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  • ISSN: 2333-6676
    Volume 4, Issue 6
    Case Report
    Vamsee M. Lakkakula, David A. Perkel*, Jerry J Crook II, and Tjuan L. Overly
    Pulmonic valve endocarditis is a rare entity with a prevalence of 1.5-2.0% in all cases of endocarditis. As few as 45 cases were reported in patients with structurally normal hearts between 1960 and 2005. Several cases have been reported with unique etiologies and have been seen in patients with PDA, sickle cell, Valsalva sinus aneurysm, skin infection of the hallux, VSD, and following a pulmonary artery catheterization. We present a case of septic thrombophlebitis inducing pulmonary endocarditis and septic pulmonary emboli.
    Short Communication
    Geladari EV, Vallianou NG*, Kratimenos Th, Trigkidis K, and Kokkinakis E
    Myocarditis is usually triggered by medications, toxins, autoimmune disorders as well as bacterial, fungal or protozoal infections, with the viruses being the most common cause. Most of the signs and symptoms are non-specific, ranging from fever, myalgias, palpitations, or dyspnea on exertion to hemodynamic instability, cardiogenic shock and sudden death. Importantly, myocarditis may be the cause of dilated cardiomyopathy through inflammatory autoimmune processes that now have been under investigation. According to the diagnostic procedures, until recently the confirmatory test was endomyocardial biopsy, but has now been replaced by the Cardiac Magnetic Resonance Imaging (MRI). The treatment consists of medications that significantly improve the left ventricular systolic dysfunction such as b-blockers, ACE inhibitors, and the use of positive inotropic agents or vasopressors. Herein, we present an eighty-one-years old female patient who was diagnosed with acute myocarditis due to Influenza B infection. Early antiviral therapy with oltesamivir resulted in full and quick recovery of the patient.
    Research Article
    Nadeem Sadiq*
    Objective: This study was aimed to determine the success, technique, complications, and outcome after Patent ductus arteriosus (PDA) device closure without arterial access under transthoracic echocardiography(TTE) guidance.
    Study Design: Quasi-experimental.
    Place & Duration of Study: Pediatric Cardiology department of AFIC/NIHD, Rawalpindi, Pakistan from June 2015 to August 2016.
    Background: The introduction of PDA device closure with transvenous approach in infants with moderate to large PDA has greatly improved symptomatology, growth. It also saves the limb in small infants with large PDA by using only femoral venous access. In certain infants with huge PDA the patients are salvaged satisfactorily with the precise estimation of device positioning and stability before release under TTE guidance.
    Subjects & Methods: A total of 45 patients with moderate to large PDA underwent device closure using only femoral vein access. After crossing the PDA from pulmonary artery side, pigtail catheter was placed in aorta to delineate the location, size and type of PDA. All patients had single procedure and data was analyzed by using SPSS 23.
    Results: Successful closure of the ductus was achieved in all the cases (100%). The mean age was 8months (range 1-16months) and mean weight was 4.5Kg (2.3Kg-7.8kg), 60% were female. All procedures were carried out under general anaesthesia. In two patients there was residual flow across the duct that closed spontaneously after 24 hours. All infants were discharged next morning confirming adequate closure and general status of the child. No emergency surgical exploration or death occurred during this period (June 15-August 16).
    Conclusion: Transcatheter occlusion of PDA by only transvenous approach is safe and real-time transthoracicechocardiography monitoring is able to guide the device placement. This procedure is especially useful for small infants with large PDA in which prolonged femoral arterial access by large size sheath can be limb threatening or impossible or contraindicated.
    Barauskiene V, Rumbinaite E*, Karuzas A, Martinkute E, and Puodziukynas A
    The autonomic nervous system plays an important role in the development of atrial fibrillation (AF). One of the most promising markers of autonomic activity is heart rate variability (HRV).
    Aim: The aim of the study was to evaluate HRV in patients with nonrheumatic atrial fibrillation.
    Patients and Methods: The study population consisted of 222 patients: group I - 75 pts with previous paroxysmal or persistent non rheumatic AF without antiarrhythmics drugs; group II - 71 pts with non-AF arrhythmias; group III - 76 healthy controls. A 24-hour measurement of HRV was carried out with Holter monitoring. The mean of the following time domain parameters were analyzed: R-R, SDNN (standard deviation of all consecutive sizes (NN) during the total ECG record), SDANN (standard deviation of all consecutive intervals, which are obtained by dividing the entire record in five-minute segments and calculating their means), SDN Ninx (the mean standard deviation of NN intervals in successive 5-minute periods) , pNN50 (the proportion between adjacent NN intervals differing by more than 50 ms the percentage of the estimated total number of NN intervals), and rMSSD (square root of successive NN interval differences). Continuous variables are presented as mean ± standard deviation. Student's t-test, Pearson Chi-square, and Mann-Whitney tests were applied where appropriate. P-value of < 0.05 was considered significant. The HRV prognostic value for AF was evaluated by using ROC curves.
    Results: According to our data, HRV was significantly lower in the group I compared with the groups II and III (p< 0.05): low HRV (rMSSD <30 ms) had46 patients (pts) (61.3%) in the group I, 21 pts (29.6%) in the group II and2 pts (2.6%) in the group III. Moderate HRV (30 =< rMSSD < 45 ms) had 27 pts (36.0%) in the group I, 25 pts (35.2%) in the group II and 42 pts (55.2%) in the group III. High HRV (rMSSD >= 45 ms) had 2 pts (2.6%) in the group I, 25 pts (35.2 %) in the group II, and 32 pts (42.2 %) in the group III. The ROC analysis of HRV role in AF prediction showed high AUC of 0.886 with sensitivity 90% and specificity 87% (cut-off 31.26 ms, p<0.001). HRV was significantly higher in patients with beta-blockers than without (p<0.005).Average heart rate was lower in the group I when beta-blockers were used (p<0,05): the group I - 59.8±5.7 bpm, the group II - 74.4±10.5 bpm, and the group III – 72.7±6.2 bpm.
    Conclusion: Patients with atrial fibrillation had a reduced HRV indicating a decreased vagal input in the heart rate regulation. HRV may be used as an important marker for the development of recurrent AF and may be used to optimize treatment. Beta–blockers had an effect on HR reduction and HRV increase in our study patients.
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