Podcasts about Dilated cardiomyopathy

Intellistent Pioneering Innovation Transforming Treatment Strategies for Pediatric Pulmonary Arterial Hypertension and Dilated Cardiomyopathy

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on papillary muscle delayed hyperenhancement prevalence and clinical implications in a large population with dilated cardiomyopathy.

Message our hosts, Kieran and Jose.Dilated cardiomyopathy is one of the most challenging diseases in veterinary cardiology. Early detection is key to maximising benefit for individual dogs, but clinical signs are lacking and physical exam may be unremarkable. Adding to this, echocardiographic diagnosis may be subtle, or changes may be caused by a an underlying disease process which is reversible or self-limiting, rather than a primary myocardial disease itself. Prof Sonya Gordon, from Texas A&M University, joins Kieran and Jose to discuss the difficulties with DCM, and her approach to overcoming these to get the most for her patients.

This week, please join authors Reza Nezafat, Shiro Nakamori, and Amine Amyar as they discuss the article "Cardiovascular Magnetic Resonance Radiomics to Identify Components of the Extracellular Matrix in Dilated Cardiomyopathy." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20240628.66549

ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology This Week: A concise summary of recent studies Genetic testing in dilated cardiomyopathy Gut microbiome and heart disease Mythbusters: Sitting is the new smoking Host: Rick Grobbee Guests: Carlos Aguiar, Arash Haghikia and Juan Pablo Kaski Want to watch that episode? Go to: https://esc365.escardio.org/event/1153 Disclaimer This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Rick Grobbee, Arash Haghikia, Juan Pablo Kaski and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, Lilly, Novartis, Pfizer, Sanofi, Servier, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Abbott Vascular, Novo Nordisk, Sanofi. Terumo, Medtronic. Emma Svennberg has declared to have potential conflicts of interest to report: institutional research grants from Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Boehringer-Ingelheim, Johnson & Johnson, Merck Sharp & Dohme.

Host Bill McBain speaks about Dilated Cardiomyopathy (DCM), and Pit Ponies 

Welcome to a special episode of The Veterinary Roundtable! This week we're joined by board-eligible veterinary nutritionist, Dr. Danielle Conway, to officially break down everything and anything regarding pet nutrition; raw diets, grain-free diets, home cooked diets, AFCO testing, and more!Do you have a question for The Veterinary Roundtable? Ask us on any social media platform or email harrison@kingmediamarketing.com!Do you have an inquiry? Send it to us on any social media platform or email harrison@kingmediamarketing.com!Episodes of The Veterinary Roundtable are on all podcast services along with video form on YouTube!Vital Vet Nutrition: https://vitalvetnutrition.com/Instagram: https://tinyurl.com/2h27xnfuTikTok: https://tinyurl.com/m8f62ameTIMESTAMPSIntro 00:00The Low Down On Grain Free Diets 01:32Good And Bag Pet Food Companies 07:14Pet Owners Overfeeding Their Pets 12:08Ingredients In Grain Free Diets 14:10Home Cooked Diets For Pets 18:04Dr. Conway's Opinion On Farmer's Dog 20:36Recommended Store Bought Fresh Foods For Pets 22:50Veterinary Nutritionists Working With Pet Food Companies 27:18The Low Down On Raw Diets 31:08AFCO Testing Explained 41:20Dr. Conway's Thoughts On "All Life Stages" Pet Foods 46:38Cutting Back Food On Obese Patients 56:30Cats Need More Protein As They Get Older 58:58All Meat Diets For Cats 01:01:38Are Obese Formulas All The Same? 01:04:49Good Resources For Pet Owners 01:09:50Outro 01:11:35

Commentary by Dr. Valentin Fuster

Welcome to another episode of The Veterinary Roundtable! In this episode, the ladies tease Devyn about not knowing who Mr. Rogers is, show off their new podcast scrubs, clarify and answer inquiries from last episode, discuss their thoughts on the new Canine Parvovirus Monoclonal Antibodies treatment, and more!Do you have a question for The Veterinary Roundtable? Ask us on any social media platform or email harrison@kingmediamarketing.com!Episodes of The Veterinary Roundtable are on all podcast services along with video form on YouTube!Social Links: https://linktr.ee/allstarvetclinicTIMESTAMPSTIMESTAMPSIntro 00:00Devyn Doesn't Know Who Mr. Ro gers Is 00:30The Ladies Have New Podcast Scrubs 03:14Dr. King And Courtney Have Bingo Night 06:19Inquiries From Last Episode 08:20Case Collections 20:38Listener Question (@brraatt_) 35:02Outro 43:30

Welcome to another episode of The Veterinary Roundtable! In this special feature with only Dr. Duckwall and Dr. King, the ladies discuss Dr. King's new (old) 1977 AKC Dogbook, an intricate cat case, the problem with grain free diets, and more!Do you have a question for The Veterinary Roundtable? Ask us on any social media platform or email harrison@kingmediamarketing.com!Episodes of The Veterinary Roundtable are on all podcast services along with video form on YouTube!Social Links: https://linktr.ee/allstarvetclinicTIMESTAMPS00:00 IntroQuick Study Tips In Vet School 03:52Vet Med Shout Outs 12:04Dr. King's 1977 AKC Dogbook 15:58Case Collections 18:22Dilated Cardiomyopathy And Grain Free Diets (Kyle Gilliam) 30:52Outro 39:26

Drs Michelle Kittleson and Evan Kransdorf talk about when to test, how genetic testing should be interpreted, and what to do with the results. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/997316). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Validating an Idiopathic Dilated Cardiomyopathy Diagnosis Using Cardiovascular Magnetic Resonance: The Dilated Cardiomyopathy Precision Medicine Study https://pubmed.ncbi.nlm.nih.gov/35240856/ Prevalence and Cumulative Risk of Familial Idiopathic Dilated Cardiomyopathy https://pubmed.ncbi.nlm.nih.gov/35103767 Family Heart Talk https://dcmproject.com/family-heart-talk/ Effectiveness of the Family Heart Talk Communication Tool in Improving Family Member Screening for Dilated Cardiomyopathy: Results of a Randomized Trial https://pubmed.ncbi.nlm.nih.gov/36938756/ Rare Variant Genetics and Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study https://pubmed.ncbi.nlm.nih.gov/37641966/ Standards and Guidelines for the Interpretation of Sequence Variants: A Joint Consensus Recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology https://pubmed.ncbi.nlm.nih.gov/25741868/ Implications of Genetic Testing in Dilated Cardiomyopathy https://pubmed.ncbi.nlm.nih.gov/32880476/ Clinical Risk Score to Predict Pathogenic Genotypes in Patients With Dilated Cardiomyopathy https://pubmed.ncbi.nlm.nih.gov/36109106/ Screening for Dilated Cardiomyopathy in At-Risk First-Degree Relatives https://pubmed.ncbi.nlm.nih.gov/37225358/

This week, in honor of the holidays, we celebrate the beauty of life by discussing only good news, such as a potential monument to the unborn, the 4-month-old sucked up by a tornado who lived, and more! While not every story we cover this week is directly abortion related, each reminds us that life is a gift. Topics Discussed:Directory of Catholic, Christian, & Pro-Life Birth ProfessionalsArkansas' Monument To The UnbornStudies Reveal Babies Born With The Ability to Perceive The Beat In MusicCouple Travels Thousands Of Miles To Find A Way To Save Their SonPreemie Who Spent 9 Months in Hospital Goes Home For Christmas4-Month-Old Sucked Up By Tornado And Lives!Holiday Free Toy Store For Kids in Nashville Opens Links Mentioned:The Made For This Birth DirectoryPro-Life America Podcast Episode 85: Surrogacy & IVF - Good or Bad?Commission recommends design for ‘monument to the unborn' at Arkansas Capitol - NPRBabies appear to be born with the ability to discern a beat in music - Popular ScienceIsraeli Couple Travels to U.S. for Life-Saving Treatment After Unborn Baby Diagnosed with Heart Failure: 'He's a Miracle' - People MagazineNICU baby born at 23 weeks, 5 days goes home in time for Christmas - Good Morning America‘By The Grace Of God': 4-Month-Old Baby Found Alive In Fallen Tree After Family's Tennessee Home Wrecked By Tornado - Daily WireBrad Paisley And Wife Kimberly Williams Open Free Toy Store For Kids Ahead Of Holidays - Daily WireRate & Review Our Podcast Have a topic you want to see discussed on the show? [Submit it here.]To learn more about what Life Dynamics does, visit: https://lifedynamics.com/about-us/Support Our Work

Commentary by Dr. Douglas Mann and Dr. Elena Amin and Mr. Seth Wagner

Case Discussion 100: ICD in non-ischemic dilated CMP

Dilated cardiomyopathy is a common disease in dogs, which is almost uniquely difficult to diagnose in the early stages. In this episode, Kieran and Jose interview Prof Gerhard Wess, a clinician and researcher who leads the cardiology department at the LMU University of Munich, Germany. Prof Wess brings his extensive, decades-spanning experience of diagnosing and managing DCM to the podcast and shares his advice on how best to assess potential cases.

Editor's Summary by Mary McGrae McDermott, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the August 1, 2023, issue. Related Content: Audio Highlights

Commentary by Dr. Valentin Fuster

Walk into any pet store and you'll be faced with aisles of options for feeding your pet. In fact, according to IBISWorld, there are currently 899 pet food production businesses in the US alone right now! It's no wonder pet parents struggle to figure out the right foods to feed to their pets. Add to that the confusion brought about by news-media headlines and social-media hype demonizing certain ingredients while touting others as the key to eternal life for your pet, and it can be downright daunting to just figure out what to put in your pet's bowl. In this episode, host Amy Castro interviews Dr. Jeff Grognet, a holistic veterinarian who shares insight into some of the biggest nutrition challenges facing our pets today and what pet parents can do to make good food choices for their pets. They discuss:How nutrition can adversely affect your pet's healthWhy so many cats and dogs are fat, and what pet parents can do about itHow to find and eliminate the not-so-hidden and unnecessary carbs in your pet's dietHow feeding an "ancestral diet" or one that is as close as possible, is key to pet healthHow to address common health problems such as bladder stones Dilated Cardiomyopathy in dogs and how misinformation about its connections to grain-free foods still persistWhy pet parents really need to educate themselves on pet nutritionAnd more!Dr. Jeff Grognet is a veterinarian based in British Columbia, Canada. He focuses on helping animals live better lives using holistic methods. His focus is nutrition and avoiding chemicals of all types. He has several courses available for pet parents as well as holding educational conferences. Find out more at: www.newearthvet.com .#petadoption #adoptdontshop #dogbreeder #pets #petstagram #petsofinstagram #petsagram #instapets #petshop #pets_of_instagram #cutepets #petscorner #petsofig #picpets #worldofcutepets #pets_perfection #lovepetKeep this podcast coming to you each week and bringing you GREAT content so you can be the best pet parent ever! https://www.buymeacoffee.com/starlightpettalkGET YOUR STARLIGHT PET TALK MERCHANDISE HERE! www.starlightoutreachandrescue.org/store FOLLOW STARLIGHT PET TALK ▷ Official Site: https://www.starlighpettalk.com ▶ Facebook: / starlightoutreachandrescue ▶ YouTube: -https://bit.ly/starlightsubscribe ▶ TikTok: ...

Are you wondering about grain-free diets, Diet Associated DCM, and what cardiologists are currently recommending? On this month's episode of Real Talk Unleashed, we sit down with Dr. Emily Suess, a resident in cardiology at CVCA, to discuss:

In this episode we take you through all the need-to-knows for your next patient with dilated cardiomyopathy! Written by: Dr. Jasper Ho (Internal Medicine Resident) Reviewed by: Dr. Katie Connolly (Cardiologist) and Dr. John Neary (General Internist)Support the show

In this episode, we review the high-yield topic of Dilated Cardiomyopathy from the Cardiovascular section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.01.23.523684v1?rss=1 Authors: Bretherton, R. C., Reichardt, I. M., Zabrecky, K. A., Goldstein, A. J., Bailey, L. R. J., Bugg, D., McMillen, T. S., Kooiker, K. B., Flint, G., Martinson, A., Gunaje, J., Koser, F., Linke, W. A., Regnier, M., Moussavi-Harami, F., Sniadecki, N. J., DeForest, C. A., Davis, J. Abstract: Inherited mutations in contractile and structural genes, which decrease cardiomyocyte tension generation, are principal drivers of dilated cardiomyopathy (DCM)- the leading cause of heart failure1,2. Progress towards developing precision therapeutics for and defining the underlying determinants of DCM has been cardiomyocyte centric with negligible attention directed towards fibroblasts despite their role in regulating the best predictor of DCM severity, cardiac fibrosis3,4. Given that failure to reverse fibrosis is a major limitation of both standard of care and first in class precision therapeutics for DCM, this study examined whether cardiac fibroblast-mediated regulation of the hearts material properties is essential for the DCM phenotype. Here we report in a mouse model of inherited DCM that prior to the onset of fibrosis and dilated myocardial remodeling both the myocardium and extracellular matrix (ECM) stiffen from switches in titin isoform expression, enhanced collagen fiber alignment, and expansion of the cardiac fibroblast population, which we blocked by genetically suppressing p38 in cardiac fibroblasts. This fibroblast-targeted intervention unexpectedly improved the primary cardiomyocyte defect in contractile function and reversed ECM and dilated myocardial remodeling. Together these findings challenge the long-standing paradigm that ECM remodeling is a secondary complication to inherited defects in cardiomyocyte contractile function and instead demonstrate cardiac fibroblasts are essential contributors to the DCM phenotype, thus suggesting DCM-specific therapeutics will require fibroblast-specific strategies. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.12.08.519616v1?rss=1 Authors: Zhang, Y., Gregorich, Z. R., Wang, Y., Braz, C. U., Zhang, J., Liu, Y., Liu, P., Aori, N., Hacker, T. A., Granzier, H., Guo, W. Abstract: Human patients carrying genetic mutations in RNA binding motif 20 (RBM20) develop a clinically aggressive dilated cardiomyopathy (DCM). RBM20 is a splicing factor with two canonical domains, an RNA recognition motif (RRM) and an arginine-serine rich (RS) domain. RRM loss-of-function disrupts the splicing of RBM20 target transcripts and leads to systolic dysfunction without overt DCM, while mutations in the RS domain precipitate DCM. We show that mice lacking the RS domain (Rbm20deltaRS) manifest DCM with mis-splicing of RBM20 target transcripts. We found that RBM20 is mis-localized in Rbm20{Delta}RS mice but not in mice lacking the RRM, which are also deficient in RBM20 splicing. We determine that the RS domain, not other domains including the RRM, is critical for RBM20 nuclear import and define the core nuclear localization signal (NLS) within this domain. Mutation analysis of phosphorylation sites within the RS domain indicate that phosphorylation is dispensable for RBM20 nuclear import. Collectively, our findings establish disruption of the NLS in RBM20 as a causative mechanism in DCM through nucleocytoplasmic transport. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.11.03.515033v1?rss=1 Authors: Krumbein, M., Oberman, F., Cinnamon, Y., Golomb, M., May, D., Vainer, G., Belzer, V., Meir, K., Fridman, I., Haybaeck, J., Poelzl, G., Kehat, I., Beeri, R., Kessler, S., Yisraeli, J. K. Abstract: The IGF2BP family of RNA binding proteins consists of three paralogs that regulate intracellular RNA localization, RNA stability, and translational control. Although IGF2BP1 and 3 are oncofetal proteins, IGF2BP2 expression is maintained in many tissues, including the heart, into adulthood. Previous studies indicated that IGF2BP2 is upregulated in cardiomyocytes during cardiac stress and remodelling and returns to normal levels in recovering hearts. These results suggested that IGF2BP2 might play an adaptive role during cardiac stress and recovery. Using a conditional, inducible transgenic mouse line, we found that enhanced expression of the IGF2BP2 transgene in newborn or adult hearts leads to dilated cardiomyopathy (DCM), with remodelling, fibrosis, and death within 3-4 weeks. Downregulation of the transgene after 2 weeks, however, rescues these mice, with complete recovery by 12 weeks. Proteomic analysis identified a downregulation of sarcomeric and mitochondrial proteins in hearts overexpressing IGF2BP2, and electron microscopy revealed fragmented mitochondria and elongated, thinner sarcomeres. Consistent with these results, IGF2BP2 is upregulated in patients with DCM or after myocardial infarction. These results show that cardiac stress upregulates IGF2BP2, leading to remodelling and compensation of the heart. Prolonged expression, however, leads to heart failure and death, making it an attractive target for therapeutic intervention. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Commentary by Dr. Valentin Fuster

Commentary by Dr. Valentin Fuster

Commentary by Dr. Valentin Fuster

Ever heard of "broken heart syndrome"?... it's a real thing. It's also called Takotsubo Cardiomyopathy or stress induced cardiomyopathy. In this episode we discuss a case of a patient who developed this unexpectedly, came very close to death, but made a full recovery. We break down the cause, presentation, and pathophysiology of Takotsubo Cardiomyopathy as well as treatment and prognosis.

Commentary by Dr. Valentin Fuster

Dilated cardiomyopathy (DCM) is a rare but serious condition of children and often progresses to heart failure. The outcomes for children with DCM are poor, with 50% of pediatric patients dying or needing a heart transplant within 5 years of diagnosis. In this episode, Geoff Marsh meets professor Carmen Sucharov from the University of Colorado Anschutz campus and the director of the Pediatric Cardiology Research Laboratories. She and her team have been studying the regulation of micro-RNAs and their putative target genes in the pediatric DCM heart that may contribute to the distinctive phenotype of this disease in children. Read the article here. See acast.com/privacy for privacy and opt-out information.

Dear friends, the English edition of DCM is available, enjoy listening to this episode and you can download slides via this link:http://ecardiocast.com/wp-content/uploads/2022/03/DCM.pdf

Dear Friends, wish you a wonderful year and we hope you have a great vacation, meanwhile, we prepared another comprehensive episode which is about dilated cardiomyopathy and its latest updates. enjoy listening to this episode and download slides via this link:http://ecardiocast.com/wp-content/uploads/2022/03/DCM.pdf

Katie and Dr. Jessica Levy break down what dilated cardiomyopathy means to your pets, and to be aware what you should be feeding your pets. Callers also call in to ask questions on supplements, why your cat is chasing their tail, and leash training!

Hemostemix CEO Thomas Smeenk joined Steve Darling from Proactive to share news about the company that is using stem cell therapy to aid in a number of diseases. Smeenk telling Proactive more about their lead product ACP-01 which is looking to treat CLI, PAD, Angina, Ischemic Cardiomyopathy, Dilated Cardiomyopathy and other conditions of ischemia. ACP-01 has been used to treat over 300 patients and right now is the subject of a randomized, placebo-controlled, double blind trial for safety and efficacy in patients with advanced critical limb ischemia who have exhausted all other options to save their limb from amputation. Smeenk also talked about what to expect this year including Phase 2 trial results..

Commentary by Dr. Valentin Fuster

Hi everyone and welcome to this episode of Val Talk's Pets.  Well this episode is one that has caused controversy, mayhem with dog's diets, and basically left many pet owners very confused as to what to feed their dogs.  I am talking about DCM, Dilated Cardiomyopathy.  If you haven't heard of this yet, well maybe that means the panic and knee jerk reactions have settled down, or it just hasn't reached your ears as of yet.  So, I'm going to try and wade through this miasma of misinformation, look at some peer reviewed papers and see if I can't help pet parents navigate through this rather confusing health issue.Thanks for Listening!Please remember to follow or subscribe to ensure that you never miss an episode.You can support the podcast by purchasing a coffee, or two at our ko-fi page.  All proceeds go towards the running of Val Talks Pets.Please don't forget to Rate and Review each episode that you find helpful/educational.  By doing so you will help others find Val Talks Pets.Email me at: val@valtalkspets.com with topics you think would be of interest or with any questions you may have.Also, visit and be a part of my website at valtalkspets.com and help it grow!Thanks for all your support!

Editor's Summary by Linda Brubaker, MD, Associate Editor of JAMA, the Journal of the American Medical Association, for the February 1, 2022, issue.

Just back from the North American Veterinary Conference in his first episode in 2022, Dr. Roger reports on the latest AVMA (American Veterinary Medical Association) and FDA (Food and Drug Administration) updates on the grain free diets linked to the deadly heart disease in dogs, Dilated Cardiomyopathy.  As it turns out, the story is becoming increasingly complex with not just grain free diets implicated, but now expanded into what the AVMA is calling BEG diets.  BEG stands for Boutique style, Exotic proteins and ingredients, and Grain free.  Tune in as Dr. Roger kicks off the New Year's first episode sorting through all of this information for you to help keep your dogs safe. Remember to keep the listener emails coming to be selected to be addressed on the air at comments@web-dvm.net.  For more content from Dr. Roger, visit his blogs at Web-DVM.net and DrRogerHolisticVet.com.    

Genetic Testing in Dilated Cardiomyopathy Guest: Naveen L. Pereira, M.D. (@nl_pereira) Host: Kyle W. Klarich, M.D. (@KyleWKlarich) It's just a blood test — but genetic testing informs effective precision medicine-guided therapies for specific patients at high risk of sudden death and their family members. Joining us today to discuss genetic testing for patients at risk of dilated cardiomyopathy is Naveen L. Pereira, M.D., a cardiologist at Mayo Clinic in Rochester, Minnesota. Specific topics discussed: Genetics as a cause of dilated cardiomyopathy Screening and implications for family members Specific genes that put patients at high risk Sequencing panels that identify genes as benign, pathogenic or variants of uncertain significance Genetic counseling applications in practice Repeat testing recommendations Precision medicine-guided therapies Evolution of cost and insurance coverage Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Last addressed on the podcast in 2018, Dr. Roger revisits the controversial grain free dog food diets named by the FDA to cause the deadly heart disease, Dilated Cardiomyopathy, aka, DCM.  Has anything changed since the report?  Have any more diets been named?  Have the named diets addressed the issue to fix the problem?  Tune in to find out! We accept listener e-mail comments to be selected to be addressed on the air by sneding them to comments@web-dvm.net.  Listeners whose comments are selected to be discussed on the air will receive a free copy of Dr. Roger's book, The Man in the White Coat.  For more content from Dr. Roger, visit his blogs at Web-DVM.Net and DrRogerHolisticVet.com.   

Commentary by Dr. Valentin Fuster

Today's episode touches on the challenge of diagnosing cancer, and then dives into diet-related dilated cardiomyopathy (DCM). In 2018 the FDA reported an increase in DCM in dogs that do not fit the typical profile for breeds predisposed to this heart condition, and a correlation with grain-free, boutique diets that are high in legumes. Research is still ongoing to find out exactly why these diets are associated with DCM in dogs. Dr. Nancy Reese, Dr. Kendra Pope, and vet tech Kate Basedow weigh in on the different factors you need to consider when choosing what to feed your dog. Links Mentioned in Today's Show: The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity by Dr. Demian Dressler and Dr. Susan Ettinger. Volition's Nu.Q™ Vet Cancer Screening Test at Texas A&M Balance IT Cummings Veterinary Medical School at Tufts articles on diet-related DCM Related Links: WSAVA Guidelines on Selecting Pet Food FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy About Today's Guest, Dr. Nancy Reese: Dr. Nancy Reese is a small animal veterinarian with over 30 years of clinical experience taking care of cats and dogs and other critters in the Sierra Nevada foothills. In addition to her Doctor of Veterinary Medicine from the University of California, Davis, she earned a Masters in Preventive Veterinary Medicine at UC Davis and then a Ph.D. in Epidemiology at UC Davis. About Today's Guest, Dr. Kendra Pope: Dr. Pope began her academic career as a graduate of Virginia Tech in 2005 and went on to complete veterinary school at the University of Florida. Dr. Pope went on to complete a rotating internship in small animal medicine and surgery at the University of Pennsylvania in 2012, which was followed by a three-year residency in medical oncology at the University of Pennsylvania. She successfully obtained board certification in her specialty of oncology and became a Diplomate of the American College of Veterinary Internal Medicine in 2015. Dr. Pope's holistic training is an ongoing journey. About Today's Guest, Kate Basedow, LVT: Kate grew up training and showing dogs, and her passion for canines has affected all parts of her life. She earned a BA in English from Cornell University and an AAS in Veterinary Science from SUNY Delhi, and is a licensed veterinary technician in the state of New York. She worked in small-animal practice for four years and is now the associate producer of Dog Cancer Answers. Other Links: To join the private Facebook group for readers of Dr. Dressler's book “The Dog Cancer Survival Guide,” go to https://www.facebook.com/groups/dogcancersupport/ Dog Cancer Answers is a Maui Media production in association with Dog Podcast Network This episode is sponsored by the best-selling animal health book The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity by Dr. Demian Dressler and Dr. Susan Ettinger. Available everywhere fine books are sold. Have a guest you think would be great for our show? Contact our producers at DogCancerAnswers.com Have an inspiring True Tail about your own dog's cancer journey you think would help other dog lovers? Share your true tail with our producers. If you would like to ask a dog cancer related question for one of our expert veterinarians to answer on a future Q&A episode, call our Listener Line at 808-868-3200 www.dogcanceransers.com. Dog Cancer News is a free weekly newsletter that contains useful information designed to help your dog with cancer. To sign up, please visit: www.dogcancernews.com

Consists of etiopathogenesis of Dilated Cardiomyopathy, symptoms, signs , investigations to be done and the treatment to be given.

With Perry Elliott & Douglas Cannie, UCL Institute of Cardiovascular Science - London Link to paper  

Dr. Marc Semigran is the Chief Medical Officer of Renovacor and shines a light on BAG3-associated cardiomyopathy and the cardiac gene therapy in development to treat this rare genetic disease. Marc explains, "So, what we are focusing on are patients who have a genetic or familial origin of their dilated cardiomyopathy. Our first target is a gene described as BAG3, which is an important protein within the cardiac muscle cells. And some patients with heart failure have the heart failure because the gene that they have is mutated and is not able to fully express a functional protein." "We are studying our lead asset, which is REN-001, a modified virus that we believe will specifically target the heart. This will insert into the cardiac muscle cells a good copy of the BAG3 gene, which can then be expressed and allow those cardiac muscle cells to begin to function normally." #Renovacor #GeneTherapy #DilatedCardiomyopathy #DCM #BAG3 #RareDisease Renovacor.com Download the transcript here

Dr. Marc Semigran is the Chief Medical Officer of Renovacor and shines a light on BAG3-associated cardiomyopathy and the cardiac gene therapy in development to treat this rare genetic disease. Marc explains, "So, what we are focusing on are patients who have a genetic or familial origin of their dilated cardiomyopathy. Our first target is a gene described as BAG3, which is an important protein within the cardiac muscle cells. And some patients with heart failure have the heart failure because the gene that they have is mutated and is not able to fully express a functional protein." "We are studying our lead asset, which is REN-001, a modified virus that we believe will specifically target the heart. This will insert into the cardiac muscle cells a good copy of the BAG3 gene, which can then be expressed and allow those cardiac muscle cells to begin to function normally." #Renovacor #GeneTherapy #DilatedCardiomyopathy #DCM #BAG3 #RareDisease Renovacor.com Listen to the podcast here

Commentary by Dr. Valentin Fuster

Dilated Cardiomyopathy, Restrictive Cardiomyopathy, Hypertrophic Cardiomyopathy review for your Pance, Panre, and Eor’s. --- Support this podcast: https://anchor.fm/scott--shapiro/support

Commentary by Dr. Kalyanam Shivkumar

Commentary by Dr. Kalyanam Shivkumar

With Perry Elliott and Mohammed Majid Akhtar, UCL Institute of Cardiovascular Science - London - UK Link to EHJ paper Link to EHJ editorial

This week, I spoke with Dr. Sean Delaney, Veterinary Nutritionist and founder of Davis Veterinary Medical Consulting. He speaks on the intricacies and depths of pet nutrition and gives us a tool, his creation, 'Balance It' to help understand and properly fortify your specific pets needs.

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Lynne Millar from Bart's Hospital, London. They discuss her recent paper entitled "Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals". Link to published papers: https://heart.bmj.com/content/early/2020/04/26/heartjnl-2019-316147 https://heart.bmj.com/content/early/2020/04/26/heartjnl-2020-316979 If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

In part 2 of our series with Dr. Ryan Yamka, we look at the recent controversy over grain free foods and dilated cardiomyopathy (DCM). Are they really linked? What started the debate and what do you need to know? For more information and show notes please visit: Your Family Dog 

Barb Fox DVM discusses Dilated Cardiomyopathy and proactive support for canine heart health.   Dr. Fox offers online consultations and resources on her educational website at https://barbfoxdvm.com   Join the conversation to discuss this topic on Facebook   https://www.facebook.com/groups/welloiledk9 Come Sit and Stay Well! Dana Brigman | The K9 Coach Carolinas | Located in North Myrtle Beach SC | Online Consultations Canine Nutrition | Essential Oils for Dogs | Natural Wellness for Dogs | Canine Behavior www.k9coach.dog | www.welloiledk9.com   Interested in Volhard Dog Nutrition Food:   Visit My FAQ Volhard Website:   Visit Here   Essential Oils for Dogs | Canine Nutrition | Fresh Dog Food | Feed Raw | Raw Dog Food | Nutrition North Myrtle Beach SC | Canine Aromatherapy | Energy Work for Animals | Raindrop For Animals | Reiki for Animals | Canine Behavior | 

Sam Godfrey is a true inspiration. Cyclist, ex-Marine & plant-based pioneer, he is thriving despite a cardiomyopathy diagnosis that could have led him down a very different path. Hear his incredible story in this week's episode & if you can please donate to...Cardiac Risk in the Young  

Dr. Alin Gragossian is currently an Emergency Medicine (EM) resident in Pennsylvania. Alin’s story is a unique one - she is a survivor of death. After experiencing a life threatening heart condition, known as Dilated Cardiomyopathy, Alin had to undergo a heart transplant and experience being brought back to life. Alin’s story teaches us the power of resilience, hope, and gratitude when faced with calamity.To learn more about Alin, follow her blog at https://www.achangeofhe.artTo see her IG, follow her @a_change_of_heart_blog.

Commentary by Dr. Valentin Fuster

This is a podcast for diligent, dedicated dog and cat parents on topics that have been in the news lately.Recently, the FDA issued a report citing 16 dog food brands linked to cases of dilated cardiomyopathy ( DCM), essentially a form of heart failure. Specifically, the FDA linked grain-free products and "exotic" foods to DCM. The proposed mechanism of action is that grain-free diets lead to a depletion of taurine, a non-essential amino acid made from cysteine and methionine in the liver, which then leads to cardiomyopathy. As one can imagine, the FDA's report caused massive panic amongst dog parents who worried that their dogs, if on a grain-free or exotic diet, may be at risk for DCM. In the second half of this podcast, Dr. Dodds discusses the FDA report, the data for and against the notion that grain-free diets cause DCM, benefits vs risks of a grain-free diet for dogs, and what dog parents can do if they are worried about their dog having DCM. Vaccines are always in the news. In the first half of this podcast, Dr. Dodds discusses her recommended vaccination protocol for dogs and cats, the concept of vaccinosis, dogs at the highest risk for vaccinosis, lifestyle vaccines ( Leptospirosis, Lyme Disease, Bordetella and Canine Flu) vs core vaccines, and why she recommends getting titer tests vs getting boosters. Dr. Jean Dodds received her doctorate of veterinary medicine in 1964 and has been a clinical research veterinarian and hematologist for over 5 decades. She was a grantee of the National Heart, Lung and Blood Institute and has authored over 150 peer-reviewed publications in top journals. She started HemoPet, the first national nonprofit blood bank for animals, in 1986. Some of the services HemoPet provides include: Providing canine blood components, adopting retired Greyhound blood donors as companions and the Hemolife diagnostic division which focuses on hematology ( the study of blood cells), blood banking, immunology, endocrinology, nutrition and holistic medicine. She invented NutriScan, a food sensitivity and intolerance diagnostic test for dogs, cats and horses and is also a Co-Trustee of the Rabies Challenge Fund, a nonprofit project for assessing the duration of immunity and safety of current rabies vaccines in animals. She's an active member of the American Holistic Veterinary Medical Association and the American Holistic Veterinary Medical Foundation. For information about this podcast, please contact Dr. Erin Stair through her website, Blooming Wellness. To read Erin's new comedic book on the wellness industry, click here: Yours in Wellness, Krystal Heeling.Follow Erin on Instagram here.

Genetic Testing Helps You Swipe Right for Your DogToday’s dog breeders are getting a boost from the burgeoning field of genetic testing. https://www.dobermandiversityproject.org/ (Doberman Diversity Project) co-founder Sophie Liu talks about her work using advanced tools to improve genetic health issues in Doberman Pinschers. Liu was a vet student researching her next dog when she became aware of the multitude of health challenges facing Dobermans. According to the DDP website: ​OUR MISSION is to reduce the incidence of heritable diseases in the Doberman by studying and addressing the depression in the overall genetic diversity of the Doberman breed and studying and researching widespread disease-associated mutations, through comprehensive genetic testing and analysis, development and sharing of evidence-based breeding findings, development of online breeder decision-making tools, and long-term tracking of results to measure the effectiveness of varied approaches to breeding -- in terms of genetic health and longevity.Combatting DCMLiu said that a major focus of their research is geared toward reducing the incidence of Dilated Cardiomyopathy in the breed, which currently is plagued by the devastating disease, with nearly half of the breed being affected. A great deal of DDP’s research and studies are directed at developing a tool which establishes a genetic value for the risk of passing on DCM. Building on the work done by Guide Dogs for the Blind, DDP hopes to enable breeders to determine an “https://www.vet.cornell.edu/health-topics/estimated-breeding-values-ebvs (estimated breeding value)” for DCM on a pedigree and genetic basis. “This is a super powerful tool,” Liu said. “This is how guide dogs have systematically improved their breeding program.” The two genes identified to date that are associated with DCM in Dobermans are autosomal dominant, Liu said. Because the disease shows up late in a dog’s life, it can be hard to stay ahead of, she noted. Genetic testing offered through Embark at cost enables DDP to track genetic data. Study participants also update all clinical health data for the research project. Need more dogs testedLiu said that in just about two years DDP has tested more than 2,500 dogs, but they need many more. “We need more dogs tested. Affected and unaffected dogs. We need raw data and clinical updates and medical records,” Liu said. The guide dog programs’ success relies on having the advantage of huge breeding colonies that are all tested in house, she added. DDP’s relationship with Embark enables breeders to find the right balance between the inbreeding percentages needed to fix type and maintain health. Embark’s breeder tool enables people to make that decision for themselves, Liu noted, “just like Tinder for your Doberman.” “We’re finding out that the genetic bottlenecks are worse than we thought,” Liu noted. “Over 99% of Dobermans share a single paternal haplotype, in other words, one stud dog is behind nearly every Doberman tested.”The research is also turning up valuable information about the heritability of various traits – in other words, how much variation of the trait is genetic. For example, studies indicate 40 percent of fear behavior is genetic. For more on the topic of how genetics impact fear behavior, listen to Pure Dog Talk https://puredogtalk.com/podcast/testing-the-genetics-and-biological-markers-of-fear-in-dogs-pure-dog-talk/ (Episode 221). “People go to breeders for consistency,” Liu said. “The better we get at it, the better it is for everyone.”Pure Dog Talk is sponsored by:   Support this podcast

Commentary by Dr. Valentin Fuster

Listen as Dr. London Smith (.com) and his producer Cameron discuss Dilated Cardiomyopathy with special guest Tank. Not so boring! http://www.londonsmith.com/jockdocpodcast/17-dilated-cardiomyopathy-tank/ Performed by: London Smith, Cameron Clark, Dylan Walker. Written by: London Smith, Cameron Clark, Dylan Walker, Stewart Zimmerman. Produced by: London Smith, Cameron Clark, Dylan Walker. Created by: London Smith

Commentary by Dr. Valentin Fuster

Welcome to Season two of HPR! In the first episode we are going to chat about the current research on DCM, the FDA reports, and much more! Shownotes: www.holisticpetradio.ca/DCM_______Website: www.holisticpetradio.ca Facebook: https://www.facebook.com/HolisticPetRadio/Instagram: https://www.instagram.com/holisticpetradio/Twitter: https://twitter.com/HolisticPetRadYouTube: https://youtube.com/holisticpetradioFacebook Group: https://www.facebook.com/groups/holisticpetparents/ Music: BenSound

Welcome to Season two of HPR! In the first episode we are going to chat about the current research on DCM, the FDA reports, and much more! Shownotes: www.holisticpetradio.ca/DCM_______Website: www.holisticpetradio.ca Facebook: https://www.facebook.com/HolisticPetRadio/Instagram: https://www.instagram.com/holisticpetradio/Twitter: https://twitter.com/HolisticPetRadYouTube: https://youtube.com/holisticpetradioFacebook Group: https://www.facebook.com/groups/holisticpetparents/ Music: BenSound

This week we review a recent publication on modern day outcomes for children with dilated cardiomyopathy. It seems as if they are doing better than patients did 10 years earlier - why is this so? What factors may account for the improvements in outcomes? We discuss these questions and more with the first author of this multi center work, Dr. Rakesh Singh, Associate Professor of Pediatrics at UC SanDiego and also the Director of the Pediatric Heart Failure and Transplantation Program at Rady Children's Hospital. doi: 10.1016/j.jacc.2017.09.1089

This week we review a recent publication on modern day outcomes for children with dilated cardiomyopathy. It seems as if they are doing better than patients did 10 years earlier - why is this so? What factors may account for the improvements in outcomes? We discuss these questions and more with the first author of this multi center work, Dr. Rakesh Singh, Associate Professor of Pediatrics at UC SanDiego and also the Director of the Pediatric Heart Failure and Transplantation Program at Rady Children's Hospital. doi: 10.1016/j.jacc.2017.09.1089

In this episode, Dr Thomas Craven discusses key points from a recent case report published in EHJ – Case Reports. For the paper discussed in this episode, please visit https://doi.org/10.1093/ehjcr/ytz016.

Grain-Free dog food has been all over the news since July 12th and sadly the information the mass media has reported been oversimplified and incomplete. The fact is this is a complex issue. In this episode of The Woof Meow Show from September 29, 2018, Don speaks with canine nutritionist, science writer, and the author of Dog Food Logic Linda Case about this very issue, asking, Is Feeding A Grain-Free Food to Our Dogs Dangerous? Other issues addressed in the show are: Should dog parents currently feeding their dogs a grain-free diet immediately switch to a non-grain-free dog food? What is Dilated Cardiomyopathy and what is the role of Taurine in the disease and grain-free foods? Does the FDA know with 100% certainty that grain-free food is the cause or could it be something else? There has been some suggestion in posts on Facebook and other places online that one should only purchase dog food that has been tested via AAFCO feeding trials. Is that sound advice? Is it important for dog parents to review the ingredients label when making decisions about what to feed their dog? Recommended Resources FDA Reports FDA Investigating Potential Connection Between Diet and Cases of Canine Heart Disease – 12JUL2018 – https://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm613305.htm Questions & Answers: FDA Center for Veterinary Medicine’s Investigation into a Possible Connection Between Diet and Canine Heart Disease – https://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm616279.htm How to Report a Pet Food Complaint – https://www.fda.gov/AnimalVeterinary/SafetyHealth/ReportaProblem/ucm182403.htm Whole Dog Journal Articles DCM in Dogs: Taurine's Role in the Canine Diet - What is taurine-deficiency dilated cardiomyopathy (DCM), and how can dog owners prevent it? (Hint: It involves more than just grain-free foods.) – The Whole Dog Journal – September 2018 – https://www.whole-dog-journal.com/issues/21_9/features/DCM-in-Dogs-Taurines-Role-in-the-Canine-Diet_21901-1.html Please Don’t Panic About the “Grain-Free Thing” – Whole Dog Journal’s Blog – 2AUG18 – https://www.whole-dog-journal.com/blog/Please-Dont-Panic-About-the-Grain-Free-Thing-21893-1.html Articles on Don’s Blog ( http://www.words-woofs-meows.com ) UPDATE! – Pet Nutrition – Grain-Free Foods and FDA Reports of Increased Heart Disease in Dogs – https://www.greenacreskennel.com/blog/2018/07/27/update-pet-nutrition-grain-free-foods-and-fda-reports-of-increased-heart-disease-in-dogs/ Grain-Free Foods and FDA Reports of Increased Heart Disease in Dogs –  https://www.greenacreskennel.com/blog/2018/07/22/pet-nutrition-grain-free-foods-and-fda-reports-of-increased-heart-disease-in-dogs/ What Do You Feed Your Dog? – http://bit.ly/WhatDoYouFeedYourDog Some Myths and Facts – Part 1 – My story with Gus – Maine Dog Magazine – Winter 2017 – http://bit.ly/Gus-Nutrition Book Review – Ruined by Excess, Perfected by Lack – The paradox of pet nutrition by Richard Patton – http://bit.ly/RuinedByExcess-BookReview Podcasts from The Woof Meow Show ( http://www.woofmeowshow.com ) What do you feed your pets? – http://bit.ly/WhatDoYouFeedYourPets-Podcast Podcast – Pet Nutrition with Dr. Richard Patton – http://bit.ly/DrPatton-Podcast Podcast – Pet Fooled – A Look Inside A Questionable Industry with Kohl Harrington – http://bit.ly/WfMw-Pet-Fooled

Commentary by Dr. Valentin Fuster

Myocardial infarction (MI) in children is uncommon, but underdiagnosed.  This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector!  Case examples Congenital Two main presentations of MI due to congenital lesions: novel and known.  The novel presentation is at risk for underdiagnosis, due to its uncommonness and vague, atypical symptoms.  There are usually some red flags with a careful H&P.  The known presentation is a child with a history of congenital heart disease, addressed by corrective or palliative surgery.  This child is at risk for expected complications, as well as overdiagnosis and iatrogenia.  Risk stratify, collaborate with specialists. The fussy, sweaty feeder: ALCAPA Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is an example of what can go wrong during fetal development: any abnormality in the number, origin, course, or morphology of the coronary arteries can present as a neonate with sweating during feeds (steal syndrome), an infant in CHF, or an older child with failure to thrive or poor exercise tolerance. The stable child with chest pain: myocardial bridge Normal coronary arteries run along the epicardial surface of the heart, with projections into the myocardium.  If part of the artery’s course runs within the myocardium (i.e. the artery weaves into and/or out of the myocardium), then there is a myocardial bridge of the coronary artery.  With every systolic contraction, the artery is occluded.  Although a myocardial bridge may not cause symptoms (especially at distal portions), the area it supplies is at risk. With any minor trauma or exertion, demand may outpace supply, resulting in ischemia.  Diagnosis is made on coronary angiography. The unwell child post-cardiac surgery: Fontan problems The child with single ventricle physiology may have a Norwood procedure at birth (creation of a neoaorta, atrial septectomy, and Blalock-Taussig shunt), a Bidirectional Glenn procedure at 3-6 months (shunt removed, superior vena cava connected to pulmonary arteries), and a Fontan procedure at about 2-3 years of age (inferior vena cava blood flow is shunted into the pulmonary arteries). These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.  They are typically on an anticoagulant (often aspirin), a diuretic (e.g. furosemide), and an afterload reduction agent (e.g. enalapril).  Any disturbance in volume status (hyper- or hypovolemia), anticoagulation, or afterload may cause myocardial strain or infarction.  Take the child s/p Fontan seriously and involve his specialists early with any concerns. Autoimmune The body’s inflammatory-mediated reaction to a real or perceived insult can cause short- and long-term cardiac sequelae.  Find out how well the underlying disease is controlled, and what complications the child has had in the past. The red, hot, crispy, flaky child: acute Kawasaki disease Kawasaki disease (KD) is an acute systemic vasculitis, diagnosed by the presence of fever for five or more days accompanied by four or more criteria:  bilateral conjunctival injection, mucositis, cervical lymphadenopathy, polymorphous rash, and palmar or sole desquamation.  The criteria may occur (and disappear) at any time during the illness. Infants are under double jeopardy with Kawasaki Disease.  They are more likely to have incomplete KD (i.e. not fulfill strict criteria) and if they have KD, they are more likely to suffer the dangerous consequences of aneurysm formation (chiefly coronary arteries, but also brain, kidney).  Have a low threshold for investigation. Treatment includes 2 g/kg/day IVIG and high-dose aspirin (30-50 mg/kg/day) acutely, then low-dose aspirin (5 mg/kg/day) for weeks to months.  Regular and long-term follow-up with Cardiology is required. The aftermath: sequelae of Kawasaki disease The family and child with a history of KD may have psychological trauma and continuous anxiety about the child’s risk of MI.  Approximately 4.7% of children who were promptly diagnosed and correctly treated will go on to have cardiac sequelae. Children who have no detected cardiac sequelae by 8 weeks, typically continue to be asymptomatic up to 20 years later.  Smaller aneurysms tend to regress over time, especially those < 6 mm. Thrombi may calcify, or the lumen may become stenotic due to myofibroblast proliferation.  Children with any coronary artery dilatation from KD should be followed indefinitely. Giant aneurysms (≥8 mm) connote the highest risk for MI.  Parents often are concerned about recurrence, and any subsequent fever can be distressing.  There is a low rate of recurrence for KD: approximately 2%.  Infants who have coronary aneurysms are at the highest risk for recurrence. The older child with vague chest complaints and hypercoagulability: Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome Up to 15% of cases of SLE begin in childhood.  Adult criteria are used, with the caveat that the diagnosis of SLE in children can be challenging; many children only manifest a few of the criteria initially before going on to develop further systemic involvement. The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012.  The patient should have ≥4/17 clinical and/or immunologic criteria.  The clinical criteria are: acute cutaneous (malar); chronic cutaneous (discoid); oral; alopecia; synovitis; serositis; renal; neurologic; hemolytic anemia; leukopenia; or thrombocytopenia.  The immunologic criteria are: ANA; anti-dsDNA; anti-Sm; antiphospholipid; low complement; and/or Direct Coombs (in absence of hemolytic anemia).  At least one criterion should be clinical, and at least one should be immunologic.  Children with antiphospholipid syndrome (APS) may occur with or without SLE.  Patients are at risk for venous and arterial thrombi formation.  APS may also cause structural damage, such as valvular thickening and valvular nodes (Libman-Sacks endocarditis).  Mitral and aortic valves are at the highest risk. Although most children with chest pain will not have MI, those with comorbidities should be investigated carefully. Trauma Direct, blunt trauma to the chest can cause myocardial stunning, dysrhythmias, or an asymptomatic rise in Troponin I.  However, some children are at risk for disproportionate harm due to a previously unknown risk factor.  Clinically significant cardiac injury occurs in up to 20% of patients with non-penetrating thoracic trauma. The motor vehicle collision: blunt myocardial injury Direct trauma (steering wheel, airbag, seatbelt), especially in fast acceleration-deceleration injury, may cause compression of the heart between the sternum and the thoracic spine. Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury.  A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring. Elevation in troponin is common, but not predicted.  A solitary elevated troponin without ECG abnormality is of unclear significance.  Author’s advice: obtain troponin testing if there is an abnormal ECG, more than fleeting suspicion of BCI, and/or the child will be admitted for monitoring. Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The high-velocity object: coronary artery dissection or thrombus Direct trauma (e.g. MVC, baseball, high-velocity soccer ball) may cause damage to the left anterior descending artery or left circumflex artery, at the highest risk due to their proximity to the chest wall.  Thrombosis and/or dissection may result, often presenting in a focal pattern of ischemia on the ECG. Echocardiography may reveal valvular damage related to the injury, as well as effusion and ejection fraction.  Since there is often a need to investigate the coronary anatomy, percutaneous coronary intervention (PCI) is recommended. The minor trauma with disproportionate complaint: myocardial bridge As mentioned in the congenital section (above), a known variation of a coronary artery’s course involves weaving in and out of the myocardium, creating a baseline risk for ischemia.  Even minor trauma in a child with a myocardial bridge may cause acute thrombus, or slow stenosis from resulting edema.  Unfortunately, the presence of myocardial bridging is often unknown at the time of injury.  Approximately 25% of the population may have myocardial bridging, based on autopsy studies. Take the child seriously who has disproportionate symptoms to what should be a minor injury. Hematologic Coagulopathic and thrombophilic states may predispose children to focal cardiac ischemia.  The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The child with sickle cell disease and chest pain: when it’s not acute chest syndrome Sickle cell disease (SCD) can affect any organ system, although the heart is traditionally considered a lower-risk target organ for direct sickling and ischemia.  The major cardiac morbidity in sickle cell is from strain, high-output failure and multiple, serial increases in myocardial demand, causing left ventricular hypertrophy and congestive heart failure. However, there is mounting evidence that acute myocardial ischemia in sickle cell disease may be underappreciated and/or attributed to other causes of chest pain. Other cardiac sequelae from SCD include pulmonary hypertension, left ventricular dysfunction, right ventricular dysfunction, and chronic iron overload. Evidence of myocardial ischemia/infarction in children with SCD has been demonstrated on single-photon emission computed tomography (SPECT) scan. The puffy faced child with chest pain: nephrotic syndrome hypercoagulability Children who suffer from nephrotic syndrome lose proteins that contribute to the coagulation cascade.  In addition, lipoprotein profiles are altered: there is a rise in the very low-density lipoproteins (LDL), contributing to accelerated atherosclerosis.  Typically nephrotic patients have normal levels of high-density lipoproteins (HDL), unless there is profuse proteinuria. Children with difficult-to-control nephrotic syndrome (typically steroid-resistant) may form accelerated plaques that rupture, causing focal MI, as early as school age. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI.  However, the presence of PFO alone does not connote higher risk.  When paired with an inherited or acquired thrombogenic condition, the venous thrombus may travel from the right-sided circulation to the left, causing distal ischemia.  Many of these cases are unknown until a complication arises. The chronically worried, now with a reason: hypercholesterolemia A family history of adult-onset hypercholesterolemia is not necessarily a risk factor for early complications in children, provided the child does not have the same acquired risk factors as adults (e.g. obesity, sedentary lifestyle, smoking, etc).  Parents may seek help in the ED for children with chest pain and no risk factors, but adult parents who have poor cholesterol profiles. The exception is the child with familial hypercholesterolemia, who is at risk for accelerated atherosclerosis and MI. Infectious Myocarditis has varied etiologies, including infectious, medications (chemotherapy agents), immunologic (rheumatologic, transplant rejection), toxins (arsenic, carbon monoxide, heavy metals such as iron or copper), or physical stress (electrical injury, heat illness, radiation). In children, the most common cause of myocarditis is infectious (viruses, protozoa, bacteria, fungal, parasites).  Of these, viral causes are the most common (adenovirus, enterovirus, echovirus, rubella, HHV6). The verbal child may complain of typical chest complaints, or may come in with flu-like illness and tachycardia or ill appearance out of proportion to presumed viral illness. The most common presenting features in children with myocarditis are: shortness of breath, vomiting, poor feeding, hepatomegaly, respiratory distress, and fever. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’.  That may very well be true, but any virus can be invasive with myocardial involvement.  Infants are only able to increase their cardiac output through increasing their heart rate; they cannot respond to increased demands through ionotropy.  Look for signs of acute heart failure, such as hepatomegaly, respiratory distress, and sacral edema. The child with tachycardia out of proportion to complaint: myocarditis The previously healthy child with “a bad flu” may simply be very symptomatic from influenza-like illness, or he may be developing myocarditis.  Look for chest pain and tachycardia out of proportion to presumed illness, and constant chest pain, not just associated with cough. The “pneumonia” with suspicious chest x-ray: myocarditis Acute heart failure may mimic viral pneumonia.  Look for disproportionate signs and symptoms. Toxins Younger children may get into others’ medications, be given dangerous home remedies, take drugs recreationally, have environmental exposures (heavy metals), suffer from a consequence of a comorbidity (iron or copper overload) or have adverse events from generally safe medications. The hyperactive boy with a hyperactive precordium: methylphenidate Attention deficit hyperactivity disorder (ADHD) is growing in rate of diagnosis and use of medications.  As the only medical diagnosis based on self-reported criteria, many children are given stimulants regardless of actual neurologic disorder; with a higher proportion of children exposed to stimulants, adverse effects are seen more commonly. Methylphenidate is related to amphetamine, and they both are dopaminergic drugs.  Their mechanisms of action are different, however.  Methylphenidate increases neuronal firing rate.  Methamphetamine reduces neuronal firing rate; cardiovascular sequelae such as MI and CHF are more common in chronic methamphetamine use. Although methylphenidate is typically well tolerated, risks include dysrhythmias such as ventricular tachycardia. The child with seizure disorder and chest pain: anti-epileptics Some anti-epileptic agents, such as carbamazepine, promote a poor lipid profile, leading to atherosclerosis and early MI.  Case reports include school-aged children on carbamazepine who have foamy cells in the coronary arteries, aorta, and vasa vasorum on autopsy.  It is unclear whether this is a strong association. The spice trader: synthetic cannabinoids Synthetic cannabinoids are notoriously difficult to regulate and study, as the manufacturers label them as “not for human consumption”.  Once reports surface of abuse of a certain compound, the formula is altered slightly and repackaged, often in a colorful or mysterious way that is attractive to teenagers. The misperceptions are: are a) synthetics are related to marijuana and therefore safe and b) marijuana is inherently “safe”. Both tend to steer unwitting teens to take these unknown entities.  Some suffer MI as a result. Exposure to tetrahydrocannabinol (THC) in high-potency marijuana has been linked to myocardial ischemia, ventricular tachycardia, and ventricular fibrillation.  Marijuana can increase the heart rate from 20-100%, depending on the amount ingested. K2 (“kush 2.0”) or Spice (Zohai, Genie, K3, Bliss, Nice, Black Mamba, fake weed, etc) is a mixture of plant leaves doused in synthetic chemicals, including cannabinoids and fertilizer (JWH-108), none of which are tested or safe for human consumption.  Synthetic cannabinoids have a higher affinity to cannabinoid receptors, conferring higher potency, and therefore worse adverse effects.  They are thought to be 100 to 800 times more potent as marijuana. Bath salts (Purple Wave, Zoom, Cloud Nine, etc) can be ingested, snorted, or injected.  They typically include some form of cathinone, such as mephedrone, similar to the substance found in the naturally occurring khat plant. Hallucinations, palpitations, tachycardia, MI, and dysrhythmias have been reported from their use as a recreational drug. Chest pain with marijuana, synthetic cannabinoid, or bath salt ingestion should be investigated and/or monitored. Riding that train: high on cocaine Cocaine is a well-known cause of acute MI in young people.  In addition to the direct stimulant causes acutely, such as hypertension, tachycardia, and impaired judgement (coingestions, risky behavior), chronic cocaine use has long-term sequelae.  Cocaine causes accelerated atherosclerosis.  That, in conjunction with arterial vasospasm and platelet activation, is a recipe for acute MI in the young. Cranky: methamphetamine Methamphetamine is a highly addictive stimulant that is relatively inexpensive and widely available.  Repeated use causes multiple psychiatric, personality, and neurologic changes.  Risky behavior, violence, and motor vehicle accidents are all linked to this drug.  Like cocaine, methamphetamine may cause fatal dysrhythmias, acute MI from demand ischemia, and long-term sequelae such as congestive heart failure. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! References Congenital AboulHosn JA et al. Fontan Operation and the Single Ventricle. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. A case of anomalous origin of the left coronary artery presenting with acute myocardial infarction and cardiovascular collapse. African Health Sci. 2014; 14(1): 23-227. Andrews RE et al. Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome. Heart. 2004; 90:e17. Canale LS et al. Surgical treatment of anomalous coronary artery arising from the pulmonary artery. Interactive Cardiovascaulr and Thoracic Surgery. 2009; 8:67-69. Güvenç O et al. Correctable Cause of Dilated Cardiomyopathy in an Infant with Heart Failure: ALCAPA Syndrome. J Curr Pediatr. 2017; 15:47-50. Hastings RS et al. Embolic Myocardial Infarction in a Patient with a Fontan Circulation. World Journal for Pediatric Congenital Heart Surgery. 2014; 5(4)L631-634. Hoffman JIE et al. Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants. Pediatr Cardiol. 2013; 34(3):489-491. Kei et al. Rare Case of Myocardial Infarction in a 19-Year-Old Caused by a Paradoxical Coronary Artery Embolism. Perm J.2015; 19(2):e107-e109. Liu Y, Miller BW. ALCAPA Presents in an Adult with Exercise Inlerance but Preserved Cardiac Function. Case Reports Cardiol. 2012; AID 471759. Möhlenkamp S et al. Update on Myocardial Bridging.Circulation. 2002;106:2616-2622. Murgan SJ et al. Acute myocardial infraction n the neonatal period. Cardiol Young. 2002; 12:411-413. Sieweke JT et al. Myocardial infarction in grown up patients with congenital heart disease: an emergening high-risk combination. International Journal of Cardiology. 2016; 203:138-140. Schwerzmann M et al. Anomalous Origin of the Left Coronary Artery From the Main Pulmonary Artery in Adults. Circulation. 2004; 110:e511-e513. Tomkewicz-Pajak L et al. Arterial stiffness in adult patients after Fontan procedure. Cardiovasculr Ultrasound. 2014; 12:15. Varghese MJ et al. The caveats in the diagnosis of anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Images Paediatr Cardiol. 2010; 12(3): 3–8. Autoimmune Ayala et al. Acute Myocardial Infarction in a Child with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Turk J Rheumatol. 2009; 24:156-8. Nakano H et al. Clinical characteristics of myocardial infarction following Kawasaki disease: Report of 11 cases. J Pediatr. 1986; 108(2):198-203. Pongratz G et al. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. European Heart J. 1994. 15:1002-1004. Newburger JW et al.  Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747-2771. Son MB et al. Kawaski Disease. Pediatr Rev. 2013; 34(4). Yuan S. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. Libyan J Med. 2012; 7:19796. Trauma Abdolrahim SA et al. Acute Myocardial Infarction Following Blunt Chest Trauma and Coronary Artery Dissection. J Clin Diagnost Res. 2016; 10(6):14-15. Galiuto L et al. Post-traumatic myocardial infarction with hemorrhage and microvascular damage in a child with myocardial bridge: is coronary anatomy actor or bystander. Signa Vitae. 2013; 8(2):61-63. Janella BL et al. Acute Myocardial Infarction related to Blunt Thoracic Trauma. Arq Bras Cardiol. 2006; 87:e168-e171. Liu X et al. Acute myocardial infarction in a child with myocardial bridge World J Emerg Med. 2011; 2(1):70-72. Long WA et al. Childhood Traumatic Infarction Causing Left Ventricular Aneurysm: Diagnosis by Two-Dimensional Echocardiography. JACC. 1985; 5(6):1478-83. Smith S. Right Bundle Branch Block after Blunt Trauma: A Tragic Case. [Blog Post] July 22, 2012. Retrievable at: http://hqmeded-ecg.blogspot.com/2012/07/right-bundle-branch-block-after-blunt.html. Hematologic Carano N et al. Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated with Heritable Thrombophilia. Pediatr. 2004; 114(2):255-258.      Chacko P et al. Myocardial Infarction in Sickle Cell Disease. J Cardiovascl Transl Res. 2013; 6(5):752-761. De Montalembert M et al. Myocardial ischaemia in children with sickle cell disease. Arch Dis Child. 2004; 89:359-362. Gladwin MT et al. Cardiovascular Abnormalities in Sickle Cell Disease. JACC. 2012; 59(13):1123-1133. Osula S et al. Acute myocardial infarction in young adults: causes and management. Postgrad Med J. 2002; 78:27-30. Silva JMP et al. Premature acute myocardial infarction in a child with nephrotic syndrome. Pediatr Nephrol. 2002; 17:169-172. Suryawanshi SP. Myocardial infarction in children: Two interesting cases. Ann Pediatr Cardiol. 2011 Jan-Jun; 4(1): 81–83. Infectious Cunningham R et al. Viral myocarditis Presenting with Seizure and Electrocardiographic Findings of Acute Myocardial Infarction in a 14-Month-Old Child. Ann Emerg Med. 2000; 35(6):618-622. De Vettten L et al. Neonatal Myocardial Infarction or Myocarditis? Pediatr Cardiol. 2011; 32:492-497. Durani Y et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009; 27:942-947. Erden I et al. Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza virus. Cardiol J. 2011; 552-555. Hover MH et al. Acute Myocarditis Simulating Myocardial Infarction in a Child. Pediatr. 1191; 87(2):250-252. Lachant D et al. Meningococcemia Presenting as a Myocardial Infarction. Case Reports in Critical Care. 2015; AID 953826. Laissy JP et al. Differentating Myocardial Infarction from Myocarditis. Radiology. 2005; 237(1):75-82. Miranda CH et al. Evaluation of Cardiac Involvement During Dengue Viral Infection. CID. 2013; 57:812-819. Rettig JS et al. Myocarditis in Children Requiring Critical Care Transport. In:  "Diagnosis and Treatment of Myocarditis", Milei J, Ambrosio G (Eds). DOI: 10.5772/56177. Toxins De Chadarévian JP et al. Epilepsy, Atherosclerosis, Myocardial Infarction, and Carbamazepine. J Child Neurol. 2003; 18(2):150-151. McIlroy G et al. Acute myocardial infarction, associated with the use of a synthetic adamantly-canabinoid: a case report. BMC Pharmacology and Toxicology. 2016; 17:2. Mir A et al. Myocardial Infarction Associated with Use of the Synthetic Cannabinoid K2. Pediatr. 2011; 128(6):1-6 Munk K et al. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate. Case Reports Pediatr. 2015; AID 905097. Rezkalla SH et al. Cocaine-Induced Acte Mycardial Infarction. Clin Med Res. 2007; 5(3):172-176. Schelleman H et al. Methylphenidate and risk of serious cardiovascular events in adults. Am J Psychiatry. 2012 Feb;169(2):178-85. Sheridan J et al. Injury associated with methamphetamine use: a review of the literature. Harm Reduction Journal, 2006; 3(14):1-18. Stiefel G et al. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of attention-deficit hyperactivity disorder. Drug Saf. 2010 Oct 1;33(10):821-42.   This post and podcast are dedicated to Edwin Leap, MD for his sanity and humanity in the practice of Emergency Medicine.  Thank you, Dr Leap for all that you do.

Commentary by Dr. Valentin Fuster

Rebecca shares her story about her daughter who has Dilated Cardiomyopathy. She talks about how her daughter's heart disease was not discovered until she was four months old. Plus, Rebecca talks about her journey in the hospital and having her daughter placed on the heart transplant list. Rebecca shares her experience of having her daughter on the heart transplant list and everything that entails. She talks about how her daughter is doing today – after working her way off the heart transplant list. Rebecca shares how she explained to her other children that their sister has chd. She talks about how her daughter's twin brother developed differently and then reveals some of her daughter's developmental delays. Plus, Rebecca talks about her job as a physical therapist and how she helps children with developmental delays. She emphasizes why it is important for parents to be the #1 advocates for their child in regards to getting services for any developmental delays. And finally, Rebecca briefly talks about Mended Little Hearts and how she lead the local chapter in Central Virginia.

Commentary by Dr. David Wilber

Commentary by Dr. Valentin Fuster

Commentary by Dr. Valentin Fuster

Commentary by Dr. Valentin Fuster

Background: Genome wide association studies (GWAS) are applied to identify genetic loci, which are associated with complex traits and human diseases. Analogous to the evolution of gene expression analyses, pathway analyses have emerged as important tools to uncover functional networks of genome-wide association data. Usually, pathway analyses combine statistical methods with a priori available biological knowledge. To determine significance thresholds for associated pathways, correction for multiple testing and over-representation permutation testing is applied. Results: We systematically investigated the impact of three different permutation test approaches for over-representation analysis to detect false positive pathway candidates and evaluate them on genome-wide association data of Dilated Cardiomyopathy (DCM) and Ulcerative Colitis (UC). Our results provide evidence that the gold standard - permuting the case-control status - effectively improves specificity of GWAS pathway analysis. Although permutation of SNPs does not maintain linkage disequilibrium (LD), these permutations represent an alternative for GWAS data when case-control permutations are not possible. Gene permutations, however, did not add significantly to the specificity. Finally, we provide estimates on the required number of permutations for the investigated approaches. Conclusions: To discover potential false positive functional pathway candidates and to support the results from standard statistical tests such as the Hypergeometric test, permutation tests of case control data should be carried out. The most reasonable alternative was case-control permutation, if this is not possible, SNP permutations may be carried out. Our study also demonstrates that significance values converge rapidly with an increasing number of permutations. By applying the described statistical framework we were able to discover axon guidance, focal adhesion and calcium signaling as important DCM-related pathways and Intestinal immune network for IgA production as most significant UC pathway.

Editor's Audio Summary by J. Michael Gaziano, MD, MPH, Contributing Editor, the Journal of the American Medical Association, for the March 06, 2013 issue

Sun, 1 Jan 2012 12:00:00 +0100 http://jnnp.bmj.com/content/83/Suppl_2/A14.4.abstract?sid=ccc27018-25b8-4eae-8af8-c02e427d8cf0 https://epub.ub.uni-muenchen.de/20879/1/oa_20879.pdf Radunovic, A.; Page, S.; Early, M.; Bader, B.; Danek, A.; Mohiddin, S.; Chan, J.; Fiddes, B.; Williamson, J. ddc:610, Medizin

Up to now, the occult phase of the cardiomyopathy in Doberman Pinschers, with a cumulative prevalence of 63 % in Europe (WESS et al., 2009b), can only be diagnosed by specialized and cost-intensive methods, such as the 24-h-ECG (Holter) and the echocardiogram. Electrocardiographic and echocardiographic changes usually appear at an age, in which the dogs were already used for breeding. Considering the genetic health of the Doberman Pinscher breed, it is of great importance to diagnose the genetically determined cardiomyopathy before it can be passed on to the offspring. The aim of this study Analysis of NTpro-BNP in Dilated Cardiomyopathy of the Doberman Pinscher was to evaluate NTpro-BNP in the Doberman Pinscher population, in healthy animals as well as in various stages of cardiomyopathy, to define reference values and to validate the use of NTpro-BNP as a diagnostic tool. Therefore, 250 healthy and 108 dogs with cardiomyopathy were studied between 2004 and 2008, in total 480 examinations. NTpro-BNP measurements were performed in plasma samples, using the ELISA VETSIGNTM Canine CardioSCREEN Ntpro-BNP, Guildhay Ltd., UK. NTpro-BNP concentrations increased in correlation with the severity of disease. There was a statistically significant difference between the healthy control group (mean 315.7 pmol/l) and the occult and decompensated groups as well as the whole dog population with cardiomyopathy. To differentiate healthy dogs from dogs with cardiomyopathy, a cut-off value of 413.8 pmol/l was established that provided an area under the receiver operator curve of 0.820, with a sensitivity and specifity of 72.4 % and 80.2 %, respectively. There was no significant influence of age, weight or sex on the NTpro-BNP concentration. Sensitivity reached 90.0 % for predicting abnormal echocardiographic changes. Interestingly, there was a statistically significant increase of NTpro-BNP in the occult group with exclusively VPCs even before echocardiographic changes were present. The “still normal” group, consisting of examinations of dogs that appeared to be healthy without any measurable signs at that time, but which later on developed cardiomyopathy, is highly interesting. Although the mean NTpro-BNP level (499.7 pmol/l) was higher than the mean NTpro-BNP concentration in the occult group with exclusively VPCs, no statistically significant difference was achieved in comparision to the healthy control group using Bonferroni’s equitation. The small number of only 17 dogs in this group might be a reason for the lack of statistical significance. One limitation of this study is the fact that not all dogs, especially those in the healthy control group, could be followed up to the end of their lives. Therefore, it might be possible that “still healthy” dogs with genetically determined cardiomyopathy are included in the healthy control group. As a consequence, the reference value could be falsely high. Long-term studies will be needed to validate the reference value in a group of definitively genetically healthy animals. The tendency to higher NTpro-BNP values in the still normal group also should be studied in a larger population in order to evaluate the potential of NTpro-BNP as an early marker of cardiomyopathy in Doberman Pinschers. NTpro-BNP cannot replace the Holter ECG and echocardiographic measurements in the diagnosis of occult cardiomyopathy at present. But if the time-consuming and cost-intensive methods that require a high specialization are not available, NTpro-BNP levels could indicate the necessity of referring the patient to a cardiologist. Because of the high sensitivity of 90 % for predicting abnormal echocardiographic changes, it might be possible that the measurement of NTpro-BNP eventually could replace the echocardiographic examination, but not the Holter-ECG.