There are many findings support the hypothesis that Peripartum Cardiomyopathy (PPCM) might indeed be a subtype of dilated Cardiomyopathy (DCM). The mechanisms underlying PPCM remain unclear. Recently, genetic susceptibility is increasingly recognized as a risk factor of PPCM. More than 10% of women undergo PPCM with a pathogenic TTN gene (encoding giant protein titin) mutation. TTN truncation is also a mainly contributive genetic factor of DCM.
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The sympathetic overdrive is considered as one of the common medical condition for many diseases. According to the principles of a disease, this is considered under disease. Some early warning signs include (high resting heart rate;high blood pressure; and obesity). There are some unspecified signs of the related medical conditions. The risk factors and the mechanisms are clear. Organ failures and morality is quite common. To identify the sympathetic overdrive as a disease and to treat the signs at the same time will prevent many common diseases. This article elucidates the hypothesis of the disease of sympathetic overdrive. It ought to be treated at the earliest instead of ignoring or misidentifying the disease which may drastically affect many people around the world.
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Wilson's disease (WD), a genetic disorder of copper metabolism due to the mutant ATP7B enzyme, is characterized by reduced excretion, disordered accumulation and abnormal deposits of copper causing toxic damage to various organs. D-penicillamine (D-PCA) is an effective oral chelation agent for WD. A WD patient with clinical manifestations was reversed by D-PCA. However, the patient thought that he was healthy enough to lead to the administration of penicillamine being terminated. The reoccurrence of many manifestations of Wilson's disease were reported but the regular fellow-up were also stopped. In addition, his liver function after drinking alcohol started to deteriorate with the findings of symptoms such as progressive jaundice (yellowing of the skin and eyes), dark urine, fatigue, nausea, vomiting, migraine headaches, lower extremity edema, diarrhea. There were no signs of alleviation of Wilson's disease after taking a few pairs of Chinese herbs. Approximately 4 months after the administration of D-PCA treatment, improvement in jaundice and dysphoria, reduced serum levels of alanine aminotransferase, and elevated ceruloplasmin, as well as stabilization in the radiographic of neurologic and hepatic examination, were observed. Our case provides major recommendations for improving the compliance of WD patients and it is a lifelong challenge in terms of the management of WD.
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A persistent left superior vena cava is formed by remains of the oblique vein of the left atrium, which is not completely degenerated during embryonic development. The incidence is approximately 0.3% in the general population. Approximately 80-92% of PLSVCs drain into the right atrium through the coronary sinus. In most cases, the persistent left superior vena cava (PLSVC) is asymptomatic and discovered accidentally. The persistence of a left superior vena cava is an intrinsically cardiac anomaly cardiovascular disease, which can lead to serious complications during catheterization or internal jugular vein. We describe a patient with a history of a diagnosis of atrioventricular blockade grade 3, which has an additional PLSVC, which flows into the coronary sinus.
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Background: Understanding racial differences in outcomes for atrial fibrillation (AF) may guide interventions to diminish health inequities. Methods and Results: In a retrospective, cross-sectional study of adults hospitalized with a principal diagnosis of AF using the 2001-2012 National Inpatient Sample, we assessed racial differences for in-hospital. We accounted for case-mix and clustering by race within hospitals to estimate odds ratios (OR) for death associated with individual patient race and hospital racial composition. We identified 676,567 hospitalizations (mean age 71.8 years, 53.6% women) with principal diagnosis of AF (84.2% White, 7.1% Black, 5.0% Hispanic). Black (vs. White) race was associated with 1.63-fold (95% CI, 1.50-1.78) risk of death. Other races had similar risk of death as Whites. Risk of death for Blacks (vs. Whites) declined over time [2001: OR 1.78(95% CI 1.31-2.43); 2012: OR 1.23(95% CI 0.92-1.64)]. Racial differences in deaths within hospitals narrowed, while hospitals with larger proportions of Blacks had persistently worse outcomes than hospitals with fewer Blacks (OR 1.08 per 10% increase in Blacks in 2001 and 2012). Conclusion: Black patients with a principal diagnosis of AF were more likely to suffer in-hospital death than Whites. Our findings suggest racial disparities based upon individual patients’ race improved over time, but outcomes were persistently worse at hospitals with higher proportions of Black patients, regardless of patients’ races
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Calcified deposits on the fibrosa side of the aortic heart valve leaflet have been linked to the presence of oscillatory blood flow patterns. This study evaluated the oscillatory shear index (OSI) in a human aortic valve with and without the presence of calcified deposits during the early diastolic phase of the cardiac cycle. The mean OSI in regions which developed calcified deposits was altered negligibly by only 1.6% in comparison to regions which did not calcify, which exhibited a decrease in mean OSI of nearly 36%. Our preliminary results suggest that a noticeable change in oscillatory flow patterns (a decrease in OSI) on the fibrosa-surface will occur during normal rates of valve tissue remodeling with aging. However, when this rate of remodeling is much slower than normal, the OSI will remain relatively unaltered, which may serve as a triggering point for the secretion of a calcified valve extracellular matrix. Clinical monitoring of leaflet fibrosa-OSI may thereby serve as a biomarker for early detection of calcification of the aortic valve, specifically when OSI does not exhibit longitudinal changes.
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Infections are often accompanied by activation of the blood coagulation system. These abnormalities range from subtle activation of haemostasis that can only be detected by sensitive markers for coagulation factor activation to somewhat more stronger hemostatic activation that may be detected by small decrease in platelet count and sub-clinical prolongation of global clotting times, to fulminant disseminated intravascular coagulation [DIC] characterized by simultaneous widespread microvascular thrombosis and profuse bleeding from various sites. There is ample evidence that activation of coagulation in concert with inflammatory activation can result in microvascular thrombosis and thereby contributes to multiple organ failure in patients with severe infections. Indeed, infection-associated coagulopathy has shown to be and independent predictor of organ failure in patients with sepsis.
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Femoral artery catheterization is an invasive vascular access route used for Coronary Angiography (CAG), intra-aortic balloon pump implantation, hemodialysis catheters and other similar purposes. Complications such as Arteriovenous Fistula (AVF) may develop during the placement of arterial cannulae or catheters. The first choice in the treatment of AVF repair is invasive methods. In this report, we present the surgical treatment of a patient with AVF complication. In our case, AVF developed immediately after femoral artery catheterization during the CAG procedure, Treatment of AV fistula planned by invasive embolization. Because of the risk of occlusion in femoral vein it is not performed. Surgical repair is one of the options in AVF treatment and successfull results can be obtained like in our case.
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Stroke is a serious disease which can lead to significant disability, [1] most of stroke is preceded by transient ischemic attack [2], diagnosing TIA in timely manner is of Para amount importance as 10% of patient diagnosed with TIA will develop stroke in two weeks, [3], It is important to confirm the diagnosis and rule out stroke mimics like migraineurs aura, transient Global Amnesia, syncope, hypoglycemia, delirium, seizure [4] functional disorder, demyelination, and intracranial tumor, treating TIA can prevent stroke [4] cardio embolic TIA due to AF can be prevented with anticoagulation, TIA due to critical stenosis of extra cranial carotid stenosis can be treated with revascularizations [5], Uncommon TIA or stroke due posterior reversal loco encephalopathy (PRESS) and posterior reversible vasoconstriction syndrome, can be treated with controlling blood pressure [6], further more diagnosed TIA lead to starting secondary prevention,(anti platelet , statin, antihypertensive and modified life style) [7] which prevent stroke in the future
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Novel coronavirus disease-19 (COVID-19) has widely spread all over the world and seriously threatened people’s health. This disease is currently diagnosed by clinical features, chest Computed Tomography (CT) scan, and nucleic acid test of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Recently, some studies have suggested that multiple ground-glass opacities sign in severe cases. However, the effective treatment for COVID-19 patient’s with multiple ground-glass opacities has not been discussed. Herein, we report a case of a 51-year-old man who suffered from COVID-19 with multiple ground-glass opacities. Our findings revealed that the body temperature and clinical laboratory test all returned to normal after this patient received treatment, but the imaging features of this patient are still particularly serious. Furthermore, chest CT showed the multiple ground-glass opacities meanwhile nucleic acid retest of SARS-CoV-2was already negative. These results provide the important reference for the diagnosis and treatment option of COVID-19 with multiple ground-glass
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Novel Coronavirus-2019 has widely spread all over the world and seriously threatened people’s life. The virus has spread to at least 218 countries and more than 66,501,425 confirmed cases and 1,529,154 deaths have been recorded world-wide. Now a days for early diagnosis of COVID-19, nucleic acid-based technique like real-time reverse transcription polymerase chain reaction (rRT-PCR) is the most consistent and the gold-standard method for the clinical diagnosis of COVID-19 and used all over the world. The current study was carried out to detect 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR method at Sheikh Hasina Medical College, Jamalpur, Bangladesh from 12thMay 2020 to 29th November, 2020. A total of 10675 samples were tested from different upazilas of Jamalpur district of Mymensingh division for rRT-PCR. Among them 1321 (12.7%) patients were positive for SARS-CoV-2. Out of 1321 positive cases 933(70.6%) were male and 388(29.4%) were female. Maximum positivity was found in Bakshiganjupazilaof Jamalpur district, followed by Sarishabari, Jamalpur Sadar, Islampur, Melandaha, Madarganj and Dewanganj respectively. This is the first base line study for genetic detection of 2019-nCoV in Jamalpur district of Mymensingh division which may reflect nearly the total scenario of Bangladesh situation.
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Coronavirus Disease 2019 (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. The common clinical manifestations are related to airway involvement. However, manifestations in other organs should not be ignored. This review sought to describe the possible ocular presentations of COVID-19 infection. A total of 11articles was included by searching PubMed, SciELO and Lilacs databases for articles published between December 2019 and April 2020.Conjunctivitis and keratoconjunctivitis can be the initial symptoms in infected patients. The virus can be identified in tear and conjunctival secretions, requiring highest attention. This review study recommends that there is a potential risk of transmission from the conjunctiva and requires appropriate precautionary and mitigation strategies especially for ophthalmologist who may encounter presymptomatic patients with COVID-19. However, with the evolving COVID-19 pandemic and with its high infectivity, it is mandatory to rearrange ophthalmologist routine clinical practice to control viral spread and try to maximize patient and health-care provider’s safety.
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Fifty-two-year-old man with diagnosed heart failure presented to the ED with a history of peripheral edema, dyspnea, and tachycardia among other symptoms. After many tests, the patient was found to have a large aortic root abscess and heart block and underwent surgery to receive a bovine aortic valve.
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Potassium plays an important role in the electrophysiological regulation of myocardium, and the conduction system. Hyperkalemia can frequently cause arrhythmias, including high-grade AV conduction abnormalities. These AV conduction abnormalities due to hyperkalemia are usually reversible with conventional treatment of hyperkalemia. We present a case of persistent high-grade AV conduction abnormalities which were not completely reversed with treatment of hyperkalemia, necessitating permanent pacemaker implantation.
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Mr. B is a 51-year-old male that presented to the Emergency Department at DSMC with a history of hypertension, hyperlipidemia, and Human Immunodeficiency Virus (HIV). The patient stated that he had been experiencing a “weird” heart rate for roughly four years. During his HIV wellness checks, he stated that the staff had told him that his heart rate was elevated. He stated during the interview that he experienced an episode of a high heart rate every day and that these would last several hours. He also stated that he used to be a runner, often running three miles at a time, but with the elevated heart rate, he was experiencing shortness of breath when he tried to run and was unable to run more than a single mile. He said that he was experiencing orthopnea, shortness of breath when lying flat, and shortness of breath at night when trying to sleep. He explained that he had also been experiencing weakness because of his high heart rate but had not seen a doctor about it until he came to the emergency room. Upon examination, the patient appeared well and was fully aware of his surroundings. He demonstrated an appropriate mood and affect for his situation and was anxious to understand what was happening to him. When he had his EKG read, he was shown to be in atrial fibrillation with rapid ventricular rate. The cardiology team was contacted to determine if pharmacologic or cardioversion would help him. When the team arrived and performed a history and physical which showed the atrial fibrillation rhythm to be long standing, it ruled out the efficacy of cardioversion. An echocardiogram was ordered and performed which showed a mildly reduced ejection fraction of 40 percent and provided the team some concern that the patient might also have some cardiomyopathy as a result of the tachycardia. The team determined that the atrial fibrillation was most likely the result of his uncontrolled hypertension. To address his atrial fibrillation, the underlying cause, and take preventative action against consequences of his disease state, the patient was placed on four different medications. These medications were carvedilol to lower his heart rate, digoxin to help with the heart rate control, apixaban to prevent clot formation, and lisinopril to help with his high blood pressure. He was sent home with an appointment to meet with a cardiologist in two weeks’ time.
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Aorto-Left Ventricular Tunnel (ALVT) is a rare congenital heart disease (CHD) that is worth studying, specifically when considering the differential diagnosis in other pathologies such as coronary artery fistulas (CAF), sub arterial VSD with aortic insufficiency, ductus arteriosus and the like. We present a case of a child who was asymptomatic until the age of 12 and was diagnosed of ALVT during the study of a heart murmur. We found two interesting associations: a unique coronary artery and a sub aortic VSD. After attempting to close the tunnel and VSD, aortic regurgitation was detected, which required reintervention. Authors highlight the importance of the echocardiogram and catheterization to reveal details of the malformation as well as the need for constant follow up after surgery to monitor the possibility of later complications.
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Introduction: In the heart failure population, overweight individuals are associated with lower mortality, termed the obesity survival paradox. The influence of body mass index (BMI) on outcomes in cardiac amyloidosis has not been characterized. We sought to determine the association between BMI and mortality, and hematologic and cardiac response in patients with light chain (AL) amyloidosis. Methods: We conducted a retrospective study of patients with cardiac AL amyloidosis referred between 1/1/2009 and 09/30/2018. We collected baseline demographics including BMI and recorded mortality and hematologic and cardiac response. Cox proportional hazards model and logistic regression models were constructed to examine the association between BMI and outcomes. Results: Of the 78 patients, 17 patients had a BMI of 17-22.5, 19 a BMI of 22.6-25, 23 a BMI of 25.1-29.9, and 19a BMI of ≥ 30kg/m2. The median follow-up was 51 months. There was no relationship between BMI as a continuous variable and mortality (adjusted HR 0.98, 95% CI 0.91-1.05, p=0.54).While there was no relationship between high BMI ( 25 kg/m2) and hematologic response (adjusted OR 0.97, 0.34-2.76, p=0.96), there was a relationship between high BMI and a lower likelihood of achieving cardiac response (adjusted OR 0.23, 0.07-0.71, p=0.011). Conclusions: In this cohort of patients with AL cardiac amyloidosis, there was no significant relationship between BMI and mortality. Patients with a higher BMI were significantly less likely to achieve a cardiac response. These findings highlight the importance of a multidisciplinary approach involving oncologists, cardiologists, and nutritionists in the treatment of this very complex multi-organ disease.
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Infectious aortic aneurysm leads to poor prognosis and high mortality rate as high as 50% due to delayed/missed diagnosis. Early use of appropriate antibiotics and adequate surgical debridement would improve outcome of patients which is dependent on diagnosis on time. It takes as long as 7 days before a certain bacterium could be isolated/biochemical identified. It is difficult to differential these bacteria by the isolation/biochemical identification on time. Direct detection of a certain bacterium using molecular diagnostic assays such for PCR with specific primers is a preferred option for rapid diagnosis but requires sophisticated laboratories. A high degree of clinical suspicion should be the key for a diagnosis of infectious aortic aneurysm in endemic areas.
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The coronavirus disease 2019 (COVID-19) has revolutionised the healthcare system and has had a profound impact on the clinical practice and on the management of cardiovascular (CV) diseases.
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