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1.
Scand Cardiovasc J ; 53(6): 337-341, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476881

RESUMO

Objectives. Coronary revascularisation and intra-aortic balloon pump (IABP) has been considered the gold standard treatment of acute coronary syndrome with cardiogenic shock, recently challenged by the SHOCK II study. The aim of this non-randomised study was to investigate the long term prognosis after immediate IABP supported angiography, in patients with acute chest pain and cardiogenic shock, treated with percutaneous coronary intervention (PCI), cardiac surgery or optimal medical treatment. We assessed data from 281 consecutive patients admitted to our department from 2004 to 2010. Results. Mean (±SD) age was 63.8 ± 11.5 (range 30-84) years with a follow-up of 5.6 ± 4.4 (0-12.7) years. Acute myocardial infarction was the primary diagnosis in 93% of the patients, 4% presented with unstable angina pectoris and 3% cardiomyopathy or arrhythmias of non-ischemic aetiology. Systolic blood pressure at admittance was 85 ± 18 mmHg and diastolic 55 ± 18 mmHg. Thirty day, one- and five-year survival was 71.2%, 67.3% and 57.7%, respectively. PCI was performed immediately in 70%, surgery was done in 17%, and 13% were not eligible for any revascularisation. Independent variables predicting mortality were medical treatment vs revascularisation, out-of-hospital cardiac arrest, and advanced age. Three serious non-fatal complications occurred due to IABP treatment, i.e. 0.001 per treatment day. Conclusions. We report the use of IABP in patients with acute chest pain admitted for angiography. Long-term survival is acceptable and discriminating factors were no revascularisation, out-of-hospital cardiac arrest and age. IABP was safe and feasible and the complication rate was low.


Assuntos
Angina Pectoris/terapia , Fármacos Cardiovasculares/uso terapêutico , Ponte de Artéria Coronária , Balão Intra-Aórtico , Intervenção Coronária Percutânea , Choque Cardiogênico/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/mortalidade , Angina Pectoris/fisiopatologia , Fármacos Cardiovasculares/efeitos adversos , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Feminino , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/mortalidade , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
2.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340947

RESUMO

The Cabrol technique employs a synthetic graft to connect the coronary arteries to an aortic graft in patients with complex disease of the ascending aorta. Acute Cabrol graft thrombosis is a life-threatening situation that presents as acute coronary syndrome, as it leads to acute coronary hypoperfusion. We present a patient with unstable anginal symptoms who had undergone aortic surgery 6 months prior to presentation. Cardiac catheterisation was concerning for aortic dissection yet was later revealed to be acute occlusion of a Cabrol graft. The patient ultimately died of cardiogenic shock. We review the Cabrol technique, complications and management of acute graft thrombosis.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Implante de Prótese Vascular/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/cirurgia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Choque Cardiogênico/diagnóstico , Síndrome Coronariana Aguda/etiologia , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Choque Cardiogênico/etiologia , Trombose
3.
Int Heart J ; 60(4): 1009-1012, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204372

RESUMO

Spontaneous coronary artery rupture (SCAR) is an extremely rare, life-threatening entity without any previous underlying diseases. The clinical presentation may differ according to the site of the rupture and some patients may deteriorate early into sudden death due to the abrupt evolution of the associated cardiac tamponade and cardiogenic shock.1) The correct diagnosis of SCAR deserves a high level of suspicion. It may be confirmed as a differential diagnosis in patients with cardiac tamponade using transthoracic echocardiography (TTE) and computed tomography angiography (CTA) following emergency pericardiocentesis, and a definite diagnosis can be achieved by selective angiography. Although SCAR is associated with a dismal prognosis, some patients have recovered through emergency surgical operations or catheter interventions.2) We report the case of a patient presenting cardiac tamponade and cardiogenic shock due to spontaneous rupture of the circumflex branch of the left coronary artery, which was successfully isolated by bilateral ligation.


Assuntos
Tamponamento Cardíaco/etiologia , Doença da Artéria Coronariana/complicações , Vasos Coronários/diagnóstico por imagem , Choque Cardiogênico/etiologia , Doença Aguda , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pericardiocentese , Ruptura Espontânea , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
4.
Dtsch Med Wochenschr ; 144(13): 884-891, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31252442

RESUMO

Diagnosing and managing patients in shock is a challenge for the treating clinicians in acute medicine. Early diagnosis and treatment are crucial. Mortality of septic shock is between 40 % and 60 %, and that of the cardiogenic shock about 40 %. This article provides an overview of diagnostic approaches to the patient in shock, different aetiologies and treatment strategies, and it guides the clinician through the management from first contact until definite treatment.


Assuntos
Anafilaxia , Choque Cardiogênico , Choque Séptico , Doença Aguda , Anafilaxia/diagnóstico , Anafilaxia/fisiopatologia , Anafilaxia/terapia , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Humanos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Choque Séptico/diagnóstico , Choque Séptico/fisiopatologia , Choque Séptico/terapia
5.
Intern Med ; 58(14): 2045-2049, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30996179

RESUMO

A 72-year-old woman with primary biliary cholangitis was admitted to our hospital with heart failure with a preserved ejection fraction. An accidental right ventricular perforation that occurred during an endomyocardial biopsy precipitated cardiogenic shock. Despite successful surgical treatment, she demonstrated progressive hemodynamic deterioration, which was resistant to the administration of high-dose catecholamines. She was diagnosed with acute adrenal insufficiency, which was attributed to the discontinuation of Celestamine® (betamethasone/dextrochlorpheniramine combination) just after the perforation. Prompt intravenous administration of hydrocortisone (150 mg/day) led to hemodynamic stabilization. The serial noninvasive assessment of systemic vascular resistance using transthoracic echocardiography was instrumental in detecting acute adrenal insufficiency in this case.


Assuntos
Insuficiência Adrenal/tratamento farmacológico , Betametasona/uso terapêutico , Clorfeniramina/uso terapêutico , Insuficiência Cardíaca/fisiopatologia , Hidrocortisona/uso terapêutico , Adesão à Medicação , Resistência Vascular/efeitos dos fármacos , Insuficiência Adrenal/diagnóstico , Idoso , Ecocardiografia , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/tratamento farmacológico , Resultado do Tratamento
6.
J Invasive Cardiol ; 31(5): E95, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034443
7.
Arch Cardiovasc Dis ; 112(5): 343-353, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30982720

RESUMO

BACKGROUND: Most data on the epidemiology of cardiogenic shock (CS) have come from patients with acute myocardial infarction admitted to intensive cardiac care units (ICCUs). However, CS can have other aetiologies, and could be managed in intensive care units (ICUs), especially the most severe forms of CS. AIM: To gather data on the characteristics, management and outcomes of patients hospitalized in ICCUs and ICUs for CS, whatever the aetiology, in France in 2016. METHODS: We included all adult patients with CS between April and October 2016 in metropolitan France. CS was defined (at admission or during hospitalization) by: low cardiac output, defined by systolic blood pressure<90mmHg and/or the need for amines to maintain systolic blood pressure>90mmHg and/or cardiac index<2.2L/min/m2; elevation of the left and/or right heart pressures, defined by clinical, radiological, biological, echocardiographic or invasive haemodynamic overload signs; and clinical and/or biological signs of malperfusion (lactate>2mmol/L, hepatic insufficiency, renal failure). RESULTS: Over a 6-month period, 772 patients were included in the survey (mean age 65.7±14.9 years; 71.5% men) from 49 participating centres (91.8% were public, and 77.8% of these were university hospitals). Ischaemic trigger was the most common cause (36.3%). CONCLUSIONS: To date, FRENSHOCK is the largest CS survey; it will provide a detailed and comprehensive global description of the spectrum and management of patients with CS in a high-income country.


Assuntos
Choque Cardiogênico , Idoso , Idoso de 80 Anos ou mais , Unidades de Cuidados Coronarianos , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dados Preliminares , Prognóstico , Estudos Prospectivos , Sistema de Registros , Projetos de Pesquisa , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Fatores de Tempo
9.
Tex Heart Inst J ; 46(1): 32-35, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30833835

RESUMO

Infections from coxsackie B2 viruses often cause viral myocarditis and, only rarely, multisystem organ impairment. We present the unusual case of a 42-year-old man in whom coxsackie B2 virus infection caused multiorgan infection, necessitating distal pancreatectomy, splenectomy, renal dialysis, and venoarterial extracorporeal membrane oxygenation with mechanical ventilation. In addition, the patient had a rapid-eye-movement sleep-related conduction abnormality that caused frequent sinus pauses of longer than 10 s, presumably due to myocarditis from the coxsackievirus infection. He recovered after permanent pacemaker placement and was discharged from the hospital. We discuss our aggressive supportive care and the few other reports of multiorgan impairment from coxsackieviruses.


Assuntos
Infecções por Coxsackievirus/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Choque Cardiogênico/etiologia , Adulto , Infecções por Coxsackievirus/diagnóstico , Infecções por Coxsackievirus/virologia , Ecocardiografia , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Choque Cardiogênico/diagnóstico , Tomografia Computadorizada por Raios X
10.
J Coll Physicians Surg Pak ; 29(3): 205-209, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823942

RESUMO

OBJECTIVE: To determine the association between hypertensive retinopathy (HR) and post ST elevation myocardial infarction (STEMI) complications among successfully thrombolysed patients. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: Cardiology Unit, Lady Reading Hospital, Peshawar, from June 2016 to December 2017. METHODOLOGY: Patients with history of hypertension for at least 5 years who presented with STEMI and were successfully thrombolysed, were included. On the basis of fundoscopy, patients were grouped into no, mild, moderate, and severe hypertensive retinopathy. Primary and secondary endpoints included a composite of death, re-MI, stroke, re-hospitalisation secondary to left ventricular failure, cardiogenic shock, arrhythmia, heart block, and ventricular septal rupture at 30 days and 4 months, respectively. Association between hypertensive retinopathy and post STEMI complications was determined by Chi-square test. Regression model was used to calculate relative risk of complications with hypertensive retinopathy. P <0.05 was taken as significant. RESULTS: A total of 118 patients with a mean age of 54.83 ±8.6 years were included in the study. Of these, 49.2% (n=58) were males. Moreover, 38.1% (n=45) of patients were grouped under no HR, 22.8% (n=27) under mild HR, 21.1% (n=25) and 17.7% (n=21) under moderate and severe HR, respectively. Primary endpoints achieved were 0% in no HR group and 19% in severe HR group x² = 18.1, p <0.001). Secondary endpoints were achieved in 2.2% in no HR group and 40.7%, 56% and 100% in mild, moderate and severe HR group, respectively, ( x² = 81.1, p <0.001). HR also increased the relative risk of complications by 3.17 times (p <0.001) and death by 1.75 times (p <0.001). CONCLUSION: Hypertensive retinopathy is an independent risk factor for post-acute STEMI complications in successfully thrombolysed patients and increased the relative risk for complications by 3.17 times.


Assuntos
Causas de Morte , Insuficiência Cardíaca/epidemiologia , Retinopatia Hipertensiva/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Choque Cardiogênico/epidemiologia , Ruptura do Septo Ventricular/epidemiologia , Doença Aguda , Distribuição por Idade , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Comorbidade , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/epidemiologia , Insuficiência Cardíaca/diagnóstico , Humanos , Retinopatia Hipertensiva/diagnóstico , Retinopatia Hipertensiva/terapia , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paquistão , Intervenção Coronária Percutânea/métodos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Índice de Gravidade de Doença , Distribuição por Sexo , Choque Cardiogênico/diagnóstico , Taxa de Sobrevida , Ruptura do Septo Ventricular/diagnóstico
12.
Can J Cardiol ; 35(2): 229.e7-229.e9, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30760435

RESUMO

We describe the case of a 68-year-old woman presenting with stress cardiomyopathy (SCM), with concomitant cardiogenic shock, left ventricular outflow tract obstruction, and ventricular septal rupture. These complications have not simultaneously been reported in a single SCM case. The importance of early diagnosis of serial complications of SCM and using mechanical circulatory support as a treatment strategy are highlighted.


Assuntos
Choque Cardiogênico/etiologia , Cardiomiopatia de Takotsubo/complicações , Obstrução do Fluxo Ventricular Externo/etiologia , Ruptura do Septo Ventricular/etiologia , Idoso , Ecocardiografia Doppler em Cores , Evolução Fatal , Feminino , Humanos , Choque Cardiogênico/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Obstrução do Fluxo Ventricular Externo/diagnóstico , Ruptura do Septo Ventricular/diagnóstico
14.
Asian Cardiovasc Thorac Ann ; 27(4): 304-306, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30798610

RESUMO

A neonate was diagnosed with ventricular septal defect and aortic coarctation. Bilateral pulmonary artery banding was performed at 9 days of age (weight 1472 g). Because of ductal shock, emergency extracorporeal membrane oxygenation was initiated after surgery. Fine adjustment of the bilateral pulmonary artery banding sites using hemoclips was carried out to facilitate weaning from extracorporeal membrane oxygenation, and staged delayed sternal closure was achieved. Arch repair, ventricular septal defect closure, and tricuspid annuloplasty were undertaken when the patient was 4-months old (weight 1.8 kg). She was discharged at 11 months of age (3.0 kg).


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Oxigenação por Membrana Extracorpórea , Cardiopatias Congênitas/cirurgia , Recém-Nascido de Baixo Peso , Choque Cardiogênico/terapia , Peso ao Nascer , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Recém-Nascido , Recuperação de Função Fisiológica , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Resultado do Tratamento
15.
Semin Thorac Cardiovasc Surg ; 31(3): 327-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30616006

RESUMO

Utilization of extracorporeal membrane oxygenation (ECMO) has increased dramatically over the last decade. Despite this trend, many medical centers have limited, if any, access to this technology or the resources necessary to manage these complex patients. In an effort to improve the current infrastructure of regional ECMO care, ECMO centers of excellence have an obligation to partner with facilities within their communities and regions to increase access to this potentially life-saving technology. While the need for this infrastructure is widely acknowledged in the ECMO community, few reports describe the actual mechanisms by which a successful interfacility transport program can operate. As such, the purpose of this document is to describe the elements of and methods for providing safe and efficient mobile ECMO services from the perspective of an experienced, high-volume tertiary ECMO center of excellence in the Southeastern United States.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Oxigenação por Membrana Extracorpórea , Transferência de Pacientes/organização & administração , Encaminhamento e Consulta/organização & administração , Regionalização/organização & administração , Insuficiência Respiratória/terapia , Choque Cardiogênico/terapia , Tomada de Decisão Clínica , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Humanos , Equipe de Assistência ao Paciente/organização & administração , Seleção de Pacientes , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Resultado do Tratamento , Triagem
16.
Arch Cardiovasc Dis ; 112(4): 253-260, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30612896

RESUMO

BACKGROUND: Post cardiac arrest shock (PCAS) occurring after resuscitated cardiac arrest (CA) is a main cause of early death. Extracorporeal life support (ECLS) could be useful pending recovery from myocardial failure. AIM: To describe our PCAS population, and the factors associated with initiation of ECLS. METHODS: This analysis included 921 patients admitted to two intensive care units between 2005 and 2014 for CA and PCAS; 43 of these patients had ECLS initiated. Neurological and ECLS-related outcomes were gathered retrospectively. RESULTS: The 43 patients treated with ECLS were predominantly (70%) young males with evidence of myocardial infarction on coronary angiography. ECLS was initiated in patients with severe cardiovascular dysfunction (median left ventricular ejection fraction 15% [interquartile range 10-25%]), a median of 9hours [interquartile range 6-16hours] after the CA. At 1 year, eight patients (19%) had survived without neurological disability. Blood lactate and coronary aetiology were associated with neurological outcomes. Logistic regression conducted using 878 controls with PCAS identified age>62 years, location of CA, use of a high dose of adrenaline (>3mg) and blood lactate and serum creatinine concentrations (>5mmol/L and>109µmol/L, respectively) as risk factors for initiation of ECLS. CONCLUSIONS: ECLS, as a salvage therapy for PCAS, could be an acceptable alternative for highly-selected patients.


Assuntos
Reanimação Cardiopulmonar , Circulação Extracorpórea/métodos , Parada Cardíaca/terapia , Choque Cardiogênico/terapia , Adulto , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/mortalidade , Tomada de Decisão Clínica , Circulação Extracorpórea/efeitos adversos , Circulação Extracorpórea/mortalidade , Parada Cardíaca/diagnóstico , Parada Cardíaca/mortalidade , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Paris , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Volume Sistólico , Síndrome , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
17.
Enzyme Microb Technol ; 123: 30-38, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30686348

RESUMO

The nanoparticles of commercially available pyruvate oxidase (POx) from Aerococcus species were prepared by desolvation method, which were then characterized and covalently immobilized onto gold electrode (AuE) to construct an improved model of amperometric pyruvate biosensor. The POxNPs/Au electrode was analyzed morphologically by scanning electron microscopy (SEM). On the other hand, cyclic voltammetry studies (CV) and electrochemical impedance spectroscopy (EIS) helped in deciphering the electrochemical properties of the electrode at different stages of construction. The biosensor showed optimum response within 7.5 s, at a potential of 0.28 V, pH 5.5 and 35 °C. A linear relationship was observed between biosensor response i.e. current (µA) and pyruvate concentration in the range, 0.01 µM - 5000 µM, with a lower detection limit of 0.67 µM. The analytical recovery of added pyruvate in sera was 99.0% and 99.5% within and between batch coefficient of variation (CV) were 0.045% and 0.040% respectively. The working electrode displayed an excellent correlation coefficient (R2 = 0.99%) between levels of pyruvate in sera, as detected by the standard spectrophotometric method and the present biosensor. The biosensor was utilized for detection of total pyruvate level in sera of apparently healthy individuals and patients suffering from cardiogenic stress, more specifically cardiac failure. The activity of the biosensor deteriorated by 25%, after its regular use over a period of 240 days, while being stored dry at 4°C.


Assuntos
Técnicas Biossensoriais/métodos , Enzimas Imobilizadas/química , Ouro/química , Nanopartículas Metálicas/química , Ácido Pirúvico/sangue , Choque Cardiogênico/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/diagnóstico
18.
Sci Rep ; 9(1): 91, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30643187

RESUMO

Proactive detection of hemodynamic shock can prevent organ failure and save lives. Thermal imaging is a non-invasive, non-contact modality to capture body surface temperature with the potential to reveal underlying perfusion disturbance in shock. In this study, we automate early detection and prediction of shock using machine learning upon thermal images obtained in a pediatric intensive care unit of a tertiary care hospital. 539 images were recorded out of which 253 had concomitant measurement of continuous intra-arterial blood pressure, the gold standard for shock monitoring. Histogram of oriented gradient features were used for machine learning based region-of-interest segmentation that achieved 96% agreement with a human expert. The segmented center-to-periphery difference along with pulse rate was used in longitudinal prediction of shock at 0, 3, 6 and 12 hours using a generalized linear mixed-effects model. The model achieved a mean area under the receiver operating characteristic curve of 75% at 0 hours (classification), 77% at 3 hours (prediction) and 69% at 12 hours (prediction) respectively. Since hemodynamic shock associated with critical illness and infectious epidemics such as Dengue is often fatal, our model demonstrates an affordable, non-invasive, non-contact and tele-diagnostic decision support system for its reliable detection and prediction.


Assuntos
Aprendizado de Máquina , Imagem Óptica/métodos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/patologia , Termometria/métodos , Adolescente , Pressão Sanguínea , Criança , Pré-Escolar , Frequência Cardíaca , Humanos , Lactente , Estudos Longitudinais , Masculino , Modelos Estatísticos
19.
Rev. esp. anestesiol. reanim ; 66(1): 53-56, ene. 2019.
Artigo em Espanhol | IBECS | ID: ibc-177291

RESUMO

Pese a que fue descrito hace casi 3 décadas, ha sido en los últimos años cuando se ha producido un incremento notable en la comunicación de casos de síndromes coronarios agudos desarrollados en el contexto de reacciones alérgicas, entidad que es conocida como síndrome de Kounis. En este artículo nos planteamos esta posibilidad diagnóstica ante un fracaso biventricular agudo en el transcurso de una reacción anafiláctica durante el intraoperatorio de una cirugía valvular cardiaca


Although Kounis syndrome was described almost 3 decades ago, there has been a notable increase in the reports of cases of acute coronary syndromes developed in the context of allergic reactions, also known as Kounis syndrome. This article discusses the diagnostic possibility in the face of an acute biventricular failure in the course of an anaphylactic reaction during the intra-operative period of a cardiac valve surgery


Assuntos
Humanos , Masculino , Idoso , Anafilaxia/diagnóstico , Síndrome Coronariana Aguda/diagnóstico , Disfunção Ventricular/complicações , Choque Cardiogênico/diagnóstico , Implante de Prótese de Valva Cardíaca/métodos , Diagnóstico Diferencial , Anafilaxia/complicações , Síndrome Coronariana Aguda/complicações , Insuficiência da Valva Mitral/cirurgia
20.
Rev. esp. cardiol. (Ed. impr.) ; 72(1): 40-47, ene. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182497

RESUMO

Introducción y objetivos: Este estudio investigó si la escala de vasoactivos inotrópicos (VIS) es un predictor independientemente de la mortalidad en el shock cardiogénico (SC). Métodos: Estudio observacional retrospectivo. Se estudió a los pacientes que ingresaron entre enero de 2012 y diciembre de 2015 en la unidad de cuidados intensivos cardiacos, y finalmente se incluyó a 493 pacientes con SC. Para cuantificar el apoyo farmacológico, se dividió a los pacientes en quintiles de VIS: 1-10, 11-20, 21-38, 39-85 y > 85 puntos. El objetivo primario fue la mortalidad hospitalaria. Resultados: La mortalidad hospitalaria de los quintiles de VIS, en orden creciente, fue del 8,2, el 14,1, el 21,1, el 32,0 y el 65,7% respectivamente (p < 0,001). El análisis multivariable indicó que los valores de VIS de 39-85 (ORa = 3,85; IC95%, 1,60-9,22; p = 0,003) y > 85 puntos (ORa = 10,83; IC95%, 4,43-26,43; p < 0,001) siguieron siendo predictores de mortalidad hospitalaria. En la regresión logística múltiple para eliminar cualquier efecto de confusión, se halló que la probabilidad de muerte (tratamiento solo médico frente a combinado con oxigenador extracorpóreo de membrana) se cruzaron entre sí cuando el valor de VIS era de 130 puntos. En contraste con la correlación lineal entre la VIS y la mortalidad de los pacientes tratados solo con terapia médica, hubo poca asociación entre VIS ≥ 130 puntos y la mortalidad hospitalaria de los pacientes tratados además con membrana de oxigenación extracorpórea. Conclusiones: Un alto grado de apoyo con vasoactivos inotrópicos durante las primeras 48 h se asocia significativamente con mayor mortalidad hospitalaria de pacientes adultos con SC


Introduction and objectives: This study investigated whether the vasoactive inotropic score (VIS) is independently predictive of mortality in cardiogenic shock (CS). Methods: This study was retrospective, observational study. Patients who were admitted to the cardiac intensive care unit from January 2012 to December 2015 were screened, and 493 CS patients were finally enrolled. To quantify pharmacologic support, the patients were divided into 5 groups based on a quintile of VIS: 1 to 10, 11 to 20, 21 to 38, 39 to 85, and > 85. The primary outcome was in-hospital mortality. Results: In-hospital mortalities in the 5 VIS groups in increasing order were 8.2%, 14.1%, 21.1%, 32.0%, and 65.7%, respectively (P < .001). Multivariable analysis indicated that VIS ranges of 39 to 85 (aOR, 3.85; 95%CI, 1.60-9.22; P = .003) and over 85 (aOR, 10.83; 95%CI, 4.43-26.43; P < .001) remained significant prognostic predictors for in-hospital mortality. With multiple logistic regression to remove any confounding effects, we found that the localized regression lines regarding the odds of death intersected each other's (medical therapy alone and combined extracorporeal membrane oxygenation group) path at VIS = 130. In contrast to linear correlation between VIS and mortality for patients treated with medical therapy alone, there was little association between a VIS of 130 or more and the probability of in-hospital mortality for patients who were treated with extracorporeal membrane oxygenation. Conclusions: A high level of vasoactive inotropic support during the first 48 hours was significantly associated with increased in-hospital mortality in adult CS patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Cardiotônicos/sangue , Choque Cardiogênico/diagnóstico , Oxigenação por Membrana Extracorpórea/métodos , Choque Cardiogênico/mortalidade , Fatores de Risco , Biomarcadores/análise , Cardiotônicos/efeitos adversos
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