Management of Acute Hypertensive Heart Failure.

Heart failure presents a particularly difficult public health challenge. Of the heart failure presentations, acute hypertensive heart failure represents a distinct clinical phenotype and is characterized by sudden-onset systemic hypertension and pulmonary edema. The pathophysiology of acute hypertensive heart failure is primarily driven by an abnormal ventricular-vascular relationship, and the medical management is aimed at improving this relationship.

Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography.

Allergic reactions to contrast media are a frequently reported complication of coronary angiography. The majority of patients experience mild, self-limited episodes, but in rare cases patients may experience severe, persistent symptoms. A strategy of premedication with corticosteroids and anti-histamines and an optimal selection of contrast agent is almost always successful in averting contrast reactions, yet a select few patients will continue to have breakthrough events. This is a case of recurrent, severe allergy to contrast media despite standard precautions complicating the treatment of non-ST elevation myocardial infarction (NSTEMI). Our patient was successfully managed with a strategy of rapid desensitization to iodinated contrast media achieved by administering progressively incremental doses of the media.

Right Ventricular Myocardial Infarction Complicated by Cardiac Arrest: Utilization of Extracorporeal Membrane Oxygenation.

A 44-year-old male with an out-of-hospital cardiac arrest due to an acute left ventricular (LV) inferoposterior wall myocardial infarction (MI) involving the right ventricle (RV) is presented. This case highlights the challenges in the management of patients with cardiac arrest, indications for use of ventricular assist devices, potential effects of LV assist devices on the RV in the setting of RV MI, and culprit versus complete coronary artery revascularization in these patients.