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Gédéon T, Akl E, D'Souza R, Altit G, Rowe H, Flannery A, Siriki P, Bhatia K, Thorne S, Malhamé I. Acute Myocardial Infarction in Pregnancy. Curr Probl Cardiol 2022; 47:101327. [PMID: 35901856 DOI: 10.1016/j.cpcardiol.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease, and particularly ischemic heart disease, is a leading cause of maternal morbidity and mortality in high-income countries. The incidence of acute myocardial infarction (AMI) has been rising over the past two decades due to increasing maternal age and a higher prevalence of cardiovascular risk factors in the pregnant population. Causes of AMI in pregnancy are diverse and may require specific considerations for their diagnosis and management. In this narrative review, we provide an overview of physiologic changes, risk factors, and etiologies leading to AMI in pregnancy, as well as diagnostic tools, reperfusion strategies, and pharmacological treatments for this complex population. In addition, we outline considerations for labor and delivery planning and long-term follow-up of patients with AMI in pregnancy.
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Affiliation(s)
- Tara Gédéon
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Elie Akl
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Gabriel Altit
- Department of Paediatrics, McGill University Health Centre, Montreal, Canada
| | - Hilary Rowe
- Department of Pharmacy, Nanaimo Regional General Hospital, Island Health, Nanaimo, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Alexandria Flannery
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Kailash Bhatia
- Department of Anaesthesia, Manchester University Hospitals and St Mary's Hospital, University of Manchester, Manchester, United Kingdom
| | - Sara Thorne
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
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Natenzon A, Morris B, Schulman-Marcus J. An Update on Coronary Artery Disease in Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00893-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Physiological Changes and Cardiovascular Investigations in Pregnancy. Heart Lung Circ 2020; 30:e6-e15. [PMID: 33158736 DOI: 10.1016/j.hlc.2020.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023]
Abstract
Profound physiological changes in the maternal cardiovascular system occur shortly after conception. These changes may impact upon the investigation of healthy and complicated pregnancies. Additionally, concerns regarding fetal exposure to ionising radiation are important considerations in maternal testing. This manuscript reviews the important physiological changes pertinent to the investigation of maternal cardiovascular disease in pregnancy.
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil
- Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil
- Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil
- Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
- Hospital Barão de Lucena, Recife, PE – Brazil
- Hospital EMCOR, Recife, PE – Brazil
- Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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Herrey AS, Francis JM, Hughes M, Ntusi NAB. Cardiovascular magnetic resonance can be undertaken in pregnancy and guide clinical decision-making in this patient population. Eur Heart J Cardiovasc Imaging 2018; 20:291-297. [PMID: 30462196 DOI: 10.1093/ehjci/jey162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/13/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna S Herrey
- St. Bartholomew’s Hospital/Barts Heart Centre, West Smithfield, London, UK
- Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, London, UK
| | - Jane M Francis
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headington, Oxford, UK
| | - Marina Hughes
- Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond St, London, UK
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Main Rd, Observatory, Cape Town, South Africa
- The Hatter Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Private Bag, Observatory, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, UCT MRI Unit 10, J Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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6
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Romagano M, Louis-Jacques A, Quinones J, Freudenberger R, Fleming L, Smulian J, Martinez M. Is there a role for cardiac magnetic resonance imaging during pregnancy? J Matern Fetal Neonatal Med 2018; 33:558-563. [PMID: 29973095 DOI: 10.1080/14767058.2018.1497598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To assess the role of cardiac magnetic resonance imaging (CMR) for the evaluation and management of women with cardiac disorders in pregnancy and postpartum.Methods: Retrospective record review of women at a university-affiliated, single institution referred for CMR without contrast due to known or suspected cardiac disorders between January 2010 and December 2015. Medical records, echocardiogram and CMR reports were reviewed. Instances where clinical management was changed based on CMR findings were identified.Results: There were 17 peripartum CMR studies performed without contrast in 17 pregnancies from 16 women. Indications for CMR included congenital heart disease (N = 8, 47.1%), Marfan syndrome or strong family history of Marfan syndrome (N = 5, 29.4%), cardiomyopathy (N = 1, 5.9%), cardiac mass (N = 1, 5.9%), persistent dyspnea with a normal echocardiogram (N = 1, 5.9%), and hypertension with suspected aortic root dilation (N = 1, 5.9%). CMR confirmed the echocardiogram diagnosis in eight (47.1%) and improved the diagnosis in five (29.4%). Availability of CMR findings changed the delivery management in 2/17 (11.8%) women. CMR was especially helpful in assessing the size of the aortic root in women at risk for dilation.Conclusions: Although echocardiogram imaging of the heart is considered the first-line method for assessing the maternal cardiac status, CMR can provide information about cardiac anatomy and function in pregnant women with complex cardiac disease or suspected aortic pathology. Management may be changed based on results.
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Affiliation(s)
- Matthew Romagano
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Adetola Louis-Jacques
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Joanne Quinones
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Ronald Freudenberger
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Laurie Fleming
- Lehigh Magnetic Imaging Center, Lehigh Valley Health Network, Allentown, PA, USA
| | - John Smulian
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Matthew Martinez
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Abstract
Peripartum cardiomyopathy (PPCM) is life-threatening and its diagnosis is a challenge. We highlight the clinical characteristics and bio-markers of PPCM and the proper differential diagnosis of peripartum dyspnea to aim to make an early diagnosis available.We analyzed 262 peripartum patients with dyspnea, and summed up the final diagnosis. The clinical data of the control group and the PPCM group as well as before and after the treatment of the PPCM group were compared.In total, 147 (56%) of the perinatal patients were physiologic dyspnea of pregnancy; only 11 (4%) patients met the PPCM diagnostic criteria. Compared with the basic baseline characteristics between the PPCM group and control group, patients with PPCM had a higher heart rate, and the white blood cell, high-sensitivity C-reactive protein (hs-CRP), and B-type natriuretic peptide (BNP) levels were markedly elevated, whereas PaO2 and left ventricular ejection fraction (LVEF) were lower. The heart rate, CRP and BNP levels were lower at the follow-up compared with the pretreatment. Patients who were followed up showed significant improvements in the LVEF and New York Heart Association function class.We standardized the symptoms of dyspnea for calculating, and analyzed the diagnostic efficacy of laboratory indicators. The research highlighted that the use of echocardiography and disease-specific bio-markers may aid in the diagnosis and management.
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Ntusi NA, Samuels P, Moosa S, Mocumbi AO. Diagnosing cardiac disease during pregnancy: imaging modalities. Cardiovasc J Afr 2017; 27:95-103. [PMID: 27213857 PMCID: PMC4928175 DOI: 10.5830/cvja-2016-022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/04/2016] [Indexed: 01/20/2023] Open
Abstract
Pregnant women with known or suspected cardiovascular disease (CVD) often require cardiovascular imaging during pregnancy. The accepted maximum limit of ionising radiation exposure to the foetus during pregnancy is a cumulative dose of 5 rad. Concerns related to imaging modalities that involve ionising radiation include teratogenesis, mutagenesis and childhood malignancy. Importantly, no single imaging study approaches this cautionary dose of 5 rad (50 mSv or 50 mGy). Diagnostic imaging procedures that may be used in pregnancy include chest radiography, fluoroscopy, echocardiography, invasive angiography, cardiovascular computed tomography, computed tomographic pulmonary angiography, cardiovascular magnetic resonance (CMR) and nuclear techniques. Echocardiography and CMR appear to be completely safe in pregnancy and are not associated with any adverse foetal effects, provided there are no general contra-indications to MR imaging. Concerns related to safety of imaging tests must be balanced against the importance of accurate diagnosis and thorough assessment of the pathological condition. Decisions about imaging in pregnancy are premised on understanding the physiology of pregnancy, understanding basic concepts of ionising radiation, the clinical manifestations of existent CVD in pregnancy and features of new CVD. The cardiologist/physician must understand the indications for and limitations of, and the potential harmful effects of each test during pregnancy. Current evidence suggests that a single cardiovascular radiological study during pregnancy is safe and should be undertaken at all times when clinically justified. In this article, the different imaging modalities are reviewed in terms of how they work, how safe they are and what their clinical utility in pregnancy is. Furthermore, the safety of contrast agents in pregnancy is also reviewed.
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Affiliation(s)
- Ntobeko A Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - Petronella Samuels
- Cape University Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Ana O Mocumbi
- Instituto Nacional de Saúde and Department of Medicine, University Eduardo Mondlane, Maputo, Mozambique
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Ducloy-Bouthors AS, Gonzalez-Estevez M, Constans B, Turbelin A, Barre-Drouard C. Cardiovascular emergencies and cardiac arrest in a pregnant woman. Anaesth Crit Care Pain Med 2016; 35 Suppl 1:S43-S50. [DOI: 10.1016/j.accpm.2016.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Dubbs SB, Tewelde SZ. Cardiovascular Catastrophes in the Obstetric Population. Emerg Med Clin North Am 2015; 33:483-500. [DOI: 10.1016/j.emc.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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The pregnant heart: cardiac emergencies during pregnancy. Am J Emerg Med 2015; 33:573-9. [DOI: 10.1016/j.ajem.2015.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/23/2022] Open
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12
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Shim WJ. Role of echocardiography in the management of cardiac disease in women. J Cardiovasc Ultrasound 2014; 22:173-9. [PMID: 25580190 PMCID: PMC4286637 DOI: 10.4250/jcu.2014.22.4.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 12/14/2022] Open
Abstract
The widespread use of echocardiography has contributed to the early recognition of several distinct cardiac diseases in women. During pregnancy, safe monitoring of the disease process, as well as a better understanding of hemodynamics, is possible. During the use of potentially cardiotoxic drugs for breast cancer chemotherapy, echocardiographic patient monitoring is vital. Compared to men, the addition of an imaging modality to routine electrocardiogram monitoring during stress testing is more informative for diagnosing coronary disease in women. This review briefly discusses the role of echocardiography in the management of several women-specific cardiac diseases where echocardiography plays a pivotal role in disease management.
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Affiliation(s)
- Wan Joo Shim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
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Cosyns B, Plein S, Nihoyanopoulos P, Smiseth O, Achenbach S, Andrade MJ, Pepi M, Ristic A, Imazio M, Paelinck B, Lancellotti P. European Association of Cardiovascular Imaging (EACVI) position paper: Multimodality imaging in pericardial disease. Eur Heart J Cardiovasc Imaging 2014; 16:12-31. [PMID: 25248336 DOI: 10.1093/ehjci/jeu128] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although pericardial diseases are common in the daily clinical practice and can result in a significant morbidity and mortality, imaging of patients with suspected or known pericardial disorders remain challenging. Multimodality imaging is part of the management of pericardial diseases. Echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance are often used as complementary imaging modalities. The choice of one or multiple imaging modalities is driven by the clinical context or conditions of the patient. The scope of the present document is to highlight the respective role of each technique according to the clinical context in the diagnosis and management of pericardial diseases.
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Affiliation(s)
- Bernard Cosyns
- Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Sven Plein
- The Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Petros Nihoyanopoulos
- Department of Cardiology, Imperial College, NHLI Hammersmith Hospital London, London, UK
| | - Otto Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Stephan Achenbach
- Department of Cardiology, University Hospital Erlangen, Medizinische Klinik 2, Erlangen, Germany
| | - Maria Joao Andrade
- Department of Cardiology, Hospital Santa Cruz, Instituto Cardiovascular de Lisboa, Lisboa, Portugal
| | - Mauro Pepi
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Arsen Ristic
- Department of Cardiology, Clinical Center of Serbia, Belgrad, Serbia
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Bernard Paelinck
- Cardiac Imaging, Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liege, Belgium
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Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA, Messonnier NE, Jamieson DJ. Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. Emerg Infect Dis 2014; 20. [PMID: 24457117 PMCID: PMC3901460 DOI: 10.3201/eid2002.130611] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Clinical recommendations for the prevention and treatment of anthrax among pregnant women are updated. In August 2012, the Centers for Disease Control and Prevention, in partnership with the Association of Maternal and Child Health Programs, convened a meeting of national subject matter experts to review key clinical elements of anthrax prevention and treatment for pregnant, postpartum, and lactating (P/PP/L) women. National experts in infectious disease, obstetrics, maternal fetal medicine, neonatology, pediatrics, and pharmacy attended the meeting, as did representatives from professional organizations and national, federal, state, and local agencies. The meeting addressed general principles of prevention and treatment for P/PP/L women, vaccines, antimicrobial prophylaxis and treatment, clinical considerations and critical care issues, antitoxin, delivery concerns, infection control measures, and communication. The purpose of this meeting summary is to provide updated clinical information to health care providers and public health professionals caring for P/PP/L women in the setting of a bioterrorist event involving anthrax.
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Atrial shunts: presentation, investigation, and management, including recent advances in magnetic resonance imaging. Cardiol Young 2014; 24:403-16. [PMID: 24397877 DOI: 10.1017/s1047951113002321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Atrial shunts are a common finding in both paediatric and adult populations. Recent developments in advanced imaging have widened the options for diagnosis and evaluation of such shunts. This paper reviews the various types of interatrial communications, discusses the features of clinical presentation in adults and children, and provides an overview of the clinical assessment including physical examination, electrocardiography, echocardiography, cardiac catheterisation, computed tomography, and magnetic resonance imaging. Focus will be placed on recent developments in magnetic resonance imaging that may improve the non-invasive evaluation of atrial shunts.
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