No abstract

In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury.

Background Silent atrial fibrillation is a frequent etiology of cryptogenic stroke. Spontaneous conversion of atrial fibrillation to sinus rhythm results in atrial stunning. Objective To evaluate if the presence of a lower left atrial appendage peak emptying velocity (LAAV) after a cryptogenic stroke is associated with the occurrence of atrial fibrillation (AF). Methods We retrospectively selected consecutive patients with an acute ischemic stroke that had a transoesophageal echocardiogram (TEE) performed in the first 30 days of the acute event. Documented AF or potential cardioembolic sources in the TEE were considered exclusion criteria. We assessed the LAAV. During follow‐up, we evaluated the occurrence of new‐onset AF and the combined endpoint of death or new ischemic stroke. Results We studied 73 consecutive patients, during a mean follow‐up period of 54.9 ± 19.3 months. Seven developed AF, and 13 had the combined endpoint. LAAV was independently associated with AF occurrence (HR: 0.93, 95% CI: 0.88–0.99; P = .016). Patients with a LAAV ≤ 46.5 cm/s (AUC: 0.766, 95% CI: 0.579–0.954; P = .021) had a lower survival rate free from AF occurrence (Log‐rank, P < .001) and free from the combined endpoint of death or ischemic stroke (Log‐rank, P = .010). Conclusion A lower LAAV was associated with AF occurrence and the combined endpoint of death or ischemic stroke after an initial episode of cryptogenic stroke. Patients with this finding could eventually benefit from long‐term cardiac rhythm monitoring.

Changes in iron metabolism in heart failure (HF) have been described as an important prognostic marker.To check if the markers of iron kinetics are related to the morbidity and etiology of chagasic cardiomyopathy.Patients with Chronic Chagasic Cardiomyopathy (CCC, n = 40), with indeterminate form (IND, n = 40), besides non-chagasic cardiomyopathy (NCh, n = 40).The mean age was 50.98 ± 5.88 in CCC, 50% were male, 49.68 ± 5.28 in IND, 52.2% were male, and 49.20 ± 10.09 in NCh, 12.5% were male. Lower levels of iron (FeSe) were observed in the CCC groups (93.15 ± 36.53), when compared to IND (125.30 ± 22.79) and NCh (114.77 ± 18.90) (p = 0.0004), lower IST transferrin saturation index in CCC (29.48 ± 6.59), when compared to IND (30.95 ± 7.06) and in the NCh group (39.70 ± 7.54) p = 0.0001), total binding capacity of the lower CTLF iron in the CCC group (297.30 ± 36.46), when compared to the IND group (196.52 ± 56.95) and the NCh group (275.18 ± 33, 48) (p = 0.0001), lower ferritin in the CCC group (134.55, 1.56-42.36), when compared to the IND group (156,25, 1,72-42,20) and the NCh group (112.95, 2.88-42.66) (p = 0.0004). It was also observed that FeSe (95% CI 1.00-1.04, p = 0.0014), IST (95% CI 1.02-1.22) (p = 0.0012) and gender (95% CI 1.07-14.43 p = 0.0038) were independently associated with the degree of ventricular dysfunction in chagasic cardiomyopathy.CCC patients showed greater change in iron metabolism regarding the indeterminate form and other forms of cariomyopathies.

No abstract

No abstract

No abstract

Paciente feminino, 44 anos transferida para o centro de terapia intensiva (CTI) do Hospital das Clínicas de Belo Horizonte/MG, com quadro de dor abdominal, náuseas, vômitos, icterícia e febre, anorexia, inapetência, iniciado há 30 dias. História de hipotireoidismo e tratamento irregular com T4 há cinco anos; interrompeu a medicação quando iniciou o quadro atual. Apresentava T3 (7,26 pg/ml) VN.: 2,77 a 5,07; TSH (0,214 mU/L) VN: 0,465. Transaminases AST (977  U/L) VN.:15 a 46; ALT (795 U/L) VN.:13 a 69; bilirrubina total (4.12 mg/dL) VN.: 0.2 a 1.3; bilirrubina direta (30 mg/dL) VN.: até 0.25. Foi mantida sem anti- tireoidiano e iniciado propranolol até dose de 480 mg /dia. Exame de ressonância magnética abdominal e colangio com líquido livre abdominal, sugestivo de estar relacionado ao processo inflamatório. Espessamento inespecífico da vesícula biliar. Derrame pleural bilateral. Sorologia para o vírus da hepatite A, B e C negativo. Ocorreu piora da função hepática e manutenção de níveis elevados de hormônios tireoidianos. A paciente evoluiu para um quadro de hepatite aguda fulminante, imediatamente submetida ao transplante hepático. Após procedimento o fígado (explante) foi enviado para estudo anatopatológico; os achados histopatológicos incluíram a presença de extensa área de necrose do parênquima hepático. Nos septos remanescentes, mostravam-se infiltrados inflamatórios mononucleares (IIMM). Conclui-se, portanto, que o hipertireoidismo crônico pode exacerbar e perpetuar a disfunção hepática aguda fulminante e que o tratamento medicamentoso regular aliado aos exames laboratoriais de rotina clínica poderão prevenir complicações graves, permitindo uma terapêutica bem sucedida em pacientes com hipertireoidismo.