, and lipid profile were gathered. Echocardiography was performed to evaluate cardiac function. Left ventricular ejection fraction was lower in workers of the agglomeration/coke-making parts than in controls (mean difference = 5 to 5.5 %, P right ventricular dilatation and grade I pulmonary hypertension were present in three (12 %) workers of the coke-making part, but none of the controls (P = 0.010). According to these results, occupational air pollution exposure in workers of the steel industry is associated with left heart systolic dysfunction. Possible right heart insults due to air pollution exposure warrant further investigations.

  2. Case report: isolated cardiac amyloidosis: an enigma unravelled. (United States)

    Khalid, Umair; Awar, Omar; Verstovsek, Gordana; Cheong, Benjamin; Yellapragada, Sarvari Venkata; Jneid, Hani; Deswal, Anita; Virani, Salim S


    Amyloidosis is a rare, multisystem disease characterized by deposition of fibrils in extracellular tissue involving kidney, liver, heart, autonomic nervous system, and several other organs. This report discusses a 75-year-old male who presented with worsening dyspnea on exertion, orthopnea, and lower-extremity edema. On physical exam, he had elevated jugular venous pressure and lower-extremity edema. Electrocardiogram depicted low voltage in limb leads and a prolonged PR interval. Echocardiogram revealed left ventricular hypertrophy, severe biatrial dilatation, and restrictive filling physiology. Coronary angiography showed absence of significant epicardial coronary artery disease. On right heart catheterization, a "dip-and-plateau sign" was noted on right ventricular pressure tracings. A diagnosis of cardiac amyloidosis was considered, but a complete hematology work-up for systemic amyloidosis was negative. Cardiac magnetic resonance imaging was pursued, showing delayed gadolinium enhancement, and this ultimately led to the myocardial biopsy confirming the diagnosis of isolated cardiac amyloidosis. Further genetic analyses confirmed isolated cardiac amyloid caused by mutant transthyretin protein (Val-122-Ile). Isolated cardiac amyloidosis is an extremely rare entity, and diagnosis may be difficult despite the use of multimodality imaging. If the index of suspicion is high, then myocardial biopsy should be considered.

  3. Life quality index revisited

    DEFF Research Database (Denmark)

    Ditlevsen, Ove Dalager


    The derivation of the life quality index (LQI) is revisited for a revision. This revision takes into account the unpaid but necessary work time needed to stay alive in clean and healthy conditions to be fit for effective wealth producing work and to enjoyable free time. Dimension analysis...... consistency problems with the standard power function expression of the LQI are pointed out. It is emphasized that the combination coefficient in the convex differential combination between the relative differential of the gross domestic product per capita and the relative differential of the expected life...... at birth should not vary between countries. Finally the distributional assumptions are relaxed as compared to the assumptions made in an earlier work by the author. These assumptions concern the calculation of the life expectancy change due to the removal of an accident source. Moreover a simple public...

  4. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld


    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....

  5. The Danish Cardiac Rehabilitation Database

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne


    AIM OF DATABASE: The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). STUDY POPULATION: Hospitalized patients with CHD with stenosis on coronary angiography treated with percutane...

  6. Biosynthesis of cardiac natriuretic peptides

    DEFF Research Database (Denmark)

    Goetze, Jens Peter


    . An inefficient post-translational prohormone maturation will also affect the biology of the cardiac natriuretic peptide system. This review aims at summarizing the myocardial synthesis of natriuretic peptides focusing on B-type natriuretic peptide, where new data has disclosed cardiac myocytes as highly...

  7. [Cardiac myxoma with cerebral metastases]. (United States)

    Bazin, A; Peruzzi, P; Baudrillard, J C; Pluot, M; Rousseaux, P


    A 56 year old woman developed multiple metastases in the cerebrum and cerebellum, four years after cardiac intervention on a left atrial myxoma. The absence of stroke is noteworthy. Multiple high density lesions with contrast enhancement were seen by CT scan, suggesting metastatic neoplasms. Histological examination confirmed the diagnosis of metastases of cardiac myxoma. Only four cases were recorded in the literature.

  8. Health Instruction Packages: Cardiac Anatomy. (United States)

    Phillips, Gwen; And Others

    Text, illustrations, and exercises are utilized in these five learning modules to instruct nurses, students, and other health care professionals in cardiac anatomy and functions and in fundamental electrocardiographic techniques. The first module, "Cardiac Anatomy and Physiology: A Review" by Gwen Phillips, teaches the learner to draw…

  9. Pneumothorax in cardiac pacing

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard;


    AIM: To identify risk factors for pneumothorax treated with a chest tube after cardiac pacing device implantation in a population-based cohort.METHODS AND RESULTS: A nationwide cohort study was performed based on data on 28 860 patients from the Danish Pacemaker Register, which included all Danish...... patients who received their first pacemaker (PM) or cardiac resynchronization device from 1997 to 2008. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals for the association between risk factors and pneumothorax treated with a chest tube. The median...... age was 77 years (25th and 75th percentile: 69-84) and 55% were male (n = 15 785). A total of 190 patients (0.66%) were treated for pneumothorax, which was more often in women [aOR 1.9 (1.4-2.6)], and in patients with age >80 years [aOR 1.4 (1.0-1.9)], a prior history of chronic obstructive pulmonary...

  10. Leadership in cardiac surgery. (United States)

    Rao, Christopher; Patel, Vanash; Ibrahim, Michael; Ahmed, Kamran; Wong, Kathie A; Darzi, Ara; von Segesser, Ludwig K; Athanasiou, Thanos


    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance.

  11. Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

    Directory of Open Access Journals (Sweden)

    Edward Gologorsky


    Full Text Available Early institution of extracorporeal perfusion support (ECPS may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes advanced cardiac life support (ACLS protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

  12. Rapid progression to cardiac tamponade in Erdheim-Chester disease despite treatment with interferon alpha. (United States)

    Nakhleh, Afif; Slobodin, Gleb; Elias, Nizar; Bejar, Jacob; Odeh, Majed


    Erdheim-Chester disease (ECD) is a rare form of non-Langerhans histiocytosis with heterogeneous clinical manifestations. The most common presentation is bone pains typically involving the long bones. Approximately 75% of the patients develop extraskeletal involvement. Cardiac involvement is seen in up to 45% of the patients, and although, pericardial involvement is the most common cardiac pathology of this rare disease, cardiac tamponade due to ECD has been very rarely reported. We describe a case of a patient found to have ECD with multi-organ involvement and small pericardial effusion, which progressed to cardiac tamponade despite treatment with interferon alpha.

  13. Presión parcial de oxígeno, pH, hematocrito, hemoglobina e índice cardíaco en pollos de engorde a 2.600 metros sobre el nivel del mar Arterial blood oxygen partial pressure, hematocrit, haemoglobin, and cardiac index in broilers at 2600 m above sea level

    Directory of Open Access Journals (Sweden)



    Full Text Available La incidencia de hipertensión arterial pulmonar (HP en pollosparrilleros constituye un problema económico importante. Dentrode los mecanismos de adaptación del organismo a la altitud se encuentran,además del aumento de la tensión arterial pulmonar, el incremento de la masa muscular ventricular derecha, la policitemía y posiblemente la hiperventilación con la subsecuente alcalosis respiratoria. Es factible que el alto nivel de energía en la ración incremente la hipoxemia derivada de la hipoxia; con lo anterior, el grado de policitemia se puede elevar y producirse un efecto agravante de la HP. Para establecer valores de pO2, Ht, Hb e IC en pollos parrilleros residentes a 2.600 m de altura sobre el nivel del mar, se estudiaron 24 aves de ambos sexos, de una población de 400 animales. Los valores promedios obtenidos fueron los siguientes: a pO2: 67.21 mmHg ± 5.21. Hubo diferencias estadísticas (pWideman y Buss (1985y Julian y col. (1985. La correlación inversa entre el IC y la pO2 arterial indican el efecto de la hipoxia de las vías aéreas en la hipoxemia y en el grado de hipertrofia e hiperplasia ventricular derecha.High incidence of cardiac failure in broilers due to hypoxic pulmonaryhypertension (PH, produces huge economical losses. Adaptive responsesinclude right ventricular hypertrophy and polycythemia. High energy levelin feed could increase hypoxemia and therefore the degree of polycythemia,thus increasing PH. To establish normal values in arterial oxygen partialpressure (pO2, pH, hematocrit (Ht, haemoglobin (Hb, and cardiacindex (CI, 24 broilers (12 males and 12 females, chosen at random, froma population of 400 birds, were studied in Bogotá, Colombia, 2600m above sea level. Mean values obtained were as follows: a pO2:67.21 ± 5.21 mmHg; statistical differences between sexes and among ages were found (p<0.05; b pH: 7.5 ± 0.05; c Ht: 37.13 ± 3.27%. In males, Ht values were higher at 24 and 37 days. In females, therewas a

  14. Cardiac arrests in patients undergoing gastrointestinal endoscopy: A retrospective analysis of 73,029 procedures

    Directory of Open Access Journals (Sweden)

    Basavana Goudra


    Full Text Available Background/Aims: Airway difficulties leading to cardiac arrest are frequently encountered during propofol sedation in patients undergoing gastrointestinal (GI endoscopy. With a noticeable increase in the use of propofol for endoscopic sedation, we decided to examine the incidence and outcome of cardiac arrests in patients undergoing gastrointestinal (GI endoscopy with sedation. Patients and Methods: In this retrospective study, cardiac arrest data obtained from the clinical quality improvement and local registry over 5 years was analyzed. The information of patients who sustained cardiac arrest attributable to sedation was studied in detail. Analysis included comparison of cardiac arrests due to all causes until discharge (or death versus the cardiac arrests and death occurring during the procedure and in the recovery area. Results: The incidence of cardiac arrest and death (all causes, until discharge was 6.07 and 4.28 per 10,000 in patients sedated with propofol, compared with non–propofol-based sedation (0.67 and 0.44. The incidence of cardiac arrest during and immediately after the procedure (recovery area for all endoscopies was 3.92 per 10,000; of which, 72% were airway management related. About 90.0% of all peri-procedural cardiac arrests occurred in patients who received propofol. Conclusions: The incidence of cardiac arrest and death is about 10 times higher in patients receiving propofol-based sedation compared with those receiving midazolam–fentanyl sedation. More than two thirds of these events occur during EGD and ERCP.

  15. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

    Directory of Open Access Journals (Sweden)

    Ray Patrick


    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  16. Automated detection of cardiac phase from intracoronary ultrasound image sequences. (United States)

    Sun, Zheng; Dong, Yi; Li, Mengchan


    Intracoronary ultrasound (ICUS) is a widely used interventional imaging modality in clinical diagnosis and treatment of cardiac vessel diseases. Due to cyclic cardiac motion and pulsatile blood flow within the lumen, there exist changes of coronary arterial dimensions and relative motion between the imaging catheter and the lumen during continuous pullback of the catheter. The action subsequently causes cyclic changes to the image intensity of the acquired image sequence. Information on cardiac phases is implied in a non-gated ICUS image sequence. A 1-D phase signal reflecting cardiac cycles was extracted according to cyclical changes in local gray-levels in ICUS images. The local extrema of the signal were then detected to retrieve cardiac phases and to retrospectively gate the image sequence. Results of clinically acquired in vivo image data showed that the average inter-frame dissimilarity of lower than 0.1 was achievable with our technique. In terms of computational efficiency and complexity, the proposed method was shown to be competitive when compared with the current methods. The average frame processing time was lower than 30 ms. We effectively reduced the effect of image noises, useless textures, and non-vessel region on the phase signal detection by discarding signal components caused by non-cardiac factors.

  17. Deaths from ischemic disease, anthropometry and cardiac biometry


    Leal, A; de Oliveira, J.; Amado, J.; Gomes, L.; Magalhaes, T.


    Rev Port Cardiol. 2005 Apr;24(4):521-30. Deaths from ischemic disease, anthropometry and cardiac biometry. [Article in English, Portuguese] Leal A, Oliveira J, Amado J, Gomes L, Magalhães T. Instituto de Ciencias Biomédicas Abel Salazar-Saúde Comunitária, Porto, Portugal. Abstract INTRODUCTION: The relation between body mass index (BMI)/obesity and left ventricular hypertrophy (LVH) in ischemic heart disease (IHD) has not been completely established, based o...

  18. Early manifestation of alteration in cardiac function in dystrophin deficient mdx mouse using 3D CMR tagging

    Directory of Open Access Journals (Sweden)

    Zhong Jia


    Full Text Available Abstract Background Duchenne muscular dystrophy (DMD is caused by the absence of the cytoskeletal protein, dystrophin. In DMD patients, dilated cardiomyopathy leading to heart failure may occur during adolescence. However, early cardiac dysfunction is frequently undetected due to physical inactivity and generalized debilitation. The objective of this study is to determine the time course of cardiac functional alterations in mdx mouse, a mouse model of DMD, by evaluating regional ventricular function with CMR tagging. Methods In vivo myocardial function was evaluated by 3D CMR tagging in mdx mice at early (2 months, middle (7 months and late (10 months stages of disease development. Global cardiac function, regional myocardial wall strains, and ventricular torsion were quantified. Myocardial lesions were assessed with Masson's trichrome staining. Results Global contractile indexes were similar between mdx and C57BL/6 mice in each age group. Histology analysis showed that young mdx mice were free of myocardial lesions. Interstitial fibrosis was present in 7 month mdx mice, with further development into patches or transmural lesions at 10 months of age. As a result, 10 month mdx mice showed significantly reduced regional strain and torsion. However, young mdx mice showed an unexpected increase in regional strain and torsion, while 7 month mdx mice displayed similar regional ventricular function as the controls. Conclusion Despite normal global ventricular function, CMR tagging detected a biphasic change in myocardial wall strain and torsion, with an initial increase at young age followed by progressive decrease at older ages. These results suggest that CMR tagging can provide more sensitive measures of functional alterations than global functional indexes in dystrophin-related cardiomyopathies.

  19. Cardiac size of high-volume resistance trained female athletes: shaping the body but not the heart. (United States)

    Venckunas, T; Simonavicius, J; Marcinkeviciene, J E


    Introduction Exercise training, besides many health benefits, may result in cardiac remodelling which is dependent on the type and amount of exercise performed. It is not clear, however, whether significant adaptation in cardiac structure is possible in females undergoing resistance type of exercise training. Rigorous high volume training of most muscle groups emphasising resistance exercises are being undertaken by athletes of some aesthetic sports such as female fitness (light bodybuilding). The impact of this type of training on cardiac adaptation has not been investigated until now. The aim of the current study was to disclose the effect of high volume resistance training on cardiac structure and function. Methods 11 top-level female fitness athletes and 20 sedentary age-matched controls were recruited to undergo two-dimensional echocardiography. Results Cardiac structure did not differ between elite female fitness athletes and controls (p > 0.05), and fitness athletes had a tendency for a smaller (p = 0.07) left ventricular (LV) mass indexed to lean body mass. Doppler diastolic function index (E/A ratio) and LV ejection fraction were similar between the groups (p > 0.05). Conclusions Elite female fitness athletes have normal cardiac size and function that do not differ from matched sedentary controls. Consequently, as high volume resistance training has no easily observable effect on adaptation of cardiac structure, when cardiac hypertrophy is present in young resistance-trained lean female, other reasons such as inherited cardiac disease are to be considered carefully.

  20. Suppression of circulating free fatty acids with acipimox in chronic heart failure patients changes whole body metabolism but does not affect cardiac function. (United States)

    Halbirk, Mads; Nørrelund, Helene; Møller, Niels; Schmitz, Ole; Gøtzsche, Liv; Nielsen, Roni; Nielsen-Kudsk, Jens Erik; Nielsen, Søren Steen; Nielsen, Torsten Toftegaard; Eiskjær, Hans; Bøtker, Hans Erik; Wiggers, Henrik


    Circulating free fatty acids (FFAs) may worsen heart failure (HF) due to myocardial lipotoxicity and impaired energy generation. We studied cardiac and whole body effects of 28 days of suppression of circulating FFAs with acipimox in patients with chronic HF. In a randomized double-blind crossover design, 24 HF patients with ischemic heart disease [left ventricular ejection fraction: 26 ± 2%; New York Heart Association classes II (n = 13) and III (n = 5)] received 28 days of acipimox treatment (250 mg, 4 times/day) and placebo. Left ventricular ejection fraction, diastolic function, tissue-Doppler regional myocardial function, exercise capacity, noninvasive cardiac index, NH(2)-terminal pro-brain natriuretic peptide (NT-pro-BNP), and whole body metabolic parameters were measured. Eighteen patients were included for analysis. FFAs were reduced by 27% in the acipimox-treated group [acipimox vs. placebo (day 28-day 0): -0.10 ± 0.03 vs. +0.01 ± 0.03 mmol/l, P < 0.01]. Glucose and insulin levels did not change. Acipimox tended to increase glucose and decrease lipid utilization rates at the whole body level and significantly changed the effect of insulin on substrate utilization. The hyperinsulinemic euglycemic clamp M value did not differ. Global and regional myocardial function did not differ. Exercise capacity, cardiac index, systemic vascular resistance, and NT-pro-BNP were not affected by treatment. In conclusion, acipimox caused minor changes in whole body metabolism and decreased the FFA supply, but a long-term reduction in circulating FFAs with acipimox did not change systolic or diastolic cardiac function or exercise capacity in patients with HF.

  1. Cardiac evaluation of liver transplant candidates

    Institute of Scientific and Technical Information of China (English)

    Mercedes Susan Mandell; JoAnn Lindenfeld; Mei-Yung Tsou; Michael Zimmerman


    Physicians previously thought that heart disease was rare in patients with end stage liver disease. However, recent evidence shows that the prevalence of ischemic heart disease and cardiomyopathy is increased in transplant candidates compared to most other surgical candidates. Investigators estimate that up to 26% of all liver transplant candidates have at least one critical coronary artery stenosis and that at least half of these patients will die perioperatively of cardiac complications. Cardiomyopathy also occurs in greater frequency. While all patients with advanced cardiac disease have defects in cardiac performance, a larger than expected number of patients have classical findings of dilated, restrictive and hypertropic cardiomyopathy. This may explain why up to 56% of patients suffer from hypoxemia due to pulmonary edema following transplant surgery. There is considerable controversy on how to screen transplant candidates for the presence of heart disease. Questions focus upon, which patients should be screened and what tests should be used. This review examines screening strategies for transplant candidates and details the prognostic value of common tests used to identify ischemic heart disease. We also review the physiological consequences of cardiomyopathy in transplant candidates and explore the specific syndrome of "cirrhotic cardiomyopathy".

  2. Major adverse cardiac events during endurance sports. (United States)

    Belonje, Anne; Nangrahary, Mary; de Swart, Hans; Umans, Victor


    Major adverse cardiac events in endurance exercise are usually due to underlying and unsuspected heart disease. The investigators present an analysis of major adverse cardiac events that occurred during 2 consecutive annual long distance races (a 36-km beach cycling race and a 21-km half marathon) over the past 5 years. All patients with events were transported to the hospital. Most of the 62,862 participants were men (77%; mean age 40 years). Of these, 4 men (3 runners, 1 cyclist; mean age 48 years) collapsed during (n = 2) or shortly after the races, rendering a prevalence of 0.006%. Two patients collapsed after developing chest pain, 1 of whom needed resuscitation at the event site, which was successful. These patients had acute myocardial infarctions and underwent primary angioplasty. The third patient was resuscitated at the site but did not have coronary disease or inducible ventricular tachycardia or ventricular fibrillation and collapsed presumably because of catecholamine-induced ventricular fibrillation. The fourth patient experienced heat stroke and had elevated creatine kinase-MB and troponins in the absence of electrocardiographic changes. In conclusion, the risk for major adverse cardiac events during endurance sports in well-trained athletes is very low.

  3. Cardiac MRI for myocardial ischemia.

    LENUS (Irish Health Repository)

    Daly, Caroline


    Proper assessment of the physiologic impact of coronary artery stenosis on the LV myocardium can affect patient prognosis and treatment decisions. Cardiac magnetic resonance imaging (CMR) assesses myocardial perfusion by imaging the myocardium during a first-pass transit of an intravenous gadolinium bolus, with spatial and temporal resolution substantially higher than nuclear myocardial perfusion imaging. Coupled with late gadolinium enhancement (LGE) imaging for infarction during the same imaging session, CMR with vasodilating stress perfusion imaging can qualitatively and quantitatively assess the myocardial extent of hypoperfusion from coronary stenosis independent of infarcted myocardium. This approach has been validated experimentally, and multiple clinical trials have established its diagnostic robustness when compared to stress single-photon emission computed tomography. In specialized centers, dobutamine stress CMR has been shown to have incremental diagnostic value above stress echocardiography due to its high imaging quality and ability to image the heart with no restriction of imaging window. This paper reviews the technical aspects, diagnostic utility, prognostic values, challenges to clinical adaptation, and future developments of stress CMR imaging.

  4. CENDI Indexing Workshop (United States)


    The CENDI Indexing Workshop held at NASA Headquarters, Two Independence Square, 300 E Street, Washington, DC, on September 21-22, 1994 focused on the following topics: machine aided indexing, indexing quality, an indexing pilot project, the MedIndEx Prototype, Department of Energy/Office of Scientific and Technical Information indexing activities, high-tech coding structures, category indexing schemes, and the Government Information Locator Service. This publication consists mostly of viewgraphs related to the above noted topics. In an appendix is a description of the Government Information Locator Service.

  5. Physics of Cardiac Arrhythmogenesis (United States)

    Karma, Alain


    A normal heartbeat is orchestrated by the stable propagation of an excitation wave that produces an orderly contraction. In contrast, wave turbulence in the ventricles, clinically known as ventricular fibrillation (VF), stops the heart from pumping and is lethal without prompt defibrillation. I review experimental, computational, and theoretical studies that have shed light on complex dynamical phenomena linked to the initiation, maintenance, and control of wave turbulence. I first discuss advances made to understand the precursor state to a reentrant arrhythmia where the refractory period of cardiac tissue becomes spatiotemporally disordered; this is known as an arrhythmogenic tissue substrate. I describe observed patterns of transmembrane voltage and intracellular calcium signaling that can contribute to this substrate, and symmetry breaking instabilities to explain their formation. I then survey mechanisms of wave turbulence and discuss novel methods that exploit electrical pacing stimuli to control precursor patterns and low-energy pulsed electric fields to control turbulence.

  6. Mediastinitis after cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Noedir A. G. Stolf


    Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6% of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years and 10 (83.3% patients were males. Seven (58.3% patients showed sternal stability on palpation, 4 (33.3% patients had pleural empyema, and 2 (16.7% patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7% patients. Staphylococcus epidermidis was identified in 2 (16.7% patients, Enterococcus faecalis in 1 (8.3% patient, and the cause of mediastinitis could not be determined in 1 (8.3% patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7% patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3% patient. Out of this series, 5 (41.7% patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3% patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

  7. Cardiac Rehabilitation After Heart Valve Surgery

    DEFF Research Database (Denmark)

    Pollmann, Agathe Gerwina Elena; Frederiksen, Marianne; Prescott, Eva


    PURPOSE: Evidence of the effect of cardiac rehabilitation (CR) after heart valve surgery is scarce, but nevertheless CR is recommended for this group of patients. Therefore, this study assessed the effect of CR on exercise capacity, cardiovascular risk factors, and long-term mortality and morbidity......·O2peak) or 6-minute walk test (6MWT). A composite endpoint of all-cause mortality and hospital admission due to myocardial infarction, stroke, heart failure, endocarditis, revascularization, or reoperation was used to assess the hazard ratio between CR attenders and nonattenders. Multivariable...

  8. The timing statistics of spontaneous calcium release in cardiac myocytes.

    Directory of Open Access Journals (Sweden)

    Mesfin Asfaw

    Full Text Available A variety of cardiac arrhythmias are initiated by a focal excitation that disrupts the regular beating of the heart. In some cases it is known that these excitations are due to calcium (Ca release from the sarcoplasmic reticulum (SR via propagating subcellular Ca waves. However, it is not understood what are the physiological factors that determine the timing of these excitations at both the subcellular and tissue level. In this paper we apply analytic and numerical approaches to determine the timing statistics of spontaneous Ca release (SCR in a simplified model of a cardiac myocyte. In particular, we compute the mean first passage time (MFPT to SCR, in the case where SCR is initiated by spontaneous Ca sparks, and demonstrate that this quantity exhibits either an algebraic or exponential dependence on system parameters. Based on this analysis we identify the necessary requirements so that SCR occurs on a time scale comparable to the cardiac cycle. Finally, we study how SCR is synchronized across many cells in cardiac tissue, and identify a quantitative measure that determines the relative timing of SCR in an ensemble of cells. Using this approach we identify the physiological conditions so that cell-to-cell variations in the timing of SCR is small compared to the typical duration of an SCR event. We argue further that under these conditions inward currents due to SCR can summate and generate arrhythmogenic triggered excitations in cardiac tissue.

  9. Metoclopramide-induced cardiac arrest

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    Martha M. Rumore


    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  10. Fetal cardiac rhabdomyoma: case report

    Directory of Open Access Journals (Sweden)

    Seyed Mostafa Ghavami


    Full Text Available Background: The primary manifestation of cardiac tumors in embryonic period is a very rare condition. Cardiac rhabdomyomas most frequently arise in the ventricular myocardium, they may also occur in the atria and the epicardial surface. In spite of its benign nature, the critical location of the tumor inside the heart can lead to lethal arrhythmias and chamber obstruction. Multiple rhabdomyomas are strongly associated with tuberous sclerosis which is associated with mental retardation and epilepsy of variable severity. Ultrasonography as a part of routine prenatal screening, is the best method for the diagnosis of cardiac rhabdomyomas. In the review of articles published in Iran, fetal cardiac rhabdomyoma was not reported. Case presentation: We report a case of cardiac rhabdomyoma on a 24-year-old gravid 1, referred to Day Medical Imaging Center for routine evaluation of fetal abnormalities at 31 weeks of her gestational age. Ultrasonographic examination displayed a homogenous echogenic mass (13×9mm, originating from the left ventricle of the fetal heart. It was a normal pregnancy without any specific complications. Other organs of the fetus were found normal and no cardiac abnormalities were appeared. No Pericardial fluid effusion was found. The parents did not have consanguineous marriage. They did not also have any specific disease such as tuberous sclerosis. Conclusion: The clinical features of cardiac rhabdomyomas vary widely, depending on the location, size, and number of tumors in the heart. Although cardiac rhabdomyoma is a benign tumor in many affected fetuses, an early prenatal diagnosis of the tumor is of great significance in making efficient planning and providing adequate follow up visits of the patients and the complications such as, heart failure and outlet obstruction of cardiac chambers.

  11. Cardiac myxoma: A surgical experience of 38 patients over 9 years, at SSKM hospital Kolkata, India

    Directory of Open Access Journals (Sweden)

    Mohammad Shahbaaz Khan


    Full Text Available Background: Cardiac myxoma is the most common benign intracardiac tumor. We studied its clinical presentation, morbidity, mortality and recurrence following surgery over a period of 9 years. Materials and Methods: This study was performed at cardiothoracic and vascular surgery department of a tertiary level hospital of eastern India, Seth Sukhlal Karnani Memorial hospital, Institute of Post Graduate Medical Education and Research Kolkata. Near 6000 cardiac cases were operated at our center over this period. Preoperative diagnosis was made with clinical presentation and preoperative echocardiography. Complete tumor excision was done and all patients were followed up for recurrence and complications. Result: A total of 38 cases of cardiac myxoma were operated over a period from October 2002 to October 2011. Cardiac myxoma constituted about 0.6% of all cardiac cases operated at our institute. This most commonly presented at fifth decade of life. Of these, 35 cases were left atrial and 2 cases were right atrial, and 1 case was having both atrial involvements. The left atrial myxoma mostly presented as mitral stenosis and very few presented with embolic and constitutional symptoms. No death or recurrence was observed during the follow up period. Conclusion: Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity.

  12. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seok Tae; Lee, Dong Soo; Kang, Won Jon; Chung, June Key; Lee, Myung Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)


    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7{+-}10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6{+-}5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

  13. Epigenetic regulation in cardiac fibrosis

    Institute of Scientific and Technical Information of China (English)

    Li-Ming; Yu; Yong; Xu


    Cardiac fibrosis represents an adoptive response in the heart exposed to various stress cues. While resolution of the fibrogenic response heralds normalization of heart function, persistent fibrogenesis is usually associated with progressive loss of heart function and eventually heart failure. Cardiac fibrosis is regulated by a myriad of factors that converge on the transcription of genes encoding extracellular matrix proteins, a process the epigenetic machinery plays a pivotal role. In this minireview, we summarize recent advances regarding the epigenetic regulation of cardiac fibrosis focusing on the role of histone and DNA modifications and non-coding RNAs.

  14. Cardiac Involvement in Ankylosing Spondylitis (United States)

    Ozkan, Yasemin


    Ankylosing spondylitis is one of the subgroup of diseases called “seronegative spondyloarthropathy”. Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed. PMID:27222669

  15. Acupuncture therapy related cardiac injury. (United States)

    Li, Xue-feng; Wang, Xian


    Cardiac injury is the most serious adverse event in acupuncture therapy. The causes include needling chest points near the heart, the cardiac enlargement and pericardial effusion that will enlarge the projected area on the body surface and make the proper depth of needling shorter, and the incorrect needling method of the points. Therefore, acupuncture practitioners must be familiar with the points of the heart projected area on the chest and the correct needling methods in order to reduce the risk of acupuncture therapy related cardiac injury.

  16. American Samoa ESI: INDEX (Index Polygons) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains vector polygons representing the boundaries of all the hardcopy cartographic products produced as part of the Environmental Sensitivity Index...




    Due to increasing the usage of media, the utilization of video play central role as it supports various applications. Video is the particular media which contains complex collection of objects like audio, motion, text, color and picture. Due to the rapid growth of this information video indexing process is mandatory for fast and effective retrieval. Many current indexing techniques fails to extract the needed image from the stored data set, based on the users query. Urgent attention in the fi...

  18. Human Use Index (Future) (United States)

    U.S. Environmental Protection Agency — Human land uses may have major impacts on ecosystems, affecting biodiversity, habitat, air and water quality. The human use index (also known as U-index) is the...

  19. Master Veteran Index (MVI) (United States)

    Department of Veterans Affairs — As of June 28, 2010, the Master Veteran Index (MVI) database based on the enhanced Master Patient Index (MPI) is the authoritative identity service within the VA,...

  20. Glycemic index and diabetes (United States)

    ... this page: // Glycemic index and diabetes To use the sharing features on ... GI diet also may help with weight loss. Glycemic Index of Certain Foods Low GI foods (0 to ...

  1. IndexCat (United States)

    U.S. Department of Health & Human Services — IndexCat provides access to the digitized version of the printed Index-Catalogue of the Library of the Surgeon General's Office; eTK for medieval Latin texts; and...

  2. Human Use Index (United States)

    U.S. Environmental Protection Agency — Human land uses may have major impacts on ecosystems, affecting biodiversity, habitat, air and water quality. The human use index (also known as U-index) is the...

  3. Audio Indexing for Efficiency (United States)

    Rahnlom, Harold F.; Pedrick, Lillian


    This article describes Zimdex, an audio indexing system developed to solve the problem of indexing audio materials for individual instruction in the content area of the mathematics of life insurance. (Author)

  4. Anaphylactic shock and cardiac arrest caused by thiamine infusion

    DEFF Research Database (Denmark)

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald


    intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance...

  5. High-Risk Cardiac Disease in Pregnancy Part I

    NARCIS (Netherlands)

    Elkayam, Uri; Goland, Sorel; Pieper, Petronella G.; Silverside, Candice K.


    The incidence of pregnancy in women with cardiovascular disease is rising, primarily due to the increased number of women with congenital heart disease reaching childbearing age and the changing demographics associated with advancing maternal age. Although most cardiac conditions are well tolerated

  6. Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle;


    AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopres...

  7. Normal cardiac function in mice with supraphysiological cardiac creatine levels. (United States)

    Santacruz, Lucia; Hernandez, Alejandro; Nienaber, Jeffrey; Mishra, Rajashree; Pinilla, Miguel; Burchette, James; Mao, Lan; Rockman, Howard A; Jacobs, Danny O


    Creatine and phosphocreatine levels are decreased in heart failure, and reductions in myocellular phosphocreatine levels predict the severity of the disease and portend adverse outcomes. Previous studies of transgenic mouse models with increased creatine content higher than two times baseline showed the development of heart failure and shortened lifespan. Given phosphocreatine's role in buffering ATP content, we tested the hypothesis whether elevated cardiac creatine content would alter cardiac function under normal physiological conditions. Here, we report the creation of transgenic mice that overexpress the human creatine transporter (CrT) in cardiac muscle under the control of the α-myosin heavy chain promoter. Cardiac transgene expression was quantified by qRT-PCR, and human CrT protein expression was documented on Western blots and immunohistochemistry using a specific anti-CrT antibody. High-energy phosphate metabolites and cardiac function were measured in transgenic animals and compared with age-matched, wild-type controls. Adult transgenic animals showed increases of 5.7- and 4.7-fold in the content of creatine and free ADP, respectively. Phosphocreatine and ATP levels were two times as high in young transgenic animals but declined to control levels by the time the animals reached 8 wk of age. Transgenic mice appeared to be healthy and had normal life spans. Cardiac morphometry, conscious echocardiography, and pressure-volume loop studies demonstrated mild hypertrophy but normal function. Based on our characterization of the human CrT protein expression, creatine and phosphocreatine content, and cardiac morphometry and function, these transgenic mice provide an in vivo model for examining the therapeutic value of elevated creatine content for cardiac pathologies.

  8. Unified Index Unveiled

    Institute of Scientific and Technical Information of China (English)



    China unveiled a unified stock index to track both markets in Shanghai and Shenzhen in April, a move likely to open a floodgate for more trading derivatives such as index futures. The new index, with 300 component companies traded on Shanghai and Shenzhen stock exchanges, will be the first of its kind on the mainland. The index members will be the largest 300 stocks - 180 from Shanghai and 120 from Shenzhen - in terms of market capitalization,

  9. Index to Volume 110 (United States)

    Marriott, R. A.


    The Subject Index references items under general headings; where a contribution covers two or more clearly defined subjects, each is separately referenced, but otherwise sub-headings within the same topic are not included. Book and other reviews are indexed as such, but their subjects are not further cross-indexed. The Author Index details all named contributions, including talks at Ordinary Meetings, but not questions from the floor.

  10. Central indexes to the citation distribution: A complement to the h-index

    CERN Document Server

    Dorta-Gonzalez, Pablo; 10.1007/s11192-011-0453-3


    The citation distribution of a researcher shows the impact of their production and determines the success of their scientific career. However, its application in scientific evaluation is difficult due to the bi-dimensional character of the distribution. Some bibliometric indexes that try to synthesize in a numerical value the principal characteristics of this distribution have been proposed recently. In contrast with other bibliometric measures, the biases that the distribution tails provoke, are reduced by the h-index. However, some limitations in the discrimination among researchers with different publication habits are presented in this index. This index penalizes selective researchers, distinguished by the large number of citations received, as compared to large producers. In this work, two original sets of indexes, the central area indexes and the central interval indexes, that complement the h-index to include the central shape of the citation distribution, are proposed and compared.

  11. Textile Index Monitor

    Institute of Scientific and Technical Information of China (English)


    Part I–Price Index National Index for China Textile City (located in Keqiao, Shaoxing county in Zhejiang Province, east of China) concludes its price index (periodic code:20101101) at 100.31 points rise of 0.68% as against its previous week.

  12. Textile Index Monitor

    Institute of Scientific and Technical Information of China (English)


    Part I—Price IndexNational Index for China Textile City (located in Keqiao,Shaoxing county in Zhejiang Province,east of China) concludes its price index (periodic code:20110606) at 110.56 points.

  13. Use of cardiac biomarkers in neonatology. (United States)

    Vijlbrief, Daniel C; Benders, Manon J N L; Kemperman, Hans; van Bel, Frank; de Vries, Willem B


    Cardiac biomarkers are used to identify cardiac disease in term and preterm infants. This review discusses the roles of natriuretic peptides and cardiac troponins. Natriuretic peptide levels are elevated during atrial strain (atrial natriuretic peptide (ANP)) or ventricular strain (B-type natriuretic peptide (BNP)). These markers correspond well with cardiac function and can be used to identify cardiac disease. Cardiac troponins are used to assess cardiomyocyte compromise. Affected cardiomyocytes release troponin into the bloodstream, resulting in elevated levels of cardiac troponin. Cardiac biomarkers are being increasingly incorporated into clinical trials as indicators of myocardial strain. Furthermore, cardiac biomarkers can possibly be used to guide therapy and improve outcome. Natriuretic peptides and cardiac troponins are potential tools in the diagnosis and treatment of neonatal disease that is complicated by circulatory compromise. However, clear reference ranges need to be set and validation needs to be carried out in a population of interest.

  14. Agreement between cardiac index measured with FloTrac-Vigileo system and pulmonary artery catheter in patients undergoing off-pump coronary artery bypass grafting%非体外循环冠状动脉旁路移植术患者FloTrac-Vigileo系统与肺动脉导管技术监测心指数的一致性

    Institute of Scientific and Technical Information of China (English)

    杜伯祥; 史宏伟; 宋杰; 葛亚力


    目的 评价非体外循环冠状动脉旁路移植术患者FloTrac- Vigileo( FV)系统与肺动脉导管(PAC)技术监测心指数(CI)的一致性.方法 拟行非体外循环冠状动脉旁路移植术患者43例,年龄53~75岁,身高150~ 183 cm,体重46~100 kg,ASA分级Ⅱ或Ⅲ级.静脉注射咪达唑仑、舒芬太尼、异丙酚和罗库溴铵行麻醉诱导,麻醉维持:静脉输注异丙酚和瑞芬太尼,间断静脉注射阿曲库铵.于锯胸骨后至搭桥开始前和搭桥完成后至闭合胸骨前,吸入1 MAC七氟醚,其余时间不吸入七氟醚.采用FV系统和PAC技术监测CI.于锯胸骨后未吸入七氟醚时、吸入七氟醚5、15 min时,冠状动脉搭桥完成后未吸入七氟醚时、吸人七氟醚5、15 min时记录两种方法监测的CI数据对,进行一致性分析.结果 FV系统和PAC技术测定CI共计258次配对数据,配对数据平均值的均数(2.8±0.6)L·min- ·m-2.配对数据差值的均数(平均偏差)为0.23 L· min-1·m-2,一致性限度(- 0.57,1.02)L·min-1·m-2,百分误差为28.6%,Kappa系数为0.546.结论 FV系统与PAC技术监测CI的一致性尚可,可替代PAC技术用于非体外循环冠状动脉旁路移植术患者CI的监测.%Objective To determine ff the cardiac index (CI) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midasolam,sufentunil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.CI was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison

  15. The Net Reclassification Index (NRI)

    DEFF Research Database (Denmark)

    Pepe, Margaret S.; Fan, Jing; Feng, Ziding;


    The Net Reclassification Index (NRI) is a very popular measure for evaluating the improvement in prediction performance gained by adding a marker to a set of baseline predictors. However, the statistical properties of this novel measure have not been explored in depth. We demonstrate the alarming...... performance improvement, such as measures derived from the receiver operating characteristic curve, the net benefit function, and the Brier score, cannot be large due to poorly fitting risk functions....

  16. Recent developments in cardiac pacing. (United States)

    Rodak, D J


    Indications for cardiac pacing continue to expand. Pacing to improve functional capacity, which is now common, relies on careful patient selection and technical improvements, such as complex software algorithms and diagnostic capabilities.

  17. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson


    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.


    Directory of Open Access Journals (Sweden)

    Saurabh Karmakar


    Full Text Available BACKGROUND Although pulmonary tuberculosis is a common disease in India, tuberculosis of right middle lobe is infrequent. Tuberculosis of the right middle lobe leading to chronic collapse is a cause of Right Middle Lobe syndrome. METHODS The patients attended Pulmonary Medicine Outdoor at Era’s Lucknow Medical College, Lucknow from April 2015 to March 2016. The purpose of this study is to describe the clinicoradiological features of patients of middle lobe syndrome due to tuberculosis. All patients presented with cough with or without expectoration, fever, chest pain, haemoptysis and constitutional symptoms like loss of appetite and weight. Chest X-ray PA view revealed ill-defined opacity abutting the right cardiac border. HRCT thorax was done in each case. The diagnosis of tuberculous aetiology was based on (1 History of chronic cough and fever, not responding to antibiotic therapy and constitutional symptoms, (2 A positive tuberculin test using 2 TU of PPD RT 23 and (3 Detection of acid fast bacilli by direct smear or Mycobacterium tuberculosis by polymerase chain reaction in bronchoalveolar lavage. RESULTS Out of 10 patients, 4 (40% were males and 6 (60% were females. The mean ages of the males were 55.8 years and females were 60.8 years and overall mean age was 59 years. Most of the patients were females and belonged to the middle age and old age group. ATT was started in all the patients. CONCLUSIONS Right middle lobe syndrome predominantly affects the older population and the female gender. Although tuberculosis is a common disease in India, Middle Lobe Syndrome is a very rare presentation of the disease. Due to non-specific symptoms and usually normal chest X-ray PA view in Right Middle Lobe Syndrome, we should keep a high index of suspicion to diagnose the condition.

  19. Analysis in indexing

    DEFF Research Database (Denmark)

    Mai, Jens Erik


    is presented as an alternative and the paper discusses how this approach includes a broader range of analyses and how it requires a new set of actions from using this approach; analysis of the domain, users and indexers. The paper concludes that the two-step procedure to indexing is insufficient to explain...... the indexing process and suggests that the domain-centered approach offers a guide for indexers that can help them manage the complexity of indexing. © 2004 Elsevier Ltd. All rights reserved....

  20. Advances in cardiac magnetic resonance imaging of congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Driessen, Mieke M.P. [University of Utrecht, University Medical Center Utrecht, Department of Radiology, PO Box 85500, Utrecht (Netherlands); University of Utrecht, University Medical Center Utrecht, Department of Cardiology, PO Box 85500, Utrecht (Netherlands); The Interuniversity Cardiology Institute of the Netherlands (ICIN) - Netherlands Heart Institute, PO Box 19258, Utrecht (Netherlands); Breur, Johannes M.P.J. [Wilhelmina Children' s Hospital, University Medical Center Utrecht, Department of Pediatric Cardiology, PO Box 85500, Utrecht (Netherlands); Budde, Ricardo P.J.; Oorschot, Joep W.M. van; Leiner, Tim [University of Utrecht, University Medical Center Utrecht, Department of Radiology, PO Box 85500, Utrecht (Netherlands); Kimmenade, Roland R.J. van; Sieswerda, Gertjan Tj [University of Utrecht, University Medical Center Utrecht, Department of Cardiology, PO Box 85500, Utrecht (Netherlands); Meijboom, Folkert J. [University of Utrecht, University Medical Center Utrecht, Department of Cardiology, PO Box 85500, Utrecht (Netherlands); Wilhelmina Children' s Hospital, University Medical Center Utrecht, Department of Pediatric Cardiology, PO Box 85500, Utrecht (Netherlands)


    Due to advances in cardiac surgery, survival of patients with congenital heart disease has increased considerably during the past decades. Many of these patients require repeated cardiovascular magnetic resonance imaging to assess cardiac anatomy and function. In the past decade, technological advances have enabled faster and more robust cardiovascular magnetic resonance with improved image quality and spatial as well as temporal resolution. This review aims to provide an overview of advances in cardiovascular magnetic resonance hardware and acquisition techniques relevant to both pediatric and adult patients with congenital heart disease and discusses the techniques used to assess function, anatomy, flow and tissue characterization. (orig.)

  1. MELAS Syndrome with Cardiac Involvement: A Multimodality Imaging Approach

    Directory of Open Access Journals (Sweden)

    Sara Seitun


    Full Text Available A 49-year-old man presented with chest pain, dyspnea, and lactic acidosis. Left ventricular hypertrophy and myocardial fibrosis were detected. The sequencing of mitochondrial genome (mtDNA revealed the presence of A to G mtDNA point mutation at position 3243 (m.3243A>G in tRNALeu(UUR gene. Diagnosis of cardiac involvement in a patient with Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes syndrome (MELAS was made. Due to increased risk of sudden cardiac death, cardioverter defibrillator was implanted.

  2. Cardiac transplantation in Friedreich ataxia. (United States)

    Yoon, Grace; Soman, Teesta; Wilson, Judith; George, Kristen; Mital, Seema; Dipchand, Anne I; McCabe, Jane; Logan, William; Kantor, Paul


    In this article, we describe a 14-year-old boy with a confirmed diagnosis of Friedreich ataxia who underwent cardiac transplantation for left ventricular failure secondary to dilated cardiomyopathy with restrictive physiology. His neurological status prior to transplantation reflected early signs of neurological disease, with evidence of dysarthria, weakness, mild gait impairment, and limb ataxia. We review the ethical issues considered during the process leading to the decision to offer cardiac transplantation.

  3. Cardiac Transplantation in Friedreich Ataxia


    Yoon, Grace; Soman, Teesta; Wilson, Judith; George, Kristen; Mital, Seema; Dipchand, Anne I; McCabe, Jane; Logan, William; Kantor, Paul


    In this paper, we describe a 14-year-old boy with a confirmed diagnosis of Friedreich ataxia who underwent cardiac transplantation for left ventricular failure secondary to dilated cardiomyopathy with restrictive physiology. His neurological status prior to transplantation reflected early signs of neurologic disease, with evidence of dysarthria, weakness, mild gait impairment, and limb ataxia. We review the ethical issues considered during the process leading to the decision to offer cardiac ...

  4. Human cardiac systems electrophysiology and arrhythmogenesis: iteration of experiment and computation. (United States)

    Holzem, Katherine M; Madden, Eli J; Efimov, Igor R


    Human cardiac electrophysiology (EP) is a unique system for computational modelling at multiple scales. Due to the complexity of the cardiac excitation sequence, coordinated activity must occur from the single channel to the entire myocardial syncytium. Thus, sophisticated computational algorithms have been developed to investigate cardiac EP at the level of ion channels, cardiomyocytes, multicellular tissues, and the whole heart. Although understanding of each functional level will ultimately be important to thoroughly understand mechanisms of physiology and disease, cardiac arrhythmias are expressly the product of cardiac tissue-containing enough cardiomyocytes to sustain a reentrant loop of activation. In addition, several properties of cardiac cellular EP, that are critical for arrhythmogenesis, are significantly altered by cell-to-cell coupling. However, relevant human cardiac EP data, upon which to develop or validate models at all scales, has been lacking. Thus, over several years, we have developed a paradigm for multiscale human heart physiology investigation and have recovered and studied over 300 human hearts. We have generated a rich experimental dataset, from which we better understand mechanisms of arrhythmia in human and can improve models of human cardiac EP. In addition, in collaboration with computational physiologists, we are developing a database for the deposition of human heart experimental data, including thorough experimental documentation. We anticipate that accessibility to this human heart dataset will further human EP computational investigations, as well as encourage greater data transparency within the field of cardiac EP.

  5. Associations between childhood body size, composition, blood pressure and adult cardiac structure: the Fels Longitudinal Study.

    Directory of Open Access Journals (Sweden)

    Roy T Sabo

    Full Text Available To determine whether childhood body size, composition and blood pressure are associated with adult cardiac structure by estimating childhood "age of divergence."385 female and 312 male participants in the Fels Longitudinal Study had echocardiographic measurements of left ventricular mass, relative wall thickness, and interventricular septal thickness. Also available were anthropometric measurements of body mass index, waist circumference, percentage body fat, fat free mass, total body fat, and systolic and diastolic blood pressures, taken in both childhood and adulthood. The age of divergence is estimated as the lowest age at which childhood measurements are significantly different between patients with low and high measurements of adult cardiac structure.Childhood body mass index is significantly associated with adult left ventricular mass (indexed by height in men and women (ages of divergence: 7.5 years and 11.5 years, respectively, and with adult interventricular septal thickness in boys (age of divergence: 9 years. Childhood waist circumference indexed by height is associated with left ventricular mass (indexed by height in boys (age of divergence: 8 years. Cardiac structure was in general not associated with childhood body composition and blood pressure.Though results are affected by adult body size, composition and blood pressure, some aspects of adult cardiac structure may have their genesis in childhood body size.

  6. [Stem cells and cardiac regeneration]. (United States)

    Perez Millan, Maria Ines; Lorenti, Alicia


    Stem cells are defined by virtue of their functional attributes: absence of tissue specific differentitated markers, capable of proliferation, able to self-maintain the population, able to produce a large number of differentiated, functional progeny, able to regenerate the tissue after injury. Cell therapy is an alternative for the treatment of several diseases, like cardiac diseases (cell cardiomyoplasty). A variety of stem cells could be used for cardiac repair: from cardiac and extracardiac sources. Each cell type has its own profile of advantages, limitations, and practicability issues in specific clinical settings. Differentiation of bone marrow stem cells to cardiomyocyte-like cells have been observed under different culture conditions. The presence of resident cardiac stem cell population capable of differentiation into cardiomyocyte or vascular lineage suggests that these cells could be used for cardiac tissue repair, and represent a great promise for clinical application. Stem cells mobilization by cytokines may also offer a strategy for cardiac regeneration. The use of stem cells (embryonic and adult) may hold the key to replacing cells lost in many devastating diseases. This potential benefit is a major focus for stem cell research.

  7. Cardiac Regeneration and Stem Cells. (United States)

    Zhang, Yiqiang; Mignone, John; MacLellan, W Robb


    After decades of believing the heart loses the ability to regenerate soon after birth, numerous studies are now reporting that the adult heart may indeed be capable of regeneration, although the magnitude of new cardiac myocyte formation varies greatly. While this debate has energized the field of cardiac regeneration and led to a dramatic increase in our understanding of cardiac growth and repair, it has left much confusion in the field as to the prospects of regenerating the heart. Studies applying modern techniques of genetic lineage tracing and carbon-14 dating have begun to establish limits on the amount of endogenous regeneration after cardiac injury, but the underlying cellular mechanisms of this regeneration remained unclear. These same studies have also revealed an astonishing capacity for cardiac repair early in life that is largely lost with adult differentiation and maturation. Regardless, this renewed focus on cardiac regeneration as a therapeutic goal holds great promise as a novel strategy to address the leading cause of death in the developed world.

  8. Cardiac imaging. A multimodality approach

    Energy Technology Data Exchange (ETDEWEB)

    Thelen, Manfred [Johannes Gutenberg University Hospital, Mainz (Germany); Erbel, Raimund [University Hospital Essen (Germany). Dept. of Cardiology; Kreitner, Karl-Friedrich [Johannes Gutenberg University Hospital, Mainz (Germany). Clinic and Polyclinic for Diagnostic and Interventional Radiology; Barkhausen, Joerg (eds.) [University Hospital Schleswig-Holstein, Luebeck (Germany). Dept. of Radiology and Nuclear Medicine


    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  9. Recurrent late cardiac tamponade following cardiac surgery : a deceiving and potentially lethal complication

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Meuzelaar, Jacobus J.


    Background - Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery. Case report - We present a case of recurrent cardiac tamponade following valve surgery. At first presentation, diagno

  10. Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT

    DEFF Research Database (Denmark)

    Perkiomaki, Juha S; Ruwald, Anne-Christine; Kutyifa, Valentina;


    causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P ...AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify...... the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known...

  11. Cardiac arrhythmia and heart failure: From bench to bedside

    Institute of Scientific and Technical Information of China (English)

    Yong-Fu Xiao


    @@ Cardiac arrhythmia is an abnormal rate and/or rhythm of a heart due to its abnormal electrical impulse origination and/or propagation.Various etiologies can cause arrhythnuas.Heart failure(HF)is a clinical syndrome due to an impaired heart that can not pump sufficient blood to meet the systemic metabolic needs.The common causes of HF include myocardial infarction,hypertension,valvular heart disease,and cardiomyopathy.

  12. Segmental Renal Infarction due to Blunt Trauma. (United States)

    Alevizopoulos, Aristeidis; Hamilton, Lauren; Stratu, Natalia; Rix, Gerald


    Segmental renal infarction is a rare situation which has been reported so far in the form of case reports. It's caused usually by cardiac conditions, such as atrial fibrillation, and systemic diseases (e.g. systemic lupus erythematous). We are presenting a case of a 31 year old healthy male, who sustained a left segmental renal infarction, following a motorbike accident. We report his presentation, management and outcome. We also review the literature in search of the optimal diagnostic and treatment pathway. To our knowledge, this is the first report of segmental renal infarction due to blunt trauma.

  13. Cardiac output during exercise

    DEFF Research Database (Denmark)

    Siebenmann, C; Rasmussen, P.; Sørensen, H.


    Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from...... the right atrium (Q(Fick-M)), Innocor (inert gas rebreathing; Q(Inn)), Physioflow (impedance cardiography; Q(Phys)), and Nexfin (pulse contour analysis; Q(Pulse)) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2  = 12%). While all four methods reported...... a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for Q(Fick-M), Q(Inn), QP hys and Q(Pulse), respectively; P = 0...

  14. [Calpains and cardiac diseases]. (United States)

    Perrin, C; Vergely, C; Rochette, L


    Calpains are a large family of cytosolic cysteine proteases composed of at least fourteen distinct isoforms. The family can be divided into two groups on the basis of distribution: ubiquitous and tissue-specific. Our current knowledge about calpains properties apply mainly to the ubiquitous isozymes, micro- and milli-calpain (classic calpains). These forms are activated after autolysis. Translocation and subsequent interactions with phospholipids of these enzymes increase their activity. Calpains are able to cleave a subset of substrates, as enzymes, structural and signalling proteins. Cardiac pathologies, such as heart failure, atrial fibrillation or clinical states particularly ischemia reperfusion, are associated with an increase of cytosolic calcium and in this regards, calpain activation has been evoked as one of the mediators leading to myocardial damage. Calpain activities have been shown to be increased in hearts experimentally subjected to ischemia reperfusion or during hypertrophy, but also in atrial tissue harvested from patients suffering from atrial fibrillations. These activities have been related to an increase of the proteolysis of different myocardial components, particularly, troponins, which are major regulators of the contraction of cardiomyocytes. Moreover, recent works have demonstrated that calpains are involved in the development of myocardial cell death by necrosis or apoptosis.

  15. Cardiac Imaging System (United States)


    Although not available to all patients with narrowed arteries, balloon angioplasty has expanded dramatically since its introduction with an estimated further growth to 562,000 procedures in the U.S. alone by 1992. Growth has fueled demand for higher quality imaging systems that allow the cardiologist to be more accurate and increase the chances of a successful procedure. A major advance is the Digital Cardiac Imaging (DCI) System designed by Philips Medical Systems International, Best, The Netherlands and marketed in the U.S. by Philips Medical Systems North America Company. The key benefit is significantly improved real-time imaging and the ability to employ image enhancement techniques to bring out added details. Using a cordless control unit, the cardiologist can manipulate images to make immediate assessment, compare live x-ray and roadmap images by placing them side-by-side on monitor screens, or compare pre-procedure and post procedure conditions. The Philips DCI improves the cardiologist's precision by expanding the information available to him.

  16. Cardiac Tamponade as Initial Presentation of Hodgkin Lymphoma

    Directory of Open Access Journals (Sweden)

    Adrija Hajra


    Full Text Available Cardiac involvement in malignant lymphoma is one of the least investigated subjects. Pericardial effusion is rarely symptomatic in patients of Hodgkin lymphoma (HL. Few case reports are available in the literature. There are case reports of diagnosed HL patients presenting with pericardial effusion. HL patients who present with recurrent episodes of pericardial effusion have also been reported. Pericardial effusion has also been reported in cases of non HL. However, pericardial effusion leading to cardiac tamponade as an initial presentation of HL is extremely rare. Very few such cases are there in the literature. Here, we present a case of a 26-year-old male patient who presented with cardiac tamponade and in due course was found to be a case of classical type of HL. This case is interesting because of its presentation.

  17. Hydrogel based injectable scaffolds for cardiac tissue regeneration. (United States)

    Radhakrishnan, Janani; Krishnan, Uma Maheswari; Sethuraman, Swaminathan


    Tissue engineering promises to be an effective strategy that can overcome the lacuna existing in the current pharmacological and interventional therapies and heart transplantation. Heart failure continues to be a major contributor to the morbidity and mortality across the globe. This may be attributed to the limited regeneration capacity after the adult cardiomyocytes are terminally differentiated or injured. Various strategies involving acellular scaffolds, stem cells, and combinations of stem cells, scaffolds and growth factors have been investigated for effective cardiac tissue regeneration. Recently, injectable hydrogels have emerged as a potential candidate among various categories of biomaterials for cardiac tissue regeneration due to improved patient compliance and facile administration via minimal invasive mode that treats complex infarction. This review discusses in detail on the advances made in the field of injectable materials for cardiac tissue engineering highlighting their merits over their preformed counterparts.

  18. Cardiac abnormalities in children with sickle cell anemia. (United States)

    Lester, L A; Sodt, P C; Hutcheon, N; Arcilla, R A


    The cardiac status of 64 children (ages 0.2 to 18 yr) with sickle cell anemia documented by hemoglobin electrophoresis was evaluated by echocardiography. Left atrial, left ventricular and aortic root dimensions were significantly increased in over 60 percent of these children at all ages compared to values for 99 normal black (non-SCA) control subjects. Left ventricular wall thickness was increased in only 20 percent of older children with sickle cell anemia. Estimated LV mass/m2 and left ventricular cardiac index were increased compared to control subjects (p less than 0.001). Left heart abnormalities expressed as a single composite function, derived from multivariate regression analysis, correlated well with severity of anemia expressed as grams of hemoglobin (r = -0.52, p = less than 0.001) and with percentage of hemoglobin S (r = 0.51, p less than 0.001), but not to the same extent with age. Echocardiographically assessed left ventricular function at rest was comparable to that of control subjects. These data suggest that the major cardiac abnormalities in children are related to the volume overload effects of chronic anemia, and that in this age group, there is no evidence for a distinct "sickle cell cardiomyopathy" or cardiac dysfunction.

  19. Cardiac Biomarkers and Cycling Race

    Directory of Open Access Journals (Sweden)

    Caroline Le Goff, Jean-François Kaux, Sébastien Goffaux, Etienne Cavalier


    Full Text Available In cycling as in other types of strenuous exercise, there exists a risk of sudden death. It is important both to understand its causes and to see if the behavior of certain biomarkers might highlight athletes at risk. Many reports describe changes in biomarkers after strenuous exercise (Nie et al., 2011, but interpreting these changes, and notably distinguishing normal physiological responses from pathological changes, is not easy. Here we have focused on the kinetics of different cardiac biomarkers: creatin kinase (CK, creating kinase midbrain (CK-MB, myoglobin (MYO, highly sensitive troponin T (hs-TnT and N-terminal brain natriuretic peptide (NT-proBNP. The population studied was a group of young trained cyclists participating in a 177-km cycling race. The group of individuals was selected for maximal homogeneity. Their annual training volume was between 10,000 and 16,000 kilometers. The rhythm of races is comparable and averages 35 km/h, depending on the race’s difficulty. The cardiac frequency was recorded via a heart rate monitor. Three blood tests were taken. The first blood test, T0, was taken approximately 2 hours before the start of the race and was intended to gather values which would act as references for the following tests. The second blood test, T1, was realized within 5 minutes of their arrival. The third and final blood test, T3, was taken 3 hours following their arrival. The CK, CK-MB, MYO, hs-TnT and NT-proBNP were measured on the Roche Diagnostic modular E (Manhein, Germany. For the statistical analysis, an ANOVA and post hoc test of Scheffé were calculated with the Statistica Software version 9.1. We noticed an important significant variation in the cardiac frequency between T0 and T1 (p < 0.0001, T0 and T3 (p < 0.0001, and T1 and T3 (p < 0.01. Table 1 shows the results obtained for the different biomarkers. CK and CK-MB showed significant variation between T0-T1 and T0-T3 (p < 0.0001. Myoglobin increased significantly

  20. Right ventricle segmentation from cardiac MRI: a collation study. (United States)

    Petitjean, Caroline; Zuluaga, Maria A; Bai, Wenjia; Dacher, Jean-Nicolas; Grosgeorge, Damien; Caudron, Jérôme; Ruan, Su; Ayed, Ismail Ben; Cardoso, M Jorge; Chen, Hsiang-Chou; Jimenez-Carretero, Daniel; Ledesma-Carbayo, Maria J; Davatzikos, Christos; Doshi, Jimit; Erus, Guray; Maier, Oskar M O; Nambakhsh, Cyrus M S; Ou, Yangming; Ourselin, Sébastien; Peng, Chun-Wei; Peters, Nicholas S; Peters, Terry M; Rajchl, Martin; Rueckert, Daniel; Santos, Andres; Shi, Wenzhe; Wang, Ching-Wei; Wang, Haiyan; Yuan, Jing


    Magnetic Resonance Imaging (MRI), a reference examination for cardiac morphology and function in humans, allows to image the cardiac right ventricle (RV) with high spatial resolution. The segmentation of the RV is a difficult task due to the variable shape of the RV and its ill-defined borders in these images. The aim of this paper is to evaluate several RV segmentation algorithms on common data. More precisely, we report here the results of the Right Ventricle Segmentation Challenge (RVSC), concretized during the MICCAI'12 Conference with an on-site competition. Seven automated and semi-automated methods have been considered, along them three atlas-based methods, two prior based methods, and two prior-free, image-driven methods that make use of cardiac motion. The obtained contours were compared against a manual tracing by an expert cardiac radiologist, taken as a reference, using Dice metric and Hausdorff distance. We herein describe the cardiac data composed of 48 patients, the evaluation protocol and the results. Best results show that an average 80% Dice accuracy and a 1cm Hausdorff distance can be expected from semi-automated algorithms for this challenging task on the datasets, and that an automated algorithm can reach similar performance, at the expense of a high computational burden. Data are now publicly available and the website remains open for new submissions (

  1. Characterization of Cardiac Patients Based on the Synergy Model

    Directory of Open Access Journals (Sweden)



    Full Text Available Background Cardiac patients need comprehensive support due to the adverse effects of this disease on different aspects of their lives. Synergy intervention is a model that focuses on patients' requirements. Objectives This study aimed to determine the eightfold characteristic of cardiac patients based on the synergy model that represent their clinical requirements. Materials and Methods In this descriptive cross-sectional study, 40 cardiac patients hospitalized at the cardiac care unit (CCU of Yazd Afshar Hospital were randomly selected. The data were collected by using a two-part check-list including demographic characteristics and also by studying eight characteristics of patients through interviewing and reviewing their records. The results were analyzed using descriptive statistics such as frequency (percentage and analytical statistics such as Spearman and Mann-Whitney test with the SPSS software, version 18. Results The results showed that among patients' internal characteristics, reversibility (70.6%, vulnerability (68.6%, and predictability (80.4% at level 1 (the minimum score had the highest frequency and stability (49% and complexity (54.9% were at level 3 (average score. Among external characteristics participation in decision-making (80.4% at level 1 had the highest frequency while care (62.7% and recourses (98% were at level 3. Conclusions Ignoring any of the eightfold characteristics based on the synergy model interferes with comprehensive support of cardiac patients. Therefore, it is necessary for professional health practitioners, especially nurses, to consider patients' eightfold characteristics in order to provide quality care.

  2. Inflammation and cardiac dysfunction during sepsis, muscular dystrophy, and myocarditis

    Directory of Open Access Journals (Sweden)

    Ying Li


    Full Text Available Inflammation plays an important role in cardiac dysfunction under different situations. Acute systemic inflammation occurring in patients with severe burns, trauma, and inflammatory diseases causes cardiac dysfunction, which is one of the leading causes of mortality in these patients. Acute sepsis decreases cardiac contractility and impairs myocardial compliance. Chronic inflammation such as that occurring in Duchenne muscular dystropshy and myocarditis may cause adverse cardiac remodeling including myocyte hypertrophy and death, fibrosis, and altered myocyte function. However, the underlying cellular and molecular mechanisms for inflammatory cardiomyopathy are still controversial probably due to multiple factors involved. Potential mechanisms include the change in circulating blood volume; a direct inhibition of myocyte contractility by cytokines (tumor necrosis factor (TNF-a, interleukin (IL-1b; abnormal nitric oxide and reactive oxygen species (ROS signaling; mitochondrial dysfunction; abnormal excitation-contraction coupling; and reduced calcium sensitivity at the myofibrillar level and blunted b-adrenergic signaling. This review will summarize recent advances in diagnostic technology, mechanisms, and potential therapeutic strategies for inflammation-induced cardiac dysfunction.

  3. The spectrum of epidemiology underlying sudden cardiac death. (United States)

    Hayashi, Meiso; Shimizu, Wataru; Albert, Christine M


    Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15%-20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who experience a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly because of inherited disorders. Coronary heart disease is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. During the past 3 decades, declines in SCD rates have not been as steep as for other causes of coronary heart disease deaths, and there is a growing fraction of SCDs not due to coronary heart disease and ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition before death. Multifaceted preventative approaches, which address risk factors in seemingly low-risk and known high-risk populations, will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies.

  4. Epidural catheterization in cardiac surgery: The 2012 risk assessment

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling


    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  5. Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots (United States)

    Al-Nimer, Marwan S.; Al-Mahdawi, Sura A.; Abdullah, Namir M.; Al-Mahdawi, Akram


    Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias. PMID:28149075

  6. Epileptic patients are at risk of cardiac arrhythmias: A novel approach using QT-nomogram, tachogram, and cardiac restitution plots

    Directory of Open Access Journals (Sweden)

    Marwan S Al-Nimer


    Full Text Available Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz, and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I and 64 newly diagnosed epileptic patients (Group II were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

  7. Cost-effectiveness of new cardiac and vascular rehabilitation strategies for patients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Sandra Spronk

    Full Text Available OBJECTIVE: Peripheral arterial disease (PAD often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD undergoing cardiac rehabilitation. DATA SOURCES: Best-available evidence was retrieved from literature and combined with primary data from 231 patients. METHODS: We developed a markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs, life-time costs (US $, incremental cost-effectiveness ratios (ICER, and gain in net health benefits (NHB in QALY equivalents were calculated. A threshold willingness-to-pay of $75,000 was used. RESULTS: ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44,251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: -0.17, 0.29 at a threshold willingness-to-pay of $75,000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30,246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:-0.24, 0.46 compared to current practice. The results were robust for other different input parameters. CONCLUSION: ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.

  8. On eccentric connectivity index

    CERN Document Server

    Zhou, Bo


    The eccentric connectivity index, proposed by Sharma, Goswami and Madan, has been employed successfully for the development of numerous mathematical models for the prediction of biological activities of diverse nature. We now report mathematical properties of the eccentric connectivity index. We establish various lower and upper bounds for the eccentric connectivity index in terms of other graph invariants including the number of vertices, the number of edges, the degree distance and the first Zagreb index. We determine the n-vertex trees of diameter with the minimum eccentric connectivity index, and the n-vertex trees of pendent vertices, with the maximum eccentric connectivity index. We also determine the n-vertex trees with respectively the minimum, second-minimum and third-minimum, and the maximum, second-maximum and third-maximum eccentric connectivity indices for

  9. NEW CONCEPTS IN INDEXING. (United States)

    SHANK, R


    Recent trends in indexing emphasize mechanical, not intellectual, developments. Mechanized operations have produced indexes in depth (1) of information on limited areas of science or (2) utilizing limited parameters for analysis. These indexes may include only citations or both useful data and citations of source literature. Both keyword-in-context and citation indexing seem to be passing the test of the marketplace. Mechanical equipment has also been successfully used to manipulate EAM cards for production of index copy. Information centers are increasingly being used as control devices in narrowly defined subject areas. Authors meet growing pressures to participate in information control work by preparing abstracts of their own articles. Mechanized image systems persist, although large systems are scarce and the many small systems may bring only limited relief for information control and retrieval problems. Experimentation and limited development continue on theory and technique of automatic indexing and abstracting.

  10. Objectively measured daily physical activity related to cardiac size in young children

    DEFF Research Database (Denmark)

    Dencker, M; Thorsson, O; Karlsson, M K;


    ), aged 8-11 years, from a population-based cohort. Left ventricular end-diastolic diameter (LVDD) and left atrial end-systolic diameter (LA) were measured with echocardiography and indexed for body surface area (BSA). Physical activity was assessed by accelerometry, and the duration of vigorous physical...... activity per day (VPA) was calculated. Acceptable accelerometer and echocardiography measurements were obtained in 228 children (boys=127, girls=101). Univariate correlations between VPA and LVDD were indexed for BSA in boys (r=0.27, P... that independent factors for LVDD, indexed for BSA for boys, were age and VPA. LA indexed for BSA was not related to physical activity variables in either gender. No clear relationship exists between cardiac size and daily physical activity in children aged 8-11 years. This suggests that significant cardiac...

  11. Resuscitation of sudden cardiac death caused by acute epileptic seizures:A case report

    Institute of Scientific and Technical Information of China (English)

    Dana-Oliviana Geavlete; Oana Ionita; Leonard Mandes; Iulia Kulcsar; Emanuel Stoica; Radu Ciudin; Cezar Macarie; Ovidiu Chioncel


    Symptomatic long QT syndrome in pediatric patients is a life-threatening condition. Sometimes, this pathology can be misdiagnosed and erroneously managed as generalized epilepsy due to similar clinical manifestations. The presented case discusses a 13-year-old female patient with generalized epilepsy since the age of 4, admitted for two episodes of resuscitated cardiac arrest due to torsades de pointes and ventricular fibrillation. The final diagnosis of congenital long QT was established and due to the patient's high-risk profile for future cardiac events, implantable cardiac defibrillator was subsequently indicated. Early recognition of congenital long QT and timing of cardiac therapy were crucial and potentially lower the incidence of fatal dysrhythmias commonly associated this condition. In high-risk patients, both medical and interventional therapy can be life-saving.

  12. Cardiac output monitoring

    Directory of Open Access Journals (Sweden)

    Mathews Lailu


    Full Text Available Minimally invasive and non-invasive methods of estimation of cardiac output (CO were developed to overcome the limitations of invasive nature of pulmonary artery catheterization (PAC and direct Fick method used for the measurement of stroke volume (SV. The important minimally invasive techniques available are: oesophageal Doppler monitoring (ODM, the derivative Fick method (using partial carbon dioxide (CO 2 breathing, transpulmonary thermodilution, lithium indicator dilution, pulse contour and pulse power analysis. Impedance cardiography is probably the only non-invasive technique in true sense. It provides information about haemodynamic status without the risk, cost and skill associated with the other invasive or minimally invasive techniques. It is important to understand what is really being measured and what assumptions and calculations have been incorporated with respect to a monitoring device. Understanding the basic principles of the above techniques as well as their advantages and limitations may be useful. In addition, the clinical validation of new techniques is necessary to convince that these new tools provide reliable measurements. In this review the physics behind the working of ODM, partial CO 2 breathing, transpulmonary thermodilution and lithium dilution techniques are dealt with. The physical and the physiological aspects underlying the pulse contour and pulse power analyses, various pulse contour techniques, their development, advantages and limitations are also covered. The principle of thoracic bioimpedance along with computation of CO from changes in thoracic impedance is explained. The purpose of the review is to help us minimize the dogmatic nature of practice favouring one technique or the other.

  13. Patch in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alireza Alizadeh Ghavidel


    Full Text Available Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients or wait and see method (9 cases, were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20 of the surgeries were redo surgeries versus 100% (22/22 in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03.Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01, however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67.Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

  14. USGS 1-min Dst index (United States)

    Gannon, J.L.; Love, J.J.


    We produce a 1-min time resolution storm-time disturbance index, the USGS Dst, called Dst8507-4SM. This index is based on minute resolution horizontal magnetic field intensity from low-latitude observatories in Honolulu, Kakioka, San Juan and Hermanus, for the years 1985-2007. The method used to produce the index uses a combination of time- and frequency-domain techniques, which more clearly identifies and excises solar-quiet variation from the horizontal intensity time series of an individual station than the strictly time-domain method used in the Kyoto Dst index. The USGS 1-min Dst is compared against the Kyoto Dst, Kyoto Sym-H, and the USGS 1-h Dst (Dst5807-4SH). In a time series comparison, Sym-H is found to produce more extreme values during both sudden impulses and main phase maximum deviation, possibly due to the latitude of its contributing observatories. Both Kyoto indices are shown to have a peak in their distributions below zero, while the USGS indices have a peak near zero. The USGS 1-min Dst is shown to have the higher time resolution benefits of Sym-H, while using the more typical low-latitude observatories of Kyoto Dst. ?? 2010.

  15. Matrix Metalloproteinase 9 Secreted by Hypoxia Cardiac Fibroblasts Triggers Cardiac Stem Cell Migration In Vitro

    Directory of Open Access Journals (Sweden)

    Qing Gao


    Full Text Available Cessation of blood supply due to myocardial infarction (MI leads to complicated pathological alteration in the affected regions. Cardiac stem cells (CSCs migration plays a major role in promoting recovery of cardiac function and protecting cardiomyocytes in post-MI remodeling. Despite being the most abundant cell type in the mammalian heart, cardiac fibroblasts (CFs were underestimated in the mechanism of CSCs migration. Our objective in this study is therefore to investigate the migration related factors secreted by hypoxia CFs in vitro and the degree that they contribute to CSCs migration. We found that supernatant from hypoxia induced CFs could accelerate CSCs migration. Four migration-related cytokines were reported upregulated both in mRNA and protein levels. Upon adding antagonists of these cytokines, the number of migration cells significantly declined. When the cocktail antagonists of all above four cytokines were added, the migration cells number reduced to the minimum level. Besides, MMP-9 had an important effect on triggering CSCs migration. As shown in our results, MMP-9 induced CSCs migration and the underlying mechanism might involve TNF-α signaling which induced VEGF and MMP-9 expression.

  16. STEM promotion through museum exhibits on cardiac monitoring & cardiac rhythm management. (United States)

    Countryman, Jordan D; Dow, Douglas E


    Formal education in science, technology, engineering and math (STEM) does not successfully engage all of the students who have potential to become skilled in STEM activities and careers. Museum exhibits may be able to reach and engage a broader range of the public. STEM Exhibits that are both understandable and capture the imagination of viewers may contribute toward increased interest in STEM activities. One such topic for such an exhibit could be cardiac pacemakers and cardioverter defibrillators that sustain life. Although museums have existed for centuries, the available types of exhibit designs has dramatically increased in recent decades due to innovations in technology. Science and technology museums have especially taken advantage of the progression of exhibit design to developed new ways to communicate to their viewers. These novel presentation tools allow museums to more effectively convey to and engage viewers. This paper examines the techniques employed by museums in exhibits and considers the practices of several museums with exhibits related to cardiac monitoring (CM) and cardiac rhythm management (CRM).

  17. Supplement: Commodity Index Report (United States)

    Commodity Futures Trading Commission — Shows index traders in selected agricultural markets. These traders are drawn from the noncommercial and commercial categories. The noncommercial category includes...

  18. Semantic Text Indexing

    Directory of Open Access Journals (Sweden)

    Zbigniew Kaleta


    Full Text Available This article presents a specific issue of the semantic analysis of texts in natural language – text indexing and describes one field of its application (web browsing.The main part of this article describes the computer system assigning a set of semantic indexes (similar to keywords to a particular text. The indexing algorithm employs a semantic dictionary to find specific words in a text, that represent a text content. Furthermore it compares two given sets of semantic indexes to determine texts’ similarity (assigning numerical value. The article describes the semantic dictionary – a tool essentialto accomplish this task and its usefulness, main concepts of the algorithm and test results.

  19. Macaque cardiac physiology is sensitive to the valence of passively viewed sensory stimuli.

    Directory of Open Access Journals (Sweden)

    Eliza Bliss-Moreau

    Full Text Available Autonomic nervous system activity is an important component of affective experience. We demonstrate in the rhesus monkey that both the sympathetic and parasympathetic branches of the autonomic nervous system respond differentially to the affective valence of passively viewed video stimuli. We recorded cardiac impedance and an electrocardiogram while adult macaques watched a series of 300 30-second videos that varied in their affective content. We found that sympathetic activity (as measured by cardiac pre-ejection period increased and parasympathetic activity (as measured by respiratory sinus arrhythmia decreased as video content changes from positive to negative. These findings parallel the relationship between autonomic nervous system responsivity and valence of stimuli in humans. Given the relationship between human cardiac physiology and affective processing, these findings suggest that macaque cardiac physiology may be an index of affect in nonverbal animals.

  20. Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus with or without anticardiolipin antibodies. (United States)

    Barutcu, A; Aksu, F; Ozcelik, F; Barutcu, C A E; Umit, G E; Pamuk, O N; Altun, A


    The aim of this study was to use transthoracic Doppler echocardiographic (TTE) imaging methods to identify cardiac dysfunction, an indicator of subclinical atherosclerosis in asymptomatic systemic lupus erythematosus (SLE) patients in terms of cardiac effects. This study involved 80 patients: a study group (n = 50) and control group (n = 30). They were categorized into four subgroups: anticardiolipin antibodies (aCL) (+) (n = 14) and aCL (-) (n = 36); systemic lupus erythematosus disease activity index (SLEDAI) ≥ 6 (n = 15) and SLEDAI 5 years group compared with the disease period <5 years group (p < 0.01, p < 0.05, respectively). Carrying out regular scans with TTE image of SLE patients is important in order to identify early cardiac involvement during monitoring and treatment. Identifying early cardiac involvement in SLE may lead to a reduction in mortality and morbidity rates.

  1. Intraoperative cardiac arrest during anesthesia:a retrospective study of 218 274 anesthetics undergoing non-cardiac surgery in a US teaching hospital

    Institute of Scientific and Technical Information of China (English)

    AN Jian-xiong; Li-Ming Zhang; Erin A.Sullivan; GUO Qu-lian; John P.Williams


    Background Patient safety has been gained much more attention in recent years.The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center,USA.The main objectives of the study were to determine the incidence of intraoperative cardiac arrest,to identify possible causes of cardiac arrest and to explore amenable modifications.Methods With approval by the University of Pittsburgh Institutional Review Board,patients experienced cardiac arrest during surgery were retrieved from medical records,surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS),a hospital electronic searching system.Cases of cardiac arrest were collected over a period of thirteen years from the Pre byteria University Hospital (PUH),USA.Results We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000).Fourteen patients (60.8%) died in the operating room,leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics.Immediate overall survival rate after arrest was 39% (9/23).Half of the patients (12/23) were emergency cases with 41% survival rate (5/12).One fourth of the arrests were trauma patients (6/23).Most arrest patients (87%,20/23) were American Society of Anesthesiologists Physical Status (ASA PS) Ⅳ and Ⅴ,while only three patients were ASA PS-Ⅰ,Ⅱ and Ⅲ,respectively.One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.Conclusions Most intraoperative cardiac arrests were not due to anesthesia-related causes.Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

  2. An index of financial safety of China

    Directory of Open Access Journals (Sweden)

    Xiaojun Jia


    Full Text Available Purpose: This paper combines a synthetic index system by the variables and evaluates China’s financial safety through the change of indexes in a comprehensive way. First of all, it builds the financial industry evaluation index system composed of 25indicators in terms of the operation of the financial industry and external economic environment and particularly takes into consideration factors which might trigger liquidity risks such as off-balance-sheet business, interbank business and shadow banking; then it selects 10 indicators to conduct empirical analysis and identifies the indicator weight through principal component analysis; finally it combines the financial safety indexes through the linear weighted comprehensive evaluation model.Design/methodology/approach: Synthesis of indexes is made by constructing a proper comprehensive evaluation mathematical model, integrating a number of evaluation indexes into one comprehensive evaluation index and then obtaining corresponding comprehensive evaluation results. In this paper, it selects 10 indexes to conduct empirical analysis and identifies the index weight through principal component analysis; finally it combines the financial safety indexes through the linear weighted comprehensive evaluation model. Principal component analysis (PCA is a statistical procedure that uses an orthogonal transformation to convert a set of observations of possibly correlated variables into a set of values of linearly uncorrelated variables called principal components. PCA was invented in 1901 and was later independently developed (and named by Harold Hotelling in the 1930s.Findings: From 2003 to 2013 China’s financial safety indexes fluctuated. From 2003 to 2007 indexes rose, which indicates China’s financial safety status gradually improved; from 2007 to 2009 indexes declined, which indicates due to the impact of subprime crisis, China’s financial safety status took a turn for the worse; from 2009 to 2012

  3. Cardiac Penetrating Injuries and Pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    CHEN Shifeng


    Objective To discuss the early diagnosis and treatment of cardiac penetrating injuries and pseudoaneurysm. Methods 18 cases of cardiac penetrating injuries, in which 2 cases were complicated with pseudoaneurysm, were diagnosed by emergency operation and color Doppler echocardiography between May 1973 and Dec. 2001 in our hospital. The basis for emergency operation is the injured path locating in cardiac dangerous zone, severe shock or pericardial tamponade. ResultsAmong 18 cases of this study, 17 cases underwent emergency operation. During the operation, 11 cases were found injured in right ventricle, 2 cases were found injured in right atrium, 1 case was found injured in pulmonary artery,4 cases were found injured in left ventricle, 2 cases were found complicated with pseudoaneurysm. 17cases underwent cardiac repair including 1 case of rupture of aneurysm. 1 case underwent elective aneurysm resection. In whole group, 15 cases survived(83.33% ), 3 cases died( 16.67%). The cause of death is mainly hemorrhagic shock. Conclusion Highly suspicious cardiac penetrating injuries or hemopericaridium should undergo direct operative exploration. Pseudoaneurysm should be resected early,which can prevent severe complications.

  4. Automatic basal slice detection for cardiac analysis (United States)

    Paknezhad, Mahsa; Marchesseau, Stephanie; Brown, Michael S.


    Identification of the basal slice in cardiac imaging is a key step to measuring the ejection fraction (EF) of the left ventricle (LV). Despite research on cardiac segmentation, basal slice identification is routinely performed manually. Manual identification, however, has been shown to have high inter-observer variability, with a variation of the EF by up to 8%. Therefore, an automatic way of identifying the basal slice is still required. Prior published methods operate by automatically tracking the mitral valve points from the long-axis view of the LV. These approaches assumed that the basal slice is the first short-axis slice below the mitral valve. However, guidelines published in 2013 by the society for cardiovascular magnetic resonance indicate that the basal slice is the uppermost short-axis slice with more than 50% myocardium surrounding the blood cavity. Consequently, these existing methods are at times identifying the incorrect short-axis slice. Correct identification of the basal slice under these guidelines is challenging due to the poor image quality and blood movement during image acquisition. This paper proposes an automatic tool that focuses on the two-chamber slice to find the basal slice. To this end, an active shape model is trained to automatically segment the two-chamber view for 51 samples using the leave-one-out strategy. The basal slice was detected using temporal binary profiles created for each short-axis slice from the segmented two-chamber slice. From the 51 successfully tested samples, 92% and 84% of detection results were accurate at the end-systolic and the end-diastolic phases of the cardiac cycle, respectively.

  5. Evaluation of Cardiac Involvement in Children with Dengue by Serial Echocardiographic Studies.

    Directory of Open Access Journals (Sweden)

    Tawatchai Kirawittaya

    Full Text Available Infection with dengue virus results in a wide range of clinical manifestations from dengue fever (DF, a self-limited febrile illness, to dengue hemorrhagic fever (DHF which is characterized by plasma leakage and bleeding tendency. Although cardiac involvement has been reported in dengue, the incidence and the extent of cardiac involvement are not well defined.We characterized the incidence and changes in cardiac function in a prospective in-patient cohort of suspected dengue cases by serial echocardiography. Plasma leakage was detected by serial chest and abdominal ultrasonography. Daily cardiac troponin-T levels were measured. One hundred and eighty one dengue cases were enrolled. On the day of enrollment, dengue cases that already developed plasma leakage had lower cardiac index (2695 (127 vs 3188 (75 (L/min/m2, p = .003 and higher left ventricular myocardial performance index (.413 (.021 vs .328 (.026, p = .021 and systemic vascular resistance (2478 (184 vs 1820 (133 (dynes·s/cm5, p = .005 compared to those without plasma leakage. Early diastolic wall motion of the left ventricle was decreased in dengue cases with plasma leakage compared to those without. Decreased left ventricular wall motility was more common in dengue patients compared to non-dengue cases particularly in cases with plasma leakage. Differences in cardiac function between DF and DHF were most pronounced around the time of plasma leakage. Cardiac dysfunction was transient and did not require treatment. Transient elevated troponin-T levels were more common in DHF cases compared to DF (14.5% vs 5%, p = 0.028.Transient left ventricular systolic and diastolic dysfunction was common in children hospitalized with dengue and related to severity of plasma leakage. The functional abnormality spontaneously resolved without specific treatment. Cardiac structural changes including myocarditis were uncommon.

  6. EJSCREEN Supplementary Indexes 2015 Public (United States)

    U.S. Environmental Protection Agency — There are 40 supplementary EJSCREEN indexes that are divided into 5 categories: EJ Index with supplementary demographic index, Supplementary EJ Index 1 with...

  7. EJSCREEN Supplementary Indexes 2015 Internal (United States)

    U.S. Environmental Protection Agency — There are 60 supplementary EJ Indexes in EJSCREEN that are divided into 5 categories: EJ Index with supplementary demographic index, Supplementary EJ Index 1 with...

  8. Cardiac diastolic dysfunction and metabolic syndrome in young women after placental syndrome.

    NARCIS (Netherlands)

    Zandstra, M.; Stekkinger, E.; Vlugt, M.J. van der; Dijk, A.P.J. van; Lotgering, F.K.; Spaanderman, M.E.A.


    OBJECTIVE: To estimate whether women with a recent history of a placental syndrome and concomitant metabolic syndrome have reduced cardiac diastolic function. METHODS: In this cohort study, women with a history of a placental syndrome were included. We assessed body mass index, blood pressure, fasti

  9. Assessment of cardiac output with transpulmonary thermodilution during exercise in humans

    DEFF Research Database (Denmark)

    Calbet, José A L; Boushel, Robert


    The accuracy and reproducibility of transpulmonary thermodilution (TPTd) to assess cardiac output (Q̇) in exercising men was determined using indocyanine green (ICG) dilution as a reference method. TPTd has been utilized for the assessment of Q̇ and preload indexes of global end-diastolic volume...

  10. Universal Index System (United States)

    Kelley, Steve; Roussopoulos, Nick; Sellis, Timos; Wallace, Sarah


    The Universal Index System (UIS) is an index management system that uses a uniform interface to solve the heterogeneity problem among database management systems. UIS provides an easy-to-use common interface to access all underlying data, but also allows different underlying database management systems, storage representations, and access methods.

  11. Global Ecosystem Restoration Index

    DEFF Research Database (Denmark)

    Fernandez, Miguel; Garcia, Monica; Fernandez, Nestor


    The Global ecosystem restoration index (GERI) is a composite index that integrates structural and functional aspects of the ecosystem restoration process. These elements are evaluated through a window that looks into a baseline for degraded ecosystems with the objective to assess restoration...

  12. Exercise-induced cardiac remodeling. (United States)

    Weiner, Rory B; Baggish, Aaron L


    Early investigations in the late 1890s and early 1900s documented cardiac enlargement in athletes with above-normal exercise capacity and no evidence of cardiovascular disease. Such findings have been reported for more than a century and continue to intrigue scientists and clinicians. It is well recognized that repetitive participation in vigorous physical exercise results in significant changes in myocardial structure and function. This process, termed exercise-induced cardiac remodeling (EICR), is characterized by structural cardiac changes including left ventricular hypertrophy with sport-specific geometry (eccentric vs concentric). Associated alterations in both systolic and diastolic functions are emerging as recognized components of EICR. The increasing popularity of recreational exercise and competitive athletics has led to a growing number of individuals exhibiting these findings in routine clinical practice. This review will provide an overview of EICR in athletes.

  13. [Ectopia cordis and cardiac anomalies]. (United States)

    Cabrera, Alberto; Rodrigo, David; Luis, María Teresa; Pastor, Esteban; Galdeano, José Miguel; Esteban, Susana


    Ectopia cordis is a rare disease that occurs in 5.5 to 7.9 per million live births. Only 267 cases had been reported as of 2001, most (95%) associated with other cardiac anomalies. We studied the cardiac malformations associated in 6 patients with ectopia cordis. Depending on where the defect was located, the cases of ectopia were classified into four groups: cervical, thoracic, thoraco-abdominal, and abdominal. All 6 patients died before the third day of life, 4 during delivery. Three of the patients were included in the thoracic group, whereas the other 3 belonged to the thoraco-abdominal group. All the patients had associated ventricular septal defects, 3 double-outlet right ventricle (50%) and the rest (50%) tetralogy of Fallot-pulmonary atresia. Two patients with double-outlet right ventricle presented mitral-valve pathology, a parachute valve and an atresic mitral valve. None of these cardiac anomalies have been reported to date.

  14. Electrophysiological Cardiac Modeling: A Review. (United States)

    Beheshti, Mohammadali; Umapathy, Karthikeyan; Krishnan, Sridhar


    Cardiac electrophysiological modeling in conjunction with experimental and clinical findings has contributed to better understanding of electrophysiological phenomena in various species. As our knowledge on underlying electrical, mechanical, and chemical processes has improved over time, mathematical models of the cardiac electrophysiology have become more realistic and detailed. These models have provided a testbed for various hypotheses and conditions that may not be easy to implement experimentally. In addition to the limitations in experimentally validating various scenarios implemented by the models, one of the major obstacles for these models is computational complexity. However, the ever-increasing computational power of supercomputers facilitates the clinical application of cardiac electrophysiological models. The potential clinical applications include testing and predicting effects of pharmaceutical agents and performing patient-specific ablation and defibrillation. A review of studies involving these models and their major findings are provided.

  15. Integrative Cardiac Health Project (United States)


    of obesity including weight, BMI and % body fat were reduced by 5%. Additionally, a 5% reduction in waist circumference and a 7% reduction in...Diameter (cm) 24.0 ± 3.8 22.3 ± 3.7 -1.7 ± 1.6 ɘ.0011 Waist Circumference (cm) 100.6 ± 13.1 95.6 ± 13.1 -5.0 ± 4.1 ɘ.0011 13 Baseline Study...mass index (mean± SD ·31.1 ± 5.9 vs. 29.0 ± 5.9, rs = 0.175), increased waist circumference (102 ± 17 em vs. 98 ± 14, rs = 0.135), and elevated high

  16. Evolutionary algorithm based index assignment algorithm for noisy channel

    Institute of Scientific and Technical Information of China (English)

    李天昊; 余松煜


    A globally optimal solution to vector quantization (VQ) index assignment on noisy channel, the evolutionary algorithm based index assignment algorithm (EAIAA), is presented. The algorithm yields a significant reduction in average distortion due to channel errors, over conventional arbitrary index assignment, as confirmed by experimental results over the memoryless binary symmetric channel (BSC) for any bit error.

  17. Eccentric connectivity index

    CERN Document Server

    Ilić, Aleksandar


    The eccentric connectivity index $\\xi^c$ is a novel distance--based molecular structure descriptor that was recently used for mathematical modeling of biological activities of diverse nature. It is defined as $\\xi^c (G) = \\sum_{v \\in V (G)} deg (v) \\cdot \\epsilon (v)$\\,, where $deg (v)$ and $\\epsilon (v)$ denote the vertex degree and eccentricity of $v$\\,, respectively. We survey some mathematical properties of this index and furthermore support the use of eccentric connectivity index as topological structure descriptor. We present the extremal trees and unicyclic graphs with maximum and minimum eccentric connectivity index subject to the certain graph constraints. Sharp lower and asymptotic upper bound for all graphs are given and various connections with other important graph invariants are established. In addition, we present explicit formulae for the values of eccentric connectivity index for several families of composite graphs and designed a linear algorithm for calculating the eccentric connectivity in...


    Directory of Open Access Journals (Sweden)

    Devarj Saravanan


    Full Text Available Due to increasing the usage of media, the utilization of video play central role as it supports various applications. Video is the particular media which contains complex collection of objects like audio, motion, text, color and picture. Due to the rapid growth of this information video indexing process is mandatory for fast and effective retrieval. Many current indexing techniques fails to extract the needed image from the stored data set, based on the users query. Urgent attention in the field of video indexing and image retrieval is the need of the hour. Here a new matrix based indexing technique for image retrieval has been proposed. The proposed method provide better result, experimental results prove this.

  19. Roles of Calcium Regulating MicroRNAs in Cardiac Ischemia-Reperfusion Injury

    Directory of Open Access Journals (Sweden)

    Eunhyun Choi


    Full Text Available Cardiac Ca2+ cycling and signaling are closely associated with cardiac function. Changes in cellular Ca2+ homeostasis may lead to aberrant cardiac rhythm and may play a critical role in the pathogenesis of cardiac diseases, due to their exacerbation of heart failure. MicroRNAs (miRNAs play a key role in the regulation of gene expression at the post-transcriptional level and participate in regulating diverse biological processes. The emerging evidence indicates that the expression profiles of miRNAs vary among human diseases, including cardiovascular diseases. Cardiac Ca2+-handling and signaling proteins are also regulated by miRNAs. Given the relationship between cardiac Ca2+ homeostasis and signaling and miRNA, Ca2+-related miRNAs may serve as therapeutic targets during the treatment of heart failure. In this review, we summarize the knowledge currently available regarding the role of Ca2+ in cardiac function, as well as changes in Ca2+ cycling and homeostasis and the handling of these processes by miRNAs during cardiac ischemia-reperfusion injury.

  20. An update on insertable cardiac monitors

    DEFF Research Database (Denmark)

    Olsen, Flemming J; Biering-Sørensen, Tor; Krieger, Derk W


    Continuous cardiac rhythm monitoring has undergone compelling progress over the past decades. Cardiac monitoring has emerged from 12-lead electrocardiograms being performed at the discretion of the treating physician to in-hospital telemetry, Holter monitoring, prolonged external event monitoring...

  1. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard;


    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...


    Directory of Open Access Journals (Sweden)



    Full Text Available We here present our experience with ventricular tachycardia (VT leading to cardiac arrest in a patient with American Society of Anesthesiologists grade-I (ASA-I 11 hours after cholecystectomy. Excessive fluid overload and hypoxemia due to lung congestion may lead to cardiac arrest in this case. Immediate diagnosis and appropriate intervention saved the life of the patient.

  3. Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients

    DEFF Research Database (Denmark)

    Jakobsen, Carl-Johan; Ryhammer, Pia Katarina; Jensen, Mariann Tang


    Numerous reports have emphasized the need for reduction in transfusions of allogeneic red blood cells (RBC) due to increased morbidity and mortality. Nevertheless, transfusion rates are still high in several cardiac surgery institutions. Reports on long-term survival after cardiac surgery and RBC...

  4. Clinical advances on Cardiac Insuffiency

    Directory of Open Access Journals (Sweden)

    Angel Julio Romero Cabrera


    Full Text Available Cardiac insuffiency is a complex clinical syndrome which constitutes a common final path to get in by the majority of the cardiac diseases. Studies based on the communitarian surveys shows that from 30 to 40 % of the patients decease within the first year of the diagnosis. The rest of the patients (from 60 to 70 % die within the 5 years after being diagnosed. For this reason it has been called as the ¨cancer of cardiology¨. The objective of this article is to update the advances reached in the clinical and therapeutic aspects of this important syndrome.

  5. Cardiac Glycoside Plants Self-Poisoning

    Directory of Open Access Journals (Sweden)

    Radenkova-Saeva J.


    Full Text Available Cardiac glycosides are found in a diverse group of plants including Digitalis purpurea and Digitalis lanata (foxgloves, Nerium oleander, Convallaria majalis (lily of the valley, Strophanthus gratus, etc. Nerium Oleander is an indoor and ornamental plant of an evergreen shrub. It’s widespread in countries with a Mediterranean climate. Oleander is one of the most poisonous plants known to humans. All parts of the nerium oleander are poisonous, primarily due to the contained cardiac glycosides - oleandrin, nerin, digitoxigenin, and olinerin of which oleandrin is the principal toxin. The bark contains the toxic substances of rosagenin which causes strychnine-like effects. Signs of poisoning appear a few hours after the adoption of the parts of the plant. Two cases of Nerium Oleander poisoning were presented. Clinical picture included gastrointestinal, cardiovascular and central nervous system effects. The clinical symptoms were characterized by nausea, vomiting, salivation, colic, diarrhoea, ventricular tachycardia, dysrhythmia, heart block, ataxia, drowsiness, muscular tremor. Treatment included administration of activated charcoal, symptomatic and supportive care.

  6. Coupling of cardiac and locomotor rhythms. (United States)

    Kirby, R L; Nugent, S T; Marlow, R W; MacLeod, D A; Marble, A E


    The pressure within exercising skeletal muscle rises and falls rhythmically during normal human locomotion, the peak pressure reaching levels that intermittently impede blood flow to the exercising muscle. Speculating that a reciprocal relationship between the timing of peak intramuscular and pulsatile arterial pressures should optimize blood flow through muscle and minimize cardiac load, we tested the hypothesis that heart rate becomes entrained with walking and running cadence at some locomotion speeds, by means of electrocardiography and an accelerometer to provide signals reflecting heart rate and cadence, respectively. In 18 of 25 subjects, 1:1 coupling of heart and step rates was present at one or more speeds on a motorized treadmill, generally at moderate to high exercise intensities. To determine how exercise specific this phenomenon is, and to refute the competing hypothesis that coupling is due to vertical accelerations of the heart during locomotion, we had 12 other subjects cycle on an electronically braked bicycle ergometer. Coupling was found between heart rate and pedaling frequency in 10 of them. Cardiac-locomotor coupling appears to be a normal physiological phenomenon, and its identification provides a fresh perspective from which to study endurance.

  7. Computer Generated Cardiac Model For Nuclear Medicine (United States)

    Hills, John F.; Miller, Tom R.


    A computer generated mathematical model of a thallium-201 myocardial image is described which is based on realistic geometric and physiological assumptions. The left ventricle is represented by an ellipsoid truncated by aortic and mitral valve planes. Initially, an image of a motionless left ventricle is calculated with the location, size, and relative activity of perfusion defects selected by the designer. The calculation includes corrections for photon attenuation by overlying structures and the relative distribution of activity within the tissues. Motion of the ventricular walls is simulated either by a weighted sum of images at different stages in the cardiac cycle or by a blurring function whose width varies with position. Camera and collimator blurring are estimated by the MTF of the system measured at a representative depth in a phantom. Statistical noise is added using a Poisson random number generator. The usefulness of this model is due to two factors: the a priori characterization of location and extent of perfusion defects and the strong visual similarity of the images to actual clinical studies. These properties should permit systematic evaluation of image processing algorithms using this model. The principles employed in developing this cardiac image model can readily be applied to the simulation of other nuclear medicine studies and to other medical imaging modalities including computed tomography, ultrasound, and digital radiography.

  8. Cardiac atrophy after bed rest and spaceflight (United States)

    Perhonen, M. A.; Franco, F.; Lane, L. D.; Buckey, J. C.; Blomqvist, C. G.; Zerwekh, J. E.; Peshock, R. M.; Weatherall, P. T.; Levine, B. D.


    Cardiac muscle adapts well to changes in loading conditions. For example, left ventricular (LV) hypertrophy may be induced physiologically (via exercise training) or pathologically (via hypertension or valvular heart disease). If hypertension is treated, LV hypertrophy regresses, suggesting a sensitivity to LV work. However, whether physical inactivity in nonathletic populations causes adaptive changes in LV mass or even frank atrophy is not clear. We exposed previously sedentary men to 6 (n = 5) and 12 (n = 3) wk of horizontal bed rest. LV and right ventricular (RV) mass and end-diastolic volume were measured using cine magnetic resonance imaging (MRI) at 2, 6, and 12 wk of bed rest; five healthy men were also studied before and after at least 6 wk of routine daily activities as controls. In addition, four astronauts were exposed to the complete elimination of hydrostatic gradients during a spaceflight of 10 days. During bed rest, LV mass decreased by 8.0 +/- 2.2% (P = 0.005) after 6 wk with an additional atrophy of 7.6 +/- 2.3% in the subjects who remained in bed for 12 wk; there was no change in LV mass for the control subjects (153.0 +/- 12.2 vs. 153.4 +/- 12.1 g, P = 0.81). Mean wall thickness decreased (4 +/- 2.5%, P = 0.01) after 6 wk of bed rest associated with the decrease in LV mass, suggesting a physiological remodeling with respect to altered load. LV end-diastolic volume decreased by 14 +/- 1.7% (P = 0.002) after 2 wk of bed rest and changed minimally thereafter. After 6 wk of bed rest, RV free wall mass decreased by 10 +/- 2.7% (P = 0.06) and RV end-diastolic volume by 16 +/- 7.9% (P = 0.06). After spaceflight, LV mass decreased by 12 +/- 6.9% (P = 0.07). In conclusion, cardiac atrophy occurs during prolonged (6 wk) horizontal bed rest and may also occur after short-term spaceflight. We suggest that cardiac atrophy is due to a physiological adaptation to reduced myocardial load and work in real or simulated microgravity and demonstrates the plasticity

  9. Análise da correlação do índice de Helkimo com a função respiratória no pré e pós-operatório de pacientes submetidos à cirurgia cardíaca: estudo piloto Correlation analysis of Helkimo index with lung function in pre-and postoperative patients undergoing cardiac surgery: pilot study

    Directory of Open Access Journals (Sweden)

    Cristiane Delgado Alves Rodrigues


    Full Text Available Avaliar a articulação temporomandibular (ATM e a função respiratória no pré e pós-operatório de pacientes submetidos à cirurgia cardíaca eletiva, com intubação orotraqueal (IOT e verificar se há correlação entre o Índice de disfunção clínica craniomandibular (IDCCM com a função respiratória. Foram avaliados pacientes no pré, primeiro e segundo dias de pós-operatório (PO1, PO2 de cirurgia cardíaca com até 24 horas IOT. Na avaliação da ATM foi utilizado o IDCCM e para a avaliação respiratória foram utilizados a cirtometria axilar, xifoideana e umbilical, ventilometria, incluindo capacidade vital (CV, volume minuto (VM e frequência respiratória (FR. Completaram o estudo 13 pacientes. Não foi encontrada diferença estatística entre o IDCCM nos diferentes períodos de avaliação. Houve diminuição significativa dos valores de cirtometria nas três medidas e da CV com pTo evaluate the temporomandibular joint (TMJ and respiratory function in pre-and postoperative patients undergoing elective cardiac surgery with tracheal intubation (TI and verifying the correlation between Clinical dysfunction index (CDI with lung function. Patients were evaluated during the first and second days after surgery (PO1, PO2 of cardiac surgery with 24 hours of intubation. For the evaluation of the TMJ was used CDI and for respiratory function were used cirtometry axillary, xiphoid and umbilical, and respirometry, including vital capacity (VC, minute volume (MV and respiratory rate (RR. Thirteen patients completed the study. There was no statistical difference between the CDI at different stages of evaluation, and when evaluated the 5 sub-items, only the item assessing function showed significant result, p = 0.01. There was a significant decrease of the values of circumferences in the three measures and CV p <0.001. Negative correlation was found between the CDI and circumference in PO1 axillary; negative correlation between the CDI in

  10. Elevated sensitivity to cardiac ischemia in proteinuric rats is independent of adverse cardiac remodeling

    NARCIS (Netherlands)

    Szymanski, Mariusz K.; Hillege, Hans L.; Danser, A. H. Jan; Garrelds, Ingrid M.; Schoemaker, Regien G.


    Objectives: Chronic renal dysfunction severely increases cardiovascular risk. Adverse cardiac remodeling is suggested to play a major role as predisposition for increased cardiac ischemic vulnerability. The aim of the present study was to examine the role of adverse cardiac remodeling in cardiac sen

  11. Cardiac and metabolic effects of chronic growth hormone and insulin-like growth factor I excess in young adults with pituitary gigantism. (United States)

    Bondanelli, Marta; Bonadonna, Stefania; Ambrosio, Maria Rosaria; Doga, Mauro; Gola, Monica; Onofri, Alessandro; Zatelli, Maria Chiara; Giustina, Andrea; degli Uberti, Ettore C


    Chronic growth hormone (GH)/insulin-like growth factor I (IGF-I) excess is associated with considerable mortality in acromegaly, but no data are available in pituitary gigantism. The aim of the study was to evaluate the long-term effects of early exposure to GH and IGF-I excess on cardiovascular and metabolic parameters in adult patients with pituitary gigantism. Six adult male patients with newly diagnosed gigantism due to GH secreting pituitary adenoma were studied and compared with 6 age- and sex-matched patients with acromegaly and 10 healthy subjects. Morphologic and functional cardiac parameters were evaluated by Doppler echocardiography. Glucose metabolism was assessed by evaluating glucose tolerance and homeostasis model assessment index. Disease duration was significantly longer (Pgigantism than in patients with acromegaly, whereas GH and IGF-I concentrations were comparable. Left ventricular mass was increased both in patients with gigantism and in patients with acromegaly, as compared with controls. Left ventricular hypertrophy was detected in 2 of 6 of both patients with gigantism and patients with acromegaly, and isolated intraventricular septum thickening in 1 patient with gigantism. Inadequate diastolic filling (ratio between early and late transmitral flow velocitygigantism and 1 of 6 patients with acromegaly. Impaired glucose metabolism occurrence was higher in patients with acromegaly (66%) compared with patients with gigantism (16%). Concentrations of IGF-I were significantly (Pgigantism who have cardiac abnormalities than in those without cardiac abnormalities. In conclusion, our data suggest that GH/IGF-I excess in young adult patients is associated with morphologic and functional cardiac abnormalities that are similar in patients with gigantism and in patients with acromegaly, whereas occurrence of impaired glucose metabolism appears to be higher in patients with acromegaly, although patients with gigantism are exposed to GH excess for a

  12. Cardiac tamponade as an independent condition affecting the relationship between the plasma B-type natriuretic peptide levels and cardiac function. (United States)

    Minai, Kosuke; Komukai, Kimiaki; Arase, Satoshi; Nagoshi, Tomohisa; Matsuo, Seiichiro; Ogawa, Kazuo; Kayama, Yosuke; Inada, Keiichi; Tanigawa, Shin-Ichi; Takemoto, Tomoyuki; Sekiyama, Hiroshi; Date, Taro; Ogawa, Takayuki; Taniguchi, Ikuo; Yoshimura, Michihiro


    Plasma B-type natriuretic peptide (BNP) is finely regulated by the cardiac function and several extracardiac factors. Therefore, the relationship between the plasma BNP levels and the severity of heart failure sometimes seems inconsistent. The purpose of the present study was to investigate the plasma BNP levels in patients with cardiac tamponade and their changes after pericardial drainage. This study included 14 patients with cardiac tamponade who underwent pericardiocentesis. The cardiac tamponade was due to malignant diseases in 13 patients and uremia in 1 patient. The plasma BNP levels were measured before and 24-48 h after drainage. Although the patients reported severe symptoms of heart failure, their plasma BNP levels were only 71.2 ± 11.1 pg/ml before drainage. After appropriate drainage, the plasma BNP levels increased to 186.0 ± 22.5 pg/ml, which was significantly higher than that before drainage (P = 0.0002). In patients with cardiac tamponade, the plasma BNP levels were low, probably because of impaired ventricular stretching, and the levels significantly increased in response to the primary condition after drainage. This study demonstrates an additional condition that affects the relationship between the plasma BNP levels and cardiac function. If inconsistency is seen in the relationship between the plasma BNP levels and clinical signs of heart failure, the presence of cardiac tamponade should therefore be considered.

  13. Pregnancy as a cardiac stress model



    Cardiac hypertrophy occurs during pregnancy as a consequence of both volume overload and hormonal changes. Both pregnancy- and exercise-induced cardiac hypertrophy are generally thought to be similar and physiological. Despite the fact that there are shared transcriptional responses in both forms of cardiac adaptation, pregnancy results in a distinct signature of gene expression in the heart. In some cases, however, pregnancy can induce adverse cardiac events in previously healthy women witho...

  14. Bifid cardiac apex in a 25-year-old male with sudden cardiac death. (United States)

    Wu, Annie; Kay, Deborah; Fishbein, Michael C


    Although a bifid cardiac apex is common in certain marine animals, it is an uncommon finding in humans. When present, bifid cardiac apex is usually associated with other congenital heart anomalies. We present a case of bifid cardiac apex that was an incidental finding in a 25-year-old male with sudden cardiac death from combined drug toxicity. On gross examination, there was a bifid cardiac apex with a 2-cm long cleft. There were no other significant gross or microscopic abnormalities. This case represents the very rare occurrence of a bifid cardiac apex as an isolated cardiac anomaly.

  15. Discovery and progress of direct cardiac reprogramming. (United States)

    Kojima, Hidenori; Ieda, Masaki


    Cardiac disease remains a major cause of death worldwide. Direct cardiac reprogramming has emerged as a promising approach for cardiac regenerative therapy. After the discovery of MyoD, a master regulator for skeletal muscle, other single cardiac reprogramming factors (master regulators) have been sought. Discovery of cardiac reprogramming factors was inspired by the finding that multiple, but not single, transcription factors were needed to generate induced pluripotent stem cells (iPSCs) from fibroblasts. We first reported a combination of cardiac-specific transcription factors, Gata4, Mef2c, and Tbx5 (GMT), that could convert mouse fibroblasts into cardiomyocyte-like cells, which were designated as induced cardiomyocyte-like cells (iCMs). Following our first report of cardiac reprogramming, many researchers, including ourselves, demonstrated an improvement in cardiac reprogramming efficiency, in vivo direct cardiac reprogramming for heart regeneration, and cardiac reprogramming in human cells. However, cardiac reprogramming in human cells and adult fibroblasts remains inefficient, and further efforts are needed. We believe that future research elucidating epigenetic barriers and molecular mechanisms of direct cardiac reprogramming will improve the reprogramming efficiency, and that this new technology has great potential for clinical applications.

  16. Multimodality imaging to guide cardiac interventional procedures

    NARCIS (Netherlands)

    Tops, Laurens Franciscus


    In recent years, a number of new cardiac interventional procedures have been introduced. Catheter ablation procedures for atrial fibrillation (AF) have been refined and are now considered a good treatment option in patients with drug-refractory AF. In cardiac pacing, cardiac resynchronization therap

  17. Regulation of Cardiac Hypertrophy: the nuclear option

    NARCIS (Netherlands)

    D.W.D. Kuster (Diederik)


    textabstractCardiac hypertrophy is the response of the heart to an increased workload. After myocardial infarction (MI) the surviving muscle tissue has to work harder to maintain cardiac output. This sustained increase in workload leads to cardiac hypertrophy. Despite its apparent appropriateness, c

  18. Cardiac manifestations of myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Vissing, John; Witting, Nanna;


    To estimate the degree of cardiac involvement regarding left ventricular ejection fraction, conduction abnormalities, arrhythmia, risk of sudden cardiac death (SCD) and the associations between cardiac involvement and cytosine-thymine-guanine (CTG)-repeat, neuromuscular involvement, age and gende...... in patients with myotonic dystrophy type 1 (MD1)....

  19. Cardiac anatomy and physiology: a review. (United States)

    Gavaghan, M


    This article reviews the normal anatomy and physiology of the heart. Understanding the normal anatomic and physiologic relationships described in this article will help perioperative nurses care for patients who are undergoing cardiac procedures. Such knowledge also assists nurses in educating patients about cardiac procedures and about activities that can prevent, reverse, or improve cardiac illness.

  20. Supersymmetric Berry index

    CERN Document Server

    Ilinskii, K N; Melezhik, V S; Ilinski, K N; Kalinin, G V; Melezhik, V V


    We revise the sequences of SUSY for a cyclic adiabatic evolution governed by the supersymmetric quantum mechanical Hamiltonian. The condition (supersymmetric adiabatic evolution) under which the supersymmetric reductions of Berry (nondegenerated case) or Wilczek-Zee (degenerated case) phases of superpartners are taking place is pointed out. The analogue of Witten index (supersymmetric Berry index) is determined. As the examples of suggested concept of supersymmetric adiabatic evolution the Holomorphic quantum mechanics on complex plane and Meromorphic quantum mechanics on Riemann surface are considered. The supersymmetric Berry indexes for the models are calculated.

  1. Glycemic index and disease. (United States)

    Pi-Sunyer, F Xavier


    It has been suggested that foods with a high glycemic index are detrimental to health and that healthy people should be told to avoid these foods. This paper takes the position that not enough valid scientific data are available to launch a public health campaign to disseminate such a recommendation. This paper explores the glycemic index and its validity and discusses the effect of postprandial glucose and insulin responses on food intake, obesity, type 1 diabetes, and cardiovascular disease. Presented herein are the reasons why it is premature to recommend that the general population avoid foods with a high glycemic index.

  2. Primary cardiac B-cell lymphoma with atrioventricular block and paroxysmal ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Chen Ke-Wei


    Full Text Available Abstract Primary cardiac lymphoma (PCL is very rare, and is extremely challenging to diagnose due to nonspecific symptoms. When discovered, the right atrium and ventricle are most commonly affected, while diffuse cardiac involvement is uncommon. PCL is fatal unless promptly diagnosed and treated. Herein, we present the case of a 36-year-old immunocompetent male who presented with a 5-year history of non-specific chest symptoms and was diagnosed with primary diffuse cardiac large B-cell lymphoma involving the entire heart.

  3. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

    Directory of Open Access Journals (Sweden)

    Sankalp Dwivedi


    Full Text Available Central venous catheter (CVC insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ central venous catheter (CVC insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

  4. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign. (United States)

    Dwivedi, Sankalp; Siddiqui, Fayez; Patel, Milan; Cardozo, Shaun


    Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

  5. Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

    LENUS (Irish Health Repository)

    O'Donnell, David H


    OBJECTIVE: This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. CONCLUSION: Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.

  6. Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function. (United States)

    Hurwitz, Barry E; Coryell, Virginia T; Parker, Meela; Martin, Pedro; Laperriere, Arthur; Klimas, Nancy G; Sfakianakis, George N; Bilsker, Martin S


    The study examined whether deficits in cardiac output and blood volume in a CFS (chronic fatigue syndrome) cohort were present and linked to illness severity and sedentary lifestyle. Follow-up analyses assessed whether differences in cardiac output levels between CFS and control groups were corrected by controlling for cardiac contractility and TBV (total blood volume). The 146 participants were subdivided into two CFS groups based on symptom severity data, severe (n=30) and non-severe (n=26), and two healthy non-CFS control groups based on physical activity, sedentary (n=58) and non-sedentary (n=32). Controls were matched to CFS participants using age, gender, ethnicity and body mass. Echocardiographic measures indicated that the severe CFS participants had 10.2% lower cardiac volume (i.e. stroke index and end-diastolic volume) and 25.1% lower contractility (velocity of circumferential shortening corrected by heart rate) than the control groups. Dual tag blood volume assessments indicated that the CFS groups had lower TBV, PV (plasma volume) and RBCV (red blood cell volume) than control groups. Of the CFS subjects with a TBV deficit (i.e. > or = 8% below ideal levels), the mean+/-S.D. percentage deficit in TBV, PV and RBCV were -15.4+/-4.0, -13.2+/-5.0 and -19.1+/-6.3% respectively. Lower cardiac volume levels in CFS were substantially corrected by controlling for prevailing TBV deficits, but were not affected by controlling for cardiac contractility levels. Analyses indicated that the TBV deficit explained 91-94% of the group differences in cardiac volume indices. Group differences in cardiac structure were offsetting and, hence, no differences emerged for left ventricular mass index. Therefore the findings indicate that lower cardiac volume levels, displayed primarily by subjects with severe CFS, were not linked to diminished cardiac contractility levels, but were probably a consequence of a co-morbid hypovolaemic condition. Further study is needed to address

  7. Increased in vivo mitochondrial oxygenation with right ventricular failure induced by pulmonary arterial hypertension: Mitochondrial inhibition as driver of cardiac failure?

    NARCIS (Netherlands)

    G.M. Balestra (Gianmarco); E.G. Mik (Egbert); O. Eerbeek (Otto); P. Specht (Patricia); W.J. van der Laarse (Willem J.); C.J. Zuurbier (Coert J.)


    textabstractBackground: The leading cause of mortality due to pulmonary arterial hypertension (PAH) is failure of the cardiac right ventricle. It has long been hypothesized that during the development of chronic cardiac failure the heart becomes energy deprived, possibly due to shortage of oxygen at

  8. Molecular therapies for cardiac arrhythmias

    NARCIS (Netherlands)

    Boink, G.J.J.


    Despite the ongoing advances in pharmacology, devices and surgical approaches to treat heart rhythm disturbances, arrhythmias are still a significant cause of death and morbidity. With the introduction of gene and cell therapy, new avenues have arrived for the local modulation of cardiac disease. Th

  9. The cardiac patient in Ramadan. (United States)

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan


    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting.

  10. Thoracocentesis in cardiac surgery patients. (United States)

    Wickbom, Anders; Cha, Soon Ok; Ahlsson, Anders


    Pleural effusion following cardiac surgery is a common complication that sometimes requires invasive treatment. Conventional methods for evacuation include needle aspiration and chest tube insertion. We present an effective, easy and potentially time-saving method of thoracocentesis, using a single-lumen central venous catheter.

  11. Cardiac leiomyosarcoma, a case report

    DEFF Research Database (Denmark)

    Andersen, Rikke; Kristensen, Bjarne W; Gill, Sabine


    In this case report we present the history of a patient admitted with recurrent pulmonary edema. Transesophageal chocardiography showed a tumour in the left atrium, occluding the ostium of the mitral valve and mimicking intermittent mitral stenosis. Cardiac surgery followed by pathological...

  12. Cardiac connexins and impulse propagation

    NARCIS (Netherlands)

    J.A. Jansen; T.A.B. van Veen; J.M.T. de Bakker; H.V.M. van Rijen


    Gap junctions form the intercellular pathway for cell-to-cell transmission of the cardiac impulse from its site of origin, the sinoatrial node, along the atria, the atrioventricular conduction system to the ventricular myocardium. The component parts of gap junctions are proteins called connexins (C

  13. [Acute cardiac failure in pheochromocytoma.

    DEFF Research Database (Denmark)

    Jønler, Morten; Munk, Kim


    Pheochromocytoma (P) is an endocrine catecholamine-secreting tumor. Classical symptoms like hypertension, attacks of sweating, palpitations, headache and palor are related to catecholamine discharge. We provide a case of P in a 71 year-old man presenting with acute cardiac failure, severe reduction...

  14. Cardiac resynchronization therapy in China

    Institute of Scientific and Technical Information of China (English)

    Wei HUA


    @@ Congestive heart failure (HF) is a major and growing public health problem. The therapeutic approach includes non-pharmacological measures, pharmacological therapy,mechanical devices, and surgery. Despite the benefits of optimal pharmacologic therapy, the prognosis is still not ideal. At this time, cardiac resynchronization therapy (CRT)has gained wide acceptance as an alternative treatment for HF patients with conduction delay.1

  15. Cardiac abnormalities after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Bilt, I.A.C. van der


    Aneurysmal subarachnoid hemorrhage(aSAH) is a devastating neurological disease. During the course of the aSAH several neurological and medical complications may occur. Cardiac abnormalities after aSAH are observed often and resemble stress cardiomyopathy or Tako-tsubo cardiomyopathy(Broken Heart Syn

  16. Response to cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Schiffer, Angélique A; Widdershoven, Jos W


    Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders...

  17. Paracrine Effects of Adipose-Derived Stem Cells on Matrix Stiffness-Induced Cardiac Myofibroblast Differentiation via Angiotensin II Type 1 Receptor and Smad7 (United States)

    Yong, Kar Wey; Li, Yuhui; Liu, Fusheng; Bin Gao; Lu, Tian Jian; Wan Abas, Wan Abu Bakar; Wan Safwani, Wan Kamarul Zaman; Pingguan-Murphy, Belinda; Ma, Yufei; Xu, Feng; Huang, Guoyou


    Human mesenchymal stem cells (hMSCs) hold great promise in cardiac fibrosis therapy, due to their potential ability of inhibiting cardiac myofibroblast differentiation (a hallmark of cardiac fibrosis). However, the mechanism involved in their effects remains elusive. To explore this, it is necessary to develop an in vitro cardiac fibrosis model that incorporates pore size and native tissue-mimicking matrix stiffness, which may regulate cardiac myofibroblast differentiation. In the present study, collagen coated polyacrylamide hydrogel substrates were fabricated, in which the pore size was adjusted without altering the matrix stiffness. Stiffness is shown to regulate cardiac myofibroblast differentiation independently of pore size. Substrate at a stiffness of 30 kPa, which mimics the stiffness of native fibrotic cardiac tissue, was found to induce cardiac myofibroblast differentiation to create in vitro cardiac fibrosis model. Conditioned medium of hMSCs was applied to the model to determine its role and inhibitory mechanism on cardiac myofibroblast differentiation. It was found that hMSCs secrete hepatocyte growth factor (HGF) to inhibit cardiac myofibroblast differentiation via downregulation of angiotensin II type 1 receptor (AT1R) and upregulation of Smad7. These findings would aid in establishment of the therapeutic use of hMSCs in cardiac fibrosis therapy in future. PMID:27703175

  18. Molecular Modeling of Cardiac Troponin (United States)

    Manning, Edward P.

    The cardiac thin filament regulates interactions of actin and myosin, the force-generating elements of muscular contraction. Over the past several decades many details have been discovered regarding the structure and function of the cardiac thin filament and its components, including cardiac troponin (cTn). My hypothesis is that signal propagation occurs between distant ends of the cardiac troponin complex through calcium-dependent alterations in the dynamics of cTn and tropomyosin (Tm). I propose a model of the thin filament that encompasses known structures of cTn, Tm and actin to gain insight into cardiac troponin's allosteric regulation of thin filament dynamics. By performing molecular dynamics simulations of cTn in conjunction with overlapping Tm in two conditions, with and without calcium bound to site II of cardiac troponin C (cTnC), I found a combination of calcium-dependent changes in secondary structure and dynamics throughout the cTn-Tm complex. I then applied this model to investigate familial hypertrophic cardiomyopathy (FHC), a disease of the sarcomere that is one of the most commonly occurring genetic causes of heart disease. Approximately 15% of known FHC-related mutations are found in cardiac troponin T (cTnT), most of which are in or flank the alpha-helical N-tail domain TNT1. TNT1 directly interacts with overlapping Tm coiled coils. Using this model I identified effects of TNT1 mutations that propagate to the cTn core where site II of cTnC, the regulatory site of calcium binding in the thin filament, is located. Specifically, I found that mutations in TNT1 alter the flexibility of TNT1 and that the flexibility of TNT1 is inversely proportional to the cooperativity of calcium activation of the thin filament. Further, I identified a pathway of propagation of structural and dynamic changes linking TNT1 to site II of cTnC. Mutation-induced changes at site II cTnC alter calcium coordination which corresponds to biophysical measurements of calcium

  19. Prospective surveillance for cardiac adverse events in healthy adults receiving modified vaccinia Ankara vaccines: a systematic review.

    Directory of Open Access Journals (Sweden)

    Marnie L Elizaga

    Full Text Available BACKGROUND: Vaccinia-associated myo/pericarditis was observed during the US smallpox vaccination (DryVax campaign initiated in 2002. A highly-attenuated vaccinia strain, modified vaccinia Ankara (MVA has been evaluated in clinical trials as a safer alternative to DryVax and as a vector for recombinant vaccines. Due to the lack of prospectively collected cardiac safety data, the US Food and Drug Administration required cardiac screening and surveillance in all clinical trials of MVA since 2004. Here, we report cardiac safety surveillance from 6 phase I trials of MVA vaccines. METHODS: Four clinical research organizations contributed cardiac safety data using common surveillance methods in trials administering MVA or recombinant MVA vaccines to healthy participants. 'Routine cardiac investigations' (ECGs and cardiac enzymes obtained 2 weeks after injections of MVA or MVA-HIV recombinants, or placebo-controls, and 'Symptom-driven cardiac investigations' are reported. The outcome measure is the number of participants who met the CDC-case definition for vaccinia-related myo/pericarditis or who experienced cardiac adverse events from an MVA vaccine. RESULTS: Four hundred twenty-five study participants had post-vaccination safety data analyzed, 382 received at least one MVA-containing vaccine and 43 received placebo; 717 routine ECGs and 930 cardiac troponin assays were performed. Forty-five MVA recipients (12% had additional cardiac testing performed; 22 for cardiac symptoms, 19 for ECG/laboratory changes, and 4 for cardiac symptoms with an ECG/laboratory change. No participant had evidence of symptomatic or asymptomatic myo/pericarditis meeting the CDC-case definition and judged to be related to an MVA vaccine. CONCLUSIONS: Prospective surveillance of MVA recipients for myo/pericarditis did not detect cardiac adverse reactions in 382 study participants. TRIAL REGISTRATION: NCT00082446 NCT003766090 NCT00252148 NCT00083603

  20. Fibrinolytic therapy for thrombosis in cardiac valvular prosthesis short and long term results

    Directory of Open Access Journals (Sweden)

    Auristela I. O. Ramos


    Full Text Available OBJECTIVE: To assess the short- and long-term results of the use of streptokinase (SK for the treatment of thromboses in cardiac valvular prostheses. METHODS: Seventeen patients with cardiac prosthetic thrombosis diagnosed by clinical, echocardiographic, and radioscopic findings underwent fibrinolytic treatment with a streptokinase bolus of 250,000 U followed by 100.000 U/hour. Short- and long-term results were assessed by radioscopy and echocardiography. RESULTS: Of the 17 patients, 12 had mechanical double-disk prostheses (4 aortic, 6 mitral, 2 tricuspid, 4 had single-disk prostheses (2 aortic, 1 mitral, and 1 tricuspid, and 1 had a tricuspid bioprosthesis. The success rate was 64.8%, the partial success rate was 17.6%, and the nonsuccess rate was 17.6%. All patients with a double-disk prosthesis responded, completely or partially, to the treatment. None of the patients with a single-disk prosthesis had complete resolution of the thrombosis. The time of streptokinase infusion ranged from 6 to 80 hours (mean of 56 h. The mortality rate due to the use of streptokinase was 5.8% and was secondary to cerebral bleeding. During streptokinase infusion, 3 (17.6% embolic episodes occurred as follows: 1 cerebral, 1 peripheral, and 1 coronary. The rethrombosis index was 33% in a mean follow-up of 42 months. CONCLUSION: The use of fibrinolytic agents was effective and relatively safe in patients with primary thrombosis of a double-disk prosthesis. A fatal hemorrhagic complication occurred in 1 (5.8% patient, and embolic complications occurred in 3 (17.6% patients. In a mean 42-month follow-up, 67% of the patients were free from rethrombosis.

  1. Index of Glossary Terms (United States)

    ... be limited. Home Visit Global Sites Search Help? Index of Glossary Terms Share this page: Was this ... Serum Serum Sickness Shock Shwachman-Diamond Syndrome Sideroblastic Anemia Sigmoidoscopy Sign Somatic Cells Specificity Spina bifida Spirochete ...

  2. Arizona - Social Vulnerability Index (United States)

    U.S. Environmental Protection Agency — The Social Vulnerability Index is derived from the 2000 US Census data. The fields included are percent minority, median household income, age (under 18 and over...

  3. National Death Index (United States)

    U.S. Department of Health & Human Services — The National Death Index (NDI) is a centralized database of death record information on file in state vital statistics offices. Working with these state offices, the...

  4. Textile Index Monitor

    Institute of Scientific and Technical Information of China (English)


    Textile Index Monitor is a new column that delivers a textile-specific price index profile in weeks that are bygone when this monthly magazine comes to your hand. China Textile City is the name of the world-largest yarn&fabric marketplace in the famous town of Keqiao in Zhejiang,China.Several years ago,Ministry of Commerce(MOC)set up a national price index centre for textiles-specific category,China Textile City takes the leading role in publishing its analytical report of textile price index on weekly,monthly,quarterly and yearly basis,making it possible for Keqiao or its textile city to be the weathercock for textiles market trend in China and in the world as well.From this issue,a new column is given to cover the gist&feeds of the latest developments&gradients in this market barometer.

  5. TOMS Absorbing Aerosol Index (United States)

    Washington University St Louis — TOMS_AI_G is an aerosol related dataset derived from the Total Ozone Monitoring Satellite (TOMS) Sensor. The TOMS aerosol index arises from absorbing aerosols such...

  6. Palmer Drought Severity Index (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — PDSI from the Dai dataset. The Palmer Drought Severity Index (PDSI) is devised by Palmer (1965) to represent the severity of dry and wet spells over the U.S. based...

  7. Regional Snowfall Index (RSI) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA's National Climatic Data Center is now producing the Regional Snowfall Index (RSI) for significant snowstorms that impact the eastern two thirds of the U.S. The...

  8. Topographic Accessability Index (United States)

    U.S. Geological Survey, Department of the Interior — The topographic accessibility index is a measure of elevation in relation to valley floor corrected for variation in valley floor elevation across the western United...

  9. ParkIndex

    DEFF Research Database (Denmark)

    Kaczynski, Andrew T; Schipperijn, Jasper; Hipp, J Aaron


    A lack of comprehensive and standardized metrics for measuring park exposure limits park-related research and health promotion efforts. This study aimed to develop and demonstrate an empirically-derived and spatially-represented index of park access (ParkIndex) that would allow researchers......, planners, and citizens to evaluate the potential for park use for a given area. Data used for developing ParkIndex were collected in 2010 in Kansas City, Missouri (KCMO). Adult study participants (n=891) reported whether they used a park within the past month, and all parks in KCMO were mapped and audited...... using ArcGIS 9.3 and the Community Park Audit Tool. Four park summary variables - distance to nearest park, and the number of parks, amount of park space, and average park quality index within 1 mile were analyzed in relation to park use using logistic regression. Coefficients for significant park...

  10. [Cardiac rehabilitation in patients with atrial fibrillation]. (United States)

    Schlitt, Axel; Kamke, Wolfram; Guha, Manju; Haberecht, Olaf; Völler, Heinz


    The course of cardiac rehabilitation is often altered due to episodes of paroxysmal, predominantly postoperative atrial fibrillation. In symptomatic patients, a TEE-guided cardioversion - preferential DC shock - is indicated. In patients with persistent / permanent atrial fibrillation, a heart rate up to 110 / min and 170 / min at rest and during physical activity should, respectively, be tolerated. Therefore, training should not be quitted by heart rate but rather by load. The antithrombotic management is in addition a great task in treating patients with atrial fibrillation. With the exception of patients with a CHA2DS2-VASc-Score < 1, oral anticoagulation is indicated. Atrial fibrillation has little impact on social aspects, whereas the underlying heart disease and drug treatment (oral anticoagulation) has an important impact.

  11. Management and outcome of cardiac and endovascular cystic echinococcosis.

    Directory of Open Access Journals (Sweden)

    Marta Díaz-Menéndez


    Full Text Available BACKGROUND: Cystic echinococcosis (CE can affect the heart and the vena cava but few cases are reported. METHODS: A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995-2009 is reported. RESULTS: Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4-93 months. One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications. CONCLUSIONS: Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.

  12. Can cardiac surgery cause hypopituitarism? (United States)

    Francis, Flverly; Burger, Ines; Poll, Eva Maria; Reineke, Andrea; Strasburger, Christian J; Dohmen, Guido; Gilsbach, Joachim M; Kreitschmann-Andermahr, Ilonka


    Apoplexy of pituitary adenomas with subsequent hypopituitarism is a rare but well recognized complication following cardiac surgery. The nature of cardiac on-pump surgery provides a risk of damage to the pituitary because the vascular supply of the pituitary is not included in the cerebral autoregulation. Thus, pituitary tissue may exhibit an increased susceptibility to hypoperfusion, ischemia or intraoperative embolism. After on-pump procedures, patients often present with physical and psychosocial impairments which resemble symptoms of hypopituitarism. Therefore, we analyzed whether on-pump cardiac surgery may cause pituitary dysfunction also in the absence of pre-existing pituitary disease. Twenty-five patients were examined 3-12 months after on-pump cardiac surgery. Basal hormone levels for all four anterior pituitary hormone axes were measured and a short synacthen test and a growth hormone releasing hormone plus arginine (GHRH-ARG)-test were performed. Quality of life (QoL), depression, subjective distress for a specific life event, sleep quality and fatigue were assessed by means of self-rating questionnaires. Hormonal alterations were only slight and no signs of anterior hypopituitarism were found except for an insufficient growth hormone rise in two overweight patients in the GHRH-ARG-test. Psychosocial impairment was pronounced, including symptoms of moderate to severe depression in 9, reduced mental QoL in 8, dysfunctional coping in 6 and pronounced sleep disturbances in 16 patients. Hormone levels did not correlate with psychosocial impairment. On-pump cardiac surgery did not cause relevant hypopituitarism in our sample of patients and does not serve to explain the psychosocial symptoms of these patients.

  13. Cardiac energetics: sense and nonsense. (United States)

    Gibbs, Colin L


    1. The background to current ideas in cardiac energetics is outlined and, in the genomic era, the need is stressed for detailed knowledge of mouse heart mechanics and energetics. 2. The mouse heart is clearly different to the rat in terms of its excitation-contraction (EC) coupling and the common assumption that heart rate difference between mice and humans will account for the eightfold difference in myocardial oxygen consumption is wrong, because the energy per beat of the mouse heart is approximately one-third that of the human heart. 3. In vivo evidence suggests that there may well be an eightfold species difference in the non-beating metabolism of mice and human hearts. It is speculated that the magnitude of basal metabolism in the heart is regulatable and that, in the absence of perfusion, it falls to approximately one-quarter of its in vivo rate and that in clinical conditions, such as hibernation, it probably decreases; its magnitude may be controlled by the endothelium. 4. The active energy balance sheet is briefly discussed and it is suggested that the activation heat accounts for 20-25% of the active energy per beat and cross-bridge turnover accounts for the balance. It is argued that force, not shortening, is the major determinant of cardiac energy usage. 5. The outcome of recent cardiac modelling with variants of the Huxley and Hill/Eisenberg models is described. It has been necessary to invoke 'loose coupling' to replicate the low cardiac energy flux measured at low afterloads (medium to high velocities of shortening). 6. Lastly, some of the unexplained or 'nonsense' energetic data are outlined and eight unsolved problems in cardiac energetics are discussed.

  14. Index Conditions of Resolution

    Institute of Scientific and Technical Information of China (English)

    Xiao-Chun Cheng


    In this paper, the following results are proved: (1) Using both deletion strategy and lock strategy, resolution is complete for a clause set where literals with the same predicate or proposition symbol have the same index. (2) Using deletion strategy, both positive unit lock resolution and input lock resolution are complete for a Horn set where the indexes of positive literals are greater than those of negative literals. (3) Using deletion strategy, input half-lock resolution is complete for a Horn set.

  15. Nudibranch Systematic Index



    This is an index of my approximately 6,200 nudibranch reprints and books. I have indexed them only for information concerning systematics, taxonomy, nomenclature, & description of taxa. This list should allow you to quickly find information concerning the description, taxonomy, or systematics of almost any species of nudibranch. The full citation for any of the authors and dates listed may be found in the nudibranch bibliography at

  16. Index of Financial Inclusion


    Mandira Sarma


    The promotion of an inclusive financial system is considered a policy priority in many countries. While the importance of financial inclusion is widely recognized, the literature lacks a comprehensive measure that can be used to measure the extent of financial inclusion across economies. This paper attempts to fill this gap by proposing an index of financial inclusion (IFI). The IFI is a multi-dimensional index that captures information on various dimensions of financial inclusion in one sing...

  17. Hemorrhagic Cardiac Tamponade: Rare Complication of Radiofrequency Ablation of Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Loh, Kok Beng; Bux, Shaik Ismail; Abdullah, Basri Johan Jeet; Mokhtar, Raja Amin Raja; Mohamed, Rosmawati [Faculty of Medicine, University of Malaya, Kuala Lumpur (Malaysia)


    Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.

  18. Functional cardiomyocytes derived from Isl1 cardiac progenitors via Bmp4 stimulation.

    Directory of Open Access Journals (Sweden)

    Esra Cagavi

    Full Text Available As heart failure due to myocardial infarction remains a leading cause of morbidity worldwide, cell-based cardiac regenerative therapy using cardiac progenitor cells (CPCs could provide a potential treatment for the repair of injured myocardium. As adult CPCs may have limitations regarding tissue accessibility and proliferative ability, CPCs derived from embryonic stem cells (ESCs could serve as an unlimited source of cells with high proliferative ability. As one of the CPCs that can be derived from embryonic stem cells, Isl1 expressing cardiac progenitor cells (Isl1-CPCs may serve as a valuable source of cells for cardiac repair due to their high cardiac differentiation potential and authentic cardiac origin. In order to generate an unlimited number of Isl1-CPCs, we used a previously established an ESC line that allows for isolation of Isl1-CPCs by green fluorescent protein (GFP expression that is directed by the mef2c gene, specifically expressed in the Isl1 domain of the anterior heart field. To improve the efficiency of cardiac differentiation of Isl1-CPCs, we studied the role of Bmp4 in cardiogenesis of Isl1-CPCs. We show an inductive role of Bmp directly on cardiac progenitors and its enhancement on early cardiac differentiation of CPCs. Upon induction of Bmp4 to Isl1-CPCs during differentiation, the cTnT+ cardiomyocyte population was enhanced 2.8±0.4 fold for Bmp4 treated CPC cultures compared to that detected for vehicle treated cultures. Both Bmp4 treated and untreated cardiomyocytes exhibit proper electrophysiological and calcium signaling properties. In addition, we observed a significant increase in Tbx5 and Tbx20 expression in differentiation cultures treated with Bmp4 compared to the untreated control, suggesting a link between Bmp4 and Tbx genes which may contribute to the enhanced cardiac differentiation in Bmp4 treated cultures. Collectively these findings suggest a cardiomyogenic role for Bmp4 directly on a pure population of

  19. The Cause and Mechanism of Cardiac Electrical Instability. Defibrillation Mechanism

    Directory of Open Access Journals (Sweden)

    Rustam G. Habchabov


    Full Text Available The reason for the ominous arrhythmias pathway, causing sudden somatic death from cardiovascular diseases is still not clear, cardiological examinations of this phenomenon are conducted throughout the world. Laceration of connective insulating tissue membrane of heart pathway with ectopic nodes oxidation may cause ominous arrhythmias; nobody has considered this cause as a cardiac electrical instability before. Defibrillator electric discharges cannot penetrate into myocardium due to the connective insulating tissue membrane, nobody has considered nervous system, transmitting electricity.

  20. Cardiac ion channels and mechanisms for protection against atrial fibrillation

    DEFF Research Database (Denmark)

    Grunnet, Morten; Bentzen, Bo Hjorth; Sørensen, Ulrik S;


    Atrial fibrillation (AF) is recognised as the most common sustained cardiac arrhythmia in clinical practice. Ongoing drug development is aiming at obtaining atrial specific effects in order to prevent pro-arrhythmic, devastating ventricular effects. In principle, this is possible due to a different...... to the recent discovery that Ca(2+)-activated small conductance K(+) channels (SK channels) are important for the repolarisation of atrial action potentials. Finally, an overview of current pharmacological treatment of AF is included....

  1. Due process traditionalism. (United States)

    Sunstein, Cass R


    In important cases, the Supreme Court has limited the scope of "substantive due process" by reference to tradition, but it has yet to explain why it has done so. Due process traditionalism might be defended in several distinctive ways. The most ambitious defense draws on a set of ideas associated with Edmund Burke and Friedrich Hayek, who suggested that traditions have special credentials by virtue of their acceptance by many minds. But this defense runs into three problems. Those who have participated in a tradition may not have accepted any relevant proposition; they might suffer from a systematic bias; and they might have joined a cascade. An alternative defense sees due process traditionalism as a second-best substitute for two preferable alternatives: a purely procedural approach to the Due Process Clause, and an approach that gives legislatures the benefit of every reasonable doubt. But it is not clear that in these domains, the first-best approaches are especially attractive; and even if they are, the second-best may be an unacceptably crude substitute. The most plausible defense of due process traditionalism operates on rule-consequentialist grounds, with the suggestion that even if traditions are not great, they are often good, and judges do best if they defer to traditions rather than attempting to specify the content of "liberty" on their own. But the rule-consequentialist defense depends on controversial and probably false assumptions about the likely goodness of traditions and the institutional incapacities of judges.

  2. Isolation, Characterization, and Transplantation of Cardiac Endothelial Cells

    Directory of Open Access Journals (Sweden)

    Busadee Pratumvinit


    due to difficulties in isolation, cell heterogeneity, lack of specific markers to identify myocardial endothelial cells, and inadequate conditions to maintain long-term cultures. Herein, we developed a method for isolation, characterization, and expansion of cardiac endothelial cells applicable to study endothelial cell biology and clinical applications such as neoangiogenesis. First, we dissociated the cells from murine heart by mechanical disaggregation and enzymatic digestion. Then, we used flow cytometry coupled with specific markers to isolate endothelial cells from murine hearts. CD45+ cells were gated out to eliminate the hematopoietic cells. CD31+/Sca-1+ cells were isolated as endothelial cells. Cells isolated from atrium grew faster than those from ventricle. Cardiac endothelial cells maintain endothelial cell function such as vascular tube formation and acetylated-LDL uptake in vitro. Finally, cardiac endothelial cells formed microvessels in dorsal matrigel plug and engrafted in cardiac microvessels following intravenous and intra-arterial injections. In conclusion, our multicolor flow cytometry method is an effective method to analyze and purify endothelial cells from murine heart, which in turn can be ex vivo expanded to study the biology of endothelial cells or for clinical applications such as therapeutic angiogenesis.

  3. The articulo-cardiac sympathetic reflex in spinalized, anesthetized rats. (United States)

    Nakayama, Tomohiro; Suzuki, Atsuko; Ito, Ryuzo


    Somatic afferent regulation of heart rate by noxious knee joint stimulation has been proven in anesthetized cats to be a reflex response whose reflex center is in the brain and whose efferent arc is a cardiac sympathetic nerve. In the present study we examined whether articular stimulation could influence heart rate by this efferent sympathetic pathway in spinalized rats. In central nervous system (CNS)-intact rats, noxious articular movement of either the knee or elbow joint resulted in an increase in cardiac sympathetic nerve activity and heart rate. However, although in acutely spinalized rats a noxious movement of the elbow joint resulted in a significant increase in cardiac sympathetic nerve activity and heart rate, a noxious movement of the knee joint had no such effect and resulted in only a marginal increase in heart rate. Because this marginal increase was abolished by adrenalectomy suggests that it was due to the release of adrenal catecholamines. In conclusion, the spinal cord appears to be capable of mediating, by way of cardiac sympathetic nerves, the propriospinally induced reflex increase in heart rate that follows noxious stimulation of the elbow joint, but not the knee joint.

  4. AVE 0991 attenuates cardiac hypertrophy through reducing oxidative stress. (United States)

    Ma, Yuedong; Huang, Huiling; Jiang, Jingzhou; Wu, Lingling; Lin, Chunxi; Tang, Anli; Dai, Gang; He, Jiangui; Chen, Yili


    AVE 0991, the nonpeptide angiotensin-(1-7) (Ang-(1-7)) analog, is recognized as having beneficial cardiovascular effects. However, the mechanisms have not been fully elucidated. This study was designed to investigate the effects of AVE 0991 on cardiac hypertrophy and the mechanisms involved. Mice were underwent aortic banding to induce cardiac hypertrophy followed by the administration of AVE 0991 (20 mg kg·day (-1)) for 4 weeks. It was shown that AVE 0991 reduced left ventricular hypertrophy and improved heart function, characterized by decreases in left ventricular weight and left ventricular end-diastolic diameter, and increases in ejection fraction. Moreover, AVE 0991 significantly down-regulated mean myocyte diameter and attenuate the gene expression of the hypertrophic markers. Furthermore, AVE 0991 inhibited the expression of NOX 2 and NOX 4, meaning that AVE 0991 reduced oxidative stress of cardiac hypertrophy mice. Our data showed that AVE 0991 treatment could attenuate cardiac hypertrophy and improve heart function, which may be due to reduce oxidative stress.

  5. Study on clinical symptoms in canine cardiac diseases

    Directory of Open Access Journals (Sweden)

    F. Karlette Anne

    Full Text Available Cardiac diseases in canines are an extensively studied phenomenon all over the world but meagre information has been reported in India. Certain problems, including historical, physical, and laboratory abnormalities, are associated with cardiovascular or pulmonary disease. In India however, the recognition of canine cardiac diseases has been delayed, and ignored on account of lack of awareness and knowledge by the owner and inadequate diagnostic facility to a field veterinarian. Considering the above facts, the present study was undertaken in Gujarat to survey the prevalence of common cardiac diseases in hospital population of dogs along with the clinical symptoms which often goes undetected due to lack of proper diagnostic techniques to be implied and the most forms of heart disease may be present for many years before any evidence of failure develops. In the present study most of the clinical cases of cardiac diseases were presented with a history of nocturnal coughing (seven cases; 2.55%, exercise intolerance (five cases; 1.82%, partial or complete anorexia (five cases; 1.82%, swelling in abdominal area (four cases; 1.45%, dullness and depression (two cases; 0.72%, cachexia and hepatojugular pulsation (one case each; 0.36% each at times. [Vet World 2009; 2(8.000: 307-309

  6. Fabrication and characterization of bio-engineered cardiac pseudo tissues

    Energy Technology Data Exchange (ETDEWEB)

    Xu Tao; Boland, Thomas [Department of Bioengineering, 420 Rhodes Hall, Clemson University, Clemson, SC 29634 (United States); Baicu, Catalin; Aho, Michael; Zile, Michael, E-mail: tboland@clemson.ed [Department of Medicine, Medical University of South Carolina, Charleston, SC 29425 (United States)


    We report on fabricating functional three-dimensional (3D) tissue constructs using an inkjet based bio-prototyping method. With the use of modified inkjet printers, contractile cardiac hybrids that exhibit the forms of the 3D rectangular sheet and even the 'half heart' (with two connected ventricles) have been fabricated by arranging alternate layers of biocompatible alginate hydrogels and mammalian cardiac cells according to pre-designed 3D patterns. In this study, primary feline adult and H1 cardiomyocytes were used as model cardiac cells. Alginate hydrogels with controlled micro-shell structures were built by spraying cross-linkers in micro-drops onto un-gelled alginic acid. The cells remained viable in constructs as thick as 1 cm due to the programmed porosity. Microscopic and macroscopic contractile functions of these cardiomyocyte constructs were observed in vitro. These results suggest that the inkjet bio-prototyping method could be used for hierarchical design of functional cardiac pseudo tissues, balanced with porosity for mass transport and structural support.

  7. Capsule endoscopy in patients with cardiac pacemakers, implantable cardioverter defibrillators and left heart assist devices. (United States)

    Bandorski, Dirk; Höltgen, Reinhard; Stunder, Dominik; Keuchel, Martin


    According to the recommendations of the US Food and Drug Administration and manufacturers, capsule endoscopy should not be used in patients carrying implanted cardiac devices. For this review we considered studies indexed (until 30.06.2013) in Medline [keywords: capsule endoscopy, small bowel endoscopy, cardiac pacemaker, implantable cardioverter defibrillator, interference, left heart assist device], technical information from Given Imaging and one own publication (not listed in Medline). Several in vitro and in vivo studies included patients with implanted cardiac devices who underwent capsule endoscopy. No clinically relevant interference was noticed. Initial reports on interference with a simulating device were not reproduced. Furthermore technical data of PillCam (Given Imaging) demonstrate that the maximum transmission power is below the permitted limits for cardiac devices. Hence, impairment of cardiac pacemaker, defibrillator or left ventricular heart assist device function by capsule endoscopy is not expected. However, wireless telemetry can cause dysfunction of capsule endoscopy recording. Application of capsule endoscopy is feasible and safe in patients with implanted cardiac devices such as pacemakers, cardioverter defibrillators, and left heart assist devices. Development of new technologies warrants future re-evaluation.

  8. Onycholysis due to trauma

    Directory of Open Access Journals (Sweden)

    Patricia Chang


    Full Text Available Female patient, 35 years old who came to the private office due to discoloration of her left thumbnail and little pain since 1 month ago. Clinical examination shows nail disease on her left thumbnail with onycholysis and dyschromia, dermatoscopy showed white-yellowish discoloration (Fig. 1A, B. The rest of the clinical examination was normal. Patient use to using acrylic nails since 2 years ago and denied some trauma at the nail. The diagnosis of onycholysis due to trauma was done and recommended her not to use acrylic nail, maintain the nail short and avoid wetness.

  9. Diabetes and cardiac autonomic neuropathy: Clinicalmanifestations, cardiovascular consequences, diagnosisand treatment

    Institute of Scientific and Technical Information of China (English)

    Akif Serhat Balcloglu; Haldun Müderrisoglu


    Cardiac autonomic neuropathy (CAN) is a frequentchronic complication of diabetes mellitus with potentiallylife-threatening outcomes. CAN is caused by theimpairment of the autonomic nerve fibers regulatingheart rate, cardiac output, myocardial contractility, cardiacelectrophysiology and blood vessel constriction anddilatation. It causes a wide range of cardiac disorders,including resting tachycardia, arrhythmias, intraoperativecardiovascular instability, asymptomatic myocardialischemia and infarction and increased rate of mortalityafter myocardial infarction. Etiological factors associatedwith autonomic neuropathy include insufficient glycemiccontrol, a longer period since the onset of diabetes,increased age, female sex and greater body mass index.The most commonly used methods for the diagnosisof CAN are based upon the assessment of heart ratevariability (the physiological variation in the time intervalbetween heartbeats), as it is one of the first findings inboth clinically asymptomatic and symptomatic patients.Clinical symptoms associated with CAN generally occurlate in the disease process and include early fatigue andexhaustion during exercise, orthostatic hypotension,dizziness, presyncope and syncope. Treatment is basedon early diagnosis, life style changes, optimization ofglycemic control and management of cardiovascular riskfactors. Medical therapies, including aldose reductaseinhibitors, angiotensin-converting enzyme inhibitors,prostoglandin analogs and alpha-lipoic acid, have beenfound to be effective in randomized controlled trials.The following article includes the epidemiology, clinicalfindings and cardiovascular consequences, diagnosis,and approaches to prevention and treatment of CAN.

  10. An exploratory study of cardiac health in college athletes. (United States)

    Muñoz, Laura; Norgan, Gary; Rauschhuber, Maureen; Allwein, David; Powell, Brent W; Mitchell, David; Gilliland, Irene; Beltz, Suzanne; Mahon, Marveen; Mikan, Vanessa; Cook, Jennifer; Lowry, Jolynn; Richardson, Cynthia; Sethness, Renee; Etnyre, Annette; Jones, Mary Elaine


    A common assumption is that college athletes are healthy based on their age and level of physical activity. This study used a descriptive correlational design to explore relationships and predictors of physical fitness levels among an ethnically diverse sample of 135 college athletes from a National College Athletic Association Division II university. Both subjective and objective indices of cardiac health and physical fitness level (blood pressure [BP], body mass index [BMI], waist-to-hip ratio, waist circumference, hip circumference, blood lipids, glucose, and VO(2max)) were collected. Minimal research exists with this population or with such an array of subjective and objective measures. More than one fourth of the athletes had a BMI in the overweight range, one fifth was prehypertensive, and one fourth had lower-than-recommended high-density lipoprotein (HDL) cholesterol levels. Waist circumference accounted for 21% of the variance in systolic BP level. These factors may predispose the college athletes to cardiac risk in the future when exercise regimens are reduced. Gender differences were found in all physical size variables and in physical fitness levels, with physical fitness level alone predicting gender correctly 98.5% of the time. Differences support the need to account for gender and fitness levels in cardiac risk assessment of young populations.

  11. [Drowning versus cardiac ischemia: Cardiac arrest of an 11-year-old boy at a swimming lake]. (United States)

    Födinger, A; Wöss, C; Semsroth, S; Stadlbauer, K H; Wenzel, V


    This report describes a case of sudden cardiac arrest and subsequent attempted cardiopulmonary resuscitation of an 11-year-old child on the shores of a swimming lake. Reports of eyewitnesses excluded the obviously suspected diagnosis of a drowning accident. The result of the autopsy was sudden cardiac death due to a congenital coronary anomaly (abnormal left coronary artery, ALCA). Favored by vigorous physical activity, this anomaly can lead to malignant arrhythmias because the ectopic coronary artery with its intramural course through the aortic wall is compressed during every systole. This pathology was not known to the boy or his family; in fact he liked sports but had suffered of a syncope once which was not followed up. Without a strong suspicion it is difficult to diagnose a coronary artery anomaly and it is often missed even in college athletes. Tragically, sudden cardiac arrest may be the first symptom of an undiagnosed abnormal coronary artery. Following syncope or chest pain during exercise with a normal electrocardiogram (ECG) cardiac imaging, such as computed tomography (CT) or angiography should be initiated in order to enable surgical repair of an abnormal coronary artery.

  12. Transcutaneous cervical vagal nerve stimulation modulates cardiac vagal tone and tumor necrosis factor-alpha. (United States)

    Brock, C; Brock, B; Aziz, Q; Møller, H J; Pfeiffer Jensen, M; Drewes, A M; Farmer, A D


    The vagus nerve is a central component of cholinergic anti-inflammatory pathways. We sought to evaluate the effect of bilateral transcutaneous cervical vagal nerve stimulation (t-VNS) on validated parameters of autonomic tone and cytokines in 20 healthy subjects. 24 hours after t-VNS, there was an increase in cardiac vagal tone and a reduction in tumor necrosis factor-α in comparison to baseline. No change was seen in blood pressure, cardiac sympathetic index or other cytokines. These preliminary data suggest that t-VNS exerts an autonomic and a subtle antitumor necrosis factor-α effect, which warrants further evaluation in larger controlled studies.

  13. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

    Energy Technology Data Exchange (ETDEWEB)

    El Demerdash, Salah [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Khorshid, Hazem, E-mail: [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salah, Iman; Abdel-Rahman, Mohamed A. [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salem, Alaa M. [Department of Internal Medicine, Medical Division, National Research Centre, Cairo (Egypt)


    Background: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. Aim: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. Methods: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study. Results: The mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT

  14. The Fetal Modified Myocardial Performance Index: Is Automation the Future?

    Directory of Open Access Journals (Sweden)

    Priya Maheshwari


    Full Text Available The fetal modified myocardial performance index (Mod-MPI is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1 a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2 cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3 ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed.

  15. The effects of long-term aerobic exercise on cardiac structure, stroke volume of the left ventricle, and cardiac output. (United States)

    Lee, Bo-Ae; Oh, Deuk-Ja


    The purpose of this study is to investigate the effect of the long-term aerobic exercises on cardiac structure, left ventricular stroke volume, and cardiac output. To achieve the purpose of the study, a total of 22 volunteers-including 10 people who have continued regular exercises and 12 people as the control group-were selected as subjects. With regard to data processing, the IBM SPSS Statistics ver. 21.0 was used to calculate the mean and standard deviation, and the difference of the means between the groups was verified through an independent t-test. As a result, there were significant differences between groups in the left ventricular end-diastolic internal dimension, left ventricular end-systolic internal dimension, left ventricular end-diastolic septum thickness. There were significant differences between groups in left ventricular end-diastolic volume, left ventricular mass, and left ventricular mass index per body surface area. However, in cardiac function, only left ventricular stroke volume showed a significant difference between groups.

  16. Estimating the Upcrossings Index

    CERN Document Server

    Sebastião, João Renato; Ferreira, Helena; Pereira, Luísa


    For stationary sequences, under general local and asymptotic dependence restrictions, any limiting point process for time normalized upcrossings of high levels is a compound Poisson process, i.e., there is a clustering of high upcrossings, where the underlying Poisson points represent cluster positions, and the multiplicities correspond to cluster sizes. For such classes of stationary sequences there exists the upcrossings index $\\eta,$ $0\\leq \\eta\\leq 1,$ which is directly related to the extremal index $\\theta,$ $0\\leq \\theta\\leq 1,$ for suitable high levels. In this paper we consider the problem of estimating the upcrossings index $\\eta$ for a class of stationary sequences satisfying a mild oscillation restriction. For the proposed estimator, properties such as consistency and asymptotic normality are studied. Finally, the performance of the estimator is assessed through simulation studies for autoregressive processes and case studies in the fields of environment and finance.

  17. Diet quality assessment indexes

    Directory of Open Access Journals (Sweden)

    Kênia Mara Baiocchi de Carvalho


    Full Text Available Various indices and scores based on admittedly healthy dietary patterns or food guides for the general population, or aiming at the prevention of diet-related diseases have been developed to assess diet quality. The four indices preferred by most studies are: the Diet Quality Index; the Healthy Eating Index; the Mediterranean Diet Score; and the Overall Nutritional Quality Index. Other instruments based on these indices have been developed and the words 'adapted', 'revised', or 'new version I, II or III' added to their names. Even validated indices usually find only modest associations between diet and risk of disease or death, raising questions about their limitations and the complexity associated with measuring the causal relationship between diet and health parameters. The objective of this review is to describe the main instruments used for assessing diet quality, and the applications and limitations related to their use and interpretation.

  18. [Cardiac cephalgia: an underdiagnosed condition? ]. (United States)

    Gutiérrez Morlote, Jesús; Fernández García, José M; Timiraos Fernández, Juan J; Llano Cardenal, Miguel; Llano Catedral, Miguel; Rodríguez Rodríguez, Eloy; Pascual Gómez, Julio


    Cardiac cephalgia, or headache occurring as manifestation of myocardial ischemia, has only recently been recognized as a distinct entity. In patients with known ischemic cardiopathy, its diagnosis depends on the presence of severe headache that is accompanied by nausea, worsened by physical exercise, and only ceases with nitrate administration. We report on two patients who met diagnostic criteria for this entity. In both, headache was the only symptom of coronary ischemia, and delayed its diagnosis. Headache occurred both at rest and during exertion, and resolved only after the administration of nitrates. Cardiac cephalgia should be suspected in patients with a history of ischemic cardiopathy who present with de novo headache, even when thoracic pain is absent, especially if the headache improves with nitrates. Differential diagnosis with migraine is crucial to avoid the administration of vasoconstrictors.

  19. [Cardiac toxicity of 5-fluorouracil]. (United States)

    Fournier, C; Benahmed, M; Blondeau, M


    A 67 year-old patient receives 5-fluorouracil for vocal chord cancer. During the perfusion, atypical angina pain occurs, accompanied with offset of ST above the baseline in standard leads and in V4 through V6. The pain subsides spontaneously in 45 minutes. These ECG alterations are followed 48 hours later by diffuse inverted T waves with lengthened QT. Cardiac ultrasonography and isotopic angiography do not show any abnormality of the left ventricular function, but myocardial tomoscintigraphy with labelled thallium show a lower hypofixation on exertion. The cardiac toxicity of 5-fluorouracil is in frequent. It is usually believed that it involves a coronary spasm, as suggested by the ECG tracing in the reported cases. The incident, which may be painful or painless, may result in a myocardial infarction or even sudden death during the perfusion. Therefore, it is advisable to discontinue the treatment as soon as an angina-type pain occurs.

  20. Progeria syndrome with cardiac complications. (United States)

    Ilyas, Saadia; Ilyas, Hajira; Hameed, Abdul; Ilyas, Muhammad


    A case report of 6-year-old boy with progeria syndrome, with marked cardiac complications is presented. The boy had cardiorespiratory failure. Discoloured purpuric skin patches, alopecia, prominent forehead, protuberant eyes, flattened nasal cartilage, malformed mandible, hypodentition, and deformed rigid fingers and toes were observed on examination. The boy was unable to speak. A sclerotic systolic murmur was audible over the mitral and aortic areas. Chest x-rays showed cardiac enlargement and the electrocardiogram (ECG) showed giant peaked P waves (right atrial hypertrophy) and right ventricular hypertrophy. Atherosclerotic dilated ascending aorta, thickened sclerotic aortic, mitral, and tricuspid valves with increased echo texture, left and right atrial and right ventricular dilatation, reduced left ventricular cavity, and thickened speckled atrial and ventricular septa were observed on echocardiography.

  1. Sudden cardiac death in athletes

    Directory of Open Access Journals (Sweden)

    Fábio Camilo Pellegrino dos Santos


    Full Text Available ABSTRACT The most accepted definition of sudden cardiac death nowadays is an unexplained death occurred suddenly within one hour of symptom onset. If it was not witnessed, individuals need to had been observed for at least 24 hours before the event and should be discarded the possibility of non cardiac causes of sudden death, pulmonary embolism or extensive malignancy. The term athlete refers to individuals of any age who participate in collective or individual regular physical activity, as well as physical training program for regular competitions. The sudden death of a young athlete, whether amateur or professional, especially during competitions, is always dramatic, with strong negative social impact and in the media. The fact that sports are recommended as a formula for longevity and quality of life makes these events a cause for concern in sports and society in general.

  2. Heart fields and cardiac morphogenesis. (United States)

    Kelly, Robert G; Buckingham, Margaret E; Moorman, Antoon F


    In this review, we focus on two important steps in the formation of the embryonic heart: (i) the progressive addition of late differentiating progenitor cells from the second heart field that drives heart tube extension during looping morphogenesis, and (ii) the emergence of patterned proliferation within the embryonic myocardium that generates distinct cardiac chambers. During the transition between these steps, the major site of proliferation switches from progenitor cells outside the early heart to proliferation within the embryonic myocardium. The second heart field and ballooning morphogenesis concepts have major repercussions on our understanding of human heart development and disease. In particular, they provide a framework to dissect the origin of congenital heart defects and the regulation of myocardial proliferation and differentiation of relevance for cardiac repair.

  3. Systems biology and cardiac arrhythmias. (United States)

    Grace, Andrew A; Roden, Dan M


    During the past few years, the development of effective, empirical technologies for treatment of cardiac arrhythmias has exceeded the pace at which detailed knowledge of the underlying biology has accumulated. As a result, although some clinical arrhythmias can be cured with techniques such as catheter ablation, drug treatment and prediction of the risk of sudden death remain fairly primitive. The identification of key candidate genes for monogenic arrhythmia syndromes shows that to bring basic biology to the clinic is a powerful approach. Increasingly sophisticated experimental models and methods of measurement, including stem cell-based models of human cardiac arrhythmias, are being deployed to study how perturbations in several biologic pathways can result in an arrhythmia-prone heart. The biology of arrhythmia is largely quantifiable, which allows for systematic analysis that could transform treatment strategies that are often still empirical into management based on molecular evidence.

  4. Nutritional Status and Cardiac Autophagy

    Directory of Open Access Journals (Sweden)

    Jihyun Ahn


    Full Text Available Autophagy is necessary for the degradation of long-lasting proteins and nonfunctional organelles, and is activated to promote cellular survival. However, overactivation of autophagy may deplete essential molecules and organelles responsible for cellular survival. Lifelong calorie restriction by 40% has been shown to increase the cardiac expression of autophagic markers, which suggests that it may have a cardioprotective effect by decreasing oxidative damage brought on by aging and cardiovascular diseases. Although cardiac autophagy is critical to regulating protein quality and maintaining cellular function and survival, increased or excessive autophagy may have deleterious effects on the heart under some circumstances, including pressure overload-induced heart failure. The importance of autophagy has been shown in nutrient supply and preservation of energy in times of limitation, such as ischemia. Some studies have suggested that a transition from obesity to metabolic syndrome may involve progressive changes in myocardial inflammation, mitochondrial dysfunction, fibrosis, apoptosis, and myocardial autophagy.

  5. Streptococcus pneumoniae translocates into the myocardium and forms unique microlesions that disrupt cardiac function.

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    Armand O Brown


    Full Text Available Hospitalization of the elderly for invasive pneumococcal disease is frequently accompanied by the occurrence of an adverse cardiac event; these are primarily new or worsened heart failure and cardiac arrhythmia. Herein, we describe previously unrecognized microscopic lesions (microlesions formed within the myocardium of mice, rhesus macaques, and humans during bacteremic Streptococcus pneumoniae infection. In mice, invasive pneumococcal disease (IPD severity correlated with levels of serum troponin, a marker for cardiac damage, the development of aberrant cardiac electrophysiology, and the number and size of cardiac microlesions. Microlesions were prominent in the ventricles, vacuolar in appearance with extracellular pneumococci, and remarkable due to the absence of infiltrating immune cells. The pore-forming toxin pneumolysin was required for microlesion formation but Interleukin-1β was not detected at the microlesion site ruling out pneumolysin-mediated pyroptosis as a cause of cell death. Antibiotic treatment resulted in maturing of the lesions over one week with robust immune cell infiltration and collagen deposition suggestive of long-term cardiac scarring. Bacterial translocation into the heart tissue required the pneumococcal adhesin CbpA and the host ligands Laminin receptor (LR and Platelet-activating factor receptor. Immunization of mice with a fusion construct of CbpA or the LR binding domain of CbpA with the pneumolysin toxoid L460D protected against microlesion formation. We conclude that microlesion formation may contribute to the acute and long-term adverse cardiac events seen in humans with IPD.

  6. Pregnancy as a cardiac stress model. (United States)

    Chung, Eunhee; Leinwand, Leslie A


    Cardiac hypertrophy occurs during pregnancy as a consequence of both volume overload and hormonal changes. Both pregnancy- and exercise-induced cardiac hypertrophy are generally thought to be similar and physiological. Despite the fact that there are shared transcriptional responses in both forms of cardiac adaptation, pregnancy results in a distinct signature of gene expression in the heart. In some cases, however, pregnancy can induce adverse cardiac events in previously healthy women without any known cardiovascular disease. Peripartum cardiomyopathy is the leading cause of non-obstetric mortality during pregnancy. To understand how pregnancy can cause heart disease, it is first important to understand cardiac adaptation during normal pregnancy. This review provides an overview of the cardiac consequences of pregnancy, including haemodynamic, functional, structural, and morphological adaptations, as well as molecular phenotypes. In addition, this review describes the signalling pathways responsible for pregnancy-induced cardiac hypertrophy and angiogenesis. We also compare and contrast cardiac adaptation in response to disease, exercise, and pregnancy. The comparisons of these settings of cardiac hypertrophy provide insight into pregnancy-associated cardiac adaptation.


    Directory of Open Access Journals (Sweden)



    Full Text Available : Heart transplantation has emerged as the definitive therapy for patients with end-stage cardiomyopathy. The two most common forms of cardiac disease that lead to transplantation are ischemic cardiomyopathy and dilated cardiomyopathy, which together comprise approximately 90% of cases. The other less common forms of heart disease include viral cardiomyopathy, infiltrative cardiomyopathy, postpartum cardiomyopathy, valvular heart disease and congenital heart disease

  8. Chaos control of cardiac arrhythmias. (United States)

    Garfinkel, A; Weiss, J N; Ditto, W L; Spano, M L


    Chaos theory has shown that many disordered and erratic phenomena are in fact deterministic, and can be understood causally and controlled. The prospect that cardiac arrhythmias might be instances of deterministic chaos is therefore intriguing. We used a recently developed method of chaos control to stabilize a ouabain-induced arrhythmia in rabbit ventricular tissue in vitro. Extension of these results to clinically significant arrhythmias such as fibrillation will require overcoming the additional obstacles of spatiotemporal complexity.

  9. Path indexing for term retrieval



    Different methods for term retrieval in deduction systems have been introduced in literature. This report eviews the three indexing techniques discrimination indexing, path indexing, and abstraction tree indexing. A formal approach to path indexing is presented and algorithms as well as data structures of an existing implementation are discussed. Eventually, experiments will show that our implementation outperforms the implementation of path indexing in the OTTER theorem prover.

  10. [The effect of the severity of congenital pectus excavatum on the cardiac morphology in children: evaluation with multislice helical CT]. (United States)

    Lu, Tao; Deng, Kaihong


    This paper is aimed to evaluate the CT manifestation of congenital pectus excavatum and its effect on the cardiac morphology. CT features of 34 children with pectus excavatum were retrospectively reviewed. The Haller index (HI), CT depression index (CTDI), cardiac rotation angle (CRA), pulmonary vein angle (PVA), cardiac compression index (CCI) and cardiac asymmetry index (CAI) were measured from the images on the PACS system. The relationships among these indexes were evaluated. The HI was 4.12 +/- 1.48, the CTDI was 2.39+/- 0.70, CRA was (53.52 +/- 7.68) degrees, PVA was (66.51 +/- 11.02) degrees, CCI was 2.43 +/- 0.95, and CAI was 1.55 +/- 0.56. There was statistical significance of CCI and CAI between children with severe or slight pectus excavatum. The HI and CTDI were positively related with CCI and CAI respectively, whereas there was no statistical significance of CRA and PVA between children with severe or slight pectus excavatum. There was no statistical significance of HI, CTDI, CRA, PVA, CCI and CAI among different age groups. The morphological change of the heart compressed in children with pectus excavatum can be accurately evaluated by multislice helical CT.

  11. Cardiac autonomic nerve distribution and arrhythmia

    Institute of Scientific and Technical Information of China (English)

    Quan Liu; Dongmei Chen; Yonggang Wang; Xin Zhao; Yang Zheng


    OBJECTIVE: To analyze the distribution characteristics of cardiac autonomic nerves and to explore the correlation between cardiac autonomic nerve distribution and arrhythmia.DATA RETRIEVAL: A computer-based retrieval was performed for papers examining the distribution of cardiac autonomic nerves, using "heart, autonomic nerve, sympathetic nerve, vagus nerve, nerve distribution, rhythm and atrial fibrillation" as the key words.SELECTION CRITERIA: A total of 165 studies examining the distribution of cardiac autonomic nerve were screened, and 46 of them were eventually included.MAIN OUTCOME MEASURES: The distribution and characteristics of cardiac autonomic nerves were observed, and immunohistochemical staining was applied to determine the levels of tyrosine hydroxylase and acetylcholine transferase (main markers of cardiac autonomic nerve distribution). In addition, the correlation between cardiac autonomic nerve distribution and cardiac arrhythmia was investigated.RESULTS: Cardiac autonomic nerves were reported to exhibit a disordered distribution in different sites, mainly at the surface of the cardiac atrium and pulmonary vein, forming a ganglia plexus. The distribution of the pulmonary vein autonomic nerve was prominent at the proximal end rather than the distal end, at the upper left rather than the lower right, at the epicardial membrane rather than the endocardial membrane, at the left atrium rather than the right atrium, and at the posterior wall rather than the anterior wall. The main markers used for cardiac autonomic nerves were tyrosine hydroxylase and acetylcholine transferase. Protein gene product 9.5 was used to label the immunoreactive nerve distribution, and the distribution density of autonomic nerves was determined using a computer-aided morphometric analysis system.CONCLUSION: The uneven distribution of the cardiac autonomic nerves is the leading cause of the occurrence of arrhythmia, and the cardiac autonomic nerves play an important role in the

  12. Guidebook/index

    Energy Technology Data Exchange (ETDEWEB)


    The Guidebook/Index introduces information dealing with the general rationale for energy conservation and deals with some of the definitions and concepts common to each of the subjects covered in the series of 10 booklets. The master index for the series is presented. Subjects covered are saving money in heating, cooling, and lighting; in process design and heat recovery; through production optimization; through combustion control; through steam and compressed air management; in transportation and delivery; through efficient people moving; in office practices; and through employee motivation and participation.

  13. Mechanical modulation of cardiac microtubules. (United States)

    White, Ed


    Microtubules are a major component of the cardiac myocyte cytoskeleton. Interventions that alter it may influence cardiac mechanical and electrical activity by disrupting the trafficking of proteins to and from the surface membrane by molecular motors such as dynein, which use microtubules as tracks to step along. Free tubulin dimers may transfer GTP to the α-subunits of G-proteins, thus an increase in free tubulin could increase the activity of G-proteins; evidence for and against such a role exists. There is more general agreement that microtubules act as compression-resisting structures within myocytes, influencing visco-elasticity of myocytes and increasing resistance to shortening when proliferated and resisting deformation from longitudinal shear stress. In response to pressure overload, there can be post-translational modifications resulting in more stable microtubules and an increase in microtubule density. This is accompanied by contractile dysfunction of myocytes which can be reversed by microtubule disruption. There are reports of mechanically induced changes in electrical activity that are dependent upon microtubules, but at present, a consensus is lacking on whether disruption or proliferation would be beneficial in the prevention of arrhythmias. Microtubules certainly play a role in the response of cardiac myocytes to mechanical stimulation, the exact nature and significance of this role is still to be fully determined.

  14. Review Article of Cardiac Amyloidosis

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    Jittiporn PURATTANAMAL


    Full Text Available Cardiac amyloidosis is a term that means the deposit of abnormal proteins in the myocardium leading to global thickening of the heart walls. The clinical character is that of infiltrative cardiomyopathy. AL amyloidosis is the most common type that involves cardiac failure. Cardiac amyloid precedes clinical congestive heart failure, especially right-sided heart failure. Laboratory investigations have identified the amyloid fibril proteins deposited in the organ tissues. Immunofixation tests are the most sensitive that recognize the paraprotein mean light chain protein or immunoglobulin subtype deposit. Prognosis is poor if AL amyloidosis is untreated. Treatment of systemic involvement in AL amyloidosis is via chemotherapy such as melphalan and prednisolone. UK experts have reported the results of treatment in AL amyloidosis. Regardless of the use of adjunctive chemotherapy, the five-year survival after heart transplantation was generally poorer for AL (20 % at five years, but similar for non-AL amyloidosis (64 % at five years, than heart transplants in other cases. Progression of the systemic disease contributed to increased mortality. A specific treatment that increases the chances of survival is unknown.

  15. Sudden cardiac death risk stratification. (United States)

    Deyell, Marc W; Krahn, Andrew D; Goldberger, Jeffrey J


    Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized.

  16. Inherited arrhythmias: The cardiac channelopathies

    Directory of Open Access Journals (Sweden)

    Shashank P Behere


    Full Text Available Ion channels in the myocardial cellular membrane are responsible for allowing the cardiac action potential. Genetic abnormalities in these channels can predispose to life-threatening arrhythmias. We discuss the basic science of the cardiac action potential; outline the different clinical entities, including information regarding overlapping diagnoses, touching upon relevant genetics, new innovations in screening, diagnosis, risk stratification, and management. The special considerations of sudden unexplained death and sudden infant death syndrome are discussed. Scientists and clinicians continue to reconcile the rapidly growing body of knowledge regarding the molecular mechanisms and genetics while continuing to improve our understanding of the various clinical entities and their diagnosis and management in clinical setting. Two separate searches were run on the National Center for Biotechnology Information′s website. The first using the term cardiac channelopathies was run on the PubMed database using filters for time (published in past 5 years and age (birth-18 years, yielding 47 results. The second search using the medical subject headings (MeSH database with the search terms "Long QT Syndrome" (MeSH and "Short QT Syndrome" (MeSH and "Brugada Syndrome" (MeSH and "Catecholaminergic Polymorphic Ventricular Tachycardia" (MeSH, applying the same filters yielded 467 results. The abstracts of these articles were studied, and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles where further explored and read in full.

  17. Cardiac autonomic testing and diagnosing heart disease. 'A clinical perspective'

    Directory of Open Access Journals (Sweden)

    Nicholas L. DePace


    Full Text Available Background Coronary heart disease (CHD is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD, including risk stratification of patients for major adverse cardiac events (MACE, modifying the risks and treating the patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from autonomic testing. Methods Traditional and non-traditional, and modifiable and non-modifiable risk factors for MACE where compared, including newer risk factors, such as inflammation, carotid intimal thickening, ankle-brachial index, CT calcium scoring, and autonomic function testing, specifically independent measurement of parasympathetic and sympathetic (P&S activity. Results The Framingham Heart Study, and others, have identified traditional risk factors for the development of CHD. These factors effectively target high-risk patients, but a large number of individuals who will develop CHD and MACE are not identified. Many patients with CHD who appear to be well-managed by traditional therapies still experience MACE. In order to identify these patients, other possible risk factors have been explored. Advanced autonomic dysfunction, and its more severe form, cardiac autonomic neuropathy, have been strongly associated with an elevated risk of cardiac mortality and are diagnosable through P&S testing. Conclusions Independent measures of P&S activity, provides additional information and has the potential to incrementally add to risk assessment. This additional information enables physicians to (1 specifically target more high-risk patients and (2 titrate therapies, with autonomic testing guidance, in order to minimize risk of cardiac mortality and morbidity.

  18. A multiresolution restoration method for cardiac SPECT (United States)

    Franquiz, Juan Manuel

    Single-photon emission computed tomography (SPECT) is affected by photon attenuation and image blurring due to Compton scatter and geometric detector response. Attenuation correction is important to increase diagnostic accuracy of cardiac SPECT. However, in attenuation-corrected scans, scattered photons from radioactivity in the liver could produce a spillover of counts into the inferior myocardial wall. In the clinical setting, blurring effects could be compensated by restoration with Wiener and Metz filters. Inconveniences of these procedures are that the Wiener filter depends upon the power spectra of the object image and noise, which are unknown, while Metz parameters have to be optimized by trial and error. This research develops an alternative restoration procedure based on a multiresolution denoising and regularization algorithm. It was hypothesized that this representation leads to a more straightforward and automatic restoration than conventional filters. The main objective of the research was the development and assessment of the multiresolution algorithm for compensating the liver spillover artifact. The multiresolution algorithm decomposes original SPECT projections into a set of sub-band frequency images. This allows a simple denoising and regularization procedure by discarding high frequency channels and performing inversion only in low and intermediate frequencies. The method was assessed in bull's eye polar maps and short- axis attenuation-corrected reconstructions of a realistic cardiac-chest phantom with a custom-made liver insert and different 99mTc liver-to-heart activity ratios. Inferior myocardial defects were simulated in some experiments. The cardiac phantom in free air was considered as the gold standard reference. Quantitative analysis was performed by calculating contrast of short- axis slices and the normalized chi-square measure, defect size and mean and standard deviation of polar map counts. The performance of the multiresolution

  19. Effect of siRNA silencing of inducible co-stimulatory molecule on myocardial cell hypertrophy after cardiac infarction in rats. (United States)

    Wang, W M; Liu, Z; Chen, G


    As the most common cardiac disease, myocardial infarction is followed by hypertrophy of cardiac myocytes and reconstruction of ventricular structure. The up-regulation of a series of factors including metalloproteinases, inflammatory factors, and growth factors after primary infarction lead to the hypertrophy, apoptosis, necrosis, and fibroblast proliferation in cardiac muscle tissues. Recent studies have reported on the potency of small interfering RNA (siRNA) in treating cardiac diseases. We thus investigated the efficacy of inducible co-stimulatory molecule (ICOS)-specific siRNA silencing in myocardial hypertrophy in a cardiac infarction rat model. This cardiac infarction model was prepared by ligating the left anterior descending coronary artery. ICOS-siRNA treatment was administered in parallel with non-sense siRNA. After 18 days, the cross-sectional area of cardiac muscle tissues and the left ventricle weight index were measured, along with ICOS mRNA and protein expression levels, and pathological staining. Compared to those in the control groups, in myocardial infarcted rats, the application of ICOS-siRNA effectively decreased the left ventricle weight index, as well as the surface area of cardiac myocytes. Both mRNA and protein levels of ICOS were also significantly decreased. HE staining was consistent with these results. In conclusion, ICOS-targeted siRNA can effectively silence gene expression of ICOS, and provided satisfactory treatment efficacy for myocardial cell hypertrophy after infarction.

  20. Cardiac anatomy and diastolic filling in professional road cyclists. (United States)

    Missault, L; Duprez, D; Jordaens, L; de Buyzere, M; Bonny, K; Adang, L; Clement, D


    In the literature two divergent types of exercise-induced cardiac hypertrophy have been described: isotonic exercise induced eccentric hypertrophy with proportional increase in end-diastolic left ventricular dimension and wall thickness and isometric exercise induced concentric hypertrophy with normal end-diastolic left ventricular dimension but increased wall thickness. Using echocardiography, cardiac anatomy and diastolic filling were studied in 26 professional road cyclists. Compared to 21 control subjects, matched according to age, sex and morphometry the athletes had significantly larger left atrial dimension [41.3 (SD 4.8) vs 36.6 (SD 4.5) mm], left ventricular dimension [56.0 (SD 3.8) vs 53.2 (SD 4.7) mm], end-diastolic septum thickness [11.1 (SD 2.5) vs 8.4 (SD 1.9) mm], end-diastolic posterior wall thickness [11.6 (SD 2.2) vs 8.4 (SD 1.5) mm] and left ventricular mass index [170.4 (SD 40.6) vs 107.0 (SD 27.7) g.m-2]. We concluded that the hypertrophy in the road cyclists was of the mixed type (concentric-eccentric) with an increase in the internal dimension of the left ventricle and an even larger increase in the thickness of the ventricular walls. Diastolic filling however was similar in the athletes and control subjects. No correlations were found between the left ventricular mass index and diastolic filling parameters. We concluded therefore that professional road cycling causes mixed cardiac hypertrophy without diastolic filling abnormalities and can therefore be considered benign.