Echocardiographic evaluation of pulmonary hypertension,right ventricular function,and right ventricular-pulmonary arterial coupling in patients with rheumatoid arthritis

Clinical Rheumatology - Rheumatoid arthritis (RA) patients are at increased risk for developing cardiovascular disease, including right heart failure. The evaluation of right ventricle (RV) using...     

The Heart in Diabetic Ketoacidosis: A Narrative Review Focusing on the Acute Cardiac Effects and Electrocardiographic Abnormalities

Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus. Hyperglycemia, acidosis, and electrolyte imbalances can directly affect the heart by inducing toxicity, impairing myocardial blood flow, autonomic dysfunction, and altering activation and conduction of electrical impulses throughout the heart, increasing the risk of arrhythmias and ischemia. The electrocardiogram is useful in monitoring patients during and after an episode of DKA, as it allows the detection of arrhythmias and guides metabolic correction. Unfortunately, reports on electrocardiographic abnormalities in patients with DKA are lacking. We found two electrocardiographic patterns that are frequently reported in the literature: a pseudo-myocardial infarction and a Brugada Phenocopy. Both are associated with DKA metabolic anomalies and they resolve after treatment. Because of their clinical relevance and the challenge they represent for clinicians, we analyzed the clinical characteristics of these patients and the mechanisms involved in these electrocardiographic findings.     

The best cardiovascular risk calculator to predict carotid plaques in rheumatoid arthritis patients

Clinical Rheumatology - Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors...     

Round opacity as a presentation of pneumocystis jirovecii pneumonia in an HIV-infected patient

We present the case of a human immunodeficiency virus (HIV)-infected patient who arrived at our emergency department with fever, headache and exertional dyspnea. Throughout their stay, a chest x-ray was taken and a rounded opacity in his left lung was observed. CT images showed same abnormality and also ground glass opacities were seen. Symptoms and images strongly suggested a pulmonary infection due to pneumocystis jirovecii, however a presence of a round lesion should always lead to neoplasia being suspected. We empirically started treatment based on trimethoprim and sulfamethoxazole. Once available, flexible bronchoscopy and bronchoalveolar lavage was performed and stained preparations from his respiratory specimens confirmed the diagnosis of pulmonary pneumocystis infection. Finally, after 4?days of antibiotic therapy, an important clinical improvement was documented; a new chest x-ray was performed and the previous rounded opacity was absent. This finding strongly suggested a case of round pneumonia.     

Thermal burn resulting from prolonged transcutaneous pacing in a patient with complete heart block

Temporary transcutaneous pacing devices are used to treat symptomatic bradyarrhythmias that are unresponsive to medical therapy until it resolves or a more stable pacing device is established. Pain is the most common complication. Skin burns as a complication are uncommon. A female patient presented with a complete atrioventricular block that caused altered mental status and required orotracheal intubation. A temporary transcutaneous pacing device was used to treat the bradyarrhythmia and maintained for 12?h until a temporary transvenous pacemaker was placed. The patient developed a third degree skin burn in the area where the anterior pacing patch was placed.Bradycardia is a common complaint in the emergency department. Temporary transcutaneous cardiac pacing is a widely available treatment modality that serves as initial management for these cases and allows us to keep patients stable until a more stable pacing solution is available. Burns as a complication of transcutaneous pacing are uncommon.     

Assessment of six cardiovascular risk calculators in Mexican mestizo patients with rheumatoid arthritis according to the EULAR 2015/2016 recommendations for cardiovascular risk management

Clinical Rheumatology - Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS),...