Sarcoidosis of the heart

In 2 patients arrhythmias and conduction disorders were the first symptoms at presentation of cardiac sarcoidosis. One patient with severe conduction disorders showed normalisation of the EKG during steroid treatment. The other patient developed an overall cardiomyopathy and the arrhythmia was treated with conventional drugs. The frequency of cardiac involvement in sarcoidosis is much higher than that of clinical symptoms of sarcoid heart disease. Cardiac sarcoidosis is increasingly diagnosed in the last few decades. In most cases, it presents with sudden death, arrhythmia, conduction disorders or cardiomyopathy. The main diagnostic pathological feature is evidence of noncaseating granulomas, but mononuclear cell infiltration and focal interstitial fibrosis have also been found. The basal part of the interventricular septum is particularly prone to involvement. If conventional therapy in clinically important cases proves inadequate, steroid therapy should be added. It is recommended to make an EKG in every patient presenting with sarcoidosis even in the absence of cardiac symptoms. Sarcoid heart disease should be considered in every patient with diagnostic sarcoidosis and heart disease but also in every case of difficult heart disease without an obvious aetiology. Because of the relatively early age at onset, life expectancy is shortened.     

Anorexia nervosa and second-degree atrioventricular block (Type I)

OBJECTIVE: This is the first case report of a second-degree heart block (Mobitz Type I) described in a patient with anorexia nervosa (AN). METHOD: We present the case of a 20-year-old woman with AN and second-degree heart block. Pertinent reports in the literature regarding atrioventricular conduction abnormalities as well as cardiac rhythm disturbances are reviewed. RESULTS AND CONCLUSION: Although this patient's second-degree heart block may represent an intrinsic conduction abnormality unrelated to her AN, the importance of the validation of medical conditions during the treatment of AN is discussed.     

Clinical reasoning and decision-making in practice. A patient with shortness of breath and hyponatraemia

A 61-year-old man with no significant medical history was referred by the general practitioner with progressive dyspnoea despite treatment with steroids and antibiotics. The patient had severe hyponatraemia. Eventually hypervolemic hyponatraemia due to ischemic cardiac failure was diagnosed. After recompensation by fluid restriction and lisdiuretics coronary bypass surgery was carried out. The patient was discharged free of symptoms. This case is a reminder that heart failure may not present itself in a classical manner but as hypervolemic hyponatraemia.     

射血分数保留心力衰竭患者NT-proBNP、UA及Hcy水平与心功能的相关性

目的分析射血分数保留的心力衰竭患者血清N末端B型利钠肽原(N-terminal pro-B type natriuretic peptide,NT-proBNP)、尿酸(uric acid,UA)及同型半胱氨酸(homocysteine,Hcy)水平与心功能的相关性。方法选取2016-02至2019-05珠海高新技术产业开发区人民医院收治的88例射血分数保留的心力衰竭患者作为观察组,并根据纽约心脏病协会(new york heart association,NYHA)心功能分级,将患者分为Ⅱ~Ⅳ级,同时选取同期心功能正常的30例体检者作为对照组,分析血清NT-proBNP、UA及Hcy水平与心功能的相关性。结果观察组患者的NT-proBNP、UA及Hcy水平均明显高于对照组,且随着心功能等级提高,各指标水平呈明显上升趋势,差异均有统计学意义(P<0.05);经Spearman等级相关分析显示,射血分数保留心力衰竭患者的血清NT-proBNP、UA及Hcy水平与心功能呈正相关(ρ>0.6,P<0.05)。结论射血分数保留心力衰竭患者的血清NT-proBNP、UA、Hcy水平与其心功能呈正相关。     

目标剂量美托洛尔缓释片治疗明显改善原发性高血压伴心衰患者预后

目的探讨目标剂量美托洛尔缓释片治疗原发性高血压伴心衰患者的疗效和血压、血管内皮生长因子(VEGF)及高敏C-反应蛋白(hs-CRP)的相关性。方法入选原发性高血压伴心衰患者133例,目标剂量美托洛尔缓释片治疗12个月,观察治疗前后一般临床资料、超声心动图、放射性核素和实验室检查结果的变化。结果目标剂量美托洛尔缓释片治疗12个月后左室舒张末径及左室收缩末径显著减少;左室射血分数(LVEF)、左室高峰充盈率(LVPFR)及N末端B型利钠肽原(NT-proBNP)明显增加。目标剂量美托洛尔缓释片治疗后患者收缩压、舒张压及脉压较治疗前显著降低,且血管内皮生长因子及高敏C-反应蛋白亦明显降低。结论对原发性高血压伴心衰患者,目标剂量美托洛尔缓释片治疗可以显著改善心脏重构、心功能和降低病死率。     

Hydatic pulmonary embolism complicating a cardiac hydatic cyst. A case report

Hydatic pulmonary embolism: complication of a cardiac hydatic cyst:a case report hydatic cardiac cyst is a rare condition and represents only 0.5 to 2% of all visceral localisations of the hydatid disease. We reported a 28 year old patient with a multiple hydatic pulmonary embolism caused by the rupture of a hydatic cyst of the interventricular septum. The diagnosis was established by transthoracic echocardiography and CT Scan. Surgery was performed without delay and the outcome was good after a five month follow-up. This case illustrates the diagnostic value of the non invasive imaging means in hydatic cyst of the heart and underlines the importance of surgery realized before complications occur.     

心力衰竭患者B型钠尿肽及其肌钙蛋白Ⅰ和超敏C反应蛋白水平的变化

目的:观察慢性心力衰竭(CHF)患者心肌损伤指标肌钙蛋白I(cTnI)和炎症指标超敏C反应蛋白(hs-CRP)含量变化并探讨其与CHF不同类型及B型钠尿肽(BNP)之间的关系。方法:选择经临床确诊的CHF患者160例(NYHAⅠ-Ⅳ级),健康对照者150名,无CHF的心血管患者142例。用免疫荧光定量分析法测定其全血hs-CRP和BNP水平,微粒子酶促化学发光免疫分析法测定其血清cTnI水平,并进行对比分析。结果:CHF患者组全血BNP和hs-CRP水平均显著高于无CHF的心血管患者组和健康对照组,血清cTnI值CHF患者组亦均显著高于无CHF的心血管患者组和健康对照组(P均<0.01)。且随心功能NY-HA分级的增高,全血BNP水平逐渐升高,组间差别均有统计学意义,而全血hs-CRP与血清cTnI水平随心功能NYHA分级的增高,组间差别均无统计学意义(P均>0.05),但均较健康对照组升高。结论:慢性心力衰竭疾病过程中存在着心肌损伤和炎症,表明心肌损伤和炎症是这种疾病病理生理过程的重要成分,但这种心肌损伤和炎症与心功能NYHA分级和障碍程度无关。     

Cardiac amyloidosis revealing multiple myeloma

INTRODUCTION: Amyloidosis is a rare disease characterized by an extracellular accumulation of a protein polysaccharid complex (Amyloid). Cardiac involvement is considered as a major prognostic factor. OBSERVATIONS: We report the case of two women, hospitalized for heart failure. The diagnosis of cardiac amyloidosis was suggested by echocardiography: Left ventricular concentric hypertrophy and typical amyeloid infiltration with hyperechoic, shiny and granite-like aspect of the interventricular septum. The histological confirmation was obtained by gastric biopsy in the first case and biopsy of the salivary glands in the second revealing an amyloidosis AL. This cardiac amyloidosis was secondary to multiple myeloma: monoclonal Gammopathy with immunoglobulin Lambda in the first and Kappa in the second, and the presence of a plasmocyte infiltration in the sternal puncture. CONCLUSION: Amyloidosis is a rare pathology, the cardiac involvement is frequent in the type AL and can occur with or without clinical manifestations. Echocardiography should be systematic in patients with confirmed amyloidosis.     

The acute and chronic effects of ethanol on cardiac muscle protein synthesis in the rat in vivo.

An investigation was made into the acute and chronic effects of ethanol on rates of protein synthesis in the hearts of young rats (80-100 g body weight). Acute ethanol administration (75 mmol/kg body weight, IP) significantly reduced the fractional rate of protein synthesis by 20% after 2.5 hr, compared with saline-treated controls. Chronic ethanol feeding (36% of total calories) for 6 weeks significantly reduced cardiac wet weight by 11%, when compared to rats fed isovolumetric amounts of the same diet in which ethanol was substituted by isocaloric glucose. Neither the concentration nor the content of mixed cardiac proteins relative to body weight were overtly altered by chronic ethanol feeding, although, the total content of mixed cardiac proteins were significantly decreased. RNA concentrations and RNA relative to body weight increased slightly, but total cardiac DNA decreased. Indices for the capacity or potential of the heart to synthesis protein (indicated by the RNA/protein and RNA/DNA ratios) and the "DNA-unit" (protein/DNA ratio) were increased in response to chronic ethanol treatment. The fractional and absolute rates of mixed protein synthesis in the heart were (relatively) unaltered by chronic ethanol treatment, as was RNA efficiency and synthesis relative to DNA. It was concluded that the heart displays contrasting responses to acute and chronic ethanol exposure.     

A relapse of systemic type juvenile idiopathic arthritis after a rubella vaccination in a patient during a long-term remission period

An 11-year-old female patient, whose systemic type juvenile idiopathic arthritis (JIA) had maintained in remission for the previous 4 years while taking only a small amounts of ibuprofen, showed an abrupt 2nd relapse with congestive heart failure five days after receiving a live-attenuated rubella vaccine, which was a primary immunization. Her serum levels of anti-rubella IgM and IgG antibodies increased, and her laboratory findings such as a leukocytosis, elevated serum levels of CRP, IL-6 and other inflammatory cytokine profiles were similar to the findings observed during her previous JIA active stage. After being administration of co-therapy with steroid pulse, ibuprofen, methotrexate and phosphodiesterase inhibitor gradually improved her clinical symptoms such as spiky fever, heart failure and arthralgia. Her intermittent fever and increased serum levels of CRP and IL-6, however, have been sustained for more than 2 years, and this prolonged active clinical course therefore differed from her previous JIA active stage.This abrupt relapse only five days after vaccination was suggested not to be directly related with rubella infection, but instead to be related with the molecular mimicry between rubella and JIA.     

低钠合并低蛋白血症与慢性心衰患者心功能及预后的关系

目的：探讨低钠、低蛋白血症对慢性心衰患者心功能及临床预后的影响。方法：收集2006年5月-2012年3月定西市第二人民医院心内科住院的慢性心力衰竭患者285例,均符合慢性心衰的诊断标准。记录患者一般资料、心功能分级、基础心脏病病因、心脏超声、心电图、血清白蛋白。评价低钠、低蛋白等因素与心衰严重程度的关系以及临床预后的关系。结果：285例心衰患者中低钠血症51例,占17.9%;低钠合并低蛋白血症患者18例,占6.3%。51例低钠患者心功能Ⅱ级5例、Ⅲ级17例、Ⅳ级29例。低钠合并低蛋白血症患者左室射血分数降低,死亡率增高,与单纯低钠血症比较差异有统计学意义（P〈0.05）。结论：血钠、血清白蛋白水平与心衰的严重程度密切相关,重视并积极纠正低钠、低蛋白血症,能明显改善心衰患者的心功能,并能明显降低死亡率。     

心肌肌钙蛋白I在儿科的临床应用进展

心肌肌钙蛋白I是心肌特有的蛋白质 ,在心脏收缩过程中起主要调节作用。当心肌细胞轻度受损时 ,其快速释放进入血液循环 ,血液中心肌肌钙蛋白I的浓度发生变化 ,测定其浓度已成为检测心肌损伤的指标。该指标敏感性高 ,特异性强 ,在儿科临床中对心肌损害的诊断有重要意义     

A rare case of ovarian carcinoid causing heart failure

Carcinoid tumours are rare tumours of the neuro-endocrine system. They most commonly present in the gut; however, they can present in other organs. In all, 0.3% of carcinoid tumours are ovarian in origin. Subsequently, very few cases of ovarian carcinoid affecting the heart have been reported and this case adds to the literature on this. There are very few reports in the literature of ovarian carcinoid and even fewer on cardiac failure due to carcinoid. Generally, carcinoid heart disease only affects the right-sided valves, sparing the mitral and aortic valves. We present the case of a patient who had an ovarian carcinoid tumour excised successfully and had been asymptomatic for 14 years prior to an incidental finding of right valvular signs on echocardiography, before subsequently right heart failure deemed to be secondary to ovarian carcinoid heart disease. The diagnosis is generally made on the findings of right-sided heart failure and the valvular abnormalities on echocardiogram (isolated pulmonary and tricuspid involvement). If the tumour is present at the same time as the development of heart failure, cardiac function can improve with timely tumour resection; however, cardiac disease can occur despite tumour removal.     

慢性心力衰竭患者血清氨基末端B型脑钠肽前体和超敏C反应蛋白及糖类抗原-125水平分析

目的 分析慢性心力衰竭患者血清氨基末端B型脑钠肽前体(NT-pro BNP)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)和糖类抗原-125(carbohydrate antigen-125,CA-125)水平特征.方法 选取2019年1月—2020年12月沈阳医学...     

卡维地洛治疗老年充血性心力衰竭72例疗效观察及安全性评价

目的 探讨卡维地洛治疗老年充血性心力衰的疗效及安全性.方法 将2009年7月～2011年9月于某院进行常规治疗的72例老年充血性心力衰竭患者设为对照组,同期的72例加用卡维地洛进行治疗的患者为观察组,后将两组患者的治疗总有效率、不良反应发生率及治疗前、治疗后1个月、2个月的心功能、血清BNP、hs-CRP水平进行对比.结果 观察组不仅治疗总有效率及不良反应发生率明显好于对照组,且其治疗后的心功能、血清BNP、hs-CRP水平改善幅度也明显大于对照组,P均＜ 0.05,差异有统计学意义.结论 卡维地洛治疗老年充血性心力衰的临床疗效及安全性均受肯定,心功能及相关血清因子也从多个方面肯定了其疗效.     

心力衰竭患者血清可溶性ST2水平检测及其临床意义

目的探讨白介素-1受体家族成员可溶性ST2(sST2)在心力衰竭患者的水平及其临床意义。方法回顾性分析84例心衰患者血清sST2浓度,根据纽约心脏病学会(NYHA)心功能分级:Ⅱ级46例,Ⅲ级19例,Ⅳ级19例。选取同期住院的无心衰患者95例作为对照组。检测两组患者血清ST2浓度,比较其ST2水平,分析其与左室射血分数(Left Ventricular Ejection Fraction,LVEF)、NYHA心功能分级的相关性,并比较不同心功能级别患者之间ST2浓度的差异。结果与对照组相比,心衰患者血清ST2水平升高,差异有统计学意义(p<0.001)。不同心功能级别间血清ST2水平差异有统计学意义(p<0.001)。sST2水平随着心衰程度的加重而增高(p<0.05),与NYHA心功能分级(r=0.227,p<0.01)呈正相关性,与LVEF分级(r=-0.22,p<0.01)呈负相关关系。ST2诊断心衰的敏感性77.8%,特异性55.3%,AUCROC为0.758(95%C10.669～0.846)。结论 sST2是诊断心衰新的标志物,与左室射血分数、心功能分级相关,为判断心衰严重程度及心功能分层提供了参考意义。     

Role of dietary fatty acids and acute hyperglycemia in modulating cardiac cell death

OBJECTIVE: We examined the effect of dietary manipulation of palmitic acid (20% [w/w] palm oil [PO]) on cardiomyocyte apoptosis in the rat heart under normoglycemic and hyperglycemic conditions in vivo. We used 20% (w/w) sunflower oil (SO; a diet rich in omega-6 polyunsaturated fatty acids) as an isocaloric control. METHODS: Adult male Wistar rats were fed experimental diets containing normal laboratory chow (5% corn oil) or a high fat diet (AIN-76A with PO or SO) for 4 wk. Subsequently, to induce diabetes, rats were injected with streptozotocin (55 mg/kg, intravenously). After 4 d of diabetes, hearts were tested for evidence of lipotoxicity and cell death, and the serum for its related markers. RESULTS: Feeding PO and SO magnified palmitic and linoleic acid contents within lipoproteins and hearts respectively. Compared with SO, PO diabetic hearts demonstrated significantly higher levels of apoptosis, with an altered Bax:Bcl-2 ratio, augmented lipid peroxidation, and protein modification by formation of nitrotyrosine. Interestingly, SO-fed diabetic animals demonstrated an increase in serum lactate dehydrogenase and myocardial necrotic changes. CONCLUSION: In marked contrast to results obtained in vitro, PO feeding led to only a minor fraction of cardiomyocytes undergoing apoptosis and suggests that, in the intact heart, protective mechanisms could be triggered that dampen excessive apoptosis. Of greater clinical significance was the observation that "heart-friendly" vegetable oils such as SO, rich in omega-6 polyunsaturated fatty acids, could precipitate cardiac necrosis, and questions its beneficial role in the cardiovascular system, especially following diabetes.     

直接心脏辅助装置的现状与未来

直接心脏辅助装置包围在心脏外表面或主动脉上帮助衰弱心脏恢复功能。这类辅助装置因为不与血液接触．可避免引发血液生物兼容性的问题．在血栓、血感染严重困扰其它心脏辅助装置发展的今天．尤其有开发意义。该文回顾了直接心脏辅助装置的现状．并讨论了未来的发展和面临的挑战。     

心脏人工瓣膜术后真菌性心内膜炎2例报告及治疗策略文献综述

目的探讨心脏人工瓣膜置换术后真菌性心内膜炎的治疗策略。方法对2例心脏人工瓣膜术后并发严重真菌感染病例进行回顾性分析,并进行相关文献复习。结果 2例患者术后并发真菌性心内膜炎,均影响瓣膜功能,术后均反复住院,病例一,心脏术后45 d出现发热,返院复诊,予以急诊在体外循环下行再次二尖瓣置换术,术后赘生物培养为黄曲霉菌;病例二,心脏术后5个月在体外循环下行主动脉壁赘生物清除,术后赘生物病理提示毛霉菌。2例患者均及时手术清除感染灶并进行规范抗真菌治疗,曲霉菌感染患者抢救无效,毛霉菌感染患者治愈,后者抗真菌治疗强度更大。结论心脏人工瓣膜置换术后并发真菌性心内膜炎,预防是关键,治疗要及时、有效,抗真菌药物必须足量、足疗程。