Takotsubo cardiomyopathy (TCM), otherwise cardiomyopathy,apical ballooning syndrome or broken heart syndrome is a reversible cardiomyopathy, predominantly occurs in post-menopausal women and commonly due to emotional or physical stress. Typically, patients present with chest pain and ST elevation or T wave inversion on their electrocardiogram mimicking acute coronary syndrome, but with normal or non-flow limiting coronary artery disease. Acute dyspnoea, hypotension and even cardiogenic shock may be the presenting feature of this condition. The wall motion abnormalities typically involve akinesia of the apex of the left ventricle with hyperkinesia of the base of the heart. Atypical forms of TCM have also recently been described. An urgent left ventriculogram or echocardiogram is the key investigation to identify this syndrome. Characteristically, there is only a limited release of cardiac enzymes disproportionate to the extent of regional wall motion abnormality. Transient right ventricular dysfunction may occur and is associated with more complications, longer hospitalisation and worse left ventricular systolic dysfunction. Recently, cardiac MRI has been increasingly used to diagnose this condition and to differentiate from acute coronary syndrome in those who have abnormal coronary arteries. Treatment is often supportive, however beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocking agent are being used in routine clinical practice. The syndrome is usually spontaneously reversible and cardiovascular function returns to normal after a few weeks. This review article will elaborate on the pathophysiology, clinical features including the variant forms, latest diagnostic tools, management and prognosis of this condition.
Ensite NavX and Carto procedures have similar effectiveness and safety to a conventional approach; however, they both reduce X-ray exposure, with NavX producing a significantly greater effect than Carto. Although this benefit is achieved at a greater financial cost, there may be long-term benefits to catheter laboratory staff.
Pulmonary veno-occlusive disease (PVOD) is a disorder which causes progressive pulmonary hypertension, usually presenting with worsening dyspnoea and right heart failure. Pulmonary oedema induced by pulmonary vasodilator therapy to reduce pulmonary arterial pressure has been well described in PVOD, but here we describe a case of PVOD presenting with recurrent episodes of acute non-cardiogenic pulmonary oedema, in the absence of significant pulmonary hypertension. Concern over the risk of precipitating pulmonary oedema led us to use inhaled nitric oxide to predict the safety and efficacy of sildenafil.Pulmonary veno-occlusive disease (PVOD) usually presents with worsening dyspnoea and right heart failure as a result of pulmonary arterial hypertension (PAH). Here we describe a case of PVOD presenting with recurrent episodes of acute noncardiogenic pulmonary oedema with only a borderline increase in pulmonary artery pressure, confounding the diagnosis until surgical lung biopsy was performed. In view of the risk of precipitating pulmonary oedema with vasodilator therapy, we also report on the use of inhaled nitric oxide to predict the safety and efficacy of sildenafil. CASE REPORTA previously healthy 21-year-old Afro-Caribbean male presented with a 2 h history of breathlessness. There was no associated chest pain, cough, wheeze or fever. He was apyrexial and had a saturation of 90% on high flow oxygen. He was tachycardic in sinus rhythm with a blood pressure of 110/70 mm Hg. He had widespread inspiratory crackles. His chest radiograph is shown in fig 1A. Routine blood tests revealed neutrophilia with a C reactive protein level of 4 mg/l. He started on continuous positive airway pressure (CPAP) and was treated for pneumonia with intravenous cefuroxime and clarithromycin. Pending results of an HIV test (subsequently negative), he received septrin and prednisolone for 2 days. Microbiological investigations for pneumonia were negative. Rheumatoid factor, sickle solubility test, serum ACE and autoantibodies were also negative.He improved rapidly over 2 days, with complete resolution of radiographic changes, but remained persistently hypoxaemic with exertional breathlessness and desaturation (from 93% to 76%). A CT excluded a pulmonary embolus and indirect evidence of PAH, such as dilated pulmonary arteries or right-sided cardiac chambers. There was no septal thickening, but extensive mediastinal and hilar lymphadenopathy and peripheral lung attenuation ( fig 1B). Lung function showed normal lung volumes with severely impaired gas transfer (carbon monoxide transfer factor 5.09 mmol/min/ kPa (43%), KCO 1.0 mmol/min/kPa/l (59%)). Given these findings and because of the rapid response presumed secondary to steroids, he was restarted on oral prednisolone 40 mg, with a presumptive diagnosis of sarcoidosis.Following discharge he was readmitted twice in quick succession with similar clinical and radiographic findings, responding rapidly to CPAP. On both occasions he had also reported streaky haemoptysis and frothy sputu...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.