Search Results (1,287)

Background and Objectives: Heart failure (HF) represents a clinical syndrome characterized by symptoms and signs such as fatigue, dyspnea, edema of the lower limb, or pulmonary rales. It usually occurs in elderly individuals due to decreased cardiac pumping function and/or increased diastolic ventricular filling pressures. The COVID-19 pandemic deeply altered many daily life habits, and one of the most affected groups of people were those with chronic diseases because of their need for regular medical follow-up. Furthermore, SARS-CoV-2 infection itself has been shown to exacerbate cardiovascular diseases (CVDs). Materials and Methods: This retrospective, observational, and comparative study aimed to characterize and compare patients with chronic heart failure hospitalized in the Cardiology Department of Medical Clinic II, Mureș County Emergency Clinical Hospital, in Târgu Mureș, Romania, between January and December 2019 (pre-pandemic), January and December 2021 (pandemic), and January and December 2023 (post-pandemic). Results: A total of 406 patients were analyzed: 202 patients hospitalized in 2019, 101 patients hospitalized in 2021, and 103 patients hospitalized in 2023. Women with HF were significantly older (median age 72 years) than men (median age 65 years; p < 0.001). During the pandemic, the median length of hospitalization increased (8 days vs. 7 days in the other periods). The pandemic period was also associated with a decrease in left ventricular ejection fraction (LVEF), as reflected by a higher incidence of patients with HF with reduced ejection fraction (42% during the pandemic; p < 0.01). Conclusions: During and after the pandemic, men exhibited significantly higher rates of right and left bundle branch blocks, as well as chronic obliterating artery disease of the lower limb. Left ventricular function declined during the pandemic in both men and women. Throughout the years, we observed distinct patterns between male and female patients regarding associated diseases or behaviours, suggesting lifestyle and psychological changes due to the COVID-19 pandemic. Full article

Primary cardiac tumors are rare, with an estimated incidence of 0.001% to 0.3% in autopsy series. Most are benign, the most common being cardiac myxomas, which typically originate in the left atrium. Right ventricular myxoma is among the rarest primary cardiac tumors, and its true incidence is difficult to determine, as most data come from isolated case reports. This paper aims to report a case of right ventricular myxoma in a young woman with a history of childhood malignancy and to discuss the possible association between the two conditions. Echocardiography, thoracic computed tomography (CT), and pulmonary CT angiography were used to assess the presence, location, and size of the tumor. The definitive diagnosis was established by histopathological examination. A 34-year-old woman, with a past medical history of acute lymphoblastic leukemia (ALL) in childhood, presented with a dry cough and exertional dyspnea persisting for three weeks. Transthoracic echocardiography revealed a mass located in the right ventricular outflow tract (RVOT), attached near the tricuspid valve and intermittently prolapsing into the pulmonary trunk. CT imaging confirmed the presence of the tumor in the RVOT and the main pulmonary artery. Because of the high risk of massive pulmonary embolism, the patient underwent urgent surgical excision of the tumor. Histopathological analysis confirmed the diagnosis of cardiac myxoma. The postoperative recovery was uneventful, and the three-month follow-up showed no recurrence or signs of pulmonary embolism. The patient’s history of ALL raised the question of a possible association; however, a review of the literature revealed no previously reported link. In conclusion, right ventricular myxomas are extremely rare. The occurrence of cardiac myxoma in this patient following childhood ALL appears to be incidental. Further research is needed to determine whether ALL survivors have an increased predisposition to subsequent cardiac tumors. Full article

Background/Objectives: To assess the safety and efficacy of submucosal mitomycin C (MMC) injection as an adjunct in patients undergoing endoscopic treatment for laryngotracheal stenosis (LTS). Methods: All patients affected by LTS receiving endoscopic treatment with adjuvant MMC were screened and selected from a retrospective database spanning from May 2022 to July 2023 at IRCCS Humanitas Research Hospital (Rozzano, Italy). Demographic data, bronchoscopic findings, and treatment-related outcomes were recorded and analyzed. Results: A total of 16 patients were included in the study. Subglottic stenosis was the most common condition, occurring in 88.9% of cases. All procedures were completed safely without intraoperative or postoperative complications or conversion to open surgery. Re-stenosis occurred in 6 (37.5%) cases, with a median time to recurrence of 136.5 (±43.9) days, requiring additional treatments. At last follow-up, all included patients were asymptomatic, except for two who reported mild dyspnea. Conclusions: Submucosal MMC injections represent a safe and promising delivery method in the endoscopic treatment of LTS and may provide a more durable effect on the stenosis reducing the risk of recurrence. Further prospective studies are needed to evaluate MMC’s effectiveness and develop standardized treatment protocols. Full article

Background: Anxiety disorders, including panic disorder, agoraphobia, specific phobias, and generalized anxiety disorder, are among the most frequent psychiatric conditions in primary care. They often present with somatic symptoms such as dyspnea, palpitations, chest or gastrointestinal discomfort, sweating, or flushing. Adaptol^® is a non-benzodiazepine anxiolytic with nootropic properties that modulates the limbic-reticular system, hypothalamic emotional centers, and multiple neurotransmitter systems. This study aimed to assess the association between Adaptol^® use and changes in anxiety symptoms, including somatic manifestations, in routine practice. Methods: A noninterventional observational study was conducted in 100 adults diagnosed with anxiety disorders in primary care. All received Adaptol^® 500 mg as prescribed. Patients had to have mild-to-moderate anxiety (5–14 points according GAD-7) to be enrolled. Exclusion criteria ruled out individuals with concomitant psychiatric or severe somatic conditions and those with use of other medications or any interventions that could affect the symptoms. Anxiety severity and somatic symptom burden were assessed at baseline and after treatment. Results: Adaptol^® treatment was associated with reduction in anxiety and somatic complaints. Improvements were reported in palpitations, chest discomfort, gastrointestinal disturbances, and autonomic symptoms. Greater benefit was observed in male patients, though without significance testing, and in those with severe baseline anxiety, as demonstrated by correlation between GAD-7 scores at baseline and changes after the treatment (r = 0.5). No unexpected adverse events occurred. Conclusions: In this real-world study, Adaptol^® showed anxiolytic efficacy and good tolerability, improving both psychological and somatic manifestations of anxiety disorders. These findings support its use in primary care, especially in severe cases of anxiety. Controlled trials are needed to support these results. Full article

A 3-year-old West Highland White Terrier presented to our hospital with dyspnea following aspiration of barium contrast medium during diagnostic imaging for a suspected esophageal foreign body (day 0). Barium contrast radiography had revealed a foreign body in the lower esophagus. During anesthesia, the patient regurgitated and developed respiratory failure and cyanosis. Despite immediate intubation, suction, and ventilatory management, respiratory parameters remained poor. Respiratory support with extracorporeal membrane oxygenation (ECMO) enabled control of blood gas parameters, and tracheobronchial lavage with temporary complete airway occlusion was performed. ECMO was withdrawn once the respiratory status normalized (total support time: 3 h). Considering the possibility of hypoxia-induced brain damage, the patient was extubated on day 1. The dog was alert, changed positions, and drank water independently 5 h after extubation. However, neurological symptoms were observed 1 h later. Cranial magnetic resonance imaging was performed on day 6 owing to persistent neurological symptoms. Although no ECMO-related complications, such as cerebral infarction, hemorrhage, or herniation, were observed, the white matter exhibited hyposignal, indicating hypoxic encephalopathy. The patient died on day 8, without improvement in neurological symptoms. ECMO is an effective treatment option for dogs with respiratory failure, and its prompt introduction may improve survival. Full article

Background: This cross-sectional study reports exploratory observations on respiratory symptom patterns in individuals with prior coronavirus disease 2019 (COVID-19), evaluating associations with exercise habits, number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection episodes, vaccine doses received, body mass index (BMI), age, sex, and comorbidities. Methods: A total of 240 participants were assessed for age, sex, height, weight, BMI, comorbidities, SARS-CoV-2 infection episodes, vaccine doses received, and exercise habits; the self-reported duration of symptomatic periods was summarized descriptively and was not modeled as an exposure or outcome. Results: Compared with the first SARS-CoV-2 infection episode (reference), patients who experienced a second episode had higher odds of dyspnea (adjusted odds ratio; OR = 7.61; 95% confidence interval CI = 1.54–37.66). In univariate analysis, patients who received three vaccine doses had lower odds of dyspnea than those who received two doses (OR = 0.39; 95% CI = 0.16–0.98), but this association was not significant after adjustment (adjusted OR = 0.46; 95% CI = 0.13–1.63). After adjustment, patients who exercised had lower odds of secretion compared with those who did not (adjusted OR = 0.30; 95% CI = 0.12–0.73). Conclusions: These cross-sectional, hypothesis-generating observations suggest higher adjusted odds of dyspnea among individuals with repeat infection and lower adjusted odds of sputum among those reporting regular exercise; estimates are imprecise and subject to residual confounding due to unbalanced group sizes. Confirmation in larger, longitudinal cohorts is required. Full article

Background and Clinical Significance: Sleeve gastrectomy is an effective and widely performed bariatric procedure that provides long-term, sustained weight loss, but it carries risks of early and late complications. Among these, gastric fistula is a rare occurrence associated with an increased mortality rate and must be carefully considered to ensure timely diagnosis and appropriate management. Case Presentation: We will present the complex case of a patient who was referred to the general surgery department due to severe abdominal pain, exertional dyspnea, nausea, fever and fatigue, symptoms that appeared one month after a robotic gastric sleeve. The investigations led to the diagnostic of high gastric fistula secondary to a gastric sleeve procedure. The patient underwent exploratory laparotomy with jejunostomy, peritoneal lavage, drainage, and endoscopic placement of an endoluminal vacuum assisted closure (E-VAC) system. Close clinical, laboratory, imaging, and endoscopic monitoring demonstrated progressive improvement, with complete resolution of the fistula achieved after seven weeks of E-VAC therapy. Conclusions: The particularity of this case lies in the occurrence of a delayed mechanical gastric suture dehiscence, with late diagnosis, managed using E-VAC. Even though rare, gastric fistulas represent a potentially life-threatening complication of sleeve gastrectomy. Early diagnosis and a multidisciplinary approach, which includes infection control, surgical intervention and minimally invasive techniques like E-VAC, are essential for effective management and favorable outcomes. Full article

Background: The term preserved ratio impaired spirometry (PRISm) is defined as post-bronchodilator forced expiratory volume in 1 s (FEV₁) <80% predicted and FEV₁/forced vital capacity (FVC) ratio ≥0.7 or ≥lower limit of normal (LLN). The population prevalence is estimated to be between 3% and 20%. PRISm does not indicate a specific lung disease but is associated with functional limitations, respiratory symptoms, comorbidities, and mortality. The aim of this study is to analyze the PRISm prevalence in an excellently characterized epidemiological study, to obtain better insight into the influence of comorbidities on PRISm development and its impact on overall mortality. Methods: We included 3403 healthy subjects from the Study of Health in Pomerania (SHIP) and 507 individuals with PRISm. Data from lung function testing, cardiopulmonary exercise testing (CPET), and echocardiography were compared in both groups. Comorbidities, as well as cardiovascular and all-cause mortality data, were analyzed. Results: Individuals in the PRISm group reported more often a history of myocardial infarction, hypertension, type 2 diabetes, dyspnea, and lung disease, and had more unfavorable median values for most of the lung function, CPET, and echocardiographic parameters compared to the non-PRISm group. Furthermore, they were older, more often current smokers, and had higher body fat marker values. Likewise, all-cause and cardiovascular death were more frequently observed in the PRISm group. Conclusions: Future studies are warranted to identify the underlying mechanisms and longitudinal progression of PRISm. However, our findings reveal that PRISm is not only associated with cardiovascular comorbidities but also with increased dyspnea, an impaired exercise capacity, and mortality. Full article

Background: PRKAG2-related disease is an autosomal dominant disorder caused by pathogenic variants in the PRKAG2 gene, leading to glycogen accumulation in cardiomyocytes. It is characterized by left ventricular hypertrophy (LVH), ventricular pre-excitation, and conduction disease. Due to the rarity of the condition and the frequent occurrence of private variants, functional or pathological testing is required for definitive pathogenicity classification. Case Presentation: We describe a 22-year-old male referred for evaluation after experiencing exertional dyspnea and a syncopal episode. Family history revealed sudden cardiac deaths and conduction disease requiring pacemaker implantation. The patient exhibited mild LVH on imaging, conduction abnormalities on electrophysiological study, and a heterozygous PRKAG2 variant (c.1643C>T; p.Ser548Leu), classified as likely pathogenic according to ACMG guidelines. Cascade screening identified the variant in three family members, one of whom exhibited a positive phenotype. Endomyocardial biopsy revealed glycogen accumulation, providing histopathological confirmation of PRKAG2-related disease. Conclusions: This case underscores the importance of integrating genetic, clinical, and histopathological data in variant interpretation. Endomyocardial biopsy can provide definitive evidence to reclassify a PRKAG2 variant as pathogenic, thereby guiding management and family screening. Full article

Background/Objectives: At Fiona Stanley Hospital’s pulmonary rehabilitation program, people awaiting lung transplantation (LTx), whose exertional oxygen requirements are unable to be met with traditional oxygen interfaces, utilize high-flow nasal oxygen (HFNO) to exercise. In this paper, we aim to: (i) describe the characteristics of our service and of the people who have utilized HFNO; and (ii) explore differences between those who survived vs. did not survive whilst awaiting LTx. Methods: We conducted a description of the service and a retrospective analysis (from January 2021 to April 2024). The service description included: facility, equipment/cost, staffing/patient ratio, exercise program characteristics, and safety. Inclusion criteria for the analysis were: people actively listed for LTx and completion of three or more exercise sessions on HFNO. Data extracted included patient characteristics, comorbidities, 6-min walk distance (6MWD) prior to commencing HFNO, and survival pre-LTx. Differences between those who survived vs. did not survive whilst awaiting LTx were explored. Results: Nineteen patients were included (13 males; age 60 ± 12 yr; 18 with interstitial lung disease). The median [IQR] number of exercise sessions on HFNO was 15 [9; 25]. Eight (42%) patients died whilst awaiting LTx. In those who survived, the median time to LTx was 46 [25; 268] days. Compared to those who died, those who underwent LTx had fewer comorbidities (median: 2 [1; 4] vs. 4 [3; 5], p = 0.03). They also tended to be younger and have greater absolute 6MWD prior to commencing HFNO (mean difference, 95%CI: age −8.6 yr, −19.3 to 2.1; 6MWD 55 m, −74 to 185). Associations between dyspnea or body mass index with survival were not demonstrated. This analysis is hypothesis-generating rather than inferential, given the limited sample size. Conclusions: Our unique service of high-flow nasal oxygen (HFNO) use in patients participating in pulmonary rehabilitation whilst awaiting lung transplantation is described. Preliminary analysis suggests that, in people utilizing HFNO whilst awaiting LTx, those who underwent LTx had fewer comorbidities than those who did not survive the waitlist period. Larger studies are needed to explore further differences between those who survive vs. those who do not survive whilst awaiting LTx. Full article

Background: Combined Pulmonary Fibrosis and Emphysema (CPFE) is a distinct syndrome characterized by upper-lobe emphysema and lower-lobe fibrosis, predominantly in older male smokers. Despite often preserved spirometric volumes, patients exhibit severely reduced diffusing capacity and high susceptibility to complications, including pulmonary hypertension (PH), acute exacerbations, and lung cancer, contributing to poor prognosis. Purpose: This review aims to synthesize current evidence on CPFE, focusing on clinical phenotype, functional impairment, differential diagnosis, complications, and emerging management strategies, highlighting distinctions from idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). Methods: A narrative review of observational cohorts, retrospective series, and clinical studies examining CPFE patients was performed. Data on demographics, smoking history, symptomatology, pulmonary function, radiology, comorbidities, complications, and treatment approaches were extracted and integrated. Results: CPFE affects mainly males aged 65–70, with >90% reporting > 40 pack–years smoking history. Dyspnea is the cardinal symptom (>95%), often disproportionate to preserved FVC and TLC, accompanied by chronic cough in 30–70%. Exercise-induced desaturation is frequent, correlating with PH, observed in 47–90% of patients. Pulmonary function tests reveal preserved volumes, normal or near-normal FEV1/FVC, and severely reduced DLCO (35–45%), distinguishing CPFE from COPD and IPF. HRCT confirms the combined emphysematous and fibrotic pattern, critical for differential diagnosis. Acute exacerbations occur in 20–28% of cases, lung cancer in 22–46% (mostly squamous cell), and long-term oxygen therapy is required in >70%. Five-year survival is 35–55%, lower than emphysema alone and comparable or worse than IPF. Management focuses on smoking cessation, antifibrotics, oxygen therapy, and complication-specific treatments, and selected patients may undergo lung transplantation. Conclusions: CPFE is a clinically and functionally unique entity with a high burden of pulmonary and systemic complications. Accurate recognition using HRCT and DLCO, along with early intervention and tailored management, is essential to improve patient outcomes and guide prognostic stratification. Full article

Acute exposure to hypoxia will induce right ventricular (RV) hemodynamic changes and may increase the degree of right-to-left shunting, which can contribute to dyspnea at altitude. In this retrospective study, 125 patients (median age 66 years; 50.4% women) with unexplained dyspnea at altitude underwent hypoxic simulation testing (HST) with transthoracic echocardiography (TTE). During simulated hypoxia (mode (Min-Max) altitude: 8000 (6000–18,000) ft, were observed a significant decrease in oxygen saturation (97% (95–98) vs. 88% (82–92), p < 0.001) and RV free wall longitudinal strain (−19.6 ± 3.99% vs. −17.3 ± 4.17%, p < 0.01), an increase in RV systolic pressure (RVSP: 26 (23–30.5) vs. 29 (25–36.5) mmHg, p < 0.001). No significant changes were observed in TAPSE (20 (18–23) vs. 20 (19–24) mm) or S wave (0.12 (0.11–0.14) vs. 0.13 (0.12–0.14) m/s). Right-to-left shunting was present in 47.2% of patients and 11.9% exhibited inducible shunting only under hypoxia. However, under hypoxia, there were no significant differences in RV hemodynamic parameters or saturation between those with and without shunting. TTE with HST is useful to characterize both cardiopulmonary response and the dynamic changes in right-to-left shunt behavior under hypoxic stress. Full article

Background/Objectives: Right ventricular (RV) failure (RVF) is associated with poor prognosis and currently has no known treatment. Meldonium is a clinically used cardiometabolic drug that improves RV function in a preclinical RVF model. This study aimed to assess the safety and efficacy of meldonium in patients with pulmonary arterial hypertension (PAH)-induced RVF. Methods: Twenty RVF patients received meldonium (500 mg, b.i.d.) for 30 days; afterward, they were followed up for 30 days. The 6 min walk test (6MWT), 36-Item Short Form Survey (SF-36, a quality-of-life questionnaire), WHO functional class (FC), and Borg dyspnea score (BDS) were used to indirectly assess exercise capacity. Blood samples were obtained before and after treatment and at the end of follow-up. Results: Walking distance in the 6MWT increased from 352.2 ± 114.8 m to 398.9.8 ± 128.5 m (p = 0.021) after meldonium. Meldonium treatment markedly improved WHO FC and SF-36 scores (p < 0.05). The drug significantly improved the BDS after the 6MWT (p = 0.003). Meldonium did not affect vital signs or blood biochemistry, including BNP. Meldonium treatment was safe in RVF patients. Conclusions: Meldonium treatment increases the functional capacity and overall well-being of RVF patients. Our results suggest that meldonium might be a viable novel drug for RVF treatment. Full article

Background/Objectives: Lithocarpus litseifolius (Hance) Chun, also known as sweet tea, is a traditional Chinese tea-making plant. Acute lung injury (ALI), a life-threatening syndrome with symptoms like hypoxemia and dyspnea, can be triggered by infection or trauma, with high morbidity and mortality. Whether the water extract of Lithocarpus litseifolius (WEL) has therapeutic effects on ALI remains unclear. This study aimed to analyze WEL’s components, establish in vitro cellular inflammation and mouse ALI models, and investigate WEL’s protective effects against LPS-induced ALI. Methods: LC-MS analysis identified 42 compounds in WEL and quantified three key ones. In an LPS-induced mouse ALI model, WEL significantly reduced lung injury severity, lung wet-to-dry ratio, pulmonary edema, and levels of NO, ROS, IL-1β, TNF-α, and MPO in lung tissues and bronchial alveolar lavage fluid. Immunohistochemical analysis showed WEL pretreatment inhibited the upregulation of NLRP3, Caspase-1, and GSDMD-NT expression, mitigated tissue oxidative stress and cell pyroptosis, and alleviated ALI severity in mice. Cellular experiments confirmed WEL’s protective effects via anti-inflammatory, antioxidant actions, and inhibiting cell pyroptosis, with phlorizin and trilobatin as potential key active ingredients. Conclusions: This research demonstrates sweet tea’s significant protective effects against ALI and its potential to alleviate inflammation by inhibiting pyroptosis, providing a theoretical basis for developing new health-promoting functions of sweet tea. Full article

Background: This study compared the accuracy of diagnosing left ventricular diastolic dysfunction (DD) between emergency physician (EP)-performed focused cardiac ultrasound (FCU) and cardiologist-interpreted reference standards in adult patients presenting to the emergency department (ED) with suspected acute heart failure (HF). Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched for studies focusing on adult ED patients with symptoms of acute HF that compared the accuracy of DD diagnosis between EP-performed FCU and reference standards including cardiologist-reviewed FCU clips, formal transthoracic echocardiography, or invasive hemodynamics without language/date restrictions. Results: Meta-analysis of four eligible observational studies (327 patients enrolled; 298 analyzed) demonstrate excellent sensitivity of EP-performed FCU compared with the standards (94%, 95% CI: 87 to 97%) but moderate specificity (59%, 95% CI: 42 to 74%) in diagnosing DD patients with suspected acute HF. Three of the four studies showed a high risk of overall bias. Conclusions: EP-performed FCU exhibited excellent sensitivity and low negative likelihood ratios, supporting its use as an effective initial triage tool for ruling out DD in ED patients with suspected acute HF. However, its moderate specificity and limited positive likelihood ratios hamper its standalone use as a definitive diagnostic modality for ruling in DD (PROSPERO: CRD420251046794). Full article