Takotsubo Cardiomyopathy — NEJM

Takotsubo Cardiomyopathy — NEJM: Images in Clinical Medicine from The New England Journal of Medicine — Takotsubo Cardiomyopathy



Takotsubo cardiomyopathy, also called apical ballooning syndrome or stress cardiomyopathy, typically occurs in postmenopausal women and may be preceded by a stressful or emotional event. The clinical presentation may be identical to that seen in patients with acute coronary syndrome, but the condition is characterized by transient left ventricular systolic and diastolic dysfunction of the apex and midventricle in the absence of attributable coronary artery disease

Embryonic Heart Rate as a Prognostic Factor for Chromosomal Abnormalities

Embryonic Heart Rate as a Prognostic Factor for Chromosomal Abnormalities

Abstract

Objective. The purpose of this study was to evaluate the role of a slow embryonic heart rate in embryos before 7 weeks' gestation as a marker in screening for chromosomal abnormalities. Methods. Fifty-seven embryos before 7 weeks' gestation with slow heart rates were compared with 1156 embryos of the same gestational period with normal heart rates. Embryos that showed an increased risk of chromosomal abnormalities in the screening blood tests underwent invasive analysis for abnormal karyotype detection. Results. The rates of first-trimester death were 15.8% for pregnancies with slow embryonic heart rates (9 of 57) and 2.5% for those with normal heart rates (29 of 1156). Because of the increased risk of chromosomal abnormalities, amniocentesis was performed on 6 with slow embryonic heart rates and 61 with normal embryonic heart rates. After karyotype analysis, there were 2 fetuses with trisomy 21 in each group, which represented significantly higher percentage of embryos with trisomy 21 in the slow–heart rate group compared with the normal–heart rate group (P < .05). Conclusions. When a slow embryonic heart rate is detected before 7 weeks' gestation, there is a higher likelihood of chromosomal abnormalities.

Associations of Carotid Artery Intima‐Media Thickness (IMT) With Risk Factors and Prevalent Cardiovascular Disease

Associations of Carotid Artery Intima‐Media Thickness (IMT) With Risk Factors and Prevalent Cardiovascular Disease

Abstract

Objective. The goal of this study was to compare internal carotid artery (ICA) intima-media thickness (IMT) with common carotid artery (CCA) IMT as global markers of cardiovascular disease (CVD). Methods. Cross-sectional measurements of the mean CCA IMT and maximum ICA IMT were made on ultrasound images acquired from the Framingham Offspring cohort (n = 3316; mean age, 58 years; 52.7% women). Linear regression models were used to study the associations of the Framingham risk factors with CCA and ICA IMT. Multivariate logistic regression models and receiver operating characteristic (ROC) curve analysis were used to compare the associations of prevalent CVD with CCA and ICA IMT and determine sensitivity and specificity. Results. The association between age and the mean CCA IMT corresponded to an increase of 0.007 mm/y; the increase was 0.037 mm/y for the ICA IMT. Framingham risk factors accounted for 28.6% and 27.5% of the variability in the CCA and ICA IMT, respectively. Age and gender contributed 23.5% to the variability of the CCA IMT and 22.5% to that of the ICA IMT, with the next most important factor being systolic blood pressure (1.9%) for the CCA IMT and smoking (1.6%) for the ICA IMT. The CCA IMT and ICA IMT were statistically significant predictors of prevalent CVD, with the ICA IMT having a larger area under the ROC curve (0.756 versus 0.695). Conclusions. Associations of risk factors with CCA and ICA IMT are slightly different, and both are independently associated with prevalent CVD. Their value for predicting incident cardiovascular events needs to be compared in outcome studies.

Các xử lý một số tình huống cấp cứu (sai-đúng)