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MedWorm: Cardiogenic Shock



MedWorm.com provides a medical RSS filtering service. Over 7000 RSS medical sources are combined and output via different filters. This feed contains the latest news and research in the Cardiogenic Shock category.



Last Build Date: Tue, 22 Mar 2016 08:26:08 +0100

 



The Impella(R) Recover mechanical assist device in acute cardiogenic shock: a single-centre experience of 66 patients

Mon, 21 Mar 2016 00:00:00 +0100

CONCLUSIONS The Impella® Recover device improved haemodynamics in patients with acute cardiogenic shock. Still, 30-day mortality remains high and future studies must focus on the optimal timing of placement of the device. (Source: Interactive CardioVascular and Thoracic Surgery)

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Oral Nitrate Administration Ameliorates Cardiogenic Shock due to Eclipsed Mitral Regurgitation

Thu, 17 Mar 2016 04:34:27 +0100

Eclipsed mitral regurgitation (MR) has been reported as transient massive functional MR caused by a sudden coaptation defect in the absence of left ventricular remodeling or epicardial coronary artery stenosis. Coronary spasm or microvascular dysfunction has been suggested to be associated with the pathogenesis. Here, we present a 68-year-old woman with eclipsed MR with cardiogenic shock ameliorated by nitrate. She was admitted for transient shock with massive functional MR. Transient MR was associated with a complete absence of mitral leaflet coaptation owing to tethering of the lateral posterior mitral leaflet. The leaflet tethering was triggered by transient myocardial ischemia around the anterolateral papillary muscle, which could have been caused by coronary spasm and/or microvascular...



Hemiarch replacement with concomitant antegrade stent grafting of the descending thoracic aorta versus total arch replacement for treatment of acute DeBakey I aortic dissection with arch tear [AORTIC SURGERY]

Wed, 16 Mar 2016 00:00:00 +0100

CONCLUSION In treating DeBakey I aortic dissection with arch tear, hemiarch replacement with primary tear repair and concomitant TEVAR is a safe alternative to conventional TAR, with improved distal aortic remodelling. (Source: European Journal of Cardio-Thoracic Surgery)






Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Tue, 15 Mar 2016 00:00:00 +0100

Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a ca...



Decade-Long Trends (2001-2011) in the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction [Original Articles]

Tue, 15 Mar 2016 00:00:00 +0100

Conclusions— We found suggestions of a decline in the death, but not incidence, rates of cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop cardiogenic shock. (Source: Circulation: Cardiovascular Quality and Outcomes)

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Multidisciplinary approach for primary cardiac lymphoma associated with hemodynamic failure caused by tricuspid valve obstruction

Mon, 14 Mar 2016 00:00:00 +0100

We report the case of a 65-year-old man with PCL associated with unstable hemodynamics caused by tricuspid valve obstruction. Generally, chemotherapy is the first choice of treatment for patients with PCL. This patient required emergency tumor reduction as he was at risk of having acute hemodynamic failure caused by tricuspid valve obstruction. Therefore, he underwent a 2-staged treatment: urgent surgery to avoid sudden death by tricuspid valve obstruction as well as pulmonary embolism during chemotherapy, followed by early chemotherapy. Pathological findings showed diffuse large B-cell lymphoma, and rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone (R-CHOP) therapy was initiated to treat any residual tumor infiltrating the myocardial wall. The patient showe...



Sequential Organ Failure Assessment Score at Presentation Predicts Survival in Patients Treated With Percutaneous Veno-Arterial Extracorporeal Membrane Oxygenation.

Fri, 11 Mar 2016 00:32:02 +0100

CONCLUSIONS: Lower presenting SOFA score and smaller cannula size were associated with increased survival in patients with cardiogenic shock (CS) or CA who underwent percutaneous VA-ECMO placed in the cardiac catheterization laboratory using a portable system. Calculation of the SOFA score at presentation may help physicians determine which patients may derive benefit from ECMO. Smaller cannula size, while decreasing the amount of flow, may result in decreased bleeding and increased survival. PMID: 26887027 [PubMed - as supplied by publisher] (Source: The Journal of Invasive Cardiology)



Bail-Out Use of Impella CP as a Bridge to TAVI in a Cardiogenic Shock Patient: The "Pump-Rewiring" Technique.

Fri, 11 Mar 2016 00:32:02 +0100

CONCLUSION: This case example demonstrates how a tailored step-by-step strategy including PCI, BAV, peripheral angioplasty, percutaneous ventricular assistance, and transcatheter aortic valve implantation (TAVI) allowed the successful treatment of a critical patient with CS. Impella CP could be considered an effective bridge to TAVI in patients developing aortic regurgitation after BAV, since maintaining arterial access can be achieved using the pump-rewiring technique. PMID: 26716594 [PubMed - in process] (Source: The Journal of Invasive Cardiology)



Contemporary Use of Veno-Arterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Acute Coronary Syndrome.

Fri, 11 Mar 2016 00:32:02 +0100

CONCLUSION: VA-ECMO is infrequently used in patients for cardiopulmonary resuscitation in the AMI setting. When used judiciously, it has good clinical outcomes in this group of patients. However, use of VA-ECMO should be individualized based on vascular anatomy for best results. Close cooperation among interventional cardiologists, cardiovascular surgeons, cardiologists, cardiac intensivists, and perfusionists is essential for success of this therapy for RCS in AMI. PMID: 26689415 [PubMed - in process] (Source: The Journal of Invasive Cardiology)



Catheter Ablation of Ischemic Ventricular Tachycardia With Remote Magnetic Navigation: STOP‐VT Multicenter Trial

Thu, 10 Mar 2016 00:00:00 +0100

ConclusionsThis first prospective, single‐procedure, multicenter study indicates that remote magnetic navigation is a safe and effective method for catheter ablation of post‐infarction VT. (Source: Journal of Cardiovascular Electrophysiology)

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The Use of Mechanical Support Devices in Percutaneous Coronary Interventions: The Controversy?

Wed, 09 Mar 2016 00:00:00 +0100

We read with great interest the report by Khera et al describing the use of mechanical support (MCS) devices in percutaneous coronary interventions (PCI) using the Nationwide Inpatient Sample (NIS) data.1 The authors did not find any evidence of clear benefit with the use of percutaneous ventricular assist devices (PVADs), i.e. Impella and TandemHeart, when compared with intraaortic balloon pump (IABP) in patients undergoing PCI in the propensity matched population or in the subgroups of patients with cardiogenic shock, acute myocardial infarction (AMI) without cardiogenic shock and non- AMI/non cardiogenic shock (elective high-risk PCI). (Source: The American Journal of Cardiology)



Mechanical Circulatory Support in Pediatrics.

Tue, 08 Mar 2016 21:17:01 +0100

Authors: Steffen RJ, Miletic KG, Schraufnagel DP, Vargo PR, Fukamachi K, Stewart RD, Moazami N Abstract End-stage heart failure affects thousands of children yearly and mechanical circulatory support is used at many points in their care. Extracorporeal membrane oxygenation supports both the failing heart and lungs, which has led to its use as an adjunct to cardiopulmonary resuscitation as well as in post-operative cardiogenic shock. Continuous-flow ventricular assist devices (VAD) have replaced pulsatile-flow devices in adults and early studies have shown promising results in children. The Berlin paracorporeal pulsatile VAD recently gained U.S. Food and Drug Administration approval and remains the only VAD approved in pediatrics. Failing univentricular hearts and other congenitally...



Complete versus culprit-only revascularization in ST-elevation myocardial infarction and multivessel disease

Mon, 07 Mar 2016 00:00:00 +0100

In conclusion, the current available evidence from the randomized clinical trials, with a total sample size of only 2000 patients, is not robust enough to firmly recommend complete revascularization in STEMI patients. This uncertainty lends support to the continuation of the COMPLETE trial. This ongoing trial is anticipated to enroll 3900 patients with STEMI from across the world, and will be powered for the hard outcomes of death and myocardial infarction. Until the results of the COMPLETE trial are reported, physicians need to individualize care regarding the opportunity and the timing of the non-IRA PCI. (Source: Internal and Emergency Medicine)



Radial vs. femoral approach in STEMI: what do we know so far?

Sun, 06 Mar 2016 14:13:01 +0100

Authors: Santucci A, Gargiulo G, Ariotti S, Marino M, Magnani G, Baldo A, Piccolo R, Franzone A, Valgimigli M Abstract Radial approach has been used since 1989 to perform coronary angiography as an alternative to femoral access. During past decades, the development of dedicated equipment led to high efficacy also in complex procedures. ST elevation myocardial infarction (STEMI) is known to be a high bleeding risk setting and in turn bleeding events can negatively impact on outcomes. Observational studies have demonstrated feasibility, efficacy and safety of radial approach when compared to femoral access in STEMI patients, with benefit in bleeding rates. These advantages have been described also in specific populations as elderly or patients in cardiogenic shock. Some large randomi...



Cardiac complications in a metamizole-induced type I Kounis syndrome

Sun, 06 Mar 2016 00:00:00 +0100

We present the case of a patient who suffered Kounis syndrome with cardiogenic shock and asystole after intravenous infusion of Metamizole, and in which no lesions were observed in coronariography. (Source: Brazilian Journal of Anesthesiology)

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Hemodynamic effects, safety and feasibility of intravenous esmolol infusion during Takotsubo cardiomyopathy with left ventricular outflow tract obstruction: Results from a multicenter registry

Fri, 04 Mar 2016 21:35:51 +0100

ConclusionsEsmolol infusion was temporally associated with reduction in intra‐ventricular gradient and systemic blood pressure in patients with TTC and LVOTO. Further controlled studies are warranted to confirm these preliminary findings.This article is protected by copyright. All rights reserved. (Source: Cardiovascular Therapeutics)



Scorpion envenomation-induced acute thrombotic inferior myocardial infarction - Baykan AO, Gür M, Acele A, Şeker T, Çaylı M.

Thu, 03 Mar 2016 20:19:31 +0100

The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalanc... (Source: SafetyLit)



One-year cardiovascular outcomes of drug-eluting stent versus bare-metal stent implanted in diabetic patients with acute coronary syndrome

Wed, 02 Mar 2016 00:00:00 +0100

Conclusion The results of this study support the use of DES over BMS in Taiwanese patients with DM and ACS, providing the clinical benefits of lower rates of total mortality and MACE, and without increased TVR at 1 year in a real-world setting. (Source: Journal of the Chinese Medical Association)



Initial Experience of Transaortic Catheter Venting in Patients with Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Tue, 01 Mar 2016 06:00:00 +0100

Extracorporeal membrane oxygenation (ECMO) has become one of the often applied mechanical support for acute cardiogenic shock. During venoarterial (VA) ECMO support, left heart decompression should be considered when left ventricular (LV) distension develops with pulmonary edema and LV dysfunction. The aim of this study was to report the results of transaortic catheter venting (TACV), as an alternative venting method, performed during VA-ECMO in patients with acute cardiogenic shock. We retrospectively reviewed the records of seven patients who underwent both ECMO and TACV between February 2013 and February 2014. Extracorporeal membrane oxygenation was performed uneventfully, and TACV was introduced under transthoracic echocardiographic guidance in all cases. Hemodynamic parameters, LV eje...



Toward catecholamine responsiveness in cardiogenic shock: insights from the CRASH score.

Mon, 29 Feb 2016 00:00:00 +0100

CONCLUSIONS: In patients with cardiogenic shock, the CRASH score (= CPI/square root (IS + 1)) <0.0375 allowed patients at high risk of adverse outcome to be identified. PMID: 26953902 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)

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Percutaneous Coronary Intervention for Older Adults Who Present with Syncope and Coronary Artery Disease? Insights from the National Cardiovascular Data Registry®

Sun, 28 Feb 2016 00:00:00 +0100

Conclusions In patients presenting with syncope and obstructive CAD, PCI was not associated with significant improvements in the risk of readmission, but was associated with lower long-term mortality compared with medical therapy, suggesting the need to more definitively assess the benefit of PCI among elderly syncope patients. (Source: American Heart Journal)



Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction

Fri, 26 Feb 2016 00:00:00 +0100

Conclusions Supplemental oxygen exposure in the first 12 h after STEMI was associated with a clinically significant increase in cTnI and CK release. (Source: Heart)



Abstract 268: Using Lean Methodology to Reduce Variation in Care of Acute Coronary Syndrome Patients [Session Title: Abstract Poster Session II]

Fri, 26 Feb 2016 00:00:00 +0100

Discussion: BC is attempting to reduce unexplained variation in coronary revascularization using the Lean methodology to take a systematic approach to the analysis of the process of ACS care across the province. Involving physicians and point of care staff in the detailed mapping process has proven to be a significant step in engaging key stakeholders in the project by allowing input into the process of describing the factors affecting variation of practice at each site. The next step is to convene provincially to determine where to improve standardized practice in order to improve patient outcomes at key points along the value stream. (Source: Circulation: Cardiovascular Quality and Outcomes)



An unusual case of cardiogenic shock late following surgical aortic valve replacement

Thu, 25 Feb 2016 00:00:00 +0100

Publication date: Available online 24 February 2016 Source:Journal of Cardiology Cases Author(s): Maria Chiara Todaro, Alfonso Ielasi, Antonio Silvestro, Davide Personeni, Giulietta Grigis, Antonio Saino, Maurizio Tespili The present case describes a rare but potentially life-threatening complication following surgical aortic valve replacement (AVR): iatrogenic coronary ostial stenosis (ICOS). The incidence of ICOS is estimated to be between 0.3% and 5% of all AVR and it generally occurs within 6 months after the procedure. In most cases, either the left main stem or the ostium of the right coronary artery (RCA) is affected, although stenosis of the ostium of the left anterior descending artery can also occur. However, to the best of our knowledge, the simultaneous involvement of ...



Spontaneous coronary artery dissection resulting in very late stent thrombosis

Wed, 24 Feb 2016 00:00:00 +0100

A 58-year-old man with a history of coronary angioplasty done to right coronary artery 6 years back presented to the hospital with sudden-onset chest pain for 1 h. His ECG on admission revealed ST elevation in leads II, III and augmented vector foot (aVF). The patient was thrombolysed with streptokinase, which resulted in resolution of chest pain and ECG changes. Three hours later there was reappearance of ST elevation in same leads with cardiogenic shock. It was decided to take the patient for rescue angioplasty. Angiogram revealed significant luminal stenosis of proximal right coronary artery along with in-stent thrombotic occlusion (see online supplementary video 1). The optical coherence tomography (OCT) study showed evidence of coronary dissection with intramural haematoma p...

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Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction.

Tue, 23 Feb 2016 00:00:00 +0100

CONCLUSIONS: STEMI patients with an elevated admission shock index had more pronounced myocardial and microvascular damage. Moreover, the shock index was independently associated with MACE at 12 months. PMID: 26902549 [PubMed - as supplied by publisher] (Source: Circulation Journal)



Severe Acute Traumatic Mitral Regurgitation, Cardiogenic Shock Secondary to Embolized Polymethylmethracrylate Cement Foreign Body After a Percutaneous Vertebroplasty.

Mon, 22 Feb 2016 18:25:05 +0100

We report the case of a 61-year-old woman with acute decompensated heart failure secondary to acute traumatic mitral regurgitation, resulting from polymethylmethacrylate cement found in the left ventricle less than 24 hours after fluoroscopic percutaneous vertebroplasty. The patient had a history of ovarian cancer and had undergone treatment for symptomatic osteoporotic compression fractures of the vertebrae (T11, L1, and L3). The patient underwent a successful emergency open-heart operation, mitral valve replacement, closure of an atrial septal defect, and video-assisted removal of the cement foreign body from the left ventricle. The patient was later discharged with a good outcome. PMID: 26897199 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)



How should I treat refractory cardiogenic shock in a patient with chronic biventricular heart failure and mitral regurgitation with difficult valve characteristics?

Mon, 22 Feb 2016 11:12:02 +0100

Authors: Salaun E, Pankert M, Habib G, Bonnet JL, Vahanian A, Himbert D, Brochet E, Nataf P, D'Ancona G, Kische S, Öner A, Ince H PMID: 26897293 [PubMed - as supplied by publisher] (Source: EuroIntervention)



Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching children's hospital

Sat, 20 Feb 2016 19:19:14 +0100

ConclusionDespite recent improvements in safety of pediatric anesthesia, many preventable factors still remain that can lead to critical incidents. (Source: Pediatric Anesthesia)



Advanced mechanical circulatory support for post-cardiotomy cardiogenic shock: a 20-year outcome analysis in a non-transplant unit

Thu, 18 Feb 2016 00:00:00 +0100

Post-cardiotomy cardiogenic shock (PCCS) has an incidence of 2–6 % after routine adult cardiac surgery. 0.5–1.5 % are refractory to inotropic and intra-aortic balloon pump (IABP) support. Advanced mechanical c... (Source: Journal of Cardiothoracic Surgery)

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Severe Bilateral Ocular Hypotony after Emergent Coronary Artery Bypass Graft Surgery Complicated with Cardiogenic Shock

Wed, 17 Feb 2016 16:34:31 +0100

Intraocular hypotony (IH), defined as a decrease in intraocular pressure (IOP) below 5 mmHg, is sometimes seen after ocular surgeries, but it is rarely clinically significant unless IOP decreases to the 0 to 4 mmHg range.1 Severe IH after cardiac surgery is exceedingly rare.2 The figure shows a marked bilateral distortion of the corneas with an almost “sucked-in effect” in an elderly patient who underwent an emergent coronary artery bypass grafting with hypothermic cardiopulmonary bypass complicated by cardiogenic and vasoplegic shock with severe lactic acidosis. (Source: Anesthesiology)



Intra-aortic balloon counterpulsation in cardiogenic shock: is it really the end of an indication?

Wed, 17 Feb 2016 15:42:02 +0100

Authors: Hermansen SE, Myrmel T PMID: 25426756 [PubMed - indexed for MEDLINE] (Source: Scandinavian Cardiovascular Journal)



Primary Angioplasty For Patients in Cardiogenic Shock – Optimal Management

Wed, 17 Feb 2016 06:06:14 +0100

Cardiogenic shock is a clinical condition of inadequate end-organ perfusion due to cardiac dysfunction (see Table 1). It most commonly occurs in the setting of acute MI with left ventricular failure (~80 % cases),1,2 but can also be caused by right ventricular infarction or late mechanical complications, such as acute mitral regurgitation or ventricular rupture (septal or free wall). Non-infarct-related cardiogenic shock is comparatively rare, and may result from decompensated valvular heart disease and arrhythmias, to name a few mechanisms. (Source: Radcliffe Cardiology)



Early Risk Period Seen for Survivors of Cardiogenic Shock

Tue, 16 Feb 2016 20:00:00 +0100

(MedPage Today) -- In-hospital mortality declining but a vulnerable time follows for rehospitalization, studies say (Source: MedPage Today Cardiovascular)

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Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock Findings From the NCDR

Tue, 16 Feb 2016 04:19:11 +0100

ConclusionsHospital survivors of AMI who had cardiogenic shock have a higher risk of death and/or hospitalization during the first year after discharge. The risk is time-dependent and is clustered in the early post-discharge period, after which the prognosis is similar in patients with and without cardiogenic shock. (Source: Journal of the American College of Cardiology)



Cardiogenic Shock How Long Does the Storm Last? ∗

Tue, 16 Feb 2016 04:19:11 +0100

Cardiogenic shock, the most common cause of in-hospital mortality following acute myocardial infarction (AMI), complicates between 5% and 10% of cases (1). Although the past few decades have seen a decline in early mortality in patients with cardiogenic shock—largely due to increased rates of early revascularization (2) and improved adjunctive pharmacotherapy—in-hospital mortality remains high, at up to 50% (3). Although cardiogenic shock is more common among patients with ST-segment elevation myocardial infarction (STEMI), patients with non–ST-segment elevation myocardial infarction (NSTEMI) tend to have higher baseline risk profiles. Some registries report no difference in early mortality according to AMI subtype in patients with cardiogenic shock (4). Others report higher mortal...



Effective percutaneous “edge‐to‐edge” mitral valve repair with mitraclip in a patient with acute post‐MI regurgitation not related to papillary muscle rupture

Tue, 16 Feb 2016 00:00:00 +0100

A 65‐year‐old woman was admitted to our institution for rest dyspnea and hypotension. EKG showed sinus tachycardia with signs of infero‐posterior STEMI. 2D‐echocardiogram showed severe left ventricular systolic dysfunction with a‐ diskynesia of the inferior and posterior walls and severe functional mitral regurgitation (MR). The patient underwent urgent coronary angiography that showed 3‐vessels disease with total occlusion of both first obtuse marginal (OM) branch of the left circumflex artery and right coronary artery (RCA) and critical stenosis of left anterior descending (LAD). Because of extremely high surgical risk, we performed a staged totally percoutaneous approach. First, we reopened the presumed culprit vessels (RCA and OM) and then, after 48 hr, we performed angiopl...



Perforation of the Anterior Mitral Leaflet following Impella LP 5.0 Therapy in Cardiogenic Shock

Tue, 16 Feb 2016 00:00:00 +0100

The Impella is an axial rotary pump used for cardiogenic shock as temporary support for recovery or bridge to heart transplantation. It has an inlet area in the left ventricle and the outlet area in the ascending aorta cranial to the aortic valve 1. Three sizes exist: 2.5 l/min, 3.5 l/min og 5.0 l/min. The two smaller sizes are implanted with trans-femoral access. Impella LP 5.0 (21 French) is implanted surgically through the right subclavian artery 1. The volume output of the Impella 5.0 is higher and allows a longer period of mechanical support2. (Source: The American Journal of Cardiology)



Experts’ recommendations for the management of cardiogenic shock in children

Tue, 16 Feb 2016 00:00:00 +0100

Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no internationa... (Source: Annals of Intensive Care)

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Perforation of the Anterior Mitral Leaflet After Impella LP 5.0 Therapy in Cardiogenic Shock

Tue, 16 Feb 2016 00:00:00 +0100

A 52-year old man was admitted with out-of-hospital cardiac arrest, and he was resuscitated after 100 minutes. The initial hemodynamic condition was critical due to cardiogenic shock (left ventricular ejection fraction 10 % and mean arterial pressure 60 mmHg on inotropics). Acute coronary angiography did not reveal any new lesions. Due to persistent hemodynamic instability, mechanical support with Impella LP 5.0 was decided. The surgical procedure guided by fluoroscopy and transesophageal echocardiography was uncomplicated. (Source: The American Journal of Cardiology)



Heart attack patients with cardiogenic shock fair well 60 days post-discharge

Mon, 15 Feb 2016 20:23:28 +0100

Heart attack patients who experience cardiogenic shock have a higher risk of death or rehospitalization than non-shock patients in the first 60 days post-discharge, but by the end of the first year, the gap between the two groups narrows, according to a study. (Source: ScienceDaily Headlines)



Long-term intravenous inotropes in low-output terminal heart failure?

Mon, 15 Feb 2016 00:00:00 +0100

Abstract Intravenous inotropic therapy may be necessary to achieve short-term survival in end-stage heart failure patients with cardiogenic shock or extreme low output and severe organ hypoperfusion. However, mid- or long-term intravenous inotropic therapy is associated with an increased mortality in advanced stage D heart failure patients using β-adrenoceptor agonists (dobutamine) or PDE-3-inhibitors (milrinone). Intermittent levosimendan may evolve as a reasonable therapeutic option. Randomized trials or other meaningful scientific evidence addressing the optimal treatment of exclusively the most threatened subgroup of hospitalized patients with persistent severe organ hypoperfusion are missing, but urgently needed. Despite a lack of other beneficial pharmacological options, th...



Understanding cardiogenic shock: a nursing approach to improve outcomes.

Sun, 14 Feb 2016 19:12:02 +0100

Authors: Warise L Abstract Shock is a common complication associated with cardiac hospitalization post-myocardial infarction. Although shock is considered a physiologic response rather than a disease state, the lack of adequate pumping function leads to decreased tissue perfusion and initiation of the general shock response. Regardless of the etiology, the effects of shock are the same. Shock is essentially a widespread impairment of cellular metabolism, specifically, resulting from anaerobic metabolism related to inadequate tissue oxygenation leading to tissue dysfunction and necrosis. The purpose of this article is based on an actual clinical case study, precipitating factors, pathophysiology, common medical diagnosis and therapy, and nursing implications. PMID: 25650490 [Pu...



Diagnosis of hantavirus infection in humans.

Sun, 14 Feb 2016 16:32:09 +0100

Authors: Mattar S, Guzmán C, Figueiredo LT Abstract Rodent-borne hantaviruses (family Bunyaviridae, genus Hantavirus) cause hantavirus pulmonary syndrome in the Americas and hemorrhagic fever with renal syndrome in Europe and Asia. The viruses are transmitted to humans mainly by inhalation of virus-contaminated aerosols of rodent excreta and secreta. Classic clinical hemorrhagic fever with renal syndrome occurs in five phases: fever, hypotension, oliguria, polyuria, and convalescence. Hantavirus pulmonary syndrome is a severe acute disease that is associated with respiratory failure, pulmonary edema and cardiogenic shock. The diagnosis of hantavirus infections in humans is based on clinical and epidemiological information as well as laboratory tests. We review diagnosis for hantav...

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Takotsubo Cardiomyopathy: What we have learned in the last 25 years? A comparative literature review.

Sat, 13 Feb 2016 22:31:01 +0100

Authors: Said SM, Saygili E, Rana OR, Genz C, Hahn J, Bali R, Varshney S, Albouaini K, Prondzinsky R, Braun-Dullaeus RC Abstract We performed a comparative literature review, to elucidate the major features of the Takotsubo (stress) cardiomyopathy (TCM) collected in last 25 years. TCM is characterized by left- or biventricular apical ballooning with a clinical presentation, electrocardiographic abnormalities, and biomarker profils similar to those seen in acute myocardial infarction. Epidemiological studies have shown that TCM is more common in postmenopausal women; however exact figures are not available. The underlying aetiology is still largely undetermined. Elevated catecholamine levels, lack of estrogen, disturbed myocardial fatty acid metabolism and plaque rupture with sponta...



Acute Myocardial Infarction/Thrombectomy

Sat, 13 Feb 2016 00:00:00 +0100

This article focuses on specialized techniques and devices used in the most challenging cases of acute myocardial infarction. Areas where high-quality evidence is either clear or absent are avoided. Controversies in the use of support or thrombectomy devices, the addition of adjunct pharmacology, and the decision to treat nonculprit lesions are discussed. Recent years have seen a shift in guidelines to downgrading the use of assist devices in cardiogenic shock and aspiration thrombectomy, whereas consideration of nonculprit coronary intervention has been revived. These changes come in the wake of a series of large, practice-changing clinical trials. (Source: Interventional Cardiology Clinics)



Severe bupropion overdose and ECMO: two great saves

Fri, 12 Feb 2016 05:29:54 +0100

ChaNaWiT/shutterstock.com 3.5 out of 5 stars Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrance Oxygenation. Heise CW et al. J Med Toxicol 2016 Feb 8 [Epub Ahead of Print] Abstract This awesome, exciting paper from Banner University Medical Center in Phoenix describes two teenagers with severe bupropion overdose who survived refractory cardiac arrest after veno-arterial extracorporeal membrane oxygenation (VA-ECMO): Case 1: A 15-year-old girl was brought to hospital after ingesting up to 90 150-mg bupropion tablets. She had a seizure en route and arrived with pulseless electrical activity (PEA). Return of spontaneous circulation was achieved after 20 minutes of cardiopulmonary resuscitation. She was sent by a...



A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

Fri, 12 Feb 2016 00:00:00 +0100

Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB. (Source: Indian Journal of Anaesthesia)



Cardiogenic shock from atypical Takotsubo cardiomyopathy attributed to acute disseminated encephalomyelitis lesion involving the medulla

Fri, 12 Feb 2016 00:00:00 +0100

We present here a case of atypical Takotsubo cardiomyopathy arising as a result of a lesion in the medulla oblongata. The patient was diagnosed with acute disseminated encephalomyelitis, and had improvement with intravenous steroids. (Source: Clinical Autonomic Research)

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Patients With Acute Myocardial Infarction–Related Cardiogenic Shock

Wed, 10 Feb 2016 00:00:00 +0100

To the Editor We read with great interest the Viewpoint by Tchantchaleishvili et al calling for organized statewide networks for the management of acute myocardial infarction–related cardiogenic shock. We applaud the authors’ insights into one of the major current challenges in cardiovascular care. Despite advances in the treatment of coronary artery disease and in the technology of mechanical circulatory support devices (MCSDs), patients with myocardial infarction complicated by cardiogenic shock still have mortality rates in the range of 40% to 50%. While no trial since the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial has demonstrated a clear benefit to any intervention beyond early revascularization, observational data suggest that impro...



Incessant fascicular VT presenting as cardiogenic shock with multi-organ dysfunction syndrome

Mon, 08 Feb 2016 00:00:00 +0100

We report a rare clinical presentation of incessant idiopathic fascicular ventricular tachycardia (FVT), presenting as multi-organ dysfunction (MOD) syndrome with cardiogenic shock. Our patient was a 19-year-old male who presented with slowly progressive dyspnea from New York Heart Association (NYHA) II to NYHA IV at the time of presentation, palpitations, and dilated cardiomyopathy due to drug-refractory FVT. The patient was in cardiogenic shock with raised central venous pressures and required inotropic support for maintaining systolic blood pressure above 90mmHg. The MOD was seen in the form of deranged liver and kidney parameters. Echocardiography showed a dilated left ventricle (LV, 58mm at end-diastole, 52mm at end-systole) and decreased ejection fraction (20%). Electrocardiography s...



Is Extracorporeal Membrane Oxygenator a New Weapon to Improve Prognosis in Patients With Profound Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention?

Mon, 08 Feb 2016 00:00:00 +0100

Authors: Sung PH, Wu CJ, Yip HK Abstract Despite advancements in pharmacological therapy and refinement of the tools and technique of primary percutaneous coronary intervention (PCI) and coronary artery bypass surgery, patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock (CS) still have unacceptably high in-hospital mortality and unfavorable long-term outcome. Thus, there is an imminent need of a new and safe treatment modality in the management of AMI complicated by profound CS. Growing evidence suggests that extracorporeal membrane oxygenator (ECMO)-supported primary PCI is an effective therapeutic option for saving lives under such conditions. In this review, we describe and interpret the potential role of circulatory mechanical support by EC...

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Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation.

Mon, 08 Feb 2016 00:00:00 +0100

We report two cases of severe bupropion toxicity resulting in refractory cardiogenic shock, cardiac arrest, and repeated seizures treated successfully. Patients with cardiovascular failure related to poisoning may particularly benefit from extracorporeal membrane oxygenation (ECMO). These are the first cases of bupropion toxicity treated with veno-arterial EMCO (VA-ECMO) in which bupropion toxicity is supported by confirmatory testing. Both cases demonstrate the effectiveness of VA-ECMO in poisoned patients with severe cardiogenic shock or cardiopulmonary failure. PMID: 26856351 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)



When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock [TRANSPLANTATION AND MECHANICAL CIRCULATORY SUPPORT]

Sat, 06 Feb 2016 00:00:00 +0100

CONCLUSIONS ECLS serves as a bridge-to-decision and bridge-to-treatment device. Our interdisciplinary ECLS programme achieved acceptable survival of critically ill patients despite a substantial percentage of patients having been resuscitated and no absolute exclusion criteria. Further studies defining inclusion- and exclusion criteria might additionally improve outcome. (Source: European Journal of Cardio-Thoracic Surgery)



Mitral clip–looking back and moving forward

Fri, 05 Feb 2016 08:20:02 +0100

This article will review current evidence supporting the use of MitraClip across the spectrum of patient risk and discuss future directions for this technology. Recent findings: Both randomized and registry studies have demonstrated the efficacy and safety of MitraClip for mitral regurgitation reduction, with significant improvements in functional class and reductions in heart failure hospitalizations. With increasing global experience, a broader scope of patients and diseases can now be successfully treated, ranging from patients with failed surgical annuloplasty rings to those in cardiogenic shock. Ongoing randomized trials will further define the role of MitraClip in the management of heart failure patients with secondary mitral regurgitation. Summary: MitraClip is a useful therapeuti...



Clinical characteristics and outcomes after unplanned intraaortic balloon counterpulsation in the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction trial

Fri, 05 Feb 2016 00:00:00 +0100

Conclusions The most significant predictor of crossover to IABC in the setting of anterior STEMI was relative hypotension at the time of hospital admission, and crossover to IABC in CRISP AMI was associated with significantly worse clinical outcomes. (Source: American Heart Journal)



Histological examination of the right atrial appendage after failed catheter ablation for focal atrial tachycardia complicated by cardiogenic shock in a post-partum patient

Thu, 04 Feb 2016 00:00:00 +0100

Publication date: Available online 3 February 2016 Source:Journal of Arrhythmia Author(s): Akira Mizukami, Makoto Suzuki, Rena Nakamura, Shunsuke Kuroda, Maki Ono, Yuya Matsue, Ryota Iwatsuka, Taishi Yonetsu, Akihiko Matsumura, Yuji Hashimoto A 26-year-old woman in her first pregnancy presented with persistent atrial tachycardia (AT). AT was resistant to medications, cardioversions, and the first attempt of catheter ablation. Two months after delivery she developed severe systolic dysfunction and circulatory collapse. Emergent catheter ablation was performed with the support of percutaneous cardiopulmonary bypass and intraaortic balloon pump. The AT originated in the apex of the right atrial appendage (RAA). Repeated attempts at ablation were unsuccessful, prompting surgical RA...

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Electrocardiogram in a patient with “acute intermittent porphyria”–triggered Takotsubo syndrome

Wed, 03 Feb 2016 00:00:00 +0100

I read with great interest the report of Messas et al. [1], published ahead of print on January 6, in the Journal, about the 44year-old woman, who suffered Takotsubo syndrome (TTS), triggered by an attack of acute intermittent porphyria (AIP), precipitating an abdominal pain crisis. Under the care of the authors the patient had a complete recovery of her severe left ventricular (LV) dysfunction, leading to cardiogenic shock which required among others, the implementation of intra-aortic balloon pump. (Source: International Journal of Cardiology)



Ablation of an electrical storm in a patient with giant cell myocarditis using continuous flow left ventricular assist device and percutaneous right ventricular assist device

Wed, 03 Feb 2016 00:00:00 +0100

A 35-year old female patient was transferred to our hospital with cardiogenic shock due to a multifocal giant cell myocarditis revealing severe myocyte necrosis, inflammation and fibrosis (Fig. 1A). At the time of admittance to our intensive care unit the left-ventricular ejection fraction was not quantifiable, due to the lack of significant contraction. Significant coronary stenosis had already been ruled out before the transfer to our hospital. To stabilize the patient an extracorporeal life support system (ECLS) had been implanted and an immunosuppressive regime with prednisolone and cyclosporine was started. (Source: International Journal of Cardiology)



Levosimendan meta-analyses: Is there a pattern in the effect on mortality?

Wed, 03 Feb 2016 00:00:00 +0100

Levosimendan is an inodilator developed for treatment of acute heart failure and other cardiac conditions where the use of an inodilator is considered appropriate. Levosimendan has been studied in different therapeutic settings including acutely decompensated chronic heart failure, advanced heart failure, right ventricular failure, cardiogenic shock, septic shock, and cardiac and non-cardiac surgery. This variety of data has been re-analysed in 25 meta-analyses from 15 different international research groups, based on different rationales to select the studies included. (Source: International Journal of Cardiology)



Electrocardiogram in a patient with “acute intermittent porphyria”-triggered Takotsubo syndrome

Wed, 03 Feb 2016 00:00:00 +0100

I read with great interest the report of Messas et al. [1], published ahead of print on January 6, in the Journal, about the 44year-old woman, who suffered Takotsubo syndrome (TTS), triggered by an attack of acute intermittent porphyria (AIP), precipitating an abdominal pain crisis. Under the care of the authors the patient had a complete recovery of her severe left ventricular (LV) dysfunction, leading to cardiogenic shock which required among others, the implementation of intra-aortic balloon pump. (Source: International Journal of Cardiology)



Shock, acute disseminated intravascular coagulation, and microvascular thrombosis: is ‘shock liver’ the unrecognized provocateur of ischemic limb necrosis?

Sat, 30 Jan 2016 00:00:00 +0100

Summary For unknown reasons, a small minority of critically ill patients with septic or cardiogenic shock, multiorgan failure, and disseminated intravascular coagulation develop symmetrical acral (distal extremity) limb loss due to microvascular thrombosis (‘limb gangrene with pulses’). Case reports have described preceding ‘shock liver’ in some critically ill patients who developed such a picture of ischemic limb necrosis. This suggests that profoundly disturbed procoagulant–anticoagulant balance featuring uncontrolled generation of thrombin—resulting from failure of the protein C and antithrombin natural anticoagulant systems due to insufficient hepatic synthesis of these crucial proteins—could explain the microvascular thrombosis and associated limb loss. We hypothesize th...

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In-Hospital Outcome of Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction: Results from Royal Hospital Percutaneous Coronary Intervention Registry, Oman.

Fri, 29 Jan 2016 04:56:04 +0100

CONCLUSIONS: CS in AMI patients presenting to a tertiary hospital in Oman have high in-hospital mortality despite the majority undergoing PCI. Even though the in-hospital mortality is comparable to other studies and registries, there is an urgent need to determine the causes and find any remedies to provide better care for such patients, specifically concentrating on the early transfer of patients from regional hospitals for early PCI. PMID: 26814946 [PubMed] (Source: Oman Medical Journal)



ShockOmics: multiscale approach to the identification of molecular biomarkers in acute heart failure induced by shock

Thu, 28 Jan 2016 00:00:00 +0100

DiscussionShockOmics will provide new insights into the pathophysiological mechanisms underlying shock as well as new biomarkers for the timely diagnosis of cardiac dysfunction in shock and quantitative indices for assisting the therapeutic management of shock patients. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)



The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis: intermediate-term efficacy and durability

Wed, 27 Jan 2016 00:00:00 +0100

Conclusions: Our 5-year experience indicates that the Magna valve offers excellent intermediate-term durability and substantial echocardiographic improvement; its low-profile design make it ideal for reoperations and for concomitant cardiac procedures, including valve replacement. (Source: Journal of Cardiothoracic Surgery)



Percutaneous Decompression of the Left Ventricle in Cardiogenic Shock Patients on Venoarterial Extracorporeal Membrane Oxygenation

Tue, 26 Jan 2016 17:34:10 +0100

ConclusionAntegrade transseptal left ventricular decompression is feasible in patients on extracorporeal membrane oxygenation and persistent pulmonary edema. (Source: Journal of Cardiac Surgery)



Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients

Tue, 26 Jan 2016 04:19:16 +0100

Conclusions Severe hyperlactatemia (>10 mmol/L) is associated with extremely high ICU mortality especially when there is no marked lactate clearance within 12 h. In such situations, the benefit of continued ICU therapy should be evaluated. (Source: Intensive Care Medicine)

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Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis.

Tue, 26 Jan 2016 00:00:00 +0100

CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP. PMID: 26839661 [PubMed] (Source: World Journal of Cardiology)



Cyclosporine A in Reperfused Myocardial Infarction The Multicenter, Controlled, Open-Label CYCLE Trial

Mon, 25 Jan 2016 23:06:10 +0100

ConclusionsIn the CYCLE (CYCLosporinE A in Reperfused Acute Myocardial Infarction) trial, a single intravenous CsA bolus just before primary percutaneous coronary intervention had no effect on ST-segment resolution or hs-cTnT, and did not improve clinical outcomes or LV remodeling up to 6 months. (CYCLosporinE A in Reperfused Acute Myocardial Infarction [CYCLE]; NCT01650662; EudraCT number 2011-002876-18) (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)



Registry Finds Mounting Deaths With Cardiogenic Shock (CME/CE)

Fri, 22 Jan 2016 17:30:00 +0100

(MedPage Today) -- Worrying trend despite years of clinician experience (Source: MedPage Today Cardiovascular)



Acute myocardial infarction due to left main coronary artery disease in men and women: does ST-segment elevation matter?

Fri, 22 Jan 2016 09:39:02 +0100

CONCLUSIONS: There were no gender-related differences in the management within the STEMI or NSTEMI group. Although acute myocardial infarction due to ULMCA disease is associated with high mortality in both genders, STEMI was a negative prognostic factor of in-hospital and 12-month mortality. Despite poor baseline characteristics and clinical presentation in women, female gender itself did not influence mortality. PMID: 26788080 [PubMed] (Source: Archives of Medical Science)



Efficacy of early invasive management post-fibrinolysis for ST-segment elevation myocardial infarction in relation to initial troponin status

Thu, 21 Jan 2016 00:00:00 +0100

Conclusions Patients with STEMI and abnormal initial troponin have worse short-term and long-term outcomes. Accounting for overall baseline risk with the GRACE risk score, troponin status did not modulate the efficacy of pharmacoinvasive management. Clinical Trial Registration http://www.clinicaltrials.gov/ct2/show/NCT00164190 (Source: Canadian Journal of Cardiology)

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Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and survival in patients requiring prolonged resuscitation efforts

Thu, 21 Jan 2016 00:00:00 +0100

Conclusions: Among patients suffering CA treated with mechanical CC in the cath-lab, 25 % had a good neurological outcome at hospital discharge compared to 10 % treated with manual CC. Long term survival in patients discharged from hospital is good. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)



Pulsatile-flow mechanical circulatory support (MCS) as a bridge to transplantation or recovery. Single-centre experience with the POLCAS system in 2014.

Wed, 20 Jan 2016 13:34:12 +0100

CONCLUSIONS: The POLCAS heart assist system is an effective method of treatment as a bridge to transplantation or recovery in patients with end-stage heart failure. Early survival after the treatment remains at a satisfactory level. The main problem is the large number of complications related to the therapy. PMID: 26702278 [PubMed] (Source: Polish Journal of Cardio-Thoracic Surgery)



A large pseudoaneurysm of the left cardiac ventricle in a 57-year-old patient after urgent coronary artery bypass grafting and surgical mitral valve replacement due to acute myocardial infarction.

Wed, 20 Jan 2016 13:34:12 +0100

We present a rare case of a left ventricular pseudoaneurysm in a patient after inferior wall myocardial infarction. The infarction was complicated with acute mitral insufficiency, pulmonary edema, and cardiogenic shock. Urgent surgical mitral valve replacement and coronary artery bypass grafting were performed. After several months, the patient was hospitalized again because of deterioration of exercise tolerance and symptoms of acute congestive heart failure. A large pseudoaneurysm of the left ventricle was recognized and successfully treated surgically. PMID: 26336464 [PubMed] (Source: Polish Journal of Cardio-Thoracic Surgery)



Oxygenator in short-term LVAD circuit: a rescue in post-LVAD pulmonary complications.

Wed, 20 Jan 2016 00:00:00 +0100

Authors: Mohite PN, Patil NP, Popov AF, Bahrami T, Simon AR Abstract Pulmonary complications after left ventricular assist device (LVAD) implantation, though infrequent, can be potentially catastrophic. A 62-year-old female with cardiogenic shock, supported on short-term LVAD, developed pulmonary oedema. An oxygenator was introduced into the LVAD circuit, which improved the gas exchange and, eventually, after weaning off the oxygenator, the patient received long-term LVAD. The introduction of an oxygenator into the short-term LAVD circuit is a lifesaving manoeuvre in such a situation. It offers freedom of introducing and removing the oxygenator into the LVAD circuit without opening the chest and competing for LVAD flow. PMID: 26791273 [PubMed - as supplied by publisher] (Source...



Bilateral pleural effusion, cardiogenic shock, renal failure, and generalized anasarca: A dreaded iatrogenic complication of umbilical venous catheterization

Tue, 19 Jan 2016 00:00:00 +0100

Gaurav Garg, Gaurav Mandhan, Poonam SidanaAnnals of Pediatric Cardiology 2016 9(1):108-109 (Source: Annals of Pediatric Cardiology)

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The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of Randomized Controlled Trials of Coronary Artery Bypass Grafting and Stenting Era

Tue, 19 Jan 2016 00:00:00 +0100

Conclusion In patients undergoing high-risk coronary revascularization, IABP did not significantly decrease mortality. But high-risk CABG patients may be benefit from IABP. Rigorous criteria should be applied to the use of IABPs. (Source: PLoS One)



Management Strategies and Outcomes of ST‐Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States

Tue, 19 Jan 2016 00:00:00 +0100

ABSTRACT Fibrinolytic therapy is still used in patients with ST‐segment elevation myocardial infarction (STEMI) when the primary percutaneous coronary intervention cannot be provided in a timely fashion. Management strategies and outcomes in transferred fibrinolytic‐treated STEMI patients have not been well assessed in real‐world settings. Using the Nationwide Inpatient Sample from 2008 to 2012, we identified 18 814 patients with STEMI who received fibrinolytic therapy and were transferred to a different facility within 24 hours. The primary outcome was in‐hospital mortality. Secondary outcomes included gastrointestinal bleeding, bleeding requiring transfusion, intracranial hemorrhage (ICH), length of stay, and cost. The patients were divided into 3 groups: those who received medic...



Postinfarction ventricular septal rupture: can we improve clinical outcome of surgical repair?

Mon, 18 Jan 2016 00:00:00 +0100

Abstract Postinfarction ventricular septal rupture (VSR) is a lethal structural complication following acute myocardial infarction (AMI). Surgical repair of VSR was first reported in 1957 by Cooley. Since then, many methods have been introduced, variously using right and/or left ventriculotomy. Daggett used infarctectomy and septal reconstruction via left ventriculotomy, reporting 52 % operative mortality when repair was attempted within 21 days, but only 7 % when done after 3 weeks. Komeda and David described single pericardial patch infarct exclusion without infarctectomy through a left ventriculotomy in 1990. It seemed conceptually simple, and became a standard technique. Modifications of that technique and development of other methods have been reported by many surgeons. N...



Use of venoarterial extracorporeal membrane oxygenation in fulminant chagasic myocarditis as a bridge to heart transplant

Sat, 16 Jan 2016 15:30:25 +0100

RESUMO Jovem com 17 anos de idade atendido com dispneia progressiva há 15 dias e piora nas últimas 24 horas. Foi admitido em estado de insuficiência respiratória e choque cardiogênico com disfunção de múltiplos órgãos. O ecocardiograma mostrou fração de ejeção ventricular esquerda de 11%, grave hipocinesia difusa e pressão sistólica da artéria pulmonar de 50mmHg. Houve necessidade de suporte hemodinâmico com uso de dobutamina (20mcg/kg/minuto) e noradrenalina (1,7mcg/kg/minuto). Após 48 horas, o paciente não apresentou melhora hemodinâmica nem clínica, optando-se, então, pela implantação de membrana de oxigenação extracorpórea. Ocorreu melhora do ponto de vista hemodinâmico, da perfusão sistêmica, da função renal e hepática, porém, após 72 horas, não ho...



Left ventricular thrombus associated with arteriovenous extra corporeal membrane oxygenation.

Sat, 16 Jan 2016 07:24:04 +0100

Authors: Makdisi G, Hashmi ZA, Wozniak TC, Wang IW Abstract Extra corporeal membrane oxygenation (ECMO) has remarkably progressed over the recent years. It has become an invaluable tool in the care of adults and pediatric patients with severe cardiogenic shock. At the initiation of ECMO support, the left ventricular contractility is profoundly impaired. Inadequate right ventricular drainage and bronchial circulation can lead to left ventricular distension, with potential deleterious consequences, ranging from inadequate myocardial rest, pulmonary edema, or intracardiac clot formation. Therefore, it is of extreme importance to ensure an adequate left ventricular drainage. Here we present a case of LV thrombus developed while the patient is on central venoarterial (VA) ECMO. PMI...

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Spinal Cord Infarct During Concomitant Circulatory Support With Intra-Aortic Balloon Pump and Veno-Arterial Extracorporeal Membrane Oxygenation

Sat, 16 Jan 2016 05:45:21 +0100

Conclusions: The timeline of events suggests a causal relation between intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, and significant neurologic deficits. This is likely due to hypoperfusion of the spinal cord, which is multifactorial in origin, including small aortic calibre, low cardiac output states, high vasopressor requirements causing vasospasm of the artery of Adamkiewicz, occlusion of retrograde oxygenated blood flow from peripheral veno-arterial extracorporeal membrane oxygenation due to intra-aortic balloon pump being in situ, and possible thromboembolic phenomena. The thoracic spinal cord is intrinsically susceptible to ischemia due to the anatomy of the arterial supply, which is described here. We identify several risk factors and make several rec...



An unusual case of fulminant myocarditis closely mimicking ST-segment elevation myocardial infarction and presenting as refractory cardiogenic shock complicated by multiple life-threatening arrhythmiasAn unusual case of fulminant myocarditis

Sat, 16 Jan 2016 00:00:00 +0100

We report a case of severe fulminant myocarditis that closely mimicked acute inferior ST-segment elevation myocardial infarction (STEMI) and presented with refractory cardiogenic shock, multiple life-threatening arrhythmias and rapidly progressive liver failure. This case was successfully differentiated from STEMI by emergency coronary angiography. Recurrent cardiogenic shock was reversed by intra-aortic balloon pumping (IABP). Life-threatening arrhythmias including ventricular tachycardia, ventricular fibrillation, and high-degree atrioventricular block (AVB) were terminated by immediate cardioversion and temporary pacemaker. High-dose hydrocortisone effectively attenuated the inflammatory injury to the myocardium. The patient recovered and was well at the follow-up visit four months afte...



Clinical Characteristics and Outcomes of Patients With Myocardial Infarction and Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery: Data From The Society of Thoracic Surgeons National Database

Fri, 15 Jan 2016 00:00:00 +0100

Conclusions Most patients undergoing CABG for AMI-CS have a sizeable but not prohibitive risk. Patients who require MCS and those undergoing operation as a salvage procedure reflect higher risk populations. (Source: The Annals of Thoracic Surgery)



The Ankle-Brachial Index is Associated With Cardiovascular Complications After Noncardiac Surgery

Thu, 14 Jan 2016 00:00:00 +0100

Conclusions: In patients submitted to noncardiac surgery, abnormal ABI is associated with a higher occurrence of a cardiovascular event. (Source: Angiology)



Paraganglioma masquerading as acute myocardial infarction and cardiogenic shock

Thu, 14 Jan 2016 00:00:00 +0100

Publication date: Available online 14 January 2016 Source:Indian Heart Journal Author(s): Tanveer Ahmad, Shankaragouda Patil, Ashwini Kumar Pasarad, Nandakumar Neralakere Maheshwarappa, Kolkebaile Sadanand Kishore Paragangliomas, extra-adrenal pheochromocytomas, are rare catecholamine-secreting tumor. A 34-year-old lady admitted with diagnosis of ST elevation acute myocardial infarction with cardiogenic shock. Left ventricular function, severely depressed, returned to normal after initial stabilization. Coronary angiogram was normal. A para-aortic paraganglioma was diagnosed during the patient's work-up with biochemical studies, computed tomography of abdomen and functional radioisotopes imaging and was eventually surgically resected. This case shows that acute myocardial infarction...

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STEMI vs NSTEACS management trends in non-invasive hospital

Thu, 14 Jan 2016 00:00:00 +0100

Conclusion NSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors. (Source: Indian Heart Journal)



Characteristics of 1‐day postoperative mortality: a comparison with 2‐ to 7‐day postoperative mortality

Wed, 13 Jan 2016 00:00:00 +0100

ConclusionsThe characteristics of POD 1 mortality were different from those of POD 2–7 mortality. A large proportion of early postoperative deaths were due to POD 1 mortality. Human factor‐related causes were more associated with POD 1 mortality, indicating much room for improvement. (Source: Acta Anaesthesiologica Scandinavica)



Percutaneous Mechanical Circulatory Support for Cardiogenic Shock

Wed, 13 Jan 2016 00:00:00 +0100

Opinion statement The use of percutaneous, non-durable mechanical circulatory support (MCS) for cardiogenic shock (CS) is growing; however, large, randomized clinical trials confirming benefit in this population do not exist. Guidelines and recommendations regarding optimal timing for MCS implementation, patient selection, device selection, and post-implantation management are beginning to emerge. A better understanding of (1) the distinct hemodynamic effects of each device option, (2) the need for early implementation of the appropriate device option for a particular clinical scenario, (3) the definition of non-salvageable CS to help clinicians know when to say “no” to non-durable MCS, and (4) best practices to monitor, wean, and optimize metabolic parameters while using non...



Double organ transplantation in cardiac amyloidosis

Tue, 12 Jan 2016 17:01:45 +0100

We report here the remarkable case of a 63-year-old man with heart failure caused by AL amyloidosis. After a long course, which included rapid deterioration of preexisting heart failure, cardiac arrest, cardiogenic shock, biventricular assist device support, heart transplantation, renal failure, kidney transplantation and finally a life-threatening H1N1 virus pneumonia, the patient managed not only to survive but also to return fully to his previous demanding duties and lifestyle. Discussion: Early use of left ventricular or biventricular mechanical circulatory support may be beneficial as a bridge to transplantation in patients with cardiac AL amyloidosis. (Source: Journal of Cardiovascular Medicine)



Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia

Tue, 12 Jan 2016 17:01:45 +0100

We describe the surgical technique and treatment of a 59-year-old male with cardiogenic shock, who underwent a minimally invasive off-pump ventricular assist device (VAD) implantation with the aid of paravertebral regional analgesia in bilateral mini-thoracotomies as first procedure described in the literature. He was extubated soon after the procedure, in the operating room, with the aim to reduce the right ventricle impairment. These issues are particularly true for patients suffering from pulmonary hypertension and disease, in whom the shortest time of postoperative intubation is fundamental to allow self-inotropic support and recovery of the right ventricle. We illustrate how a minimally invasive implant may improve the clinical outcomes of VAD patients shortening their return time to ...

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Epidemiology, pathophysiology, and in-hospital management of pulmonary edema: data from the Romanian Acute Heart Failure Syndromes registry

Tue, 12 Jan 2016 17:01:44 +0100

Conclusions: In this national registry, the PE profile was found to be a high-acuity clinical presentation with distinctive treatment patterns and a poor short-term prognosis. Advances in the management of PE may necessitate both the development of novel targeted therapies as well as systems-based strategies to identify high-risk patients early in their course. (Source: Journal of Cardiovascular Medicine)



Complete occlusion of the left main trunk coronary artery by a cardiac papillary fibroelastoma in a hemodynamically unstable patient

Tue, 12 Jan 2016 00:00:00 +0100

We present the case of a 60-year-old woman who underwent stent placement in the LMT three years prior to developing chest pain and cold sweats. On coronary arteriography, the catheter could not be advanced into the LMT due to resistance in the ostium. Insertion of the catheter was achieved after the resolution of resistance via catheterization of the LMT by means of an intra-aortic balloon pump drive system. The LMT was normal, and the patient's circulatory failure improved. The cause of the LMT embolism was a cardiac papillary fibroelastoma. Primary surgical excision is the recommended therapy for symptomatic cardiac papillary fibroelastoma. If the patient is hemodynamically stable, it may be possible to delay surgery. However, the patient in question developed cardiogenic shock secondary...



Coronary artery vasospasm and cardiogenic shock as the initial presentation for eosinophilic granulomatosis with polyangiitis

Tue, 12 Jan 2016 00:00:00 +0100

We present a case of refractory coronary artery vasospasm in the setting of eosinophilic granulomatosis with polyangiitis (EGPA). Typically, calcium channel blockers and nitrates are used to treat hyperreactive narrowing of the coronary vasculature but we propose this case was refractory to standard treatment due to the underlying pathology of EGPA. Alternative causes of coronary vasospasm when standard therapies fail should be considered.> (Source: Journal of Cardiology Cases)



Epinephrine administration and Takotsubo syndrome: Lessons from past experiences

Sat, 09 Jan 2016 00:00:00 +0100

The objective of the present study was to explore the particulars (age, gender, dose, route of injection, and circumstances) of EPI administration triggered-TTS. Accordingly, a review was undertaken of 29 entries available as of 1/3/16 in Pubmed, in response to the MeSH term “epinephrine administration and Takotsubo” [1–29], plus a recent report with a fatal outcome [30], not accessed as described above, which provided 20 papers (22 patients). (Source: International Journal of Cardiology)



Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

Sat, 09 Jan 2016 00:00:00 +0100

Publication date: Available online 8 January 2016 Source:Journal of Acute Disease Author(s): Rengin Çetin Güvenç, Tolga Sinan Güvenç Acute mitral regurgitation (MR) is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary oedema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality...

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Cardiogenic shock secondary to methamphetamine induced cardiomyopathy requiring veno-arterial extra-corporeal membrane oxygenation

Fri, 08 Jan 2016 00:00:00 +0100

A 31year old male with no significant past medical history was transferred to our institution for management of cardiogenic shock after presenting with new severe bi-ventricular dysfunction. Previously, he had smoked regular crystal-methamphetamine, with heavy daily usage for 8years until becoming abstinent 2months prior to presentation. He had also used intermittent gamma hydroxyl-butymate with occasional heavy alcohol binges. Throughout this period of substance use, he had maintained regular employment and had a supportive social network. (Source: International Journal of Cardiology)