Open Access Case Report

Tachycardiomyopathy: Clinical Profile, Treatment and Outcome of a Series of Clinical Cases

Rose Mary Ferreira Lisboa da Silva, Sara Magro Borigato, Ítala Ferreira de Jesus, Giovanni Oliveira Carvalho, Mariana Alves Gomes, Raissa Alves Pinto Moura, Isabella Capobiango Rodrigues

Cardiology and Angiology: An International Journal, Page 16-20
DOI: 10.9734/ca/2020/v9i230131

Background: Tachycardiomyopathy is a non-familial cause of heart failure that can be reversible. A high index of suspicion is necessary for its diagnosis and for a rational approach in the management of patients.

Aims: To describe the clinical profile and verify the treatment and outcome of a series of cases of patients with tachycardiomyopathy.

Methodology: Among patients without previous ventricular dysfunction, those with tachycardiomyopathy were identified. They underwent clinical evaluation, complementary diagnostic tests, treatment and clinical follow-up.

Results: 10 patients had tachycardiomyopathy, mean age 64.5 ± 11.5 years, 6 women. The arrhythmias were atrial fibrillation with a high heart rate (80%); atrial tachycardia with high heart rate and frequent ventricular premature beats. Mean baseline heart rate was 110.2 bpm and the ejection fraction was 36.8%. For heart rate control, all were treated with beta-blockers, in association with digoxin in 6 patients. It was necessary to implant a pacemaker in VVI mode        (V: ventricle is stimulated, V: ventricle sensed; I: inhibiting response) and ablation of the atrioventricular node in 2 patients with persistent atrial fibrillation. After a mean 27.6 months, the mean heart rate was 76.5 bpm (p <0.0001, paired t-test) and there was clinical improvement of all patients. There was an average increase of 9.6% in the left ventricular ejection fraction. Despite this, 4 patients still had ventricular dysfunction (3 of them developed comorbidities).

Conclusion: In this series, the main cause of tachycardiomyopathy was atrial fibrillation with high heart rate. Similar to the description of literature, there was remission of symptoms with restore normal heart rhythm or control heart rate.

Open Access Case Study

Stuck Mitral Valve with Thromboembolic Stroke Managed with Anticoagulation and Mechanical Thrombectomy

Akshat Jain, Gurkirat Singh, Aniruddha Kaushik, Rahul Singla, Narendra Omprakash Bansal

Cardiology and Angiology: An International Journal, Page 10-15
DOI: 10.9734/ca/2020/v9i230130

Heart valve replacements are commonly performed these days in India with mitral valve replacement being most common of all. Thromboemboli are a major source of morbidity in patients with prosthetic heart valves. The incidence of clinically recognizable events ranges from 0.6% to 2.3% per patient-year. Mechanical valve thrombosis is another common complication, incidence of which is estimated at 0.3% to 1.3% per patient-year in developed countries, but as high as 6% per patient-year in developing countries. Management of either complication in these patients requires adequate knowledge and clinical experience. We here describe a rare case of a patient who came to us with both complication of stuck mitral valve prosthesis and embolic stroke simultaneously. We here discuss the approach, monitoring and management of these patients, the clinical difficulties we faced in our case, immediate and short term prognosis of our patient.

Open Access Minireview Article

Nursing Diagnoses in Heart Failure: Integrative Review

Daniele Melo Sardinha, Leila de Massena e Neiva Assis, Alexsandro Soares Amoedo, Katia Regina de Oliveira Gonçalves, Renato Hugo Dias Melo, Cassia Andreia Silva Lima, Jessica da Silva Ferreira, Jaqueline Cristina da Silva Belém, Jaqueline Dantas Neres Martin, Gabriel Fazzi Costa, Aurenice Monteiro Pinto Gualdez, Alziney Simor

Cardiology and Angiology: An International Journal, Page 1-9
DOI: 10.9734/ca/2020/v9i230129

Heart Failure is characterized by a complex clinical syndrome in which the myocardium has an inability to adequately pump blood to meet tissue metabolic needs, or can do so only at high filling pressures. Thus, the aim of this study is to describe the Nursing Diagnostics in patients with Cardiac Failure described in the scientific literature. It is a descriptive, exploratory study, with a qualitative approach, in the modality Integrative Literature Review. In Latin American and Caribbean Literature in Health Sciences and PubMed databases, including original articles, case studies and systematic review, in Portuguese, English and Spanish, published from 2014. Tabulation was used for data collection and analysis. Seven articles were searched and the following nursing diagnoses were highlighted: Harmful Comfort; Acute Pain; Disposition to Improve Comfort; Decreased Cardiac Output; Excessive Liquid Volume; Ineffective Respiratory Pattern; Intolerance to Activity; Fatigue; Anxiety; Sexual Dysfunction; Disabled Knowledge; Ineffective Cardiopulmonary Tissue Perfusion. It was concluded that heart failure is a complex pathology and that the use of the systematization of nursing care only enhances the quality of service and benefits the patient, because from the nursing diagnostcs it is possible to prescribe evidence-based interventions.

Open Access Original Research Article

Erythrocyte Membrane and Plasma Fatty Acids Composition in Patients with Coronary Heart Disease Requiring Percutaneous Angioplasty

Takeshi Arita, Taku Yokoyama, Mitsuhiro Fukata, Toru Maruyama, Seira Hazeyama, Shiro Mawatari, Takehiko Fujino, Koichi Akashi

Cardiology and Angiology: An International Journal, Page 21-30
DOI: 10.9734/ca/2020/v9i230132

Aims: Atherosclerosis is associated with oxidative stress and fatty acid composition plays a critical role in vascular endothelial dysfunction and injury leading to the coronary atherosclerotic progression. However, the correlation between the fatty acid profile and coronary atherosclerosis is debatable. The goal of this study is to assess the erythrocyte membrane and plasma fatty acid composition in patients with coronary heart disease.

Methods: The erythrocyte membrane and plasma distributions of fatty acids were quantified in patients with coronary heart disease (n = 30, group A) which needs both intensive medication and elective percutaneous coronary intervention and age-matched controls (n = 38, group B) using high-performance liquid chromatography combined with evaporative light scattering detection method. Baseline data were extracted from medical records.

Results: Logistic regression analysis demonstrated that hypoalbuminemia (p = 0.010) and HbA1c (p = 0.005) are associated with required percutaneous coronary intervention. Although appropriate logistic regression model for percutaneous coronary intervention could not be obtained by incorporating fatty acid components, percutaneous coronary intervention was correlated mostly to the increased oleic acid and decreased stearic acid in both erythrocyte membrane and plasma in receiver-operating characteristic analysis.

Conclusion: This single-center, cross-sectional study indicated that erythrocyte membrane and plasma fatty acids have a potential impact on the coronary atherosclerotic progression which requires coronary intervention. Longitudinal studies are necessary to clarify the clinical role of fatty acids distribution as a novel atherogenic marker.

Open Access Original Research Article

Sex Differences in Patients Hospitalized for Syncope: Experience in University Hospital of Middle-income Country and with a Predominance of Chagasic Etiology

Rose Mary Ferreira Lisboa da Silva, Jéssica Silva de Paula, Daniela Tereza Gonçalves Manso, Gabriela Veloso de Freitas, Marcelo Augusto Antunes de Carvalho, Paulo Victor Alves Pinto, Pollyanna Antônia Duarte Vitor, Leonardo Roever

Cardiology and Angiology: An International Journal, Page 31-41
DOI: 10.9734/ca/2020/v9i230133

Background: Syncope is a common sign with an inpatient rate of up to 83%. Data on sex differences of patients with syncope in the emergency and hospitalization are scarce.

Aim: The present study aimed to verify sex differences regarding clinical profile, risk scores, causes of syncope and treatment modalities.

Study Design: This is a single center, prospective, observational study.

Place and Duration of Study: Department of Internal Medicine, Faculty of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Brazil, between February 2015 and February 2017.

Methodology: We included 375 consecutive patients, 203 men and mean age of 52 years, hospitalized because of syncope. They underwent clinical evaluation, the laboratory tests, and the calculation of Martin, OESIL and EGSYS scores.

Results: 114 patients had chagasic cardiomyopathy. The causes of syncope due to arrhythmia were ventricular tachycardia in 127 patients (66.1% men), supraventricular in 117 (63.2% women) and bradyarrhythmias in 56 patients (66.1% men), p<0.0001. Odds ratio for ventricular tachycardia in chagasic patients was 8.78 (95% IC: 5.33-14.46). Heart disease was predominant among men (p=0.001), even among patients with Chagas' heart disease. Comparing male and female, median age was 57 versus 48 years (p=0.04) and ejection fraction was 53 versus 58% (p=0.03). Martin and OESIL scores were higher in males (p <0.0001). There was no difference in treatment. Applying the receiver operating characteristic curve for ventricular tachycardia, Martin score had the largest area under the curve (0.84), p <0.0001.

Conclusions: Men hospitalized for syncope were older, had more systolic ventricular dysfunction, and had higher Martin and OESIL scores. The main causes of syncope were ventricular tachycardia and bradyarrhythmias among men and supraventricular tachycardias among women.