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Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El tratamiento de la enfermedad hepática terminal con Cardiomiopatía Cirrótica (CMC) es el trasplante hepático (TH), sin embargo el tratamiento médico con la combinación de diuréticos y beta bloqueantes no selectivos antes y después tienen un rol importante. A diferencia de la insuficiencia cardíaca de otras etiologías, los inhibidores de la enzima convertidora (IECA), los bloqueadores del receptor de angiotensina 2 (ARA-2) o los inhibidores del receptor de angiotensina y de neprilisina (ARNI) no se recomiendan debido a la fisiopatología particular de la CMC. El shunt porto-sistémico intrahepático transyugular (Transjugular intrahepatic porto-systemic shunt: TIPS) tiene sus indicaciones con posibles beneficios y riesgos pero más estudios son necesarios en la CMC. El TH es la opción más eficaz y puede revertir el QTc del ECG y la disfunción diastólica y sistólica; en las últimas décadas, a pesar del aumento de la complejidad en los pacientes (mayor score MELD), con la mejoría de la técnica quirúrgica, cuidados intensivos, drogas inmunosupresoras y diagnóstico por imágenes la sobrevida ha mejorado significativamente.

The clinical case of a one-year-old miniature Bull Terrier is presented. The patient was brought to the cardiology service of the Small Animal Clinic at the Universidad Nacional de Colombia due to historical syncopal episodes during exercise or moments of excitement, as well as at rest. Additionally, these syncopal episodes have increased in frequency to the point of daily occurrence. Echocardiography reveals thickening of the interventricular septum and the free wall of both ventricles. Additionally, irregular enlargement is evidenced in the mass of the papillary muscles of the left ventricle, which are distributed concentrically to the ventricular cavity, as well as a thickened mitral valve, which neither closes nor opens correctly causing mitral insufficiency and regurgitant flow to the left atrium. Similarly, narrowing of the left ventricular outflow tract and increased echogenicity in the aortic valve are observed, which, similarly to the mitral valve, is unable to open properly. The findings suggest congenital mitral valve dysplasia leading to stenosis, accompanied by aortic stenosis. Due to the absence of surgical intervention options, therapy aims to control existing clinical signs and halt the progression of cardiac enlargement using beta-blockers. [ABSTRACT FROM AUTHOR]

Sepsis-induced cardiomyopathy is a clinical entity rarely reported in the literature. It lacked an objective and agreedupon definition, and although there are clinical criteria, there are no diagnostic guidelines or specific treatment; its identification, approach, and management imply a challenge for the clinician. Its presence increases mortality by up to 70%. It is considered an acute onset complication that manifests with alterations in systolic and diastolic function, finally showing reversibility in a period of seven to ten days. When this entity is suspected, the gold standard for diagnosis is the echocardiogram. Infection control, life support, and hemodynamic measures associated with the use of vasopressors and inotropes are the main therapeutic tools that have shown a decrease in mortality. However, this entity usually requires advanced organic support, even requiring ventricular assistance devices such as an intraaortic balloon pump (IABP) or extra corporeal membrane oxygenation (ECMO), which have shown promising results in the treatment of this pathology. Despite this, mortality is high, and the prognosis continues to be unfavorable without early identification, hence the importance of unifying criteria, establishing risk factors, validated diagnostic tools as well as differentiating it from other clinical entities, thereby improving its outcome and prognosis. [ABSTRACT FROM AUTHOR]

O tromboembolismo aórtico felino é uma afecção decorrente da obstrução vascular por êmbolos. As alterações clínicas observadas cursam com quadros de neuromiopatia isquêmica, constatado por paraplegia dos membros pélvicos, com redução da temperatura e hiperalgesia lombar. Para auxiliar no diagnóstico, podem ser realizados exames por imagem como a termografia infravermelha, método não invasivo, não iônico e que minimiza a contenção do paciente. Outros exames como ultrassonografia com doppler vascular, ecocardiograma, tomografia computadorizada e angiografia por ressonância magnética também podem auxiliar no diagnóstico. Além disso, a utilização de exames laboratoriais pode indicar a existência do quadro. O prognóstico é reservado, devido à alta incidência de óbitos. Dessa maneira, o presente estudo teve como objetivo, relatar a eficiência da termografia infravermelha no diagnóstico de tromboembolismo aórtico felino e discutir com base na literatura a utilização dos exames complementares frente ao diagnóstico da afecção. Por fim, constata-se que a termografia infravermelha possui capacidade significativa na detecção de diferenças térmicas cutâneas, e que associada ao exame físico, neurológico, ecocardiográfico e ultrassonográfico, o diagnóstico de tromboembolismo aórtico felino se torna mais rápido e assertivo. [ABSTRACT FROM AUTHOR]

O tromboembolismo arterial (TEA), é uma síndrome caracterizada pela formação de trombos que atingem a corrente sanguínea e podem se depositar nas artérias causando uma série de complicações. As cardiomiopatias que induzem aumento do átrio esquerdo dos gatos, é o fator predisponente à ocorrência da síndrome. O diagnóstico do TEA é feito através dos sinais clínicos e exames complementares, principalmente o ecocardiograma. A terapia antitrombótica é indicada como primeira escolha, mas o prognóstico varia de reservado a ruim. Analgesia é de extrema importância no protocolo terapêutico de pacientes com TEA. A cardiomiopatia restritiva é uma cardiomiopatia importante na clínica de felinos, no qual uma baixa porcentagem de gatos demonstra sinais clínicos anterior ao evento trombótico ou Insuficiência Cardíaca Congestiva. O objetivo deste relato foi descrever a evolução de um caso de tromboembolismo arterial decorrente de cardiomiopatia restritiva não tratada em uma gata de oito anos, castrada, pesando 4,9 kg com cianose de coxins e paralisia bilateral dos membros pélvicos. Após o diagnóstico, foi instituído o protocolo terapêutico com clopidorgel, rivaroxabana, analgesia e tratamento sintomático associado. A paciente respondeu favoravelmente à terapia clínica nos primeiros três dias e, após isso, teve piora clínica, no qual foi realizado eutanásia por questões pessoais da proprietária e prognóstico desfavorável.

Background: Hypertrophic phenotype cardiomyopathy is the most common heart disease in cats. Although the echocardiogram is the gold standard test for diagnosing fHCM, patients with the disease may have electrocardiographic changes. Despite being reported in most 12-lead electrocardiograms, the P wave axis generally receives little attention when compared to other wave parameters. We performed a Doppler echocardiographic and electrocardiographic study in cats, in order to verify the presence of correlation between the electrical axis average P wave and the presence of fCMH, aiming to investigate the possibility of its aid in the early diagnosis of cardiac disorders. Materials, Methods & Results: One hundred cats of different breeds, ages, males and females were evaluated. Those animals with a history of previous disease other than hypertrophic cardiomyopathy were excluded from the study. The groups were formed after obtaining the results of the echocardiographic examination. Eight of the 100 cats did not allow echocardiographic evaluation, and the remaining 92 were divided into 2 groups (control group, n = 64 and heart disease group, n = 28) after the examination. Of these 92 animals, 28 cats had the hypertrophic cardiomyopathy phenotype. The electrocardiographic examination was performed after the allocation of animals into groups lasting 5 min with the recording of tracings for later interpretation. To calculate the axis of the P wave, leads D1 and D3 were used, measuring the amplitude of the P wave in these leads and calculating the resulting amplitude. All cats studied had mean electrical axis of the P wave within the normal range for the species (0° to 90°). Based on mean electrical axis P wave values, there was no significant difference between groups. The control group had a median of 63.7° with a maximum value of 80°, a minimum value of 60° and a mean of 65.1°. The fCMH group had a median of 68.7° with a maximum value of 85.3°, a minimum value of 56.3° and a mean of 68.8°. Of the fCMH group, 3 cats had increased P wave duration (50.33 ± 5.77 ms), suggesting left atrial overload, and 13 cats had increased QRS complex duration (66.30 ± 11.23 ms). Also, 18 cats (Control group: 11; fCMH group: 7) showed T wave amplitude greater than 25% of R, suggesting the presence of myocardial hypoxia and/or electrolyte disturbance. One cat had a prolonged PR interval (from the fCMH group). As for the QT interval, 6 cats had an interval < 120 (2 from the control group and 4 from the affected group) and 3 had an interval > 180 (1 from the control group and 2 from the affected group). The ST segment remained isoelectric in all segments. As for the mean electrical axis of the QRS complex, 5 cats (10.42%) had axis deviation to the right (control: 1; fCMH: 4) suggesting right ventricular overload; 7 cats (14.58%) had left axis deviation (control: 5; fCMH: 2), suggestive of left ventricular overload; and 36 cats (75%) had a normal mean electrical axis. Discussion: Based on the results obtained in the present study, it can be concluded that screening studies in asymptomatic felines should be increasingly implemented in the veterinary clinical routine, since the frequency found was high (30.44%) and that patients may remain asymptomatic for years until the development of signs. It should be concluded that there was no correlation between the mean electric axis of P-wave and the presence of subclinical phenotype hypertrophic cardiomyopathy. Therefore, more studies are needed, with felines at different stages of the disease, to evaluate whether this electrocardiographic measurement allows us to assist in its diagnosis, since it is a feasible measure in cats. Furthermore, it is concluded that the electrocardiogram should be used as an aid method in the diagnosis of the disease and not as a screening test. [ABSTRACT FROM AUTHOR]

Copyright of Revista Argentina de Cardiología is the property of Sociedad Argentina de Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Left ventricular noncompaction (LVNC) is a genetically heterogeneous cardiomyopathy, with familial and sporadic forms, but genetic testing only identifies a pathogenic mutation in a minority of cases. The main complications are heart failure, embolism and dysrhythmias. Herein we report a familial case of LVNC associated with a mutation in the MYH7 gene and review the literature regarding controversies in LVNC. A 50-year-old woman was referred to the cardiology clinic for palpitations. She underwent echocardiography and cardiac magnetic resonance imaging that revealed mild left ventricular systolic dysfunction and LVNC criteria. She had several episodes of non-sustained ventricular tachycardia and received an implantable cardioverter-defibrillator (ICD). Genetic testing revealed the c.1003G>C (p.Ala335Pro) mutation in the MYH7 gene. Familial screening showed clear genotype-phenotype cosegregation, which provided strong evidence for the pathogenic role of this mutation. To the best of our knowledge, this is the first report of LVNC associated with the p.Ala335Pro mutation in the MYH7 gene. This mutation has been described in hypertrophic cardiomyopathy, suggesting that the same pathogenic sarcomere mutation may be associated with different cardiomyopathies. This case also highlights the current difficulties regarding decisions on ICD implantation for primary prevention of sudden cardiac death in LVNC. Resumo: A não compactação do ventrículo esquerdo (LVNC) é uma cardiomiopatia geneticamente heterogénea, com formas familiares e esporádicas descritas. No entanto, o estudo genético permite identificar uma mutação patogénica numa minoria de casos. Neste trabalho, reportamos um caso familiar de não compactação do ventrículo esquerdo associada a uma mutação no gene MYH7 e apresentamos uma revisão das principais controvérsias na LVNC.Mulher de 50 anos, referenciada para a consulta de cardiologia por palpitações. O ecocardiograma transtorácico e a ressonância magnética cardíaca revelaram a presença de disfunção ventricular esquerda ligeira e de critérios de LVNC. Após documentação de episódios de taquicardia ventricular não sustentada foi implantado um cardiodesfibrilhador implantável (CDI). O teste genético revelou a presença da mutação c.1003G>C (p.Ala335Pro) no gene MYH7. O rastreio familiar mostrou uma clara segregação genótipo-fenótipo, o que suporta a patogenicidade desta mutação.Este é o primeiro caso de LVNC em associação com a mutação p.Ala335Pro no gene MYH7. Esta mutação já se encontrava previamente descrita em casos de cardiomiopatia hipertrófica, o que suporta que a mesma mutação sarcomérica pode expressar-se com diferentes fenótipos. Este caso destaca ainda as dificuldades atuais no que concerne à estratificação do risco arrítmico nos doentes com LVNC, mais concretamente para decisão de implantação de CDI em prevenção primária.

La Cardiomiopatía por Antraciclinas es menos observada en nuestros días gracias al reconocimiento de las limitaciones en la dosis y a los protocolos de monitoreo cardíaco utilizados en los centros de quimioterapia. De cualquier forma, es una condición que persiste debido a la sensibilidad de los pacientes a estas drogas y a la necesidad de grandes dosis a ser utilizadas en algunos casos. El beneficio de la terapia con inhibidores de la enzima convertidora de angiotensina deberá ser considerada e introducida en la mayor parte de las oportunidades tempranamente. El uso de probucol y vitaminas antioxidantes, capaces de prevenir el desarrollo de la cardiomiopatía en humanos, parece requerir mayor investigación, pero puede reducir la incidencia de esta condición en el futuro.

La taquicardia atrial focal es un tipo de taquiarritmia supraventricular poco prevalente, generalmente presente en jóvenes, y constituye una causa rara de taquicardiomiopatía (10%). Presentamos un caso clínico de taquicardiomiopatía en un varón de 30 años, sin comorbilidades, que fue diagnosticado de taquicardia atrial focal incesante, refractaria a terapia médica y cardioversión eléctrica, por lo que se realizó ablación endocárdica, la misma que fue exitosa y en seguimiento ambulatorio a los 6 meses evidenció una recuperación de la fracción de eyección del ventrículo izquierdo y reducción de cavidades izquierdas a rangos normales, con disminución progresiva de disnea.

Antecedentes. Los pacientes con lupus eritematoso sistémico (LES) tienen alto riesgo de compromiso cardíaco con elevada mortalidad, por lo que el diagnóstico subclínico podría mejorar su sobrevida. Se ha observado que el strain (deformación) miocárdico longitudinal (SGL) puede ser de utilidad para la evaluación de la función cardíaca en estos pacientes. Objetivos. Evaluar la función miocárdica mediante el análisis del strain longitudinal bidimensional (2D), comparar el strain longitudinal entre pacientes con LES y controles, y determinar la correlación con el índice de actividad del LES. Material y métodos. Se estudiaron a 44 pacientes con LES (50 ±13 años) y 50 controles (49 ±12 años) pareados por edad y sexo, a quienes se les realizó un ecocardiograma transtorácico bidimensional. Se valoró el strain longitudinal mediante el método de speckle tracking, y la actividad del LES se estimó mediante el Systemic Lupus Erythematous Disease Activity Index (SLEDAI). Se definió como LES activo con una puntuación ≥ 4. Resultados. El strain longitudinal global2D fue menor en pacientes con LES que los controles (– 17,3% ± 1,9% vs. – 20%, ± 1,9%; p=0,00). No hubo diferencias en la fracción de eyección de ventrículo izquierdo entre ambos grupos, ni en 2D (p=0,650), ni en 3D (p=0,718). En los pacientes lúpicos, el SLEDAI varió entre 0 y 10, y el 63,8% estuvieron inactivos. Se halló correlaciones negativas significativas entre el puntaje de SLEDAI y la FEVI bidimensional (r de Pearson=-0,372, p=0,017); no se encontró correlación entre el puntaje de SLEDAI y el strain longitudinal global 2D (rho de Spearman=- 0,091 p =0,582). Conclusiones. El strain longitudinal global 2D se encontró disminuida en aquellos afectados con LES, lo que sugiere que podría ser una herramienta útil para evaluar la función cardíaca en estos pacientes.

Left ventricular false tendons are fibrous or fibromuscular bands that transverse the ventricular cavity and have no attachment to the mitral valve in many species. In cats it is considered a congenital defect that is rarely related to clinical disease and death in adult cats. A 45 days-old mixed breed cat had a history of inappetence since birth. At the physical exam the patient was lethargic and presented restrictive dyspnoea. At necropsy, there were marked ascites, hydrothorax, hepatomegaly with enhanced lobular pattern (nutmeg liver), and the lungs were markedly diminished (compressive pulmonary atelectasis). The heart was enlarged due to marked dilation of the cardiac chambers. Moreover, multiple slightly whitish and irregular cord-like structures were connecting the posterior papillary muscle to the interventricular septum (excessive moderator bands/left ventricular false tendons) at the left ventricle. Microscopically, these structures were characterized by a marked proliferation of fibrous connective tissue intermixed with Purkinje cells and well-differentiated cardiomyocytes lined by a single layer of endocardium. This study described a case of excessive moderator bands (left ventricular false tendons) in a young cat associated with congestive heart failure and death. [ABSTRACT FROM AUTHOR]

Copyright of Revista Argentina de Cardiología is the property of Sociedad Argentina de Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Compendium of Veterinary Sciences / Compendio de Ciencias Veterinarias is the property of Facultad de Ciencias Veterinarias de la Universidad Nacional de Asuncion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La Cardiomiopatía Hipertrófica es una patología en la que se caracteriza por presentar una hipertrofia septal, que a su vez, genera una obstrucción del flujo de salida del ventrículo izquierdo. Sin embargo, hay 2 formas de presentación: Una obstructiva, de la cual, es la de mal pronóstico; y la de tipo No Obstructiva, la cual, generalmente es de buen pronóstico. Puede esta patología ser hereditaria o deberse a una mutación. Afecta más a mujeres y a jóvenes. Se suele manifestar comunmente con disnea, fatiga, pressíncope, síncope, fibrilación auricular y progresar incluso a Insuficiencia Cardiaca. Hay diversas formas de diagnóstico, que incluyen como más importante: Electrocardiograma, Ecocardiograma, Eco-doppler, y Resonancia Magnética, que es el gold standard. Para el tratamiento, se suele usar betabloqueadores o bloqueadores de calcio; sin embargo, si es refractario, se suele recurrir a terapia de reducción septal o ablación septal con alcohol.

Acromegaly is a chronic and slowly progressive disease that results from the hypersecretion of growth hormone (GH) and consequently insulin-like growth factor type 1 (IGF-1), due to a GH-secreting pituitary adenoma in 95-98% of cases. There are several complications or co-morbidities associated with acromegaly, the most frequent being cardiovascular, metabolic and neoplastic. The cardiovascular complications of acromegaly go from arterial hypertension to a peculiar form of cardiomyopathy and are the result of the long-standing exposure to high GH and IGF-1 levels. The pathophysiology of these complications is complex and includes an increased tubular reabsorption of sodium and the direct effects of GH and IGF-1 on the endothelium and the cardiac tissue itself. Frequently, the cardiovascular comorbidities of acromegaly occur concomitantly with metabolic complications such as diabetes and respiratory abnormalities such as the sleep apnea syndrome. In this brief review we analyze the pathophysiology, the clinical manifestations and the management of the cardiovascular complications of acromegaly. [ABSTRACT FROM AUTHOR]

Copyright of Médicas UIS is the property of Universidad Industrial de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: la miocardiopatía periparto (MP) es una insuficiencia cardiaca asociada al embarazo, que tiene los siguientes criterios clínicos para establecer su diagnóstico: 1- aparición de la patología en el último mes de embarazo o en los cinco primeros meses del puerperio. 2- ausencia de etiología determinante de insuficiencia cardiaca. 3- ausencia de cardiopatía demostrable antes del último mes de embarazo. 4- deterioro de la función sistólica del ventrículo izquierdo demostrado por Eco cardiografía Material y Método. Estudio descriptivo, transversal simple y retrospectivo. Revisión de las historias clínicas de las embarazadas y puérperas que ingresaron por internación en el servicio de terapia Intensiva con diagnóstico de insuficiencia cardiaca congestiva entre febrero de 1999 y febrero de 2007 Resultados: de 23 historias clínicas con insuficiencia cardiaca, 7 tuvieron el diagnóstico de MP, 5 embarazadas y 2 puérperas. Las edades de las 7 mujeres con la patología estuvieron entre los 20 y los 37 años, con una media de 31 años. La fracción de eyección evaluada por eco cardiografía promedió un 32.8%, 4 mujeres con 30%. La vía de terminación del embarazo no estuvo influida por la enfermedad, habiendo terminado por indicaciones exclusivamente obstétricas, 5 por cesáreas y 2 por partos vaginales. Todos los recién nacido lo fueron de término y con pesos adecuados a la edad gestacional, con scorer de Apgar normales. No se registraron muertes maternas, ni feto neonatales. La incidencia de la patología en el Hospital materno neonatal, resulta ser de 1/7500 nacidos vivos (7/52.026)

Globally, cardiovascular diseases (CVD) are the number one cause of death. It is predicted that 23.6 million people will die from it by 2030, mainly caused by strokes and heart attacks. This study aimed to investigate the new treatment of cardiomyopathy, a cardiovascular disease that hinders blood supply from the heart to the body and can cause heart failure. While the traditional treatment focus on cardiac rehabilitation, including lifestyle counseling and prescription exercise, surgery on coronary bypass artery, and medication of increasing the flow of blood, the use of therapeutic cells is a new way to deal with cardiovascular diseases and heart infarction. It intends to effectively replace or regenerate dead or damaged heart cells, as the main advantage of this treatment. The use of alternative methods to treat cardiovascular diseases has high potential value, as found in the immunotherapy method through the use of "regenerative macrophages." This study is a qualitative case report research study which provides an exploration of phenomenon or opportunity of sharing efforts to intervene single patient's health with unreported health features previously. The result of this study showed that a 71 years old man was hospitalized in Gatot Soebroto Central Army Hospital Jakarta, Indonesia, by the diagnosis of coronary artery disease. He presented for chronic cough and peripheral edema. He denied syncope, dyspnea, nausea, vomiting, and diaphoresis. The application of echocardiography regarding the previous treatment indicated diastolic dysfunction, left ventricle hypokinesis and left ventricular hypertrophy with 44% of low ejection on the fraction. After the vaccines of Regenerative Macrophages (ReM) therapy were given to the patient, significant improvements in the echocardiography parameters were observed, with normal kinetics, improved ejection fraction, and diastolic dysfunction increased to 56%. Significantly, regenerative macrophages could be an option of immunotherapy in patients with cardiomyopathies with low risk of effective treatment further. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivo. Se describe el caso de un paciente masculino de siete meses de edad, evaluado por cardiología a los quince días de vida por antecedente de muerte súbita cardíaca de hermana a los cuatro meses, no se sospechó nada pese a consanguinidad de padres y diagnóstico temprano del paciente de cardiomiopatía. Evoluciona con un cuadro clínico de infecciones respiratorias a repetición desde los tres meses (bronquiolitis recurrente), falla de medro y cuadro de neumonía reciente y fallece a los ocho días de la consulta con la genetista. Métodos. El abordaje inicial fue la realización de un ecocardiograma a los quince días de nacido por antecedente de muerte súbita de hermana a los cuatro meses por cardiomegalia y consanguinidad de los padres. Continúa con deterioro clínico a través de los meses por lo que se remite a genética, se toman pruebas enzimáticas en gota de sangre seca, el paciente fallece antes de recibir el diagnóstico de Enfermedad de Pompe. Resultados. Se enfocó al paciente con un posible diagnóstico de Enfermedad de Pompe solicitándose enzima lisosomal alfaglucosidasa (GAA) en muestra de gota de sangre seca y reporte final de la secuenciación genética.

La cardiomiopatía periparto es una forma de miocardiopatía dilatada que afecta a mujeres en edad fértil, ocasionando elevada morbimortalidad. Se presenta el caso de una paciente joven primípara con sintomatología de insuficiencia cardiaca que además súbitamente presentó dolor lumbar de gran intensidad asociado a náuseas y vómitos. El examen de laboratorio reportó niveles altos de deshidrogenasa láctica sérica y tomografía de vías urinarias. El diagnóstico de insuficiencia cardiaca con una severa disfunción sistólica e infarto renal fueron realizados con evaluación clínica, de laboratorio, ecocardiográfico y tomográfico, donde se demostró una severa disfunción sistólica. Se realizó tratamiento con medidas convencionales para insuficiencia cardiaca, empleándose anticoagulación parenteral y oral. La evolución del cuadro clínico fue favorable, con recuperación parcial de su funcionalidad. Se presenta este caso debido a la complicación atípica de una patología infrecuente o sub diagnosticada.

Objetivos: El ventrículo izquierdo no compacto es cada vez más diagnosticado en el mundo con impacto significativo en la morbimortalidad. No existen registros en el medio local que describan el perfil de los pacientes afectados. El objetivo es describir las características: demográficas, clínicas e imagenológicas de los pacientes diagnosticados con el ventrículo izquierdo no compacto en un registro regional. Métodos: Estudio descriptivo de corte transversal que incluyó pacientes con sospecha del ventrículo izquierdo no compacto por la ecocardiografía y confirmación con la resonancia magnética contrastada. Se evaluaron las historias clínicas e imágenes de los pacientes obtenidas desde el año 2006 hasta el año 2013. Se analizan las características: demográficas, clínicas e imagenológicas. La caracterización anatómica y la fracción de eyección se basaron en la resonancia magnética contrastada. Resultados: Fueron incluidos 33 pacientes con diagnóstico del ventrículo izquierdo no compacto por la resonancia magnética contrastada. El promedio de edad fue 21,9 ± 19,8 años, siendo la población pediátrica la más representativa (30,3% de 1 a 10 años y 30,3% de 11 a 20 años). Hubo concordancia diagnóstica entre la ecocardiografía y la resonancia magnética contratada del 63,6%; los síntomas más frecuentes fueron: la disnea, el dolor torácico y las palpitaciones (78,8, 36,4 y 33,3%, respectivamente). La insuficiencia cardiaca fue el síndrome prevalente al diagnóstico (51,5%). La mayoría de los pacientes tenían fracción de eyección del ventrículo izquierdo £40% (57,6%), fracción de eyección del ventrículo izquierdo normal el 21,2%. Las paredes apicolaterales fueron las más comprometidas (48,3%). Los síntomas y la presencia de embolismo tuvieron relación con la severidad de la disfunción sistólica. Conclusiones: El ventrículo izquierdo no compacto es un diagnóstico cada vez más frecuente en el medio local y su presentación y evolución son similares a series de otros países. La sospecha de la ecocardiografía guarda correlación con los hallazgos en la resonancia magnética. El diagnóstico suele hacerse en infantes y adolescentes en estadios avanzados.

O objetivo deste estudo foi avaliar os indicadores laboratoriais, eletrocardiográficos e histológicos de lesão cardíaca em diferentes grupos clínicos de cães com leishmaniose visceral. Foram analisados marcadores séricos, traçado eletrocardiográfico e fragmentos de tecido cardíaco de 41 cães naturalmente infectados, distribuídos em três grupos: assintomático, oligossintomático e sintomático. Todos os animais apresentaram aumento na atividade sérica da enzima creatina quinase fração MB. No traçado eletrocardiográfico, o complexo de baixa voltagem foi o distúrbio de condução mais frequente (8/10). Na análise histológica, 75,6% dos cães apresentaram reação inflamatória com predomínio de infiltrados linfo-histiocítico (13/31) de intensidade discreta a moderada e distribuição multifocal. As alterações microscópicas identificadas no miocárdio foram independentes dos achados laboratoriais, eletrocardiográficos e do quadro clínico apresentado pelos animais estudados. A ausência de associação entre alterações histopatológicas e os parâmetros investigados alerta para a dificuldade de identificação de cardiopatia em cães com leishmaniose visceral e ressalta a importância de incluir a leishmaniose visceral no diagnóstico de patologias cardíacas principalmente em regiões endêmicas para o agente.

Dogs are as considered important reservoirs of trypanosomiasis and play a vital role in maintaining the interaction between the domestic and wild cycles of this disease. This paper reports the clinical and pathological findings of a case of Chagas disease myocarditis in a dog from an urban area in Brazil. During clinical examination, the animal showed apathy, weakness and pale ocular mucous and died shortly after. Necropsy revealed ascites, hydrothorax and hydropericardium. The heart was remarkably globoid with scattered multifocal pale in the epicardium and ventricular miocardium and dilated chambers. Histological analysis revealed non-suppurative myocarditis and cardiomyocyte necrosis. The sarcoplasms of cardiomyocytes were frequently infiltrated by T. cruzi pseudocysts filled with amastigotes. The myocardium immunostained positive for anti-T. cruzi antibody. The presence of Chagas disease in a dog from an urban area increases the risk of disease transmission to man, which renders this diagnosis a matter of significant public health concern.

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Copyright of Pesquisa Veterinaria Brasileira is the property of Colegio Brasileiro de Patologia Animal - CBPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We describe a case of a 57-year-old white woman treated for rheumatoid arthritis (RA) with tofacitinib 10 mg daily (started one year ago) and prednisolone 5 mg daily. She presented to the emergency department with a tight squeezing chest pain and shortness of breath for 7 h and the clinical evaluation revealed regional systolic dysfunction of the left ventricle, mimicking a myocardial infarction, in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. All changes were transient and resolved completely within 4 days. The diagnosis of Takotsubo cardiomyopathy (TKM) was established. This is, as far as we know, the first report of a case of TKM in a RA patient taking tofacitinib. Although the association has not been previously described and the precise cause cannot be identified in this patient, the association with tofacitinib should be considered given the etiopathogenic rationale and the absence of any other identifiable cause. [ABSTRACT FROM AUTHOR]

A distrofia muscular de Duchenne (DMD) em humanos é uma alteração neuromuscular hereditária, de caráter recessivo, ligada ao cromossomo X e causada pela ausência ou disfunção da distrofina. Clinicamente, caracteriza-se por grave alteração na musculatura esquelética, resultando em morte precoce do indivíduo acometido. Em cães da raça Golden Retriever, a mutação que leva à distrofia muscular ocorre espontaneamente e a extensa homologia entre a patogênese da DMD e da distrofia muscular do Golden Retriever permite qualificar o cão como o principal substituto de humanos nos testes clínicos de novas terapias. O miocárdio deficiente em distrofina é mais vulnerável à sobrecarga de pressão e os pacientes com DMD podem desenvolver cardiomiopatia dilatada, hipertensão arterial e o eletrocardiograma pode se apresentar distintamente anormal. No presente estudo, foram avaliados exames eletrocardiográficos de 38 cães da raça Golden Retriever clinicamente sadios (20 animais de até 12 meses de idade e 18 animais entre 12 e 36 meses de idade), com a finalidade de se obter parâmetros para a padronização do eletrocardiograma nessa referida raça, o que futuramente poderá servir de referência na identificação de cães portadores ou afetados pela distrofia muscular. Os valores eletrocardiográficos obtidos encontraram-se dentro dos valores de normalidade e referência para as diferentes raças de cães; e as variáveis peso e idade alteraram significativamente a freqüência cardíaca e a amplitude do complexo QRS.The Duchenne's muscular dystrophy (DMD) in humans is a X-linked neuromuscular disease, of recessive character, caused either by the absence or dysfunction of the dystrophin. Clinically, it is characterized by severe alteration in the skeletal musculature, resulting in precocious death. In Golden Retriever dogs, the mutation that takes to the muscular dystrophy happens spontaneously and the extensive homology among the pathogenesis of DMD and of Golden Retriever muscular dystrophy allows to qualify the dog as the main substitute of humans in the clinical tests of new therapies. The deficient myocardium in distrofin is more vulnerable to the pressure overload and the patients with DMD can develop dilated cardiomyopathy, arterial hypertension and the electrocardiogram can come distinctly abnormal. In the present study, 38 healthy Golden Retriever dogs were evaluated by electrocardiographic exam with the purpose to obtain parameters for the standardization of the electrocardiogram in the referred breed, what hereafter can serve as reference in the identification of bearer or affected dogs. Electrocardiographic values obtained were within normal values and reference for the various breeds of dogs, and the variables weight and age significantly altered heart rate and amplitude of the QRS complex.

INTRODUCTION: The purpose of this study was to determine digoxin serum concentrations in patients with Chagas' cardiomyopathy with chronic heart failure, because little is known concerning this laboratory test in patients with this condition. METHODS: This study focuses on 29 (29%) out of 101 patients with chronic heart failure secondary to Chagas' cardiomyopathy receiving digoxin therapy. Digoxin was measured by the immune-enzymatic method. RESULTS: New York Heart Association Functional Class III/IV was noted in 13 (45%) patients. The mean potassium serum level was 4.3± 0.5mEq/L, mean creatinine serum levels 1.4± 0.3dg/100ml, and left ventricular ejection fraction 34.7± 13.8%. The median digoxin serum level was 1.27 (0.55; 1.79)ng/ml. Sixteen (55%) patients had digoxin serum levels higher than 1.0ng/ml. Abnormal digoxin serum levels were verified in 13 (45%) patients. Digoxin serum levels correlated moderately with creatinine serum levels (r = 0.39; p< 0.03) and negatively with sodium serum levels (r= -0.38; p= 0.03). CONCLUSIONS: Digoxin serum concentration should be measured in patients with Chagas' cardiomyopathy with chronic heart failure receiving digoxin therapy due to the potential for digoxin toxicity.INTRODUÇÃO: O propósito deste trabalho foi o de determinar a concentração sérica de digoxina em pacientes com insuficiência cardíaca crônica secundária à cardiomiopatia da doença de Chagas porque pouco se conhece sobre os níveis séricos desse fármaco em pacientes com tal condição clínica. MÉTODOS: Foram recrutados 29 (29%) de 101 pacientes com insuficiência cardíaca crônica secundária à cardiomiopatia da doença de Chagas, os quais estavam sendo tratados com digoxina. Essa droga foi medida no soro desses pacientes pelo método imunoenzimático. RESULTADOS: Treze (45%) pacientes estavam no grau III/ IV da Sociedade Nova-Iorquina de Cardiologia. Os níveis séricos de potássio médio foram 4,3± 0,5 mEq/L, a creatinina sérica média 1,4± 0,3dg/100ml, e a fração de ejeção do ventrículo esquerdo 34.7± 13. 8%. Os níveis séricos médios de digoxina foram 1,27 (0,55; 1,79)ng/ml. Dezesseis (55%) pacientes apresentaram níveis séricos de digoxina > 1,0ng/ml. Níveis séricos anormais de digoxina foram observados em 13 (45%) pacientes. Os níveis séricos de digoxina correlacionaram moderadamente com os de creatinina (r= 0,39; p< 0,03) e negativamente com os de sodium (r= -0,38; p= 0,03). CONCLUSÕES: Os níveis séricos de digoxina devem ser medidos em pacientes com insuficiência cardíaca crônica secundária à cardiomiopatia da doença de Chagas por causa do potencial para ocorrer toxicidade pela digoxina.

Sixty dogs with idiopathic dilated cardiomyopathy were randomly treated with traditional therapy - digitalis, diuretics, angiotensin-converting inhibitors - (group A) or treated with these drugs plus carvedilol (group B). Echocardiographic variables were measured before and after 3, 13, 26, and 52 weeks of treatment or until death. Comparisons between groups and time were performed. No significant differences between groups were found in the most of the echocardiographic variables. The left ventricular end-systolic diameter indexed to body surface area (LVESDi) increased significantly in the group A dogs compared to the group B animals. The survival of groups A and B dogs were not different (P-value=0.1137). In conclusion, the stability of the LVESDi observed in the group treated with carvedilol may represent the beneficial effect over the ventricular remodeling.Sessenta cães com cardiomiopatia dilatada idiopática receberam, aleatoriamente, tratamento convencional - digitálicos, diuréticos, inibidores da enzima conversora de angiotensina - (grupo A) ou esses fármacos mais carvedilol (grupo B). As variáveis ecocardiográficas foram avaliadas antes e depois de três, 13, 26 e 52 semanas de tratamento ou até o óbito. Não foram encontradas diferenças significativas entre os grupos de animais quanto à maioria das variáveis ecocardiográficas. O diâmetro sistólico final do ventrículo esquerdo indexado à superfície corpórea (DSVEi) aumentou de forma significativa no grupo A quando comparado ao grupo B. Não se observou diferença na sobrevida dos grupos A e B (P=0,1137). Concluiu-se que a estabilização do DSVEi no grupo tratado com carvedilol pode representar o efeito benéfico deste fármaco sobre o remodelamento ventricular.

Os marcadores cardíacos são utilizados com o intuito de auxiliar no diagnóstico clínico de animais com doença cardíaca com maior acurácia e em menor tempo possível, possibilitando o estabelecimento do prognóstico e a terapia precocemente. Entretanto, em medicina veterinária, no Brasil, sua aplicabilidade ainda é, em geral, restrita a pesquisas. Esta revisão tem como objetivo abordar os principais marcadores cardíacos para que futuramente estes possam se tornar índices essenciais na avaliação cardíaca.Cardiac markers have been used in order to assist clinical diagnosis of animals with heart disease, more accurately, enabling the establishment of earlier prognosis and therapy. However, in Brazilian veterinary medicine, these markers are generally still restricted to researches. This review aims to approach the major cardiac markers, which further may become essential indexes in heart assessment.

On the American continent, almost 15 million people are affected by Chagas disease, resulting in important economic and social damages. Dogs are considered to be an excellent experimental model to study Chagas' disease; as a result, in this research, the characterization of cardiovascular abnormalities was performed in dogs experimentally infected with Trypanosoma cruzi (the Colombian strain) that were at chronic stage. Thirteen adult female dogs were evaluated by electrocardiographic, echocardiographic, hematological and biochemical analyses in the chronic phase. For the electrocardiographic studies, respiratory sinus arrhythmia was the predominant rhythm during the entire research period (49.55% to 67%), with a low prevalence of right bundle branch block (0-13%) and first-degree atrioventricular block (0-14%). The spectral Doppler echocardio-graphy showed E and A mitral wave reversal (0.71±0.17), confirming the diastolic dysfunction present in all dogs. An increase in the enzymes activities was detected in the serum analysis, indicating myocardial injury by the infection. Six dogs died during the follow-up. In this way, the clinical characterization of experimentally infected dogs, as described here, increases the knowledge and allows for recognition of the behavioural modifications present in Chagas' disease in affected dogs.No continente Americano, aproximadamente 15 milhões de pessoas são afetadas pela doença de Chagas, ocasionando importantes danos econômicos e sociais. O cão é considerado excelente modelo experimental para o estudo dessa enfermidade; assim sendo, foram caracterizadas, neste ensaio, as anormalidades cardiovasculares de 13 cães experimentalmente infectados com a cepa Colombiana do Trypanosoma cruzi, em fase crônica (1997-2004). Ao eletrocardiograma, a arritmia sinusal respiratória foi o ritmo predominante durante todo período experimental (49,55-67%), com baixas prevalências de bloqueio de ramo direito (0-13%) e de bloqueio atrioventricular de primeiro grau (0-14%). A EcoDopplercardiografia espectral revelou inversão das ondas E e A mitral (0.71±0.17), confirmando a disfunção diastólica presente em todos os cães avaliados. O aumento da atividade enzimática sérica foi detectado, indicando agressão miocárdica pela infecção. Seis cães morreram durante o período experimental. Desta forma, a caracterização clínica dos cães experimentalmente infectados trouxe informações importantes, possibilitando reconhecer o comportamento clínico dessa importante infecção, na espécie canina.

Foi realizada a intoxicação experimental em ovelhas em diferentes dias de gestação, 12 ovelhas foram dividas em quatro grupos. As ovelhas do Grupo 1 consumiram quatro doses de 5g/kg de folhas verdes durante quatro dias; ovinos do Grupo 2 consumiram duas doses de 10g/kg durante dois dias, o Grupo 3 consumiu uma dose de 20g/kg em um único dia e os ovinos do Grupo 4 não consumiram a planta (controle-negativo). Para testar a toxicidade da planta um ovino macho consumiu 5g/kg até manifestação dos sintomas. Não foram observados sinais clínicos da intoxicação nas ovelhas, mas três cordeiros tiveram morte perinatal, e um cordeiro morreu com três meses de idade; o ovino controle-positivo morreu após 38 dias de consumo diário da planta e os sinais clínicos foram taquipnéia, taquicardia, sonolência, incoordenação e fraqueza. Todos os quatro cordeiros e o ovino controle-positivo foram necropsiados e os achados de necropsia foram áreas esbranquiçadas no miocárdio, evidenciação do padrão lobular do fígado, pulmão vermelho enegrecido e rúmen acentuadamente distendido com presença de gases livres. Os achados histopatológicos foram fibrose cardíaca, necrose dos cardiomiócitos, congestão e edema pulmonar, congestão hepática centrolobular e degeneração esponjosa na região subcortical do encéfalo. Tetrapterys multiglandulosa demonstrou ser tóxica para os fetos ovinos em dosagens que não foram suficientes para induzir sinais clínicos nas ovelhas prenhes, e que a intoxicação pode ocorrer com morte de cordeiros logo após o parto, mesmo após meses de ter cessada a ingestão da planta.In order to verify the effects of non-lethal doses of Tetrapterys multiglandulosa on ovine fetuses, experimental poisoning in sheep at different days of pregnancy was performed. Green leaves of shooting plants were administered to 9 pregnant ewes divided into three experimental groups. Sheep from Group 1 received four doses of 5g/kg of fresh leaves for 4 days; those from Group 2 received 10g/kg for 2 days; Group 3 sheep received a dose of 20g/kg for one day, and sheep from Group 4 did not receive the plant and served as negative controls. To check the plant toxicity, a male sheep (positive control) received 5g/ kg until the onset of clinical signs. No signs of poisoning were observed in pregnant ewes; three lambs died 1-5 days after birth, and a fourth lamb died within 3 months after have been born. The positive control died after 38 days of daily consumption of the plant, presenting tachypnea, tachycardia, drowsiness, incoordination, weakness and sudden death. All four dead lambs and the positive control sheep were necropsied. The gross lesions were whitish areas in the myocardium, increased lobular pattern of the liver, dark red lungs, metabolization of pericardial fat, and ruminal distention with free gas. Histological findings were cardiac fibrosis, cardiomyocyte necrosis, pulmonary congestion and edema, and spongy degeneration in subcortical cerebral white matter. Tetrapterys multiglandulosa resulted toxic for ovine fetuses at doses that were not suffient to induce clinical signs in the pregnant ewes, demonstrating that the poisoning may be a cause of death of lambs soon after birth, even several months after the ingestion of the plant has been discontinued.

FUNDAMENTO: As técnicas de substituição mitral com preservação do aparelho subvalvar têm reafirmado sua superioridade, sendo a papilopexia cruzada uma nova opção técnica que além de permitir preservação de estruturas anatômicas, oferece suporte na contração e protege o miocárdio na diástole ventricular, necessitando de estudos que documentem seus resultados. OBJETIVO: Avaliar as funções atrial e ventricular esquerdas, através de ecodopplercardiografia, em pacientes submetidos à substituição da valva mitral com papilopexia cruzada. MÉTODOS: Foram submetidos à substituição valvar mitral 15 pacientes, sendo nove (60%) do sexo masculino, com idade média de 45,7 anos. Quanto à etiologia, nove (60%) casos eram degenerativos, três (20%) reumáticos, dois (13,3%) isquêmicos e um (6,7%) com endocardite infecciosa. Após atriotomia e avaliação anatômica do aparelho valvar o folheto anterior foi desinserido do anel e centralmente dividido, sendo cada metade com seu complexo de cordas tendíneas fixada à comissura oposta por sua extremidade medial. Foi Implantada a prótese valvar biológica (em 13 casos) ou mecânica, fixada por pontos separados, com redução do anel valvar nos casos com miocardiopatia dilatada. Foram tomadas avaliações clinicas e ecodopplercardiográficas no pré-operatório, e sexto mês de pós-operatório. RESULTADOS: Todos os pacientes receberam alta em condições clínicas estáveis. Foi demonstrada redução significativa dos diâmetros ventriculares e dos diâmetros atriais (p< 0,001) sem comprometimento das vias de entrada e saída do ventrículo esquerdo. CONCLUSÃO: As substituições da valva mitral realizadas com a técnica de papilopexia cruzada apresentaram resultados favoráveis, com efeito positivo na recuperação morfológica atrial e ventricular esquerdas.FUNDAMENTO: Las técnicas de sustitución mitral con preservación del aparato subvalvular han estado reafirmando su superioridad, siendo la resuspensión de los músculos papilares una nueva opción técnica que además de permitir la preservación de estructuras anatómicas, ofrecer soporte en la contracción y protege el miocardio en la diástole ventricular, necesitando estudios que documenten sus resultados. OBJETIVO: Evaluar las funciones atrial y ventricular izquierdas, mediante ecocardiografía Doppler, en pacientes sometidos a sustitución de la válvula mitral con resuspensión de los músculos papilares. MÉTODOS: Se sometieron a sustitución valvular mitral 15 pacientes, siendo nueve (60%) del sexo masculino, con una edad promedio de 45,7 años. En cuanto a la etiología, nueve (60%) casos eran degenerativos, tres (20%) reumáticos, dos (13,3%) isquémicos y uno (6,7%) con endocarditis infecciosa. Después de la atriotomía y evaluación anatómica del aparato valvular, el velo anterior se retiró del anillo y se dividió centralmente, siendo cada mitad con su complejo de cuerdas tendinosas fijadas a la comisura opuesta por su extremidad medial. Se implantó prótesis valvular biológica (en 13 casos) o mecánica, fijada por puntos separados, con reducción del anillo valvular en los casos con miocardiopatía dilatada. Se realizaron evaluaciones clínicas y por ecocardiografía Doppler en el preoperatorio, y sexto mes de postoperatorio. RESULTADOS: Todos los pacientes recibieron alta en condiciones clínicas estables. Se demostró reducción significativa de los diámetros ventriculares y de los diámetros atriales (p< 0,001) sin compromiso de las vías de entrada y salida del ventrículo izquierdo. CONCLUSIÓN: Las sustituciones de la válvula mitral realizadas con la técnica de resuspensión de los músculos papilares presentaron resultados favorables, con efecto positivo en la recuperación morfológica atrial y ventricular izquierdas.BACKGROUND: Techniques for mitral valve replacement with preservation of the subvalvular apparatus have proven their superiority, and crossed papillopexy is a new technical option which, besides allowing Preservation of the anatomical structures, provides contractility support and protection to the myocardium during ventricular diastole. The technique requires further studies that document its results. OBJECTIVE: To evaluate the left atrial and ventricular function by Doppler echocardiography in patients who have undergone mitral valve replacement with crossed papillopexy. METHODS: Fifteen patients underwent mitral valve replacement, 9 (60%) of them male, and the mean age was 45.7 years. As to the etiology of aortic valve disease, nine (60%) cases were degenerative, three (20%) were rheumatic, two (13.3%) were ischemic, and one patient (6.7%) had infectious endocarditis. After closure of the atriotomy and anatomical evaluation of the valvar apparatus, the anterior leaflet was detached from the annulus and centrally split in halves, each one with its complex tendinous chords attached to the opposing commissure by its medial extremity. Biological (13 cases) or mechanical prosthetic valves were implanted and secured with separate stitches. Reduction of the valvar annulus was performed in patients with dilated cardiomyopathy. Patients underwent clinical and Doppler echocardiographic examinations before surgery and six months after the procedure. RESULTS: All patients were clinically stable at discharge. A significant reduction in ventricular and atrial diameters was demonstrated (p< 0.001) without impairment of the entry and exit points of the left ventricle. CONCLUSION: Mitral valve replacements performed with the crossed papillopexy technique showed favorable results with a positive effect on the recovery of left atrial and ventricular morphology.