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Background Ebstein's anomaly is a rare congenital heart disease characterized by apical displacement of the septal and posterior tricuspid valve leaflets. It is commonly associated with other defects such as patent foramen ovale or accessory atrioventricular pathways. Case summary We describe a case of an Ebstein anomaly diagnosed in an adult in his 50s in association with a septal defect between the left ventricle and right atrium (Gerbode defect). The diagnosis was confirmed on magnetic resonance imaging. A third anomaly was noted on coronary angiography, consisting of an aberrant origin of the right coronary artery from the left sinus of Valsalva. The patient was paucisymptomatic until he developed typical atrial flutter. Catheter ablation was employed after first arrhythmia recurrence and the patient is to date in good clinical condition. Conclusion The association of Ebstein's anomaly–Gerbode defect is extremely rare, and to our knowledge, this is the first case that presents in addition an anomalous coronary artery. Both structural defects were without haemodynamic significance, and there was no proof of myocardial ischaemia. As the case illustrates, congenital disorders, even when in conjunction, can have a silent clinical course and multimodality imaging is sometimes necessary for a complete and final diagnosis. [ABSTRACT FROM AUTHOR]

The escalation of global obesity is driving research to understand environmental influences on this process, particularly during vulnerable developmental stages such as childhood and adolescence. Efforts include the development of various structured data collection tools. We aimed to adapt a series of previously validated questionnaires from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), the Child Feeding Questionnaire, and elements from the World Health Organization Childhood Obesity Surveillance Initiative (COSI) in order to assess local lifestyle patterns among Romanian high school students and their families that may predispose them to obesity. To this goal, an expert committee was formed as part of a research partnership to oversee the questionnaire's translation and adaptation. It consisted of education and school management specialists, clinical research professionals, language experts, and public health experts. The adapted questionnaires were then applied to 114 students enrolled in the 9th and 10th grades attending a high school situated in Sibiu, and their parents. The variables measured were investigated for correlations with overweight and obesity and, as a secondary objective, academic performance. The study revealed several critical findings, including suboptimal sleep durations and physical activity levels among students, a significant amount of screen time, and correlations between weight status and physical activity, sedentary time, and maternal weight status and education levels. The adapted questionnaires proved to be effective tools in capturing the multifaceted factors implicated in adolescent obesity, providing a foundation for targeted interventions and broader public health strategies to address this issue. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are common heart muscle disorders that are caused by pathogenic variants in sarcomere protein genes. In this study, we describe a variant in the MHY7 gene, segregating in a family having three different phenotypes of cardiomyopathies. MYH7 encodes for the myosin heavy-chain β (MHC-β) isoform involved in cardiac muscle contractility. Method and results: We present the case of a family with four members diagnosed with HCM and four members with DCM. The proband is a 42-year-old man diagnosed with HCM. He has an extended family of eight siblings; two of them are diagnosed with HCM and are implantable cardioverter–defibrillator (ICD) carriers. One of the siblings died at the age of 23 after suffering a sudden cardiac arrest and DCM of unknown etiology which was diagnosed at autopsy. Another brother was diagnosed with DCM during a routine echocardiographic exam. Genetic testing was performed for the proband and two of his siblings and a niece of the proband, who suffered a cardiac arrest at the age of nine, all being MYH7 mutation positive. For all four of them, cardiac imaging was performed with different findings. They are ICD carriers as well. Conclusions: Our results reveal three variants in phenotypes of cardiomyopathies in a family with MYH7 mutation associated with high SCD risk and ICD needed for primary and secondary prevention. [ABSTRACT FROM AUTHOR]

The relation between renal impairment and cardiovascular disease is currently a well documented problem within the "heart-kidney axis" concept. In the patients with coronary heart disease, acute renal dysfunction occurs with an incidence of between 9 and 19%.(1) Regarding the preexisting renal function status, status with a powerful prognostic significance, this may occur in the patients with normal renal function or with the renal failure. In our study, we wish to characterize the profile of patients through an analytical, observational, retrospective cohort study on a group of patients hospitalized between 01.01.2012 and 01.03.2012 in the Cardiology Clinic within the County Clinical Emergency Hospital of Sibiu, associated with a descriptive study of this group. This study is useful to establish a relation between myocardial infarction and renal dysfunction. [ABSTRACT FROM AUTHOR]

The relation between renal impairment and cardiovascular disease is currently a well documented problem within the "heart-kidney axis" concept. In the patients with coronary heart disease, acute renal dysfunction occurs with an incidence of between 9 and 19%.(1) Regarding the pre-existing renal function status, status with a powerful prognostic significance, this may occur in the patients with normal renal function or with the renal failure. In our study, we wish to characterize the profile of patients through an analytical, observational, retrospective cohort study on a group of patients hospitalized between 01.01.2012 and 01.03.2012 in the Cardiology Clinic within the County Clinical Emergency Hospital of Sibiu, associated with a descriptive study of this group. This study is useful to establish a relation between myocardial infarction and renal dysfunction. INT [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise testing is a specialized advanced investigation characterizing in a complex manner the exercise capacity of the person who undertakes it. Thus, on effort electrocardiogram, blood pressure and oxygen saturation are monitored, oxygen consumption rate and carbon dioxide consumption are measured, as well as other ventilator parameters. The information obtained allows an evaluation of all organs and systems involved in the effort process: cardiovascular, respiratory, musculoskeletal, hematopoietic and mental. In this article, we present the most important parameters resulted from the cardiopulmonary exercise testing and their interpretation. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise testing is a specialized advanced investigation characterizing in a complex manner the exercise capacity of the person who undertakes it. Thus, on effort electrocardiogram, blood pressure and oxygen saturation are monitored, oxygen consumption rate and carbon dioxide consumption are measured, as well as other ventilator parameters. The information obtained allows an evaluation of all organs and systems involved in the effort process: cardiovascular, respiratory, musculoskeletal, hematopoietic and mental. In this article, we present the most important parameters resulted from the cardiopulmonary exercise testing and their interpretation. [ABSTRACT FROM AUTHOR]

Introduction: The cardiorenal syndrome (CRS) is a heterogeneous pathology with important prognostic significance when present. Aim of the study: In this study, we aimed at identifying some of the risk factors influencing the prognosis of CRS patients. Materials and Methods: We analyzed 85 patients with heart failure hospitalized in Monzino Cardiology Centre in Milan during a 3-month period. The glomerular filtration rate (GFR) was calculated using the MDRD equation (Modification of Diet in Renal Disease) and maximal oxygen consumption (VO2max) was measured during cardiopulmonary exercise testing. Results: VO2 max was significantly decreased correspondingly to the decrease of the GFR. Patients with a GFR <30ml/min/l, 73m² had more major risk factors (advanced age, NYHA class 4, anemia, diabetes, BNP> 600pg/ml, VO2max <14ml/kg/min) than the patients with higher GFR. Conclusions: The presence of cardiorenal syndrome is associated with an increased incidence of major cardiovascular risk factors and a poor performance during exercise. [ABSTRACT FROM AUTHOR]

Introduction: The cardiorenal syndrome (CRS) is a heterogeneous pathology with important prognostic significance when present. Aim of the study: In this study, we aimed at identifying some of the risk factors influencing the prognosis of CRS patients. Materials and Methods: We analyzed 85 patients with heart failure hospitalized in Monzino Cardiology Centre in Milan during a 3-month period. The glomerular filtration rate (GFR) was calculated using the MDRD equation (Modification of Diet in Renal Disease) and maximal oxygen consumption (VO2max) was measured during cardiopulmonary exercise testing. Results: VO2 max was significantly decreased correspondingly to the decrease of the GFR. Patients with a GFR <30ml/min/l, 73m² had more major risk factors (advanced age, NYHA class 4, anemia, diabetes, BNP> 600pg/ml, VO2max <14ml/kg/min) than the patients with higher GFR. Conclusions: The presence of cardiorenal syndrome is associated with an increased incidence of major cardiovascular risk factors and a poor performance during exercise. [ABSTRACT FROM AUTHOR]

Cardiorenal syndrome is often described in heart failure patients and it represents the deterioration of renal function in the context of heart failure. When it occurs, the prognosis of these patients is affected by the combination of these pathologies. The treatment for cardiorenal syndrome should be applied individually in order to achieve the improvement of the patient's clinical status, the preservation of the heart and kidney function and a better outcome. Along with traditional therapies (diuretics, inotropes), which often develop resistance, the beneficial effect of new therapeutic options (ultrafiltration, vasopressin and adenosine antagonists) is being evaluated in different trials. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The cardiorenal syndrome (SCR) is a complex syndrome which represents the interaction between the two organs when the dysfunction of one involves the dysfunction of the other. Imaging methods are necessary for the diagnosis and management of the patients with cardiorenal syndrome and they are useful in characterizing the dynamics of cardiac and renal performance, in order to define the interaction between the two systems and to characterize their progress in treatment. In the patients with cardiorenal syndrome, ultrasound provides valuable information on cardiac structure and function and on the acute or chronic nature of kidney disease. Modern imaging techniques are useful in characterizing the status of the two organs damage. These data are integrated with the results of the biological investigations to complete the pathophysiological profile and the evolution of this complex syndrome. [ABSTRACT FROM AUTHOR]

The cardiorenal syndrome (SCR) is a complex syndrome which represents the interaction between the two organs when the dysfunction of one involves the dysfunction of the other. Imaging methods are necessary for the diagnosis and management of the patients with cardiorenal syndrome and they are useful in characterizing the dynamics of cardiac and renal performance, in order to define the interaction between the two systems and to characterize their progress in treatment. In the patients with cardiorenal syndrome, ultrasound provides valuable information on cardiac structure and function and on the acute or chronic nature of kidney disease. Modern imaging techniques are useful in characterizing the status of the two organs damage. These data are integrated with the results of the biological investigations to complete the pathophysiological profile and the evolution of this complex syndrome. [ABSTRACT FROM AUTHOR]

Hyperopic eyes have specific particularities that require a special attention in the preoperative evaluation. The depth of the anterior chamber in correlation with other conditions can dictate the behaviour during the surgery. Biometry must be very accurate to respond to the expectations of the patient. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The therapeutic management of the patients with atrial fibrillation should take into account the risk for thromboembolism, resulted in an incidence of strokes 5 times higher than in the general population. The stratification of this risk is validated by two scoring systems (CHADS2, CHA2DS2- VASc) which provide the ideal therapeutic option for each patient. Some controversies about the approach of thromboembolic risk in the latest Guide for the management of the patients with atrial fibrillation seem to have been resolved by the recent studies. [ABSTRACT FROM AUTHOR]

The therapeutic management of the patients with atrial fibrillation should take into account the risk for thromboembolism, resulted in an incidence of strokes 5 times higher than in the general population. The stratification of this risk is validated by two scoring systems (CHADS2, CHA2DS2- VASc) which provide the ideal therapeutic option for each patient. Some controversies about the approach of thromboembolic risk in the latest Guide for the management of the patients with atrial fibrillation seem to have been resolved by the recent studies. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The use of Amiodarone as a first-line antiarrhythmic agent in secondary prophylaxis of sudden cardiac death is limited by its well-known toxicity. The side effects depend on the age of the patient, the dosage and the duration of the treatment. We hereby present the case of a 62-year old female patient, with obesity and hypertension, with a history of malignant rhythm disorders and a long and effective, but unsupervised treatment with Amiodarone. After a period of 7 years, the patient is hospitalized with severe acute respiratory insufficiency, initially diagnosed as a high risk pulmonary thromboembolism. Although the specific treatment, including the thrombolytic one, improved the respiratory and hemodynamic status of the patient, it did not have the estimated result. The repeated imaging showed parenchymal aspects, not farmable in the initial diagnosis, corresponding to pulmonary fibrosis. The treatment with Amiodarone was replaced with corticotherapy, resulting in a noticeable alleviation of respiratory status. [ABSTRACT FROM AUTHOR]

Minimally invasive techniques are increasingly used in cardiac valve surgery, with satisfactory results to date. The present study is important because it is an attempt to address these problems at the level of a single center, on a population of patients from 2018, who have benefited from the approach of the valvular pathologies through minimally invasive novel techniques. In this retrospective study, data were collected, in 2018 and 2019, in an observational, nonintervention study, for patients with minimally invasive cardiac valve surgery in 2018. There were 93 cases with minimally invasive valve surgery during 2018. There was only one death regarding the 30-day-follow up. In the group of patients who had minimally invasive valve surgery, in this particular center, in 2018, we conclude that the hybrid approach is safe. [ABSTRACT FROM AUTHOR]

Patients with heart failure (HF) can be divided into those with heart failure and a reduced ejection fraction (HFrEF) and those with heart failure and a preserved ejection fraction (HFpEF). In the presence of compromised systolic function, appropriate signs and symptoms make it relatively easy to set the diagnosis of heart failure. However, because of the nonspecific nature of clinical findings, especially the symptoms of heart failure, when left ventricle (LV) systolic functions normally, the diagnosis becomes more difficult. Efficient diagnosis and optimal therapy remain challenging in this population. Imaging, electrocardiographic, and circulating biomarkers, as well as pharmacogenetics, may help facilitating HF diagnosis, stratifying the risk, and individualizing the therapy. Biomarkers reflect myocyte stress, myocyte injury, renal function, systemic inflammation and fibrosis have contributed to better understanding the pathophysiologic mechanisms relevant to HFpEF, and may eventually help facilitating more effective and personalized management of this syndrome. Biomarkers include proteins, peptides, and microRNAs that can be measured in the plasma and can be shown to represent changes in myocardial structure or function that reflect underlying pathophysiologic processes.(1) In this article, we present the biomarkers that cause changes in hemodynamic and fibrosis in patients with HFpEF: natriuretic peptides, markers of extracellular matrix turnover, galectin-3, markers of renal function, cardiac troponins, ST2, growth differentiation factor (GDF-15), microRNAs. [ABSTRACT FROM AUTHOR]

Heart failure with preserved ejection fraction (HFPEF) is increasing in prevalence with the aging of the population, and morbidity and mortality rates are comparable to that of heart failure with reduced ejection fraction (HFREF). Recent literature focusing on the pathophysiology underlying this disease suggests that multiple mechanisms are involved in the generation of the phenotype, such as abnormal relaxation and ventricular-vascular coupling, chronotropic incompetence, volume overload and endothelial dysfunction. Currently, no clinically proven treatments are shown to decrease morbidity and mortality in this population; however, there may be a novel multidisciplinary and multistage treatment strategy that can be studied to address this complex disease which incorporates pharmacologic and non-pharmacologic therapeutics. The treatment of patients with heart failure and preserved left ventricular (LV) function is not well established and remains mostly empirical. The lack of large placebo-controlled trials in this field seems to be due to the fact that investigators mainly focus on systolic dysfunction, which was for a long while perceived as the only causative mechanism of heart failure, and also because of the ambiguity of the definition of diastolic heart failure (DHF). [ABSTRACT FROM AUTHOR]

Heart failure with preserved ejection fraction (HFPEF) is increasing in prevalence with the aging of the population, and morbidity and mortality rates are comparable to that of heart failure with reduced ejection fraction (HFREF). Recent literature focusing on the pathophysiology underlying this disease suggests that multiple mechanisms are involved in the generation of the phenotype, such as abnormal relaxation and ventricular-vascular coupling, chronotropic incompetence, volume overload and endothelial dysfunction. Currently, no clinically proven treatments are shown to decrease morbidity and mortality in this population; however, there may be a novel multidisciplinary and multistage treatment strategy that can be studied to address this complex disease which incorporates pharmacologic and non-pharmacologic therapeutics. The treatment of patients with heart failure and preserved left ventricular (LV) function is not well established and remains mostly empirical. The lack of large placebo-controlled trials in this field seems to be due to the fact that investigators mainly focus on systolic dysfunction, which was for a long while perceived as the only causative mechanism of heart failure, and also because of the ambiguity of the definition of diastolic heartfailure (DHF). [ABSTRACT FROM AUTHOR]

Determining the ejection fraction of the left ventricle (LV) divides the patients with clinical and objective features of heart failure into two classes: patients with altered/reduced ejection fraction (HFREF) and patients with preserved ejection fraction (HFPEF). For a long period of time, the attention was focused on HF with reduced ejection fraction, but epidemiological studies have shown that 50% of the patients with signs and symptoms of heart failure have the ejection fraction in normal limits. In our study, we wish to make a characterization of the profile of the patients with heart failure as it appears in daily practice and not in the case of carefully selected population as it happens in trials. This study is useful for emphasizing the current reality existing in the case of patients with heart failure. [ABSTRACT FROM AUTHOR]

Determining the ejection fraction of the left ventricle (LV) divides the patients with clinical and objective features of heart failure into two classes: patients with altered/reduced ejection fraction (HFREF) and patients with preserved ejection fraction (HFPEF). For a long period of time, the attention was focused on HF with reduced ejection fraction, but epidemiological studies have shown that 50% of the patients with signs and symptoms of heart failure have the ejection fraction in normal limits. In our study, we wish to make a characterization of the profile of the patients with heart failure as it appears in daily practice and not in the case of carefully selected population as it happens in trials. This study is useful for emphasizing the current reality existing in the case ofpatients with heart failure. [ABSTRACT FROM AUTHOR]

Introduction. Nicorandil, a vasodilator with strong coronary and peripheral vascular activity is current used as an antianginal agent, but its effect in heart failure (HF) patients has not been fully established. Therefore, we examined impact of nicorandil in outcomes of ischemic HF patients. Materials and methods. HF patients with ischemic etiology were prospectively registered and divided into 2 groups based on oral administration of nicorandil: nicorandil group (n = 6) and non-nicorandil group (n=6). Patients were randomly assigned to be treated with or without oral nicorandil, 10 mg twice daily for 5 days. BNP values were measured at admission and at 5th day. Patients undergo ecocardiography exam and 6 minutes walk test. Results: Echocardiographic measurements showed no statistical relevant differences between groups. The mean distance at the 6minute walk test has higher in the nicorandil group (396 meters) versus non-nicorandil group (320 meters) and BNP levels after 5 days were decreased significant in the nicorandil group. Conclusion: Nicorandil is potentially effective for treatment in patients with ischemic heart failure. [ABSTRACT FROM AUTHOR]

Introduction. Adherence to guidelines treatment in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate characteristics of HF in patients with ischemic heart disease (IHD), and to assess the adherence to current HF guidelines. Materials and methods. There were included patients admitted to the Cardiology Clinic with decompensate HF and IHD. Guideline Adherence Indicator was calculated as the number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers and diuretics. Results: 98/111 patients entered the analysis. HF class II was prevalent in 51%, class III in 38,7% and class IV 9.18%,; 29/98 patients were diagnosed with HFREF (29%). A high prevalence of arterial hypertension and PCI was found. Global adherence indicator was 73%, HFPEF patients had a lower indicator. Conclusions. Pharmacotherapy was fairly well implemented in HFREF patients, worse in patients with more preserved ejection fraction. [ABSTRACT FROM AUTHOR]

The sinovial sarcoma is extremely rare; seven cases have been described in the literature of specialty. The majority of synovial sarcomas are localized in the right heart. Dispnoea, palpitations and syncopa are the major symptoms of the heart tumors. Th e echocardiography allows the detection of masses and of the pericardial liquid. The heart synovial sarcoma has a bad prognosis, in general, the medium survival being about 6 month. In this paper we will present a case of synovial heart sarcoma, localized in the left ventricle in which the echocardiography allowed the visualization of pericardial liquid and the cardiac masses. The pericardiocentesis shows the hemoragycal nature of pericardial liquid. Th e case presented, evolutes to death in 10 month from the surgery, the survival being above the medium survival described in literature, probably due to the low grade of the mitotic activity. [ABSTRACT FROM AUTHOR]