Acute right heart failure in a patient with right heart thrombus and pulmonary thromboembolism

Right Heart Thrombus (RiHT) management is really controversial, and appropriate guidelines are not present for the management. In patients referring with RiHT and Pulmonary Embolism (PE), there are three ways of managing these patients. Out of the three one is thrombectomy which is with high risk taking in mind the comorbidities these patients have. The other is using thrombolytic which, in many cases is contraindicated or with high risk. The other less effective way is full anticoagulation. It is really controversial to choose between these ways of management and no clear approach is present. The case presented is a 44-year-old morbid obese male with history of dyspnea on exertion (functional Class II) and foot oedema or the last three months, who was transferred to the emergency department with respiratory distress and hypoxia. Echocardiography was done for the patient which showed moderate Right Ventricular (RV) dysfunction with severe RV enlargement and a severe Tricuspid Regurgitation (TR) with TR gradient of 70mmHg. He also had a semi-mobile large pedunculated mass in favour of a clot in his RV cavity. With the impression of PE heparin was administered to the patient and he was admitted in the coronary care unit. Pulmonary Computed Tomography (CT) angiography showed sub-segmental Pulmonary Thromboendarterectomy (PTE) in the left lung. He had negative cardiac markers and stable vital signs and so full anticoagulation was chosen for his treatment. His clinical course was uneventful and after 10 days of treatment the RV size and function improved significantly. On follow-up after a month he was doing well. Although recent Guidelines of European Society of Cardiology in management of acute PE stated that RiHT, particularly mobile, are associated with a significantly increased early mortality risk in patients with acute PE. Immediate therapy is mandatory, but optimal treatment is controversial in the absence of controlled trials. Thrombolysis and embolectomy are probably both effective while anticoagulation alone seems to be less effective. � 2016, Journal of Clinical and Diagnostic Research. All rights reserved

Cardiovascular patients in COVID-19 era, a case series, an experience from a tertiary cardiovascular center in Tehran, Iran

Different cardiovascular presentations of coronavirus disease 2019 can be seen because of the systemic involvement. Considering its new presentations, there is need for further studies regarding the mechanistic pathways involved. © 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Lt

Relationship between the pulmonary artery pressure and the occurrence of atrial fibrillation after coronary artery bypass graft surgery

Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG). Methods: This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF. Results: We selected 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P � 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P �0.001 and P = 0.01, respectively). Conclusions: Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. © 2017, Iranian Heart Association. All rights reserved

Relationship between the pulmonary artery pressure and the occurrence of atrial fibrillation after coronary artery bypass graft surgery

Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG). Methods: This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF. Results: We selected 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P � 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P �0.001 and P = 0.01, respectively). Conclusions: Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. © 2017, Iranian Heart Association. All rights reserved

Right ventricular dysfunction in patients with new-onset heart failure: longitudinal follow-up during guideline-directed medical therapy

Aims: Improvement in left ventricular ejection fraction (LVEF) after up-titration of guideline-directed medical therapy (GDMT) has been well described in heart failure (HF) patients. Less is known about the prevalence and clinical course of right ventricular dysfunction (RVD) in patients with new-onset HF. Methods and results: From 2012 to 2018, 625 patients with a recent (<3 months) diagnosis of HF were referred to a specialized nurse-led HF clinic for protocolized up-titration of GDMT. RVD, defined as tricuspid annular plane systolic excursion (TAPSE) <17 mm, was assessed at baseline and at the follow-up visit. Patients were followed for the combined endpoint of all-cause mortality and HF hospitalization for a mean of 3.3 ± 1.9 years. Of the 625 patients, 241 (38.6%) patients had RVD at baseline. Patients with RVD were older, more symptomatic, had a lower LVEF, and more often had a history of cardiothoracic surgery and atrial fibrillation. After a median follow-up of 9 months, right ventricular function normalized in 49% of the patients with baseline RVD. RVD at baseline was associated with a higher risk of the combined endpoint (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.21–2.18). Right ventricular function normalization was associated with a lower risk for the combined endpoint (HR 0.56, 95% CI 0.31–0.99), independent of baseline TAPSE, age, sex, and LVEF. Conclusion: More than one-third of patients with new-onset HF have RVD. RVD is associated with a higher risk of all-cause mortality and HF hospitalization. Recovery of RVD regularly occurs during up-titration of GDMT and is associated with improved clinical outcomes