AUCTORES
Globalize your Research
Case report | DOI: https://doi.org/10.31579/2690-1919/443
1Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.
2Centro Cardiologico Monzino IRCCS, Emergency Department, 20138 Milan, Italy.
3Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
*Corresponding Author: Gianluca Guarnieri, Centro Cardiologico Monzino, IRCCS Via Privata Carlo Parea 20138 - Milan (Italy).
Citation: nluca Guarnieri, Michele Della Rocca, Alessia Dalla Cia, Giancarlo Marenzi, (2024), Atypical Clinical Presentation of Takotsubo Syndrome in Association with Unusual Clinical onset of Myasthenia Gravis: a Case Report, J Clinical Research and Reports, 17(3); DOI:10.31579/2690-1919/443
Copyright: © 2024, Gianluca Guarnieri. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 21 November 2024 | Accepted: 09 December 2024 | Published: 27 December 2024
Keywords: takotsubo; myasthenia gravis; myasthenic crisis
Introduction: Takotsubo syndrome (TTS) is a cardiomyopathy triggered by emotional or physical stress. This case report presents a unique instance of TTS associated with myasthenia gravis (MG) in which myasthenic crisis developed after TTS diagnosis and not before.
Case Description: A 73-year-old man presented with difficulty swallowing, dysphonia, and dyspnea, showing moderate-severe left ventricular dysfunction. Blood tests revealed elevated troponin and BNP levels, while the ECG at the arrival showed an ST-elevation in anterior leads. Coronary angiography showed normal aspect of coronary vessels. Echocardiography confirmed TTS with apical ballooning.
After few days, myasthenic symptoms emerged leading to a myasthenic crisis. The patient improved with acetylcholinesterase inhibitors and was discharged with pyridostigmine and prednisone. Follow-up revealed complete resolution of left ventricular dysfunction.
Discussion: MG rarely affects the heart, but in this case, it led to TTS. Notably, TTS occurred before the myasthenic crisis, emphasizing the need for cardiac monitoring in patients with new neurological diagnoses and acute respiratory.
Takotsubo syndrome (TTS) is a cardiomyopathy that consists in transient abnormalities in myocardial motion that may result in left ventricle disfunction1 (LVD). This condition is generally induced by emotional or physical stress factors and it is also known as the ‘The broken heart syndrome’ [2].
TTS was firstly described in Japan and it is reported to represent almost one to two % of all patients who present positive troponin and chest pain suspected of acute coronary syndrome (ACS).
It occurs more frequently in women. Moreover, most of patients are older than 50 years of age at the time of the diagnosis. Data from the literature show a 30-days mortality about 4% that is comparable to patients with ACS. At the same time, long term risk of death in TTS is still similar3 or even higher than what observed in ACS. Furthermore, survivors of TTS have increased risk of hospitalization due to heart failure than general population, but lower to survivors of ACS [4].
Stress factors
In TTS, a stress factor may be identified in almost 85% of cases; it could be either emotional or physical. Among emotional factors, grief, anger or relationship conflicts are the most frequent; Physical stressor include surgery, chemotherapy, stroke, asthma or neurological disease [5].
The investigation of the stress factors may play a crucial role; in fact, patients who have a physical stressor are more likely to be haemodynamically unstable with worse LV function, higher incidence of cardiogenic shock compared to patients who have emotional trigger6. In particular, there is growing evidence of the fact that patients with TTS with concomitant neurological disease may present greater myocardial damage and more pronounced LVD7. Furthermore, some studies indicate the presence of critical illness as the most important determinant of both in-hospital[8] mortality and long term outcome [9]. Specifically, a worse survival rate is observed in TTS consequent to neurological disorders [10].
Among neurological diseases as possible triggers, seizures, intracranial hemorrhage and cerebral ischemia are the most frequent ones. Moreover, TTS has been occasionally reported in association with neuromuscular disorder as myasthenia gravis (MG) or Guillain Barrè syndrome[11].
In this case report, we present an unusual case of MG-related TTS, and at our best knowledge, this is the first in which myasthenic crisis developed approximately two days after TTS diagnosis and not before.
Our patients is a 73-years-old man who came to our attention due to difficulty swallowing solid foods for about 20 days, worsened in the last 3 days with the onset of dysphonia and difficulty swallowing liquids. The patient also reported occasional paroxysmal dyspnea episodes that resolved after food vomiting. Of note, he had always been asymptomatic for chest pain. The patient had no significant medical history, except for borderline hypertension under investigation.
He had no family history of cardiovascular disease, but his mother was affected by MG.
On arrival at the emergency room, the patient was markedly anxious, complaining of globus sensation in his throat. He was subjectively eupneic and asymptomatic for chest pain. There was mild dysphonia and abundant drooling. Blood pressure was normal and the hemodynamic status was stable, but with a tendency towards sinus tachycardia (HR 120 bpm).
Physical examination showed normal peripheral perfusion and normal findings throughout the body except for mild crackles at the base of the right lung; no signs of congestive heart failure were present. The physical examination did not show any obvious focal neurological sign.
An arterial blood sample showed mild hypoxemia and mild hypocapnia (pCO2 36 mmHg, pO2 65 mmHg), with a pH within the normal range and a slightly reduced peripheral oxygen saturation (SatO2 95%). The rapid antigen test for SARS-CoV-2 was negative.
Venous blood tests showed an increase in inflammation indices with CRP 145 mg/L and neutrophilic leukocytosis (WBC 18,600/mm3 with neutrophils 16,160/mm3 – 87%), normal values of renal function and plasma electrolytes. The atrial natriuretic peptide type B (BNP) and the markers of myocardial necrosis (high-sensitivity troponin I, hsTnI) were elevated (538 pg/mL and 2363 ng/L, respectively). The D-dimer value was within the normal range for age.
In light of the initial data showing high levels of hsTnI and BNP, we performed an ECG (shown in Figure 1) and a transthoracic echocardiogram (Figure 2). The ECG showed sinus tachycardia, left axis deviation, and ST-elevation in anterior leads (V2-V3).
The transthoracic echocardiogram showed apical akinesis with moderate to severe LVD; there were no pathological findings in the thoracic aorta, cardiac valves or right ventricle, and there was no pericardial effusion. A contrast-enhanced echocardiogram (Luminity) ruled out the presence of intracardiac thrombotic formations (Figure 3).
In consideration of the atypical characteristics of the patient's symptoms, a baseline CT scan (brain and thorax) was performed to rule out an acute neurological etiology. The brain CT showed a mild picture of non-specific chronic vascular leukoencephalopathy and ruled out the presence of radiological signs related to acute lesions (ischemic, embolic, or hemorrhagic). The thoracic CT showed a focal consolidation of the middle and lower right lung lobe with ground glass opacities, compatible with pneumonia (likely aspiration pneumonia). Additionally, the exam ruled out the presence of anatomical anomalies and extrinsic compression phenomena affecting the esophagus and trachea.
Despite the presence of atypical symptoms, the preliminary exams suggested the presence of acute coronary syndrome with moderate to severe LVD, whose clinical onset could not be properly identified due to the absence of chest pain or ischemic equivalents. Therefore, immediate admission to our Coronary Intensive Care Unit was arranged.
Figure 1: ECG at arrival at the emergency department
Figure 2: Echocardiogram showing apical ballooning
Figure 3: Echocardiogram with contrast agent showing the absence of thrombotic apposition in cardiac apex
Management
Due to the concomitant pneumonia documented on chest CT, a dual empirical antibiotic therapy (Ceftriaxone and Azithromycin) and oxygen therapy was administered during hospitalization. During the first days of admission, a worsening of hypoxemia and the onset of paroxysmal respiratory distress with severe desaturation was observed, which required the intermittent use of cycles of non-invasive ventilation with oro-facial mask (BiPAP). Notably, the dyspnea mainly occurred when the patient accumulated excessive saliva that he was unable to swallow, requiring multiple external aspirations to remove secretions. The symptoms onset, characterized by dysphagia and dysphonia, showed a significant worsening during hospitalization, leading to complete inability to self-nourishing; therefore, a nasogastric tube was inserted and total enteral nutrition was administered. Ivabradine and continuous infusion beta-blockers were administered to reduce heart rate and oxygen consumption.
A low dose of intravenous furosemide was administered in order to achieve an adequate urine output rate and maintain hemodynamic stability. Inizio modulo Fine modulo
On the second day of hospitalization, a contrast-enhanced CT scan was performed, which confirmed the absence of acute brain lesions, stenosis or occlusions of the major intracranial vessels, extrinsic esophago-tracheal compression, and intracardiac thrombosis. In addition, the coronary arterial circulation was investigated, which was found to be free from significant lesions except for an atheromatous plaque in the anterior descending artery causing stenosis that could not be accurately quantified due to technical artifacts.
Therefore, it was decided to proceed with coronary angiography, which showed no relevant stenosis of the major epicardial vessels (Figure 3).
Figure 4: Coronary angiography showing the absence of obstructive stenosis
A trans-thoracic echocardiogram was repeated and confirmed the presence of moderate-to-severe reduction in left ventricular systolic function with apical ballooning and compensatory hyperkinesia of the basal segments, consistent with the diagnosis of Takotsubo Syndrome. During hospitalization, serial ECG monitoring showed ischemic evolution with the appearance of biphasic/negative T waves in the anterolateral and inferior leads and prolonged QT interval duration (QTc 500-510 ms). No significant arrhythmias were documented on ECG monitoring. Serial laboratory tests showed progressive normalization of inflammation indices and cardiac necrosis enzymes (peak hsTnI = 3184 ng/L).
In addition to the cardiological investigations, a neurological specialist evaluation was performed, which documented dysarthric speech, asymmetry of the eyelid, and slight exhaustion in motor tests (tongue protrusion, head flexion, Mingazzini I and II). Therefore, a concomitant neuromuscular plaque pathology was suspected (mainly consistent with Myasthenia Gravis). Therefore, the patient was referred to General Intensive Care Unit.
The repetitive nerve stimulation test confirmed MG diagnosis and high levels of acetylcholine receptor antibodies were detected. So, a therapy with an acetylcholinesterase inhibitor was started with rapid improvement of the patient’s clinical condition.
Patient was discharged on pyridostigmine and prednisone.
After two months a trans-thoracic echocardiogram revealed a complete resolution of the LVD.
MG is a rarely condition in men and occurs with cardiac involvement in almost 16% of patients; arrhythmic disorders, pericarditis and myocarditis have been described as the most frequent and, rarely, MG could lead to TTS. Data from the National Inpatient Sample databased provides a prevalence of 0.3% of MG-related TTS.
Rathish et Al shown that MG in patients with TTS may present in various forms; respiratory involvements is the prevalent (81%), followed by blepharoptosys (63%), and limb muscle weakness (50%); myasthenic crisis is described in some cases[12].
In most of cases in which MG present with LVD the diagnosis is represented by myocarditis and in almost the whole cases antibodies towards heart muscle may be detected.
The differential diagnosis between myocarditis and TS could be made thank to cardiac MRI showing the presence of late contrast enhancement in the first case. In our case, patient could not undergo cardiac MRI because we needed to transfer him in a hospital with neurological department.
However, accordingly with the International Takotsubo Diagnostic Criteria (InterTAK diagnostic criteria), TS was the most likely diagnosis.
Correspondingly to literature, myasthenic crisis has emerged as a stress factor of TS. Moreover, when TS is concomitant to myasthenic crisis higher rate of mortality is described[13].
So, to our opinion, every patient with a new diagnosis of neurological disorder with acute respiratory condition should undergo close cardiac monitoring and serial ECG.
Nevertheless, to our best knowledge, our case is the first case in which TS occurs before myasthenic crisis presentation. So, similarly, patients with stress- induced cardiomyopathy in absence of emotional trigger should undergo neurological investigations. In fact, neurological screening may prevent life-threatening complication including myasthenic crisis.
Lastly, we suppose that there is a strong necessity to continue to report cases of myasthenic crisis and TS to improve the competence of make diagnosis earlier and start a life-saving therapy earlier.
None declared.
None declared.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
