Browsing by Subject "Echocardiogram"

Now showing 1 - 3 of 3
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    Five-Year Outcomes and Cardiac Remodeling Following Left Atrial Appendage Occlusion
    (Dovepress, 2021-04-19) Liu, Baoxin; Luo, Jiachen; Gong, Mengmeng; Li, Zhiqiang; Shi, Beibei; Zhang, Xingxu; Han, Xinqiang; Wei, Yidong; Medicine, School of Medicine
    Purpose: LAAO has been an alternative therapy to oral anticoagulants (OACs) for stroke prophylaxis in patients with nonvalvular atrial fibrillation (NVAF) with elevated CHA2DS2-Vasc score, but the long-term outcomes of LAAO and its impacts on cardiac electrical and mechanical remodeling remain to be learned. We aimed to describe the impact of left atrial appendage occlusion (LAAO) on atrial remodeling and cardiovascular outcomes within 5-year follow-up. Patients and methods: A total of 107 patients with nonvalvular atrial fibrillation (NVAF) undergoing LAAO in the Shanghai Tenth People's Hospital between January 2014 and July 2017 were included. All participants were followed for ECG, transthoracic echocardiography (TTE), and clinical outcomes (including cardiovascular death, heart failure, ischemic stroke/systemic embolism, and pericardial effusion) at 6 and 12 months, and thereafter every 12 months after LAAO discharge until 5 years. Results: After LAAO, the left atrial diameter significantly increased at 6 months (48.6 ± 6.7 vs 46.5 ± 7.0 mm); heart rate decreased immediately after the procedure (78.5 ± 14.7 vs 85.3 ± 21.7 bpm) when compared with the pre-procedure level. The QTc interval prolongated to the highest value of 460.7 ± 46.8 ms at 6 months (pre-procedure level of 433.7±49.0 ms). All these changes return to the pre-procedure level within the follow-up. For clinical outcomes, 51 patients suffered the composite of cardiovascular death (n=4, 3.7%), heart failure (n=25, 23.4%), ischemic stroke/systemic embolism (n=22, 20.6%), and pericardial effusion (n=26, 26.2%). Conclusion: LAAO did not change ECG or TTE characteristics and nonprocedure-related pericardial effusion is common during long-term follow-up. Further studies are warranted to investigate the optimal time frame of anticoagulation in patients undergoing LAAO.
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    In the Weeds: Identifying the Underlying Etiology in a Patient with Suspected Hypertrophic Obstructive Cardiomyopathy
    (2024-03-22) Wojciechowska, Klaudia; Denning, Ellen; Bice, Caroline; Nadeem, Manahil; Robles, Maria
    BACKGROUND Many cases of Hypertrophic Obstructive Cardiomyopathy (HOCM) go undetected or are underdiagnosed. Patients are typically young athletes who experience decreased cardiac output, syncope with exercise, or sudden death. The disease is diagnosed with echo but cannot be certain unless a gene mutation is identified. This creates challenges for those who do not fit the classic profile nor have an identified gene mutation. METHODS A 57 y.o. black female presented with a heart murmur. A referral was made to cardiology where imaging results pointed to HOCM, but due to a history of hypertension (HTN) and missing medical records, an underlying etiology of hypertrophy secondary to HTN could not be ruled out. Genetic testing for HOCM was negative despite the patient’s extensive family history of cardiac disease. Due to these conflicting findings, a cardiac MRI was performed. While HTN could not be ruled out as a contributing factor, HOCM was placed as the leading differential. RESULTS The fragmentation of the patient’s medical records meant that the duration of the murmur and HTN is unknown. In addition, each cardiology provider had different interpretations of the radiologic imaging. The led to difficulties obtaining a diagnosis of HOCM vs HCM due to HTN. Given that the patient did not fit the classic demographic presentation of HOCM, it is possible that the diagnosis was not initially considered. By the time a full work-up had been conducted, her HTN had been poorly controlled for years and therefore delineating the root cause of HOCM was difficult. Lastly, the patient tested negative for the 24 gene mutations linked to HOCM, despite an extensive family history of cardiac disease. This highlights that there are likely more unknown mutations and there is a need for improved diagnostic criteria independent of genetic tests. CONCLUSION This case demonstrates the importance of keeping an expanded differential diagnosis, maintaining coherent and comprehensive medical records, and pursuing prompt diagnoses.
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    Small-Group Activity to Reinforce the Impact of Valvular Defects and Heart Failure on Cardiac Pressure-Volume Relationships
    (Association of American Medical Colleges, 2018-02-06) Hopper, Mari; Tune, Johnathan; Klabunde, Richard; Cellular and Integrative Physiology, School of Medicine
    Introduction: An important topic in cardiac physiology is the relationship between changes in intracardiac pressures and volumes during the cardiac cycle. This topic lends itself well to utilizing active learning principles to facilitate student understanding of pressure and volume changes in normal cardiac physiology and in the pathophysiology of valve disease and heart failure. We describe an active learning exercise regarding this topic that engages and facilitates student learning in a small-group setting. Methods: Following an overview lecture on the normal cardiac physiology, small groups of students under the guidance of a facilitator were provided with a worksheet consisting of questions related to background knowledge of cardiac physiology. Additional questions related to five valve disease and heart failure cases were also provided to promote the application of basic physiology principles to clinically relevant problems. The facilitator was provided with a guide to help facilitate the student interactions. Following the group worksheet activity, an animated slide presentation was shown to further engage student learning through active discussion of their worksheet answers. Results: Students were assessed by written examination, and were found to have a higher performance on the subset of questions related to this learning activity compared to the overall exam. Of the 175 students completing the exercise, 23 voluntarily provided feedback via a survey. Student surveys provided overwhelmingly positive feedback on the benefits of this active learning exercise. Discussion: Small group, active learning exercises benefited student learning by providing a framework for analysis, synthesis, and application of clinically relevant cardiac physiology concepts.