-
Circulation Journal : Official Journal... Mar 2009There is an emerging interest in heart failure with preserved ejection fraction (HFPEF) because of its high prevalence in the community and several specific... (Review)
Review
There is an emerging interest in heart failure with preserved ejection fraction (HFPEF) because of its high prevalence in the community and several specific characteristics compared with "classic" heart failure with reduced ejection fraction. HFPEF patients are older and more often female, and lack left ventricular dilatation. A likely principal cause of HFPEF is diastolic dysfunction, particularly ventricular stiffening; however, the clinical phenotype of HFPEF is also modulated by dysfunction of other organs such as kidney, vasculature, etc. Despite its social burden, the diagnostic criteria and therapeutic strategies remain to be established. In particular, the lack of established diagnostic criteria has resulted in conceptual confusions about HFPEF in clinical practice. In this review, what is known and unknown about HFPEF is discussed, and several challenging proposals about its diagnosis and therapy are raised.
Topics: Heart Failure; Humans; Stroke Volume; Ventricular Dysfunction, Left
PubMed: 19194044
DOI: 10.1253/circj.cj-08-1073 -
Minerva Cardioangiologica Apr 2005Tako-tsubo-like left ventricular dysfunction phenomenon (TTP) has primarily been described in Japan and is characterized by transient left ventricular apical ballooning... (Review)
Review
Tako-tsubo-like left ventricular dysfunction phenomenon (TTP) has primarily been described in Japan and is characterized by transient left ventricular apical ballooning in the absence of coronary artery disease, associated with chest symptoms, electrocardiographic changes and minimal cardiac enzymes release. Aim of the present review is to summarize the current knowledge about TTP. TTP has been described predominantly in females. TTP occurs also outside Japan. Clinical symptoms comprise anginal chest pain, dyspnea and syncope. TTP occurs frequently after acute emotional or physical stress. Electrocardiographic ST- elevations may be present only for several hours. Then, normalization of the ST-segment occurs, followed by negative T waves, which persist for months. Arterial hypertension in TTP is found in up to 76%, hyperlipidaemia in up to 57%, diabetes mellitus in up to 12% and smoking in up to 18% of the patients. Several pathomechanisms have been proposed: myocardial stunning due to increased catecholamine levels, coronary vasospasm, atherosclerotic plaques rupture, myocarditis, catecholamine-induced hyperkinesis of the basal left ventricular segments and genetic. Patients with TTP should be monitored like patients with myocardial infarction. Care should be taken in the application of catecholamines and nitrates. Betablockers should be given in the acute and chronic phase, and possibly indefinitely to prevent recurrences. The prognosis of TTP is assumed to be good, but in the acute phase there are deaths due to multisystem organ failure, cardiogenic shock, ventricular fibrillation and ventricular rupture. The long term prognosis of TTP patients is largely unknown.
Topics: Humans; Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left
PubMed: 15986008
DOI: No ID Found -
Journal of Cardiothoracic Surgery Nov 2009Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at... (Review)
Review
BACKGROUND
Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest, while left atrial pressure does not exceed 12 mm Hg. We examined the concept of left ventricular diastolic dysfunction in a cardiac surgery setting.
MATERIALS AND METHODS
Literature review was carried out in order to identify the overall experience of an important and highly underestimated issue: the unexpected adverse outcome due to ventricular stiffness, following cardiac surgery.
RESULTS
Although diverse group of patients for cardiac surgery could potentially affected from diastolic dysfunction, there are only few studies looking in to the impact of DD on the postoperative outcome; Trans-thoracic echo-cardiography (TTE) is the main stay for the diagnosis of DD. Intraoperative trans-oesophageal (TOE) adds to the management. Subgroups of DD can be defined with prognostic significance.
CONCLUSION
DD with elevated left ventricular end-diastolic pressure can predispose to increased perioperative mortality and morbidity. Furthermore, DD is often associated with systolic dysfunction, left ventricular hypertrophy or indeed pulmonary hypertension. When the diagnosis of DD is made, peri-operative attention to this group of patients becomes mandatory.
Topics: Anesthesiology; Cardiovascular Surgical Procedures; Clinical Protocols; Humans; Intraoperative Care; Risk Factors; Thoracic Surgery; Ventricular Dysfunction, Left
PubMed: 19930694
DOI: 10.1186/1749-8090-4-67 -
Congestive Heart Failure (Greenwich,... 2007It is well recognized that patients with severe left ventricular (LV) systolic dysfunction develop pulmonary venous hypertension or postcapillary pulmonary hypertension,... (Review)
Review
It is well recognized that patients with severe left ventricular (LV) systolic dysfunction develop pulmonary venous hypertension or postcapillary pulmonary hypertension, which leads to an increase in pulmonary vascular resistance (PVR) and right ventricular (RV) systolic failure. It is often underrecognized, however, that patients with heart failure with preserved LV ejection fraction and diastolic dysfunction may also develop postcapillary pulmonary hypertension with elevated PVR leading to RV systolic failure. This form of biventricular failure is a result of diastolic failure on the left in patients with preserved LV ejection fraction and systolic failure on the right. At this time, there are no randomized trials or guidelines addressing the management of patients with diastolic heart failure with and without resultant RV failure. The authors review the pathophysiology, clinical presentation, and suggested treatment of this underrecognized clinical entity.
Topics: Biomarkers; Diastole; Heart Failure; Humans; Hypertension, Pulmonary; Natriuretic Peptide, Brain; Pulmonary Wedge Pressure; Stroke Volume; Vascular Resistance; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 17541311
DOI: 10.1111/j.1527-5299.2007.06408.x -
Acta Medica Portuguesa 2007The Peripartum Cardiomyopathy is a rare form of heart disease, of uncertain etiology, more common in black and multiparous women, older than thirty years old. Is defined...
The Peripartum Cardiomyopathy is a rare form of heart disease, of uncertain etiology, more common in black and multiparous women, older than thirty years old. Is defined as development of maternal congestive heart failure, in the last month of pregnancy or within five months after delivery, with documented left ventricular systolic dysfunction, in the absence of a demonstrable cause for heart failure in a previously healthy woman. The diagnosis is commonly established with chest radiography, electrocardiogram and echocardiography. Treatment consist in medical therapy with inotropic support, afterload and preload redution, and anticoagulation. Surgical care with cardiac transplantation is indicated in severe cases with progressive left ventricular dysfunction, despite medical therapy. Prognosis seems dependent on recovery of left ventricular function and maternal mortality rates could reach 50%. Future pregnancy is not recommended in woman with persistent ventricular dysfunction. The authors present a case report in a black nuliparous woman at term, with 33 years old, without previous heart disease that presents a sudden heart failure, with ventricular dysfunction on echocardiography, after the caesarean, with recovery of normal ventricular function at 11th day of puerperium.
Topics: Adult; Female; Heart Failure; Humans; Puerperal Disorders; Ventricular Dysfunction
PubMed: 18282442
DOI: No ID Found -
Critical Care Medicine Apr 2022
Topics: COVID-19; Humans; Respiratory Distress Syndrome; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 34923554
DOI: 10.1097/CCM.0000000000005416 -
Clinical Journal of the American... Sep 2008In this article, the pathophysiology of left ventricular failure is reviewed. By contrast, the paucity of information about pulmonary arterial hypertension and right... (Review)
Review
In this article, the pathophysiology of left ventricular failure is reviewed. By contrast, the paucity of information about pulmonary arterial hypertension and right ventricular failure is acknowledged. The potential mechanisms whereby renal sodium and water retention in right ventricular failure secondary to pulmonary arterial hypertension can occur, despite normal left ventricular function, are discussed. With right ventricular failure as the primary cause of death in patients with pulmonary hypertension, more information about the mechanisms of renal sodium and water retention in these patients is direly needed. Specifically, studies to examine the activation of the neurohumoral axis at various stages of pulmonary arterial hypertension and right ventricular failure, including inhibition of mineralocorticoid and V2 vasopressin receptors, are indicated.
Topics: Heart Failure; Hemodynamics; Hormones; Humans; Hypertension, Pulmonary; Kidney; Renin-Angiotensin System; Sodium; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Water-Electrolyte Balance
PubMed: 18614776
DOI: 10.2215/CJN.01960408 -
Current Opinion in Cardiology Jan 2010Although anecdotal evidence has long suggested links between emotion and ventricular arrhythmia, more recent studies have prospectively demonstrated the arrhythmogenic... (Review)
Review
PURPOSE OF REVIEW
Although anecdotal evidence has long suggested links between emotion and ventricular arrhythmia, more recent studies have prospectively demonstrated the arrhythmogenic effects of anger, as well as mechanisms underlying these effects.
RECENT FINDINGS
Epidemiological studies reveal that psychological stress increases sudden death, as well as arrhythmias, in patients with implantable cardioverter-defibrillators, in populations during emotionally devastating disasters such as earthquake or war. Diary-based studies confirm that anger and other negative emotions can trigger potentially lethal ventricular arrhythmias. Anger alters electrophysiological properties of the myocardium, including T-wave alternans, a measure of heterogeneity of repolarization, suggesting one mechanistic link between emotion and arrhythmia. Pilot studies of behavioral interventions have shown promise in decreasing arrhythmias in patients with implantable cardioverter-defibrillators.
SUMMARY
Anger and other strong emotions can trigger polymorphic, potentially life-threatening ventricular arrhythmias in vulnerable patients. Through autonomic changes including increased sympathetic activity and vagal withdrawal, anger leads to increases in heterogeneity of repolarization as measured by T-wave alternans, known to be associated with arrhythmogenesis, as well as increasing inducibility of arrhythmia. Further delineation of mechanisms linking anger and arrhythmia, and of approaches to decrease the detrimental effects of anger and other negative emotions on arrhythmogenesis, are important areas of future investigation.
Topics: Aged; Anger; Animals; Arrhythmias, Cardiac; Humans; Male; Stress, Psychological; Sympathetic Nervous System; Ventricular Dysfunction
PubMed: 19864944
DOI: 10.1097/HCO.0b013e32833358e8 -
Journal of the Neurological Sciences Feb 2019Takotsubo syndrome(TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate... (Review)
Review
Takotsubo syndrome(TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate and delayed detection of seizure-induced TTS differ. We screened the literature and compared clinical and electrocardiographic (ECG) findings. In 48 cases with seizure-associated TTS, the time between seizure and TTS-detection was reported. Troponin levels were elevated in 37/40. ECG abnormalities were negative T-waves(40%), ST-elevations(33%) and ventricular fibrillation/flutter(10%). Immediate detection was reported in 23 patients, in the remaining 25 patients, TTS was detected 5-288 h postictally. Patients did not differ in gender, age or symptoms. Negative T-waves were more frequent in patients with delayed detection(64 vs. 13%, p = .0009), whereas ECG-abnormalities suggesting acute myocardial infarction tended to be more prevalent in patients with immediate detection. Due to lack of typical symptoms, seizure-induced TTS can be overlooked. Postictally, an ECG should be recorded and troponin levels measured. New T-wave inversions might indicate seizure-induced TTS.
Topics: Electrocardiography; Humans; Seizures; Takotsubo Cardiomyopathy; Time Factors; Ventricular Dysfunction, Left
PubMed: 30583237
DOI: 10.1016/j.jns.2018.12.005 -
The Journal of Thoracic and... Apr 2017Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure....
OBJECTIVE
Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure. The aim of this study was to determine the prognostic value of right ventricular function.
METHODS
A total of 139 patients with ischemic heart failure (62 ± 10 years; 79% were male; left ventricular ejection fraction 27% ± 7%) underwent surgical left ventricular restoration. Biventricular function was assessed with echocardiography before surgery. The independent association between all-cause mortality and right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain was assessed. The additive effect of multiple impaired right ventricular parameters on mortality also was assessed.
RESULTS
Baseline right ventricular fractional area change was 42% ± 9%, tricuspid annular plane systolic excursion was 18 ± 3 mm, and right ventricular longitudinal peak systolic strain was -24% ± 7%. Within 30 days after surgery, 15 patients died. Right ventricular fractional area change (hazard ratio, 0.93; 95% confidence interval, 0.88-0.98; P < .01), tricuspid annular plane systolic excursion (hazard ratio, 0.80; 95% confidence interval, 0.66-0.96; P = .02), and right ventricular longitudinal peak systolic strain (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26; P < .01) were independently associated with 30-day mortality, after adjusting for left ventricular ejection fraction and aortic crossclamping time. Right ventricular function was impaired in 21%, 20%, and 27% of patients on the basis of right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain, respectively. Any echocardiographic parameter of right ventricular dysfunction was present in 39% of patients. The coexistence of several impaired right ventricular parameters per patient was independently associated with increased 30-day mortality (hazard ratio, 2.83; 95% confidence interval, 1.64-4.87, P < .01 per additional impaired parameter).
CONCLUSIONS
Baseline right ventricular systolic dysfunction is independently associated with increased mortality in patients with ischemic heart failure undergoing surgical left ventricular restoration.
Topics: Aged; Cardiac Surgical Procedures; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Ischemia; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Left; Ventricular Function, Right
PubMed: 27751580
DOI: 10.1016/j.jtcvs.2016.09.038