ABSTRACT
OBJECTIVE: Observational studies have shown that the management of patients with cardiogenic shock (CS) by dedicated multidisciplinary teams improves clinical outcomes. Nevertheless, these studies reflect a specific organizational setting with most patients being transferred from referring hospitals, hospitalized in cardiac intensive care units (ICU), or treated with mechanical circulatory support (MCS) devices. The purpose of this study was to document the organization and outcomes of a CS team offering acute care in an all-comer population. METHODS: A CS team was developed in a large academic tertiary institution. The team consisted of emergency care physicians, critical care cardiologists, interventional cardiologists, cardiac surgeons, ICU physicians, and heart failure specialists and was supported by a predefined operating protocol, a dedicated communication platform, and regular team meetings. RESULTS: Over 12 months, 70 CS patients (69 ± 13 years old, 67% males) were included. Acute myocardial infarction (AMI-CS) was the most common cause (64%); 31% of the patients presented post-resuscitated cardiac arrest and 56% needed invasive mechanical ventilation (IMV). Coronary angiography was performed in 70% and 53% had percutaneous coronary intervention. MCS was used in 10% and 6% were referred for urgent cardiac surgery. The in-hospital mortality in our center was 40% with 39% of the patients dying within 24 h from presentation. Overall, 76% of the live patients were discharged home. CONCLUSION: Across an all-comer population, AMI was the most common cause of CS. A significant number of patients presented post-cardiac arrest, and the majority required IMV. Mortality was high with a significant number dying within hours of presentation.
Subject(s)
Coronavirus Infections , Coronavirus , Extracorporeal Membrane Oxygenation , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , China , Cytokines , Humans , Inflammation , SARS-CoV-2Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis , Stents , Vascular Surgical Procedures/methods , Aged , Aorta, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortography , Female , Humans , Imaging, Three-Dimensional , Male , Prosthesis Design , Tomography, X-Ray Computed/methodsABSTRACT
A 71-year-old male presented with recurrent atrial fibrillation, anaemia and thrombocytopenia. Six months ago he underwent an urgent triple coronary artery bypass-grafting elsewhere. Postoperatively he complained of fatigue and low-grade fever. Echocardiographs and magnetic resonance imaging showed a right atrial appendage mass, which afterwards was resected. Histology confirmed a benign myxoma. Patient's symptoms spontaneously resolved. This report demonstrates the unusual sites that myxoma may occur, with probable serious complications in case of urgent heart operations. This case also emphasizes the need for preoperative echocardiography in open heart operations or in cases with recurrent atrial fibrillation.