Graves disease (GD) can lead to complications such as cardiac arrhythmia and heart failure. Although dilated cardiomyopathy (DCMP) has been occasionally reported in adults with GD, it is rare in children. We present the case of a 32-month-old boy with DCMP due to GD. He presented with irritability, vomiting, and diarrhea. He also had a history of weight loss over the past few months. On physical examination, he had tachycardia without fever, a mild diffuse goiter, and hepatomegaly. The chest radiograph showed cardiomegaly with pulmonary edema, while the echocardiography revealed a dilated left ventricle with an ejection fraction (EF) of 28%. The thyroid function test (TFT) showed elevated serum T3 and decreased thyroid stimulating hormone (TSH) levels. The TSH receptor autoantibody titer was elevated. He was diagnosed with DCMP with GD; treatment with methylprednisolone, diuretics, inotropics, and methimazole was initiated. The EF improved after the TFT normalized. At follow-up several months later, although the TFT results again showed evidence of hyperthyroidism, his EF had not deteriorated. His cardiac function continues to remain normal 1.5 months after treatment was started, although he still has elevated T3 and high TSH receptor antibody titer levels due to poor compliance with drug therapy. To summarize, we report a young child with GD-induced DCMP who recovered completely with medical therapy and, even though the hyperthyroidism recurred several months later, there was no relapse of the DCMP.
Adult ; Arrhythmias, Cardiac ; Cardiomegaly ; Cardiomyopathy, Dilated* ; Child* ; Child, Preschool ; Compliance ; Deoxycytidine Monophosphate ; Diarrhea ; Diuretics ; Drug Therapy ; Echocardiography ; Fever ; Follow-Up Studies ; Goiter ; Graves Disease* ; Heart Failure ; Heart Ventricles ; Hepatomegaly ; Humans ; Hyperthyroidism ; Male ; Methimazole ; Methylprednisolone ; Physical Examination ; Pulmonary Edema ; Radiography, Thoracic ; Receptors, Thyrotropin ; Recurrence ; Tachycardia ; Thyroid Function Tests ; Thyrotropin ; Vomiting ; Weight Loss

Graves disease (GD) can lead to complications such as cardiac arrhythmia and heart failure. Although dilated cardiomyopathy (DCMP) has been occasionally reported in adults with GD, it is rare in children. We present the case of a 32-month-old boy with DCMP due to GD. He presented with irritability, vomiting, and diarrhea. He also had a history of weight loss over the past few months. On physical examination, he had tachycardia without fever, a mild diffuse goiter, and hepatomegaly. The chest radiograph showed cardiomegaly with pulmonary edema, while the echocardiography revealed a dilated left ventricle with an ejection fraction (EF) of 28%. The thyroid function test (TFT) showed elevated serum T3 and decreased thyroid stimulating hormone (TSH) levels. The TSH receptor autoantibody titer was elevated. He was diagnosed with DCMP with GD; treatment with methylprednisolone, diuretics, inotropics, and methimazole was initiated. The EF improved after the TFT normalized. At follow-up several months later, although the TFT results again showed evidence of hyperthyroidism, his EF had not deteriorated. His cardiac function continues to remain normal 1.5 months after treatment was started, although he still has elevated T3 and high TSH receptor antibody titer levels due to poor compliance with drug therapy. To summarize, we report a young child with GD-induced DCMP who recovered completely with medical therapy and, even though the hyperthyroidism recurred several months later, there was no relapse of the DCMP.
Adult ; Arrhythmias, Cardiac ; Cardiomegaly ; Cardiomyopathy, Dilated* ; Child* ; Child, Preschool ; Compliance ; Deoxycytidine Monophosphate ; Diarrhea ; Diuretics ; Drug Therapy ; Echocardiography ; Fever ; Follow-Up Studies ; Goiter ; Graves Disease* ; Heart Failure ; Heart Ventricles ; Hepatomegaly ; Humans ; Hyperthyroidism ; Male ; Methimazole ; Methylprednisolone ; Physical Examination ; Pulmonary Edema ; Radiography, Thoracic ; Receptors, Thyrotropin ; Recurrence ; Tachycardia ; Thyroid Function Tests ; Thyrotropin ; Vomiting ; Weight Loss

OBJECTIVE: We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management. MATERIALS AND METHODS: In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores. RESULTS: The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction. CONCLUSION: Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*adverse effects/therapeutic use ; Ascites/pathology/radiography ; Benzamides/*adverse effects/therapeutic use ; Echocardiography/methods ; Edema/pathology/radiography ; Female ; Gastrointestinal Stromal Tumors/drug therapy/pathology/*radiography ; Gastrointestinal Tract/pathology/*radiography ; Heart Failure/radiography ; Humans ; Male ; Middle Aged ; Molecular Targeted Therapy/*adverse effects ; Pericardial Effusion/pathology/radiography ; Peritoneal Neoplasms/diagnosis/radiography/secondary ; Piperazines/*adverse effects/therapeutic use ; Pleural Effusion/pathology/radiography ; Pyrimidines/*adverse effects/therapeutic use ; Radiology ; Retrospective Studies ; Tomography, X-Ray Computed

We report the case of a patient with fulminant myocarditis caused by influenza A virus, who presented with acute-onset heart failure and cardiogenic shock and was treated successfully with single dose of intravenous peramivir and with pharmacologic hemodynamic support. A 45-year-old Korean woman presented to our emergency department (ED) with shortness of breath and an episode of seizure that developed abruptly 5 hours before she arrived in the ED. She had a history of recurrent epileptic seizure 25 years ago, but denied other specific medical illnesses. In the ED, she was hypoxemic (arterial partial pressure of oxygen, 59.8 mmHg on room air) and chest radiography revealed bilateral alveolar infiltrates. A rapid antigen test for influenza A virus was positive, and she was administered a single dose of peramivir (300 mg) intravenously. Five hours later, the patient's dyspnea had worsened and she was hypotensive (blood pressure, 86/53 mmHg), requiring norepinephrine infusion. Further evaluation disclosed an increased cardiac troponin I level of 1.36 ng/mL and a depressed left ventricular ejection fraction of 30%. Under the diagnosis of influenza A-associated myocarditis and cardiogenic shock, she was managed with continuous critical care in the intensive care unit. On day 3, the patient's dyspnea began to resolve and her ventricular function returned to normal. Real-time polymerase chain reaction assays for influenza viruses in serial nasopharyngeal aspirates were positive for influenza A (hH3N2) with a threshold cycle value of 27.39 on day 2, but these became negative by day 4. The patient recovered and was discharged on day 9 after admission. In conclusion, this case indicates that intravenous peramivir might be an effective antiviral agent for the treatment of severe influenza A virus infection.
Critical Care ; Diagnosis ; Dyspnea ; Emergency Service, Hospital ; Epilepsy ; Female ; Heart Failure ; Hemodynamics ; Humans ; Influenza A virus ; Influenza, Human* ; Intensive Care Units ; Middle Aged ; Myocarditis* ; Norepinephrine ; Orthomyxoviridae ; Oxygen ; Partial Pressure ; Radiography ; Real-Time Polymerase Chain Reaction ; Seizures ; Shock, Cardiogenic ; Stroke Volume ; Thorax ; Troponin I ; Ventricular Function

No abstract available.
Acute Disease ; Adult ; Arteriovenous Fistula/diagnosis/*etiology/surgery ; Brachiocephalic Trunk/*injuries/radiography/surgery/ultrasonography ; Brachiocephalic Veins/*injuries/radiography/surgery/ultrasonography ; Dislocations/*surgery ; Echocardiography, Doppler, Color ; Female ; Heart Failure/diagnosis/*etiology ; Humans ; *Iatrogenic Disease ; Orthopedic Procedures/*adverse effects ; Reoperation ; Sternoclavicular Joint/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular System Injuries/diagnosis/*etiology/surgery

Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
Cardiomyopathies/diagnosis/radiography ; Cardiotonic Agents/therapeutic use ; Chest Pain/complications/diagnosis/radiography ; Coronary Artery Bypass ; Coronary Artery Disease/*diagnosis/drug therapy/radiography ; Dobutamine/therapeutic use ; Echocardiography ; Heart Defects, Congenital/diagnosis/radiography ; Heart Failure/diagnosis/ultrasonography ; Humans ; *Magnetic Resonance Imaging ; Mucocutaneous Lymph Node Syndrome/complications/diagnosis ; Percutaneous Coronary Intervention ; Prognosis ; Risk Assessment ; Ventricular Function, Left/physiology

Percutaneous catheter-based therapy has recently been introduced to decrease blood pressure by ablation of efferent and afferent sympathetic renal nerves. The patient described here had a seven-year history of hypertension and presented with poorly controlled blood pressure despite antihypertensive therapy with four different drugs. A 44-yr-old man underwent percutaneous renal denervation under local anesthesia using an ablation catheter. After six months of follow-up his blood pressure had dropped 49/37 mmHg with a decrease in 24-hr ambulatory BP of 20/18 mmHg. Renal Doppler ultrasound showed no significant stenosis in either renal artery. This is the first case of successful percutaneous renal denervation, which has recently become available in Korea.
Adult ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Heart Failure/complications ; Humans ; Hypertension/complications/*surgery ; Kidney/ultrasonography ; Male ; Renal Artery/radiography ; Republic of Korea ; Sympathectomy

OBJECTIVETo review the updated research progress about the application of echocardiography in resynchronization treatment of chronic heart failure patients.

DATA SOURCESThe data used in this review were from PubMed, published in English and using the key terms "heart failure", "echocardiography" and "cardiac resynchronization therapy".

STUDY SELECTIONRelevant articles were reviewed and selected to address the stated purpose.

RESULTSIncreasing numbers of studies have suggested the importance of echocardiography in resynchronization treatment of chronic heart failure patients. Echocardiography can evaluate atrioventricular, inter- and intra-ventricular mechanical dyssynchrony before cardiac resynchronization therapy (CRT), as a guidance to assess the optimal left ventricular (LV) pacing location, optimize the atrioventricular and interventricular delays and predict response to CRT.

CONCLUSIONSEchocardiography is both non invasive and easily repeatable, and plays a crucial role in appraisal of heart synchronism, instruction of actuator placement, optimization of the device procedure, and prediction of the response to CRT.

Cardiac Resynchronization Therapy ; methods ; Echocardiography ; methods ; Heart Failure ; diagnostic imaging ; therapy ; Humans ; Radiography

BACKGROUNDChronic heart failure (CHF) had been characterized as an activated sympathetic system leading to the alteration of adrenergic receptor (AR) levels in the heart. Thus far, not much research has been done with regard to traditional Chinese medical treatment for CHF. We investigated the effect of Shexiangbaoxin pills (SXBXP) on the function of the heart and the expression of a(1)-AR and b-AR subtypes in the messenger RNA (mRNA) levels and protein levels of non-infarction left ventricular tissue from rats with CHF induced by myocardial infarction.

METHODSModels of CHF were established by left anterior descending coronary artery ligature. Fifty-four Wistar rats were randomly divided into five groups: normal control group (group A), sham operation group (group B), CHF model group (group C), positive medicine control group (group D), and small-dose SXBXP group (group E) and large-dose SXBXP group (group F), deployed intragastrically. Cardiac function was examined by echocardiography before and after therapy; mRNA expressed levels were measured by semiquantitative reverse transcription polymerase chain reaction (RT-PCR) for b(1)-AR, b(2)-AR, b(3)-AR, a(1A)-AR, a(1B)-AR, and a(1D)-AR; protein levels were measured by Western blotting analysis for b(1)-AR, b(2)-AR, a(1A)-AR, a(1B)-AR, and a(1D)-AR in non-infarction left ventricular tissue.

RESULTSThere was no significant difference in the left ventricular ejection fraction (LVEF) between groups A and B. Compared to group B, LVEF of groups C, D, E, and F were significantly decreased (P < 0.01) before therapy. After therapy, compared to group C, LVEF of group F was significantly improved (P < 0.05). Compared to group B, b(1)-AR and a(1B)-AR expressed levels were markedly decreased (P < 0.05), a(1A)-AR and b(3)-AR were significantly increased (P < 0.01) in group C, and in both mRNA and protein expressed levels b(2)-AR had no significant difference between groups B and C (P > 0.05). a(1D)-AR mRNA levels were unchanged in each group (P > 0.05), but a(1D)-AR protein level was significantly decreased in group C (P < 0.05). After treatment, compared to group C, mRNA levels of b(1)-AR and a(1B)-AR were significantly increased (P < 0.05 and P < 0.01), and a(1A)-AR was markedly decreased in groups D, E, and F (P < 0.05). b(3)-AR level significantly declined in both groups D and F (P < 0.01), but b(2)-AR and a(1D)-AR expressed levels remained unchanged in each group (P > 0.05). Protein levels, compared to group C, b(1)-AR was significantly increased (P < 0.01, P < 0.05, and P < 0.01) and a(1A)-AR was markedly decreased in groups D, E, and F (P < 0.05, P < 0.01, and P < 0.01). b(2)-AR expressed level was significantly increased in group F (P < 0.05). a(1B)-AR expressed level was significantly increased in both groups E and F (P < 0.05), and a(1D)-AR was remarkably increased in both groups D and F (P < 0.05).

CONCLUSIONSAfter SXBXP treatment, LVEF was increased and cardiac function was significantly ameliorated in rats with CHF. The therapeutic effect of SXBXP may be related to better blood supply for myocardium and up-regulation of b(1)-AR and a(1B)-AR, and down-regulation of a(1A)-AR and b(3)-AR. The results show that SXBXP can be used in treatment of CHF and the therapeutic effect of large-dose SXBXP is superior to small-dose SXBXP.

Animals ; Blotting, Western ; Drugs, Chinese Herbal ; therapeutic use ; Echocardiography ; Heart Failure ; diagnostic imaging ; drug therapy ; Male ; Myocardial Infarction ; diagnostic imaging ; drug therapy ; Radiography ; Rats ; Rats, Wistar ; Receptors, Adrenergic, alpha-1 ; genetics ; metabolism ; Receptors, Adrenergic, beta ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction

BACKGROUNDImpaired exercise capacity is one of the most common clinical manifestations in patients with chronic heart failure (CHF). The severity of reduced exercise capacity is an indicator of disease prognosis. The aim of the current study was to investigate the association between left heart size and mass with exercise capacity.

METHODSA total of 74 patients were enrolled in the study, with 37 having congestive heart failure (left ventricular ejection fraction (LVEF) < 0.45) and the other 37 with coronary heart disease (by coronary angiography) serving as the control group (LVEF > 0.55). Echocardiography and cardiopulmonary exercise test were performed. The multiply linear regression model was used to evaluate the association between echocardiogrphic indices and exercise capacities.

RESULTSThe study showed that left ventricular end diastolic/systolic diameter (LVEDD/LVESD), left atrial diameter (LAD) and left ventricular mass index (LVMI) were significantly enlarged in patients with chronic heart failure compared with controls (P < 0.01). The VO(2)AT, Peak VO(2), Load AT, and Load Peak in chronic heart failure patients were also significantly reduced compared with controls (P < 0.05), VE/VCO(2) slope was increased in patients with chronic heart failure (P < 0.01). Multivariate linear regression analysis indicated that the patients' exercise capacity was significantly associated with the left heart size and mass, however, the direction and/or strength of the associations sometimes varied in chronic heart failure patients and controls. Load AT correlated negatively with LVEDD in chronic heart failure patients (P = 0.012), while Load AT correlated positively with LVEDD in control patients (P = 0.006). VE/VCO(2) slope correlated positively with LAD (B = 0.477, P < 0.0001) in chronic heart failure patients, while the VE/VCO(2) slope correlated negatively with LAD in control patients (P = 0.009).

CONCLUSIONThe study indicates that the size of LVEDD and LAD are important determinants of exercise capacity in patients with CHF, which may be helpful to identify exercise tolerance for routine monitoring of systolic heart failure.

Aged ; Cardiac Volume ; physiology ; Echocardiography ; Exercise Test ; Exercise Tolerance ; physiology ; Female ; Heart Failure ; physiopathology ; Heart Ventricles ; diagnostic imaging ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; Radiography