心血管疾患と診断

Imatinib has been approved by the FDA as an oral drug for the treatment of Chronic Myeloid Leukemia (CML), gastrointestinal stromal tumors (GISTs) and hyper eosinophilic syndrome. Although imatinib is well tolerated, the incidence of edema and dyspnea are reported to be as high as 66 and 16%, respectively. Imatinib-induced cardiotoxicity is a very uncommon adverse event <1%. A 53-year-old male with history of Chronic Myeloid Leukemia (CML) on Imatinib for the past 5 years. He presented with symptoms of exertional dyspnea, poor exercise performance, fatigue, and leg swellings. Chest X-ray revealed cardiomegaly, and pulmonary edema. Electrocardiogram showed normal sinus rhythm, no ischemic changes. Cardiac enzymes were normal. 2D Echocardiogram showed ejection fraction EF of 35%, normal pulmonary systolic pressure, no wall motion abnormality, with normal valvular function. In our case report, we discuss the association between Imatinib use and congestive heart failure, which may need discontinuing the medication and prompt treatment of congestive heart failure.

Minoxidil is a powerful antihypertensive medication that has been used extensively to control blood pressure in patients with renal failure. Its mechanism of action is through a cyclic AMP-mediated effect on arteriolar smooth muscle, with little effect on veins causing a direct vasodilatation of peripheral blood vessels. Minoxidil use has been associated with cause and/or exacerbation of pericardial effusions both in dialysis patients and those with normal kidney function. We report a 58-year-old African American female with history of severe resistant hypertension that has been controlled by Minoxidil 5 mg po BID, and stage 3 chronic kidney disease who presented with shortness of breath, and headache. Blood pressure 240/124 mmHg. Her CT Brain revealed no intracranial bleed. Electrocardiogram showed normal sinus rhythm, with no ST/T wave changes. Cardiac biomarkers were normal. However, 2D Echocardiogram showed Estimated ejection fraction EF of 65%, moderate pericardial effusion, with no evidence of pericardial tamponade, and moderate Left ventricular hypertrophy. This case reviews and explains the association between Minoxidil use and pericardial effusion, which may need appropriate treatment/monitoring, and extensive work ups to rule out other pathologies.

Background: The transradial (TR) approach in percutaneous coronary intervention (PCI) has become popular among cardiologists, with potential advantages over the transfemoral (TF) approach demonstrated in previous studies conducted in unselected patients. Since elderly patients requiring PCI are a growing population, we aimed to compare the clinical outcomes of the 2 approaches in elderly population by conducting a meta-analysis of pooled data from randomized clinical trials and observational studies. Methods: PubMed, Google Scholar, Medline, and Cochrane Library, were searched for studies comparing the TR and TF approaches in PCI among elderly patients. Results: Thirteen studies met our inclusion criteria (4,066 patients: 2,540, TR; 1,526, TF). Pooled analysis demonstrated non-inferiority of the TR compared to the TF approach with regard to major adverse cardiovascular events (MACE) (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.40-1.02, P=0.06), cerebrovascular accidents (OR 1.82, 95% CI 0.28-11.68, P=0.53), revascularization (OR 1.14, 95% CI 0.43-3.04, P=0.79), pseudoaneurysm formation (OR 0.33, 95% CI 0.08-1.32, P=0.12), volume of contrast given (mean difference [MD] -1.11, 95% CI -19.57-17.35, P=0.91), and procedure time (MD 0.40, 95% CI -3.62-4.42, P=0.84). Major bleeding and ambulation time were lower in the TR group (OR 0.49, 95% CI 0.33-0.71, P=0.0002 and MD -10.51, 95% CI -19.33- -1.69, P=0.02, respectively). However, the TF group showed a higher success rate (OR 1.71, 95% CI 1.09-2.67, P=0.02). Conclusion: The safety profiles of the TR and TF approaches of PCI in elderly patients were comparable; The TR approach was associated with earlier ambulation and lower risk of major bleeding.

Introduction: Hypertension is defined as systolic blood pressure ≥ 140 mmHg and/or Diastolic Blood Pressure ≥ 90 mmHg. It’s global public health challenge worldwide that contributes to the burden of hypertensive heart disease, stroke, renal failure, premature morbidity, and mortality. Adherence to pharmacological treatment is a key to guaranteeing success full therapy outcomes.

Objectives: The general objective is to assess the prevalence of adherence to antihypertensive treatment and associated factors among hypertensive patient.

Methods: Introduction: Hypertension is defined as systolic blood pressure ≥ 140 mmHg and/or Diastolic Blood Pressure ≥ 90 mmHg. It’s global public health challenge worldwide that contributes to the burden of hypertensive heart disease, stroke, renal failure, premature morbidity, and mortality. Adherence to pharmacological treatment is a key to guaranteeing success full therapy outcomes.

Objectives: The general objective is to assess the prevalence of adherence to antihypertensive treatment and associated factors among hypertensive patient.

Methods: Cross-sectional study design was conducted in 271 study participants selected by using systematic random sampling method. The structured interviewer-administered questionnaire was used. data was cleared using EPI info version 3.5.4 and was analyzed by using SPSS version 21 software. A multivariate analysis was performed to determine the independent effects of the explanatory variables. A p-value less than 0.05 were taken as significant for all analysis.

Results and discussion: From 270 study participants 63% of the respondents were adherent to their antihypertensive treatment while the other 37% of the study participants were nonadherent. The multivariate logistic regression showed that those who have comorbid illness like heart disease were 95.4% less likely to adhere to their antihypertensive treatment. Patient who have forget fullness of their drugs were 98.6% less likely to be adherent. Those patients who perceive HTN as somehow less severe disease were 98.2% less likely to be adherent to their antihypertensive treatment. This study identify variable like presence of comorbidity Like heart disease, forgetfulness and perceived disease severity were strongest factors affecting medication adherence among patient on follow up at Debre Berhan referral hospital.

Conclusion: In this study, more than half (63%) of the study participant were adherent to their antihypertensive. However, it is found significantly lower compared to expected index 80% medication adherence.

Background: Patients presenting with suspected ST-segment elevation myocardial infarction (STEMI) may have important alternative diagnoses (e.g., aortic dissection, pulmonary emboli) or safety concerns for STEMI management (e.g. head trauma). Subarachnoid hemorrhage (SAH) is a known cause of electrocardiographic and echocardiographic changes that may mimic acute coronary syndromes (ACS) resulting in delay of diagnosis and treatment of the primary disease.
Case report: A 50-year-old female patient was admitted with suspected STEMI. She had symptoms of vomiting for three days prior to admission. She had a medical history of schizoaffective disorder, treated with selective serotonin reuptake inhibitors (SSRIs). The electrocardiogram (ECG) on presentation showed sinus rhythm with 3 mm ST-segment elevation in leads L1, AVL, V2-V5 and reciprocal changes in L3, aVf) Coronary angiography showed normal coronary arteries and Takotsubo Cardiomyopathy was diagnosed. Urgent cranial CT of the head revealed extensive SAH.
Conclusion: Urgent cranial CT should be performed in all patients with neurologic symptoms before cardiac catheterization is performed.

The patient was an 88-year-old woman. Chest X-rays revealed cardiomegaly, pulmonary congestion and pleural effusion. Electrocardiogram was sinus rhythm with STT changes. Transesophageal echocardiography showed the left ventricular ejection fraction 27% with pulmonary hypertension (67 mmHg). A shunt flow was noted from the descending aorta to the pulmonary artery with a Qp/Qs of 1.3. By day 7, the pleural effusion had dissipated. However, she later passed away. A literature search revealed that she is the oldest patient to be diagnosed with patent ductus arteriosus (PDA) by transesophageal echocardiography and that she is the third oldest reported case of PDA.

Introduction: Heart failure (HF) is a significant and rising health burden in India. Diabetes mellitus is commonly prevalent in HF patients. However, data comparing the clinical characteristics and management of Indian HF patients with and without coexistent diabetes is lacking. Also, differences in HF management patterns between cardiologists and internists have not been systematically ascertained in India. This study is designed to address these gaps in knowledge.

Methods and analysis: HF-DIAB is a prospective multicenter study that aims to obtain data on 2,500 Indian adult outpatients with chronic HF recruited from 250 outpatient clinics across India; half of the included subjects will have a history of coexistent diabetes. Data on the patient’s demographics, personal and medical history, signs and symptoms of HF, etiology and clinical presentation of HF, diagnostic tests performed, previous HF-related hospitalizations, drugs prescribed for HF/diabetes and other comorbidities will be collected. Independent sample t-test will be used to compare differences between diabetic and non-diabetic HF subjects for various clinical characteristics measured using clinical variables. Chi- square test will be used to find out the association between diabetics and non-diabetics with various risk factors and clinical characteristics measured using categorical data. Differences in HF treatment, as per the specialty of the treating doctor, will also be compared using Chi-square test.

Ethics and dissemination: The study documents have been reviewed and approved by an independent ethics committee. Data-sharing consent will be obtained from each patient before enrollment in the study. The study results will be disseminated through publications in peer-reviewed journals.

Trial registration number: Clinical Trials Registry: India [CTRI/2017/07/009069].

Transcutaneous mitral valve repair is an interventional procedure increasingly used as a method of treatment for patients with symptomatic mitral regurgitation deemed to be poor surgical candidates. The procedure involves clipping the mitral valve leaflets at the point of maximal regurgitation. This procedure has been shown to be well tolerated with an acceptable risk profile. Infective endocarditis is a known but unusual complication of this procedure. We describe a case of infective endocarditis following implantation of a MitraClip (Abbott Laboratories) in a hemodialysis patient.