RESUMEN
BACKGROUND: Diabetes Mellitus is a prevalent disease with a growing impact on individuals worldwide. Evaluating the prevalence of subclinical left ventricular dysfunction and understanding its associations with microvascular complications, uncontrolled glycemia, diabetes duration, and patient age is crucial. Our aim is to determine the utility of screening for this condition. METHODS: We conducted a retrospective cohort study involving 159 asymptomatic individuals with type 2 diabetes. Bivariate analysis was employed to assess potential factors and their associations with subclinical left ventricular dysfunction. Patients with a history of cardiac disease or interventions were excluded. RESULTS: The average age of our sample was 61.5 years. Almost half of the patients exhibited an HbA1c exceeding 7% (50.3%), and approximately half had an ejection fraction (EF) of less than 55% (50.9%). In the bivariate analysis, a notable difference in microvascular diabetic complications was observed among different EF groups. Specifically, nephropathy (62%), neuropathy (57.5%), and retinopathy (74.4%) were significantly more prevalent among patients with an EF < 55%. We also identified a significant age difference between groups, with a higher mean diabetes duration (14.1 ± 7.7 years) in the lower EF group. Notably, 63.7% of patients with an HbA1c exceeding 7% exhibited an EF < 55%. Older patients were associated with a lower EF, with an adjusted odds ratio (aOR) of 0.94. An HbA1c of 7% or less was linked to a higher likelihood of an EF > 55%. CONCLUSION: We established a correlation between subclinical left ventricular systolic dysfunction and microvascular complications. However, further extensive prospective research is necessary to deepen our understanding of these associations and their clinical implications.
Asunto(s)
Diabetes Mellitus Tipo 2 , Disfunción Ventricular Izquierda , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Persona de Mediana Edad , Disfunción Ventricular Izquierda/epidemiología , Masculino , Femenino , Prevalencia , Estudios Retrospectivos , Anciano , Líbano/epidemiología , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismoRESUMEN
Silent myocardial ischemia (SMI) is a relatively common phenomenon in patients with coronary artery disease (CAD). The original description of SMI dates back to the 1970s. We performed an extensive search of the literature starting from 2000, using MEDLINE or PubMed, and 676 documents were analyzed, and only 45 articles found suitable for the study were selected. Data regarding the prevalence and risk factors of SMI were discussed, along with the different mechanistic processes behind it; also, methods for screening and diagnosis are exposed, namely electrocardiographic stress test, stress echocardiography, and single-photon emission computed tomography (SPECT). The silent nature of the condition presumes that patients are diagnosed at a more advanced stage, and screening high-risk patients for early management is essential. Education of patients is necessary, and medical management along with cardiac rehabilitation is valid for mild cases, whereas patients with moderate-to-severe myocardial ischemia might require a more invasive approach. SMI is relatively common, diagnostic approach offers data regarding the presence of ischemia along with its anatomic extent, providing important prognostic value. Given its silent and critical nature, future directions for better screening and management must be searched and implemented extensively.
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BACKGROUND: Myxomas are the most prevalent type of heart tumors, mainly occurring in the left atrium, with approximately 20% of cases found in the right atrium. Timely diagnosis and appropriate management of myxomas are crucial for favorable outcomes and to minimize complications. CASE PRESENTATION: A 77-year-old Asian male with no significant medical history presented with intermittent trepopnea and palpitations. Physical examination revealed regular heart sounds and no other relevant findings. A transthoracic echocardiogram showed a large, round-shaped, smooth-edged mass with diameter of 86 mm, occupying most of the right atrium. Mild tricuspid flow obstruction and mild left ventricular systolic dysfunction were also observed. Cardiac tomography confirmed the size, smooth edges, and showed microcalcifications of the mass, with no invasion of surrounding tissues. Surgical intervention successfully removed the spheroid mass, leading to the alleviation of symptoms. Histopathology confirmed the myxoma nature of the mass. A comprehensive discussion based on relevant medical literature is provided, with emphasis on echocardiographic characteristics of the mass with relation to potential embolic disease. CONCLUSION: This case shows an atypical presentation of an exceptionally large myxoma in the right atrium, resembling the size of a polo ball, in a patient presenting with supraventricular arrhythmia and trepopnea. Early diagnosis and appropriate management played a vital role in achieving a successful outcome for the patient.
Asunto(s)
Neoplasias Cardíacas , Mixoma , Humanos , Masculino , Anciano , Atrios Cardíacos/diagnóstico por imagen , Ecocardiografía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Mixoma/diagnóstico por imagen , Mixoma/cirugía , DisneaRESUMEN
BACKGROUND: Bleeding in the postoperative period after cardiac surgery is relatively frequent, especially in patients with early anticoagulant therapy, as in the case of mechanical valve replacement. Diffuse hemopericardium is relatively easy to diagnose; however, loculated pericardial hematomas leading to hemodynamic collapse are relatively rare and their diagnosis is more challenging. CASE PRESENTATION: This report is of a 75-year-old Asian woman who presented dyspnea, confusion and hemodynamic collapse related to loculated pericardial hematoma compressing the right atrium 3 days after mechanical aortic valve replacement. Urgent transthoracic echocardiogram performed as point-of-care approach showed right atrial compression, the aortic valve prosthesis had normal function. Surgical removal of the hematoma resulted in complete recovery. CONCLUSION: Loculated pericardial hematoma might lead to hemodynamic collapse. Close monitoring of hemodynamic parameters is essential, also point-of-care echocardiography is essential for early recognition and prompt management in patients with critical hemodynamic condition.