RESUMEN
BACKGROUND: Patients with ST-elevation myocardial infarction (STEMI) with out-of-hospital cardiac arrest (OHCA) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non-PCI hospitals to go to a PCI center. METHODS AND RESULTS: We reported time trends in emergency medical service transport and care of patients with STEMI with and without OHCA included from 171 PCI-capable hospitals in 16 US regions with participation in the Mission: Lifeline STEMI Accelerator program between July 1, 2012, and March 31, 2014. Time trends by quarter were assessed using logistic regression with generalized estimating equations to account for hospital clustering. Of 13 189 emergency medical service-transported patients, 88.7% (N=11 703; 10.5% OHCA) were taken directly to PCI hospitals. Among 1486 transfer-in patients, 21.7% had OHCA. Direct transport to a PCI center for OHCA increased from 74.7% (July 1, 2012) to 83.6% (March 31, 2014) (odds ratio per quarter, 1.07; 95% confidence interval, 1.02-1.14), versus 89.0% to 91.0% for patients without OHCA (odds ratio, 1.03; 95% confidence interval, 0.99-1.07; interaction P=0.23). The proportion with prehospital ECGs increased for patients taken directly to PCI centers (53.9%-61.9% for those with OHCA versus 73.9%-81.9% for those without OHCA; interaction P=0.12). Of 997 patients with OHCA taken directly to PCI hospitals and treated with primary PCI, first medical contact-to-device times within the guideline-recommended goal of ≤90 minutes were met for 34.5% on July 1, 2012, versus 41.8% on March 31, 2014 (51.6% and 56.1%, respectively, for 9352 counterparts without OHCA; interaction P=0.72). CONCLUSIONS: Direct transport to PCI hospitals increased for patients with STEMI with and without OHCA during the 2012 to 2014 Mission: Lifeline STEMI Accelerator program. Proportions with prehospital ECGs and timely reperfusion increased for patients taken directly to PCI hospitals.
Asunto(s)
Paro Cardíaco Extrahospitalario/terapia , Intervención Coronaria Percutánea/tendencias , Evaluación de Procesos, Atención de Salud/normas , Mejoramiento de la Calidad/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Infarto del Miocardio con Elevación del ST/terapia , Tiempo de Tratamiento/tendencias , Transporte de Pacientes/tendencias , Anciano , Prestación Integrada de Atención de Salud/tendencias , Electrocardiografía/tendencias , Femenino , Adhesión a Directriz/tendencias , Mortalidad Hospitalaria/tendencias , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/fisiopatología , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
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Asunto(s)
Fascículo Atrioventricular Accesorio/fisiopatología , Nodo Atrioventricular/fisiopatología , Electrocardiografía/métodos , Fascículo Atrioventricular Accesorio/diagnóstico , Nodo Atrioventricular/fisiología , Electrocardiografía/tendencias , Técnicas Electrofisiológicas Cardíacas/métodos , Técnicas Electrofisiológicas Cardíacas/tendencias , HumanosRESUMEN
BACKGROUND: The most plausible hypothesis for takotsubo cardiomyopathy (TCM) is a catecholamine surge. Direct administration of catecholamines or medications causing catecholamine surge is frequently used in clinical practice. METHODS: A Medline/PubMed database search was conducted for case reports or series of drug-induced TCM. All reported cases of drug-induced TCM were systemically identified and analyzed. RESULTS: We identified 157 cases of drug-induced TCM. Fifty-seven (36.3%) cases were related to the administration of exogenous catecholamines. In 50 (31.9%) other cases, there was potential adrenergic effect. This included drugs with adrenergic vasoconstriction properties (3.2%), hyperadrenergic state due to alcohol or opioid withdrawal (7.7%), inhibitors of catecholamine reuptake (14.7%), anaphylactic reaction that is accompanied by catecholamine release (3.2%), and psychological or somatic stress coinciding with the administration of a drug that was thought to be the culprit (3.2%). Overall, 68.2% of these drug-induced TCM cases were catecholamine related. In 14 (8.9%) cases, the likely etiology of cardiomyopathy was chemotherapy-induced coronary vasospasm. CONCLUSION: Our systematic review showed that over two-thirds of drug-induced TCM cases were due to direct or indirect catecholamine stimulation. The lowest effective dose and shortest duration of catecholamines should be utilized, and alternative therapies should be considered if feasible.
Asunto(s)
Catecolaminas/efectos adversos , Electrocardiografía/efectos de los fármacos , Cardiomiopatía de Takotsubo/inducido químicamente , Cardiomiopatía de Takotsubo/diagnóstico , Electrocardiografía/tendencias , Femenino , Humanos , Cardiomiopatía de Takotsubo/fisiopatologíaRESUMEN
BACKGROUND: Surgical treatment of ischemic cardiomyopathy (ICM) with mechanical complications has been limited in favor of suboptimal treatments because of the perception of poor outcome. METHODS AND RESULTS: From May 2009 till June 2014 115 patients with severe ICM (ejection fraction, EF, ≤25%) and mechanical complications were operated on. Median EF was 24% (19, 24), mean end-systolic volume index (ESVi) was 86±27ml/m2 and all patients had an MR grade of 2 or more. The right ventricle (RV) was hypokinetic in 33 patients. All of them underwent mitral valve surgery. Left ventricular (LV) surgical remodeling was performed in 60 patients (52.2%) and tricuspid surgery in 58 (50.4%). In-hospital mortality was 4.3% (5 patients). Six-year freedom from death any cause and from death any cause and NYHA class III/IV were, respectively, 70.5±4.9% and 66.4±4.8%. Cox regression analysis showed that risk factors were lower EF (cutpoint≤20%) and RV hypokinesia. Eighty-six patients had a follow up echocardiogram after a median of 31 (19, 51) months. EF increased by 60%, from 24 (19, 24) to 35 (27 ,46) (p=0.00), and ESVi decreased by 32%, from 87±29 to 59±27ml/m2 (p=0.00). SVi increased by 32%, from 23±7 to 32±12ml/m2. MR grade was ≥2 only in 6 patients (7%) and was not severe in any of them. CONCLUSIONS: Surgery for severe ICM with MR can be performed with low surgical risk and good midterm survival. These findings have to be taken into account while abandoning a clear surgical indication in favor of suboptimal alternative therapies.
Asunto(s)
Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/cirugía , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/cirugía , Índice de Severidad de la Enfermedad , Anciano , Cardiomiopatía Dilatada/fisiopatología , Electrocardiografía/tendencias , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/fisiopatología , Volumen Sistólico/fisiologíaAsunto(s)
Terapia de Resincronización Cardíaca/métodos , Electrocardiografía/métodos , Técnicas Electrofisiológicas Cardíacas/métodos , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/terapia , Terapia de Resincronización Cardíaca/tendencias , Cardiología , Cardiomiopatías/diagnóstico , Cardiomiopatías/terapia , Electrocardiografía/tendencias , Electrocardiografía Ambulatoria/métodos , Femenino , Predicción , Humanos , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/terapia , Masculino , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Sensibilidad y EspecificidadRESUMEN
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Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Amiodarona/uso terapéutico , Anestesia Local/instrumentación , Anestesia Local/métodos , Antagonistas Adrenérgicos beta/uso terapéutico , Electrocardiografía/instrumentación , Electrocardiografía/métodos , Infarto del Miocardio/fisiopatología , Infarto del Miocardio , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca , Electrocardiografía/tendencias , ElectrocardiografíaRESUMEN
La alternancia eléctrica es un amplio concepto que describe las variaciones, latido a latido, en la dirección, amplitud y/o duración de cualquier componente del electrocardiograma. Se asocia a taponamiento cardiaco, arritmias malignas y muerte súbita. Presentamos el caso de una paciente de 77 años con alternancia eléctrica a partir de la cual se llegó al diagnóstico de taponamiento cardiaco (AU)
Electrical alternans is a broad term that describes alternate-beat variation in the direction, amplitude and duration of any component of the ECG wave-form. It is associated with cardiac tamponade, serious ventricular arrhythmias, and sudden death. We present the clinical case of a 77-year-old female with electrical alternans, from which a diagnosis of cardiac tamponade was established (AU)