Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently coexist.The classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midra...Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently coexist.The classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midrange reduced EF(40%−49%,HFmrEF)and reduced EF(<40%,HFrEF)are crucial for optimising the therapeutic approach,as each subgroup responds differently.Betablocker constitute an important component of our pharmacological regimen for chronic HF.Betablocker administration is reccomended in patients with HF with reduced ejection fraction in stable sinus rhythm,due to improvement of symptoms,the better long termoutcome and survival.The beneficial role of betablocker use in patients with preserved EF still remain unclear,as no treatment showed a positive impact,regarding morbidity or mortality reduction.The presence of AF in HF patients increases as the disease severity evolves and is associated with a higher rate of cardiovascular morbidity and mortality.But more question is the use of betablocker in HF patients irrespective of EF and concomitant AF.There are many conflicting data and publications,regarding the beta blocker benefit in this population.Generally,it is supported an attenuation of betablockers beneficial effect in HF patients with AF.A design of more randomised trials/studies with HF patients and concomitant AF may improve our clinical approach of betablockers use and identify the patients with HF,who mostly profit from an invasive approach.展开更多
The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echoc...The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.展开更多
1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular m...1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular morbidity and mortality. AF has been correlated with an increased risk of stroke, systemic embolism and long term morbidity compared to individuals with sinus rhythm. The highest prevalence of AF is reported in elderly as well as in patients with severe aortic stenosis, ranging between 16% and 40% in the latter. In the general population, AF scales the death risk up to 1.5 and 1.9 fold in men and women, respectively,展开更多
An 86-year-old male patient was admitted in our cardiology ward with signs of congestive biventricular heart failure. The patient presented with deteriorating dyspnea on mild exertion and at rest the last days, compat...An 86-year-old male patient was admitted in our cardiology ward with signs of congestive biventricular heart failure. The patient presented with deteriorating dyspnea on mild exertion and at rest the last days, compatible with class NYHA Ⅲ-Ⅳ heart failure, bilateral peripheral oedema, increased NT-proBNP （9198 pg/mL）, mildly elevated Troponin （TnT 64 pg/mL）, interstitial pulmonary oedema and bilateral pleural effusions in chest X ray.展开更多
A 76-year old female, was admitted in our cardiac surgery clinic to perform surgical aortic valve replacement due to a severe aortic regurgitation with symptoms of congestive heart failure. Her past medical history in...A 76-year old female, was admitted in our cardiac surgery clinic to perform surgical aortic valve replacement due to a severe aortic regurgitation with symptoms of congestive heart failure. Her past medical history included moderately impaired renal function （GFR 48 mL/min） and arterial hy- pertension.展开更多
1 Introduction Transcatheter aortic valve implantation （TAVI） constitutes an established treatment in inoperable or high perioperative risk patients with severe aortic stenosis, demonstrating similar mortality rates...1 Introduction Transcatheter aortic valve implantation （TAVI） constitutes an established treatment in inoperable or high perioperative risk patients with severe aortic stenosis, demonstrating similar mortality rates （at 30 days and 1 year） with surgical aortic valve replacement （SAVR）. Various complications have been reported during TAVI, weeks or months post procedure. The most frequent causes of transcatheter heart valve （THV） failure are paravalvular regurgitation, infective endocarditis （IE）, thrombosis and late valve Migration.展开更多
In the very interesting report published in Chinese Medical Journal concerning a 65-year-old hypertensive and hyperlipidemic male patient, with stent implantation 5 years previously, the patient developed anaphylactic...In the very interesting report published in Chinese Medical Journal concerning a 65-year-old hypertensive and hyperlipidemic male patient, with stent implantation 5 years previously, the patient developed anaphylactic shock accompanied by chest discomfort, palpitation, itchiness, nausea, vomiting, dyspnea, wheezing, abdominal pain, sweating, pale complexion, dizziness, and syncope following bread and milk consumption. The clinical symptomatology was associated with electrocardiographic and laboratory evidence of acute inferolateral myocardial infarction, and the patient recovered with epinephrine, antiallergic, and myocardial infarction protocol therapy including ticagrelor and Clexane. Coronary arteriography demonstrated lesions in the left trunk and the three coronary branches, but the stented areas were unobstructed. The allergen test revealed a Grade 2 （2.11 kUA/L） for wheat and Grade 0 for milk.展开更多
文摘Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently coexist.The classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midrange reduced EF(40%−49%,HFmrEF)and reduced EF(<40%,HFrEF)are crucial for optimising the therapeutic approach,as each subgroup responds differently.Betablocker constitute an important component of our pharmacological regimen for chronic HF.Betablocker administration is reccomended in patients with HF with reduced ejection fraction in stable sinus rhythm,due to improvement of symptoms,the better long termoutcome and survival.The beneficial role of betablocker use in patients with preserved EF still remain unclear,as no treatment showed a positive impact,regarding morbidity or mortality reduction.The presence of AF in HF patients increases as the disease severity evolves and is associated with a higher rate of cardiovascular morbidity and mortality.But more question is the use of betablocker in HF patients irrespective of EF and concomitant AF.There are many conflicting data and publications,regarding the beta blocker benefit in this population.Generally,it is supported an attenuation of betablockers beneficial effect in HF patients with AF.A design of more randomised trials/studies with HF patients and concomitant AF may improve our clinical approach of betablockers use and identify the patients with HF,who mostly profit from an invasive approach.
文摘The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.
文摘1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular morbidity and mortality. AF has been correlated with an increased risk of stroke, systemic embolism and long term morbidity compared to individuals with sinus rhythm. The highest prevalence of AF is reported in elderly as well as in patients with severe aortic stenosis, ranging between 16% and 40% in the latter. In the general population, AF scales the death risk up to 1.5 and 1.9 fold in men and women, respectively,
文摘An 86-year-old male patient was admitted in our cardiology ward with signs of congestive biventricular heart failure. The patient presented with deteriorating dyspnea on mild exertion and at rest the last days, compatible with class NYHA Ⅲ-Ⅳ heart failure, bilateral peripheral oedema, increased NT-proBNP （9198 pg/mL）, mildly elevated Troponin （TnT 64 pg/mL）, interstitial pulmonary oedema and bilateral pleural effusions in chest X ray.
文摘A 76-year old female, was admitted in our cardiac surgery clinic to perform surgical aortic valve replacement due to a severe aortic regurgitation with symptoms of congestive heart failure. Her past medical history included moderately impaired renal function （GFR 48 mL/min） and arterial hy- pertension.
文摘1 Introduction Transcatheter aortic valve implantation （TAVI） constitutes an established treatment in inoperable or high perioperative risk patients with severe aortic stenosis, demonstrating similar mortality rates （at 30 days and 1 year） with surgical aortic valve replacement （SAVR）. Various complications have been reported during TAVI, weeks or months post procedure. The most frequent causes of transcatheter heart valve （THV） failure are paravalvular regurgitation, infective endocarditis （IE）, thrombosis and late valve Migration.
文摘In the very interesting report published in Chinese Medical Journal concerning a 65-year-old hypertensive and hyperlipidemic male patient, with stent implantation 5 years previously, the patient developed anaphylactic shock accompanied by chest discomfort, palpitation, itchiness, nausea, vomiting, dyspnea, wheezing, abdominal pain, sweating, pale complexion, dizziness, and syncope following bread and milk consumption. The clinical symptomatology was associated with electrocardiographic and laboratory evidence of acute inferolateral myocardial infarction, and the patient recovered with epinephrine, antiallergic, and myocardial infarction protocol therapy including ticagrelor and Clexane. Coronary arteriography demonstrated lesions in the left trunk and the three coronary branches, but the stented areas were unobstructed. The allergen test revealed a Grade 2 （2.11 kUA/L） for wheat and Grade 0 for milk.
