ABSTRACT
BACKGROUND: The stress-related cardiomyopathy (SRC) is a relatively novel cardiac syndrome characterized by peculiar transient left ventricular dysfunction, which accounts for approximately 1-3% of patients with symptoms that initially appear to be an acute coronary syndrome. To date, the true incidence and clinical significance of left ventricular thrombus and related embolic outcomes in these patients have not been fully established. METHODS: The present systematic review aimed to report updated case series of SRC patients with left ventricular thrombus and/or cardioembolic events complicating the course of syndrome, in an attempt to summarize their demographic and clinical characteristics. RESULTS: Overall, 33 eligible studies (44 patients) were selected through the PubMed-Medline archives (December 2002-April 2009), but only 26 (36 patients) matched our inclusion criteria. Left ventricular thrombus was detected in 32 patients (89%), whereas thromboembolic events occurred in 12 (33%). Morphological characteristics of thrombi are described through the article. Women >65 years of age presenting with deep/giant negative T-waves on admission ECG seem more likely to have thrombus-related embolic complications. CONCLUSIONS: Important findings from this updated review indicate that LVT approximately occurs in 5% of the estimated worldwide SRC population, similar to historical incidence in patients with myocardial infarction. In a third of cases (approximately 1.6% of above guesstimate) nonfatal cardioembolic outcomes (brain ischemia in 75% of cases) have been documented. It is worthy considering early anticoagulant therapy, especially in patients at a higher risk of thromboembolic disease, irrespective of the presence of LVT at admission.
Subject(s)
Cardiomyopathies/therapy , Embolism/therapy , Stress, Psychological/therapy , Thrombosis/therapy , Ventricular Dysfunction, Left/therapy , Age Factors , Cardiomyopathies/complications , Cardiomyopathies/psychology , Clinical Trials as Topic/methods , Clinical Trials as Topic/psychology , Embolism/complications , Embolism/psychology , Humans , Stress, Psychological/complications , Thrombosis/complications , Thrombosis/psychology , Treatment Outcome , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/psychologySubject(s)
Embolism/complications , Embolism/therapy , Femoral Artery , Gangrene/etiology , Leg/blood supply , Leg/pathology , Aged , Aged, 80 and over , Amputation, Surgical , Embolism/psychology , Female , Humans , Informed Consent , Mental Competency , Pain/etiology , Palliative Care , Schizophrenia/complications , Treatment RefusalABSTRACT
The high estrogen doses in the original oral contraceptive (OC) formulations were associated with an increased risk of cardiovascular events. Since then the steroid doses in OC have been reduced steadily, so that current low-estrogen-dose (< or = 35 micrograms) combination OC are associated with a lower risk of arterial and venous events than occurs with higher-estrogen-dose formulations. Based on the currently available epidemiologic evidence, the following conclusions can be made regarding the cardiovascular disease risks associated with use of low-dose OC by healthy, nonsmoking women: there is no increased risk of myocardial infarction (MI) or hemorrhagic or ischemic stroke; and there is a three- to fourfold increased risk of venous thrombosis and embolism (VTE). This risk is about half that associated with pregnancy. Smoking is the most important independent risk factor for MI, and is synergistic with OC use. Women smokers should be advised strongly to stop smoking, but those aged < 35 years may use any OC containing < or = 35 micrograms of estrogen. Women smokers aged > or = 35 years should be advised to use a nonestrogen or nonhormonal contraceptive method.
Subject(s)
Cardiovascular Diseases/etiology , Contraceptives, Oral, Hormonal/adverse effects , Contraceptives, Oral, Synthetic/adverse effects , Estradiol Congeners/adverse effects , Ethinyl Estradiol/adverse effects , Adolescent , Adult , Age Factors , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/psychology , Cerebrovascular Disorders/epidemiology , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/psychology , Contraceptives, Oral, Hormonal/administration & dosage , Contraceptives, Oral, Synthetic/administration & dosage , Embolism/epidemiology , Embolism/etiology , Embolism/psychology , Estradiol Congeners/administration & dosage , Ethinyl Estradiol/administration & dosage , Female , Humans , Myocardial Infarction/epidemiology , Myocardial Infarction/etiology , Myocardial Infarction/psychology , Risk Factors , Smoking , Thrombosis/epidemiology , Thrombosis/etiology , Thrombosis/psychologyABSTRACT
Central venous catheters are sometimes the cause of life-threatening complications. In two patients with underlying psychiatric disorders we observed an embolism as a result of catheter fragments. The first patient was a 30-year-old woman with a borderline personality disorder and several previous episodes of self-mutilation, psychogenic seizures and disturbances of consciousness. She cut her central venous line positioned in the external jugular vein when she was unattended. The intravasal fragment dislocated into the right ventricle and had to be removed by a forceps used for myocardial biopsies. The second patients was a 34-year-old mentally retarded male with a history of psychomotoric and grand mal seizures who suffered from a prolonged disturbance of consciousness with uncontrolled motor activity after four grand mal seizures. Despite physical restraint, the tip of his central venous catheter inserted through the subclavian vein broke and embolized in the right atrium. The embolus was removed by thoracotomy. To avoid these complications central venous lines should be used only when critically needed in uncooperative patients or those who display disturbance of consciousness and uncontrolled motor activity.