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American Journal of Cardiovascular Disease Research

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Editor-in-Chief: Dario Galante

Website: http://www.sciepub.com/journal/AJCDR

   

Article

Risk Factors of Peripartum Cardiomyopathy and the Important Role of Prenatal Care

1Department of Cardiology and Vascular Medicine, Padjadjaran University, Jalan Eijkman 38, Bandung 40161, Indonesia


American Journal of Cardiovascular Disease Research. 2015, 3(1), 5-8
doi: 10.12691/ajcdr-3-1-2
Copyright © 2015 Science and Education Publishing

Cite this paper:
Hawani Sasmaya Prameswari, Augustine Purnomowati, Toni Mustahsani Aprami. Risk Factors of Peripartum Cardiomyopathy and the Important Role of Prenatal Care. American Journal of Cardiovascular Disease Research. 2015; 3(1):5-8. doi: 10.12691/ajcdr-3-1-2.

Correspondence to: Hawani  Sasmaya Prameswari, Department of Cardiology and Vascular Medicine, Padjadjaran University, Jalan Eijkman 38, Bandung 40161, Indonesia. Email: hawanisasmaya@gmail.com

Abstract

Peripartum cardiomyopathy (PPCM) is one of dilated cardiomyopathy of unknown cause. The aim of this study is to determine the risk factors and the importance of prenatal care (PNC). This is a descriptive and analytical study with Chi Square test of PPCM cases collected from medical records January 1, 2011 through December 31, 2013 in the Dr.Hasan Sadikin Central General Hospital as the top-referral hospital of West Java Province. We collected 57 PPCM cases (18.7%) of 305 pregnant women or 6 months postpartum with cardiovascular problems. Distribution of PPCM cases decreased significantly (p= 0.002) from 2011 (27 patients), 2012 (16 patients), and 2013 (14 patients), with average age 30.3 (±7.9) years, cesarean delivery (43.8%), pervaginal (37.5%), forceps (15%), and vacuum-extractor (3.8%). Regular prenatal care was 84.20%. Lower socioeconomic patients were 63.2%, therefore the issue of welfare can lead to vulnerability to PPCM. Confirmed diagnosis using echography made during postpartum was 52.63% and antepartum was 47.5%. Preeclampsia was 43.80% (p=0.007) mostly NYHA functional class IV (86.30%). Echocardiography was performed on 57 patients have average ejection fraction 34.8%, global hypokinetic in 98.27% patients, 39.6% with all cardiac chamber dilatation, left atrium and left ventricle dilation in 34.48%, and 25.86% with left ventricular dilatation. The hospital based prevalence was 18.68%, with the majority (84.20%) was NYHA functional class IV. The significant risk factors were age over 30 years, multiparous, low socioeconomic, and preeclampsia. This study is probably the first report mentioning a high prevalence of PPCM in Indonesia. This report provides an awareness of PPCM during PNC to prevent the morbidity and mortality. PPCM disorder requires regular and careful PNC by taking into account existing risk factors is the key that is required and must be held in every health centre.

Keywords

References

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Article

“Requiring Intravenous Nitroglycerin” Should be considered a High Risk Feature in Patients with Non-ST Elevation Myocardial Infarction and Unstable Angina

1Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037

2Division of Cardiology, Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037


American Journal of Cardiovascular Disease Research. 2015, 3(1), 9-12
doi: 10.12691/ajcdr-3-1-3
Copyright © 2015 Science and Education Publishing

Cite this paper:
Olusegun Sheyin, Melissa Fajardo, Oladapo Igandan, Bredy Pierre-Louis. “Requiring Intravenous Nitroglycerin” Should be considered a High Risk Feature in Patients with Non-ST Elevation Myocardial Infarction and Unstable Angina. American Journal of Cardiovascular Disease Research. 2015; 3(1):9-12. doi: 10.12691/ajcdr-3-1-3.

Correspondence to: Olusegun  Sheyin, Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037. Email: oas2120@columbia.edu

Abstract

Introduction: Early risk stratification of patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) is crucial to identify those at high risk for further cardiac events as they may benefit from an early invasive strategy of coronary angiography and revascularization. The TIMI score, a widely used predictive model to guide management strategy in UA and NSTEMI may not accurately stratify risk. Case description: A 63-year-old man, who is an active smoker with past medical history of hypertension and dyslipidemia, presented with severe sub-sternal, crushing chest pain, which began four hours prior to presentation. His EKG revealed sinus tachycardia, without ST segment deviations or Q waves. He received aspirin, three doses of sublingual nitroglycerin and metoprolol, but continued to have chest pain, thus he was commenced on intravenous nitroglycerin infusion. His chest pain went away after two hours on nitroglycerin infusion. His initial serum troponin I was 0.31 ng/mL and 3.60 ng/mL four hours after presentation. He was admitted for NSTEMI and started on clopidogrel, atorvastatin and intravenous heparin. Echocardiogram revealed inferio-septal wall a kinesis and severely reduced left ventricular systolic function. His troponin I continued to rise, peaking at 37.4 ng/mL. He was started on eptifibatide and was referred for coronary angiography and percutaneous coronary intervention, with finding of fifty percent proximal and distal left anterior descending artery (LAD) lesions. Discussion: With a TIMI score of 2, our patient was classified as low risk at presentation. The need for intravenous nitroglycerin infusion for continuing chest pain in the management of UA or NSTEMI may suggest a greater degree of myocardial ischemia and a higher risk for adverse cardiovascular outcomes. This case demonstrates that UA and NSTEMI patients requiring intravenous nitroglycerin initially planned for conservative therapeutic approach need continuous risk stratification which may dictate a change to the invasive management strategy.

Keywords

References

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Article

The Metabolic Syndrome in Offspring of Women with a Family History of Early Onset Type 2 Diabetes Mellitus Who Developed Gestational Diabetes Mellitus

1Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica


American Journal of Cardiovascular Disease Research. 2016, 4(1), 1-6
doi: 10.12691/ajcdr-4-1-1
Copyright © 2016 Science and Education Publishing

Cite this paper:
R Irving. The Metabolic Syndrome in Offspring of Women with a Family History of Early Onset Type 2 Diabetes Mellitus Who Developed Gestational Diabetes Mellitus. American Journal of Cardiovascular Disease Research. 2016; 4(1):1-6. doi: 10.12691/ajcdr-4-1-1.

Correspondence to: R  Irving, Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica. Email: rachael.irving@uwimona.edu.jm

Abstract

Objective: To evaluate for the metabolic syndrome (MS) in offspring of women with family history of early onset type 2 diabetes mellitus (T2DM) who developed gestational diabetes mellitus (GDM) using as controls offspring of women with no family history of diabetes and normal glucose tolerance (NGT). Methods: Anthropometric and biochemical measurements were evaluated for 30 offspring age 10-16 years of women with family history of early onset T2DM who developed GDM. Obstetrical records of these mothers were also noted. Thirty offspring of women (30) with NGT and no family history of diabetes served as controls. Measurements included: Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), fasting and postprandial glucose, insulin, waist circumference, weight and height. For analyses, MS was defined as ≥3 of 4 features: glucose intolerance, dyslipidemia, obesity and hypertension in the childhood/adolescence criteria as recommended by the National Cholesterol Education Program Adult Treatment Panel Third (NCEP-ATP III) modified standard. Cox regression analysis was used to determine the independent hazard (risk) of developing MS attributable to GDM with a family history of early onset T2DM. Results: Offspring of women with GDM and family history of early onset T2DM had significantly more (≥ 2, p<0.05) features of MS than offspring of women with NGT and no family history of diabetes. Thirty percent (30.0%), 29.5% and 39.0% of the offspring of these GDM women had glucose intolerance, obesity and dyslipidemia respectively. These offspring had a hazard of 3.33 (95% CI: 2.12-9.15) of having MS compared to offspring of women with NGT and no family history of diabetes. Conclusion: Offspring of women with GDM and family history of early onset T2DM are at increased risk for MS.

Keywords

References

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