RESUMO
Severe acute respiratory syndrome coronavirus-2 causes the clinical syndrome of coronavirus disease of 2019 (COVID-19) which has become a global pandemic resulting in significant morbidity and mortality. While the virus primarily affects the respiratory system, it also causes a wide variety of complex cardiac manifestations such as acute myopericarditis, acute coronary syndrome, congested heart failure, cardiogenic shock and cardiac arrhythmias. There are numerous proposed mechanisms of cardiac injury, including direct cellular injury, pro-inflammatory cytokine storm, myocardial oxygen-demand mismatch, and systemic inflammation causing multi-organ failure. Additionally, medications commonly used to treat COVID-19 patients have various cardiovascular side effects. We aim to provide a succinct review about the pathophysiology and cardiac manifestations of COVID-19, as well as treatment considerations and the various adaptations made to the current healthcare structure as a result of the pandemic.
Assuntos
Síndrome Coronariana Aguda/terapia , Arritmias Cardíacas/terapia , COVID-19/terapia , Insuficiência Cardíaca/terapia , Pandemias , Pericardite/terapia , Choque Cardiogênico/terapia , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/patologia , Síndrome Coronariana Aguda/virologia , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/patologia , Arritmias Cardíacas/virologia , Biomarcadores/análise , COVID-19/epidemiologia , COVID-19/patologia , COVID-19/virologia , Cateterismo Cardíaco/métodos , Comorbidade , Gerenciamento Clínico , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/virologia , Hospitalização , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Pericardite/epidemiologia , Pericardite/patologia , Pericardite/virologia , Fatores de Risco , SARS-CoV-2/patogenicidade , Índice de Gravidade de Doença , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/patologia , Choque Cardiogênico/virologia , Texas/epidemiologiaRESUMO
TRIAL REGISTRATION: NCT04420468. OBJECTIVES: Severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children is frequently associated with shock; endothelial involvement may be one of the underlying mechanisms. We sought to describe endothelial dysfunction during multisystem inflammatory syndrome in children with shock and then assess the relationship between the degree of endothelial involvement and the severity of shock. DESIGN: Observational study. SETTING: A PICU in a tertiary hospital. PATIENTS: Patients aged under 18 (n = 28) with severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children and shock, according to the Centers for Disease Control and Prevention criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Correlations between endothelial marker levels and shock severity were assessed using Spearman coefficient. The median (interquartile range) age was 9 years (7.5-11.2 yr). Sixteen children presented with cardiogenic and distributive shock, 10 presented with cardiogenic shock only, and two presented with distributive shock only. The median left ventricular ejection fraction, troponin level, and lactate level were, respectively, 40% (35-45%), 261 ng/mL (131-390 ng/mL), and 3.2 mmol/L (2-4.2 mmol/L). Twenty-five children received inotropes and/or vasopressors; the median Vasoactive and Inotropic Score was 8 (5-28). Plasma levels of angiopoietin-2 (6,426 pg/mL [2,814-11,836 pg/mL]), sE-selectin (130,405 pg/mL [92,987-192,499 pg/mL]), von Willebrand factor antigen (344% [288-378%]), and the angiopoietin-2/angiopoietin-1 ratio (1.111 [0.472-1.524]) were elevated and significantly correlated with the Vasoactive and Inotropic Score (r = 0.45, p = 0.016; r = 0.53, p = 0.04; r = 0.46, p = 0.013; and r = 0.46, p = 0.012, respectively). CONCLUSIONS: Endothelial dysfunction is associated with severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children with shock and may constitute one of the underlying mechanisms.
Assuntos
COVID-19/complicações , Choque/patologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Corticosteroides/uso terapêutico , Angiopoietina-2/sangue , Biomarcadores , Proteína C-Reativa/análise , COVID-19/patologia , Cardiotônicos/uso terapêutico , Criança , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Unidades de Terapia Intensiva Pediátrica , Interleucina-6/sangue , Ácido Láctico/sangue , Masculino , Respiração Artificial , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Choque Cardiogênico/patologia , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Troponina/sangue , Vasoconstritores/uso terapêutico , Função Ventricular Esquerda , Tratamento Farmacológico da COVID-19RESUMO
We describe the clinical course and treatment of a 53-year-old female, with small chest dimensions, referred to our institution for a primary cardiogenic shock. The patient underwent an on-pump left ventricular assist-device (VAD) implantation with the aid of immediate post-operative paracorporeal right-VAD assistance for an acute right ventricular failure. After two unsuccessful weaning attempts, she underwent extrapericardial HM 3 RVAD implantation.
Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Choque Cardiogênico/cirurgia , Tórax/patologia , Tamanho Corporal/fisiologia , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Procedimentos Cirúrgicos Cardiovasculares/métodos , Circulação Extracorpórea/instrumentação , Circulação Extracorpórea/métodos , Feminino , Insuficiência Cardíaca/patologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Coração Auxiliar/efeitos adversos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Choque Cardiogênico/patologia , Resultado do TratamentoRESUMO
We report an effective therapeutic approach of mechanical circulatory support for a patient with cardiogenic shock and respiratory insufficiency due to fulminant myocarditis. An Impella® 5.0 was utilized as a left ventricular assist device (VAD) and percutaneous veno-pulmonary extracorporeal membrane oxygenation (ECMO) as a right VAD. These devices were implanted without sternotomy or thoracotomy. Although a combination of Impella and veno-arterial ECMO has been reported as percutaneous biventricular support, there are concerns that this combination is not beneficial for myocardial recovery in patients with respiratory insufficiency, because Impella expels insufficiently oxygenated blood from the left ventricle to the coronary arteries. Our approach took advantage of percutaneous implantation of ECMO and temporary VAD, eliminating the drawbacks of both devices, thus providing a more effective and less invasive form of temporary biventricular support.
Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Implante de Prótese de Valva Cardíaca , Coração Auxiliar , Miocardite/terapia , Choque Cardiogênico/terapia , Terapia Combinada , Desenho de Equipamento , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Coração Auxiliar/efeitos adversos , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Miocardite/complicações , Miocardite/patologia , Miocardite/fisiopatologia , Choque Cardiogênico/etiologia , Choque Cardiogênico/patologia , Choque Cardiogênico/fisiopatologia , Esternotomia , Resultado do TratamentoRESUMO
A 52-year-old man with consciousness disorder following a 2-day history of general fatigue, diarrhea, vomiting and excessive thirst was admitted to our hospital. Severe hyperglycemia (1,739 mg/dL) with a slightly elevated HbA1c level (6.9%), ketonuria and low C-peptide level (0.07 ng/mL) confirmed the diagnosis of fulminant type 1 diabetes mellitus (FT1DM). Following sudden unexplained cardiogenic shock shortly after the initiation of insulin therapy with no evidence of myocardial ischemia assessed by coronary angiography, the patient was supported with percutaneous venoarterial extracorporeal membrane oxygenation. Electron microscopic analysis of the myocardium revealed massive lipid droplets without the infiltration of inflammatory cells. His left ventricular function began to recover during the following days and returned to a normal level on day 14. Currently, the impact of FT1DM on intramyocardial lipid deposition is poorly understood. However, this case suggests that even short-term exposure to high concentrations of glucose can be responsible for lipotoxicity followed by severe cardiac dysfunction.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Gotículas Lipídicas , Miócitos Cardíacos/ultraestrutura , Choque Cardiogênico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/etiologiaRESUMO
PURPOSE: To validate the IABP-SHOCK II risk score in a Danish cohort and assess the association between the IABP-SHOCK II risk score and admission concentration of biomarkers reflecting neurohormonal - (Copeptin, Pro-atrial natriuretic peptide (proANP), Mid-regional pro-adrenomedullin (MRproADM)) and inflammatory (ST2) activation in patients with CS complicating ST segment elevation myocardial infarction (STEMI). METHODS: A total of 137 consecutive patients admitted with STEMI and CS at two tertiary heart centres were stratified according to the IABP-SHOCK II risk score (0-2; 3/4; 5-9), and had blood sampled upon admission. RESULTS: Plasma concentrations of Copeptin (median (pmol/L) score 0-2: 313; score 3/4: 682; score 5-9: 632 p < 0.0001), proANP (pmol/L) (1459; 2225; 2876 p = 0.0009) and MRproADM (nmol/L) (0.86; 1.2; 1.4 p = 0.04) were significantly associated with the risk score, whereas ST2 (ng/mL) was not (44; 60; 45 p = 0.23). The IABP-SHOCK II risk score predicted 30-day mortality (score 0-2: 22%; score 4/3: 51%; score 5-9: 72%, area under the curve (AUC): 0.73, plogrank < 0.0001), while the tested biomarkers did not (AUC: 0.51Assuntos
Adrenomedulina/sangue
, Fator Natriurético Atrial/sangue
, Glicopeptídeos/sangue
, Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade
, Choque Cardiogênico/mortalidade
, Idoso
, Biomarcadores/sangue
, Feminino
, Humanos
, Inflamação/sangue
, Inflamação/mortalidade
, Inflamação/patologia
, Proteína 1 Semelhante a Receptor de Interleucina-1/sangue
, Masculino
, Pessoa de Meia-Idade
, Neurotransmissores/sangue
, Intervenção Coronária Percutânea/efeitos adversos
, Infarto do Miocárdio com Supradesnível do Segmento ST/sangue
, Infarto do Miocárdio com Supradesnível do Segmento ST/patologia
, Choque Cardiogênico/sangue
, Choque Cardiogênico/patologia
RESUMO
BACKGROUND Inflammation plays an important part in the pathogenesis of cardiogenic shock (CGS). Whether the neutrophil-lymphocyte ratio (NLR), an integrated biomarker of inflammation, is associated with the outcome of CGS patients remains unknown. This retrospective cohort study was performed to identify the utility of using NLR among patients with CGS. MATERIAL AND METHODS Data were extracted from the MIMIC database. We applied smooth curve fitting to define the NLR cutoff values. The primary outcome was 30-day mortality. Cox proportional hazards models, subgroup analysis, and receiver operator characteristic (ROC) curve analysis were performed. RESULTS A total of 1470 CGS patients were extracted, among which 801 (54.5%) were men. The mean age of the population was 70.37 years. An inverse U-shaped relationship was observed between NLR and mortality in CGS patients, with the highest risk being at values ranging from 9.4 to 15. For the primary outcome of 30-day mortality, the adjusted HR (95% CI) values of the middle tertile (NLR 9.4-15) and the upper tertile (NLR >15) were 1.47 (1.14, 1.88) and 1.22 (0.94, 1.57) compared with the reference of lower tertile (NLR <9.4). ROC curve analysis showed that NLR had a more sensitive prognostic value in predicting 30-day mortality of CGS than the neutrophil or lymphocyte percentage alone (0.660 vs. 0.540, 0.549). CONCLUSIONS An inverse U-shaped curve was presented between NLR and the mortality of CGS. NLR seemed to be a readily available and independent prognostic biomarker for patients with CGS. The prognostic value of NLR was more sensitive than the neutrophil or lymphocyte percentage alone, but not as good as SOFA or SAPSII score.
Assuntos
Contagem de Leucócitos/métodos , Choque Cardiogênico/imunologia , Choque Cardiogênico/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Inflamação/patologia , Estimativa de Kaplan-Meier , Contagem de Linfócitos/métodos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/patologia , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Choque Cardiogênico/mortalidadeRESUMO
BACKGROUND: Consciousness disturbance is one of the major clinical signs associated with shock state, but its prognostic value has not been previously evaluated in cardiovascular shock patients. We aimed to evaluate the prognostic value of neurological status for 30-day mortality in cardiovascular shock patients without out-of-hospital cardiac arrest (OHCA). MethodsâandâResults: Patients with out-of-hospital onset cardiovascular shock were recruited from the Japanese Circulation Society Shock Registry. Neurological status upon hospital arrival was evaluated using the Japan Coma Scale (JCS). Patients were divided into 4 groups according to the JCS: alert, JCS 0; awake, JCS 1-3 (not fully alert but awake without any stimuli); arousable, JCS 10-30 (arousable with stimulation); and coma JCS 100-300 (unarousable). The primary endpoint was 30-day all-cause death. In total, 700 cardiovascular shock patients without OHCA were assessed. The coma group was associated with a higher incidence of 30-day all-cause death compared with other groups (alert, 15.3%; awake, 24.4%; arousable, 36.8%; coma, 48.5%, P<0.001). Similar trends were observed in etiologically divergent subgroups (acute coronary syndrome, non-ischemic arrhythmia, and aortic disease). On multivariate Cox regression analysis, arousable (hazard ratio [HR], 1.82; 95% CI: 1.16-2.85, P=0.009) and coma (HR, 2.72; 95% CI: 1.76-4.22, P<0.001) (reference: alert) independently predicted 30-day mortality. CONCLUSIONS: Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA.
Assuntos
Parada Cardíaca Extra-Hospitalar/mortalidade , Choque Cardiogênico/diagnóstico , Idoso , Transtornos da Consciência/classificação , Feminino , Humanos , Japão/epidemiologia , Masculino , Parada Cardíaca Extra-Hospitalar/patologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Choque Cardiogênico/mortalidade , Choque Cardiogênico/patologiaRESUMO
Hantavirus cardiopulmonary syndrome is characterized by pulmonary capillary leakage and alveolar flooding, resulting in 50% mortality due to fulminant hypoxic respiratory failure. In addition, depression of cardiac function ensues, which complicates the picture with cardiogenic shock. Early diagnosis and appropriate use of extracorporeal membrane oxygenation (ECMO) are amongst the lifesaving interventions in this fatal illness. However, a recent case report demonstrates that implementation of high volume continuous hemofilteration along with protective ventilation reverses the cardiogenic shock within few hours in hantavirus infected patients. This review article is focused on the recent advances in clinical features, diagnosis, management, epidemiology, and pathogenesis of hantavirus induced cardiopulmonary syndrome. It provides information for clinicians to help in correct diagnosis during the early stages of viral infection that could improve the prognosis of this viral illness.
Assuntos
Infecções por Hantavirus/complicações , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/patologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/patologia , Gerenciamento Clínico , Diagnóstico Precoce , Oxigenação por Membrana Extracorpórea , Síndrome Pulmonar por Hantavirus/mortalidade , Síndrome Pulmonar por Hantavirus/terapia , Hemofiltração , Humanos , Respiração Artificial , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Resultado do TratamentoRESUMO
INTRODUCTION: Profoundly impaired left ventricular (LV) function in patients undergoing femoral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can result in intra-cardiac stasis and thrombus formation. There have been several attempts to improve LV unloading in patients with peripheral VA-ECMO, either by improving contractility or by venting the LV. METHODS: Data from all patients who underwent femoral VA-ECMO between 2007 and 2015 due to cardiogenic decompensation were retrospectively analysed regarding intra-cardiac thrombus formation. RESULTS: In total, 11 of 281 patients (3.91%) with femoral VA-ECMO developed an intra- or extra-cardiac thrombus despite adequate anticoagulation therapy. None of the patients survived this serious complication. CONCLUSION: Management strategies for patients with femoral VA-ECMO support and severely impaired LV function must be reassessed to avoid insufficient LV unloading at an early stage of ECMO therapy. Early LV decompression should be considered in patients with insufficient unloading of the LV to prevent intra-cardiac thrombus formation.
Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Ventrículos do Coração/patologia , Trombose/etiologia , Trombose/patologia , Adolescente , Adulto , Idoso , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/patologia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Trombose/fisiopatologiaRESUMO
INTRODUCTION: The neutrophil to lymphocyte ratio (NLR) has proven to be a robust predictor of mortality in a wide range of cardiovascular diseases. This study investigated the predictive value of the NLR in patients supported by extracorporeal membrane oxygenation (ECMO) systems. METHODS: This study included 107 patients who underwent ECMO implantation for cardiogenic shock. Median preoperative NLR was used to divide the cohort, with Group 1 NLR <14.2 and Group 2 with NLR ≥14.2. Survival, the primary outcome, was compared between groups. RESULTS: The study cohort was composed of 64 (60%) males with an average age 53.1 ± 14.9 years. Patients in Group 1 had an average NLR of 7.5 ± 3.5 compared to 27.1 ± 19.9 in Group 2. Additionally, those in Group 2 had significantly higher preoperative blood urea nitrogen (BUN) and age. Survival analysis indicated a thirty-day survival of 56.2%, with significantly worsened mortality in patients with NLR greater than 14.2, p=0.047. DISCUSSION: Our study shows the NLR has prognostic value in patients undergoing ECMO implantation. Leukocytes are known contributors to myocardial damage and neutrophil infiltration is associated with damage caused by myocardial ischemia.
Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Linfócitos/metabolismo , Neutrófilos/metabolismo , Choque Cardiogênico/etiologia , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/patologia , Análise de SobrevidaRESUMO
Coronary bypass grafting is a routine procedure in heart surgery, which can now also be performed using a minimally invasive technique on the beating heart. In the presented case, a 55-year-old man died two days after bypass surgery. His condition had deteriorated post-operatively over 2 days until he finally died from multi-organ failure and cardiogenic shock. Autopsy revealed a fatal haemorrhage into the chest cavities from a small tear in the bypass and acute myocardial infarction. The haemorrhage had not been noticed in the hospital. Postoperative haemorrhage is a common complication after this type of surgery, which occurs in about 1-2 % of cases.
Assuntos
Implante de Prótese Vascular , Ponte de Artéria Coronária , Síndrome de Leriche/cirurgia , Infarto do Miocárdio/patologia , Complicações Pós-Operatórias/patologia , Hemorragia Pós-Operatória/patologia , Vasos Coronários/lesões , Vasos Coronários/patologia , Exsanguinação/patologia , Humanos , Síndrome de Leriche/patologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/patologia , Choque Cardiogênico/patologiaAssuntos
COVID-19/patologia , Endocárdio/patologia , Síndrome de Linfonodos Mucocutâneos/patologia , Miocárdio/patologia , SARS-CoV-2 , Biópsia , COVID-19/terapia , Baixo Débito Cardíaco/patologia , Diagnóstico Diferencial , Insuficiência Cardíaca/patologia , Humanos , Mediadores da Inflamação/sangue , Masculino , Choque Cardiogênico/patologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Adulto JovemRESUMO
Whipple's disease is a rare infectious disease caused by the bacterium Tropheryma whipplei. Usually the course of the disease is characterized by fever, diarrhea, weight loss and polyarthritis. We report on a case with a 10-year course of the disease with endocarditis, myocarditis and involvement of the bone marrow but with negative histological results of the small intestine.
Assuntos
Endocardite Bacteriana/patologia , Tropheryma , Doença de Whipple/patologia , Valva Aórtica/patologia , Fibrilação Atrial/patologia , Medula Óssea/patologia , Erros de Diagnóstico , Endocárdio/patologia , Evolução Fatal , Feminino , Histiócitos/patologia , Humanos , Intestino Delgado/patologia , Rim/patologia , Pessoa de Meia-Idade , Miocardite/patologia , Miocárdio/patologia , Reação do Ácido Periódico de Schiff , Choque Cardiogênico/patologiaRESUMO
The large spectrum of etiologies, severities, and histologic appearances of eosinophilic myocarditis (EoM) poses challenges to its diagnosis and management. Endomyocardial biopsy is the current gold standard for diagnosis. However, cardiovascular magnetic resonance imaging is becoming more frequently used to diagnose acute myocarditis because of enhanced sensitivity when compared to histopathologic examination, and its less invasive nature. We report a complicated case of EoM in a male in his mid-thirties that led to fulminant cardiogenic shock that required immunosuppressive therapy on day 5 of admission and implantation of a left ventricular assist device (LVAD) on day 30. EoM was diagnosed on histopathologic examination of the resected fragment of the left ventricular myocardium. Nine months after the initial presentation, the patient ultimately required heart transplantation. The explanted heart showed minimal residual interstitial inflammation with evidence of mildly active intimal arteritis and patchy areas of interstitial fibrosis. In this report, we describe our patient's clinical features and correlate them with imaging and histopathologic findings to illustrate the difficulty in diagnosing EoM, particularly in this complicated patient that ultimately required heart transplantation. The diagnosis can be challenging due to the variable histopathologic features, clinical presentation, and utilization of therapeutic medications and devices.
Assuntos
Eosinofilia , Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Miocardite , Miocárdio , Humanos , Masculino , Miocardite/patologia , Insuficiência Cardíaca/etiologia , Eosinofilia/patologia , Eosinofilia/complicações , Adulto , Miocárdio/patologia , Biópsia , Imunossupressores/uso terapêutico , Resultado do Tratamento , Choque Cardiogênico/etiologia , Choque Cardiogênico/patologia , Choque Cardiogênico/terapia , Choque Cardiogênico/diagnósticoAssuntos
Displasia Arritmogênica Ventricular Direita/etiologia , Insuficiência Cardíaca/etiologia , Mitocôndrias/imunologia , Miocardite/complicações , Idoso , Anticorpos/sangue , Displasia Arritmogênica Ventricular Direita/patologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/patologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/patologia , Insuficiência Cardíaca/patologia , Humanos , Miocardite/patologia , Choque Cardiogênico/etiologia , Choque Cardiogênico/patologiaRESUMO
A complex case of inferior wall infarction with ventricular septal defect and severe tricuspid valve regurgitation due to acute papillary muscle rupture in a 65 year-old male is described. This constellation of pathological lesions and the surgical approach to the repair have not been previously described.
Assuntos
Comunicação Interventricular , Choque Cardiogênico , Insuficiência da Valva Tricúspide , Idoso , Comunicação Interventricular/etiologia , Comunicação Interventricular/patologia , Comunicação Interventricular/cirurgia , Humanos , Masculino , Choque Cardiogênico/complicações , Choque Cardiogênico/patologia , Choque Cardiogênico/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/patologia , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
PURPOSE OF REVIEW: Cardiogenic shock is present in 3.5% of patients presenting with acute decompensated heart failure. Despite advances in therapy, mortality remains high, approaching 70% in some settings. Recent management strategies have incorporated the use of mechanical circulatory support (MCS), which has been associated with better survival in nonrandomized trials. MCS is increasingly used in the acute setting and has become an important treatment modality for cardiogenic shock. RECENT FINDINGS: Small studies have demonstrated improved survival when MCS is instituted early in the management of cardiogenic shock. Numerous case reports support the benefit of MCS for various causes of cardiogenic shock, including acute myocardial infarction, cardiac allograft rejection, myocarditis and refractory arrhythmias. SUMMARY: This article will review novel strategies in the management of cardiogenic shock including percutaneous MCS (intra-aortic balloon pump, Impella, TandemHeart, venoarterial extracorporeal membrane oxygenation) and surgically implanted devices (CentriMag) that are used for short-term management. We will review the mechanisms involved in cardiogenic shock and discuss management and device selection strategies.
Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Choque Cardiogênico/terapia , Doença Aguda , Algoritmos , Progressão da Doença , Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/patologia , Humanos , Índice de Gravidade de Doença , Choque Cardiogênico/etiologia , Choque Cardiogênico/patologia , Fatores de Tempo , Falha de TratamentoRESUMO
Acute myopericarditis is a well-recognized but rare complication of numerous viral infections. Here we report a case of fulminant myopericarditis presenting with acute heart failure and a state of shock in a previously healthy young woman. H1N1 influenza A virus sequences were identified in throat and pericardial fluid, suggesting a viral source of the infection.
Assuntos
Insuficiência Cardíaca/diagnóstico , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/virologia , Miocardite/diagnóstico , Miocardite/patologia , Pericardite/diagnóstico , Pericardite/patologia , Adulto , Ecocardiografia , Feminino , Insuficiência Cardíaca/patologia , Humanos , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/complicações , Miocardite/complicações , Miocardite/virologia , Derrame Pericárdico/virologia , Pericardite/complicações , Pericardite/virologia , Faringe/virologia , RNA Viral/genética , RNA Viral/isolamento & purificação , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/patologiaRESUMO
Churg-Strauss syndrome (CSS) is a multisystem disorder characterised by asthma, prominent peripheral blood eosinophilia, and vasculitis signs. We report the case of a 22 year-old man admitted to the intensive care unit for acute myocarditis complicated with cardiogenic shock. Eosinophilia, history of asthma, lung infiltrates, paranasal sinusitis, glomerulonephritis, and abdominal pain suggested the diagnosis of CSS. Cardiac MRI confirmed cardiac involvement with a diffuse subendocardial delayed enhancement of the left ventricular wall, and a left ventricular ejection fraction (LVEF) of 30%. Acute myocarditis was confirmed with myocardial biopsy. The patient was successfully treated with systemic corticosteroids, intravenous cyclophosphamide, vasopressor inotropes, intra-aortic balloon pump and mechanical ventilation, and was discharged 21 days later. One year after diagnosis, the patient was asymptomatic. The eosinophilic cell count was normal. Follow-up MRI at one year showed LVEF of 40% with persistent delayed enhancement. Cardiac involvement by CSS requires immediate therapy with corticosteroids and cyclophosphamide, which may allow recovery of the cardiac function.