Pedro Bernardo Almeida

Increasing number of components of the metabolic syndrome and cardiac structural and functional abnormalities – cross-sectional study of the general population

BackgroundWe aimed to assess whether we could identify a graded association between increasing number of components of the metabolic syndrome and cardiac structural and functional abnormalities independently of predicted risk of coronary heart disease by the Framingham risk score.MethodsWe conducted a cross-sectional study on a random sample of the urban population of Porto aged 45 years or over. Six hundred and eighty-four participants were included. Data were collected by a structured clinical interview with a physician, ECG and a transthoracic M-mode and 2D echocardiogram. The metabolic syndrome was defined according to ATPIII-NCEP. The association between the number of features of the metabolic syndrome and the cardiac structural and functional abnormalities was assessed by 3 multivariate regression models: adjusting for age and gender, adjusting for the 10-year predicted risk of coronary heart disease by Framingham risk score and adjusting for age, gender and systolic blood pressure.ResultsThere was a positive association between the number of features of metabolic syndrome and parameters of cardiac structure and function, with a consistent and statistically significant trend for all cardiac variables considered when adjusting for age and gender. Parameters of left ventricular geometry patterns, left atrial diameter and diastolic dysfunction maintained this trend when taking into account the 10-year predicted risk of coronary heart disease by the Framingham score as an independent variable, while left ventricular systolic dysfunction did not. The prevalence of left ventricular diastolic dysfunction, and the mean left ventricular mass, left ventricular diameter and left atrial diameter increased significantly with the number of features of the metabolic syndrome when additionally adjusting for systolic blood pressure as a continuous variable.ConclusionIncreasing severity of metabolic syndrome was associated with increasingly compromised structure and function of the heart. This association was independent of Framingham risk score for indirect indices of diastolic dysfunction but not systolic dysfunction, and was not explained by blood pressure level.

Late device embolization in a persistent mitral paravalvular leak

An 83-year-old man with severe organic mitral regurgitation underwent mitral valve surgery with implantation of a biologic prosthesis. Four months later he presented with hemolytic anemia and heart failure due to severe paravalvular regurgitation. Since the patient refused surgery, the paravalvular leak was closed percutaneously using two Amplatzer devices, with angiographic and clinical success. Two months after the intervention he developed heart failure again and embolization of one of the devices was documented, with significant worsening of paravalvular regurgitation. A redo percutaneous closure was attempted but although initially promising, was ultimately unsuccessful as heart failure symptoms and hemolytic anemia persisted. Surgical correction was the final solution for this case. This is the second case of late device embolization reported in the literature and highlights the importance of careful long-term follow-up of such patients, as late complications, although rare, may occur.

Spontaneous closure of a left ventricle pseudoaneurysm following apical venting

Cardiac surgery is the second most frequent aetiology of left ventricular pseudoaneurysm (LVP). Left ventricular apical venting is a recognized cause of LVP. Prompt surgical treatment is usually needed since there is a high risk of rupture and spontaneous closure is very rare. We describe a case of spontaneous closure of a left ventricle pseudoaneurysm following apical venting.

Double-chambered left ventricle plus left ventricular non-compaction: report of an abnormal association

A 57-year-old asymptomatic woman with no significant medical history was referred for routine cardiac evaluation of hypertension. A transthoracic echocardiogram showed normal cardiac chamber dimensions, preserved biventricular systolic function, and prominent trabeculation mainly in the apical region ( Panel A ; see Supplementary data online, Video S1 …

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in an Asymptomatic Adult

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly with a mortality of 90% in the first year of life, if not surgically corrected. Adult presentation of the anomalous origin of the left coronary artery from the pulmonary artery syndrome is extremely rare but may occur if a well-developed collateral circulation from right coronary artery is present. We present the case of a 22-year-old asymptomatic female with anomalous origin of the left coronary artery from the pulmonary artery.

Cardiac Fabry's disease: an unusual cause of left ventricular hypertrophy

Background A 64-year-old male was observed as an outpatient with atypical, non-exercise-induced chest pain and palpitations. He had arterial hypertension and marked concentric left ventricular hypertrophy. After 2.5 years of antihypertensive drug therapy the patients blood pressure had returned to normal, but his left ventricular hypertrophy was unchanged.Investigations Electrocardiography, transthoracic echocardiography, myocardial perfusion scintigraphic imaging, measurement of α-galactosidase A activity, gene sequencing, brain MRI, carotid artery ultrasonography, biochemical renal evaluation and cardiac Doppler tissue imaging.Diagnosis Cardiac Fabrys disease.Management Losartan, hydrochlorothiazide, low-dose aspirin and bisoprolol. The patient is expected to begin enzyme replacement therapy.

Post-cardiac injury syndrome following transvenous pacing: Case report

Post-cardiac injury syndrome (PCIS) is an inflammatory process involving the pericardium secondary to cardiac injury. It can develop after cardiac trauma, cardiac surgery, myocardial infarction, and, rarely, after certain intravascular procedures. We report a rare case of an iatrogenic cardiac rupture followed by PCIS with delayed inflammatory pericardial effusion after pacemaker implantation. A comprehensive literature review on this topic is provided.

Hipocalcemia como uma causa reversível de insuficiência cardíaca

Calcium plays a key role in heart muscle contraction and relaxation. Hypocalcemic heart failure is a rare and potentially reversible disturbance, which reflects this intrinsic relationship. The authors present the case of a 35-year-old woman who developed acute heart failure during the early postoperative period following total thyroidectomy. The echocardiogram showed severe global left ventricular dysfunction. Laboratory tests showed severe hypocalcemia and new-onset hypoparathyroidism. Cardiac catheterization showed angiographically normal coronary arteries. After clinical, hemodynamic and metabolic stabilization, a repeat echocardiogram revealed recovery of left ventricular function. Subsequently, cardiac magnetic resonance imaging was performed, which also showed no alterations. The patient was discharged asymptomatic, medicated with calcium carbonate, calcitriol and levothyroxine. This case highlights the importance of considering hypocalcemia as a cause of reversible myocardial dysfunction.

A rare primary cardiac benign tumour: diagnosis by non-invasive cardiac imaging

Received 21 April 2016; revision accepted for publication 23 May 2016. A previously healthy 22-year-old woman was admitted with three weeks evolution of sharp and pleuritic chest pain, under ibuprofen 600 mg every 8 hours. The physical examination, 12lead ECG and chest X-ray were normal, but serum elevation of inflammatory markers was documented. The transthoracic echocardiography revealed a moderate circumferential pericardial effusion and a large homogeneous mass adhering to the right atrium wall, protruding into its cavity (A), confirmed by using Sonovue contrast (B). The echo density of the mass was similar to that of the myocardium and there was no flow obstruction. Cardiac magnetic resonance demonstrated a homogeneous mass in the posterior and lateral wall of right atrium, involving interatrial septum and crista terminalis. The mass was isointense on cine steady-state free precession (SSFP) imaging and was hyperintense in T1-weighted turbo (fast) spin-echo imaging (C) and on T2-weighted turbo (fast) spin-echo imaging (D), without fat suppression (E). There was no enhancement during first-pass myocardial perfusion imaging (FPP) or myocardial delayed enhancement. Although signal imaging characteristics and associated pericardial effusion could not exclude malignancy, A rare primary cardiac benign tumour: diagnosis by non-invasive cardiac imaging

A New Hope on Treatment of Atrial Dissection Complicated by Mitral Annulus Rupture: The First Case of Percutaneous Treatment

A 75-year-old woman with severe mitral regurgitation due to chordal rupture underwent mitral valve replacement with a 27-mm St. Jude Medical bioprosthesis. Intraoperative transesophageal echocardiography (TEE) showed a normal functioning prosthesis. Postoperative period was uneventful and the