MedWorm: Cardiogenic Shock

Hypothermia Might Boost Survival in MI ShockHypothermia Might Boost Survival in MI Shock

Medscape Today Headlines — Mon, 06 Feb 2012 22:42:03 +0100

Some data suggest therapeutic hypothermia might reduce the currently high mortality from cardiogenic shock; let's do the necessary clinical studies to see whether it might be true, urges a published viewpoint. Heartwire (Source: Medscape Today Headlines)

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MI-shock proposal is cold comfort: Hypothermia might boost survival

theHeart.org — Mon, 06 Feb 2012 21:00:00 +0100

Feasibility and efficacy of bypassing the right ventricle and pulmonary circulation to treat right ventricular failure: an experimental study

Journal of Cardiothoracic Surgery — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: Bypassing the right ventricle and pulmonary circulation with an oxygenating assist device, which may offer the advantages of enhanced right ventricular decompression and augmented left atrial filling, is feasible and effective in the treatment of acute RVF. Long time experiments are needed. (Source: Journal of Cardiothoracic Surgery)

Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock: A Meta-Analysis

Journal of Cardiovascular Pharmacology and Therapeutics — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion: The present meta-analysis suggests that patients with high-risk AMI without cardiogenic shock do not seem to benefit from the use of IABP as measured by in-hospital mortality, rate of reinfarction, and recurrent angina. However, in patients with AMI with cardiogenic shock (systolic blood pressure [SBP] < 90), there was significant reduction in mortality using IABP. The use of IABP is associated with increase in the rate of both moderate and severe bleeding. (Source: Journal of Cardiovascular Pharmacology and Therapeutics)

Fluoxetine/venlafaxine overdose: Cardiogenic shock and serotonin syndrome: case report

Reactions — Sun, 05 Feb 2012 18:29:54 +0100

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Refractory Spasm of Coronary Arteries and Grafted Conduits After Isolated Coronary Artery Bypass Surgery [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions Diffuse RVS after CABG is a rare but lethal condition. Our experience, although limited, indicates that in such cases an aggressive treatment, that is, prompt extracorporeal membrane oxygenation institution and controlled cardiocirculatory assistance, represents the preferred solution to face such a dramatic event and may save patient lives. (Source: The Annals of Thoracic Surgery)

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Journal of the American College of Cardiology — Fri, 20 Jan 2012 13:57:13 +0100

We welcome Drs. Kalra and Fenster's interest in our work delineating the association between renal function–based contrast dose and the risk of renal complications in patients undergoing percutaneous coronary intervention (). They argued that in high-risk patients, and especially among patients with cardiogenic shock, the incidence of contrast-induced nephropathy (CIN) is unacceptably high, even when the ratio of contrast volume to creatinine clearance is (Source: Journal of the American College of Cardiology)

Giant congenital cervical teratoma: case report and review about therapeutic options

Revista Paulista de Pediatria — Wed, 18 Jan 2012 06:37:28 +0100

OBJETIVO:Relatar um caso de teratoma cervical congênito, destacando a gravidade e as dificuldades terapêuticas associadas. DESCRIÇÃO DO CASO: Mãe de 30 anos, com gestação por fertilização assistida. Com 23 semanas, diagnosticada malformação cervical fetal à direita. Parto cesáreo por indicação fetal com 31 semanas. Recém-nascido masculino, peso ao nascer de 1800g, Apgar 4 e 9, com volumoso processo expansivo à direita, ocupando toda a região cervical, comprometendo a mandíbula e estendendo-se para o terço superior do tórax. Com 40 horas de vida, apresentou insuficiência cardíaca congestiva de alto débito por roubo de fluxo pelo tumor. A partir de 54 horas de vida, houve progressiva deterioração hemodinâmica e respiratória, com hipotensão, anúria e labilidade d...

High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: A pilot randomized controlled trial

American Heart Journal — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion: This study found no evidence of benefit or harm from high-concentration compared with titrated oxygen in initially uncomplicated STEMI. However, our estimates have wide CIs, and as a result, large randomized controlled trials are required to resolve the clinical uncertainty. (Source: American Heart Journal)

Surgical Outcomes for Type-A Aortic Dissection in Septuagenarians and Octogenarians

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:23 +0100

Conclusions: Data suggest that despite high morbidity and mortality, satisfactory long-term survival can be achieved for 70- and 80-year-old patients requiring surgical treatment for TAAD. However, interpretation of this study, and other similar ones, must account for a likely high degree of bias in selection of only the good-risk (elderly) patients for surgery. in elderly patients treated surgically for TAAD, EF predicts mortality in the younger portion of this (elderly) group. This trend diminishes as age increases. (Source: Journal of Surgical Research)

Characteristics, management and outcomes of patients with acute coronary syndrome and prior coronary artery bypass surgery: findings from the second Gulf Registry of Acute Coronary Events{star}

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

Conclusions: ACS patients from Middle East countries with prior CABG have adverse baseline characteristics, reported higher GRACE risk score, multivessel disease, more severe LV dysfunction, cardiogenic shock, in-hospital major bleeding, but with less incidence of STEMI with less prominent surge of cardiac biomarkers. However, there was no significant difference in mortality during hospitalization, at 30 days and at one year between ACS patients with and without prior CABG. The reasons for this 'risk-mortality' paradox need to be further evaluated. (Source: Interactive CardioVascular and Thoracic Surgery)

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Mechanical circulatory support for elderly heart failure patients

Heart Failure Reviews — Wed, 11 Jan 2012 17:57:58 +0100

Abstract End-stage systolic heart failure is an increasingly common problem in elderly patients and is associated with high cost, poor quality of life, and poor outcomes. Mechanical circulatory support is a promising therapy as both a bridge to transplantation and destination therapy. Elderly patients are frequently ineligible for heart transplantation because of their age and comorbidities, and the application of mechanical circulatory support for destination therapy in this population is not well defined. A review of the literature was undertaken to better characterize our experience to date with mechanical circulatory support in older heart failure populations. Mechanical circulatory support is being employed increasingly for destination therapy indications in older pat...

Outcomes of primary percutaneous coronary intervention for acute myocardial infarction with unprotected left main coronary artery occlusion

Catheterization and Cardiovascular Interventions — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions: Despite performance of primary PCI, patients with AMI due to LMCA occlusion were associated with >50% in‐hospital mortality. Hemodynamic deficit upon arrival was the major determinant of their poor hospital outcomes. The hospital survivors, however, were associated with favorable long‐term outcomes. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Interleukin-6, -7, -8 and -10 predict outcome in acute myocardial infarction complicated by cardiogenic shock

Clinical Research in Cardiology — Tue, 03 Jan 2012 06:43:47 +0100

Conclusion The inflammatory response in patients with myocardial infarction complicated by cardiogenic shock, as reflected by the inflammatory markers IL-6, IL-7, IL-8 and IL-10, demonstrates a clinically relevant prognostic contribution to clinical outcome. Content Type Journal ArticleCategory Original PaperPages 1-10DOI 10.1007/s00392-011-0403-3Authors Roland Prondzinsky, Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, GermanySusanne Unverzagt, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, GermanyHenning Lemm, Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, GermanyNikolas-Arne Wegener, Department of Medicine III, Martin...

Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?

European Heart Journal — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion Acute myocardial infarction with RBBB is frequently caused by the complete occlusion of the infarct-related artery and is more frequently treated with primary PCI when compared with AMI + LBBB. In-hospital mortality of patients with AMI and RBBB is highest from all ECG presentations of AMI. Restoration of coronary flow by primary PCI may lead to resolution of the conduction delay on the discharge ECG. Right bundle branch block should strongly be considered for listing in future guidelines as a standard indication for reperfusion therapy, in the same way as LBBB. (Source: European Heart Journal)

Stent Thrombosis Presenting With Cardiogenic ShockStent Thrombosis Presenting With Cardiogenic Shock

Medscape Today Headlines — Fri, 30 Dec 2011 04:00:00 +0100

This 68-year-old man complained of chest pain and rapidly developed cardiogenic shock 48 hours after primary percutaneous coronary intervention. What was the cause? Journal of Medical Case Reports (Source: Medscape Today Headlines)

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Impact of preoperative percutaneous cardiopulmonary support on outcome following left ventricular assist device implantation.

Circulation Journal — Thu, 22 Dec 2011 05:00:00 +0100

Conclusions: Despite adequate hemodynamic support after LVAD implantation, patients with preoperative PCPS had significantly worse survival. LVAD should be used for patients with end-stage heart failure, before PCPS is required for hemodynamic support. (Circ J 2012; 76: 88-95). PMID: 22139359 [PubMed - in process] (Source: Circulation Journal)

Giant Syphilitic Aortic Aneurysm Presenting With Pericardial Tamponade as an Initial Sign

Journal of the American College of Cardiology — Thu, 22 Dec 2011 02:25:47 +0100

A previously healthy 38-year-old man presented to our hospital with sudden-onset dyspnea, sharp, stabbing chest pain, and a clinical picture of cardiogenic shock. Echocardiography revealed a severely dilated ascending aorta beyond the sinotubular junction (A, Online Video 1), with moderate aortic insufficiency (Online Video 2). There was a large pericardial effusion with thrombus inside (Online Videos 1 and 3). Computed tomographic angiography was performed, with a presumptive diagnosis of aortic dissection with rupture into the pericardium, and demonstrated a dilated ascending aorta 100 mm in diameter (B, C) compressing the right atrium, with no visible intimal tear or flap. (Source: Journal of the American College of Cardiology)

Reimplantation of Anomalous Single Coronary Artery From Pulmonary Artery: Diagnosis and Surgical Management [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

A newborn presented in cardiogenic shock with the diagnosis of anomalous single coronary artery from pulmonary artery and was successfully revived with prostaglandin (PGE1) infusion. She underwent surgical implantation of her coronary arteries while receiving PGE1 infusion to maintain high oxygen tension for the coronaries during cardiopulmonary bypass. She was discharged in 2 weeks with good biventricular function and moderate mitral regurgitation. At 2 months follow-up, she was gaining weight with preserved ventricular function and moderate mitral regurgitation. (Source: The Annals of Thoracic Surgery)

Extracorporeal membrane oxygenation with hemoconcentration in a hypervolemic patient with critical aortic stenosis.

Texas Heart Institute Journal — Mon, 19 Dec 2011 09:30:03 +0100

Authors: Gregoric ID, Kar B, Gholkar G, Patel S, Crane T, Nathan S, Loyalka P Abstract Herein, we describe the case of a 60-year-old man with severe nonischemic cardiomyopathy and hypervolemia. By means of venoarterial extracorporeal membrane oxygenation at the bedside, along with hemoconcentration, the patient was resuscitated from severe cardiogenic shock and normal blood volume was restored. Within 24 hours, he was able to undergo a high-risk aortic valve replacement for severe aortic stenosis, with a successful outcome. To our knowledge, this is the first reported case in which hemoconcentration with extracorporeal membrane oxygenation has been used to support a patient with severe hypervolemia. PMID: 22163137 [PubMed - in process] (Source: Texas Heart Institute Journal)

Usefulness of Transient and Persistent No Reflow to Predict Adverse Clinical Outcomes Following Percutaneous Coronary Intervention

The American Journal of Cardiology — Mon, 19 Dec 2011 05:00:00 +0100

The no reflow phenomenon is reported to occur in >2% of all percutaneous coronary interventions (PCIs) and portends a poor prognosis. We analyzed data from 5,286 consecutive patients who underwent PCI from the Melbourne Interventional Group (MIG) registry from April 2004 through January 2008 who had 30-day follow-up completed. Patients without no reflow (normal reflow, n = 5,031) were compared to 255 (4.8%) with no reflow (n = 217 for transient no reflow, n = 38 for persistent no reflow). Patients with transient or persistent no reflow were more likely to present with ST-elevation myocardial infarction (MI) or cardiogenic shock (p (Source: The American Journal of Cardiology)

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Random plasma glucose measurement may improve the diagnostic specificity of highly sensitive troponin in the emergency department

International Journal of Cardiology — Mon, 19 Dec 2011 05:00:00 +0100

Hyperglycemia is frequently observed in patients with acute myocardial infarction (AMI) and is associated with an increased hospital mortality, in both diabetic and non-diabetic patients, and especially in the younger subjects . The concentration of random plasma glucose at emergency department (ED) admission is also an independent predictor of cardiac outcome, including congestive heart failure, cardiogenic shock, and death after acute myocardial infarction . Nevertheless, the usefulness of random plasma glucose assessment has not been previously investigated in the diagnostic workout of AMI to the best of our knowledge. (Source: International Journal of Cardiology)

Quiz Page January 2012: Acute Kidney Injury With Hematuria, a Positive ANCA Test, and Low Levels of Complement

American Journal of Kidney Diseases — Sat, 17 Dec 2011 01:21:10 +0100

A 74-year-old man with a history of ischemic heart disease, atrial fibrillation, implanted cardiac defibrillator, congestive heart failure, pulmonary embolus, type 2 diabetes mellitus, and benign prostatic hypertrophy was admitted in cardiogenic shock. He described feeling unwell with intermittent fevers and increasing breathlessness during the past year. On presentation, he received inotropic support and aggressive diuresis. Transthoracic echocardiography showed ejection fraction of 25%-30% with normal valves and no vegetation, changed from a previous echocardiogram that showed ejection fraction of 40%-45% and no vegetation. (Source: American Journal of Kidney Diseases)

Single-bolus tenecteplase plus heparin compared with heparin alone for normotensive patients with acute pulmonary embolism who have evidence of right ventricular dysfunction and myocardial injury: Rationale and design of the Pulmonary Embolism Thrombolysis (PEITHO) trial

American Heart Journal — Fri, 16 Dec 2011 02:35:17 +0100

Conclusions: By determining the benefits vs risks of thrombolysis in submassive or intermediate-risk PE, this trial is expected to answer a long-standing query on the management of this patient population. (Source: American Heart Journal)

Randomized Study on the Efficacy and Safety of Landiolol, an Ultra-Short-Acting β1-Adrenergic Blocker, in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Circulation Journal — Sat, 10 Dec 2011 05:00:00 +0100

Conclusions: Early intravenous administration of landiolol in patients with AMI undergoing PCI is safe and has the potential to improve cardiac function and inhibit cardiac remodeling in the chronic phase. PMID: 22156314 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Concurrent drug eluting/bare metal stent implantation during percutaneous coronary intervention in target vessel: outcomes and 1-year follow-up

Clinical Research in Cardiology — Thu, 08 Dec 2011 18:24:06 +0100

Conclusions Concurrent BMS/DES stenting is associated with an increase in in-hospital but not long-term mortality. Further, there was a significant increase in recurrent myocardial infarction and TVR, but absolute differences were low. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00392-011-0390-4Authors Alessandro Cuneo, Abteilung für Kardiologie, Asklepios Klinik St-Georg, Hamburg, GermanyPeter Bramlage, Institut für Pharmakologie und präventive Medizin, Mahlow, GermanyMatthias Hochadel, Stiftung Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, GermanyJochen Senges, Stiftung Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, GermanyChristoph Nienabe...

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Bleeding complications in primary percutaneous coronary intervention of ST‐elevation myocardial infarction in a radial center

Catheterization and Cardiovascular Interventions — Thu, 08 Dec 2011 05:00:00 +0100

Conclusions: In the setting of radial primary PCI, the rates and types of bleeding complications are somewhat different from those observed with femoral primary PCI. The gastro‐intestinal tract has become the most frequent site of bleeding after radial primary PCI. The use of radial access appears independently associated with survival. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Cyclosporine treatment improves mesenteric perfusion and attenuates necrotizing enterocolitis (NEC)-like intestinal injury in asphyxiated newborn piglets during reoxygenation

Intensive Care Medicine — Tue, 06 Dec 2011 06:58:46 +0100

Conclusions This is the first study to demonstrate that post-resuscitation administration of cyclosporine improves mesenteric perfusion and attenuates NEC-like intestinal injury in newborn piglets following asphyxia-reoxygenation. Content Type Journal ArticleCategory Pediatric OriginalPages 1-9DOI 10.1007/s00134-011-2436-5Authors Richdeep S. Gill, Department of Surgery, University of Alberta, Edmonton, AB, CanadaNamdar Manouchehri, Department of Surgery, University of Alberta, Edmonton, AB, CanadaTze-Fun Lee, Department of Pediatrics, University of Alberta, Edmonton, AB, CanadaWoo Jung Cho, Department of Molecular Biology, Princeton University, Princeton, NJ, USAAducio Thiesen, Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, Cana...

Intraaortic Balloon Pump: Incidence and Predictors of Complications in the Florence Registry

Clinical Cardiology — Tue, 06 Dec 2011 05:00:00 +0100

Conclusions:In consecutive patients treated with IABP support, the degree of hemodynamic impairment and the decrease in platelet count were independent predictors of complications, whose development was associated with higher in‐ICCU mortality. © 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

Characteristics, management and outcomes of patients with acute coronary syndrome and prior coronary artery bypass surgery: findings from the second Gulf Registry of Acute Coronary Events{star} [Follow-up papers - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Mon, 05 Dec 2011 05:00:00 +0100

Relationship Between White Blood Cell Count and In-Hospital Outcomes in Acute Coronary Syndrome Patients From the Middle East

Angiology — Sun, 04 Dec 2011 05:00:00 +0100

We evaluated the relationship between admission white blood cell (WBC) count and in-hospital outcomes in acute coronary syndrome (ACS) patients from the Middle East. Data were analyzed from 7806 consecutive patients with ACS who were divided into 4 groups (G) according to their WBC count (x109/L; G1: <6.00; G2: 6.00-9.99; G3: 10.00-11.99; G4: ≥12.00). After significant covariate adjustment, those in G4 were 68% more likely to have cardiogenic shock than those in G1 (95% confidence interval [CI]: 1.05-2.68; P = .030) and G2 (odds ratio [OR], 2.02; 95% CI: 1.51-2.71; P < .001). Those in G4 were 2.02 times (95% CI: 1.11-3.67; P = .021) and 65% (95% CI: 1.17-2.32; P = .004) more likely to die in hospital than those in G1 and G2, respectively. Admission WBC count is an independent risk...

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Fentanyl/propofol: Cardiogenic shock: case report

Reactions — Thu, 01 Dec 2011 07:29:01 +0100

(Source: Reactions)

Fosphenytoin: Cardiogenic shock: case report

Reactions — Thu, 01 Dec 2011 07:29:01 +0100

(Source: Reactions)

Trends and predictors of length of stay after primary percutaneous coronary intervention: A report from the CathPCI Registry

American Heart Journal — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: While the predicted risk profile has remained stable, there has been a significant decrease in LOS after PPCI. Nevertheless, hospitals vary in discharging low-risk and uncomplicated patients early. Discharge within 2 days was associated with specific patient, procedure, and hospital factors. Further study is needed to determine the safety of early discharge among patients undergoing PPCI. (Source: American Heart Journal)

Successful Use of the TandemHeart Percutaneous Ventricular Assist Device as a Bridge to Recovery for Acute Cellular Rejection in a Cardiac Transplant Patient

Transplantation Proceedings — Thu, 01 Dec 2011 05:00:00 +0100

In this report, we presented a patient who benefited from hemodynamic support with the TandemHeart Percutaneous Ventricular Assist Device (pVAD; Cardiac Assist, Inc) implantation in the setting of early acute graft rejection 2 months after orthotopic heart transplant. The TandemHeart initially had been used for temporary hemodynamic assistance during postcardiotomy heart failure and high-risk coronary interventions. More recently, its use in patients with cardiogenic shock from acute myocardial infarction, fulminant myocarditis, and critical aortic stenosis has been reported. To our knowledge, this is one of the first reported cases in which the TandemHeart pVAD served as a successful device for support during acute cardiac transplant rejection. (Source: Transplantation Proceedings)

Takotsubo cardiomyopathy as a complication of electroconvulsive therapy.

The Annals of Pharmacotherapy — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSIONS: Takotsubo cardiomyopathy is a serious but transient potential complication of electroconvulsive therapy. Limited evidence indicates that β-adrenergic receptor blocking agents may help prevent its reoccurrence in patients needing further electroconvulsive treatment. Health care providers in psychiatry should be aware of this potential complication of electroconvulsive therapy, especially in postmenopausal women. However, many questions remain regarding this issue. PMID: 22116995 [PubMed - in process] (Source: The Annals of Pharmacotherapy)

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Percutaneous revascularization of total or subtotal left main occlusion in the setting of acute myocardial infarction.

Turk Kardiyoloji Dernegi arsivi — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION: Percutaneous coronary intervention in patients with LMCO complicated by AMI is feasible and effective, and offers a good mid-term outcome for hospital survivors. PMID: 22257804 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)

Amplatzer septal occluder to treat iatrogenic cardiac perforations

Catheterization and Cardiovascular Interventions — Wed, 30 Nov 2011 05:00:00 +0100

Conclusions: Percutaneous device occlusion of iatrogenic heart perforation seems to be a safe and efficient method to treat iatrogenic heart perforation. In order to perform this elegant method, it is however imperative not to prematurely withdraw the perforating catheter to maintain access to the hole for closure. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Can a meta-analysis that mixes apples with oranges be used to demonstrate that levosimendan reduces mortality after coronary revascularization?

Critical Care — Mon, 28 Nov 2011 05:00:00 +0100

In conclusion, we believe that this meta-analysis does not give any scientifically proven conclusion and creates only conclusion. (Source: Critical Care)

Heart transplantation following myocardial infarction due to Takayasu’s arteritis

Pediatric Transplantation — Sat, 26 Nov 2011 13:43:13 +0100

We report a 14‐yr‐old girl who presented with cardiogenic shock because of compression of the left main coronary artery secondary to Takayasu’s arteritis. The patient required cardiac transplantation with hemi‐arch replacement at the time of transplant because of ascending aortitis. To our knowledge, this is the first case of cardiac transplantation in Takayasu’s arteritis to be reported in the literature. (Source: Pediatric Transplantation)

Cardiogenic Shock

Critical Care Nursing Clinics of North America — Fri, 25 Nov 2011 14:54:07 +0100

This article provides a review of the current understanding of the etiologies, pathophysiology, and recommendations for management of cardiogenic shock. (Source: Critical Care Nursing Clinics of North America)

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Cor Triatriatum With Partial Anomalous Pulmonary Venous Return: A Rare Case of Parallel Obstruction and Successful Staged Treatment

Pediatric Cardiology — Thu, 24 Nov 2011 17:45:08 +0100

We present a case of such rare anatomy with multilevel obstruction that presented in infancy as cardiogenic shock. The patient underwent staged treatment with extracorporeal membrane oxygenation stabilization, catheter-based balloon dilatation of the cor triatriatum and atrial septostomy, followed by definitive surgical repair, with excellent result. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00246-011-0148-9Authors Ofer Schiller, Division of Cardiology, Children’s National Medical Center, Washington, DC 20010, USAKristin M. Burns, Division of Cardiology, Children’s National Medical Center, Washington, DC 20010, USAPranava Sinha, Department of Cardiovascular Surgery, Children’s National Medical Center, Washington, DC 20010, USASusan D. Cummings, D...

Extracorporeal Membrane Oxygenation for Advanced Refractory Shock in Acute and Chronic Cardiomyopathy [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions Extracorporeal membrane oxygenation in advanced refractory AMI-CS is associated with acceptable outcomes in a well-selected population. The ECMO in patients with an acute decompensation of a chronic CM should be carefully considered, to avoid futile support. (Source: The Annals of Thoracic Surgery)

Left Ventricular Decompression During Peripheral Extracorporeal Membrane Oxygenation Support With the Use of the Novel iVAC Pulsatile Paracorporeal Assist Device [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

We describe a minimally invasive technique for decompressing the left ventricle in this setting using a novel pulsatile paracorporeal assist device, the iVAC 3L (PulseCath, Groningen, The Netherlands). It is implanted through the right axillary artery and provides hemodynamic support while directly off-loading the left ventricle. (Source: The Annals of Thoracic Surgery)

Antihypertensives/bupropion/insulin/soya oil emulsion: Cardiogenic shock and bradyasystolic arrest: 2 case reports

Reactions — Tue, 22 Nov 2011 06:51:47 +0100

(Source: Reactions)

Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction

Catheterization and Cardiovascular Interventions — Tue, 22 Nov 2011 05:00:00 +0100

Conclusion:Patients with STEMI and a LMCA had poor clinical outcomes, which is attributable to hemodynamic deterioration during the peri‐procedural period. However, after that time, mid‐term MACEs of the survivors following the peri‐procedural period may not be different between STEMI due to LMCA and non‐LMCA. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

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What has changed in the treatment of ST-segment elevation myocardial infarction in Poland in 2003-2009? Data from the Polish Registry of Acute Coronary Syndromes (PL-ACS).

Kardiologia Polska — Sat, 19 Nov 2011 21:24:02 +0100

Conclusions: The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock. Kardiol Pol 2011; 69, 11: 1109-1118. PMID: 22090216 [PubMed - in process] (Source: Kardiologia Polska)

Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study

Journal of Thrombosis and Thrombolysis — Fri, 18 Nov 2011 06:58:01 +0100

This study investigated feasibility and safety of early PCI after successful half-dose alteplase reperfusion in a Chinese population. Patients with STEMI received half-dose alteplase if expected time delay to PCI was ≥90 min. Patients who reached clinical criteria of successful thrombolysis reperfusion were recommended to undergo diagnostic angiography within 3–24 h after thrombolysis. Patients with residual stenosis ≥70% in the infarct-related artery underwent PCI, regardless of flow or patency status. Epicardial arterial flow was assessed using thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (CTFC). Myocardial perfusion was assessed using myocardial blush grade (MBG) and TIMI myocardial perfusion frame count (TMPFC). Forty-nine patients ...

Does previous hypertension affect outcome in acute heart failure?

European Journal of Internal Medicine — Wed, 16 Nov 2011 18:00:19 +0100

CONCLUSION: Antecedent hypertension is frequent in patients with acute HF and contributes to organ and vascular impairment. However its presence has no independent influence on short- and medium-term mortality, which is influenced by other related co-morbidities. PMID: 22075286 [PubMed - in process] (Source: European Journal of Internal Medicine)

Transradial PCI in cardiogenic shock, the final frontier?

Catheterization and Cardiovascular Interventions — Tue, 15 Nov 2011 05:00:00 +0100

(Source: Catheterization and Cardiovascular Interventions)

Multiple drugs overdose/insulin: Cardiogenic shock, hypoglycaemia and hypokalaemia: 12 case reports

Reactions — Thu, 10 Nov 2011 08:03:53 +0100

(Source: Reactions)

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Percutaneous cardiopulmonary support in pulmonary embolism with cardiac arrest

Resuscitation — Mon, 07 Nov 2011 05:00:00 +0100

Abstract: Objective: To assess the role of percutaneous cardiopulmonary support (PCPS) for the resuscitation of patients with massive pulmonary embolism (PE) with circulatory collapse. We also compared outcomes for PCPS between patients with massive PE with circulatory collapse and patients with AMI with cardiogenic shock.Background: The effectiveness of PCPS for acute myocardial infarction (AMI) complicated with cardiogenic shock has been reported, but there are few reports on the use of PCPS for massive PE with circulatory collapse.Method: We studied 12 consecutive patients with massive PE and 16 patients with AMI, who required PCPS for resuscitation either during cardiopulmonary resuscitation (CPR) or after successful CPR.Results: Twelve patients with PE and 16 patients with AMI were id...

Routine use of the transradial approach in primary percutaneous coronary intervention: procedural aspects and outcomes in 2209 patients treated in a single high-volume centre

Heart — Fri, 04 Nov 2011 04:00:00 +0100

Conclusions Systematic use of the TRA in PPCI yields low access site crossover, high procedural success rates and excellent procedural performances. It can therefore represent the primary access site in the vast majority of STEMI patients. (Source: Heart)

Primary percutaneous coronary intervention for the treatment of a patient with cardiogenic shock due to acute total occlusion of unprotected left main coronary artery without supportive collateral flow

Future Cardiology — Thu, 03 Nov 2011 13:51:35 +0100

Future Cardiology , November 2011, Vol. 7, No. 6, Pages 749-755. (Source: Future Cardiology)

Predictors of Low Cardiac Output Syndrome After Isolated Coronary Artery Bypass Surgery: Trends Over 20 Years [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions The impact of LVEF less than 0.20 on development of postoperative LCOS has increased markedly in the latest era of our study. Prudent preoperative evaluation in patients with severe left ventricular dysfunction is critical. Further innovative research in myocardial protection and circulatory support is warranted in patients with severe left ventricular dysfunction. (Source: The Annals of Thoracic Surgery)

Management of acute coronary syndromes in developing countries: ACute Coronary Events—a multinational Survey of current management Strategies

American Heart Journal — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions: In this observational study of patients with ACS, the use of evidence-based pharmacologic therapies for ACS was quite high, yet 39% of eligible patients with STEMI received no reperfusion therapy. These findings suggest opportunities to further reduce the risk of long-term ischemic events in patients with ACS in developing countries. (Source: American Heart Journal)

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l‐Carnitine Increases Survival in a Murine Model of Severe Verapamil Toxicity

Academic Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions: When compared with saline, IV l‐carnitine increases survival and MAP in a murine model of severe verapamil toxicity. (Source: Academic Emergency Medicine)

l-Carnitine Increases Survival in a Murine Model of Severe Verapamil Toxicity.

Accident and Emergency Nursing — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions: When compared with saline, IV l-carnitine increases survival and MAP in a murine model of severe verapamil toxicity. PMID: 22092894 [PubMed - in process] (Source: Accident and Emergency Nursing)

Impella LP 2.5 for Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation Support

Journal of Cardiac Surgery — Tue, 01 Nov 2011 04:00:00 +0100

We report the use of the Impella LP 2.5 for LV decompression in a 70‐year‐old man with decompensated heart failure who was placed on VA‐ECMO for cardiogenic shock with severe pulmonary edema and respiratory failure. Both devices were successfully weaned on day 5 of VA‐ECMO support, after myocardial recovery. (J Card Surg 2011;26:666‐668) (Source: Journal of Cardiac Surgery)

Differences in Clinical Features and In‐Hospital Outcomes of Older Adults with Tako‐Tsubo Cardiomyopathy

Journal of the American Geriatrics Society — Mon, 31 Oct 2011 04:00:00 +0100

ConclusionThe clinical profile of participants aged 75 and older with TTC was different from that of those younger than 75 with TTC, and they had a higher in‐hospital complication rate. (Source: Journal of the American Geriatrics Society)

The Clinical Characteristics, Laboratory Parameters, Electrocardiographic, and Echocardiographic Findings of Reverse or Inverted Takotsubo Cardiomyopathy: Comparison With Mid or Apical Variant

Clinical Cardiology — Wed, 26 Oct 2011 04:00:00 +0100

Conclusions:Inverted TTC presents at a younger age and has a higher prevalence of triggering stress, whereas other TTC has a higher prevalence of heart failure symptoms, significant reversible MR, and T‐wave inversion and higher NT‐proBNP levels despite other clinical features that are mostly similar. © 2011 Wiley Periodicals, Inc.This study was supported by the Samsung Changwon Hospital Hyoseok Research Fund. The authors have no other funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

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Long Term use of the Centrimag(R) Ventricular Assist System as a Right Ventricular Assist Device: a Case Report.

Perfusion — Mon, 24 Oct 2011 04:00:00 +0100

Authors: Griffith KE, Jenkins E, Paugh T, Stulak J, Pagani F Abstract Right ventricular failure (RVF) following implantation of a left ventricular assist system (LVAS) is associated with high morbidity and mortality.(1-4) Numerous centers have reported short-term use of the CentriMag® Ventricular Assist System (CVAS) (Levitronix LLC, Waltham, MA) for treatment of cardiogenic shock, decompensated heart failure and right ventricular failure (RVF) following LVAS implantation.(5-9) The present report reviews the clinical course of a patient requiring long-term right ventricular support utilizing the CVAS, following a HeartMate® II LVAS (Thoratec Corp. Pleasanton, CA) implantation. Elevated cytotoxic antibody levels complicated the patient's treatment plan by precluding orthotropic he...

Surface cooling for induction of mild hypothermia in conscious healthy volunteers - a feasibility trial

BioMed Central — Sat, 22 Oct 2011 04:00:00 +0100

Conclusions: Cooling to body temperature below 35degreesC by the use of a non invasive surface cooling is feasible and safe in conscious healthy volunteers. Further studies are needed to investigate an altered cooling protocol to achieve temperatures below 35degreesC. (Source: BioMed Central)

Clinical characteristics and predictors of in-hospital mortality in 270 consecutive patients hospitalised due to acute heart failure in a single cardiology centre during one year.

Kardiologia Polska — Thu, 20 Oct 2011 12:35:03 +0100

Conclusions: In our registry, in-hospital mortality in patients admitted due to acute HF was slightly higher compared to other reports. Baseline values of some parameters (e.g. blood pressure, serum Na(+), renal function) as well as their changes during hospitalisation (e.g. serum K(+), renal function, plasma NT-proBNP) can help identify acute HF patients at a higher risk of in-hospital mortality. Kardiol Pol 2011; 69, 10: 997-1005. PMID: 22006596 [PubMed - in process] (Source: Kardiologia Polska)

High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass

Journal of Anesthesia — Tue, 18 Oct 2011 05:49:24 +0100

Conclusions Massive thrombosis following cardiac surgery is a highly lethal event with limited treatment options. Particular attention should be paid to the status of thrombin regulatory proteins before protamine and other hemostatic interventions in patients undergoing complex cardiac surgery with antifibrinolytic agents. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s00540-011-1253-xAuthors Satoru Ogawa, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USAJames E. Richardson, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USATetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAMasahiro Ide, Anesthesia Associates of Kobe, ...

[Cardiogenic shock after venlafaxine poisoning.]

Annales Francaises d'Anesthesie et de Reanimation — Tue, 18 Oct 2011 04:00:00 +0100

Authors: Malfroy S, Tassin C, Attof R, Perdrix JP, Piriou V PMID: 22014535 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

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Residual Platelet Reactivity, Bleedings, and Adherence to Treatment in Patients Having Coronary Stent Implantation Treated With Prasugrel

The American Journal of Cardiology — Fri, 14 Oct 2011 04:00:00 +0100

In conclusion, in clinical practice, major and minor bleeding event rates associated with prasugrel therapy are comparable to those reported in controlled randomized trials. The minimal bleeding event rate is higher than reported but does not seem to affect adherence to treatment. (Source: The American Journal of Cardiology)

Cardiogenic Shock Following Propofol and FentanylCardiogenic Shock Following Propofol and Fentanyl

Medscape Today Headlines — Thu, 13 Oct 2011 12:02:19 +0100

A healthy 32-year-old woman experienced sudden, severe hemodynamic deterioration after undergoing a minor surgical procedure. What was the cause? Journal of Medical Case Reports (Source: Medscape Today Headlines)

A simple method of vascular access to perform emergency coronary angiography in patients with veno-arterial extracorporeal membrane oxygenation

Intensive Care Medicine — Wed, 12 Oct 2011 16:33:25 +0100

Conclusion Cardiac catheterization using a Y-shaped adapter introduced into the arterial ECMO cannula is feasible. In a resuscitation setting, a new puncture of the femoral artery always carries the risk of complications, wherefore this new technology can be regarded as fast alternative. Content Type Journal ArticleCategory Physiological and Technical NotesPages 1-4DOI 10.1007/s00134-011-2383-1Authors Dierk H. Endemann, Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyAlois Philipp, Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, GermanyChristian Hengstenberg, Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyAndreas Luchner, Department of Interna...

Cardiovascular Failure and Cardiogenic Shock

Seminars in Respiratory and Critical Care Medicine — Tue, 11 Oct 2011 04:00:00 +0100

Semin Respir Crit Care Med 2011; 32: 598-606DOI: 10.1055/s-0031-1287869ABSTRACTCardiovascular system failure is commonly faced by the intensivist. Heart failure can occur due to a host of predisposing cardiac disorders or as secondary effects of systemic illness. When the heart is unable to provide an adequate cardiac output to maintain adequate tissue perfusion, cardiogenic shock ensues. Without prompt diagnosis and appropriate management, these patients have significant morbidity and mortality, with in-hospital mortality approaching 60% for all age groups. Accurate and rapid identification of cardiogenic shock as a medical emergency, with expeditious implementation of appropriate therapy, can lead to improved clinical outcomes. In this review, we discuss optimal strategies for diagnosis ...

Ventricular tachycardia in English bulldogs with localised right ventricular outflow tract enlargement

The Journal of Small Animal Practice — Mon, 10 Oct 2011 04:00:00 +0100

Objectives: To describe the electrocardiographic characteristics of ventricular tachycardia arising from the right ventricular outflow tract and the particular association between this arrhythmia and the presence of localised right ventricular outflow tract enlargement in English bulldogs.Methods: Five English bulldogs were referred with a history of syncope or cardiogenic shock. In all dogs, 12‐lead surface ECG, thoracic radiograph and echocardiography were collected. In all but one dog 24‐hours Holter monitoring and signal‐averaged ECGs was examined and in one dog electrophysiological study and radiofrequency catheter ablation of the VT substrate was performed.Results: Documented arrhythmias included a single sustained monomorphic wide QRS tachycardia in four dogs, and an alternans...

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Deep Vein Thrombosis/Pulmonary Embolism: Prophylaxis, Diagnosis, and Management

Thoracic Surgery Clinics — Mon, 10 Oct 2011 04:00:00 +0100

Thoracic surgery patients should be regarded at high risk for postoperative venous thromboembolism (VTE). VTE mechanical and pharmacologic prophylaxis with low molecular weight heparin, or low-dose unfractionated heparin or fondaparinux (Arixtra) is therefore strongly recommended. Pharmacologic prophylaxis should be extended to 4 weeks after major cancer surgery. Pulmonary embolism should be always managed with anticoagulation, in addition to thrombolytic therapy, in patients presenting with cardiogenic shock or persistent arterial hypotension. (Source: Thoracic Surgery Clinics)

Transseptal Catheter Decompression of the Left Ventricle During Extracorporeal Membrane Oxygenation

Pediatric Cardiology — Sat, 08 Oct 2011 15:44:39 +0100

We present the case of a 13-year-old girl who presented with cardiogenic shock. VA-ECMO was initiated, but after 6 days, severe left-ventricular distension resulted in decreased VA-ECMO flows. With guidance by bedside transesophageal echocardiography, a percutaneous atrial transseptal cannula was placed and connected to the venous circuit, thus decompressing the left ventricle. The patient improved, was weaned from VA-ECMO 5 days later, and was discharged from the hospital. Bedside transseptal catheter insertion is an effective method of left-ventricular decompression. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00246-011-0113-7Authors Michael F. Swartz, Department of Surgery, Strong Memorial Hospital, University of Rochester, Rochester, NY 14...

Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock

Intensive Care Medicine — Sat, 01 Oct 2011 05:49:04 +0100

Conclusions Patients who tolerated a full ECMO weaning trial and had aortic VTI ≥10 cm, LVEF >20–25%, and TDSa ≥6 cm/s at minimal ECMO flow were all successfully weaned. However, further studies are needed to validate these simple and easy-to-acquire Doppler echocardiography parameters as predictors of subsequent ECMO weaning success in patients recovering from severe cardiogenic shock. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-011-2358-2Authors Nadia Aissaoui, Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, Paris, FranceCharles-Edouard Luyt, Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistan...

Left Anterior Descending Artery Revascularization in Low-Risk Patients: Early Outcomes after Off-Pump versus On-Pump Surgery.

The Heart Surgery Forum — Sat, 01 Oct 2011 04:00:00 +0100

Conclusions: Among low-risk patients (defined according to EuroSCORE criteria) who underwent left anterior descending coronary artery bypass, the results obtained with the on-pump and off-pump methods showed no significant differences with respect to morbidity or mortality. PMID: 21997654 [PubMed - in process] (Source: The Heart Surgery Forum)

Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging.

Archives of Cardiovascular Diseases — Sat, 01 Oct 2011 04:00:00 +0100

CONCLUSION: CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution. PMID: 22044703 [PubMed - in process] (Source: Archives of Cardiovascular Diseases)

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Is high-dose insulin better than vasopressors in treating toxin-induced cardiogenic shock?

The Poison Review — Fri, 30 Sep 2011 03:29:43 +0100

3 out of 5 stars High-dose insulin: A consecutive case series in toxin-induced cardiogenic shock. Holger JS et al. Clin Toxicol 2011;49:653-658. Abstract This observational case series, from Regions Hospital in St. Paul MN, retrospectively reviewed charts of patients seen by the toxicology service and treated for toxin-induced cardiogenic shock over an approximately 3 year period (February 2007 – March 2010). Cardiogenic shock was diagnosed if a patient exhibited signs or symptoms of organ hypoperfusion. Treatment of these patients was guided by a protocol that used high-dose insulin as the primary intervention and attempted to avoid vasopressors. The authors identified 12 cases. Cardiovascular toxins included: beta-blockers (BB, 5 patients) calcium-channel blockers (CCB, 2 ...

Med Sci Monit 2011; 17(10):CQ9-12 "A severe complication after ST-segment elevation myocardial infarction (Part 2)"

Medical Science Monitor — Thu, 29 Sep 2011 23:33:02 +0100

We report the case of a 70-year-old woman with ST-segment elevation myocardial infarction of the anterior wall, complicated by ventricular septal rupture (two septal defects – VSDs) with symptoms of cardiogenic shock. After 6 weeks of conservative treatment with inotropes and intra-aortic balloon support, the patient underwent surgical repair of VSDs with good clinical outcome. (Source: Medical Science Monitor)

Analysis of Survival in 300 High-Risk Patients up to 2.5 Years After Transapical Aortic Valve Implantation [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

Conclusions The outcome of transapical aortic valve implantation in very high-risk patients was very favorable not only early after the procedure but also later on. Preoperative risk scores were not indicators for early mortality but were for later mortality. Survival was mainly influenced by noncardiac (renal, pulmonary, and vascular) comorbidities as well as by signs of advanced cardiac failure. (Source: The Annals of Thoracic Surgery)

Intermittent Coronary Artery Occlusion Caused by a Floating Thrombus in the Left Coronary Sinus of Valsalva of a Patient With a Normal Aorta and Protein C Deficiency [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

We report a case in which a floating mass in the left coronary sinus of Valsalva caused intermittent left main coronary trunk occlusion, leading to myocardial ischemia and cardiogenic shock. The mass was surgically resected. Macroscopically, the aortic wall and leaflets were normal. On histologic examination the mass was found to be a thrombus. This patient had a low level of protein C; therefore, it was presumed that the thrombus was due to protein C deficiency. (Source: The Annals of Thoracic Surgery)

Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock: The CRISP AMI Randomized Trial [Original Contribution]

JAMA — Tue, 27 Sep 2011 04:00:00 +0100

Conclusion Among patients with acute anterior STEMI without shock, IABC plus primary PCI compared with PCI alone did not result in reduced infarct size. Trial Registration clinicaltrials.gov Identifier: NCT00833612 (Source: JAMA)

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Early implementation of continuous venovenous haemodiafiltration improves outcome in patients with heart failure complicated by acute kidney injury.

Kardiologia Polska — Sat, 24 Sep 2011 13:08:02 +0100

Conclusions: An early introduction of CVVHDF significantly diminished the need to use mechanical ventilation and indicated a positive trend in the reduction of in-hospital mortality in patients with HF complicated by AKI. Kardiol Pol 2011; 69, 9: 891-896. PMID: 21928193 [PubMed - in process] (Source: Kardiologia Polska)

A Rare Shock

The American Journal of Medicine — Fri, 23 Sep 2011 04:00:00 +0100

In this case, a patient with no history of coronary artery disease presented with cardiogenic shock and eosinophilia. Her history of adult-onset asthma proved key to the eventual diagnosis. (Source: The American Journal of Medicine)

Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment-Elevation Myocardial Infarction.

Circulation — Mon, 19 Sep 2011 04:00:00 +0100

Conclusions-Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay. PMID: 21931079 [PubMed - as supplied by publisher] (Source: Circulation)

Long-Term Predictors of Mortality After Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents

The American Journal of Cardiology — Sat, 17 Sep 2011 22:30:25 +0100

The aim was to examine timing, causes, and predictors of death during long-term follow-up after contemporary percutaneous coronary intervention (PCI) using a large multicenter Australian registry. The cohort consisted of 10,682 consecutive patients from the Melbourne Interventional Group registry undergoing PCI (February 2004 through November 2009). For the first time in Australia, long-term mortality rates of a PCI cohort were defined by linkage to the National Death Index database. The cohort (mean age 64 ± 12 years) comprised 75% men, 24% diabetics, 59% with multivessel disease, 4.4% with renal failure, 25% with ST-elevation myocardial infarction (STEMI), 2.5% with cardiogenic shock, and 5.1% with heart failure. Drug-eluting stents (DES) were used in 43% of cases. Mean follow-up was 3....

Hantavirus pulmonary syndrome.

Virus Research — Sat, 17 Sep 2011 04:00:00 +0100

This article briefly reviews the knowledge on HPS-associated hantaviruses accumulated since their discovery, less than 20 years ago. PMID: 21945215 [PubMed - as supplied by publisher] (Source: Virus Research)

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Myxedema Coma: A New Look into an Old Crisis

Computational Intelligence and Neuroscience — Thu, 15 Sep 2011 15:32:33 +0100

Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive ...

One‐year Outcomes with Angiographic Follow‐Up of Paclitaxel‐Eluting Balloon for the Treatment of In‐Stent Restenosis: Insights from Spanish Multicenter Registry

Journal of Interventional Cardiology — Thu, 15 Sep 2011 04:00:00 +0100

Conclusion: In a real‐world population, treatment of ISR (including 48% DES‐ISR) with this DEB provides good mid‐term results with 12% TLR at 1 year, especially in ISR pattern IC (9% MACE). (J Interven Cardiol 2011;00:1–11) (Source: Journal of Interventional Cardiology)

Hypocalcemic cardiomyopathy presenting as cardiogenic shock

Annals of Pediatric Cardiology — Thu, 08 Sep 2011 04:00:00 +0100

We describe 5 infants presenting with cardiogenic shock over 3 years, who were found to have severe hypocalcemia as a sole cause of myocardial dysfunction. The patients responded to calcium and vitamin D supplementation promptly and left ventricular systolic function normalized within months of treatment. In any case of cardiogenic shock, hypocalcemia should be included in the differential diagnosis and must be investigated. (Source: Annals of Pediatric Cardiology)

Vitamin D deficiency presenting with cardiogenic shock in an infant

Annals of Pediatric Cardiology — Thu, 08 Sep 2011 04:00:00 +0100

Manish Kumar, Diganta Saikia, Vishal Kumar, Ruchi TomarAnnals of Pediatric Cardiology 2011 4(2):207-209A 2-month-old child was referred as a case of dilated cardiomyopathy with cardiogenic shock. On evaluation, hypocalcemia secondary to severe vitamin D deficiency was found. There were no clinical or radiological features of rickets. The child had developed multiorgan failure due to cardiogenic shock at the time of admission and could not be saved despite adequate ventilatory and pharmacologic support. Hypocalcemia should be considered as an important differential diagnosis in cases of dilated cardiomyopathy in infants. (Source: Annals of Pediatric Cardiology)

Recurrent Urosepsis and Cardiogenic Shock in an Elderly Patient with Pheochromocytoma

Clinical and Developmental Immunology — Tue, 06 Sep 2011 15:07:31 +0100

We describe a hypertensive elderly patient with incidentally diagnosed pheochromocytoma complicated by recurrent urosepsis, cardiomyopathy, and fatal myocardial infarction. Our case demonstrates that, in older hypertensive patients without classical symptoms, orthostatic hypotension and urinary retention, which are common in the elderly, may indicate catecholamine excess and that the deleterious cardiovascular consequences of catecholamine excess in the elderly are not prevented by pharmacological α- and β-blockade. (Source: Clinical and Developmental Immunology)

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Extremely localized aortic dissection and intussusception of the intimal flap into the left ventricle.

Annals of Thoracic and Cardiovascular Surgery — Sun, 04 Sep 2011 17:00:08 +0100

Authors: Yamabi H, Imanaka K, Sato H, Matsuoka T Abstract Stanford type A aortic dissection frequently deforms the aortic root and causes aortic regurgitation (AR). On the rare occasion, massive AR can occur due to circumferential intimal disruption and prolapse of the cylinder-shaped intimal flap into the left ventricle. Because of the critical, general, and hemodynamic state of such patients, surgery for this condition carries a high risk. A 62-year-old woman suffered acute chest pain and fell into cardiogenic shock. Computed tomography and transthoracic echocardiography failed to identify the etiology of this rapid hemodynamic collapse. Transesophageal echocardiography (TEE) demonstrated circumferential intimal disruption, 3 centimeters above the aortic valve annulus; a very loc...

Timely Use of a CentriMag Heart Assist Device Improves Survival in Postcardiotomy Cardiogenic Shock

Journal of Cardiac Surgery — Thu, 01 Sep 2011 04:00:00 +0100

Conclusion: In patients with PCS, timely placement of a CentriMag LVAD may increase the chance of eventual recovery. (J Card Surg 2011;26:548‐552) (Source: Journal of Cardiac Surgery)

Comparison of clinical outcomes of hydrophilic and lipophilic statins in patients with acute myocardial infarction.

The Korean Journal of Internal Medicine — Thu, 01 Sep 2011 04:00:00 +0100

CONCLUSIONS: Although short-term cardiovascular outcomes were better in the lipophilic-statin group, 1-year outcomes were similar in patients with AMI who were administered hydrophilic and lipophilic statins. In other words, the type of statin did not influence 1-year outcomes in patients with AMI. PMID: 22016590 [PubMed - in process] (Source: The Korean Journal of Internal Medicine)

Massive and Submassive Pulmonary Embolism: Experience With an Algorithm for Catheter-Directed Mechanical Thrombectomy

Annals of Vascular Surgery — Wed, 31 Aug 2011 04:00:00 +0100

Conclusion: CDMT as primary treatment of MPE and SMPE has a high rate of technical and clinical success in a high-risk patient population. Experience and strict patient selection criteria may improve therapeutic outcomes. (Source: Annals of Vascular Surgery)

Anemia Before Coronary Artery Bypass Surgery as Additional Risk Factor Increases the Perioperative Risk [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 30 Aug 2011 23:00:00 +0100

Conclusions In our patient group undergoing CABG surgery, preoperative anemia increased the mortality risk by 3.4, even when taking the higher perioperative risk of anemic patients into consideration. (Source: The Annals of Thoracic Surgery)

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Results of mechanical circulatory support in France [Original articles]

European Journal of Cardio-Thoracic Surgery — Sun, 28 Aug 2011 23:00:00 +0100

Conclusions: MCS is an essential therapeutic tool to save the life of young patients with cardiogenic shock or advanced cardiac failure. Early MCS implantation and the availability of a device that is adapted to the patient's clinical status are prerequisites for reducing overall mortality rates. (Source: European Journal of Cardio-Thoracic Surgery)

Hand-held minimised extracorporeal membrane oxygenation: a new bridge to recovery in patients with out-of-centre cardiogenic shock [Original articles]

European Journal of Cardio-Thoracic Surgery — Sun, 28 Aug 2011 23:00:00 +0100

Conclusions: The use of hand-held Mini-ECMO systems enables for the first time the rapid onset of extracorporeal life support independent from the patient's current location. However, success is extremely time- and team dependent. Highly skilled interdisciplinary patient management is essential to let minimised-ECMO become a new and highly effective bridge to recovery in out-of-centre cardiogenic shock patients. (Source: European Journal of Cardio-Thoracic Surgery)

Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock: The CRISP AMI Randomized Trial [Original Contribution]

JAMA — Sun, 28 Aug 2011 23:00:00 +0100

Conclusion Among patients with acute anterior STEMI without shock, IABC plus primary PCI compared with PCI alone did not result in reduced infarct size.Trial Registration clinicaltrials.gov Identifier: NCT00833612 (Source: JAMA)

Lipid Resuscitation Reverses Multidrug-Induced Cardiogenic Shock.

Journal of Medical Toxicology — Fri, 26 Aug 2011 23:00:00 +0100

Authors: Rubinstein I, Zider B, Weinberg G PMID: 21874380 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)

Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure

The Journal of Heart and Lung Transplantation — Thu, 25 Aug 2011 04:00:00 +0100

Conclusion: Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation. (Source: The Journal of Heart and Lung Transplantation)

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Med Sci Monit 2011; 17(9):CQ7-8 "A severe complication after ST-segment elevation myocardial infarction (Part 1)"

Medical Science Monitor — Mon, 22 Aug 2011 10:16:00 +0100

Successful use of a percutaneous miniaturized extracorporeal life support system as bridge and assistance to left ventricular assist device implantation in a patient with severe refractory cardiogenic shock.

Perfusion — Sun, 21 Aug 2011 23:00:00 +0100

We present a 51-year-old man with cardiogenic shock in whom a percutaneous extracorporeal life support system (ECLS) was inserted to restore cardiopulmonary stability. After successful stabilization, a left ventricular assist device was implanted, using the ECLS without switching to a conventional cardiopulmonary bypass system to reduce its side effects. PMID: 21859786 [PubMed - as supplied by publisher] (Source: Perfusion)

Delayed cardiac metastasis from phyllodes breast tumor presenting as cardiogenic shock.

Texas Heart Institute Journal — Sat, 20 Aug 2011 10:44:06 +0100

Authors: Garg N, Moorthy N, Agrawal SK, Pandey S, Kumari N Abstract Malignant metastases to the heart and pericardium, which occur far more often than do primary cardiac neoplasms, typically lead to fatal outcomes. The phyllodes tumor is a rare, predominantly benign fibroepithelial breast neoplasm with variable malignancy potential. Herein, we describe the case of a 35-year-old woman who, 3 years after undergoing a simple mastectomy for a rapidly enlarging breast neoplasm, presented with cardiogenic shock and was found to have a large right ventricular tumor that obstructed the right ventricular outflow tract. Despite successful resection of the ventricular mass and a right atrial mass of organized thrombus, the patient died 8 days postoperatively of multiorgan failure due to sever...

Successful use of the impella device in giant cell myocarditis as a bridge to permanent left ventricular mechanical support.

Texas Heart Institute Journal — Sat, 20 Aug 2011 10:44:06 +0100

Authors: Suradi H, Breall JA Abstract Idiopathic giant cell myocarditis is a rare condition with a poor prognosis. Patients with giant cell myocarditis typically die of refractory ventricular arrhythmias or progressive congestive heart failure in about 3 months. The benefit of immunosuppressive therapy varies among patients with giant cell myocarditis, and no factors that would predict which patients will respond to therapy have been identified. Mechanical circulatory support devices, from intra-aortic balloon pumps to more permanent systems, have been used for ventricular support in cases of acute heart failure.Herein, we describe a case of giant cell myocarditis in a previously healthy 44-year-old woman who presented with cardiogenic shock. She was supported hemodynamically with ...

Left Stellate Ganglion Block for Continuous Ventricular Arrhythmias during Percutaneous Left Ventricular Assist Device Support.

Texas Heart Institute Journal — Sat, 20 Aug 2011 10:44:06 +0100

Authors: Loyalka P, Hariharan R, Gholkar G, Gregoric ID, Tamerisa R, Nathan S, Kar B Abstract A 58-year-old man presented with chest pain and tightness and was diagnosed with a Q-wave anterior myocardial infarction. He then developed pulseless ventricular arrhythmias, which were treated with repeated direct-current shocks and intravenous amiodarone. He underwent emergency cardiac catheterization: stents were deployed in the left anterior descending coronary artery and right coronary artery, and an intra-aortic balloon pump was inserted. Severe refractory cardiogenic shock and incessant ventricular arrhythmias compelled us to place a TandemHeart percutaneous left ventricular assist device 4 hours later. The patient's hemodynamic status stabilized, but the arrhythmias persisted for 3...

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[Myocardial infarction without coronary arteries stenoses in a patient with Jervell and Lange-Nielsen syndrome - diagnostic dilemmas.]

Kardiologia Polska — Sat, 20 Aug 2011 07:16:02 +0100

Authors: Wójcik T, Kobusiak-Prokopowicz M, Sciborski K, Mysiak A Abstract According to the rules of differential diagnostics an acute coronary syndrome (ACS) often constitutes an initial diagnosis while a subsequent patient's follow-up with troponin determination results in further verification of the diagnosis. A 55 year-old female with congenital hearing loss, poorly controlled hypertension, type 2 diabetes treated with oral medications, and hypothyreosis was admitted to the Department of Cardiology with 6 h long severe chest pain radiating over her back with concomitant dyspnea. She underwent urgent coronary angiography which showed no epicardial coronary narrowing. Acute heart failure symptoms occurred immediately after coronary angiography in the form of cardiogenic shock. Ev...

Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock.

Medicina (Kaunas) — Mon, 15 Aug 2011 23:45:03 +0100

CONCLUSIONS. Aortic counterpulsation may be successfully employed providing significant hemodynamic support with rare major complications in a high-risk patient population. A unique finding of this study is a high rate of successful applications of aortic counterpulsation. PMID: 21829053 [PubMed - as supplied by publisher] (Source: Medicina (Kaunas))

Transposition of a pericardial-derived vascular adipose flap for myocardial salvage after infarct

Cardiovascular Research — Mon, 15 Aug 2011 23:00:00 +0100

Conclusions Our results indicate that a vascular fat flap exerts beneficial effects on LV function and limits myocardial remodelling. Future studies must confirm whether these findings provide an alternative therapeutic approach for myocardial salvage after infarction. (Source: Cardiovascular Research)

In Vitro Comparison of Support Capabilities of Intra‐Aortic Balloon Pump and Impella 2.5 Left Percutaneous

Artificial Organs — Sat, 06 Aug 2011 23:00:00 +0100

AbstractThe Impella 2.5 left percutaneous (LP), a relatively new transvalvular assist device, challenges the position of the intra‐aortic balloon pump (IABP), which has a long record in supporting patients after myocardial infarction and cardiac surgery. However, while more costly and more demanding in management, the advantages of the Impella 2.5 LP are yet to be established. The aim of this study was to evaluate the benefits of the 40 cc IABP and the Impella 2.5 LP operating at 47 000 rpm in vitro, and compare their circulatory support capabilities in terms of cardiac output, coronary flow, cardiac stroke work, and arterial blood pressure. Clinical scenarios of cardiogenic preshock and cardiogenic shock (CS), with blood pressure depression, lowered cardiac output, and constant he...

Incessant Ventricular Tachycardia and Cardiogenic Shock: A Common Presentation of an Uncommon Diagnosis.

The American Journal of the Medical Sciences — Tue, 02 Aug 2011 23:00:00 +0100

Authors: Drafts BC, Sutton BJ, Dubose TD, Thohan V Giant cell myocarditis is a rare and highly lethal disease that is characterized by a rapidly progressive course of biventricular dysfunction. The authors present a case of giant cell myocarditis that presented with incessant ventricular tachycardia and cardiogenic shock in which clinical improvement was achieved with immunosuppressive therapy. PMID: 21817876 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)

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Percutaneous Ventricular Assist Devices: New Deus Ex Machina?

Advances in Pharmacological Sciences — Mon, 01 Aug 2011 15:11:07 +0100

The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support. (Source: Advances in Pharmacological Sciences)

Morphine: Cardiogenic shock: case report

Reactions — Mon, 01 Aug 2011 15:09:42 +0100

(Source: Reactions)

Preliminary experience with Impella Recover(®) LP5.0 in nine patients with cardiogenic shock: A new circulatory support system in the intensive cardiac care unit.

Archives of Cardiovascular Diseases — Mon, 01 Aug 2011 04:00:00 +0100

CONCLUSION: Left ventricular assistance with the Impella LP5.0 appears to be well tolerated. It may be especially useful in patients with acute myocardial infarction complicated by cardiogenic shock who achieve INTERMACS Profile 3 with initial treatment. PMID: 21944148 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)

Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction

American Heart Journal — Sun, 31 Jul 2011 23:00:00 +0100

Conclusions: In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature. (Source: American Heart Journal)

Cardiogenic shock secondary to severe acute ischemic mitral regurgitation managed with an impella 2.5 percutaneous left ventricular assist device

Catheterization and Cardiovascular Interventions — Thu, 28 Jul 2011 23:00:00 +0100

We report a case of a patient successfully treated with an Impella Recover LP 2.5 (ABIOMED, Inc., Danvers, MA) left ventricular assist device, in the setting of cardiogenic shock secondary to severe acute mitral regurgitation associated with an acute myocardial infarction. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Long-term Extracorporeal Membrane Oxygenator Support in Resuscitation for Intractable Hibernating Myocardium after Coronary Artery Bypass Grafting.

Annals of Thoracic and Cardiovascular Surgery — Tue, 26 Jul 2011 23:00:00 +0100

We report our experience of long-term extracorporeal membrane oxygenator (ECMO) support to resuscitate a 62-year-old man who had critical three-vessel disease of coronary artery complicating intractable hibernating myocardium (HM) and sudden cardiogenic shock. Intra-aortic balloon pump and ECMO were deployed to restore the circulatory support while emergent revascularization surgery was performed.The patient was weaned from ECMO successfully after 15 days of support and discharged with recovered left ventricular function. ECMO is effective in resuscitation of patients with cardiogenic shock and HM. To our knowledge the present case necessitated the longest term of ECMO support to get rid of HM. PMID: 21881363 [PubMed - as supplied by publisher] (Source: Annals of Thoracic and Cardiovas...

Emergency Coronary Artery Bypass Grafting for Left Main Shock Syndrome.

Annals of Thoracic and Cardiovascular Surgery — Tue, 26 Jul 2011 23:00:00 +0100

Conclusions: AMI complicated by cardiogenic shock and left main coronary artery disease can be effectively treated with emergency CABG, with acceptable mortality and morbidity. Emergency CABG for MIs within 8 hours can improve survival in patients with left main shock syndrome. PMID: 21881355 [PubMed - as supplied by publisher] (Source: Annals of Thoracic and Cardiovascular Surgery)

Medication Use Pattern and Predictors of Optimal Therapy at Discharge in 8176 Patients With Acute Coronary Syndrome From 6 Middle Eastern Countries: Data From the Gulf Registry of Acute Coronary Events

Angiology — Sat, 23 Jul 2011 23:00:00 +0100

We evaluated the use of quadruple evidence-based medication (EBM) combination consisting of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, β-blocker, and lipid-lowering agent concurrently at discharge among patients (n = 8154) with acute coronary syndrome (ACS) in 6 Middle Eastern countries. In all, 49% of the patients received the quadruple EBM combination concurrently at discharge. An adjusted model demonstrated that old age, diabetes mellitus, hyperlipidemia, hypertension, ST-segment elevation myocardial infarction, cardiac catheterization, as well as cardiologists as care providers and hospitals with cardiac catheterization facilities were all positively correlated with the use of the quadruple EBM combination. However, patients w...

C-Reactive Protein and the Risk of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention.

American Journal of Nephrology — Fri, 22 Jul 2011 23:00:00 +0100

Conclusion: Elevated preprocedural CRP is associated with an increased risk for CI-AKI in patients undergoing PCI. Preprocedural risk stratification with CRP as an adjunct to established clinical risk factors might be useful. PMID: 21791916 [PubMed - as supplied by publisher] (Source: American Journal of Nephrology)

Seizure‐associated takotsubo cardiomyopathy

Epilepsia — Wed, 20 Jul 2011 23:00:00 +0100

SummaryTakotsubo cardiomyopathy is characterized by chest pain, dyspnea, electrocardiographic changes resembling an acute coronary syndrome, and transient wall‐motion abnormalities without identifiable coronary culprit lesion explaining the wall‐motion abnormality. Takotsubo cardiomyopathy occurs frequently after emotional or physical stress. Seizures have been reported as triggers of takotsubo cardiomyopathy. It is unknown if seizure‐associated takotsubo cardiomyopathy differs from takotsubo cardiomyopathy associated with other triggers. Seizure‐associated takotsubo cardiomyopathy cases from the literature were compared with takotsubo cardiomyopathy series comprising 30 or more patients. Thirty‐six seizure‐associated takotsubo cardiomyopathy cases (6 male, mean‐age 61.5 year...

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Is it safe to perform coronary angiography during acute endocarditis? [Best evidence topic - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 19 Jul 2011 23:00:00 +0100

A best evidence topic was written according to a structured protocol. The question addressed was ‘Is it safe to perform coronary angiography (CA) in acute endocarditis?’ Three hundred and ninety-seven papers were found using the reported search, of which six represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, key results and limitations of these papers are tabulated. One of the papers is a case report, which reported a fatal vegetation embolism from an infected aortic valve into the left main coronary artery 14 h after angiography. The remaining five papers are cohort studies. Four of these studies were performed between 1970 and 1980 before the era of ec...

Clinical use of temporary percutaneous left ventricular assist devices

Catheterization and Cardiovascular Interventions — Thu, 14 Jul 2011 23:00:00 +0100

Conclusion:TPLVADs can support the failing heart with acceptable risk. Outcome is better in prophylactic use than in patients with cardiogenic shock. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock.

Cochrane Database of Systematic Reviews — Thu, 14 Jul 2011 13:00:03 +0100

Authors: Unverzagt S, Machemer MT, Solms A, Thiele H, Burkhoff D, Seyfarth M, de Waha A, Ohman EM, Buerke M, Haerting J, Werdan K, Prondzinsky R Intra-aortic balloon pump counterpulsation (IABP) is currently the most commonly used mechanical assist device for patients with cardiogenic shock due to acute myocardial infarction.Although there is only limited evidence by randomised controlled trials, the current guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology strongly recommend the use of the intra-aortic balloon counterpulsation in patients with infarction-related cardiogenic shock on the basis of pathophysiological considerations as also non-randomised trials and registry data. PMID: 21735410 [PubMed - in process...

Aortic regurgitation causd by the proximal dissecting flap invagintion to the left ventricle

General Thoracic and Cardiovascular Surgery — Wed, 13 Jul 2011 06:11:34 +0100

Abstract A 68-year-old male with sudden back pain and cardiogenic shock status transferred to our ward. Transthoracic echocardiography revealed that the abnormal rond shape string was in the left ventricular outflow tract. The continuity from the string to the aortic valve was unclear. Intimal flap could not be detected at the level of the ascending aorta. Color Doppler flow imaging showed that the severe AR jet extended into the round string. TEE showed that the intimal tear and flap was seen just above the left subclavian artery. Preoperative diagnosis was acute Stanford type A dissection and acute severe AR due to the inversion of the proximal intimal flap to the left ventricular outflow tract through the aortic valve. At operation, the proximal intimal flap was dissect...

Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: Evaluation of a Regional System to Increase Access to Cooling.

Circulation — Mon, 11 Jul 2011 23:00:00 +0100

Conclusions- A comprehensive TH protocol can be integrated into a regional ST-segment elevation myocardial infarction network and achieves broad dispersion of this essential therapy for OHCA. PMID: 21747066 [PubMed - in process] (Source: Circulation)

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Percutaneous blade and balloon atrioseptostomy as a supplement to extracorporeal membrane oxygenation as a bridge to heart transplantation

Cardiovascular Revascularization Medicine — Fri, 08 Jul 2011 04:00:00 +0100

We present a case of a young male who presented for cardiogenic shock with a huge thrombus in the left main coronary artery in whom blade and balloon atrioseptostomy in addition to the ECMO was helpful to bail out and to perform heart transplantation. (Source: Cardiovascular Revascularization Medicine)

Association of Prenatal and Postnatal Exposure to Lopinavir-Ritonavir and Adrenal Dysfunction Among Uninfected Infants of HIV-Infected Mothers [Preliminary Communication]

JAMA — Mon, 04 Jul 2011 23:00:00 +0100

Conclusion Among newborn children of HIV-1–infected mothers exposed in utero to lopinavir-ritonavir, postnatal treatment with a lopinavir-ritonavir–based regimen, compared with a zidovudine-based regimen, was associated with transient adrenal dysfunction. (Source: JAMA)

Intermittent cardiogenic shock in a man with mechanical prosthesis of the aortic valve.

Circulation — Mon, 04 Jul 2011 23:00:00 +0100

Authors: Melenovsky V, Al Hiti H, Lupinek P, Marek T, Veiser T, Skalsky I, Kettner J PMID: 21730310 [PubMed - in process] (Source: Circulation)

Cardiogenic shock and heart failure post–percutaneous coronary intervention in ST-elevation myocardial infarction: Observations from “Assessment of Pexelizumab in Acute Myocardial Infarction”

American Heart Journal — Thu, 30 Jun 2011 23:00:00 +0100

Background: Mortality after ST-elevation myocardial infarction (STEMI) has reduced with reperfusion by primary percutaneous coronary intervention (PCI), which may have impacted on the adverse outcomes of cardiogenic shock (CS) and congestive heart failure (CHF).Methods and Results: In the APEX-AMI trial, 5,745 patients with STEMI and planned primary PCI were randomly assigned pexelizumab or matching placebo. Post-randomization CS or CHF was adjudicated by a clinical endpoints committee. Treatment assignment to pexelizumab did not influence either endpoint or mortality rates. Cardiogenic shock developed in 196 patients (3.4%) at a median of 6.0 hours (interquartile range 3.9-28.3) post-randomization, and mortality at 90 days was 54.6%. Congestive heart failure occurred in 254 of patients (4...

Intra‐Aortic Balloon Counterpulsation 50 Years Later: Initial Conception and Consequent Ideas

Artificial Organs — Thu, 30 Jun 2011 23:00:00 +0100

AbstractFor nearly 50 years, intra‐aortic balloon counterpulsation (IABC) has been the most widely applied temporary assistance method, operating in series with the heart. It helps wean patients from the heart–lung machine after cardiac operations. It is also used in patients with advanced coronary heart disease before and during cardiac and noncardiac operations as well as during percutaneous interventions. Cases of post‐acute myocardial infarction severe cardiogenic shock can also benefit from IABC until or during revascularization or if the latter is impractical. A brief review of mostly experimental attempts is reported as “derivatives” of IABC, as they yielded interesting and sometimes intriguing results that need further investigation. (Source: Artificial Organs)

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A 2-h Diagnostic Protocol to Assess Patients with Chest Pain Symptoms in the Asia-Pacific region (ASPECT): A Prospective Observational Validation Study: Than M, Cullen L, Reid C, et al. Lancet 2011;377:1077–84.

The Journal of Emergency Medicine — Thu, 30 Jun 2011 23:00:00 +0100

This multi-national, prospective observational study was designed to validate a new diagnostic protocol that used a combination of the Thrombolysis in Myocardial Infarction (TIMI) score, electrocardiogram (ECG), and biomarkers to identify low-risk patients that do not require traditional work-up to evaluate for acute coronary syndrome. The study aimed to validate the safety of a 2-h chest pain protocol for low-risk patients, which the authors termed the accelerated diagnostic protocol (ADP) and was conducted in 14 urban emergency departments in nine countries (Australia, China, India, Indonesia, New Zealand, Singapore, South Korea, Taiwan, and Thailand). All patients aged 18 years or older with chest pain who were deemed to need evaluation with serial biomarkers were included. The protocol...

Reversal of Acute Systolic Dysfunction and Cardiogenic Shock in Hypertrophic Cardiomyopathy by Surgical Relief of Obstruction

Echocardiography — Thu, 30 Jun 2011 23:00:00 +0100

A 70‐year‐old male with known hypertrophic cardiomyopathy (HCM) and latent obstruction presented with new onset of cardiogenic shock. He had a new resting left ventricular (LV) outflow gradient of 90 mmHg, and new severe LV systolic dysfunction. Because of rapid deterioration despite medical management he was urgently sent for surgical relief of obstruction, which immediately reversed both the LV dysfunction and shock. A second patient, a 58‐year‐old male also with hypertrophic cardiomyopathy and latent obstruction presented with collapse, cardiogenic shock, 135 mmHg resting LV outflow gradient and new severe LV systolic dysfunction. His profound shock was irreversible with pharmacologic management, but surgical relief of obstruction reversed both his LV dysfunction and shock. Echo...

Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Clinical Cardiology — Tue, 28 Jun 2011 23:00:00 +0100

Conclusions:The proportion of elderly patients referred for PCI is increasing. Procedural complications increase with age, and patients presenting with unstable symptoms are at the highest risk. © 2011 Wiley Periodicals, Inc.This work was supported by Blue Cross Blue Shield of Michigan. The authors have no other funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

Rescue extracorporeal life support as a bridge to reflection in fulminant stress-induced cardiomyopathy

International Journal of Cardiology — Mon, 27 Jun 2011 04:00:00 +0100

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as rescue therapy in severe cardiogenic shock refractory to medical treatment and intra-aortic balloon pump (IABP). Yet, indications and benefits of VA-ECMO in acute heart failure remain to be fully established. Importantly, it is unclear whether major clinical uncertainties related to potential reversibility of cardiac dysfunction and contraindications for bridging to transplantation justify refusal of VA-ECMO support in an emergency setting. (Source: International Journal of Cardiology)

Cardiogenic shock due to pheochromocytoma rescued by extracorporeal membrane oxygenation [Case report - Assisted circulation]

Interactive CardioVascular and Thoracic Surgery — Tue, 21 Jun 2011 23:00:00 +0100

This is the case of a 49-year-old female presenting in sustained cardiogenic shock due to an adrenal pheochromocytoma. She was rescued by venoarterial extracorporeal membrane oxygenation. The presence of a catecholamine-secreting tumor was confirmed by highly elevated plasma metanephrines and catecholamines. Successful open adrenalectomy was performed under protective extracorporeal life support and full anticoagulation early after cardiogenic shock. The patient could be weaned off mechanical support rapidly and made a full cardiopulmonary recovery. (Source: Interactive CardioVascular and Thoracic Surgery)

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A simple clinical model for planning transfusion quantities in heart surgery

BMC Medical Informatics and Decision Making - Latest articles — Mon, 20 Jun 2011 23:00:00 +0100

Conclusions: The regression model proved reliable for quantitative planning of number of PRBC in patients undergoing heart surgery. Besides enabling more rational resource allocation of costly blood-conservation strategies and blood bank resources, the results indicated a strong association between some essential postoperative variables and differences between the model estimate and the actual number of packs transfused. (Source: BMC Medical Informatics and Decision Making - Latest articles)

Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease as Culprit Lesion in Patients With Acute Myocardial Infarction

Journal of the American College of Cardiology: Cardiovascular Interventions — Sun, 19 Jun 2011 23:00:00 +0100

Conclusions Patients with acute myocardial infarction and thrombosis of the unprotected left main coronary artery are a high-risk subgroup with a substantial mortality, particularly if they present in cardiogenic shock. We demonstrate that in these patients, PCI is a feasible treatment option associated with reasonably good outcomes. Long-term prognosis is excellent in hospital survivors with an 89.5% survival rate at 1 year. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Primary Percutaneous Coronary Intervention for Unprotected Left Main Disease in Patients With Acute ST-Segment Elevation Myocardial Infarction: The AMIS (Acute Myocardial Infarction in Switzerland) Plus Registry Experience

Journal of the American College of Cardiology: Cardiovascular Interventions — Sun, 19 Jun 2011 23:00:00 +0100

Conclusions Emergent LM PCI in the context of acute myocardial infarction, even including 12% cardiogenic shock, appears to have a remarkably high (89%) in-hospital survival. Concurrent LM and non-LM PCI has worse outcomes than isolated LM PCI. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Heart transplant recipients supported with extracorporeal membrane oxygenation: Outcomes from a single-center experience

The Journal of Heart and Lung Transplantation — Thu, 16 Jun 2011 04:00:00 +0100

Conclusions: ECMO support is a viable option for adult heart transplant recipients with severe rejection and refractory cardiogenic shock. To maximize the benefit of this aggressive approach in heart transplant recipients requires early intervention, with a heightened awareness of this option to facilitate expedited use. (Source: The Journal of Heart and Lung Transplantation)

The Romanian Acute Heart Failure Syndromes (RO-AHFS) Registry

American Heart Journal — Wed, 15 Jun 2011 23:00:00 +0100

Conclusions: The RO-AHFS study found substantial variation both among sites and between Romania and other European countries. National and regional registries have important clinical implications for patient care and the design and conduct of global clinical trials. (Source: American Heart Journal)

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Short-Term Mechanical Management of Cardiogenic Shock

Current Treatment Options in Cardiovascular Medicine — Wed, 15 Jun 2011 05:47:39 +0100

Opinion statement Cardiogenic shock (CS), a state of cardiac dysfunction that results in systemic hypoperfusion and end-organ dysfunction, is associated with high in-hospital mortality. Various forms of mechanical circulatory support have been used to treat CS. First employed in the 1960s, the intra-aortic balloon pump (IABP) has been a mainstay in the treatment of acute CS. However, the IABP is unable to provide adequate support in many patients, and newer technologies, including extracorporeal membrane oxygenation and percutaneous ventricular assist devices, appear to be more effective in reversing CS. These devices are also useful for supporting patients during complex percutaneous coronary intervention. Perhaps most importantly, they can be used as a bridge to decision...

Dipyridamole-Associated Shock and Pulmonary Edema (July/August).

The Annals of Pharmacotherapy — Mon, 13 Jun 2011 23:00:00 +0100

CONCLUSIONS While hypotension has been previously associated with intravenous use of dipyridamole, ours is the first report to suggest a noncardiogenic mechanism for shock. To our knowledge, this is the first reported case of noncardiogenic pulmonary edema following dipyridamole infusion. PMID: 21672887 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

[The impact of chronic kidney disease on in-hospital clinical outcomes in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction.]

Turk Kardiyoloji Dernegi arsivi — Sat, 11 Jun 2011 20:00:03 +0100

CONCLUSION: Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality. PMID: 21646828 [PubMed - as supplied by publisher] (Source: Turk Kardiyoloji Dernegi arsivi)

First experience with the ultra compact mobile extracorporeal membrane oxygenation system Cardiohelp in interhospital transport [Institutional report - Cardiopulmonary bypass]

Interactive CardioVascular and Thoracic Surgery — Tue, 07 Jun 2011 23:00:00 +0100

We report on our first experience with the new Cardiohelp system for interhospital transfer of cardiopulmonarily compromised patients. The Cardiohelp system was used for transportation and in-house treatment in six male patients with a mean age of 41±17 years. Five patients suffered respiratory failure; one patient with acute myocardial infarction was in profound cardiogenic shock. Accordingly, the Cardiohelp system was implanted as a venovenous extracorporeal membrane oxygenation (ECMO) in five patients and as a venoarterial system in one patient. The preECMO ventilation time was 0.5–4 days. The patients were transported to our institution by car (n=1) or helicopter (n=5) over a distance of 80–5850 km. The subsequent in-house ECMO support was continued wi...

Successful use of a pneumatic biventricular assist device as a bridge to transplantation in cardiogenic shock

The Journal of Heart and Lung Transplantation — Mon, 06 Jun 2011 04:00:00 +0100

Conclusion: Biventricular assist device therapy represents an effective and reliable means of supporting selected Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients as a bridge to transplantation, with excellent success to transplant rates and post-transplant survival. (Source: The Journal of Heart and Lung Transplantation)

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Safety and Efficacy of Clopidogrel Reloading in Patients on Chronic Clopidogrel Therapy Who Present With an Acute Coronary Syndrome and Undergo Percutaneous Coronary Intervention

The American Journal of Cardiology — Sun, 05 Jun 2011 16:32:46 +0100

In conclusion, patients receiving long-term clopidogrel therapy who present with acute coronary syndromes do not gain any clinical benefit from additional reloading with clopidogrel. (Source: The American Journal of Cardiology)

Fatal adenoviral necrotizing bronchiolitis case in a post-cardiac surgery intensive care unit.

Braz J Infect Dis — Tue, 31 May 2011 23:00:00 +0100

We report a case of a 67 year-old-male patient admitted to the intensive care unit in the post-coronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach. PMID: 21670932 [PubMed - in process] (Source: Braz J Infect Dis)

A Fainting Teenager

Clinical Pediatric Emergency Medicine — Tue, 31 May 2011 23:00:00 +0100

A 13-year-old female presented to the emergency department after a syncopal episode. This episode was preceded by a 3-day viral prodrome consisting of a subjective fever, upper respiratory symptoms, and fatigue. She was found to have severe bradycardia secondary to complete heart block and cardiogenic shock resulting in multisystem organ failure. The patient required transthoracic pacing in the emergency department with emergent transvenous pacing in the pediatric intensive care unit. A comprehensive evaluation for the underlying etiology of her heart block, cardiogenic shock, and multisystem organ failure revealed viral myocarditis. (Source: Clinical Pediatric Emergency Medicine)

Low‐Dose versus High‐Dose Aspirin after Percutaneous Coronary Intervention: Analysis from the Guthrie Health Off‐Label StenT (GHOST) Registry

Journal of Interventional Cardiology — Tue, 31 May 2011 23:00:00 +0100

Conclusion:Low‐dose aspirin, as prescribed in this study of routine practice, was not associated with worse outcomes compared to high‐dose aspirin.(J Interven Cardiol 2011;**:1–8) (Source: Journal of Interventional Cardiology)