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1.
J Interv Cardiol ; 2019: 7873468, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772546

RESUMO

Objective: Coronary slow/no reflow is not rare after successfully undergoing primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), and shock index (SI) is an important factor for adverse cardiovascular prognosis. In this study, we are to explore whether SI is associated with coronary slow/no reflow in patients with AMI following primary PCI. Methods: A total of 153 consecutive AMI patients undergoing primary PCI within 24 hours of symptom onset were included in this study. The participants were divided into normal flow group (n=124) and slow/no reflow group (n=29) according to cineangiograms recorded during the period of PCI. Cardiovascular risk factors, hematologic parameters, preoperative management of antithrombotic therapy, and baseline angiography were collected. Results: SI, plasma glucose, white blood cells (WBC) and neutrophil count, neutrophil to lymphocyte ratio (PLR), high sensitivity C-reactive protein (hs-CRP), probrain natriuretic peptide (pro-BNP), and Killip classification on admission and thrombus burden on initial angiography were significantly different between patients with and without slow/no reflow. Multivariate analysis revealed that SI≥0.66, thrombus burden, and plasma glucose on admission were independent predictors for coronary slow/no reflow. Preoperative management of tirofiban therapy improves initial thrombolysis in myocardial infarction (TIMI). However, it has no effect on prognosis of slow/no reflow. Conclusion: Our findings demonstrated that slow/no reflow in patients with AMI following primary PCI was more likely associated with SI≥0.66, thrombus burden, and plasma glucose on admission. SI as a predictor for coronary slow/no reflow should be further confirmed in the following more large-scale and prospective studies. The clinical registration number is ChiCTR1900024447.


Assuntos
Infarto do Miocárdio/cirurgia , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Choque Cardiogênico/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenômeno de não Refluxo/diagnóstico , Fenômeno de não Refluxo/etiologia , Admissão do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Choque Cardiogênico/complicações , Resultado do Tratamento
3.
Med Klin Intensivmed Notfmed ; 114(7): 665-676, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31538212

RESUMO

Cardiogenic shock is a life-threatening condition that is frequently associated with acute hepatic dysfunction. Due to low cardiac output resulting in end-organ hypoperfusion and hypoxia, different types of liver dysfunction can develop, such as hypoxic hepatitis or acute liver failure. A very serious and late sequela is the secondary sclerosing cholangitis in critically patients. Clinical management of acute hepatic dysfunction involves the stabilization of cardiac output to improve hepatic perfusion and the optimization of liver oxygenation. However, despite maximum efforts in supportive treatment, the outcome of patients with cardiogenic shock and concomitant hepatic dysfunction remains poor.


Assuntos
Hipóxia/complicações , Falência Hepática Aguda/diagnóstico , Fígado/patologia , Choque Cardiogênico , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/etiologia , Estado Terminal , Humanos , Hipóxia/etiologia , Falência Hepática Aguda/etiologia , Testes de Função Hepática , Choque Cardiogênico/complicações
4.
Medicina (B Aires) ; 79(4): 284-286, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487249

RESUMO

Endomyocardial fibrosis is a restrictive cardiomyopathy with high morbidity and mortality rates, prevalent in the sub-Saharan Africa region but infrequent in our population. It has a close relation with blood hypereosinophilia. Hypoxic hepatitis is frequently observed in intensive care units and its diagnosis is clinical. It shows a typical enzyme pattern with high mortality too. There are multiple mechanisms responsible for this condition, such as ischemia, passive congestion and dysoxia. We described the case of a 35 year-old cocaine addict woman diagnosed with endomyocardial fibrosis and hypereosinophilic syndrome who developed cardiogenic shock with hypoxic hepatitis. The patient evolved favorably with the appropriate treatment.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Fibrose Endomiocárdica/etiologia , Hepatite/complicações , Síndrome Hipereosinofílica/complicações , Choque Cardiogênico/complicações , Adulto , Fibrose Endomiocárdica/diagnóstico , Feminino , Humanos , Hipóxia/complicações
5.
World J Pediatr Congenit Heart Surg ; 10(5): 651-653, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496401

RESUMO

Obstructive total anomalous pulmonary venous return (TAPVR) is a potentially life-threatening clinical condition and a surgical emergency. Left-sided partial anomalous pulmonary venous return (PAPVR) in association with a subdivided left atrium, also known as cor triatriatum sinister (CTS), is a very rare malformation that can mimic obstructive TAPVR. We present a case of a newborn with clinical manifestation of cardiogenic shock caused by CTS and PAPVR.


Assuntos
Coração Triatriado/cirurgia , Síndrome de Cimitarra/cirurgia , Choque Cardiogênico/cirurgia , Coração Triatriado/complicações , Átrios do Coração/cirurgia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Masculino , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Síndrome de Cimitarra/complicações , Choque Cardiogênico/complicações
6.
Int J Clin Pract ; 73(7): e13374, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31111653

RESUMO

OBJECTIVE: To conduct a systematic review evaluating the utility of brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) as biomarkers in adult patients with septic shock. MATERIALS AND METHODS: Pubmed/Medline databases were searched from inception to November 2018 using the search terms: (septic[Title/Abstract] AND shock[Title/Abstract]) AND bnp[Title/Abstract]) and (septic[Title/Abstract]) AND shock[Title/Abstract]) AND natriuretic[Title/Abstract]). No restriction was applied regarding date of publication. Comparative observational studies evaluating BNP and NT-proBNP in patients with septic shock aged ≥18 years were eligible for inclusion. Bibliographies from the extracted articles were also reviewed to identify additional relevant publications. RESULTS: In total, 46 studies met all eligibility criteria and were included. A strong body of literature has demonstrated that in patients with septic shock, increased values of BNP and NT-proBNP are associated with increased mortality. An increase from baseline BNP values has also been associated with increased mortality, whereas decreases from baseline values are not related to worse outcome. Brain natriuretic peptides have also been associated with cardiac dysfunction in patients with sepsis. Moreover, BNP values have been found to be significantly elevated in septic shock, regardless of cardiac dysfunction, and have been used to distinguish between septic and cardiogenic shock. Furthermore, BNP and NT-proBNP are significantly increased in patients with septic shock, compared to patients with sepsis and severe sepsis. CONCLUSIONS: BNP and NT-proBNP appear to be reliable predictors of outcome in septic shock.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Choque Cardiogênico/mortalidade , Choque Séptico/mortalidade , Biomarcadores/sangue , Humanos , Prognóstico , Sensibilidade e Especificidade , Choque Cardiogênico/sangue , Choque Cardiogênico/complicações , Choque Séptico/sangue , Choque Séptico/complicações
7.
Am J Emerg Med ; 37(8): 1554-1561, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31060863

RESUMO

INTRODUCTION: Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality. OBJECTIVE: This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions. DISCUSSION: Limited evidence exists for ED management of dysrhythmias in AMI due to relatively low prevalence and frequent exclusion of patients with active cardiac ischemia from clinical studies. Management decisions for bradycardia in the setting of AMI are determined by location of infarction, timing of the dysrhythmia, rhythm assessment, and hemodynamic status of the patient. Atrial fibrillation is common in the setting of AMI, and caution is warranted in acute rate control for rapid ventricular rate given the possibility of compensation for decreased ventricular function. Regular wide complex tachycardia in the setting of AMI should be managed as ventricular tachycardia with electrocardioversion in the majority of cases. Management directed towards HF from left ventricular dysfunction in AMI consists of noninvasive positive pressure ventilation, nitroglycerin therapy, and early cardiac catheterization. Norepinephrine is the first line vasopressor for patients with cardiogenic shock and hypoperfusion on clinical examination. Early involvement of a multi-disciplinary team is recommended when caring for patients in cardiogenic shock. CONCLUSIONS: This review discusses considerations of ED management of dysrhythmias and HF associated with AMI.


Assuntos
Fibrilação Atrial/terapia , Bradicardia/tratamento farmacológico , Bloqueio Cardíaco/terapia , Insuficiência Cardíaca/terapia , Infarto do Miocárdio/complicações , Taquicardia Ventricular/terapia , Fibrilação Atrial/etiologia , Bradicardia/etiologia , Medicina de Emergência , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/mortalidade , Insuficiência Cardíaca/etiologia , Humanos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Choque Cardiogênico/complicações , Taquicardia Ventricular/etiologia
8.
PLoS One ; 14(5): e0217006, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095609

RESUMO

INTRODUCTION: The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. MATERIALS AND METHODS: P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. RESULTS: Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5-4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1-3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2-5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2-7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. CONCLUSIONS: Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. TRIAL REGISTRATION: NCT01374867 at ClinicalTrials.gov.


Assuntos
Hipoalbuminemia/sangue , Hipoalbuminemia/mortalidade , Choque Cardiogênico/sangue , Choque Cardiogênico/mortalidade , Idoso , Causas de Morte , Feminino , Mortalidade Hospitalar , Humanos , Hipoalbuminemia/complicações , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Choque Cardiogênico/complicações , Resultado do Tratamento
9.
Ann Thorac Surg ; 108(4): 1127-1132, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31075249

RESUMO

BACKGROUND: The outcomes of surgical treatment of ventricular septal rupture (VSR) complicating acute myocardial infarction are worse in patients with cardiogenic shock. This study aimed to identify clinical characteristics and outcomes in patients with VSR presenting with cardiogenic shock. METHODS: A retrospective analysis was performed in 105 consecutive VSR patients, 71 with cardiogenic shock (67.6%) and 34 without cardiogenic shock (32.4%), who underwent surgical treatment in the Department of Adult Cardiac Surgery of Fuwai Hospital between January 2002 and December 2017. Baseline characteristics and outcomes in patients with VSR with and without cardiogenic shock were assessed. RESULTS: There were no differences in hypertension, diabetes, history of myocardial infarction, body mass index, or location of VSR between patients with and without cardiogenic shock. The size of VSR was larger in patients with cardiogenic shock than in those without (18.2 ± 8.1 mm vs 14.0 ± 7.8 mm; P = .013). Intraaortic balloon pump was required more in patients with cardiogenic shock before operation (39 [68.4%] vs 1 [5.0%]; P < .001]. More emergency surgeries were performed in the cardiogenic shock group (21 [29.6%] vs 3 [8.8%]; P = .018). There were 3 in-hospital deaths among patients with VSR with cardiogenic shock. After 76.56 ± 47.78 months of follow-up, only 2 noncardiac deaths were documented. CONCLUSIONS: The larger the ventricular septal rupture is, the more prone patients are to develop cardiogenic shock. Surgical treatment outcomes for VSR with cardiogenic shock are satisfactory.


Assuntos
Choque Cardiogênico/complicações , Ruptura do Septo Ventricular/cirurgia , Idoso , Feminino , Hospitalização , Humanos , Balão Intra-Aórtico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Taxa de Sobrevida , Resultado do Tratamento , Ruptura do Septo Ventricular/complicações , Ruptura do Septo Ventricular/mortalidade
11.
Ann Thorac Surg ; 108(4): e269-e270, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30878460

RESUMO

Left ventricular unloading during extracorporeal life support aims to minimize potential side effects of increased left ventricular afterload. A transaortic catheter vent implanted through a subclavian approach was used in 2 patients. Patient 1 was a 48-year-old man with a recent history of ST-elevation myocardial infarction who developed refractory cardiogenic shock due to severe biventricular dysfunction. Patient 2 was a 56-year-old man admitted for severe flu. The unloading procedure was successful in both patients, with bridge to heart transplantation in the first case and bridge to recovery in the other.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Choque Cardiogênico/terapia , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Choque Cardiogênico/complicações
12.
Am J Cardiol ; 123(10): 1715-1721, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30879608

RESUMO

In patients with severe peripheral vascular disease, the common femoral artery may be so diseased as to not allow for deployment of mechanical circulatory support (MCS) such as in the setting of cardiogenic shock (CS). We sought to study the feasibility of axillary artery as alternative access for MCS in CS patients with severe occlusive peripheral artery disease (PAD). Records of all patients who presented with CS requiring MCS through axillary artery access from January 2016 to October 2017 were examined. Demographics, clinical, procedural, and outcomes data were collected on all patients. A total of 17 patients (mean age 68 ± 14years, 95% men) were identified. This was due to severe PAD in the iliac and/or common femoral arteries prohibiting large bore sheath access in allcases. Of the 17 patients, 9 required percutaneous coronary intervention. Time from axillary access to activation of Impella was 14.8 ± 4 minutes. Three patients required concomitant Impella RP for right ventricular support due to biventricular CS. Twelve patients died before Impella was explanted due to multiorgan failure, stroke, and infection. None of the patients who died had vascular complications related to axillary access. All 5 patients who survived to Impella explant were discharged from the hospital without major complication. Axillary artery is a safe and feasible alternative access for large bore devices in patients with prohibitive PAD. The meticulous technique described assures a very low rate of access related complications.


Assuntos
Cateterismo Cardíaco/métodos , Coração Auxiliar , Doença Arterial Periférica/complicações , Choque Cardiogênico/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Artéria Axilar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Estudos Retrospectivos , Choque Cardiogênico/complicações , Choque Cardiogênico/mortalidade , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Adulto Jovem
14.
Heart Lung ; 48(2): 126-130, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30470603

RESUMO

OBJECTIVE: Ischemia and reperfusion injury (IRI) in cardiac arrest patients after return to spontaneous circulation causes dysfunctions in multiple organs. Kidney injury is generally transient but in some patients persists and contributes both to mortality and increased resource utilisation. Ongoing shock may compound renal injury from IRI, resulting in persistent dysfunction. We tested whether cardiac dysfunction was associated with the development of persistent acute kidney injury (PAKI) in the first 72 h after cardiac arrest. METHODS: We performed an observational retrospective study from January 2013 to April 2017. We included consecutive patients treated after out-of-hospital cardiac arrest at a single academic medical center with renal function measured and immediately and for 48 h post arrest. We also recorded each patient's pre arrest baseline creatinine, demographic and clinical characteristics. Our primary outcome of interest was PAKI, defined as acute kidney injury (AKI) on at least 2 measurements 24 h apart. We compared demographics and outcomes between patients with PAKI and those without, and used logistic regression to identify independent predictors of PAKI. RESULTS: Of 98 consecutive patients, we excluded 24 for missing data. AKI was present in 75% of subjects on arrival. PAKI developed in 35% of patients. PAKI patients had a longer hospital length of stay (median 21 vs 11 days) and lower hospital survival (47% vs 71%). Serum lactate levels, dosage of adrenaline during resuscitation and days of dobutamine infusion strongly predicted PAKI. CONCLUSIONS: Among patient who survive cardiac arrest, acute AKI is common and PAKI occurs in more than one third. PAKI is associated both with survival and with length of stay at the hospital. High doses of adrenaline, high serial serum lactate levels, and dose of dobutamine predict PAKI. Evaluation of the trajectory of renal function over the first few days after resuscitation can provide prognostic information about patient recovery.


Assuntos
Lesão Renal Aguda/sangue , Creatinina/sangue , Parada Cardíaca Extra-Hospitalar/terapia , Ressuscitação/métodos , Choque Cardiogênico/sangue , Lesão Renal Aguda/etiologia , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/complicações
15.
Perfusion ; 34(1): 35-41, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30024298

RESUMO

BACKGROUND: Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO. METHODS: Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified. All clinical and hemodynamic data, including echocardiographic monitoring, were collected and analyzed. RESULTS: During the study period, 10 subjects (mean age 60 years old, 80% males) underwent IABP implant after peripheral V-A ECMO positioning due to the diagnosis of protracted AV closure and inefficient LV unloading as assessed by echocardiography and an absence of pulsation in the arterial pressure wave. Recovery of blood pressure pulsatility and enhanced LV unloading were observed in 8 patients after IABP placement, with no significant differences in the main hemodynamic parameters, inotropic therapy or in the ECMO flow (p=0.48). The weaning rate in this patient subgroup (mean ECMO duration 8 days), however, was only 10%, with another patient finally transplanted, leading to a 20% survival-to-hospital discharge. CONCLUSION: IABP placement was an effective solution in order to reverse the protracted AV closure and impaired LV unloading observed during peripheral V-A ECMO support. However, the impact on the weaning rate and survival needs further investigations.


Assuntos
Valva Aórtica/fisiopatologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Rejeição de Enxerto/prevenção & controle , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemodinâmica , Balão Intra-Aórtico/métodos , Choque Cardiogênico/complicações , Adulto , Idoso , Valva Aórtica/cirurgia , Circulação Cerebrovascular , Feminino , Rejeição de Enxerto/etiologia , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/cirurgia , Resultado do Tratamento
16.
J Invasive Cardiol ; 30(12): 456-460, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30504514

RESUMO

OBJECTIVES: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is most commonly used in patients with cardiac arrest and cardiogenic shock. There are limited data on the use of VA-ECMO for elective, high-risk percutaneous coronary intervention (PCI). We examined the in-hospital and mid-term clinical outcomes in patients undergoing complex, high-risk PCI with VA-ECMO support. METHODS: . We conducted a retrospective review of ECMO-supported elective high-risk PCIs performed at our institution between May 2012 and May 2017. The electronic medical records and angiograms were individually reviewed. We assessed the in-hospital and mid-term major adverse cardiovascular and cerebrovascular event (MACCE) rates, and reviewed bleeding and vascular complications. RESULTS: Five patients underwent elective high-risk PCI with ECMO support. Mean age was 66.8 ± 8.6 years and all patients were men. The mean ejection fraction was 26.6 ± 18.0%. Most procedures were unprotected left main PCIs. All PCIs were successful; 1 patient required femoral artery surgical repair. The mean hospital stay post procedure was 6.4 ± 2.0 days. ECMO was successfully weaned in all cases, and the duration of ECMO was <24 hours in 4 cases. There was no occurrence of in-hospital and 1-year MACCE. CONCLUSION: ECMO can be successfully used for hemodynamic support during elective high-risk PCI.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/cirurgia , Parada Cardíaca/complicações , Humanos , Infarto do Miocárdio/complicações , Fatores de Risco , Choque Cardiogênico/complicações , Resultado do Tratamento
17.
Medicine (Baltimore) ; 97(49): e13582, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544481

RESUMO

RATIONALE: The Epstein-Barr (EB) virus has rarely been reported as a cause of fulminant myocarditis. To our knowledge, the present case is the first report on myocardial calcification in EB viral myocarditis and rhabdomyolysis. PATIENT CONCERNS: A 17-year-old man was admitted to the department with fever, chest tightness, and tachypnea that had been present for 2 days. DIAGNOSES: The initial investigation showed elevated liver enzyme levels, creatine kinase levels, creatine kinase isoenzyme levels, and elevated serum myoglobin. Echocardiography showed that left ventricular motion amplitude decreased. Test for immunoglobin M and immunoglobin G antibodies against Epstein-Barr virus were positive. These findings were consistent with fulminant myocarditis, cardiogenic shock, and rhabdomyolysis. INTERVENTIONS: The patient was intensively treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), continuous renal replacement therapy (CRRT). OUTCOMES: Myocardial calcification was observed in the left ventricle walls on CT examination 10 days after the admission. Four months later, the patient is still alive and with adequate daily life. LESSONS: This case indicates that this rare form of myocardial calcification may be associated with EB viral infection and rhabdomyolysis.


Assuntos
Calcinose/complicações , Infecções por Vírus Epstein-Barr/complicações , Miocardite/complicações , Rabdomiólise/complicações , Choque Cardiogênico/complicações , Adolescente , Calcinose/diagnóstico , Calcinose/terapia , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/terapia , Coração/diagnóstico por imagem , Humanos , Masculino , Miocardite/diagnóstico , Miocardite/terapia , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/terapia
18.
Expert Rev Med Devices ; 15(11): 807-817, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30343595

RESUMO

INTRODUCTION: Ischemic heart disease is the most common cause of mortality worldwide. In ST elevation myocardial infarction (STEMI) patients, optimization of primary percutaneous coronary intervention (pPCI) is crucial to improve myocardial savage and prevent reperfusion injury. In STEMI patients complicated with cardiogenic shock (CS), percutaneous mechanical circulatory support devices (MCS) have emerged as a therapeutic option in the management of this challenging condition and their use is rapidly increasing. AREAS COVERED: In this review we discuss how pPCI can be optimized with respect to thrombectomy use, stent selection and revascularization strategy, in order to reduce myocardial damage and to improve clinical outcomes. Moreover, we review the recently-published data for and against the use of commercially available MCS in STEMI patients complicated by CS (intra-aortic balloon pump counterpulsation (IABP), Impella system, TandemHeart, and venous-arterial extracorporeal membrane oxygenation (VA-ECMO)). EXPERT COMMENTARY: In pPCI, second-generation drug-eluting stent implantation and complete revascularization are always recommended. Thrombectomy does not have any role in improving mortality. In patients with CS, current MCS have shown no improvement in mortality.


Assuntos
Intervenção Coronária Percutânea/instrumentação , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Animais , Coração Auxiliar , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Choque Cardiogênico/complicações , Stents , Trombose/terapia
19.
BMJ Case Rep ; 20182018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30317201

RESUMO

A 63-year-old man was admitted for severe acute pancreatitis. On day 3 of hospitalisation, he developed shortness of breath and acute pulmonary oedema. Echocardiogram revealed global hypokinesis with a left ventricular ejection fraction of 20%, and he was diagnosed with takotsubo cardiomyopathy. He developed cardiogenic shock which was treated successfully with a percutaneous left ventricular assist device. His left ventricular ejection fraction improved by hospital follow-up 3 weeks later.


Assuntos
Pancreatite/diagnóstico , Choque Cardiogênico/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Diagnóstico Diferencial , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/diagnóstico por imagem , Pancreatite/terapia , Choque Cardiogênico/complicações , Choque Cardiogênico/terapia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/terapia , Tomografia Computadorizada por Raios X
20.
BMC Res Notes ; 11(1): 721, 2018 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-30309379

RESUMO

OBJECTIVES: The purpose of this study was to determine the frequency of in-hospital mortality in 351 patients who developed cardiogenic shock after acute myocardial infarction and by determining this; we might find that how efficiently we could manage this serious condition in our population by knowing the factors which are associated with high mortality after cardiogenic shock. Moreover impact of early revascularization like thrombolytic therapy or angioplasty was also evaluated. RESULTS: Mean age was 65.41 ± 7.78 years in our study. In-hospital mortality with cardiogenic shock after acute myocardial infarction was found to be 44.73%. Significant association of in-hospital mortality was noted with age, hypertension, diabetes mellitus and BMI. Patients receiving early revascularization were noted to have lower in-hospital mortality compared to those in whom revascularization was not done due to delayed presentation. This study concluded that there is a high frequency (44.73%) of in-hospital mortality in patients with cardiogenic shock after acute myocardial in our population. So, we recommend that for achieving a good outcome and to reduce in-hospital mortality; in addition to rapid diagnosis of this condition, underlying risk factors like hypertension and diabetes should be evaluated and managed accordingly and early revascularization should be done when possible.


Assuntos
Ponte de Artéria Coronária/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Infarto do Miocárdio/mortalidade , Revascularização Miocárdica/estatística & dados numéricos , Choque Cardiogênico/mortalidade , Terapia Trombolítica/estatística & dados numéricos , Afeganistão , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/fisiopatologia , Feminino , Hospitais , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/patologia , Infarto do Miocárdio/cirurgia , Obesidade/fisiopatologia , Fatores de Risco , Choque Cardiogênico/complicações , Choque Cardiogênico/patologia , Choque Cardiogênico/cirurgia
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