Heart Disorders Glossary
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Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease
Europace (2017) 0, 1–21 EHRA CONSENSUS DOCUMENT doi:10.1093/europace/eux240 Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulacion Cardıaca y Electrofisiologıa (SOLEACE) Gregory Y. H. Lip1*, Jean Philippe Collet2, Raffaele de Caterina3, Laurent Fauchier4, Deirdre A. Lane5, Torben B. Larsen6, Francisco Marin7, Joao Morais8, Calambur Narasimhan9, Brian Olshansky10, Luc Pierard11, Tatjana Potpara12, Nizal Sarrafzadegan13, Karen Sliwa14, Gonzalo Varela15, Gemma Vilahur16, Thomas Weiss17, Giuseppe Boriani18 and Bianca Rocca19 Document Reviewers: Bulent Gorenek20 (Reviewer Coordinator), Irina Savelieva21, Christian Sticherling22, Gulmira Kudaiberdieva23, Tze-Fan Chao24, Francesco Violi25, Mohan Nair26, Leandro Zimerman27, Jonathan Piccini28, Robert Storey29, Sigrun Halvorsen30, Diana Gorog31, Andrea Rubboli32, Ashley Chin33 and Robert Scott-Millar34 * Corresponding author. Tel/fax: þ44 121 5075503. E-mail address: [email protected] Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author 2017. For permissions, please email: [email protected]. 2 G.Y.H. Lip 1Institute of Cardiovascular Sciences, University of Birmingham and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (Chair, representing EHRA); 2Sorbonne Universite´ Paris 6, ACTION Study Group, Institut De Cardiologie, Groupe Hoˆpital Pitie´-Salpetrie`re (APHP), INSERM UMRS 1166, Paris, France; 3Institute of Cardiology, ‘G. -
Percutaneous Mitral Valve Therapies: State of the Art in 2020 LA ACP Annual Meeting
Percutaneous Mitral Valve Therapies: State of the Art in 2020 LA ACP Annual Meeting Steven R Bailey MD MSCAI, FACC, FAHA,FACP Professor and Chair, Department of Medicine Malcolm Feist Chair of Interventional Cardiology LSU Health Shreveport Professor Emeritus, UH Health San Antonio [email protected] SRB March 2020 Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below. Affiliation/Financial Relationship Company • Grant/Research Support • None • Consulting Fees/Honoraria • BSCI, Abbot DSMB • Intellectual Property Rights • UTHSCSA • Other Financial Benefit • CCI Editor In Chief SRB March 2020 The 30,000 Ft View Maria SRB March 2020 SRB March 2020 Mitral Stenosis • The most common etiology of MS is rheumatic fever, with a latency of approximately 10 to 20 years after the initial streptococcal infection. Symptoms usually appear in adulthood • Other etiologies are rare but include: congenital MS radiation exposure atrial myxoma mucopolysaccharidoses • MS secondary to calcific annular disease is increasingly seen in elderly patients, and in patients with advanced chronic kidney disease. SRB March 2020 Mitral Stenosis • Mitral stenosis most commonly results from rheumatic heart disease fusion of the valve leaflet cusps at the commissures thickening and shortening of the chordae calcium deposition within the valve leaflets • Characteristic “fish-mouth” or “hockey stick” appearance on the echocardiogram (depending on view) SRB March 2020 Mitral Stenosis: Natural History • The severity of symptoms depends primarily on the degree of stenosis. • Symptoms often go unrecognized by patient and physician until significant shortness of breath, hemoptysis, or atrial fibrillation develops. -
How to Define Valvular Atrial Fibrillation?
Archives of Cardiovascular Disease (2015) 108, 530—539 Available online at ScienceDirect www.sciencedirect.com REVIEW How to define valvular atrial fibrillation? Comment définir la fibrillation atriale valvulaire ? ∗ Laurent Fauchier , Raphael Philippart, Nicolas Clementy, Thierry Bourguignon, Denis Angoulvant, Fabrice Ivanes, Dominique Babuty, Anne Bernard Service de cardiologie, faculté de médecine, université Franc¸ois-Rabelais, CHU Trousseau, Tours, France Received 3 June 2015; accepted 8 June 2015 Available online 14 July 2015 KEYWORDS Summary Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials compar- Atrial fibrillation; ing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in Valve disease; AF were performed among patients with so-called ‘‘non-valvular’’ AF. The distinction between Stroke ‘‘valvular’’ and ‘‘non-valvular’’ AF remains a matter of debate. Currently, ‘‘valvular AF’’ refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regur- gitation, aortic stenosis (AS) and aortic insufficiency, do not result in conditions of low flow in the left atrium, and do not apparently increase the risk of thromboembolism brought by AF. Post-hoc analyses suggest that these conditions probably do not make the thromboembolic risk less responsive to NOACs compared with most forms of ‘‘non-valvular’’ AF. The pathogenesis of thrombosis is probably different for blood coming into contact with a mechanical prosthetic valve compared with what occurs in most other forms of AF. This may explain the results of the only trial performed with a NOAC in patients with a mechanical prosthetic valve (only a few of whom had AF), where warfarin was more effective and safer than dabigatran. -
Chest Pain and the Hyperventilation Syndrome - Some Aetiological Considerations
Postgrad Med J: first published as 10.1136/pgmj.61.721.957 on 1 November 1985. Downloaded from Postgraduate Medical Journal (1985) 61, 957-961 Mechanism of disease: Update Chest pain and the hyperventilation syndrome - some aetiological considerations Leisa J. Freeman and P.G.F. Nixon Cardiac Department, Charing Cross Hospital (Fulham), Fulham Palace Road, Hammersmith, London W6 8RF, UK. Chest pain is reported in 50-100% ofpatients with the coronary arteriograms. Hyperventilation and hyperventilation syndrome (Lewis, 1953; Yu et al., ischaemic heart disease clearly were not mutually 1959). The association was first recognized by Da exclusive. This is a vital point. It is time for clinicians to Costa (1871) '. .. the affected soldier, got out of accept that dynamic factors associated with hyperven- breath, could not keep up with his comrades, was tilation are commonplace in the clinical syndromes of annoyed by dizzyness and palpitation and with pain in angina pectoris and coronary insufficiency. The his chest ... chest pain was an almost constant production of chest pain in these cases may be better symptom . .. and often it was the first sign of the understood if the direct consequences ofhyperventila- disorder noticed by the patient'. The association of tion on circulatory and myocardial dynamics are hyperventilation and chest pain with extreme effort considered. and disorders of the heart and circulation was ackn- The mechanical work of hyperventilation increases owledged in the names subsequently ascribed to it, the cardiac output by a small amount (up to 1.3 1/min) such as vasomotor ataxia (Colbeck, 1903); soldier's irrespective of the effect of the blood carbon dioxide heart (Mackenzie, 1916 and effort syndrome (Lewis, level and can be accounted for by the increased oxygen copyright. -
Echo in Asymptomatic Mitral and Aortic Regurgitation
2017 ASE Florida | Orlando, FL October 9, 2017 | 10:40 – 11:00 PM | 20 min | Grand Harbor Ballroom South Echo in Asymptomatic Mitral and Aortic Regurgitation Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology | Echo Lab Associate Professor of Medicine Disclosures Speakers Bureau (Philips, Medtronic) Advisory Board (Siemens) Regurgitation Axioms ▪Typically, regurgitation is NOT symptomatic unless severe ▪The opposite is not true: Severe regurgitation may be asymptomatic ▪ Chronic regurgitation leads to chamber dilatation on either side of the regurgitant valve Regurgitation Discovery ▪ Regurgitation as a anatomic entity was recognized in the 17th century ▪ Regurgitation was first clinically diagnosed by auscultation in the 19th century, well before the advent of echocardiography First Use of Regurgitation Term in English 1683 W. Charleton Three Anat. Lect. i. 18 Those [valves] that are placed in the inlet and outlet of the left Ventricle, to obviate the regurgitation of the bloud into the arteria venosa, and out of the aorta into the left Ventricle. Walter Charleton (1619 – 1707) English Physician Heart Murmur OXFORD ENGLISH DICTIONARY DEFINITION ▪ Any of various auscultatory sounds ▪ Adventitious sounds of cardiac or vascular origin [that is, separate from standard heart sounds: S1, S2, S3, S4] ▪ Sometimes of no significance ▪ But sometimes caused by valvular lesions of the heart or other diseases of the Στῆθος : Stēthos = chest circulatory system René Laënnec Stethoscope (1781 – 1826) (‘Chest examiner’) French Physician Hollow wooden cylinder Inventor of stethoscope in 1816 Laënnec Performing Auscultation Painted by Robert Alan Thom (1915 – 1979), American illustrator Commissioned by Parke, Davis & Co. 1816 1832 René Laënnec, James Hope French physician British physician Invents MONAURAL stethoscope separates MS from MR murmur 1852 1862 George Cammann Austin Flint Sr. -
How Do We Define Valvular Heart Disease When Considering Warfarin
CORRESPONDENCE Further clarification about this issue would be very much appreciated. Dr Andrew Reid, General Practitioner Tuakau The bpacnz editorial team asked cardiologist Stewart Mann to respond: This is a very relevant question and one that probably does not yet have a definitive answer. The RE-LY trial that compared the efficacy of warfarin and dabigatran had the exclusion criterion “moderate or severe mitral stenosis”. This study also excluded How do we define valvular heart disease when patients with a potentially reversible cause of AF which might considering warfarin or dabigatran in patients with include some valve disease amenable to surgery. Other valve atrial fibrillation? disease could be included. An analysis of patients with valve Dear Editor, disease included in the trial has been conducted and published I have a query from the summary article “An update on in abstract form.1 In the RE-LY trial, around 20% of patients had antithrombotic medications: What does primary care need to valve disease, most with mitral regurgitation but some with know?”, BPJ 73 (Feb, 2016) that I would very much appreciate aortic regurgitation, aortic stenosis or mild mitral stenosis. some further information on. There is no mention of patients with tissue valve prostheses or of those who might have had a valvuloplasty. The group with The article makes this comment: valve disease had poorer outcomes than those without valve “Dabigatran should NOT be prescribed to patients disease but there was no significant difference between those with valvular -
Expert Consensus for Multi-Modality Imaging Evaluation Of
EACVI/ASE EXPERT CONSENSUS STATEMENT Expert Consensus for Multi-Modality Imaging Evaluation of Cardiovascular Complications of Radiotherapy in Adults: A Report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography Patrizio Lancellotti,* Vuyisile T. Nkomo, Luigi P. Badano, Jutta Bergler, Jan Bogaert, Laurent Davin, Bernard Cosyns, Philippe Coucke, Raluca Dulgheru, Thor Edvardsen, Oliver Gaemperli, Maurizio Galderisi, Brian Griffin, Paul A. Heidenreich, Koen Nieman, Juan C. Plana, Steven C. Port, Marielle Scherrer-Crosbie, Ronald G. Schwartz, Igal A. Sebag, Jens-Uwe Voigt, Samuel Wann, and Phillip C. Yang, In collaboration with the European Society of Cardiology Working Groups on Nuclear Cardiology and Cardiac Computed Tomography and Cardiovascular Magnetic Resonance and the American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography, Liege, Brussels, Leuven, Belgium, Rochester, MN, Padua, Italy, Vienna, Austria, Bucharest, Romania, Oslo, Norway, Zurich, Switzerland, Naples, Italy, Cleveland, OH, Palo Alto, Stanford, CA, Rotterdam, The Netherlands, Milwaukee, WI, Boston, MA, Rochester, NY, Montreal, Quebec, Canada Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy ob- tained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical stud- ies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. -
The Silver Book®: Valve Disease [email protected] Introduction
Chronic Disease and Medical Innovation in an Aging Nation The Silver Book®: Valve Disease www.silverbook.org/valvedisease [email protected] Introduction he United States is a graying nation. The number of people ages 65 and older in the U.S. is projected to almost double by 2050 — from T43 million to 83.7 million. At that point, 20 percent of our popula- tion will be 65 years or older. With these shifting demographics come far-reaching and wide-ranging implications for our society, not the least of which is the potentially crippling effect of chronic and costly diseases Cost of Valve Disease that become more prevalent with age. Chronic diseases and conditions impact 85 percent of Americans — Innovative Medical Research many of whom spend their later years at medical visits, in extensive hospital stays, and dealing with disabilities and lost independence. Age- Conclusion related diseases also impose a huge burden on our health care system and economy — costing our nation $1.7 trillion a year. References Heart valve disease is a leading type of cardiovascular disease that becomes more common with age, and imposes a significant burden on patients and their families. It involves damage to one or more of the heart’s valves, interrupting blood flow and causing serious complica- tions — including death. Every year, more than 25,000 people in the U.S. die from heart valve disease. If diagnosed in time, heart valve disease can usually be successfully treated in patients of all ages. Advances in detection, valve repair and replacement through less-invasive procedures, and prevention of post-operative complications are all leading to better outcomes and sur- vival in heart valve disease patients. -
Interpolated Bigeminy Ventricular Premature Contractions Due to Cardiac Compression of Left Pleural Effusion: a Case Report
INTERPOLATED BIGEMINY VENTRICULAR PREMATURE CONTRACTIONS DUE TO CARDIAC COMPRESSION OF LEFT PLEURAL EFFUSION: A CASE REPORT Aydın Akyüz1, Cenap Özkara2, Niyazi Güler3, Hasibe Özkara1 Çorlu Sifa Hospital, Departments of Cardiology1 and Cardiovascular Surgery2 Tekirdağ, Yüzüncü Yıl University, Medical Faculty, Department of Cardiology3, Van, Turkey We described interpolated bigeminy ventricular premature contractions due to cardiac compression by a large left pleural effusion during exercise test. A 68-year-old man was admitted to the hospital for further examination of chest oppression. His history included a rheumatoid arthritis for more than 20 years and multiple admissions to the hospital. He had been on indomethacin (75 mg/daily) in partial remission for more than 1 year. Laboratory findings of thoracentesis fluid revealed that the cause of pleural effusion was rheumatoid arthritis. He had no diabetes mellitus, thyrotoxicosis, myopericarditis, ischemic or valvular heart disease. Key words: Pleural effusion, ventricular premature contraction, exercise test. Eur J Gen Med 2006; 3(1): 29-31 INTRODUCTION ECG showed mild sinus tachycardia with QTc The seen of bigemine ventricular premature of 320 ms. Exercise test was terminated in the contractions (VPC) is important sign of 20th second of exercise because of arrhythmia. electrocardiogram (ECG) since ventricular The second beat in D1 lead, and each alternate fibrillation may begin in these patients. one following it, is a ventricular ectopic Although bigemine VPCs are occurred in premature beat (Figure 1). Arrhythmia in a patients with cardiac disease, it may develop form of premature ventricular contractions due to extracardiac diseases such as anemia (PVC) of bigeminy types continued for about or tiroid disorders. -
Valvular Heart Disease CLASS (STRENGTH) of RECOMMENDATION LEVEL (QUALITY) of EVIDENCE‡ CLASS 1 (STRONG) Benefit >>> Risk LEVEL A
Clinical Update ADAPTED FROM: 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease CLASS (STRENGTH) OF RECOMMENDATION LEVEL (QUALITY) OF EVIDENCE‡ CLASS 1 (STRONG) Benefit >>> Risk LEVEL A Suggested phrases for writing recommendations: • High-quality evidence‡ from more than 1 RCT • Is recommended • Meta-analyses of high-quality RCTs • Is indicated/useful/effective/beneficial • One or more RCTs corroborated by high-quality registry studies • Should be performed/administered/other Table 1. • Comparative-Effectiveness Phrases†: LEVEL B-R (Randomized) − Treatment/strategy A is recommended/indicated in preference to • Moderate-quality evidence‡ from 1 or more RCTs treatment B ACC/AHA • Meta-analyses of moderate-quality RCTs − Treatment A should be chosen over treatment B LEVEL B-NR (Nonrandomized) Applying Class of CLASS 2a (MODERATE) Benefit >> Risk • Moderate-quality evidence‡ from 1 or more well-designed, well- Suggested phrases for writing recommendations: executed nonrandomized studies, observational studies, or registry Recommendation Is reasonable • studies • Can be useful/effective/beneficial • Meta-analyses of such studies and Level of • Comparative-Effectiveness Phrases†: − Treatment/strategy A is probably recommended/indicated in preference to LEVEL C-LD (Limited Data) treatment B Evidence to − It is reasonable to choose treatment A over treatment B • Randomized or nonrandomized observational or registry studies with limitations of design or execution Clinical Strategies, CLASS 2b (Weak) Benefit ≥ Risk • Meta-analyses of such studies • Physiological or mechanistic studies in human subjects Suggested phrases for writing recommendations: Interventions, • May/might be reasonable LEVEL C-EO (Expert Opinion) • May/might be considered Treatments, or • Usefulness/effectiveness is unknown/unclear/uncertain or not well-established • Consensus of expert opinion based on clinical experience. -
AFA Australia Ectopic Heart FACT Sheet.Indd
Atrial Fibrillation Association Tel: 1800 050 267 or (02) 61084602 Info@atrial-fi brillation-au.org www.atrialfi brillation-au.org Australia Ectopic Heart Beats What are ectopic beats? not be possible to catch them on an ECG so a portable monitor may be required. The ECG Normal heart beats come from the pacemaker demonstrates the electrical activity of the of the heart known as the sinoatrial node normal heart beat, with ectopic beats having which is situated in the top right hand chamber a different appearance or timing. In patients (the right atrium). Sometimes beats can be with frequent symptoms a 24 hour ECG will fi red from elsewhere and these are known as sometimes be undertaken to clarify the pattern “ectopic beats”. The word “ectopic” just means and frequency of the ectopic beats and their “wrong place” – for example “ectopic pregnancy” relation to symptoms. means a pregnancy outside the womb. An ectopic beat is an early (“premature”) or Although in most individuals ectopic beats are “extra” beat which can come from either one not a cause for concern, they can occasionally Ectopic Heart Beats - Patient Information of the upper chambers of the heart (the atria) indicate underlying structural heart disease or one of the lower chambers (the ventricles). and in this scenario may be of greater signifi cance. Further cardiological assessment These beats occur before the normal beat may be advised. However, it should be of the heart can form. Thus there is more emphasised that in most individuals ectopics opportunity for them to occur when the heart do not indicate any problems with the heart. -
Profile for Estimating Risk of Heart Failure
ORIGINAL INVESTIGATION Profile for Estimating Risk of Heart Failure William B. Kannel, MD, MPH; Ralph B. D’Agostino, PhD; Halit Silbershatz, PhD; Albert J. Belanger, MS; Peter W. F. Wilson, MD; Daniel Levy, MD Context: We devised a risk appraisal function to assess pacity or chest x-ray film because these may not be readily the hazard of heart failure in persons who are predis- available in some clinical settings. posed by coronary disease, hypertension, or valvular heart disease. Results: Using the risk factors that make up the multi- variate risk formulation—derived from ordinary office Objective: To provide general practitioners and intern- procedures—the probability of developing heart failure ists with a cost-effective method to select people at high can be estimated and compared with the average risk for risk who are likely to have impaired left ventricular sys- persons of the same age and sex. Using this risk profile, tolic function and may therefore require further evalu- 60% of events in men and 73% in women occurred in ation and aggressive preventive measures. subjects in the top quintile of multivariate risk. Methods: The routinely measured risk factors used in Conclusions: Using this multivariate risk formula- constructing the heart failure profile include age, elec- tion, it is possible to identify high-risk candidates for trocardiographic left ventricular hypertrophy, cardio- heart failure who are likely to have a substantial yield megaly on chest x-ray film, heart rate, systolic blood pres- of positive findings when tested for objective evidence sure, vital capacity, diabetes mellitus, evidence of of presymptomatic left ventricular dysfunction.