Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Although a myxoma is not cancer, complications are common. Untreated, a myxoma can lead to an embolism (tumor cells breaking off and traveling with the bloodstream), which can block blood flow. Myxoma fragments can move to the brain, eye, or limbs.
If the tumor grows inside the heart, it can block blood flow through the mitral valve and cause symptoms of mitral stenosis or mitral regurgitation. This may require emergency surgery to prevent sudden death.
Myxomas are the most common type of primary heart tumor.
The tumor is derived from multipotential mesenchymal cells and may cause a ball valve-type obstruction.
About 75% of myxomas occur in the left atrium of the heart, usually beginning in the wall that divides the two upper chambers of the heart. The rest are in the right atrium, rarely in the left ventricle. Right atrial myxomas are sometimes associated with tricuspid stenosis and atrial fibrillation.
Myxomas are more common in women. About 10% of myxomas are passed down through families (inherited), as in Carney syndrome, where several other abnormalities are observed, such as skin myxomas, pigmentation, endocrine hyperactivity, schwannomas and epithelioid blue nevi. Such tumors are called familial myxomas. They tend to occur in more than one part of the heart at a time, and often cause symptoms at a younger age than other myxomas.
Atrial fibrillation increases the risk of heart failure by 11 per 1000, kidney problems by 6 per 1000, death by 4 per 1000, stroke by 3 per 1000, and coronary heart disease by 1 per 1000. Women have a worse outcome overall than men. Evidence increasingly suggests that atrial fibrillation is independently associated with a higher risk of developing dementia.
Some recent research has suggested that a proportion of cases of migraine may be caused by PFO. While the exact mechanism remains unclear, closure of a PFO can reduce symptoms in certain cases. This remains controversial; 20% of the general population has a PFO, which for the most part, is asymptomatic. About 20% of the female population has migraines, and the placebo effect in migraine typically averages around 40%. The high frequency of these facts finding statistically significant relationships between PFO and migraine difficult (i.e., the relationship may just be chance or coincidence). In a large randomized controlled trial, the higher prevalence of PFO in migraine patients was confirmed, but migraine headache cessation was not more prevalent in the group of migraine patients who underwent closure of their PFOs.
It can result in many abnormal heart rhythms (arrhythmias), including sinus arrest, sinus node exit block, sinus bradycardia, and other types of bradycardia (slow heart rate).
Sick sinus syndrome may also be associated with tachycardias (fast heart rate) such as atrial tachycardia (PAT) and atrial fibrillation. Tachycardias that occur with sick sinus syndrome are characterized by a long pause after the tachycardia. Sick sinus syndrome is also associated with azygos continuation of interrupted inferior vena cava.
Cardiac myxomas predominantly appear in females in their 30s to 40s. Myxomas are the most common primary cardiac tumor affecting adults, accounting for one quarter to half of primary cardiac tumors seen in clinical practice.
If untreated, this abnormal heart rhythm can lead to dizziness, chest pain, a sensation of fluttering or pounding in the chest (palpitations), shortness of breath, or fainting (syncope). Atrial fibrillation also increases the risk of stroke. Complications of familial atrial fibrillation can occur at any age, although some people with this heart condition never experience any health problems associated with the disorder.
Atrial fibrillation is the most common type of sustained abnormal heart rhythm (arrhythmia), affecting more than 3 million people in the United States. The risk of developing this irregular heart rhythm increases with age. The incidence of the familial form of atrial fibrillation is unknown; however, recent studies suggest that up to 30 percent of all people with atrial fibrillation may have a history of the condition in their family.
The true incidence of TIC is unclear. Some studies have noted the incidence of TIC in adults with irregular heart rhythms to range from 8% to 34%. Other studies of patients with atrial fibrillation and left ventricular dysfunction estimate that 25-50% of these study participants have some degree of TIC. TIC has been reported in all age groups.
Disorders that cause scarring, degeneration, or damage to the sinoatrial node can cause sick sinus syndrome, including sarcoidosis, amyloidosis, hemochromatosis, Chagas' disease, and cardiomyopathies. Abnormal heart rhythms are often caused or worsened by medications such as digoxin, calcium channel blockers, beta-blockers, sympatholytic medications, and anti-arrhythmics.
Coronary artery disease, high blood pressure, and aortic and mitral valve diseases may be associated with sick sinus syndrome, although this association may only be incidental. The mechanism is related to delayed escape. Congenital SSS can be due to mutations of the gene responsible for formation of Alpha subunit of sodium channel (SCN5A).
Determining the risk of an embolism causing a stroke is important for guiding the use of anticoagulants. The most accurate clinical prediction rules are:
- CHADS2
- CHA2DS2-VASc
Both the CHADS2 and the CHA2DS2-VASc score predict future stroke risk in people with a-fib with CHA2DS2-VASc being more accurate. Some that had a CHADS2 score of 0 had a CHA2DS2-VASc score of 3, with a 3.2% annual risk of stroke. Thus a CHA2DS2-VASc score of 0 is considered very low risk.
As a group, atrial septal defects are detected in one child per 1500 live births. PFOs are quite common (appearing in 10–20% of adults), but asymptomatic, so undiagnosed. ASDs make up 30 to 40% of all congenital heart diseases that are seen in adults.
The ostium secundum atrial septal defect accounts for 7% of all congenital heart lesions. This lesion shows a male:female ratio of 1:2.
In the general population, obesity appears to be the most important risk factor for LAE. LAE has been found to be correlated to body size, independent of obesity, meaning that LAE is more common in people with a naturally large body size. Also, a study found that LAE can occur as a consequence of atrial fibrillation (AF), although another study found that AF by itself does not cause LAE. The latter study also showed that the persistent type of AF was associated with LAE, but the number of years that a subject had AF was not.
Obstructive sleep apnea (OSA) may be a cause of LAE in some cases. When an OSA event occurs, an attempt is made to breathe with an obstructed airway and the pressure inside the chest is suddenly lowered. The negative intrathoracic pressure may cause the left atrium to expand and stretch its walls during each OSA event. Over time, the repetitive stretching of the left atrium may result in a persistent left atrial enlargement.
The cause is poorly understood. However several risk factors are associated with pacemaker syndrome.
Studies have shown that patients with Pacemaker syndrome and/or with sick sinus syndrome are at higher risk of developing fatal complications that calls for the patients to be carefully monitored in the ICU. Complications include atrial fibrillation, thrombo-embolic events, and heart failure.
Good peer to peer support is available on Facebook. For new and existing parents The group, Transposition of the Great Arteries
For ADULT survivors of D-TGA the Facebook group Mustard or Senning Survivors, gathers several hundred global survivors in their 20s to 50s into a single community. Supporting ADULTS born with TGA that have had a Mustard, Senning, Rastelli or Nikaidoh Heart Procedure *This group is not recommended for Parents of Arterial Switch children.
Hypertension, or abnormally high blood pressure, often signifies an elevated level of both psychological and physiological stress. Often, hypertension goes hand in hand with various atrial fibrillations including premature atrial contractions (PACs). Additional factors that may contribute to spontaneous premature atrial contractions could be:
- Increased age
- Abnormal body height
- History of cardiovascular disease (CV)
- Abnormal ANP levels
- Elevated cholesterol
It was Bex who introduced in 1980 the possibility of aortic translocation. But Nikaidoh has put the procedure in practice in 1984. It results in an anatomical normal heart, even better than with an ASO, because also the cones are switched instead of only the arteries as with an ASO.
It has as contra-indication coronary anomalies.
In otherwise healthy patients, occasional premature atrial contractions are a common and normal finding and do not indicate any particular health risk. Rarely, in patients with other underlying structural heart problems, PACs can trigger a more serious arrhythmia such as atrial flutter or atrial fibrillation. In otherwise healthy people, PACs usually disappear with adolescence.
Literature survey on epidemiology and pathology of cardiac fibroma:
During this study, researchers searched through the literature databases on cardiac fibroma to find factors that predict poor outcomes that lead to death. Researchers found that patients who did not survive were significantly younger than those who did survive. These results suggest that younger individuals diagnosed with cardiac fibroma are associated with a poorer outcome. They found no significant difference between the maximum diameter of the tumor between age groups. Even though younger individuals have smaller hearts, the high ratio of tumor-to-heart sizes may generate low cardiac output, which leads to a poor outcome. Literature revealed that 18 of 178 patients with cardiac fibroma were diagnosed during prenatal and neonatal periods, resulting in the tumor having a certain size regardless of the child's age. These findings suggest that cardiac fibromas may be a congenital disorder.
Successful Surgical Excision of a Large Cardiac Fibroma in an Asymptomatic Child:
A 3-year-old girl, who was asymptomatic, underwent a successful surgical excision of a large cardiac fibroma. She had frequent coughs, which led to a chest radiograph. A cardiac mass was found on the echocardiography and later was confirmed by magnetic resonance imaging (MRI). After 24 hours of being monitored, it showed sinus rhythms of normal variability. The mass dimensions were 38 X 28 mm in the apical area of the left ventricle. A surgical procedure was recommended due to the risk of ventricular arrhythmias and sudden cardiac death. The surgery was a success and they were able to remove the entire tumor without any complications. Follow-up evaluations at six-months and a year showed the patient was in good health and no signs of tumor recurrence. Asymptomatic patients with cardiac fibroma becomes controversial because these tumors have the tendency to grow. Situations like this, a surgical removal will be the top recommendation for patients.
Primary cardiac tumors in children: a center's experience:
The Department of Cardiac Surgery Children's Hospital in China conducted a study to analyze different characteristics and outcomes of pediatric patients who have primary cardiac tumors treated in their center. They had sixteen patients with primary cardiac tumors between the ages of 1–13 years. All patients were diagnosed by echocardiography, MRI, and computed tomography (CT). As a result, they were able to successfully remove the mass from 15 patients with cardiopulmonary bypass, whereas partial resection was done in one patient. Unfortunately, one patient died during surgery due to low cardiac output syndrome at 5 days after operation. The pathological examination of the cardiac masses showed that rhabdomyoma is the most frequent tumor in children, followed by myxoma, fibromas, etc. Morbidity of rhabdomyomas and fibromas were reported higher in infancy, while myxomas are more frequent in older children.
Almost all cases of mitral stenosis are due to disease in the heart secondary to rheumatic fever and the consequent rheumatic heart disease. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets, and as a form of congenital heart disease. However, there are primary causes of mitral stenosis that emanate from a cleft mitral valve. It is the most common valvular heart disease in pregnancy.
Other causes include infective endocarditis where the vegetations may favor increase risk of stenosis. Other rare causes include mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, whipple disease, fabry disease, and rheumatoid arthritis. hurler' disease, hunter's disease, amyloidosis.
Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition. Although other factors may contribute, left atrium size has been found to be a predictor of mortality due to both cardiovascular issues as well as all-cause mortality. Current research suggests that left atrium size as measured by an echo-cardiograph may have prognostic implications for preclinical cardiovascular disease. However, studies that have found LAE to be a predictor for mortality recognize the need for more standardized left atrium measurements than those found in an echo-cardiogram.
Symptoms associated with cardiac myxomas are typically due to the effect of the mass of the tumor obstructing the normal flow of blood within the chambers of the heart. Because pedunculated myxomas are somewhat mobile, symptoms may only occur when the patient is in a particular position.
Some symptoms of myxoma may be associated with the release of interleukin 6 (IL-6) by the myxoma. High levels of IL-6 may be associated with a higher risk of embolism of the myxoma.
Symptoms of a cardiac myxoma include:
- Dyspnea on exertion
- Paroxysmal nocturnal dyspnea
- Fever
- Weight loss (see cachexia)
- Lightheadedness or syncope (Loss of consciousness)
- Hemoptysis
- Sudden death
- Tachycardia or milder heartrate, i.e. 75 - 100 cycl/min
Until recently, it was generally assumed that the prognosis for individuals with diastolic dysfunction and associated intermittent pulmonary edema was better than those with systolic dysfunction. In fact, in two studies appearing in the New England Journal of Medicine in 2006, evidence was presented to suggest that the prognosis in diastolic dysfunction is the same as that in systolic dysfunction.
MAT usually arises because of an underlying medical condition. Its prevalence has been estimated at about 3 per 1000 in adult hospital inpatients and is much rarer in paediatric practice; it is more common in the elderly, and its management and prognosis are both those of the underlying diagnosis.
It is mostly common in patients with lung disorders, but it can occur after acute myocardial infarction and can also occur in the setting of low blood potassium or low blood magnesium.
It is sometimes associated with digitalis toxicity in patients with heart disease.
It is most commonly associated with hypoxia and COPD. Additionally, it can be caused by theophylline toxicity, a drug with a narrow therapeutic index commonly used to treat COPD. Theophylline can cause a number of different abnormal heart rhythms when in excess, and thus further predisposes COPD patients to MAT. Theophylline toxicity often occurs following acute or chronic overtreatment or factors lowering its clearance from the body.
The natural history of mitral stenosis secondary to rheumatic fever (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years.
In individuals having been offered mitral valve surgery but refused, "survival" with medical therapy alone was 44 ± 6% at 5 years, and 32 ± 8% at 10 years after they were offered correction.