exudates and Cardiomyopathies

To identify the prevalence of stage B heart failure (SBHF) in patients with type 2 diabetes mellitus (T2DM) with no history of cardiovascular disease (CVD).. Observational study.. A single-centre study in which eligible patients were recruited from T2DM clinic. Following consent, patients completed a questionnaire and underwent physical examinations. Patients had blood drawn for laboratory investigations and had a transthoracic echocardiography.. A total of 305 patients who were not known to have CVD were recruited. Patients with deranged liver function tests and end stage renal failure were excluded.. Echocardiographic parameters such as left ventricular ejection fraction, left ventricular mass index (LVMI), left ventricular hypertrophy, left atrial enlargement and diastolic function were examined.. A total of 305 patients predominantly females (65%), with mean body mass index of 27.5 kg/m. Our study has revealed a high prevalence of SBHF in T2DM patients without overt cardiac disease in Malaysia that has one of the highest prevalence of TDM in the world.

Topics: Cardiomyopathies; Coronary Artery Disease; Diabetes Mellitus, Type 2; Echocardiography; Female; Heart Failure; Humans; Hypertension; Malaysia; Male; Middle Aged; Prevalence; Risk Factors; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Function, Left

Cirrhotic cardiomyopathy is a recognised complication of liver cirrhosis and predicts poor outcomes. Detection of diastolic dysfunction, an early indicator of left ventricular dysfunction can help identify those patients at risk of disease progression. In our study we showed that there was a high prevalence of diastolic dysfunction amongst patients with liver cirrhosis at our outpatient clinic, with the majority being Child-Pugh A/low MELD score. Multiple regression analysis indicated that age and sodium levels were significantly associated with the presence of diastolic dysfunction. This further reinforces the importance of dietary sodium restriction amongst patients with liver cirrhosis.

Topics: Aged; Cardiomyopathies; Female; Hospitals; Humans; Liver Cirrhosis; Malaysia; Male; Middle Aged; Regression Analysis; Severity of Illness Index; Ventricular Dysfunction, Left

We examined the influence of sex, ethnicity, and time on competing cardiovascular and noncardiovascular causes of death following acute myocardial infarction in a multiethnic Asian cohort.. For 12 years, we followed a prospective nationwide cohort of 15 151 patients (aged 22-101 years, median age 63 years; 72.3% male; 66.7% Chinese, 19.8% Malay, 13.5% Indian) who were hospitalized for acute myocardial infarction between 2000 and 2005. There were 6463 deaths (4534 cardiovascular, 1929 noncardiovascular). Compared with men, women had a higher risk of cardiovascular death (age-adjusted hazard ratio [HR] 1.3, 95% CI 1.2-1.4) but a similar risk of noncardiovascular death (HR 0.9, 95% CI 0.8-1.0). Sex differences in cardiovascular death varied by ethnicity, age, and time. Compared with Chinese women, Malay women had the greatest increased hazard of cardiovascular death (HR 1.4, 95% CI 1.2-1.6) and a marked imbalance in death due to heart failure or cardiomyopathy (HR 3.4 [95% CI 1.9-6.0] versus HR 1.5 [95% CI 0.6-3.6] for Indian women). Compared with same-age Malay men, Malay women aged 22 to 49 years had a 2.5-fold (95% CI 1.6-3.8) increased hazard of cardiovascular death. Sex disparities in cardiovascular death tapered over time, least among Chinese patients and most among Indian patients; the HR comparing cardiovascular death of Indian women and men decreased from 1.9 (95% CI 1.5-2.4) at 30 days to 0.9 (95% CI 0.5-1.6) at 10 years.. Age, ethnicity, and time strongly influence the association between sex and specific cardiovascular causes of mortality, suggesting that health care policy to reduce sex disparities in acute myocardial infarction outcomes must consider the complex interplay of these 3 major modifying factors.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Asian People; Cardiomyopathies; Cardiovascular Diseases; Cause of Death; China; Ethnicity; Female; Health Status Disparities; Heart Failure; Humans; India; Malaysia; Male; Middle Aged; Mortality; Myocardial Infarction; Proportional Hazards Models; Sex Factors; Singapore; Time Factors; White People; Young Adult

α°-thalassemia is a well-known cause of hydrops fetalis in South-East Asia and can be detected in utero. We report a very rare case of thyrotoxic cardiomyopathy associated with hyperplacentosis secondary to α°-thalassemia-associated hydrops fetalis. A 22-year-old primigravida with microcytic anemia presented at 27 weeks' gestation with pre-eclampsia, hyperthyroidism and cardiac failure. Serum β-human chorionic gonadotrophin was markedly elevated and abdominal ultrasound revealed severe hydropic features and enlarged placenta. Serum β-human chorionic gonadotrophin, cardiac function and thyroid function tests normalized after she delivered a macerated stillbirth. Histopathology of the placenta showed hyperplacentosis. Blood DNA analysis revealed that both patient and husband have the α°-thalassemia trait. This case illustrates a very atypical presentation of α°-thalassemia-associated hydrops fetalis and the importance of early prenatal diagnosis of α-thalassemia in women of relevant ethnic origin with microcytic anemia so that appropriate genetic counseling can be provided to reduce maternal morbidity and the incidence of hydrops fetalis.

Topics: Adult; alpha-Thalassemia; Anemia, Hypochromic; Cardiomyopathies; Female; Genetic Counseling; Heart Failure; Heterozygote; Humans; Hydrops Fetalis; Hyperthyroidism; Malaysia; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Stillbirth; Thyrotoxicosis; Ultrasonography, Prenatal; Young Adult

Peripartum cardiomyopathy (PPCM) is an uncommon form of congestive heart failure, afflicting obstetric patients around the time of delivery. The epidemiology of PPCM is infrequently reported. To the best of our knowledge, there has been no report from Asia.. To define the prevalence, presentation and outcome of PPCM in a major referral centre in Malaysia.. Retrospective case record analysis of all patients admitted and diagnosed with PPCM at the University Malaya Medical Centre, Kuala Lumpur, over 5 years from 1st January, 2001 to 31st December, 2004.. Eight patients were diagnosed with PPCM over the study period reflecting a prevalence of 34: 100,000 life births. Five were diagnosed within 5 months after delivery. Three were associated with twin pregnancies. There was one death (12.5% mortality). The mean left ventricular ejection fraction (LVEF) at the time of diagnosis was 27.1 +/- SD 6.4% (range: 17-35%). Following the index event, the left ventricular function recovered in three of the eight patients (37.5%) with restoration of normal LVEF (LVEF > 50%). Two patients had subsequent pregnancies. One was terminated at 7 weeks, and the other delivered uneventfully with a normal LVEF.. Peripartum cardiomyopathy is uncommon in Malaysia. It appears to be associated with twin pregnancy. The outcome is variable with 37.5% recovering normal left ventricular function, 12.5% mortality and persistently impaired left ventricular function in the remainder.

Topics: Cardiomyopathies; Echocardiography; Female; Heart Defects, Congenital; Humans; Malaysia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prevalence; Ventricular Dysfunction, Left

Topics: Adenoviridae; Brain; Cardiomyopathies; Child; Encephalomyelitis; Hand, Foot and Mouth Disease; Humans; Malaysia; Pulmonary Edema

Congo red screening of 211 consecutive cardiac biopsy specimens obtained during cardiac surgery from 167 patients revealed 26 (16%) instances of isolated atrial amyloidosis (IAA). The ages of IAA-positive patients ranged from 25 to 52 years (mean age, 39 years). Twenty-three (88%) IAA-positive biopsy specimens were from patients with chronic rheumatic heart disease (CRHD) while three (12%) were from patients with an atrial septal defect (ASD). The prevalence of IAA in the CRHD patients was 23%, appreciably higher than that in the ASD patients (15%) and in other patients with atrial biopsies. The prevalence of IAA in both CRHD and ASD patients was significantly higher (P < .001) than in controls. Controls consisted of 247 healthy adults who were autopsied after traumatic deaths, with an age range of 18 to 89 years (mean age, 38 years). Only seven (3%) control subjects were IAA positive; all were over 40 years of age. Isolated atrial amyloidosis deposits were permanganate resistant and immunohistochemically positive for human amyloid P (AP) protein and negative for human amyloid-associated (AA) protein and immunoglobulin light chains. They were observed as fine congophilic and birefringent deposits in intramyocardial vessel walls, along the myocardial sarcolemma, and in the subendocardium. There was associated myocyte hypertrophy but no atrophy. Electron microscopy demonstrated typical nonbranching amyloid fibrils. It is postulated that stretching of the atria in chronic heart disease results in a raised prevalence of IAA. Recent reports that IAA contains atrial natriuretic peptide, a polypeptide hormone product of atrial myocytes, supports this view.

Topics: Adolescent; Adult; Aged; Amyloidosis; Cardiomyopathies; Child; Chronic Disease; Female; Heart Diseases; Heart Valve Diseases; Humans; Malaysia; Male; Microscopy, Electron; Middle Aged; Postoperative Complications; Prevalence; Rheumatic Heart Disease

Congo red screening of 27,052 routine biopsy specimens from 22,827 patients over a 5 1/2-year period in the Department of Pathology, University of Malaya detected 186 cases of amyloidosis. The categories of amyloidosis encountered and their prevalences in relation to each other were: systemic AL (5.9%); systemic AA (3.2%); isolated atrial (14%); primary localized cutaneous (7.5%); other primary localized deposits (3.2%); localized intratumour (58%); and dystrophic (8.6%). A third of patients with systemic AL amyloidosis had coexistent immunocyte abnormality. The commonest underlying pathology for systemic AA amyloidosis was leprosy. Notable among the types of localized amyloidosis revealed by this study were isolated atrial amyloidosis, which appeared to complicate chronic rheumatic heart disease, and intratumour amyloidosis complicating nasopharyngeal carcinoma. Other tumours in which amyloid deposits were observed included basal cell carcinoma, islet cell tumour and medullary carcinoma of the thyroid. Dystrophic amyloidosis was observed in fibrotic tissues, such as damaged cardiac valves and osteoarthritic joints. Heredofamilial amyloidosis, senile systemic amyloidosis and degenerative cerebral amyloidosis were notably absent from this study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amyloid; Amyloidosis; Cardiomyopathies; Child; Humans; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Immunohistochemistry; Malaysia; Microscopy, Electron; Middle Aged; Neoplasms; Potassium Permanganate; Prevalence; Skin Diseases