DOCSLIB.ORG

Revisiting Transthyretin Related Cardiac Amyloidosis: Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Revisiting Transthyretin Related Cardiac Amyloidosis: Case Report Clinics and Practice 2018; volume 8:1054 Revisiting transthyretin related our hospital with worsening shortness of cardiac amyloidosis: breath (SOB) of 1-week duration. Her SOB Correspondence: Munish Sharma, Department was worse even on walking less than 50 of Internal Medicine, Easton Hospital, Easton, Case report and review meters on a flat surface. Her primary cardi- PA, USA. E-mail: [email protected] of literature ologist at a different health facility had Key words: Cardiac amyloidosis; endomy- diagnosed her with CHF a year prior to this ocardial biopsy; cardiac magnetic resonance Munish Sharma,1 Eduard Koman,2 presentation. She was compliant with her imaging; ECG findings in cardiac amyloido- Gary S. Ledley,2 Sung-Hae Cho2 home dose of furosemide 40 mg daily. She sis. was primarily treated with intravenous 1 Department of Internal Medicine, furosemide 40 mg daily and her home med- Conflict of interest: the authors declare no 2 Easton Hospital, Easton; Department of ications including atenolol 50 mg daily and conflict of interest. Medicine-Division of Cardiology, Drexel lisinopril 5 mg daily were continued. University College of Medicine- Patient did not have history of myocardial Received for publication: 16 December 2017. Revision received: 30 April 2018. Hahnemann University Hospital, infarction in the past and did not have prior Accepted for publication: 2 May 2018. Philadelphia, PA, USA exercise/nuclear stress test or cardiac catheterization. On examination, her blood This work is licensed under a Creative pressure was 110/70 mm Hg, heart rate was Commons Attribution NonCommercial 4.0 62 bpm and regular, respiratory rate was 12 License (CC BY-NC 4.0). Abstract per minute, temperature 98.6 F and SaO2 of more than 92% at room air. Her neck was ©Copyright M. Sharma et al., 2018 Licensee PAGEPress, Italy Amyloidosis is a complex group of dis- supple and cardiovascular examination Clinics and Practice 2018; 8:1054 orders that can involve many organs and revealed muffled heart sounds, normal doi:10.4081/cp.2018.1054 cause their dysfunction. Cardiac involve- S1S2 with no appreciable murmur. ment indicates worse prognosis and influ- Her ECG showed normal sinus rhythm, ences treatment strategies. Cardiac amyloi- ventricular rate of 64 bpm, left axis devia- only dosis is an under-diagnosed entity and high tion, low voltage QRS complexes with Q was detected with a special stain (Figure 4). index of clinical suspicion and careful inter- waves in inferior and antero-septal leads Urine protein electrophoresis and serum pretation of basic diagnostic tools such as (Figure 1). Her echocardiogram was signif- protein electrophoresis results were not sig- electrocardiogram and echocardiography is icant for moderate concentric left ventricu- nificant. Liquid chromatography tandem needed for early detection. Congestive heart lar hypertrophy (LVH), mild globaluse hypoki- mass spectrometry detected a peptide pro- failure due to restrictive pattern and/or con- nesis of left ventricle (LV), EF of 40-45%, file consistent with ATTR (transthyretin/ duction system abnormality, in absence of grade III diastolic dysfunction, trace mitral prealbumin)-type amyloid deposition. coronary artery disease should raise suspi- regurgitation (MR) and severe tricuspid Patient wished to follow up with her cion. We present a case of transthyretin regurgitation (TR). Pulmonary arterial sys- primary heart failure specialist .She was related cardiac amyloidosis and discuss the tolic pressure was 45-50 mm Hg and esti- discharged on her previous home regimen key clinical and diagnostic findings along mated right atrial (RA) pressure of 3 and new diagnosis of ATTR-type cardiac with review of existing literature regarding mmHg. Interventricular septum was thick- amyloidosis was conveyed to the primary its management and outcomes. ened and showed granular sparkling cardiologist. appearance (Figure 2). In contrast, her echocardiogram done on 10/2016 had shown an EF of 50-55%, grade I diastolic Introduction dysfunction with evidence of trace TR. Her Discussion left heart catheterization revealed no signif- Amyloidosis is a unique group of disor- icant coronary artery disease while right Majority of cardiac amyloidosis is ders caused by accumulation of insoluble heart catheterization showed; RA pressure caused by one of the two different types of protein fibers, known as amyloid fibrils in 12 mm hg, right ventricle pressure = 55/10 protein; light chains or transthyretin. Light the extracellular spaces of Non-commercialtissues and mmhg, PA pressure = 55/25 (mean of 30 chain (AL) amyloidosis occurs due to clon- organs. Involvement of different organs and mmhg), pulmonary capillary wedge pres- al proliferation of plasma cells in bone mar- tissues in amyloidosis is often responsible sure (PCWP) = 20 mmhg, Aortic pressure row producing large amount of light chains, for missed or delayed diagnosis, and amy- (Ao)=134/64 (mean=97) mm hg, left ven- which are mis-folded into beta-pleated loidosis remains a considerable clinical tricular end diastolic pressure (LVEDP) = sheets and get deposited in various tissues. challenge as it is implicated in 1/1000 death 15 mm hg, cardiac output = 4.83 L/min, car- AL amyloidosis is the most common type of in developed countries.1 Cardiac involve- diac index (CI) = 2.71 L/min/m2. A cardiac cardiac amyloidosis. About 2000 to 3000 ment can be primary, a part of systemic magnetic resonance imaging (MRI) showed new cases of AL amyloidosis occur each amyloidosis, or a result of chronic systemic global hypokinesis of the LV with diffuse year in the United States, two thirds of these diseases. myocardial delayed enhancement and patients are male, and almost all of them are hypertrophy of interventricular septum over the age of 50. Transthyretin-related without any evidence of perfusion defect. (TTR) amyloidosis is derived from Case Report This constellation of symptoms was consis- transthyretin, which is produced by the tent with cardiac amyloidosis (Figure 3). liver. There are 2 types of TTR-related amy- On 3/2017, a 72-year-old female with Right ventricular endomyocardial biopsy loidosis: a genetic form known as heredi- history of CHF with preserved ejection obtained during right heart catheterization tary transthyretin-related amyloidosis fraction (EF) of 50-55 %, hypertension and showed deposits of amorphous material (ATTR) and a nonhereditary form known as Rheumatoid Arthritis (RA) was admitted to consistent with amyloid. No stainable iron wild-type ATTR amyloidosis. In ATTR, [Clinics and Practice 2018; 8:1054] [page 59] Case Report genetic mutation is present from the birth bone scintigraphy can be used reliable diag- ally seen in the late stages. EF is preserved but the abnormal deposition into tissues nosis without the need for histology espe- until end stage but strain is impaired very starts from age 30 to 60 years. It is a slowly cially in patients without monoclonal gam- early. In the late stages of the disease, a sys- progressive disease that usually affects the mopathy.9 Low voltage in the limb leads is tolic dysfunction of the left ventricle is heart of men, almost always in the sixth or one of the most common ECG manifesta- seen. Impairment of left ventricle diastolic seventh decade of life.2 tions, mainly in AL cardiac amyloidosis function is the first functional sign of car- Cardiac amyloidosis most commonly (50% cases) compared to lesser frequency diac involvement. At first, a reduced E manifests as heart failure. Dyspnea and in familial disease (25%) and senile cardiac wave with an increased deceleration time signs of right heart failure including periph- amyloidosis (40%).10 and a reduced early diastolic velocity of the eral edema, hepatomegaly and ascites are Echocardiographic findings generally left ventricular wall (E’) are noted. In the common presentation. Pulmonary edema is appear in the latter stages of the disease. advanced stage of the disease, an overt rare, although the left sided heart pressures Typically, granular appearance of the restrictive pattern can be found with are elevated. Rarely, due to disproportionate myocardium is seen in conventional 2-D increased E wave and decreased A wave, amyloid deposition in the inter-ventricular echocardiography. This finding is nonspe- shortened mitral inflow deceleration time septum, cardiac amyloidosis may be misdi- cific and is highly dependent on the and severely reduced E’ wave velocity.12 11 agnosed as hypertrophic cardiomyopathy.3 machine settings. A normally sized ventri- With the advent of new echocardiographic Presence of purpura, leg or jaw claudication cle with increased wall thickness in both techniques related to deformation imaging, or angina suggests involvement of small ventricles is generally seen. Bi-atrial dila- promising results have been seen in diag- 13 vessel. Typically, small and intramyocardial tion and inter-atrial septal thickening are nosing subclinical cases. vessel involvement gives rise to normal typically seen in the advanced stages. Cardiovascular magnetic resonance coronary angiography. Syncope or pre-syn- Ventricular dilation is also a feature gener- (CMR) is more sensitive than echocardiog- cope are common and are associated with a high mortality in the 3 months following the event.4 Ventricular arrhythmias have not been found to be frequently associated with only syncopal episodes in cardiac amyloidosis. It is more likely multifactorial; postural or exertional hypotension due to excessive diuresis and autonomic neuropathy are the
Load more

Recommended publications
  • View Pdf Copy of Original Document
    Phenotype definition for the Vanderbilt Genome-Electronic Records project Identifying genetics determinants of normal QRS duration (QRSd) Patient population: • Patients with DNA whose first electrocardiogram (ECG) is designated as “normal” and lacking an exclusion criteria. • For this study, case and control are drawn from the same population and analyzed via continuous trait analysis. The only difference will be the QRSd. Hypothetical timeline for a single patient: Notes: • The study ECG is the first normal ECG. • The “Mildly abnormal” ECG cannot be abnormal by presence of heart disease. It can have abnormal rate, be recorded in the presence of Na-channel blocking meds, etc. For instance, a HR >100 is OK but not a bundle branch block. • Y duration = from first entry in the electronic medical record (EMR) until one month following normal ECG • Z duration = most recent clinic visit or problem list (if present) to one week following the normal ECG. Labs values, though, must be +/- 48h from the ECG time Criteria to be included in the analysis: Criteria Source/Method “Normal” ECG must be: • QRSd between 65-120ms ECG calculations • ECG designed as “NORMAL” ECG classification • Heart Rate between 50-100 ECG calculations • ECG Impression must not contain Natural Language Processing (NLP) on evidence of heart disease concepts (see ECG impression. Will exclude all but list below) negated terms (e.g., exclude those with possible, probable, or asserted bundle branch blocks). Should also exclude normalization negations like “LBBB no longer present.”
    [Show full text]
  • Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: the First Report from Korea
    Journal of Clinical Medicine Article Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: The First Report from Korea Ah Young Kim 1,2 , Jo Won Jung 1,2, Se Yong Jung 1,2 , Jae Il Shin 1,2 , Lucy Youngmin Eun 1,2 , Nam Kyun Kim 3 and Jae Young Choi 1,2,* 1 Division of Pediatric Cardiology, Center for Congenital Heart Disease, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; [email protected] (A.Y.K.); [email protected] (J.W.J.); [email protected] (S.Y.J.); [email protected] (J.I.S.); [email protected] (L.Y.E.) 2 Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea 3 Department of Pediatrics, Emory University, Atlanta, GA 30322, USA; [email protected] * Correspondence: [email protected] Received: 25 July 2020; Accepted: 24 August 2020; Published: 26 August 2020 Abstract: Percutaneous pulmonary valve implantation (PPVI) is used to treat pulmonary stenosis (PS) or pulmonary regurgitation (PR). We described our experience with PPVI, specifically valve-in-valve transcatheter pulmonary valve replacement using the Melody valve and novel self-expandable systems using the Pulsta valve. We reviewed data from 42 patients undergoing PPVI. Twenty-nine patients had Melody valves in mostly bioprosthetic valves, valved conduits, and homografts in the pulmonary position. Following Melody valve implantation, the peak right ventricle-to-pulmonary artery gradient decreased from 51.3 11.5 to 16.7 3.3 mmHg and right ventricular systolic pressure ± ± fell from 70.0 16.8 to 41.3 17.8 mmHg.
    [Show full text]
  • 2010 Common Diagnosis Codes: Cardiology
    22010010 CommonCommon DiagnoDiagnossisis CCodeodess:: CardiologyCardiology Code Description Code Description Code Description 038.9 Unspec septicemia 405.91 Unspec renovascular hypertension 425.8 Cardiomyopathy diseases classifi ed elsewhere 244.9 Unspec acquired hypothyroidism 410 AMI anterolateral wall episode care unspec 425.9 Secondary cardiomyopathy unspec 250 Diabetes mellitus w/o comp Type II not uncontrolled 410.01 initial episode care 426.0 Atrioventricular block complete 250.01 Diabetes mellitus w/o complication Type I not 410.02 AMI anterolateral wall subsequent episode care 426.10 Atrioventricular block unspec uncontrolled 410.1 AMI other anterial wall episode care unspec 426.11 First degree atrioventricular block 250.02 Diabetes mellitus w/o comp Type II uncontrolled 410.11 initial episode care 426.12 Mobitz (type) ii atrioventricular block 250.8 Type II diabetes mellitus w/ other spec 410.12 subsequent episode care 426.13 Other second degree atrioventricular block manifestations, not uncontrolled 410.21 AMI inferolarteral wall initial episode care 426.2 Left bundle branch hemiblock 250.9 Type II diabetes mellitus w/unspec complication, not 410.31 AMI inferoposterior wall initial episode of care 426.3 Other left bundle branch block uncontrolled 410.4 AMI other inferior wall episode care unspec 426.4 Right bundle branch block 272 Pure hypercholesterolemia 410.41 initial episode care 426.50 Bunble branch block unspec 272.1 Pure hyperglyceridemia 410.42 AMI other inferior wall subsequent episode care 426.52 Right bundle branch
    [Show full text]
  • Vena Cava Backflow and Right Ventricular Stiffness in Pulmonary Arterial Hypertension
    Early View Original article Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension J. Tim Marcus, Berend E. Westerhof, Joanne A. Groeneveldt, Harm Jan Bogaard, Frances S. de Man, Anton Vonk Noordegraaf Please cite this article as: Marcus JT, Westerhof BE, Groeneveldt JA, et al. Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension. Eur Respir J 2019; in press (https://doi.org/10.1183/13993003.00625-2019). This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Copyright ©ERS 2019 Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension J. Tim Marcus1, Berend E. Westerhof2,3, Joanne A. Groeneveldt2, Harm Jan Bogaard2, Frances S. de Man2 and Anton Vonk Noordegraaf2 Affiliations: 1Amsterdam UMC, Vrije Universiteit Amsterdam, Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; 2Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; 3Amsterdam UMC, University of Amsterdam, Medical Biology, Section of Systems Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands. Correspondence: Dr. J.T. Marcus Amsterdam UMC, Vrije Universiteit Amsterdam, Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, Amsterdam Netherlands phone: +31 20 4440179 e-mail: [email protected] Abstract Vena cava (VC) backflow is a well-recognized clinical hallmark of right ventricular (RV) failure in pulmonary arterial hypertension (PAH).
    [Show full text]
  • Primary Prevention of Pulmonary Heart Disease
    Heart disease resources Primary prevention of pulmonary vented or diagnosed, and adequately treated, heart disease it must be recognized as a specific form of both acute and chronic heart disease. Such PULMONARY HEART DISEASE STUDY GROUP: recognition can be facilitated by the accep- Chairman: ROY H. BEHNKE, M.D. tance of a single definition of the disease Members: S. GILBERT BLOUNT, M.D.; entity. Pulmonary heart disease, cor pulmo- J. DAVID BRISTOW, M.D.; VIRGINIA CARRIERI, R.N.; JOHN A. PIERCE, M.D.; nale, is here defined as: Alteration in structure ARTHUR SASAHARA, M.D.; or function of the right ventricle resulting ALFRED SOFFER, M.D. from disease affecting the structure or func- Consultant: RICHARD GREENSPAN, M.D. tion of the lung or its vasculature, except when Introduction this alteration results from disease of the left Pulmonary heart disease, cor pulmonale, is side of the heart or congenital heart disease. a major form of heart disease yet there is reasonable evidence that it can be prevented. Incidence and prevalence Support for this contention rests in the fact Effective programs of prevention are facili- that the causative or precedent pulmonary tated by an accurate assessment of the scope diseases are in large part preventable. Primary and magnitude of the health problem. Chronic prevention of the related pulmonary diseases obstructive lung disease (bronchitis and/or is thus the initial and basic step in the pre- emphysema) is by far the most important of vention of cor pulmonale. Such an under- the respiratory diseases associated with pul- taking is a major task. It can only be achieved monary heart disease.
    [Show full text]
  • ICD-10-CM TRAINING May 2013
    ICD-10-CM TRAINING May 2013 Circulatory System The Ear Linda Dawson, RHIT, AHIMA Approved ICD-10 Trainer Diseases of the circulatory system I00-I02 Acute rheumatic fever I05-I09 Chronic rheumatic heart disease I10-I15 Hypertensive diseases I20-I25 Ischemic heart disease I26-I28 Pulmonary heart disease and diseases of the pulmonary circulation I30-I52 Other forms of heart disease I60-I69 Cerebrovascular disease I70-I79 Diseases of the arteries, arterioles and capillaries I80-I89 Diseases of veins, lymphatic vessels and lymph nodes, NEC I95-I99 Other and unspecified disorders of the circulatory system The Heart Here is a short video clip on the heart http://www.rightdiagnosis.com/animations/how-the-heart- works.htm Hypertension types changed Deletion of the codes: benign, malignant and unspecified. Hypertension table is no longer necessary. Essential (primary) hypertension I10 Includes: High blood pressure Hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic) Hypertension with Heart Disease: I50.0 or I51.4-I51.9 Assigned to a code from Ill when a causal relationship is stated or implied as in “Hypertensive Heart Disease.” ***Use an additional code from I50.- Heart failure in those patients with heart failure. Hypertensive Chronic Kidney Disease - Code I12 when both hypertension and a condition classifiable to N18.- (Chronic kidney disease) are present. Hypertensive Heart and Chronic Kidney Disease – I13 Assign combination codes when both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis. Assign additional code for Heart failure if present. I50. Hypertension Uncontrolled – May be untreated hypertension or hypertension not responding to current therapeutic regimen. Controlled – This diagnostic statement usually refers to an existing state of hypertension under control by therapy.
    [Show full text]
  • ICD-10-CM Coding Workbook for Cardiology
    ICD-10-CM Coding Workbook for Cardiology Specialty coding guidance for ICD-10-CM 2016 Contents Introduction .............................................................................................................................................. 1 Overview of ICD-10 ..............................................................................................................................................................................................1 Getting Ready for ICD-10 ................................................................................................................................................................................... 2 Using This ICD-10-CM Workbook..................................................................................................................................................................... 3 Workbook Guidelines ..........................................................................................................................................................................................4 Summary ................................................................................................................................................................................................................4 Case Studies and Questions ...................................................................................................................... 5 Case Study #1—Pulmonary Embolism ...........................................................................................................................................................5
    [Show full text]
  • Supplemental Information
    ARTICLE Supplemental Information SUPPLEMENTAL FIGURE 2 Definition of infection events. Infection events were determined for each individual beginning 7 days after the start of PPI therapy (E0) and ending 1 year after PPI start. Billing codes for all RTIs and GTIs were obtained from EHR data. Infection events (E1,E2,E3, etc) were required to be separated by at least 14 days to avoid overcounting of multiple visits for single-infection events. PEDIATRICS Volume 144, Number 6, December 2019 1 SUPPLEMENTAL FIGURE 3 Multivariable analyses of RTI events (top) and GTI events (bottom) in CYP2C19 NMs versus RM/UMs. Shown are the ORs (diamonds) and the 95% CIs (horizontal lines) for each of the variables included in the ordinal regression model for association to infection events in the 670 children treated with PPIs. ORs are for CYP2C19 phenotype (NM versus RM/UM), age (each additional month), sex (male versus female), and dose (each additional mg/kg per day) and 7 additional dichotomous variables (presence of comorbidity, congenital heart disease, chronic lung disease, gastrointestinal motility disorder, gastrointestinal structural pathology, chronic diarrhea, and prematurity, all yes versus no). Point estimates for the ORs and 95% CIs are listed to the right of each plot. 2 ARTICLE SUPPLEMENTAL TABLE 3 ICD Codes Used To Define Respiratory and Gastrointestinal Infection Events ICD Code ICD 9 ICD 10 Frequency, %a RTI Diagnosis Nasopharyngitis 460* J00* 0.1 Acute sinusitis 461* J01* 0.2 Viral pharyngitis 462* J02.9 0.6 Acute tonsillitis 463* J03.90
    [Show full text]
  • Diseases of the Circulatory System (I00-I99) ICD-10-CM
    Diseases of the Circulatory System (I00-I99) ICD-10-CM Coverage provided by Amerigroup Inc. This publication contains proprietary information. This material is for informational purposes only. Reference the Centers for Medicare and Medicaid Services (CMS) for more information on Risk Adjustment and the CMS-HCC Model. Redistribution or other use is strictly forbidden This publication is for informational purposes only and is not guaranteed to be without defect. Please reference the current version(s) of the ICD-10-CM codebook, CMS-HCC Risk Adjustment Model, and AHA Coding Clinic for complete code sets and official coding guidance. AGPCARE-0073-19 62678MUPENABS 09/15/16 Chapter 9 (I00–I99): circulatory system Ischemic heart diseases (I20-I25) Coronary artery disease (CAD) and angina: Hypertensive diseases (I10-I16) ICD-10-CM establishes the code selection by type of The hypertension codes extend from I10 to I16; there is vessel or graft: not an I14 category. CAD of a native coronary artery appears in Includes various hypertensive diseases, such as subcategory I25.1. The additional characters in hypertensive heart disease, hypertension (HTN) this code denote the presence, or absence, of with acute renal failure and HTN with chronic renal angina pectoris. By creating a combination code, failure.* it eliminates the argument about which diagnosis For a patient with HTN and chronic renal disease, should be considered the principal diagnosis. the primary code should be from category I12, The default code is I25.10 for a native coronary hypertensive chronic kidney disease (CKD), followed artery without angina pectoris. Code I25.11 by a secondary code from category N18 to report corresponds to atherosclerotic heart disease of the stage of CKD.
    [Show full text]
  • Arrhythmia and Tachycardia in Pulmonary Heart Disease*
    Br Heart J: first published as 10.1136/hrt.31.4.491 on 1 July 1969. Downloaded from Brit. Heart J., 1969, 31, 491. Arrhythmia and Tachycardia in Pulmonary Heart Disease* A. J. THOMAS AND P. VALABHJI From the Department of Medicine, Llandough Hospital (The United Cardiff Hospitals), Penarth, Glamorgan It was thought that arrhythmias and tachycardias of significant coronary artery disease which had other than sinus tachycardia were uncommon in not been recognized clinically-all in the bronchitis pulmonary disease. It is clear from intensive study group. of pulmonary disease and particularly pulmonary In 55 of the patients an acute chest infection had heart disease that atrial arrhythmias and tachycar- been the reason for admission, and others were dias are more common than previously thought found to have persisting infection when in hospital. (Corazza and Pastor, 1958; Suppa, Martini, and Not one patient was admitted to hospital because Gazzi, 1967). It is generally agreed that atrial of the tachycardia or arrhythmia alone. In 76 of fibrillation is rare in pulmonary heart disease, and the patients there was severely reduced ventilatory that ventricular disturbances are less common than capacity, FEV1.0 below one litre and FEV1.0: FVC atrial disturbances. To study further the types and ratio below 50 per cent. Fourteen had FEV1.0 possible explanations of arrhythmias and tachy- between 1.0 and 1-4 litre, 5 had FEV1.0 1-5-1-9 cardias in chronic pulmonary disease we have litre, and in 7 it was not recorded. The length of http://heart.bmj.com/ looked at the findings in 102 cases with important history was hard to establish, but in all except 15 disorders of rhythm and rate.
    [Show full text]
  • IN the Cases of Primary Pulmonary Hypertension (PPH)
    Arrhythmias in Primary Pulmonary Hypertension Nariaki KANEMOTO,M.D. and Hiroshi SASAMOTO,M.D. SUMMARY Through the examination of 171 electrocardiograms (ECG) of 101 patients with primary pulmonary hypertension (PPH), the following con- clusions were obtained. Arrhythmias were found in 27 (26.7%) of the 101 patients. Among the surviving cases, arrhythmias were found in 8 (17.8%) out of 45 pa- tients, but among the deceased cases, the figure was higher, 19 (33.9%) out of 56. There were instances of more than one kind of arrhythmias in the same patient and a total of 34 types of arrhythmias were noted. The main types of arrhythmias were sinus tachycardia (13 cases), sinus bradycardia (6 cases), and first degree A-V block (5 cases), which ac- counted for 70% of the total. Sinus tachycardia was observed in only 2 of the survivors but in 11 of the deceased cases, which showed a sig- nificant difference (p<0.05). First degree A-V block were all induced by digitalis. Wenckebach type of second degree A-V block was noted in only 1 case and it was also induced by digitalis. Since severe attacks of ventricular arrhythmias were very rare in these cases with PPH, it is difficult to consider the Adams-Stokes syndrome as the cause of syncopal attacks or sudden death. However, it is necessary to further investigate nodal functions by means of continuous ECG monitoring, the overdrive suppression test and His bundle ECGs. Additional Indexing Words: Syncopal attacks Adams-Stokes syndrome Major supraventricular arrhythmias Ventricular arrhythmias Sudden death N the cases of primary pulmonary hypertension (PPH), the major subjec- I tive symptoms are palpitation, dyspnea, and syncope, and there have also been many cases of sudden death.1) Since there is a possibility that these symptoms occur because of electrical failure, electrocardiographic examina- tions should be done.
    [Show full text]
  • Adult Cardiac Surgery ICD9 to ICD10 Crosswalks ICD-9 Code
    Adult Cardiac Surgery ICD9 to ICD10 Crosswalks ICD-9 Code ICD-9 Description ICD-10 Code ICD-10 Description 164.1 Malignant neoplasm of heart C38.0 Malignant neoplasm of heart 164.1 Malignant neoplasm of heart C45.2 Mesothelioma of pericardium 198.89 Secondary malignant neoplasm of other C79.89 Secondary malignant neoplasm of other specified specified sites sites 198.89 Secondary malignant neoplasm of other C79.9 Secondary malignant neoplasm of unspecified site specified sites 212.7 Benign neoplasm of heart D15.1 Benign neoplasm of heart 305.1 Tobacco use disorder F17.200 Nicotine dependence, unspecified, uncomplicated 305.1 Tobacco use disorder F17.201 Nicotine dependence, unspecified, in remission 358.00 Myasthenia gravis without (acute) G70.00 Myasthenia gravis without (acute) exacerbation exacerbation 391.0 Acute rheumatic pericarditis I01.0 Acute rheumatic pericarditis 391.1 Acute rheumatic endocarditis I01.1 Acute rheumatic endocarditis 391.2 Acute rheumatic myocarditis I01.2 Acute rheumatic myocarditis 391.8 Other acute rheumatic heart disease I01.8 Other acute rheumatic heart disease 391.9 Acute rheumatic heart disease, unspecified I01.9 Acute rheumatic heart disease, unspecified 393 Chronic rheumatic pericarditis I09.2 Chronic rheumatic pericarditis 394.0 Mitral stenosis I05.0 Rheumatic mitral stenosis 394.1 Rheumatic mitral insufficiency I05.1 Rheumatic mitral insufficiency 394.2 Mitral stenosis with insufficiency I05.2 Rheumatic mitral stenosis with insufficiency 394.9 Other and unspecified mitral valve diseases I05.8 Other
    [Show full text]