RESUMEN
We describe a unique case of fulminant myocarditis in a patient with presumed SARS-CoV-2 reinfection. Patient had initial infection 4 months backand had COVID-19 antibody at the time of presentation. Endomyocardial biopsy showed lymphocytic myocarditis, that is usually seen in viral myocarditis. The molecular diagnostic testing of the endomyocardial biopsy for cardiotropic viruses was positive for Parvovirus and negative for SARS-CoV-2. Authors highly suspect co-infection of SARS-CoV-2 and Parvovirus, that possibly triggered the immune cascade resulting in fulminant myocarditis. Patient was hemodynamically unstable with ventricular tachycardia and was supported on VA ECMO and Impella CP. There was impressive recovery of left ventricular function within 48 h, leading to decannulation of VA ECMO in 72 h. This unique case was written by the survivor herself.
Asunto(s)
COVID-19 , Coinfección , Miocarditis , Coinfección/diagnóstico , Humanos , Miocarditis/diagnóstico , Miocarditis/terapia , Reinfección , SARS-CoV-2RESUMEN
BACKGROUND: Left ventricular global longitudinal systolic strain (GLS) has been shown to be superior to ejection fraction in detecting subclinical dysfunction in patients with cancer and predicting mortality in patients with cardiovascular disease. Cancer-related fatigue is common in the later stages of neoplastic malignancies and may be indicative of nonovert heart failure. The aim of this study was to determine whether reduced strain by echocardiography was associated with all-cause mortality in a cancer cohort. METHODS: In this retrospective study, 120 patients with cancer undergoing or scheduled to undergo chemotherapy and with normal ejection fractions (>50%) underwent assessments of GLS. GLS was derived by averaging all speckle-tracking strain segments of the left ventricle. RESULTS: Over an average follow-up period of 21.6 ± 13.9 months, 57 of 120 patients died. Univariate predictors of all-cause mortality (P < .10) were Eastern Cooperative Oncology Group performance status, male sex, hematologic malignancy, ß-blocker use, and GLS. Multivariate analysis of all significant univariate variables showed that Eastern Cooperative Oncology Group performance status (hazard ratio, 2.12; 95% confidence interval, 1.54-2.92; P < .001), male sex (hazard ratio, 1.93; 95% confidence interval, 1.14-3.27; P = .014), and GLS (hazard ratio, 0.89; 95% confidence interval, 0.81-0.97; P = .012) were significantly and independently associated with mortality. Stepwise analysis of the multivariate associations showed an increase in the global χ(2) value after adding GLS (P = .011) to significant clinical variables. CONCLUSIONS: Eastern Cooperative Oncology Group performance status, male sex, and GLS were significantly associated with all-cause mortality in patients with cancer with normal ejection fractions receiving chemotherapy. Adding GLS to significant clinical variables provided incremental prognostic information.
Asunto(s)
Ecocardiografía/estadística & datos numéricos , Neoplasias/diagnóstico por imagen , Neoplasias/mortalidad , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/mortalidad , Comorbilidad , Femenino , Humanos , Incidencia , Indiana/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Medición de Riesgo , Sensibilidad y Especificidad , Distribución por Sexo , Volumen Sistólico , Análisis de SupervivenciaRESUMEN
Obstructive sleep apnea-hypoapnea syndrome (OSA) is a disorder that results in repetitive occlusion of the airway and hypoxemia during sleep. Epidemiologic studies have associated this disorder with increased cardiovascular morbidity and mortality. Systemic hypertension is prevalent among patients with OSA and has been recognized as a common identifiable cause of hypertension. Nasal continuous positive airway pressure (nCPAP) ventilation is an effective therapy for OSA and it may additionally reduce blood pressure. The use of nCPAP ventilation to treat hypertension in patients with OSA has been studied extensively. However, whether it is effective in treating hypertension in this population remains unclear. This review evaluates the recent literature that investigates the effects of nCPAP ventilation on hypertension in patients with OSA.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Hipertensión/etiología , Hipertensión/terapia , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapia , Humanos , Hipertensión/fisiopatología , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Apnea Obstructiva del Sueño/fisiopatologíaRESUMEN
Despite therapy with multiple optimally dosed medications, hypertension remains poorly controlled in a sizeable number of people worldwide. This has spurred interest in exploring other pharmacologic and nonpharmacologic options for treatment. The carotid baroreceptors are important in regulating blood pressure in chronic hypertension by centrally mediated sympathoinhibitory effects and other effects. This has led to renewed interest in treating hypertension by electrically stimulating the carotid baroreceptors. Although this concept was first studied several decades ago, modern technology and better understanding of physiology have finally allowed the development of a feasible treatment option. Ongoing trials are finding significant and sustained reductions in blood pressure, a good safety profile, and tolerable side-effects. These promising results indicate that this modality has the potential to become a useful tool in future treatment of hypertension.