Diagnostic approach to cardiac amyloidosis: A case report.

The authors present a case of systemic amyloidosis with cardiac involvement. We discuss the need for a high level of suspicion to establish a diagnosis, diagnostic techniques and treatment options. Our patient was a 78-year-old man with chronic renal disease and atrial fibrillation admitted with acute decompensated heart failure of unknown cause.

The plantar reflex: A study of observer agreement, sensitivity, and observer bias.

The utility of the plantar reflex in modern neurology is controversial. We studied the Babinski, Chaddock, and Oppenheim reflexes in terms of intraobserver, interobserver, and intertest agreement; sensitivity; positive predictive value (PPV); and observer bias. Sixty-two patients and 1,984 reflexes were analyzed.

Fever-induced type 1 Brugada pattern.

Brugada syndrome, first described over 20 years ago, is characterized by a typical electrocardiographic pattern with coved-type ST-segment elevation in the right precordial leads and a high risk of sudden death in otherwise healthy young adults. The electrocardiographic pattern is sometimes intermittent, and fever is a possible trigger. The authors present the case of a 68-year-old woman who came to the emergency department with fever and syncope.

Rotational atherectomy: Technical update.

Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal patients, there is an increased prevalence of calcified coronary disease. Rotational atherectomy (RA) can be useful in the treatment of these lesions.

Estimating glomerular filtration rate in acute coronary syndromes: Different equations, different mortality risk prediction.

Aims: Renal dysfunction is a powerful predictor of adverse outcomes in patients hospitalized for acute coronary syndrome. Three new glomerular filtration rate (GFR) estimating equations recently emerged, based on serum creatinine (CKD-EPIcreat), serum cystatin C (CKD-EPIcyst) or a combination of both (CKD-EPIcreat/cyst), and they are currently recommended to confirm the presence of renal dysfunction. Our aim was to analyse the predictive value of these new estimated GFR (eGFR) equations regarding mid-term mortality in patients with acute coronary syndrome, and compare them with the traditional Modification of Diet in Renal Disease (MDRD-4) formula.

Continuous infusion or bolus injection of loop diuretics for patients admitted for severe acute heart failure: is one strategy better than the other?

Introduction And Objectives: Intravenous loop diuretics are an essential part of acute heart failure management; however, data to guide their use is sparse. Our aim was to compare continuous intravenous infusion of loop diuretics with intravenous bolus administration in terms of efficacy and adverse events in patients admitted with severe acute heart failure.

Methods: Over a period of three years, 110 patients were admitted to our cardiac intensive care unit with acute heart failure.

When what appears to be mitral stenosis is not: diagnostic and therapeutic implications.

The authors report the case of a 53-year-old man, with a long-standing history of mild mitral stenosis, admitted for worsening fatigue. Transthoracic echocardiography (limited by poor image quality) showed mitral annular calcification, leaflets that were difficult to visualize and an estimated mitral valve area of 1.8 cm(2) by the pressure half-time method.

Phenotypic expression in hypertrophic cardiomyopathy and late gadolinium enhancement on cardiac magnetic resonance.

Introduction And Aim: The prognostic value of late gadolinium enhancement (LGE) for risk stratification of hypertrophic cardiomyopathy (HCM) patients is the subject of disagreement. We set out to examine the association between clinical and morphological variables, risk factors for sudden cardiac death and LGE in HCM patients.

Methods: From a population of 78 patients with HCM, we studied 53 who underwent cardiac magnetic resonance.

Fabry disease presenting as apical left ventricular hypertrophy in a patient carrying the missense mutation R118C.

Anderson-Fabry disease is an X-linked lysosomal storage disorder caused by abnormalities of the GLA gene, which encodes the enzyme α-galactosidase A. A deficiency of this enzyme leads to the lysosomal accumulation of glycosphingolipids, which may cause left ventricular hypertrophy that is typically concentric and symmetric. We present the case of a 60-year-old woman with symptoms of dyspnea, atypical chest pain and palpitations, in whom a transthoracic echocardiogram revealed an apical variant of hypertrophic cardiomyopathy.

Cardiorenal syndrome in acute heart failure: a vicious cycle?

Introduction And Objective: Worsening renal function has an unquestionably negative impact on prognosis in patients with acute heart failure (HF). In Portugal there is little information about the importance of this entity in HF patients admitted to hospital. The objective of this work was to assess the prevalence of cardiorenal syndrome and to identify its key predictors and consequences in patients admitted for acute HF.

Cardiac involvement in antiphospholipid syndrome associated with Sneddon syndrome: a challenging diagnosis.

Sneddon syndrome is a rare clinical entity characterized by the association of ischemic cerebrovascular disease and livedo reticularis. The authors report a case of stroke and myocardial infarction in a 39-year-old man with Sneddon syndrome and antiphospholipid syndrome who subsequently met some criteria for systemic lupus erythematosus, highlighting the complexity of cardiovascular involvement in systemic diseases.

Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-up.

Background: Doubts remain about atherosclerotic disease and risk stratification of asymptomatic type-2 diabetic patients (T2DP). This study aims to evaluate the usefulness of calcium score (CS) and coronary computed tomography (CT) angiography (CTA) to predict fatal and non fatal cardiovascular events (CVEV) in T2DP.

Methods: Eighty-five consecutive T2DP undergoing CT (Phillips Brilliance, 16-slice) with CS and CTA were prospectively enrolled in a transversal case-control study.

Mid-term Risk Stratification of Patients with a Myocardial Infarction and Atrial Fibrillation: Beyond GRACE and CHADS.

We hypothesize that the discriminative performance of GRACE, ACHTUNG-Rule, CHADS or CHADS-VASc may be lower in patients with a Myocardial Infarction (MI) and concurrent atrial fibrillation (AF), as none of these scores seem able to fully capture both atherothrombotic/thromboembolic risks. This study aims to evaluate the mid-term prognostic performance of these algorithms in patients with these two conditions and to analyze the utility of a score combining GRACE and CHADS-VASc. Observational retrospective single-centre cohort study including 1852 patients admitted with a MI.

Performance of the Cockcroft-Gault, MDRD and CKD-EPI Formulae in Non-Valvular Atrial Fibrillation: Which one Should be Used for Risk Stratification?

Renal dysfunction is a strong predictor of adverse events in patients with atrial fibrillation (AF). The Cokcroft-Gault, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations are available for estimating the glomerular filtration rate (GFR). No comparisons between these equations have yet been performed in patients with non-valvular AF concerning their mid-term prognostic performance.

Stroke prediction with an adjusted R-CHA2DS2VASc score in a cohort of patients with a Myocardial Infarction.

Introduction: A new risk stratification scheme incorporating the original CHADS2 score and renal function, entitled R(2)CHADS(2), was validated in the ROCKET-AF and ATRIA study cohorts.

Aims: Adjusting and validating a modified R-CHA2DS2VASc score as a predictor of ischaemic stroke and all-cause mortality in patients discharged following admission for a Myocardial Infarction (MI).

Materials And Methods: Observational retrospective single-centre cohort study including 1711 patients admitted with MI and discharged alive.

[Severe aortic stenosis and cardiogenic shock: a therapeutic challenge].

Acute heart failure in patients with severe aortic stenosis and left ventricular systolic dysfunction is well known for its dire prognosis and limited therapeutic options. The authors describe the case of a man admitted for non-ST-elevation myocardial infarction. Diagnostic exams revealed severe aortic stenosis, with good left ventricular systolic function, and two-vessel coronary artery disease.

BLEED-Myocardial Infarction Score: Predicting mid-term post-discharge bleeding events.

Aim: To derive and validate a score for the prediction of mid-term bleeding events following discharge for myocardial infarction (MI).

Methods: One thousand and fifty patients admitted for MI and followed for 19.9 ± 6.

Mean corpuscular volume and red cell distribution width as predictors of left atrial stasis in patients with non-valvular atrial fibrillation.

Background: The role of erythrocyte indexes for the prediction of left atrial stasis, assessed by transesophageal echocardiography in patients with non-valvular atrial fibrillation, has not been previously clarified.

Methods: Single center cross-sectional study comprising 247 consecutive patients admitted to the emergency department due to symptomatic atrial fibrillation and undergoing transesophageal echocardiogram evaluation for exclusion of left atrial appendage thrombus (LAAT) before cardioversion. All patients had a complete blood count performed up to 12 hours prior to the transesophageal echocardiogram.

Mean platelet volume is associated with the presence of left atrial stasis in patients with non-valvular atrial fibrillation.

Background: Mean platelet volume has been associated with stroke in patients with atrial fibrillation. However, its role as a predictor of left atrial stasis, assessed by transesophageal echocardiography, in patients with non-valvular atrial fibrillation has not yet been clarified.

Methods: Single center cross-sectional study comprising 427 patients admitted to the emergency department due to symptomatic atrial fibrillation and undergoing transesophageal echocardiogram evaluation for exclusion of left atrial appendage thrombus before cardioversion.

Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.

Introduction: In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism.

Objective: To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed.

Percutaneous closure of the left atrial appendage for thromboembolic prevention in atrial fibrillation.

Atrial fibrillation is a common arrhythmia in clinical practice. It is associated with high morbidity and mortality due to its thromboembolic potential, which makes thromboembolic prevention particularly important. Warfarin has been the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized.