Sheath hemorrhage after percutaneous ventricular assist device implantation.

Technical advances in temporary ventricular assist devices (VADs) continue to progress, allowing for percutaneous implantation during times of hemodynamic instability. However, device delivery systems, i.e., sheaths, lag in their ability to sustain the mechanical demands of these VADs for extended periods. We propose both a novel technique and the implementation of an emergency preparedness plan to be enacted specifically during those times when delivery systems fail thereby leading to potentially catastrophic bleeding complications.

Do the frequencies of adverse events increase, decrease, or stay the same with long-term use of statins?

Statins are widely used for their cholesterol-lowering properties and proven reduction of cardiovascular disease risk. Many patients take statins as long-term treatment for a variety of conditions without a clear-cut understanding of how treatment duration affects the frequency of adverse effects. We aimed to evaluate whether the frequencies of documented adverse events increase, decrease, or remain unchanged with long-term statin use. We reviewed the established literature to define the currently known adverse effects of statin therapy, including myopathy, central nervous system effects, and the appearance of diabetes, and the frequency of these events with long-term medication use. The frequency of adverse effects associated with long-term statin therapy appears to be low. Many patients who develop side effects from statin therapy do so relatively soon after initiation of therapy, so the frequency of side effects from statin therapy when expressed as a percentage of current users decreases over time. Nevertheless, patients may develop side effects such as muscle pain and weakness years after starting statin therapy; however, the absolute number of patients affected by statin myopathy increases with treatment duration. Also, clinical trials of statin therapy rarely exceed 5 years, so it is impossible to determine with certainty the frequency of long-term side effects with these drugs.

Coronary artery dissection in Prader-Willi syndrome: case report and literature review.

Prader-Willi syndrome (PWS) is a syndrome characterized in babies by small birth weight, hypogonadism, flaccid muscle tone, and skeletal abnormalities, and in older children by intense food cravings leading to morbid obesity, hypoxemia, and right heart failure. To our knowledge, PWS has not been associated with coronary artery dissection. We report a 17-year-old woman with PWS who suffered an inferior myocardial infarction secondary to dissection of her right coronary artery.

Evaluation of the HeartMate II™ left ventricular assist device in obese heart failure patients: effects on weight loss.

BACKGROUND: The purpose of this study is to evaluate the effect on weight loss of the newer generation continuous flow HeartMate II™ left ventricular assist device (VAD) in obese heart failure (HF) patients. MATERIAL/METHODS: We retrospectively reviewed 3-year surgical data from a large heart transplant facility and identified obese patients with advanced heart failure who underwent successful implantation of either the HeartMate XVE(®) or the HeartMate II(®) VAD. For each patient weight and BMI at time of VAD implantation and at 6 months post-operatively were documented. Between group comparison was achieved with Student's T tests. RESULTS: We identified 14 patients who had received the HeartMate XVE™ and 8 who had received the HeartMate II™. At 6 months, patients who received a HeartMate XVE™ demonstrated a significant reduction in mean body weight (249.6 ± 35.4lbs vs. 217.4 ± 20.5 lbs; P<0.05), while patients who received the HeartMate II™ demonstrated no significant change in weight (234.5 ± 41.7 lbs vs. 234.7 ± 43.0lbs; P=0.3). CONCLUSIONS: The HeartMate XVE™ results in significant reductions in weight at 6 months in obese patients with heart failure while the HeartMate II does not. Further research is necessary to better understand the effects of VADs on weight loss in obese HF patients.

Left ventricular assist device as 'bridge to weight loss' prior to transplantation in obese patients with advanced heart failure.

BACKGROUND: Obesity is a risk factor for heart failure (HF) and associated with poor outcomes after cardiac transplantation. We assessed change in total body weight, morbidity and mortality in obese heart failure patients after implantation of a left ventricular assist device (LVAD) compared to medical management. MATERIAL/METHODS: Nineteen patients (9 females, age 51.3 ± 10 years) with a body mass index (BMI) ≥ 30.0 kg/m² and advanced HF (NYHA class III-IV, stage D) were evaluated. Thirteen (group 1) received insertion of a LVAD as bridge to transplantation. The remaining patients (group 2) were medically managed. All were advised on lifestyle modification. RESULTS: At baseline, group 1 (49.1 ± 10.7 years) had a total body weight (BW) of 246.6 ± 34.9 pounds (mean ± SD) and a BMI of 36.1 ± 4 kg/m². Group 2 (56 ± 6.7 yrs) had a BW of 238.8 ± 73.6 pounds and a BMI of 39.1 ± 9.3 kg/m2 (n.s. compared to group 1). All patients were alive at 12 months. At 6 months, BW in group 1 was reduced to 216.3 ± 20.8 pounds, and BMI to 31.8 ± 3.3 kg/m² (p < 0.05). At 6 months, BW in group 2 was 238.2 ± 84.6 pounds, and BMI was 39.1 ± 11.6 kg/m² (n.s. vs. baseline, p < 0.05 compared to group 1). The decrease in BW in group 1 was 12.3 ± 12% (30.3 ± 28.5 pounds). There was no change in BW in group 2 (0.3 ± 8.7%, 0.6 ± 21 pounds, p < 0.05 vs. group 1). At 12 months, 7 patients in group 1 (54%) underwent cardiac transplantation. CONCLUSIONS: LVAD insertion resulted in weight loss in obese patients not considered for heart transplantation compared to medically managed patients.

Ventricular tachycardia after ingestion of ayurveda herbal antidiarrheal medication containing aconitum.

Ayurveda is an East Indian tradition involving the treatment of medical ailments through the use of herbal medications. A previously asymptomatic 62-year-old man with a history of hypertension and stable coronary artery disease developed paresthesias and fascicular and ventricular tachycardia after ingestion of an Ayurveda bowel regimen containing substrates from the Aconitum species, which is a known neurotoxin and cardiotoxin. Findings of electrophysiologic study and cardiac magnetic resonance imaging were within normal limits, pointing to the ingestion of Aconitum as the most likely source of his arrhythmia.

How does the heart (not) die? The role of autophagy in cardiomyocyte homeostasis and cell death.

Autophagy plays a critical and seemingly dual-purposed role in cardiomyocytes, being implicated as a mechanism of both cellular survival, for example, during ischemia/reperfusion injury and a mechanism of cell death at stages in which progressive myocyte alterations are beyond repair. This review aims to highlight the current literature as it relates to autophagy in cardiomyocytes. It provides background into the mechanisms of cell death, discusses the details that are known about the ubiquitin proteasome system and autophagy, delves into the pathways that are known to initiate and inhibit autophagy, and comments on the role of autophagy in cardiomyocyte homeostasis and cell death.

Erythropoiesis stimulating agents in heart failure patients with anemia: a meta-analysis.

BACKGROUND: Anemia is prevalent in patients with heart failure and an independent prognostic sign of poor outcome. The current report is a meta-analysis of published clinical trials assessing the use of erythropoeisis stimulating agents (ESA) in heart failure (HF) patients with anemia. METHODS: Literature and Medline search was performed to identify studies with control groups (case-control, cohort or randomized controlled trials) that examined the effect of ESA therapy in patients with HF and anemia. RESULTS: Seven prospective controlled trials met inclusion criteria (n = 663 subjects). The ESA studied was darbepoetin in 4 trials and erythropoietin in 3 trials. Mean follow up period ranged from 12 to 27 weeks. Compared to placebo ESA therapy was associated with improvement in six cardiovascular parameters assessed by at least three of the analyzed trials, including increase in hemoglobin levels 2.35(95% confidence interval [Cl], 1.76-2.93, P < 0.00001), increase in exercise duration 0.91(95% Cl, 0.08-1.73, P = 0.03), improvement in New York Heart Association functional class -1.46(95% Cl, -2.32 to -0.60, P = 0.0009), improvement in 6-minute walk test 1.42(95% Cl, 0.31-2.54, P = 0.01), decrease in B-type natriuretic peptide -0.54(95% Cl, -1.03 to -0.06, P = 0.03), and improvement in peak oxygen consumption 0.93(95% Cl, 0.52-1.34, P < 0.00001). CONCLUSION: In patients with heart failure and anemia, erythropoiesis stimulating agent therapy appears to have a positive effect on several important cardiovascular parameters, compared to control therapy. Large prospective randomized controlled trials are warranted to comprehensively evaluate the potential effects of erythropoiesis stimulating agents on clinical outcomes in heart failure patients with anemia.