Cardiogenic Shock and Temporary Mechanical Circulatory Support.

Cardiogenic shock is a state of circulatory collapse due to low cardiac output resulting from heart failure. Heart failure in this setting may be due to left, right, or biventricular dysfunction. Acute myocardial infarctions remain the most common cause of cardiogenic shock, although in contemporary patient populations, the increasing prevalence of end-stage heart failure has resulted in a growing population of heart failure cardiogenic shock presentations. Clinicians practicing in the cardiac intensive care unit are challenged with these increasingly complex patients. Such patients often require hemodynamic support to improve end-organ perfusion and reduce mortality. Mechanical devices, collectively known as temporary mechanical circulatory support, provide clinicians with additional tools in our armamentarium to combat the increased mortality associated with cardiogenic shock. In this article, we provide an overview of cardiogenic shock and its phenotypic clinical presentations, in addition to providing a description of temporary mechanical circulatory support devices that are currently utilized in the management of cardiogenic shock.

Vitamin D deficiency and degree of coronary artery luminal stenosis in women undergoing coronary angiography: a prospective observational study.

BACKGROUND AND AIMS: Low serum 25-OH D levels are associated with increased cardiovascular morbidity and mortality. Recent studies have linked 25-OH D deficiency with the presence of CAD. Women, especially post-menopausal, tend to suffer from accelerated atherosclerosis, along with vitamin D deficiency. In the present study we sought to investigate whether there is a direct association of coronary artery luminal stenosis with 25-OH D deficiency in women. PATIENTS AND METHODS: We enrolled women aged >40 who were scheduled to undergo elective coronary angiography between 3/2011 and 10/2016 in a prospective observational study. RESULTS: We included a total of 105 women. Patients had hypertension (73%), hyperlipidemia (54%), diabetes (29%), smoking (31%), family history of CAD (62%), and known CAD (21%). Median 25-OH D levels were 15.8 ng/mL (range, 3.9-79). Patients had left-anterior descending (31%), left circumflex (22%), and right coronary artery disease (26%); 27% had 2-vessel and 11% had 3-vessel disease. There was a significant inverse correlation between 25-OH D levels and the degree of maximum luminal stenosis. The burden of CAD increased across categories of worsening 25-OH D deficiency. CONCLUSIONS: Vitamin D deficiency is associated with the degree of luminal stenosis and burden of CAD in women undergoing coronary angiography. Future studies should investigate if the repletion of 25-OH D impacts the progression of CAD and cardiovascular mortality.