A 19-year-old female with a 2-day history of involuntary fast jerk-like movements of the left upper and lower extremities presented at the emergency department. Patient had no other known comorbidities and family history was unremarkable. Anti-streptolysin O titer (ASO) and C-reactive protein (CRP) were all normal. Two-dimensional echocardiography (2D Echo) revealed thickened anterior mitral valve leaflet with prolapsed A2 scallop, mild mitral regurgitation, thickened right coronary cusp of aortic valve without restriction of motion, trivial aortic regurgitation, other findings were unremarkable. Patient was managed as a case of Sydenham’s chorea secondary to acute rheumatic fever, with valvular heart disease secondary. Patient was initially started on valproic acid 500mg tablet every 8 hours, benzathine penicillin 1.2M units intramuscular, and carvedilol 12.5mg/tablet twice a day. The patient was then shifted to haloperidol 5mg ¼ tablet twice a day, diphenhydramine 50mg intravenously coinciding with haloperidol doses due to visual side effects of valproic acid. This report highlights the importance of a high index of suspicion and complete history and physical examination in order to diagnose and manage movement disorders in a low-income setting.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Movement Disorders ; Diphenhydramine ; Aortic Valve Insufficiency ; Heart Valve Diseases ; C-reactive Protein

OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

Science ; Heart

BACKGROUND

Persistent left superior vena cava (PLSVC) is a rare but clinically relevant congenital vascular anomaly, occurring in 0.3% of the general population and up to 4.3% in those with congenital heart disease. It is usually asymptomatic and incidentally discovered during imaging, catheterization, or surgery.

CASE SUMMARY

We present the case of a 38-year-old hypertensive female who was evaluated for acute chest discomfort, palpitations and near-syncope. Transthoracic echocardiography revealed a dilated coronary sinus, prompting a contrast echocardiography study that demonstrated early opacification of the coronary sinus upon left arm injection confirming the diagnosis of PLSVC.

CONCLUSION

This case underscores the importance of recognizing coronary sinus dilatation as a potential marker of venous anomalies such as PLSVC. Contrast echocardiography with bilateral injections remains a practical, non-invasive tool in its diagnosis, with significant implications for future invasive procedures.

Human ; Vena Cava, Superior ; Population ; Heart Diseases ; Heart Defects, Congenital ; Echocardiography ; Catheterization

Suicide left ventricle describes the development of dynamic intraventricular gradients after aortic valve replacement due to acute hemodynamic changes that happen after relieving the obstruction leading to hemodynamic collapse. This is a rare complication in transcatheter aortic valve replacement and is underreported in surgical aortic valve replacement (SAVR). We present the case of a male patient who presented with suicide left ventricle after SAVR.

World Health Organization ; Transcatheter Aortic Valve Replacement ; Suicide ; Research Report ; Hemodynamics ; Heart Ventricles ; Aortic Valve

BACKGROUND

Perimyocarditis due to inflammation of the pericardium and myocardium results in myocellular damage. Myocarditis, or myocardial inflammation, occurs after cardiac injury. Gallbladder edema, in the absence of cholecystitis, may occur in numerous conditions including cardiac inflammation.

CASE PRESENTATION

A 28-year-old previously healthy female presented with chest pain, orthopnea, exertional dyspnea and a history of fever. She also reported intermittent right upper quadrant pain. Physical exam revealed a pericardial friction rub. Electrocardiogram (ECG) showed sinus rhythm with nonspecific ST-T changes; troponin I was elevated. Echocardiography demonstrated segmental wall motion abnormalities, pericardial thickening and preserved systolic function. Initially managed as acute coronary syndrome, she was later diagnosed with perimyocarditis. On the second hospital day, she developed recurrence of right upper quadrant abdominal pain. Abdominal ultrasound revealed gallbladder edema with pericholecystic fluid, but no stones. Liver enzymes were elevated. Acalculous cholecystitis was considered and cholecystostomy offered instead due to aspirin therapy. However, repeat imaging showed resolution of cardiac and gallbladder findings, and surgery was deferred. Cardiac MRI postdischarge was unremarkable.

CONCLUSION

Perimyocarditis may present with gallbladder edema mimicking acalculous cholecystitis, potentially leading to unnecessary surgical intervention. This case emphasizes the importance of considering cardiac etiologies in atypical abdominal presentations.

Human ; Female ; Adult: 25-44 Yrs Old ; Acalculous Cholecystitis ; Research Report ; Pericardium ; Myocardium ; Myocarditis ; Inflammation

BACKGROUND AND OBJECTIVE

Mothers play a significant role as primary caregivers for children with congenital heart disease (CHD) within the family. Given the complex health needs of children with CHD, coping strategies are needed to deal with the challenges associated with caring for their children with the condition. Coping mechanisms encompass fostering resilience, seeking support, and maintaining a positive outlook to navigate stress, uncertainty, and obstacles throughout their child's medical journey with CHD. The objective of this study is to explore the coping strategies employed by mothers of children diagnosed with CHD in a tertiary hospital in the Philippines.

METHODS

Employing a descriptive qualitative study design, data was gathered through key informant interviews utilizing a semi-structured topic guide, which aimed to explore the perspectives and experiences of mothers with children with CHDs. Ethical approval was obtained, and data collection occurred from January to March 2016. Interview transcripts were recorded, transcribed verbatim, and underwent content analysis. Themes derived from the analysis were then validated and confirmed by the study participants.

RESULTS

A total of 11 mothers voluntarily participated in the study. These participants expressed utilizing various coping strategies to manage their child's condition, including seeking assistance from both physicians and traditional healers, advocating for their children, receiving support from their family and friends, regulation of emotion, and prayer and faith in God.

CONCLUSION

This study sheds light on the coping mechanisms used by mothers in raising thier children with CHD, highlighting the value of spirituality and psychological support in their journey. Enhancing assistance for impacted families and advancing genetic counseling services are two benefits of incorporating these findings into healthcare practice.

Heart Defects, Congenital ; Coping Skills

OBJECTIVE: To observe the effects of Yisui Yangxin moxibustion (moxibustion for benefiting the marrow and nourishing the heart) in sequential trial on blood pressure (BP), perimenopausal symptoms, cardiovascular function and heart rate variability (HRV) in prehypertension in perimenopausal women. METHODS: The eligible female patients of prehypertension of perimenopausal period were collected according to the inclusion criteria. Based on the requirements of open two-way qualitative response sequential trial, the sample size was not set in advance, and the matched pair design was used for random division into a moxibustion group and a health education group. The patients of the two groups were treated in pairs, and the analysis was immediately performed after the end of treatment for each pair, and the sequential trial analysis (STA) was diagrammed. The health education group provided the health education for prehypertension to the patients according to 2018 Revised Chinese Hypertension Prevention and Treatment Guidelines. In the moxibustion group, beside the health education for prehypertension, the non-suppurative moxibustion was delivered at Baihui (GV20), Guanyuan (CV4) and bilateral Neiguan (PC6) and Zusanli (ST36), once every two days, 3 treatments per week and for 4 consecutive weeks. Before treatment, in 2 and 4 weeks of treatment, as well as in 1-month follow-up after treatment, BP was measured in each group, separately. Before treatment and in 4 weeks of treatment, the observation was performed in the score of the modified Kupperman scale, and Pittsburgh sleep quality index (PSQI) score, the indexes of cardiovascular function (stroke volume [SV], cardiac output per minute [CO], stroke index [SI], cardiac index [CI], left ventricular effective pumping force [VPE], left ventricular energy efficiency [EWK], arterial compliance [AC], left ventricular ejection resistance [VER], blood viscosity (N), and microcirculation half update rate [MHR]), and heart rate variability (HRV) indexes (low frequency [LF], high frequency [HF], LF/HF, standard deviation of NN interval [SDNN], root mean square of successive differences in adjacent NN intervals [RMSSD]). RESULTS: Based on sequential test line, when the trial was performed to the 17th pair, and the test line touched the upper limit U, meaning the results of the moxibustion group was superior to the health education group, thus, the trial stopped immediately. In 2 and 4 weeks of treatment and in follow-up, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower when compared with those before treatment in the moxibustion group (P<0.05); SBP at each time point and DBP in 2 and 4 weeks of treatment in the moxibustion group were lower than those of the health education group (P<0.05). After treatment, the score of the modified Kupperman scale was reduced when compared with that before treatment in the moxibustion group (P<0.05). The score of the modified Kupperman scale and PSQI in the moxibustion group were lower than those of the health education group after treatment (P<0.05). After treatment, SV, CO, SI, CI and EWK were increased in comparison with the indexes before treatment in the moxibustion group (P<0.05), and VER and N were dropped (P<0.05). After treatment, SV, CO, SI, CI and EWK in the moxibustion group were higher than those of the health education group (P<0.05), and VER and N were lower (P<0.05). After treatment, in the moxibustion group, LF, HF, SDNN and RMSSD were increased in comparison with those before treatment (P<0.05), and LF/HF was declined (P<0.05). In the health education group, after treatment, LF, HF, SDNN and RMSSD decreased when compared with those before treatment (P<0.05). After treatment, LF, HF, SDNN and RMSSD in the moxibustion group were higher than those of the health education group (P<0.05), and LF/HF was lower (P<0.05). The total effective rate was 94.1% (16/17) in the moxibustion group, higher than that (41.2%, 7/17) in the health education group (P<0.05). CONCLUSION Moxibustion can reduce SBP and DBP in prehypertension of perimenopausal women, alleviate perimenopausal symptoms, improve cardiac function and adjust the overall balance of cardiac autonomic nerves.
Humans ; Female ; Middle Aged ; Moxibustion ; Perimenopause ; Blood Pressure ; Prehypertension/prevention & control* ; Heart Rate ; Acupuncture Points ; Adult

OBJECTIVE: To compare the clinical efficacy of acupuncture with Neiguan (PC6)-to-Waiguan (TE5) and esmolol on hemodynamics during anesthesia induction and postoperative nausea and vomiting. METHODS: A total of 100 patients undergoing elective laparoscopic hernia repair or gynecological surgery under general anesthesia were randomly divided into an acupuncture group (50 cases, 3 cases were eliminated) and an esmolol group (50 cases, 2 cases were eliminated). In the acupuncture group, before anesthesia induction, patients were applied to acupuncture with Neiguan (PC6)-to-Waiguan (TE5), and the needles were retained for 15 min on the right side and 30 min on the left side. Patients in the esmolol group were intravenously injected with 20 mg esmolol hydrochloride injection 5 min before anesthesia induction. The systolic blood pressure (SBP) and heart rate (HR) of the two groups were recorded at 5 min after entering the operating room (T₀), before anesthesia induction (T₁), after anesthesia induction (T₂), before tracheal intubation (T₃) and 1 min after tracheal intubation (T₄). The visual analogue scale (VAS) scores of pain and the incidence of nausea and vomiting in the two groups were observed at the time of entering postanesthesia care unit (PACU) (T₅), leaving PACU (T₆), 6 h after operation (T₇) and 24 h after operation (T₈). The dosage of anesthesia-related drugs in the two groups was counted. RESULTS: The SBP and HR of the two groups at T₂, T₃ and T₄ were lower than those at T₁ (P<0.05). SBP and HR at T₃ in the acupuncture group were higher than those in the esmolol group (P<0.05). Compared with the esmolol group, in the acupuncture group, the VAS scores of pain at T₆ and T₇ were decreased (P<0.05), the incidence of nausea and vomiting at T₇ and T₈ and the nausea and vomiting visual analogue scale (NVAS) scores were decreased (P<0.05). Compared with the esmolol group, the dosage of propofol in the acupuncture group was decreased (P<0.05). CONCLUSION Acupuncture with Neiguan (PC6)-to-Waiguan (TE5) can relieve hemodynamic fluctuations during anesthesia induction, reduce postoperative pain and nausea and vomiting, and reduce the dosage of propofol. The curative effect is better than that of esmolol.
Humans ; Female ; Adult ; Middle Aged ; Acupuncture Points ; Male ; Hemodynamics ; Propanolamines/administration & dosage* ; Postoperative Nausea and Vomiting/drug therapy* ; Young Adult ; Heart Rate ; Aged ; Blood Pressure ; Acupuncture Therapy

OBJECTIVE: To observe the effects of moxibustion at "Feishu" (BL13) and "Xinshu" (BL15) on the circular RNA of exon 2-5 of the Pan3 gene (circPAN3), forkhead box O3 (FOXO3), and Bcl-2/adenovirus E1B19kDa-interacting protein 3 (BNIP3) in rats with chronic heart failure (CHF), and explore the potential mechanisms of moxibustion in alleviating myocardial fibrosis. METHODS: Ten rats of 60 male SPF-grade SD rats were randomly assigned into a normal group. The remaining rats underwent left anterior descending coronary artery (LAD) ligation to establish the CHF model. Forty successfully modeled rats were randomly divided into a model group, a moxibustion group, a rapamycin (RAPA) group, and a moxibustion+RAPA group, with 10 rats in each group. The moxibustion group received mild moxibustion at bilateral "Feishu" (BL13) and "Xinshu" (BL15), 30 min per session. The RAPA group received intraperitoneal injection of the autophagy activator RAPA (1 mg/kg). The moxibustion+RAPA group first received RAPA injection, followed by mild moxibustion at bilateral "Feishu" (BL13) and "Xinshu" (BL15). All interventions were administered once daily for 4 consecutive weeks. After the intervention, cardiac ultrasound was used to measure ejection fraction (EF) and left ventricular fractional shortening (FS). Serum placental growth factor (PLGF) level was determined by ELISA. Myocardial tissue morphology and collagen volume were assessed using hematoxylin-eosin (HE) staining and Masson's trichrome staining. The expression levels of circPAN3, FOXO3, and BNIP3 mRNA in myocardial tissue were detected by real-time PCR, while FOXO3 and BNIP3 protein expression levels were analyzed by Western blot. RESULTS: Compared with the normal group, the model group exhibited myocardial cell disorder, severe fibrosis, and increased collagen volume (P<0.01), along with significantly decreased EF, FS, and circPAN3 mRNA expression in myocardial tissue (P<0.01), and the serum PLGF level, as well as FOXO3 and BNIP3 mRNA and protein expression in myocardial tissue were increased (P<0.01). Compared with the model group, the moxibustion group showed reduced myocardial fibrosis, decreased collagen volume (P<0.01), increased EF, FS, and circPAN3 mRNA expression in myocardial tissue (P<0.01), and decreased serum PLGF level as well as FOXO3 and BNIP3 mRNA and protein expression in myocardial tissue (P<0.01). Compared with the model group, the RAPA group showed further deterioration in these parameters (P<0.01). Compared with the RAPA group, the moxibustion+RAPA group exhibited alleviation of myocardial fibrosis, reduced collagen volume (P<0.01), increased EF, FS, and circPAN3 mRNA expression in myocardial tissue (P<0.01), and decreased serum PLGF level as well as FOXO3 and BNIP3 mRNA and protein expression in myocardial tissue (P<0.01). CONCLUSION Moxibustion could alleviate myocardial fibrosis in CHF rats, possibly through upregulation of myocardial circPAN3 expression, downregulation of FOXO3 and BNIP3 expression, and inhibition of excessive myocardial autophagy.
Animals ; Moxibustion ; Heart Failure/metabolism* ; Male ; Rats ; Rats, Sprague-Dawley ; Myocardium/pathology* ; RNA, Circular/metabolism* ; Membrane Proteins/metabolism* ; Forkhead Box Protein O3/metabolism* ; Acupuncture Points ; Humans ; Fibrosis/genetics* ; Chronic Disease/therapy* ; Mitochondrial Proteins