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Schrøder AS, Willesen JL, Perrin KL, Bertelsen MF, Koch J. ECHOCARDIOGRAPHY IN THIRTY AMERICAN FLAMINGOS (PHOENICOPTERUS RUBER) AND A CASE OF SUSPECTED NEURALLY MEDIATED REFLEX SYNCOPE. J Zoo Wildl Med 2024; 55:195-199. [PMID: 38453502 DOI: 10.1638/2021-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 03/09/2024] Open
Abstract
Heart disease in birds contributes to premature death and is usually detected postmortem. Echocardiography is a sensitive and noninvasive diagnostic modality but reported standard values for many species of birds, including American flamingos (Phoenicopterus ruber), are unavailable. Echocardiography was opportunistically performed on 30 unsedated American flamingos during their annual routine health examination. Structural heart disease was not found in any of the examined birds. However, 18 birds showed varying degrees of dynamic intraventricular obstruction. Echocardiographic parameters are reported. Benign neurocardiogenic weakness or syncopal events during handling were suspected in three birds. Stress combined with an intraventricular obstruction is believed to have triggered a cascade of parasympathetic innervation and sympathetic inhibition, similar to neurally mediated reflex syncope in humans.
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Affiliation(s)
- Anders S Schrøder
- University Hospital for Companion Animal, University of Copenhagen, 1870-Frederiksberg, Denmark
| | - Jakob L Willesen
- University Hospital for Companion Animal, University of Copenhagen, 1870-Frederiksberg, Denmark
| | - Kathryn L Perrin
- University Hospital for Companion Animal, University of Copenhagen, 1870-Frederiksberg, Denmark
| | - Mads F Bertelsen
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, 2000 Frederiksberg, Denmark
| | - Jørgen Koch
- University Hospital for Companion Animal, University of Copenhagen, 1870-Frederiksberg, Denmark,
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [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: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Addoumieh A, Abdallah MS, Ballout JA, Thuita L, Klein A, Jaber WA, Arsanjani R, Carey W, Majdalany D. Clinical implications of inducible left ventricular outflow tract obstruction among patients undergoing liver transplant evaluation. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 4:100026. [PMID: 38559677 PMCID: PMC10976285 DOI: 10.1016/j.ahjo.2021.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 04/04/2024]
Abstract
Introduction Patients with end stage liver disease (ESLD) have a hyperdynamic state due to decreased systemic vascular resistance and increased cardiac output. Preoperative evaluation with dobutamine stress echocardiography (DSE) is used to risk-stratify patients prior to liver transplant. We sought to identify the impact of inducible left ventricular outflow tract obstruction (LVOTO) on DSE on post-operative liver transplant outcomes. Methods Patients with ESLD who underwent liver transplant at Cleveland Clinic between January 2007 and August 2016 were identified. Pre-operative DSE data, and post-operative intensive care unit (ICU) data were extracted. Patients with inducible LVOTO were compared to those without LVOTO. Results Of the 515 patients identified who underwent DSE prior to liver transplant, 165 (30%) were female, and 95 (18%) had LVOTO. There were no major differences in baseline characteristics between the two groups. In the LVOTO group, rest gradients were 10.8 ± 3 mm Hg while peak gradients were 90 ± 48.2 mm Hg. No significant differences in ICU length of stay or duration of mechanical ventilation between both groups were noted. There were 21 deaths at 30 days. There were 2 (2.1%) deaths in the LVOTO group, versus 19 (4.5%) deaths in the non LVOTO group (p = 0.28). Higher Model for End Stage Liver Disease (MELD) scores predicted longer duration of mechanical ventilation and ICU length of stay. Conclusion Inducible LVOTO on DSE does not adversely affect the short-term outcomes post liver transplant. Presence of inducible LVOTO should not be the mere reason to deny liver transplant among patients with ESLD.
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Affiliation(s)
| | | | - Jad A. Ballout
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
| | - Lucy Thuita
- Quantitative Health Science Department, Cleveland Clinic Foundation, USA
| | - Allan Klein
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
| | - Wael A. Jaber
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - William Carey
- Digestive Disease Institute, Cleveland Clinic Foundation, USA
| | - David Majdalany
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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King P, Flaker G, Weachter R, Chockalingam A. Dobutamine-induced midcavitary gradients do not cause dyspnea. HeartRhythm Case Rep 2015; 2:74-75. [PMID: 28491637 PMCID: PMC5412635 DOI: 10.1016/j.hrcr.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Phillip King
- University of Missouri Division of Cardiology, Columbia, Missouri
| | - Greg Flaker
- University of Missouri Division of Cardiology, Columbia, Missouri
| | - Richard Weachter
- University of Missouri Division of Cardiology, Columbia, Missouri
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Chauvet JL, El-Dash S, Delastre O, Bouffandeau B, Jusserand D, Michot JB, Bauer F, Maizel J, Slama M. Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:262. [PMID: 26082197 PMCID: PMC4522114 DOI: 10.1186/s13054-015-0980-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/05/2015] [Indexed: 12/02/2022]
Abstract
Introduction Based on previously published case reports demonstrating dynamic left intraventricular obstruction (IVO) triggered by hypovolemia or catecholamines, this study aimed to establish: (1) IVO occurrence in septic shock patients; (2) correlation between the intraventricular gradient and volume status and fluid responsiveness; and (3) mortality rate. Method We prospectively analyzed patients with septic shock admitted to a general ICU over a 28-month period who presented Doppler signs of IVO. Clinical characteristics and hemodynamic parameters as well as echocardiographic data regarding left ventricular function, size, and calculated mass, and left ventricular outflow Doppler pattern and velocity before and after fluid infusions were recorded. Results During the study period, 218 patients with septic shock were admitted to our ICU. IVO was observed in 47 (22 %) patients. Mortality rate at 28 days was found to be higher in patients with than in patients without IVO (55 % versus 33 %, p < 0.01). Small, hypercontractile left ventricles (end-diastolic left ventricular surface 4.7 ± 2.1 cm2/m2 and ejection fraction 82 ± 12 %), and frequent pseudohypertrophy were found in these patients. A rise ≥12 % in stroke index was found in 87 % of patients with IVO, with a drop of 47 % in IVO after fluid infusion. Conclusion Left IVO is a frequent event in septic shock patients with an important correlation with fluid responsiveness. The mortality rate was found to be higher in these patients in comparison with patients without obstruction.
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Affiliation(s)
- Jean-Louis Chauvet
- General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France.
| | - Shari El-Dash
- Service de Réanimation Médicale, CHU Sud 80054, cedex 1, France. .,LIM-09 Medical Research Laboratory in Experimental Pneumology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil.
| | - Olivier Delastre
- General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France.
| | - Bernard Bouffandeau
- General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France.
| | - Dominique Jusserand
- General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France.
| | - Jean-Baptiste Michot
- General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France.
| | - Fabrice Bauer
- Heart Failure and pulmonary hypertension Clinic, Echo Core Lab, Cardiology Department, Charles Nicolle Hospital, Rouen University Hospital, Rouen, France.
| | - Julien Maizel
- Service de Réanimation Médicale, CHU Sud 80054, cedex 1, France. .,INSERM U-1088, Jules Verne University of Picardie, Amiens, France.
| | - Michel Slama
- Service de Réanimation Médicale, CHU Sud 80054, cedex 1, France. .,INSERM U-1088, Jules Verne University of Picardie, Amiens, France.
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Carrilho-Ferreira P, Pinto FJ. The role of multimodality imaging in takotsubo cardiomyopathy. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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