31^st European Heart and Heart Failure Congress June 18-19, 2020 Paris, France

Biography:

Abstract:

Background: To predict outcomes, acute coronary syndrome (ACS) can be assessed using GRACE and TIMI risk scores, whereas SYNTAX score is used to assess coronary artery disease (CAD) severity and clarify the management. CHA2DS2-VASc score is used as a predictive tool for stroke prevention in non-valvular atrial fibrillation, and it was studied in ACS in terms of outcome and CAD severity.

Methods: Between December 2016 and June 2017, 125 ACS patients (mean age: 57.78 (±9.5) years, 78.4% males) were enrolled in this observational prospective study at Mansoura specialized hospital. 89 patients had been followed-up for six months. Patients were assessed based on history, clinical examination, 12-lead ECG, and coronary angiography.

 

Results: CHA2DS2-VASc score was significantly correlated with SYNTAX and Gensini scores (p<0.001 and p<0.001, respectively). Receiver operating characteristic (ROC) curves were generated and cutoff values determined for the CHA2DS2-VASc score (cutoff>2; 76% sensitivity; 76.8% specificity; p<0.001) in predicting coronary multivessel disease. Patients with a CHA2DS2-VASc score ≥ 2 had higher in-hospital complications (all p<0.05).

CHA2DS2-VASc score was significantly correlated with in-hospital (11.9%, p=0.21) and six month-mortality (25%, p=0.042). ROC curves were generated and cutoff values determined for the CHA2DS2-VASc score (cutoff>2; 88% sensitivity; 65.3% specificity; p<0.001) in predicting six-month-mortality. Multivariate logistic regression analysis showed that CHA2DS2-VASc score (p<0.001 with odds ratio 2.28; 95% CI 1.47–3.53) was like Grace score a predictor of six-month-mortality.

Conclusion: CHA2DS2-VASc score is associated with increased CAD severity and in-hospital and six-month outcomes.

Keywords: CHA2DS2-VASc score, acute coronary syndrome, coronary artery disease, clinical outcome, Risk Assessment

Biography:

Abstract:

Case report

Patient of age 20 years old visited medicine OPD complaining of dyspnoea and dysphagia, diaphoresis  with sign of ,tachypnea (21 breathe per minute)and tachycardia of 150 btm with blood pressure 90/60,  he has history of 12 years pneumonia repeated treatment with recent diagnosis of tuberculosis,  treated by anti tuberculosis medication before 6 months, his weight was  25 kg at the moment of visit, in his previous visit to different clinician, suspected to have cancer due to his reduced weight  indication, due to dyspnoea symptoms, prescribed asthmatic medication which he undergone for 15 days   for example salmeterol, ipratropium, emsolone, fluticasone before the visit to our OPD, during this course of medication his shortness of breathe exacerbated and  along with difficulty in swallowing hence he forced to come to visit us.

 During our OPD visit of his examination - He was suspected to suffer from multiple organ problem due to demonstrated  symptomatic status like as tachycardia (heart beat of 150), dyspnoea, dysphagia (unable to swallow) and more focussed symptom was critical reduction in weight 25 kg in 10 years of time, hence he was referred to Cardiology department ,for further examination expecting that there must be involved of cardiac problem if not we will rule out it.

On visit to cardiology department,  Echo test was said to perform, not performed till his this age of 20 years, before visit to us.

Test performed for the diagnosis in our Hospital

Blood test, LFT,ECG, ECHO

Test result

He underwent transthoracic echocardiography that revealed an EF of 36% with severe global left ventricular (LV) hypokinesia.His echo impression revealed Global LV hypokinesia.On the basis of echo test result he was prescribed spironolactone, metoprolol,and one antibiotic to improve and strengthens the muscle of heart so that his prognosis of symptoms be amended in assumption to remodel the cardiac system and to enhance easier life survivality.

Conclusion: This is clear undiagnosed case of long term pneumonia induced Global left ventricular hypokinesia, under transthoracic investigation demonstrated LV hypokinesia.

Discussion:

Some time physician and clinician only concentrate on the symptomatic feature focussed to  that organ problem, and they get confused on the exact organ failure or association of the concerned part.

Biography:

Christie Anne I. Pabelico  has completed her MD at the age of 24 years from De La Salle University Health Sciences Institute. She is currently undergoing her fellowship training in Adult Cardiology at Perpetual Help Medical Center Las Pinas Philippines and aims to pursue training in the field of Echocardiography.            

Abstract:

Peripartum cardiomyopathy, in itself, is a rare condition. Often undiagnosed early, most cases are those already with complications, usually in decompensated heart failure. The symptoms are not recognized promptly because of the close resemblance to the normal spectrum of pregnancy. In rare occasions, this form of cardiomyopathy can be the etiology of stroke.

A 33 year old female G5P4, known hyperthyroid, admitted in labor and delivered to a live baby boy, with no complications. On the 12^th hour postpartum, noted sudden onset of right-sided body weakness. Imaging showed infarct of varying ages on the left frontal lobe. Suspecting a probable embolic origin, electrocardiogram revealed sinus tachycardia but 2D echocardiogram showed global hypokinesia with ejection fraction of 30%. During ICU stay, the patient had difficulty breathing with concomitant desaturations, associated with tachycardia. With a background of hyperthyroidism, thyroid storm was also entertained, thus, the debate regarding the etiology of heart failure secondary to thyrotoxic heart disease versus peripartum cardiomyopathy was raised.

Currently, there are no related literature regarding the incidence of all entities occurring in the same setting. 

The case presented a gray area in stroke in the spectrum of pregnancy, peripartum cardiomyopathy and hyperthyroidism because the incidence of these in the same setting is rare. It is unfortunate that the patient already suffered the devastating consequence leading to morbidity on diagnosis. The importance of a high index of suspicion and prompt diagnosis are keys, as well as adherence to medications and patient education, to guide proper management and prevent complications.

Biography:

Abstract:

Background- Aim:

Viscoelastic tests (rotational thromboelastometry, ROTEM ® ), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled.

Methods:

Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM ® implementation.

Results:

Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p=0.026) during the perioperative period. In the group monitored with ROTEM ® , decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p=0.002), fresh frozen plasma (9.8% vs 3.8%, p=0.008), prothrombin complex concentrate administration (0.9% vs 0.3%, p=0.599) and activated recombinant factor VII (0.3% vs 0.0%, p=0.603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p=0,530) and fibrinogen concentrate

(0.9% vs 3.5%, p=0.066), tranexamic acid (0.0% vs 0.6%, p=0.370) and protamine administration (0.6% vs 0.9%, p=0.908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p=0.813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p=0.037), surgical reexploration (6.0% vs 2.9%, p=0.035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p=0.026).

Conclusions:

The monitoring of hemostasis by ROTEM ® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.

Biography:

Abstract:

Introduction:

 Rheumatic heart disease is one of the most common heart diseases in developing country. One of the most common complications of Rheumatic Heart Disease is Mitral Stenosis which ultimately lead to pulmonary hypertension and heart failure and death. So, PTMC (Percutaneous Transluminal Mitral Commissurotomy) is a well established simple, effective and safe  therapeutic intervention for mitral stenosis.

While many literatures reviewed till date have shown that it takes 3-6 months time period for the reduction of pulmonary artery pressure after PTMC, this study is designed to see the result in pulmonary artery pressure immediately after  procedure.

Method

Total 42 patients with Rheumatic Mitral Stenosis in Cath Lab under Department of Cardiology of Chitwan Medical College from October 1 2018 to August 30 2019 were included in the study. Pulmonary artery pressure was assessed by Right heart catheterization by using multipurpose /pigtail catheter under conscious sedation.

Results

It is a prospective observational study on a total of 42 patients who underwent PTMC, 30 were female and 12 were male. Age ranged from 30 to 61 years with the mean age of 45.36±10 years. The mean mitral valve area increased from 0.87±0.2 cm2 to 1.74±0.17 cm2 whereas Mean Pressure Gradient decreased from 13.59± 7.30 mmHg to 5.15±30 mmHg. Mean Pulmonary Artery Pressure decreased from 41.50 ±16.00 mmHg to 33.50±12.00 mmHg. Similarly, the mean left atrial pressure decreased from 26.57±8.62 mmHg to 15.50±5.95 mmHg whereas, the mean Aortic Pressure increased from 91.43 ±23.02 mmHg  to  98.29±24.92 mmHg . Eighteen (42.85%) patients had an increase in MR by 2 grades but there is no need of immediate mitral valve replacement. During procedure, paroxysmal PSVT was noted in six (14.285%) patients and also local hematoma was observed in five (11.90%) patients.

Conclusion

There is reduction in pulmonary artery pressure immediately post PTMC which is directly correlated with left atrial pressure without significant MR and tachycardia.

This study is limited in terms of single center with small sample size.

Biography:

Abstract:

Background: Myocarditis is an acute infectious or immunologically mediated syndrome causing inflammation of the heart muscle. Around half of all cases are idiopathic (Karjalainen et al. 1983). Possible complications include syncope, arrhythmia and heart failure.

Presentation: 65 year old man with background hyperlipidaemia was presented with chest pain and palpitation. Initial ECG was monomorphic VT. Patient was haemodynamically stable. Subsequently, VT was approaching 240 bpm. Decision was made to proceed with cardioversion and sinus rhythm was restored. Electrolyte disturbance was excluded and angiogram was performed which did not show any flow limiting coronary artery disease. Cardiac MR had demonstrated normal left ventricular function with patchy mid wall epicardial mid gadolinium enhancement, consistent with a diagnosis of likely myocarditis although nonspecific cardiomyopathy could not be excluded. Being SVT with aberrancy a differential in view of regular broad complex tachycardia, EP study was subsequently performed and had confirmed VT. The patient then underwent ICD implantation and discharged well.

ECG: to be displayed on poster

Discussion: The mechanisms for  ventricular arrhythmias during myocardial inflammation are unknown. Endomyocardial biopsy is not necessary for the diagnosis of myocarditis. MRI should be performed in patients resuscitated from sudden cardiac death, to rule out myocardial inflammation. Although it is difficult to establish the exact prognosis, it is suggested that the prognosis of patients with resuscitated sudden cardiac death in the onset of acute myocarditis is favourable, arrhythmias usually being self-limited with no recurrences that follow the acute phase.

References:

E-journal of the ESC Council for Cardiology Practice. 05/04/2011. Ventricular arrhythmias complicating acute myocarditis

Celia Bagshaw / Editors: Jason Kendall, Stewart H McMorran. 08/11/2017. Myocarditis. RCEM learning.

Khabbaz Z, Grinda JM, Fabiani JN. Extracorporeal life support: an effective and non-invasive way to treat acute necrotizing eosinophilic myocarditis. J Thorac Cardiovasc Surg. 2007; 133(4): 1122-3.

Chau EM, Chow WH, Chiu C, Wang E. Treatment and outcome in biopsy proven fulminant myocarditis in adults. Int J Cardiol. 2006; 110 (3): 405-6.

Biography:

Abstract:

INTRODUCTION :

Heart failure has different characteristics depending on the sex, In case of STEMI men and women have distinct cardiovascular responses to acute myocardial ischemia with a higher risk for women to develop acute heart failure

OBJECTIVES :

The main goal of this study is to determinate the relationships between gender and acute heart failure after STEMI in patients with no prior history of heart failure recorded at baseline.

 METHODS :

This is a retrospective, study including 210 patients who had been hospitalized in a cardiology intensive care unit for myocardial infarction from september 2017 to february 2019 , The main outcome measures were the incidence of Killip's   class at hospital presentation and introhospital mortality rates.

RESULTS :

The main age was 59.3 ± 7.02 Sex ratio: 2,86 (74.1% Male, 25.9% Female) the incidence of de novo heart failure at hospital presentation was higher for women than for men (40,4% vs. 29.5%, odds ratio [OR 1,61 ; 95% confidence interval [CI], 0,83-3,11). Women with de novo heart failure had higher mortality than did their male counterparts (28,6% vs. 20.5%; OR: 1,55 ;95% CI , 0,5-3,15).About treatment 80% have been thrombolysed. The culprit artey was  Left anterior descending artery in 53,4%.

 CONCLUSIONS :

Women are at higher risk to develop de novo heart failure after STEMI and women with de novo heart failure have worse survival than men this may be related to the increased prevalence of microvascular disease in women predisposing them to heart failure after a STEMI