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Medworm: Cardiogenic Shock - Recent Medical Updates

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Incorporating patient preferences into clinical trial design: Results of the Opinions of Patients on Treatment Implications of New Studies (OPTIONS) project Stafinski: Patient Opinions on Clinical Trial Design
Conclusions While patients’ preferences appear to be comparable to those of clinicians, patients may be less willing than clinicians to tolerate potential treatment complications. The methods used in this study offer a feasible approach to incorporating patient preferences into cardiovascular trials and warrant further investigation in broader patient populations. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Large Coronary Intramural Hematomas: A Case Series and A Focused Literature Review
Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial-adventitial layers, causing subsequent hematoma formation without visible intimal flaps. It is an infrequent and serious coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. (Source: Cardiovascular Revascularization Medicine)


Cardiogenic shock after use of fluoroamphetamine confirmed with serum and urine levels - Al-Abri SA, Meier KH, Colby JM, Smollin CG, Benowitz NL.
Context. 4-Fluoroamphetamine (4-FA) is a para-substituted phenethylamine-type synthetic stimulant that has in recent years gained popularity through internet blogs and market share according to confiscated drug data. No serious toxicity has previously been... (Source: SafetyLit: All (Unduplicated))


Pertussis in the Newborn: certainties and uncertainties in 2013
Bordetella pertussis infection carries a high risk of mortality in newborns and vulnerable unimmunized young infants. The disease may develop a fulminant course characterized by pneumonia that rapidly evolves to respiratory failure with refractory hypoxemia, pulmonary hypertension, extreme leukocytosis and cardiogenic shock requiring cardiovascular support An outbreak is now under way and it is time to recognize the successes of the past and to implement new directions for the control of pertussis. (Source: Paediatric Respiratory Reviews)


An insight into short- and long-term mechanical circulatory support systems
Abstract Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac surgery, or manifestation of heart failure remains a clinical challenge with high mortality rates, despite ongoing advances in surgical techniques, widespread use of primary percutaneous interventions, and medical treatment. Clinicians have, therefore, turned to mechanical means of circulatory support. At present, a broad range of devices are available, which may be extracorporeal, implantable, or percutaneous; temporary or long term. Although counter pulsation provided by intra-aortic balloon pump (IABP) and comprehensive mechanical support for both the systemic and the pulmonary circulation through extracorporeal membrane oxygenation (ECMO) remain a major tool of acute care i...


Support with intra-aortic balloon pump vs. Impella2.5® and blood flow to the heart, brain and kidneys – an experimental porcine model of ischaemic heart failure
Cardiogenic shock as a complication to an acute myocardial infarction has an unacceptably high death rate that has not changed for the last 15years. Mortality is partly related to organ hypoperfusion and mechanical assist devices are used for the most severe cases but we do not know which assist device is the best option. Therefore, we have investigated how an IABP and an Impella®-pump influenced blood flow to the brain, heart and kidneys, in a closed-chest porcine model of severe left ventricular failure. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The Effect of the Sequential Therapy in End-Stage Heart Failure (ESHF) - from ECMO, Through the Use of Implantable Pump for a Pneumatic Heart assist System, Religa Heart EXT, as a Bridge for Orthotopic Heart Transplant (OHT). Case Study.
Conclusions Application of short-term ECMO as a bridge-to-bridge helped save the patient from severe cardiogenic shock caused by increased left ventricular afterload. The experimental implantation of an innovative Religa Heart EXT prosthesis was a safe and efficacious bridge to transplantation. Too short time of Religa Heart EXT implantation in the discussed patient prevented the possibility to evaluate the occurrence of thromboembolic complications and infections compared to the documented complications of POLVAD implanted until now. OHT is a safe and efficacious method of treatment of patients previously supported by ECMO and Religa Heart EXT. PMID: 25330851 [PubMed - in process] (Source: Annals of Transplantation)


Efficacy and Safety of Out-of-Hospital Intravenous Metoprolol Administration in Anterior ST-Segment Elevation Acute Myocardial Infarction: Insights From the METOCARD-CNIC Trial
Conclusion Out-of-hospital administration of intravenous metoprolol by EMS within 4.5 hours of symptom onset in our subjects reduced infarct size and improved left ventricular ejection fraction with no excess of adverse events during the first 24 hours. (Source: Annals of Emergency Medicine)


Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock
Conclusions The mortality of patients with CS despite treatment with IABP remains very high, especially during the in-hospital period and early after discharge. Among assessed parameters age and hypotension on the admission are the most important predictors of adverse long term prognosis. (Source: Advances in Medical Sciences)


Multivessel disease in a patient taken to the catheter laboratory with acute myocardial infarction and cardiogenic shock.
Authors: Gülşen K, Cerit L, Ozcem B, Conkbayır C, Okçün B PMID: 25341488 [PubMed - as supplied by publisher] (Source: The Anatolian Journal of Cardiology)


Prevalence, associated factors and management implications of left ventricular outflow tract obstruction in takotsubo cardiomyopathy: a two-year, two-center experience
Background: Some patients with Takotsubo cardiomyopathy (TTC) develop cardiogenic shock due to left ventricular outflow tract (LVOT) obstruction - there is, however, a paucity of data regarding this condition. Methods: Prevalence, associated factors and management implications of LVOT obstruction in TTC was explored, based on two-year data from two Belgian heart centres. Results: A total of 32 patients with TTC were identified out of 3,272 patients presenting with troponin-positive acute coronary syndrome. In six patients diagnosed with TTC (19%), a significant LVOT obstruction was detected by transthoracic echocardiography. Patients with LVOT obstruction were older and had more often septal bulging, and presented more frequently in cardiogenic shock as compared to those without LVOT obstr...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Mitral prosthetic valve thrombosis and cardiogenic shock in a limited resources setting in sub-Saharan Africa: A tailored treatment approach
We thank Dr Dogan and Colleagues for their comment on our previously described case [1] and for their contribution on the therapy of prosthetic valve thrombosis (PVT) during pregnancy [2–4]. (Source: International Journal of Cardiology)


Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States
Recent improvement in the care of patient with myocardial infarction should lead to better outcome. The goal of this study was to evaluate the incidence of all cause cardiogenic shock (CS) and CS occurring in the setting of ST elevation myocardial infarction (STEMI) in the United States. (Source: Cardiovascular Revascularization Medicine)


Reply Early Intravenous Beta-Blockade Before Primary Percutaneous Coronary Intervention Gives Major Benefits Apparently Without Side Effects
We appreciate the comment by our admired Professor Opie regarding the potential side effects of early intravenous (IV) beta-blockers in patients with ST-segment elevation myocardial infarction (STEMI). Our paper described the long-term follow-up of patients in the METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial (1). The acute effects of IV metoprolol in this trial were reported in a previous publication (2). In the first publication, we described the incidence of adverse events during admission (those that can be ascribed to an acute single administration of IV metoprolol before primary angioplasty): death during admission (2.1% vs. 2.3% in IV metoprolol vs. control, respectively), advanced atrioventricular block (0.7% vs. 1.5%), cardiog...


Design and rationale of the TOTAL trial: A randomized trial of routine aspiration ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI
The objective of this study is to evaluate the efficacy of routine upfront manual aspiration thrombectomy during PPCI compared with percutaneous coronary intervention alone in patients with STEMI. Design This is a multicenter, prospective, open, international, randomized trial with blinded assessment of outcomes. Patients with STEMI undergoing PPCI are randomized to upfront routine manual aspiration thrombectomy with the Export catheter (Medtronic CardioVascular, Santa Rosa, CA) or to percutaneous coronary intervention alone. The primary outcome is the composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening New York Heart Association class IV heart failure up to 180 days. The trial uses an event-driven design and will recruit 10,700 patie...


Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention
Abstract In an effort to improve outcomes in percutaneous coronary intervention (PCI), percutaneous ventricular assist devices (PVADs) have been investigated in (1) high-risk PCI, (2) acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) and (3) in AMI without CS. PCI has become an increasing complex due to an ageing population with complex disease and the frequent presence of impaired LV function. Patients undergoing high-risk PCI in these circumstances are prone to acute cardiovascular collapse. Additionally, mortality in AMI complicated by CS remains high. Lastly, LV support during AMI may reduce infarct size and therefore preserve LV function. At present, four commercially available devices exist: intra-aortic balloon pump counterpulsation (IABP), Impella, T...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


There Is a Pressing Need for an Evidence-Based Algorithm for Mechanical Circulatory Support in Cardiogenic Shock
No abstract available (Source: Critical Care Medicine)


Percutaneous coronary intervention for acute myocardial infarction due to unprotected left main coronary artery occlusion: Status update 2014
Abstract Acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) occlusion is an uncommon clinical entity, but often leads to severe clinical deterioration, with devastating sequalae including fatal arrhythmias, abrupt and severe circulatory failure, and sudden cardiac death. Recent guidelines have promoted treatment with percutaneous coronary intervention (PCI) as a class IIa recommendation alongside coronary artery bypass grafting (CABG), but the data are still unclear regarding optimal revascularization strategy for patients with ST‐segment elevation myocardial infarction (STEMI) and non‐STEMI (NSTEMI) with ULMCA culprit. PCI has the advantages of offering rapid reperfusion to critically ill patients, often those with prohibitive risk for surgical reva...


Pheochromocytoma Supporting Blood Pressure In The Setting Of Cardiogenic Shock
We describe the case of a 67-year-old male with significant cardiac history who presented to hospital with severe abdominal pain, nausea, vomiting and decreasing level of consciousness. The patient was tachycardic (130 - 150bpm), had a glucose of 1.0mmol/L, and fluctuating level of consciousness with initial GCS of 13. However, the patient was not hypotensive. Further decompensation and a resultant lactic acidosis prompted the need for intubation and ventilation. A CT scan of the thorax, abdomen and pelvis revealed a large peripherally enhancing mass arising from the left adrenal gland. (Source: Clinical Imaging)


GW25-e2173 The Application of Intraaortic Balloon counterpulsation for Acute Myocardial Infarction with Cardiogenic Shock
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


Acute management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: Are we complying with practice guidelines? Phase active de prise en charge des infarctus du myocarde avec élévation du segment ST dans un hôpital tertiaire au Kenya. Les directives pratiques sont-elles respectées?
Conclusion Whereas the majority of STEMI patients are evaluated within 10min of presentation, less than 50% receive reperfusion therapy within the recommended time frame. While there are attempts to comply with evidence based guidelines in resource-limited settings, there is a need to improve acute care systems to target early reperfusion of STEMI patients. (Source: African Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Extra-corporeal membrane oxygenation for the post-cardiotomy patient
Abstract Extra-corporeal membrane oxygenation remains the last resort in keeping patients alive in those with profound cardiogenic shock following percutaneous interventions or open surgery on the heart. No guidelines exist on the management of patients on such a device despite a high mortality. We attempt to highlight some universal principles that would be relevant to the current practice of those exposed to this challenging field. (Source: Heart Failure Reviews)


Does ivabradine really limit dobutamine induced tachycardia in stable heart failure patients: Parallax in significance
We have recently read with great interest the article by Gallet et al. which is assessing the effects of dobutamin and ivabradine in patients with stable heart failure and in refractory cardiogenic shock patients [1]. We, however, would like to address three major aspects. Although the authors claimed that the current study is the first to evaluate hemodynamic effects of ivabradine in addition to dobutamine in patients with severe systolic dysfunction, we have recently shown in a randomized, placebo-controlled trial that the dobutamine induced increase in heart rate (HR) was blunted by ivabradine treatment in patients hospitalized with acute decompensated heart failure [2]. (Source: International Journal of Cardiology)


Does ivabradine really limit dobutamine-induced tachycardia in stable heart failure patients: Parallax in significance
We have recently read with great interest the article by Gallet et al. which is assessing the effects of dobutamine and ivabradine in patients with stable heart failure and in refractory cardiogenic shock patients [1]. We, however, would like to address three major aspects. Although the authors claimed that the current study is the first to evaluate hemodynamic effects of ivabradine in addition to dobutamine in patients with severe systolic dysfunction, we have recently shown in a randomized, placebo-controlled trial that the dobutamine-induced increase in heart rate (HR) was blunted by ivabradine treatment in patients hospitalized with acute decompensated heart failure [2]. (Source: International Journal of Cardiology)


Trends in Early Aspirin Use Among Patients With Acute Myocardial Infarction in China, 2001-2011: The China PEACE-Retrospective AMI Study [Coronary Heart Disease]
Conclusions Despite improvements in early use of aspirin for AMI in China, there remains marked variation in practice and opportunities for improvement that are concentrated in some hospitals and patient groups. Clinical Trial Registration URL: ClinicalTrials.gov Unique identifier: NCT01624883. (Source: JAHA:Journal of the American Heart Association)


Adjunctive mild hypothermia therapy to primary percutaneous coronary intervention in patients with ST segment elevation myocardial infarction complicated with cardiogenic shock: A pilot feasibility study.
Conclusion: TH as adjunctive therapy in STEMI patients complicated with CS is feasible and safe. Based on these preliminary observations there appears to be no significant clinical advantage to this form of therapy. PMID: 25299501 [PubMed - as supplied by publisher] (Source: Cardiology Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial
Conclusion In this large-scale multicenter study in patients with CS complicating AMI, women had a worse-risk profile in comparison to men. No significant gender-related differences in treatment as well as short- and long-term outcome were observed. (Source: Clinical Research in Cardiology)


Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures
Conclusions The current study demonstrates that postoperative pulmonary complications represent a significant source of morbidity and incremental cost after major small intestinal and colon surgery and have greater incidence and costs than cardiac complications alone. Therefore, strategies to reduce the incidence of these complications should be targeted as means of improving health and bending the cost curve in health care. (Source: Perioperative Medicine)


Cardiogenic Shock And Coronary Endothelial Dysfuction Predict Cardiac Allograft Vasculopathy After Heart Transplantation
This article is protected by copyright. All rights reserved. (Source: Clinical Transplantation)


Fulminant myocarditis associated with the H1N1 influenza virus: case report and literature review
Caso de miocardite fulminante associada ao vírus influenza H1N1, em que foi descrita a evolução clínica do paciente e enfatizada a importância do ecocardiograma à beira do leito como auxílio no diagnóstico precoce e manejo de crianças com disfunção miocárdica grave, além de terem sido discutidos aspectos relevantes relacionados à terapêutica e ao prognóstico da miocardite fulminante. Trata-se de paciente do sexo feminino, 4 anos e 8 meses, previamente hígida, com história de quadro gripal há 2 semanas. Admitida no pronto-socorro com sinais de instabilidade hemodinâmica, necessitando de suporte ventilatório e drogas vasoativas. Exames laboratoriais, radiografia de tórax e ecocardiograma sugestivos de miocardite. Pesquisa positiva para H1N1 em secreção de nasofaringe....


Erratum
Caso de miocardite fulminante associada ao vírus influenza H1N1, em que foi descrita a evolução clínica do paciente e enfatizada a importância do ecocardiograma à beira do leito como auxílio no diagnóstico precoce e manejo de crianças com disfunção miocárdica grave, além de terem sido discutidos aspectos relevantes relacionados à terapêutica e ao prognóstico da miocardite fulminante. Trata-se de paciente do sexo feminino, 4 anos e 8 meses, previamente hígida, com história de quadro gripal há 2 semanas. Admitida no pronto-socorro com sinais de instabilidade hemodinâmica, necessitando de suporte ventilatório e drogas vasoativas. Exames laboratoriais, radiografia de tórax e ecocardiograma sugestivos de miocardite. Pesquisa positiva para H1N1 em secreção de nasofaringe....<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Myocarditis in Adult-Onset Still Disease
This study highlights the clinical features, treatments, and outcomes of the rare myocarditis in adult-onset Still disease (AOSD). Among a case series of 57 patients fulfilling either Yamaguchi or Fautrel AOSD criteria and seen between 1998 and 2010, we identified 4 cases of myocarditis. From a comprehensive literature review, we collected 20 additional cases of myocarditis-complicated AOSD. The characteristics of patients with myocarditis were compared with those of AOSD patients without myocarditis. In these 24 myocarditis-complicated AOSD cases, myocarditis occurred early and was present at AOSD onset in 54% of the cases. Myocarditis was often symptomatic (96% of patients) with nonspecific electrocardiographic abnormalities (79% of patients) and a left ventricle ejection fraction ≤50%...


The previous use of digoxin does not worsen early outcome of acute coronary syndromes: an analysis of the ARIAM Registry
Abstract The aim of the study was to determine the influence of the previous use of digoxin on the hospital mortality and complications of patients admitted because of acute coronary syndrome (ACS). We analyzed the data of patients included in the ARIAM-Andalucia Registry, which involves 49 hospitals in Andalucia, Spain, from 2007 to 2012. Patients on digoxin treatment prior to their admission because of ACS constituted the digoxin group (DG), and were compared with the group of patients not on digoxin. Logistic regression and propensity score matching were used to analyze the differences. We included 20,331 patients, of whom 244 (1.2 %) were on digoxin. DG patients were older (73.1 vs 63.7 years old), more often women, and had more diabetes, hypertension, previous myocardi...


National Trends in the Utilization of Short-Term Mechanical Circulatory Support Incidence, Outcomes, and Cost Analysis
ConclusionsUse of short-term MCS in the United States has increased rapidly, whereas rates of in-hospital mortality have decreased. These changes have taken place in the context of declining hospital costs associated with short-term MCS. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)


The Changing Landscape of Advanced Heart Failure Therapeutics ∗
The past decade has witnessed a rapid evolution in the tools available to treat patients with severe left ventricular systolic dysfunction. Gone are the days of managing advanced heart failure with medical therapy alone. Patients with heart failure who present for tertiary and quaternary cardiovascular care are often those who have received evidence-based medical and electrical therapies but have residual hemodynamic compromise. The intra-aortic balloon pump (IABP), historically used for its relative simplicity, has not withstood the vicissitudes of rigorous clinical trials. The modest hemodynamic support IABP provides has not been associated with survival improvements in either acute myocardial infarction (AMI) or cardiogenic shock (1,2). (Source: Journal of the American College of Cardi...


Myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs
Abstract The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups—control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P &lt; 0.05). At the end of the experiments, LV − dp/dt among t...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Ivabradine: A promising drug in cardiogenic shock to prevent the undesirable sinus tachycardia induced by dobutamine?
Severe systolic Heart Failure (HF) and especially the ultimate form represented by cardiogenic shock are associated with a very poor prognosis including a very high in hospital mortality. Inotropic drugs are until now the cornerstone of the management of cardiogenic shock. By contrast, both guidelines from the ACC/AHA and ESC recommend limited use of the inotropic agents for the management of acute HF [1,2]. Indeed, on the one hand these drugs exert a dose dependent inotropic and chronotropic positive effect leading to cardiac output increase and left ventricle (LV) filling pressures decrease, but on the other hand they expose to side-effects such as particularly induced sinus tachycardia that may in turn induce detrimental myocardial ischemia and arrhythmias and importantly as regards pat...


Mitigation of autophagy ameliorates hepatocellular damage following ischemia reperfusion injury in murine steatotic liver.
Authors: Gupta NA, Kolachala VL, Jiang R, Abramowsky C, Shenoi A, Kosters A, Pavuluri H, Anania FA, Kirk AD Abstract Ischemia reperfusion injury (IRI) is a common clinical consequence of hepatic surgery, cardiogenic shock, and liver transplantation. A steatotic liver is particularly vulnerable to IRI, responding with extensive hepatocellular injury. Autophagy, a lysosomal pathway balancing cell survival and cell death, is engaged in IRI, though its role in IRI of a steatotic liver is unclear. The role of autophagy was investigated in high fat diet-fed mice exposed to IRI in vivo and in steatotic hepatocytes subjected to hypoxia, ischemia reperfusion injury (HIRI) in vitro. Two inhibitors of autophagy, 3-methyladenine and bafilomycin A1 protected the steatotic hepatocytes from HIRI....


Monitoring the microcirculation in critically ill patients
Alterations in microvascular perfusion have been identified in critically ill patients, especially in sepsis but also in cardiogenic shock, after cardiac arrest, and in high risk surgery patients. These alterations seem to be implicated in the development of organ dysfunction and are associated with outcome. Even though microvascular perfusion can sometimes be homogenously decreased as in acute hemorrhage or in non-resuscitated cardiogenic shock, heterogeneity of perfusion is observed in sepsis and in resuscitated hemorrhagic/cardiogenic shock. (Source: Best Practice and Research. Clinical Anaesthesiology)


125 * total arch replacement versus more conservative management in type a acute aortic dissection
Conclusion: In our experience TAR and CAM were associated with similar hospital mortality and morbidity rates. Nevertheless, the more extensive arch interventions were not protective for long-term survival and freedom from aortic re-intervention. Thus, in TAAD patients, TAR remains indicated by site of intimal tear and patient-specific factors. (Source: Interactive CardioVascular and Thoracic Surgery)


258 * predictors of prolonged intensive care unit stay in patients undergoing minimally invasive right thoracotomy valve surgery: a single institution analysis with 2272 patients
Conclusion: Eight independent preoperative risk factors for a prolonged ICU stay following right thoracotomy valve surgery were identified. Using this risk model, one can predict whether a patient will have a prolonged ICU stay or not. The knowledge of risk factors may facilitate organisational procedures and rational bed management. (Source: Interactive CardioVascular and Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


295 * twelve-year surgical experience with type a aortic dissection: the impact of age on early and long-term outcomes
Conclusion: The surgical results of type A aortic dissection are affected by age at intervention with a logarithmic increase of late mortality in patients older than 60 years. (Source: Interactive CardioVascular and Thoracic Surgery)


299 * surgical management of destructive aortic endocarditis: left ventricular outflow reconstruction with sorin pericarbon freedom stentless bioprosthesis
Conclusion: The Pericarbon Freedom stentless prosthesis proved to be an excellent substitute in cases of destructive aortic endocarditis. It is promptly available in different sizes, easy to implant and, thanks to its pericardial inflow skirt, ideal for extensive reconstruction of the left ventricular outflow tract with a good haemodynamic performance and low risk of relapse. (Source: Interactive CardioVascular and Thoracic Surgery)


308 * surgical thrombectomy of mechanical valve thrombosis
Conclusion: Early surgical intervention is a safe and effective treatment in patients with mechanical valve thrombosis. (Source: Interactive CardioVascular and Thoracic Surgery)


Giant right ventricular metastasis of hypopharyngeal cancer complicated by ventricular tachycardia and cardiogenic shock
(Source: European Journal of Echocardiography)


Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction: a landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) Registry
IntroductionThere are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). The aim of this study was to assess long-term (5-year) mortality among early survivors of AMI, according to the presence of CS at the acute stage. Methods: We analyzed 5-year follow-up data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 registry, a nationwide French survey including consecutive patients admitted for ST or non-ST-elevation AMI at the end of 2005 in 223 institutions. Results: Of 3670 patients enrolled, shock occurred in 224 (6.1%), and 3411 survived beyond 30?days or hospital discharge, including 99 (2.9%) with shock. Early survivors with CS had a more severe clinical profile, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Veno-venous extracorporeal membrane oxygenation using a double-lumen bi-caval cannula for severe respiratory failure post total artificial heart implantation.
We report a unique utilization of a double-lumen, bi-caval Avalon cannula for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) during placement of a total artificial heart (TAH, SynCardia, Tucson, AZ). A 22-year-old female with post-partum cardiomyopathy was rescued on veno-arterial (VA) ECMO because of cardiogenic shock. The inability to wean ECMO necessitated implantation of the TAH as a bridge to transplant. In addition, the patient continued to have respiratory failure and concomitant VV ECMO was planned with the implant. During TAH implantation, the Avalon cannula was placed percutaneously from the right internal jugular vein into the inferior vena cava (IVC) under direct vision while the right atrium was open. During VV ECMO support, adequate flows on both ECMO and TAH wer...


[Reperfusion in ST elevation myocardial infarction. From the guidelines to practice.]
CONCLUSIONS: Forty percent of patients with STEMI were not reperfused with fibrinolysis or angioplasty in accordance with regional guidelines. Characterization of this population should allow us to improve guideline adherence. PMID: 25283574 [PubMed - as supplied by publisher] (Source: Annales de Cardiologie et d'Angeiologie)


Prognostic Factor in Patients with Fulminant Myocarditis Supported by Percutaneous Extracorporeal Life Support
Percutaneous extracorporeal life support (ECLA) is effective for the patients with cardiogenic shock or fatal arrhythmia due to fulminant myocarditis. The purpose of this study was to elucidate the prognostic factor in patients with fulminant myocarditis supported by ECLA. (Source: Journal of Cardiac Failure)


A Case of Cardiogenic Shock Treated with Paracorporeal Left Ventricular Assisted Device Caused by Acute Myocardial Infarction
Case: A 42-years-old man was suffered from chest pain and transferred to our hospital with cardiogenic shock. Under intraaortic balloon pumping (IABP) support, emergency coronary angiography was performed. Left anterior descending (LAD) and left circumflex branch (LCX) were chronic total occlusion, and right coronary artery (RCA) was total thrombotic occlusion. Percutaneous coronary intervention (PCI) was performed on RCA. However, cardiogenic shock was sustained and incessant ventricular tachycardia was occurred. (Source: Journal of Cardiac Failure)


Importance of Aortic Valve Opening Under Percutaneous Cardiopulmonary Support (PCPS) in Patients with Fulminant Myocarditis; from the 2 Distinctive Cases
A 48-year-old male, who was diagnosed as fulminant myocarditis was transferred to the intensive-care unit in our hospital. Echocardiography showed progressive decline of left ventricular function after admission. The 2nd day, intraaortic balloon pumping (IABP) and PCPS were introduced due to cardiogenic shock. Under cardiopulmonary support, we paid careful attention to keeping aortic valve open in systole to prevent thromboembolic complications. After 10 days of cardiopulmonary support, his cardiac function improved gradually and he weaned from IABP and PCPS. (Source: Journal of Cardiac Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Postoperative Management of Dogs With Gastric Dilatation and Volvulus
The objective of the study was to review the veterinary literature for evidence-based and common clinical practice supporting the postoperative management of dogs with gastric dilatation and volvulus (GDV). GDV involves rapid accumulation of gas in the stomach, gastric volvulus, increased intragastric pressure, and decreased venous return. GDV is characterized by relative hypovolemic-distributive and cardiogenic shock, during which the whole body may be subjected to inadequate tissue perfusion and ischemia. (Source: Topics in Companion Animal Medicine)


Ivabradine during cardiogenic shock: A clinical case and review of the literature
Although the introduction of novel medical and invasive therapies in recent years has led to a significant reduction in mortality from heart failure, the same cannot be said for mortality due to cardiogenic shock. Drug therapy with inotropic agents and catecholamines has the disadvantage of causing increased myocardial oxygen consumption resulting in increased heart rate which may lead to the widening of the ischemic area. A reduction in heart rate with the administration of β-blockers is contraindicated due to negative inotropic and blood pressure lowering effects, typical of this group of drugs. (Source: Heart and Lung)


Low cardiac output as physiological phenomenon in hibernating, free-ranging scandinavian brown bears (Ursus arctos) - an observational study
Conclusion: Free-ranging brown bears demonstrate hemodynamics comparable to humans during active state, whereas during hibernation, we documented extremely low-flow hemodynamics. Understanding these physiological changes in bears may help to gain insight into the mechanisms of cardiogenic shock and heart failure in humans. (Source: Cardiovascular Ultrasound)


Bridge-to-Decision Therapy With a Continuous-Flow External Ventricular Assist Device in Refractory Cardiogenic Shock of Various Causes [Original Articles]
Conclusions&mdash; Bridge-to-decision therapy with CentriMag VAD is feasible in a variety of refractory cardiogenic shock settings. Patients with postcardiotomy shock have inferior survival. (Source: Circulation: Heart Failure)


Electrocardiogram attenuation of QRS complexes in association with Takotsubo syndrome
The interesting case report by Rojas-Marte et al. [1], published ahead of print in the Journal on July 31, 2014, about a 31year-old woman who suffered Takotsubo syndrome (TTS), complicated by cardiac arrest and cardiogenic shock, following an overdose of ibuprofen and diphenhydramine, and was treated successfully with extracorporeal membrane oxygenation, provides me with the opportunity to bring to the attention of the authors a newly described association of TTS with early transient electrocardiogram (ECG) attenuation of the QRS complexes (ATTQRS) [2,3]. (Source: Cardiovascular Revascularization Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Reverse Takotsubo cardiomyopathy after iatrogenic epinephrine injection requiring percutaneous extracorporeal membrane oxygenation.
CONCLUSION: Takotsubo cardiomyopathy following an injection of epinephrine remains a rare but increasingly described occurrence. The severity of the symptoms appears to be patient dependent, but refractory cardiogenic shock may occur and require significant circulatory support. If this situation occurs in a hospital where this necessary equipment is lacking, a mobile ECMO unit appears to be a viable solution to optimize the patient's chances of survival. PMID: 25187250 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)


The double-edged sword of mechanical ventilation for patients with cardiogenic shock.
Authors: Champion S PMID: 25178036 [PubMed - in process] (Source: Cardiology Journal)


Does Change of Catecholamine Use Improve the Outcome of Patients With Shock Admitted to Intensive Care Unit?
Up to 2008, dopamine was the catecholamine that was the most recommended in our intensive care unit (ICU) after fluid resuscitation. However, recently, norepinephrine has become the catecholamine that was most recommended in our ICU after fluid resuscitation. The aim of this study was to determine if there was an efficacy or safety benefit to this protocol therapeutic change in patients with shock admitted to our ICU. The primary outcome variable was ICU mortality. This is a prospective observational study conducted in 2 periods in our ICU (Habib Bourguiba University Hospital, Sfax, Tunisia). During the 2 study periods, 251 patients were included. There were 130 patients in group 1 and 121 patients in group 2. There were no significant differences between the 2 groups with regard to most o...


Antiangiogenic Drugs and Cardiogenic Shock: A Case Report
A 56-year-old man attended the emergency room with respiratory failure, deteriorated general status, fatigue, and diarrhea. His clinical history included a liver transplant because of alcoholic cirrhosis, which developed to hepatocellular carcinoma. Initial immunosuppression consisted of corticosteroids, tacrolimus, and mycophenolate mofetil. Examination of the explant revealed vascular invasion, and tacrolimus was replaced with everolimus. The patient presented recurrence of the carcinoma with peritoneal implants, and treatment with sorafenib was started. He was admitted to the gastroenterology department and, after withdrawal of sorafenib, the patient improved clinically. However, 6 days later, he was admitted to the intensive care unit with acute respiratory failure and metabolic acidos...


Thoratec CentriMag for Temporary Treatment of Refractory Cardiogenic Shock or Severe Cardiopulmonary Insufficiency: A Systematic Literature Review and Meta-Analysis of Observational Studies
The aim of the study was to systematically evaluate effect of CentriMag heart pump (Thoratec Corporation) as temporary ventricular assist device (VAD) and part of extracorporeal membrane oxygenation (ECMO) system on outcomes in patients with cardiac or cardiac-respiratory failure. A systematic search was conducted in five databases for the period 2003 to 2012. Fifty-three publications with data for 999 patients, supported with CentriMag, were included. In 72% studies, CentriMag was used as a VAD and in 25% as part of ECMO circuit. Mean duration of VAD support was 25.0 days in precardiotomy group, 10.9 days in postcardiac surgery cardiogenic shock group, 8.8 days in post-transplant graft failure and rejection group, and 16.0 days in post-LVAD placement right ventricular failure group. Survi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Perioperative Use of TandemHeart Percutaneous Ventricular Assist Device in Surgical Repair of Postinfarction Ventricular Septal Defect
We report our experience regarding utilization of TandemHeart, a percutaneous ventricular assist device (pVAD) as an adjunct to the treatment of these patients. Retrospective case series study design included a total of 11 patients with post-AMI VSD and severe refractory cardiogenic shock who received pVAD support at our institution. Three patients underwent immediate surgical repair and received pVAD support for postcardiotomy cardiogenic shock for 2, 4, and 7 days, respectively. However, all three died. The other eight patients had pVAD implanted prior to surgical repair in order to rest the myocardium before operation. Hemodynamics improved immediately after pVAD placement, and after receiving pVAD support for 7 ± 3 days, they underwent surgical VSD repair. Their total pre- and post-su...


Mechanical circulatory support devices in the ICU.
This article is a succinct introduction and overview of the hemodynamic principles and complications after device implantation for ICU clinicians. We review the concepts of device physiology, clinical pearls for perioperative management, and common medical complications after device implantation. PMID: 25180728 [PubMed - in process] (Source: Chest)


Intra-aortic balloon counterpulsation for acute decompensated heart failure
Intra-aortic balloon pump (IABP) counterpulsation is the oldest technology in current use for mechanical circulatory support [1]. Many studies have demonstrated the usefulness of IABP in cardiogenic shock during acute myocardial infarction, perioperative low cardiac output during coronary angioplasty, and management of end-stage heart failure as a bridge to cardiac transplantation [2–5]. However, no study has reported epidemiological data on the use of IABP in acute decompensated heart failure (ADHF) patients without acute coronary syndrome (ACS). (Source: International Journal of Cardiology)


Short-term ventricular assist device in post-cardiotomy cardiogenic shock: factors influencing survival
Abstract Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support. The aim of this study was to evaluate factors influencing survival during short-term ventricular assist support in PCCS. In total, 154 CentriMag® (Thoratec; CA, USA) devices were implanted for cardiogenic shock between 2004 and 2011 out of which 31 were for PCCS. A retrospective review was performed in 31 PCCS patients who required the CentriMag short-term VAD as a bridge to decision. Survivors and non-survivors were compared with respect to pre- and intra-operative characteristics as well as duration of short-term VAD support. Mean duration of support was 11.7 ± 15.4 days (range 1–65 days). Seventeen (54.83 %)...


Less-invasive off-pump ventricular assist device implantation in regional paravertebral analgesia
We describe the clinical course and treatment of a 58-year-old male with a primary cardiogenic shock, who underwent a minimally invasive off-pump ventricular-assist-device (VAD) implantation with the aid of paravertebral regional analgesia. He was extubated soon after the procedure, in the operating room, with the aim to reduce the right ventricle impairment. We illustrate how a minimally invasive implant may improve the clinical outcomes of VAD patients shortening their return time to active life. (Source: Journal of Artificial Organs)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Prevalence and 1-year prognosis of transient heart failure following coronary revascularization
Abstract The occurrence of heart failure during the whole pre-discharge course of coronary revascularization, as far as its influence on subsequent prognosis, is poorly understood. The present study examined the effect of transient heart failure (THF) developing in the acute and rehabilitative phase on survival after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI). Patients in the Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization (ICAROS) were analyzed for THF, the latter being defined either as signs and symptoms consistent with decompensation or cardiogenic shock. ICAROS was a prospective, multicenter registry of 1,262 consecutive patients discharged from 62 cardiac rehabilitation (CR) faci...


Mechanical Circulatory Support
The role for temporary and durable mechanical circulatory support is rapidly expanding. As the use of these technologies continues to grow, the emergency physician has an increasing opportunity to participate in the advancement of these potentially life-saving technologies. This review discusses the current role of the intra-aortic balloon pump in cardiogenic shock, describes the complications and management strategies for the critically ill patient with a left ventricular assist device, and explores the emerging role of ECMO in the emergency department for patients presenting in refractory cardiogenic shock and cardiac arrest. (Source: Emergency Medicine Clinics of North America)


Microcirculatory Alterations in Shock States
Functional components of the microcirculation provide oxygen and nutrients and remove waste products from the tissue beds of the body’s organs. Shock states overwhelmingly stress functional capacity of the microcirculation, resulting in microcirculatory failure. In septic shock, inflammatory mediators contribute to hemodynamic instability. In nonseptic shock states, the microcirculation is better able to compensate for alterations in vascular resistance, cardiac output, and blood pressure. Therefore, global hemodynamic and oxygen delivery parameters are appropriate for assessing, monitoring, and guiding therapy in hypovolemic and cardiogenic shock but, alone, are inadequate for septic shock. (Source: Critical Care Nursing Clinics of North America)


Prasugrelvs clopidogrel in cardiogenic shock patients undergoing primary PCI for acute myocardial infarction. Results of the ISAR-SHOCK registry.
Authors: Orban M, Mayer K, Morath T, Bernlochner I, Hadamitzky M, Braun S, Schulz S, Hoppmann P, Hausleiter J, Tiroch K, Mehilli J, Schunkert H, Massberg S, Laugwitz KL, Sibbing D, Kastrati A Abstract There is limited clinical data comparing different P2Y12-receptor inhibitors in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. The aim of the ISAR-SHOCK registry was to compare the clinical outcome of patients treated with clopidogrel vs prasugrel in this setting. Patients (n=145) with AMI complicated by cardiogenic shock and undergoing primary PCI in two centres (Deutsches Herzzentrum München and Klinikum rechts der Isar, Technical University Munich) between January 2009 and May 2012 were included in this registry. The use of prasugrel for patients...


Emergent double valve replacement in Austrian syndrome
We present a case of a woman found to have Austrian syndrome who presented to the emergency department (ED) with dehydration and radiographical signs of lobar pneumonia and quickly deteriorated to fulminant cardiogenic shock in less than four hours. An early echocardiogram in the ED confirmed a diagnosis of bi-valvular endocarditis with severe aortic and mitral valve insufficiency and large vegetations on the valve leaflets requiring emergent surgical intervention with double valve replacement. (Source: The American Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Transapical Aortic Valve Implantation: Predictors of Leakage and Impact On Survival: An Update.
CONCLUSIONS: In transapical TAVI, the risk of relevant paravalvular leakage may be eliminated completely. There is no negative impact on survival in patients with lesser, irrelevant grades of regurgitation. PMID: 25149051 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


A specialized post anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial
IntroductionFast-track treatment in cardiac surgery has become the global standard of care. We compared the efficacy and safety of a specialised post-anaesthetic care unit (PACU) to a conventional intensive care unit (ICU) in achieving defined fast-track end-points in adult patients after elective cardiac surgery. Methods: In a prospective, single blinded, randomized study, 200 adult patients undergoing elective cardiac surgery (coronary artery bypass graft (CABG), valve surgery or combined CABG and valve surgery), were selected to receive their postoperative treatment either in the ICU (n?=?100), or in the PACU (n?=?100). Patients who, at the time of surgery, were in cardiogenic shock, required renal dialysis, or had an additive EuroSCORE of more than 10 were excluded from the study. The ...


A perilous course following myocardial infarction: ischaemic ventricular septal defect in a transplanted heart
Coronary artery disease in the donor heart is an established cause of early graft failure. However, identification of this before implantation is difficult. Cardiogenic shock associated with significant myocardial infarction during the early postoperative period is rare. Here, we report a case of a 42-year-old man who presented acutely with cardiogenic shock; he was supported by short-term extracorporeal support as a bridge to transplantation. Following successful orthotopic heart transplantation, he sustained coronary artery atheromatous plaque rupture, resulting in acute coronary artery occlusion, and subsequently developed an ischaemic ventricular septal defect on the third postoperative day. (Source: Interactive CardioVascular and Thoracic Surgery)


Review of scorpion envenomation
Asian forest scorpion 3 out of 5 stars Scorpion Envenomation. Isbister GK, Bawaskar HS. N Engl J Med 2014 Jul 31;371:457-463. Reference With over 1700 species of scorpions found all over the world, this brief review article is much too short and unfocused to provide more than a superficial overview of its topic. The authors point out that most scorpion stings cause, at most, minor toxicity with pain and other local effects only. Most serious envenomations are associated with the Buthidae family, which include the genus Centruroides, several of which are found in North America and commonly cause neuromuscular excitation. Major toxicity is associated with α-toxins, which inhibit deactivation of voltage-gated sodium channels causing sympathetic and parasympathetic autonomic excitation,...


Transapical Aortic Valve Implantation in Patients with Poor Left Ventricular Function and Cardiogenic Shock
In line with our institutional “no exclusion” policy we accept patients with very poor left ventricular performance and cardiogenic shock for transcatheter aortic valve implantation (TAVI). The purpose of this study was to analyze outcome in these patients and to identify what happens to the left ventricular function after TAVI in patients with failing ventricles. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Transapical aortic valve implantation in patients with poor left ventricular function and cardiogenic shock
In line with our institutional no exclusion policy we accept patients with very poor left ventricular performance and cardiogenic shock for transcatheter aortic valve implantation (TAVI). The purpose of our study was to analyze outcome in these patients and to identify what happens to the left ventricular function after TAVI in patients with failing ventricles. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Five Recurrent Misconceptions Regarding Cardiogenic Shock Management
Medical therapeutic knowledge advances by continual action and reaction between retrospective and prospective evaluation on the one hand and clinical real-life observation and assessment on the other. In this regard, our goal is to articulate and demystify certain myths and misconceptions that impede the optimal management of patients with circulatory failure related to acute cardiac diseases. More specifically, we outline 5 statements that represent misconceptions about cardiogenic shock management that we have frequently faced throughout years of caring for critically ill patients. Moreover, for each statement, we suggest concise, corrective responses. (Source: Cardiology in Review)


Cardiogenic shock, asthma, and hypereosinophilia
We report the case of a 21-year-old man admitted for cardiogenic shock revealing a severe left and right ventricular dysfunction. Hypereosinophilia, history of asthma, and peripheral neuropathy strongly suggested the diagnosis of EGPA. Cardiac magnetic resonance imaging confirmed heart involvement with a diffuse subendocardial late gadolinium enhancement. (Source: The American Journal of Emergency Medicine)


Recurrence and metastasis of pheochromocytoma mimic acute ST-segment elevation myocardial infarction: a case report
Pheochromocytomas are cathecholamine-secreting tumor and may present with numerous of general symptoms, such as hypertension, pallor, headache tachycardia, chest pain, and cold sweating. Cardiac manifestations include typical angina, electrocardiographic change, and elevated cardiac biomarker. Transient systolic dysfunction of the left ventricle sometimes may happen with, the worst, heart failure and cardiogenic shock, in a similar manner of apical ballooning syndrome (Tokotsubo or stress cardiomyopathy) and mimics ST-segment elevation myocardial infarction. (Source: The American Journal of Emergency Medicine)


Single-center experience with a minimally invasive apicoaxillary external ventricular assist device
Mechanical circulatory support (MCS) devices have become more popular in the treatment of cardiogenic shock (CS). Options for emergency support include venoarterial extracorporeal membrane oxygenation, percutaneous ventricular assist devices (VADs), and surgical VADs. Among MCS devices, surgical VADs have the advantage of providing sufficient circulatory support1; however, the standard technique requires implantation through a median sternotomy.2 (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Epidemiology and Clinical Profile of Takotsubo Cardiomyopathy.
Authors: Sharkey SW, Maron BJ Abstract First described in Japan over 2 decades ago, takotsubo cardiomyopathy (TTC) has emerged as a unique cardiomyopathy with world-wide recognition, mimicking acute coronary syndrome. In early TTC experience, typical patients were older women, with a triggering emotional event, ST-segment elevation, and apical ballooning left ventricular (LV) contraction pattern. However, TTC is now more heterogeneous, occurring in males and younger individuals, without ST-segment elevation, as a spontaneous event in the absence of a trigger, and with diverse LV contraction patterns. Furthermore, TTC is more common than initially thought, now constituting 10% of women with suspected acute coronary syndrome. TTC is also associated with a broader range of psychologic...


Utility of intra-aortic balloon pump support for multivessel coronary artery spasm and cardiac arrest
Coronary artery spasm is an important cause of chest pain syndromes which was first described in 1959 by Prinzmetal et al. [1]. They described a syndrome of nonexertional chest pain with ST-segment elevation on electrocardiography (ECG) that usually occurred in the morning, at rest. This syndrome became known as Prinzmetal or variant angina, and was believed to be due to vasospasm in coronary arteries without obstructive lesions. Subsequently studies demonstrated that the clinical presentation of coronary artery spasm can be variable, ranging from asymptomatic ischemia to acute myocardial infarction, cardiogenic shock, life-threatening ventricular arrhythmias, and even cardiac arrest [2–4]. (Source: International Journal of Cardiology)


Predicting Left Ventricular Recovery after VA ECMO Using Speckle Tracking
VA extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to recovery in patients with potentially reversible cardiogenic shock. Predicting LV recovery is critical in determining likelihood of surviving after ECMO. The purpose of this study was to assess the feasibility of speckle-tracking by 2D echocardiography prior to ECMO implantation to predict long-term LV recovery. (Source: Journal of Cardiac Failure)


Outcomes of Patients Placed on VA ECMO Stratified by Indication
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be a life-saving strategy for patients with refractory cardiogenic shock. Whether the outcomes differ by indication for VA-ECMO has not been well studied. (Source: Journal of Cardiac Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Fulminant Myocarditis
Fulminant myocarditis is a rare condition with acute onset, rapid clinical deterioration and cardiogenic shock We identified all adult patients with fulminant myocarditis referred to our institution over an eleven-year period and describe their initial management and clinical outcomes. (Source: Journal of Cardiac Failure)


Mechanical Left Ventricular Support with the Impella 5.0: A Single Center Experience
Cardiogenic shock is associated with a high morbidity and mortality. Early mechanical support for the left ventricle is slowly gaining favor in the management of these ill patients. One of the newer, less invasive devices used for this purpose is the Impella 5.0, a microaxial pump that can provide short-term circulatory support. Our study was designed to assess morbidity and mortality in patients with an acute indication for the device, its effectiveness in providing ventricular assistance and to explore its effects on hemodynamic parameters. (Source: Journal of Cardiac Failure)


Older Women Benefit from Early Mechanical Support: An Update from the USPella Registry
Data regarding sex differences in outcome with mechanical circulatory support are sparse. We aimed to assess sex-specific differences in outcome with use of the Impella 2.5 in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (AMI). (Source: Journal of Cardiac Failure)


Single Center Experience with Implantation of Permanent LVADs after VA ECMO Bridge in Patients with Acute Cardiogenic Shock
INTERMACS class I patients often require temporary mechanical support as a bridge to permanent left ventricular device (LVAD) implantation. The use of venous-arterial extracorporeal membrane oxygenation (VA ECMO) as a bridge to a permanent LVAD has not been well studied. (Source: Journal of Cardiac Failure)


Mechanical Circulatory Support in Cardiogenic Shock Following an Acute Myocardial Infarction: A Systematic Review
We present a systematic review of this treatment alternative and suggest guidelines to be considered in the treatment of these patients. (Source: Journal of Cardiac Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Lateral Left Ventricular Wall Rupture Following Acute Myocardial Infarction: Pathophysiological Interpretation by Multimodality Imaging Approach
Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in‐hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three‐dimensional echocardiography showed a pseudoaneurysm. (Source: Echocardiography)


Entrapped Thrombus in a Patent Foramen Ovale After Transurethral Resection of Prostate: A Ticking Time Bomb
We report a relatively rare complication of pulmonary embolism (PE) and an impending paradoxical embolism due to a thrombus that was caught in transit in a PFO in the immediate postoperative period in a patient who had an uneventful transurethral prostatectomy (TURP). Echocardiography and computed tomography helped in early detection that led to a successful surgical outcome. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Medication-Induced Takotsubo Cardiomyopathy Presenting with Cardiogenic Shock- Utility of Extracorporeal Membrane Oxygenation (ECMO): Case Report and Review of the Literature
Takotsubo cardiomyopathy (TTC) is a transient condition that affects the myocardium and is seen mostly in post-menopausal women secondary to an emotional or physical stressor; however, certain drugs have been described as cause of this syndrome. Patients with TTC usually present with shortness of breath and chest pain and usually have total recovery of the cardiac function, necessitating only supportive care. However, cardiac arrest or refractory cardiogenic shock could be the initial presentation of this condition and more aggressive and invasive interventions might be required. (Source: Cardiovascular Revascularization Medicine)


Beware of Life-Threatening Activation of Air Bubble Detector during Contrast Echocardiography in Patients on Venoarterial Extracorporeal Membrane Oxygenator Support
Venoarterial extracorporeal membrane oxygenation (ECMO) is a temporizing therapy for patients with refractory cardiogenic shock, and it may also be a bridge to destination therapy or cardiac transplantation. Patients requiring venoarterial ECMO are, by definition, on the verge of cardiopulmonary collapse. Acute disruption of forward flow in ECMO-dependent patients will result in severe hypoperfusion and must be avoided at all costs.1 It is common practice to use contrast transthoracic echocardiography to improve the visualization of endocardial borders and allow more accurate assessments of ventricular function. (Source: Journal of the American Society of Echocardiography)


Medication-induced Takotsubo Cardiomyopathy presenting with cardiogenic shock—utility of extracorporeal membrane oxygenation (ECMO): case report and review of the literature
We report the case of a young female with medication-induced TTC, who presented with cardiogenic shock as initial manifestation, treated successfully with extracorporeal membrane oxygenation (ECMO). To our knowledge, this is the first case in the literature describing the use of ECMO in cardiogenic shock due to medication-induced TTC. (Source: Cardiovascular Revascularization Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Predictive factors of contrast-induced nephropathy in patients undergoing primary coronary angioplasty.
CONCLUSION: Renal failure and cardiogenic shock at admission were independent predictors of CIN in our acute myocardial infarction population. Mehran's score added little to the discrimination of patients undergoing primary coronary angioplasty, particularly high-risk individuals. PMID: 25082735 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)


Acute Rupture of Chordae Tendineae of the Mitral Valve in Infants: A Nationwide Survey in Japan Exploring a New Syndrome.
CONCLUSIONS: -Acute heart failure due to rupture of the mitral chordae tendineae in infants is a unique disease resulting from diverse etiologies. This condition should be recognized as a significant cardiovascular disorder that may cause sudden onset of cardiogenic shock and death in infants. PMID: 25062691 [PubMed - as supplied by publisher] (Source: Circulation)


Risk factors associated with adverse outcome following extracorporeal life support: analysis from 360 consecutive patients.
CONCLUSION: ECLS therapy offers one-year survival to one quarter of patients with an otherwise fatal prognosis. Procedural mortality is low and morbidity at the implantation site typically moderate. Thus, prolonged metabolic deterioration in combination with high-dose vasopressor support prior to ECLS therapy should be avoided, particularly in younger patients. PMID: 25049285 [PubMed - as supplied by publisher] (Source: Perfusion)


Intra-aortic balloon pump insertion
The intra-aortic balloon pump (IABP) is the most commonly utilized circulatory support device during percutaneous coronary intervention (PCI) procedures. The physiological principles that underpin IABP counterpulsation therapy are the simultaneous increase in coronary blood flow by augmentation of the diastolic aorto-coronary pressure gradient, with a decrease in myocardial oxygen demand by reducing after-load. Recent data suggest that IABP use would be of greatest benefit in conditions where microcirculatory reserve is exhausted, such as extreme hypotension, cardiogenic shock or persistent ischaemia. (Source: Medicine)


Awake Extracorporeal Membrane Oxygenation (ECMO) as Bridge to Recovery After Left Main Coronary Artery Occlusion: A Promising Concept of Haemodynamic Support in Cardiogenic Shock
Cardiogenic shock following acute myocardial infarction is associated with high mortality rate. Different management concepts including fluid management, inotropic support, intra aortic balloon counterpulsation (IABP) and extracorporeal membrane oxygenation (ECMO) mainly in mechanically ventilated patients have been used as cornerstones of management. However, success rates have been disappointing. Few reports suggested that ECMO when performed under circumvention of mechanical ventilation, may offer some survival benefits. (Source: Heart, Lung and Circulation)


Dont let your bradycardic patient D.I.E.
At the risk of plagiarizing myself, I&#8217;d like to revisit a topic that I discussed on my personal blog a couple of years ago. The story goes that I am not very good with mnemonics. For me they are almost never useful in clinical practice, and as the patient gets sicker my chances of properly recalling the applicable mnemonic decreases exponentially. There is, however, one mnemonic that I never forget, and it&#8217;s the DIE mnemonic for bradycardia. I developed this memory aid based off a talk on bradycardia given by the great Dr. Mel Herbert, where he discusses the above differential but in a different order and with no handy catch-phrase. [D]rugs [I]schemia [E]lectrolytes When the patient in front of you is sick, these are the three common and reversible causes of bradycardia that yo...


A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis
Sinus of Valsalva-right atrial fistulas are abnormal connections between the aorta and the right atrium, and present challenging surgical conditions. An extremely rare etiology of aorto-right atrial fistula is infective endocarditis. This case report presents a 21 year old Caucasian female patient who had native aortic valve Staphylococcus aureus endocarditis complicated by sinus of Valsalva abscess perforation associated with an acute heart block, an aorto-right atrial fistula, severe heart failure, and cardiogenic shock. She underwent emergent aortic valve replacement and complex sinus of Valsalva fistula pericardial patch reconstruction and repair. This case report further explores the advantages and disadvantages of different valves for different patient populations, and evaluates the ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Minimally Invasive Access for Central Extracorporeal Life Support: How We Do It
We present our minimally invasive technique for central ECLS through a nonsternotomy incision. Minimized right‐sided thoracotomy is performed. Flexible arterial and venous cannulas are tunneled toward the right thoracotomy incision through the eighth intercostal space. A sewing ring is secured to the right atrium and a tube graft is anastomosed to the ascending aorta. Following full‐dose heparinization, the arterial cannula is inserted with the tip into the vascular graft of the ascending aorta and the venous cannula via the ring into the right atrium. After meticulous deairing, the central ECLS is set at full flow. (Source: Artificial Organs)


Mortality in Intra-aortic Balloon Pump therapy in Patients with ST Elevation Myocardial Infarction and Cardiogenic Shock: Data from Nationwide Inpatient Sample
(Source: International Journal of Cardiology)


Clinical consequences of Tityus bahiensis and Tityus serrulatus scorpion stings in the region of Campinas, southeastern Brazil.
Authors: Bucaretchi F, Fernandes LC, Fernandes CB, Branco MM, Prado CC, Vieira RJ, De Capitani EM, Hyslop S Abstract Scorpion stings account for most envenomations by venomous animals in Brazil. A retrospective study (1994-2011) of the clinical consequences of Tityus scorpion stings in 1327 patients treated at a university hospital in Campinas, southeastern Brazil, is reported. The clinical classification, based on outcome, was: dry sting (no envenoming), class I (only local manifestations), class II (systemic manifestations), class III (life-threatening manifestations, such as shock and/or cardiac failure requiring inotropic/vasopressor agents, and/or respiratory failure), and fatal. The median patient age was 27 years (interquartile interval = 15-42 years). Scorpions were broug...


Meta-analysis Questions Post-MI Use of Beta-blockersMeta-analysis Questions Post-MI Use of Beta-blockers
While beta-blockers reduce reinfarction and angina in the post-MI setting, there is no reduction in the risk of mortality. More important, the analysis showed an increased risk of heart failure and cardiogenic shock with beta-blockers when used post-MI. Heartwire (Source: Medscape Medical News Headlines)


Intra-Aortic Balloon Pump During Extracorporeal Life SupportIntra-Aortic Balloon Pump During Extracorporeal Life Support
Does the use of an intra-aortic balloon pump during extracorporeal life support improve survival in patients with myocardial infarction and cardiogenic shock? BMC Anesthesiology (Source: Medscape Today Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


International differences in acute coronary syndrome patients' baseline characteristics, clinical management and outcomes in Western Europe: the EURHOBOP study
Conclusions Inhospital mortality rates of STEMI and NSTEMI patients were two to three times higher in Finland, Germany and Portugal than in Greece and Spain, with intermediate values for France. Differences in baseline characteristics and clinical management partly explain differences in outcome. Our data also suggest an impact of the healthcare system organisation. (Source: Heart)


45 year old male with “numb hands” – Discussion
Go back to 45 year old male with “numb hands” to read about the presentation, and see the ECGs. &nbsp; The culprit artery? After arriving at the hospital, the patient bypassed the ED, going directly to the cardiac catheterization lab. The patient was found to have a total occlusion of the proximal RCA, and the cardiologist was able to deploy a stent without problem. &nbsp; Excellent D2B, but &#8230; Despite prompt activation of the 911 system, excellent EMS care, field activation of the cath lab, and an uncomplicated percutaneous coronary intervention, he was left with moderate ventricular dysfunction. The system “did everything right,” but the patient still had significant heart damage &#8211; why? &nbsp; Faster STEMI treatment, but no change in mortality? A recent study in the Ne...


Cardiogenic Shock
Cardiogenic shock is the most common cause of in-hospital mortality for patients who have suffered a myocardial infarction. Mortality exceeds 50% and management is focused on a rapid diagnosis of cardiogenic shock, restoration of coronary blood flow through early revascularization, complication management, and maintenance of end-organ homeostasis. Besides revascularization, inotropes and vasodilators are potent medical therapies to assist the failing heart. Pulmonary arterial catheters are an important adjunctive tool to assess patient hemodynamics, but their use should be limited to select patients in cardiogenic shock. (Source: Critical Care Clinics)


Mechanical Circulatory Devices in Acute Heart Failure
This article describes the most commonly used temporary ventricular assist devices and their use in the various causes of cardiogenic shock. (Source: Critical Care Clinics)


Swallowed a needle stuck in heart.
Authors: Yolcu M, Aydın A, Korkmaz AF, Dağ O, Ipek E, Erkut B Abstract Cardiac tamponade (CT) is a clinical entity characterized by hemodynamic insufficiency resulting from increased intrapericardial pressure due to accumulation of contents such as serous fluid, blood, and pus. CT is a treatable cause of cardiogenic shock, which can be fatal unless diagnosed promptly. Dyspnea, chest pain, hypotension, tachycardia, pulsus paradoxus, raised jugular venous pressure, muffled heart sounds, decreased electrocardiographic voltage, and enlarged cardiac silhouette on chest X-ray are the major clinical signs in CT. Idiopathic or viral pericardititis, iatrogenic trauma during percutaneous coronary interventions or coronary artery bypass grafting, external trauma, malignancies, acute or chro...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Clinical outcomes of patients with acute myocardial infarction complicated by severe refractory cardiogenic shock assisted with percutaneous cardiopulmonary support.
CONCLUSION: In spite of PCPS management, AMI patients complicated by severe refractory cardiogenic shock demonstrated high mortality. Older age, CPR, lower lactate clearance for 48 hours, and unsuccessful revascularization were independent predictors of in-hospital mortality. PMID: 24954319 [PubMed - in process] (Source: Yonsei Medical Journal)


Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction.
Authors: Gorjup V, Noc M, Radsel P Abstract Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion ("ACS" lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is ...


Unexpected triggers for pheochromocytoma-induced recurrent heart failure
We describe an uncommon case of recurrent non-hypertensive heart failure with systolic dysfunction in a young female due to pheochromocytoma compression. It presented as acute pulmonary oedema while straining during pregnancy and later on as cardiogenic shock after a recreational body massage. Such crisis occurring during pregnancy is rare. Moreover, of the few reported cases of pheochromocytoma-induced cardiogenic shock, recreational body massage has not yet been reported as a trigger for this condition. (Source: BioMed Central)


The cost impact of short-term ventricular assist devices and extracorporeal life support systems therapies on the National Health Service in the UK
CONCLUSIONS CentriMag&reg; and PediVAS&reg; blood pumps can lead to significant cost savings to the National Health Service, when used instead of other pumps for short-term VAD or ECLS treatment. (Source: Interactive CardioVascular and Thoracic Surgery)


[Ischemic heart failure making the diagnosis of a Vaquez disease: A rare event.]
We present the case of a 46-year-old patient without any past medical history, admitted to our ICU for cardiogenic shock complicating acute coronary syndrome. The blood tests found polycethemia, a polycethemia vera was suspected and confirmed by genetic analysis. Ischemic heart failure as an initial symptom of polycethemia vera and its treatment by arterial bleeding is a rare event that we describe in this article. PMID: 24953661 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Transradial vs Transfemoral Coronary Intervention for AMITransradial vs Transfemoral Coronary Intervention for AMI
When cardiogenic shock occurs after AMI, which access point is safer for PCI? The Journal of Invasive Cardiology (Source: Medscape Today Headlines)


[Correspondence] Neurodevelopmental toxicity: still more questions than answers
We read with interest Grandjean and Landrigan's Review of developmental neurotoxins, in which glyphosate herbicide was listed as a human neurotoxicant on the basis of a case report by Malhotra and colleagues. The individual in this case report was a 71-year-old man who was unresponsive and in cardiogenic shock with a profound metabolic acidaemia (pH 7·13) and lactic acidosis (7·1 mmol/L; normal levels are 0·5–1·6 mmol/L). He received ventilator support and veno-venous haemodiafiltration and was presumptively managed as having organophosphate intoxication, receiving 239 mg of atropine and 4 g of pralidoxime over an unspecified period of time. (Source: Lancet Neurology)


Low Incidence of Late Pseudoaneurysm and Reoperation After Conventional Repair of Acute Type A Aortic Dissection
ConclusionsA reinforced sandwich technique was a good technique resulting in a low incidence of late reoperation and pseudoaneurysm formation. (Source: Journal of Cardiac Surgery)


Incidence and correlates of major bleeding after percutaneous coronary intervention across different clinical presentations
Conclusions: In patients undergoing PCI, the worsening severity of clinical presentation corresponds to an increase in incidence of post-PCI major bleeding. The increased risk with CGS, STEMI, and NSTEMI persisted despite adjusting for more aggressive pharmacotherapy and use of IABP. Careful attention to antithrombotic pharmacotherapy is warranted in this high-risk population. (Source: American Heart Journal)


Use of a single circuit to provide temporary mechanical respiratory and circulatory support in patients with LV apical thrombus and cardiogenic shock.
CONCLUSION: We demonstrated the use of MCS as a bridge to decision in patients with LV thrombi, utilizing biatrial cannulation with a 'Y' connection to drain both right- and left-sided circulation through a single circuit and pump. PMID: 24916009 [PubMed - as supplied by publisher] (Source: Perfusion)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Acute kidney injury in adults receiving extracorporeal membrane oxygenation.
Authors: Chen YC, Tsai FC, Fang JT, Yang CW Abstract Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as patients with postcardiotomy cardiogenic shock or life-threatening respiratory failure. Acute kidney injury (AKI) that develops during ECMO is associated with a very poor outcome, possibly because of accumulated extravascular water causing interstitial overload, impaired oxygen transport through tissues, and increased extravascular lung water volume with impaired O2 transport. Increased water is associated with subsequent organ dysfunction, particularly of the heart, lungs, and brain. Based on single-center studies, the incidence of AKI is 70-85% in ECMO patients. Therefore, renal replacement therapy is required in approximately 50% o...


The use of aortic counterpulsation in United States: What can we learn from administrative databases?
In the ideal clinical setting, every physician and health care system should aggregate their data to be able to better understand how the practice of medicine affects outcomes among their patients. Unfortunately, we are currently far from this state of affairs. Very few health care systems collect careful clinical information to be able to examine their practice with attention to what drives physician practice and how this affects outcomes. Fortunately, we do not rely on observational data to make an assessment of the risk and benefit with any procedure, as most cardiovascular devices have gone through an approval process that, for higher risk procedures, involves a single or multiple randomized trials. However, one cannot randomize patients in every clinical scenario, and there are device...


Intra-aortic balloon pump: indications, efficacy, guidelines and future directions
Purpose of reviewThe intra-aortic balloon pump (IABP) has been used as a cardiac assist device in various clinical situations since 1968 on the basis of the physiological principles and observational data, with little randomized data until recently. Recent findingsRecently published randomized controlled trials (RCTs) and meta-analyses have demonstrated acceptable safety for IABP but have raised doubt over efficacy in acute myocardial infarction (MI) both with and without cardiogenic shock. RCTs and meta-analyses have provided limited and qualified support for the efficacy of IABP in high-risk percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). There remains only observational data to support the efficacy of IABP in other niche indications, including mechanica...


Temporal Trends in Incidence and Outcomes of Peripartum Cardiomyopathy in the United States: A Nationwide Population-Based Study [Heart Failure]
Conclusion From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, utilization of mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted. (Source: JAHA:Journal of the American Heart Association)


Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers
Abstract: The presented work relates to the procedure followed for the automation of a portable extracorporeal circulatory support system. Such a device may help increase the chances of survival after suffering from cardiogenic shock outside the hospital, additionally a controller can provide of optimal organ perfusion, while reducing the workload of the operator.Animal experiments were carried out for the acquisition of haemodynamic behaviour of the body under extracorporeal circulation. A mathematical model was constructed based on the experimental data, including a cardiovascular model, gas exchange and the administration of medication. As the base of the controller fuzzy logic was used allowing the easy integration of knowledge from trained perfusionists, an adaptive mechanism was incl...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Abstract 29: Temporal Trends in Incidence and Outcomes of Peripartum Cardiomyopathy in the United States: A Nationwide Population-Based Study [Session Title: Concurrent III Session A: Oral Abstracts on Outcomes Issues]
Conclusion: From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, need for mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 122: Characteristics of Patients with Multivessel Coronary Disease Treated with Percutaneous Intervention Versus Bypass Surgery and Preliminary Mortality Outcomes: A Province-wide Field Evaluation [Session Title: Poster Session I]
Conclusions: Patients with multivessel disease who were treated with PCI were more likely to present with acute symptoms, have more cardiogenic shock and more previous valve surgery but have less extensive coronary disease, less diabetes and less heart failure. Age and other risk factors and comorbidities were very similar in the 2 groups. Crude mortality during the index surgical hospital admission was higher for PCI despite a shorter length of stay. To gain more insight into these results, it will be important to link to medico-administrative data to examine 30-day and 1-year mortality and to adjust appropriately for potential confounders. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 217: Characteristics and 1-year Outcomes of Patients with Long-term Left Ventricular Assist Devices (LVAD) in Quebec Compared with the INTERMACS Registry [Session Title: Poster Session II]
Conclusion: In comparison with INTERMACS patients, Quebec LVAD patients are younger but sicker and less likely to be implanted as destination therapy. Despite low volumes, clinical results in Quebec hospitals are very similar to those reported for INTERMACS. Only half of Quebec LVAD patients were on the transplant list at the time of implant. Similar clinical results for patients on and off the transplant list in Quebec support the recommendation that transplant eligibility should not be an essential criterion for selection of patients for LVAD. Continued independent monitoring in collaboration with hospitals will be important to optimize quality of care. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 333: Hypothyroidism As a Predictor of Worse Clinical Outcomes After Percutaneous Coronary Interventions: 1 Year Follow Up Study [Session Title: Poster Session III]
Conclusion: Although there was no difference in MACE, HT was associated with higher all cause mortality after PCI. We suggest monitoring of thyroid function for patients who undergo PCI. Treatment may improve survival in hypothyroid patients post PCI, however further outcome studies are needed. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 350: The 'Frequent Flyer' Hypothesis and Increased Risk of Thirty Day Readmission after Percutaneous Coronary Intervention [Session Title: Poster Session III]
Conclusion: A prior history of frequent admissions and anxiety or depression diagnoses contribute significantly and independently towards 30DR post PCI, even after adjusting for traditional risk factors of readmissions. As such, they should be considered as important risk factors for post PCI readmission. Patients with diagnoses of anxiety or depression were not at increased risk of 30DR for cardiovascular events such as PCI, CABG or acute CHF. Future studies are needed to evaluate the role of treating anxiety and depression in patients at risk for frequent readmissions. (Source: Circulation: Cardiovascular Quality and Outcomes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Case images: Cardiogenic shock caused by huge para-aortic hematoma and pseudoaneurysm after Bentall operation.
Authors: Sunman H, Erat M, Doğan M, Yeter E PMID: 24899493 [PubMed - as supplied by publisher] (Source: Turk Kardiyoloji Dernegi arsivi)


Left Anterior Descending Coronary Artery Blood Flow and Left Ventricular Unloading During Extracorporeal Membrane Oxygenation Support in a Swine Model of Acute Cardiogenic Shock


Cardiogenic Shock Masquerading as Septic Shock
(Source: Clinical Pediatric Emergency Medicine)


Comparison of the Safety and Efficacy of Biodegradable Polymer Biolimus‐Eluting Stents and Durable Polymer Everolimus‐Eluting Stents: Propensity Score‐Matched Analysis
ConclusionIn a single‐center registry with unrestricted use of EES and BES‐B, these stents showed comparable efficacy and safety in terms of TLF, POCO, and ST at 1‐year follow‐up. (Source: Journal of Interventional Cardiology)


Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers
The presented work relates to the procedure followed for the automation of a portable extracorporeal circulatory support system. Such a device may help increase the chances of survival after suffering from cardiogenic shock outside the hospital, additionally a controller can provide of optimal organ perfusion, while reducing the workload of the operator.Animal experiments were carried out for the acquisition of haemodynamic behaviour of the body under extracorporeal circulation. A mathematical model was constructed based on the experimental data, including a cardiovascular model, gas exchange and the administration of medication. (Source: Medical Engineering and Physics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Takotsubo syndrome with refractory cardiogenic shock after trauma: successful treatment with an intra‐aortic balloon pump
(Source: ANZ Journal of Surgery)


Management and decision‐making process leading to coronary angiography and revascularization in octogenarians with coronary artery disease: Insights from a large single‐center registry
ConclusionIn the present study, in octogenarians, long‐term mortality was lower in the group of patients who underwent a coronary angiogram, regardless of revascularization. The selection process for coronary angiography and angioplasty was mostly influenced by the existence of age‐associated comorbidities. Risk prediction models are required to reduce age‐dependent biases. Geriatr Gerontol Int 2014; ●●: ●●–●●. (Source: Geriatrics and Gerontology International)


In Vivo Testing of a Novel Blood Pump for Short-Term Extracorporeal Life Support.
CONCLUSIONS: The BioVAD performed well for 5 days in this animal model of temporary left ventricular assistance. Its potential advantages over centrifugal pumps may make it applicable for short-term mechanical circulatory support. PMID: 24856794 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


[Ten-year experience with out-of-hospital cardiac arrest patients (OHCA) admitted for urgent coronary angiography from invasive cardiology centre.]
CONCLUSIONS: The most important cause of OHCA is coronary artery disease, especially ACS. UCA and PCI seem to be important element of proper post resuscitation care, because such treatment could probably improve survival but it is still unclear whether PCI could influence neurological outcome as well. PMID: 24846357 [PubMed - as supplied by publisher] (Source: Polish Heart Journal)


[Emergency coronary artery bypass grafting for acute coronary syndrome: mid-term follow-up results].
CONCLUSION: Despite a slight increase of the in-hospital mortality, ECABG can improve the mid-term survival, freedom from cardiac event, and cardiac function when the indications and timing for surgery are well controlled with optimal perioperative management. PMID: 24849435 [PubMed - in process] (Source: Journal of Southern Medical University)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Inotropes
have been fundamental to resuscitation of acute cardiogenic shock for decades. Heart failure and cardiogenic shock, in severe cases, are syndromes characterized in many patients by a reduction in myocardial contractile force. While inotropes successfully increase cardiac output, their use has been plagued by excessive mortality due to increased tachycardia and myocardial oxygen consumption leading to arrhythmia and myocardial ischemia. There is a pressing need for new inotropic agents that avoid these harmful effects. This review describes the mechanism of action and the clinical utility of some of the older inotropic agents, which are still commonly used, and provides an update for physicians on the development of newer inotropic drugs. The field is rapidly changing, and it is likely tha...


Hypocalcemic cardiomyopathy- different mechanisms in adults and pediatric cases.
Conclusion: Hypocalcemia is a rare but a treatable cause of dilated CMP. In infants, hypocalcemia is usually due to maternal vitamin D deficiency and is accompanied by compensatory hyperparathyroidism. In contrast, in adult patients, hypocalcemic CMP is usually a result of hypoparathyroidism, with or without concomitant vitamin D deficiency. PMID: 24840807 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)


Post‐partum spontaneous coronary artery dissection and the use of veno‐arterial extra‐corporeal membrane oxygenation
This article highlights requirement for further research into several aspects of care for the adult ECMO patient. Questions to be answered raised in this case study include recommendations for the weaning of inotropes and vasoconstrictors, frequency of blood gas sampling and whether it remains essential to have two nurses caring for the ECMO patient. Relevance to clinical practiceAs medical treatment progresses, there is an increasing demand for therapies such as ECMO to become more readily available for the care of the critically ill adult patient. This article highlights challenges that may be faced and what changes could be made to further improve standards of care and survival rates for ECMO patients. (Source: Nursing in Critical Care)


Cardiogenic shock due to acute tramadol intoxication.
We report the case of a 7-year-old child admitted in cardiac intensive care unit for cardiogenic shock due to tramadol intoxication. Without any past history, the child was admitted at emergency room for generalised convulsion, followed by respiratory distress. Cardiogenic shock was suspected after clinical examination and chest X-ray and confirmed by transthoracic echocardiography showing low left ventricular ejection fraction (&lt;30 %) with pulmonary hypertension. No evidence of cardiac infarction or myocarditis was found. Tramadol intoxication was suspected because of empty tramadol tablets found near the child and later confirmed by toxicologic analysis showing high blood concentration of tramadol (&gt;1 mg/L) and O-desmethyltramadol (&gt;1.5 mg/L). Hemodynamic support by inotropic...


Efficacy and safety of a routine early invasive strategy after fibrinolysis stratified by glycoprotein IIb/IIIa inhibitor use during percutaneous coronary intervention: a pre-specified subgroup analysis of the TRANSFER-AMI randomised controlled trial
Conclusions The apparent difference in the efficacy of an early invasive strategy between GPIIb/IIIa inhibitor strata likely reflects an association between GPIIb/IIIa inhibitor use and baseline risk. GPIIb/IIIa inhibitor use during PCI at the discretion of the treating physician does not appear to modulate the efficacy of an early invasive strategy post-fibrinolysis. Clinical Trial Registration: http://www.clinicaltrials.gov/ct2/show/NCT00164190, NCT00164190. (Source: Heart)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Cardiogenic Shock and Pulmonary Embolism.
Authors: Romero Gómez C, Aguilar García JA, Martín Escalante MD PMID: 24816126 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)


Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis
Conclusion Mortality in patients with critical IE remains unacceptably high. Factors associated with long-term outcomes are the severity of multiorgan failure, prosthetic mechanical valve IE, vegetation size &ge;15 mm, and surgical treatment. Up to one-third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. The strongest independent predictor of post-operative mortality is the pre-operative multiorgan failure score while surgical timing does not seem to impact on outcomes. (Source: European Heart Journal)


Impact of Early and Intensive Continuous Veno-Venous Hemofiltration on Patients with Cardiogenic Shock and Acute Kidney Injury following Cardiac Surgery
(Source: The Journal of Thoracic and Cardiovascular Surgery)


Effect of early and intensive continuous venovenous hemofiltration on patients with cardiogenic shock and acute kidney injury after cardiac surgery
(Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Transradial Versus Transfemoral Coronary Intervention for Acute Myocardial Infarction Complicated by Cardiogenic Shock: Is Transradial Coronary Intervention Suitable for Emergency PCI in High-Risk Acute Myocardial Infarction?
Section:&nbsp; Original Contribution Topics:&nbsp; Cardiogenic Shock Issue Number:&nbsp; Volume 26 - Issue 5 - May 2014 Author(s):&nbsp; Atsushi Iga, MD1, Kenji Wagatsuma, MD, PhD2, Junichi Yamazaki, MD, PhD1, Takanori Ikeda, MD, PhD1 wm 196-202 Iga JIC May 2014.pdf Data are limited regarding the clinical results of transradial coronary intervention (TRI) in acute myocardial infarction (AMI) complicated by cardiogenic shock. TRI is associated with fewer major bleeding and vascular complications than transfemoral intervention, and appears suitable for both low- and high-risk AMI patients, especial...


A single pathophysiological pathway in Takotsubo cardiomyopathy: Catecholaminergic stress.
CONCLUSION: Whatever the trigger, the common denominator in TTC is catecholaminergic stress. Classically suggested after emotional trauma, TTC may also be induced by surgical stress or endogenous or iatrogenic β2-mimetic intoxication. The various contexts all have a similarly excellent cardiovascular prognosis if treated early. PMID: 24796853 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)


Prognostic implication of out of hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction
(Source: Resuscitation)


Extracorporeal Membrane Oxygenation Support in Refractory Cardiogenic Shock: Treatment Strategies and Analysis of Risk Factors
Abstract Two centrifugal pumps, the RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and Levitronix CentriMag (Levitronix LCC, Waltham, MA, USA), used in central or peripheral veno‐arterial extracorporeal membrane oxygenation (ECMO) support systems have been investigated, in terms of double‐center experience, as treatment for patients with refractory cardiogenic shock (CS). Between January 2006 and December 2012, 228 consecutive adult patients were supported on RotaFlow (n = 213) or CentriMag (n = 15) ECMO, at our institutions (155 men; age 58.3 ± 10.5 years, range: 19–84 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 118) and primary donor graft failure (n = 37); postacute m...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Short-term and long-term adverse cardiovascular events across the glycaemic spectrum in patients with acute coronary syndrome: the Gulf Registry of Acute Coronary Events-2
BackgroundLimited data exist on the prognostic impacts of diabetes mellitus (DM) and new-onset hyperglycaemia (NOH) on cardiovascular outcomes in Middle Eastern patients with acute coronary syndrome (ACS). Here, we explored this relationship in a large contemporary Middle Eastern ACS registry: the second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Patients and methodsOur analysis included 6362 consecutive ACS patients enrolled from October 2008 to June 2009, with or without a known DM diagnosis, and with an available fasting blood sugar measurement from the index hospitalization. Baseline demographics, risk factors for atherosclerosis, medical history, investigations and therapies were registered. Adverse hospital outcomes, as well as short-term and long-term mortalities were com...


Short-Term Ventricular Assist Devices (Implantable and Percutaneous)
Abstract Short-term ventricular assist devices (VADs), percutaneous or surgical, are used in the settings of cardiogenic shock (CS) refractory to medical management, as bridges to myocardial recovery, heart transplantation, durable long-term devices, and in the aid of high-risk PCIs. Recent innovations in continuous-flow pump technology have contributed to the development of various short-term VADs with many impressive features. These include the CentriMag VAD and percutaneous VADs such as the Impella and TandemHeart VAD systems. With these and other advances in mechanical circulatory support, it is highly likely that the significant morbidity and mortality associated with CS are improving. However, clinical evidence supporting the use of these devices remains at the level of sm...


Prognostic implications of quantitative evaluation of baseline Q-wave width in ST-segment elevation myocardial infarction
Abstract: Objectives: To evaluate quantitative relationships between baseline Q-wave width and 90-day outcomes in ST-segment elevation myocardial infarction (STEMI).Background: Baseline Q-waves are useful in predicting clinical outcomes after MI.Methods: 3589 STEMI patients were assessed from a multi-centre study.Results: 1156 patients of the overall cohort had pathologic Q-waves. The 90-day mortality and the composite of mortality, congestive heart failure (CHF), or cardiogenic shock (p (Source: Journal of Electrocardiology)


Effects of intra-aortic balloon pump on cerebral blood flow during peripheral venoarterial extracorporeal membrane oxygenation support
Conclusion: These results demonstrate that an IABP significantly changes the CBF during peripheral VA ECMO, depending on the antegrade blood flow by spontaneous cardiac function. The addition of an IABP to VA ECMO support decreased the CBF during cardiac stun, and it increased CBF without cardiac stun. (Source: Journal of Translational Medicine)


[ST segment elevation myocardial infarction: What is the best timing for revascularization of non-culprit lesions?]
This article is a review over timing of secondary revascularization in STEMI patients with multi-vessels disease. PMID: 24834992 [PubMed - as supplied by publisher] (Source: Annales de Cardiologie et d'Angeiologie)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Towards a proactive therapy utilizing the modern spectrum of extracorporeal life support: a single-centre experience.
CONCLUSIONS: Our results exemplify the benefits of ELS as a bridge to initial stabilization of critically ill patients. Potentially, the early application of ELS technology can lower mortality and morbidity in patients with a regressive pathology. PMID: 24759930 [PubMed - as supplied by publisher] (Source: Perfusion)


Tako-Tsubo cardiomyopathy presenting with cardiogenic shock successfully treated with milrinone: A case report
We report the case of a middle age patient presenting with Tako-Tsubo cardiomyopathy (TTC) complicated by cardiogenic shock that was successfully handled with milrinone. A 64-year old man presented with cardiogenic shock after benzodiazepine and alcohol intoxication. A slight elevation of troponin and typical left ventricular ballooning without coronary lesions suggested TTC. Within a few hours milrinone infusion normalized the cardiac index. TTC is responsible for severe transient left ventricular dysfunction occurring after physical or psychological stress. The major pathophysiological mechanism involved is disproportionate catecholamine secretion, which may stun the myocardium. We considered if treatment of this unique physiopathology with catecholamines could be dangerous in these pati...


Hybrid approach in hypoplastic left heart syndrome
Hypoplastic left heart syndrome (HLHS), morphologically subdivided in mitral and/or aortic atresia or stenosis, accounts for 2&ndash;3% of all congenital heart defects and is a fatal congenital heart defect if untreated.1 Early postnatal survival requires a patent ductus arteriosus (DA) to provide systemic blood flow from the RV to aorta and an atrial septal defect to allow mixing of oxygenated pulmonary venous and deoxygenated systemic venous blood flow. Neonates that present with HLHS are clinically stable as long as the parallel pulmonary and systemic circulations are balanced, although the postnatal decrease in pulmonary vascular resistance may result in clinical decompensation. In about 6% of HLHS patients, the atrial septum is intact at birth, and up to 22% have a severely restrictiv...


Hypoglycemia, hypotriglyceridemia and starvation associated with cardiogenic shock
A recent case report reported on three undernourished patients who manifested cardiac complications, including cardiogenic shock as well as hypoglycemia and hypotriglyceridemia [1]. (Source: Nutrition)


Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment-Myocardial Infarction: A Prospective, Randomized, Open-Labeled Trial [Myocardial Infarction]
Conclusions&mdash; Treatment with NAC or NaHCO3 did not reduce the rate of acute CIN significantly. Combined treatment with NAC and NaHCO3 may reduce the risk of renal dysfunction after 30 days. Clinical Trial Registration&mdash; URL: http://www.clinicaltrials.gov. Unique identifier: NCT01160627. (Source: Circulation: Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Emergency coronary artery bypass grafting for cardiogenic shock due to left main coronary artery obstruction caused by Kawasaki disease in a 4‐year‐old boy
We describe the case of a 4‐year‐old boy whose clinical course after Kawasaki disease resulted in coronary artery bypass grafting (CABG) due to acute myocardial infarction (AMI) causing cardiogenic shock. He had developed an ischemic cardiomyopathy due to severe localized stenosis of the left main coronary artery (LCA) and went into cardiogenic shock due to AMI on the day before a scheduled operation. He underwent successful emergency CABG within 4 h of MI. Postoperatively his neurological status was intact. This is the first report of a successful emergency CABG in a small child with cardiogenic shock due to LCA occlusion. CABG should be undertaken in small patients when appropriate indications exist, if bodyweight is &gt;10 kg. (Source: Pediatrics International)


Emergent use of mechanical circulatory support devices: ethical dilemmas
Purpose of reviewMechanical Circulatory Support (MCS) devices are ‘life-sustaining devices’ placed as a bridge to decision, either recovery, transplantation or a lifetime tether with the device. Cardiogenic shock may compromise patient autonomy, or the right for an individual patient to determine his own care. This review addresses an ethical dilemma in the context of complex clinical medical decision-making, during marked uncertainty for outcomes. Recent findingsThe language in an advanced directive is often imprecise and may not provide clear guidance, especially for emergent decisions related to MCS devices. Despite improving outcomes, application of MCS in critical illness is associated with excessive morbidity and quality of life-limiting adverse outcomes. Several cohort experienc...


Pharmacologic therapies for acute cardiogenic shock
Purpose of reviewThe natural history of cardiogenic shock has improved significantly with the utilization of revascularization and mechanical circulatory support. Despite the interest in identifying new pharmacological agents, the medical therapy to restore perfusion is limited by their side-effects and no solid evidence about improving outcomes. In this article, we review the current pharmacological agents utilized during cardiogenic shock. Recent findingsInotropes and vasopressors are widely used to improve hemodynamics acutely; however, reliable information regarding comparative efficacy of individual agents is lacking. A subanalysis of a prospective randomized trial suggested that norepinephrine may be preferred over dopamine in patients with cardiogenic shock. Levosimendan is a new in...


Current and future applications of the intra-aortic balloon pump
Purpose of reviewThe intra-aortic balloon pump (IABP) has been used for more than 40 years. Although recommended in a wide variety of clinical settings, most of these indications are not evidence-based. This review focuses on studies challenging these traditional indications and evaluates potentially new applications of intra-aortic counterpulsation. Recent findingsRecent studies have failed to confirm an improvement in clinical outcomes conferred by the IABP in patients developing cardiogenic shock after acute myocardial infarction. This issue is in need of further investigations. While conflicting results of several retrospective studies and meta-analyses have been published regarding the performance of the IABP in high-risk percutaneous coronary interventions, it has recently been found...


Short-term continuous-flow ventricular assist devices
Purpose of reviewTo provide a comprehensive update on the current state of short-term, continuous-flow ventricular assist devices (CF-VADs) in the treatment of refractory cardiogenic shock in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 patients. Recent findingsThe mortality rate associated with refractory cardiogenic shock remains markedly elevated, with INTERMACS 1 profile repeatedly demonstrating the worst outcomes. Recent innovations in continuous-flow pump technology have not only contributed to improved outcomes with long-term left ventricular assist device technology, but have also led to the development of various short-term, percutaneous, and surgical CF-VADs. Short-term CF-VADs have several favorable features, but, most notably, they allow the ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The role of extracorporeal membrane oxygenation circulatory support in the ‘crash and burn’ patient: from implantation to weaning
Purpose of reviewIn advanced cardiogenic shock, early mechanical circulatory support may prevent multiorgan failure and death. In this article, we are describing our experience with extracorporeal membrane oxygenation (ECMO) application. Recent findingsVenoarterial ECMO has been used successfully as a therapeutic option for patients with advanced cardiogenic shock and cardiac arrest. SummaryIn this review, based on the daily routine of the Hershey group using ECMO for therapy of advanced cardiogenic shock, the application of ECMO is described. The aim is to share our hands-on experience during emergent implantation and to contribute to the knowledge within the field of mechanical circulatory support. (Source: Current Opinion in Cardiology)


Spotlight on cardiogenic shock therapies in the era of mechanical circulatory support
No abstract available (Source: Current Opinion in Cardiology)


Clinical variability within the INTERMACS 1 profile: implications for treatment options
Purpose of reviewThe Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) I classification encompasses patients with varying clinical presentations and prognoses. The purpose of this review is to discuss four sub-classifications of cardiogenic shock patients (acute myocardial infarction, acute decompensated heart failure, biventricular failure, and myocarditis), and explore management considerations for these groups, with particular emphasis on strategies for device placement. Recent findingsIn single-center studies, the use of intra-aortic balloon counterpulsation, percutaneous ventricular assist devices, and extra-corporeal membrane oxygenation (ECMO) has allowed approximately half of cardiogenic shock patients to receive an implantable left ventricular assist d...


Clinical impact of intra-aortic balloon pump during extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock
Conclusions: The combined use of ECLS and IABP did not improve in-hospital survival in patients with AMI complicated by cardiogenic shock. (Source: BMC Anesthesiology)


Editorial: Hypoglycaemia, Hypotriglyceridaemia and Starvation Associated with Cardiogenic Shock
(Source: Nutrition)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Impact of multivessel disease on infarct size among STEMI patients undergoing primary angioplasty
Abstract: Background: Although primary angioplasty achieves Thrombolysis In Myocardial Infarction (TIMI) 3 flow in most patients with ST-elevation myocardial infarction, epicardial recanalization does not guarantee optimal perfusion in a large proportion of patients. Multivessel disease has been demonstrated to be associated with impaired survival, however its impact on infarct size has not been largely investigated, that therefore is the aim of the current study.Methods: Our population is represented by 827 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi.Results: Multivessel disease was observed in 343 patients (41.5%). It was associated with older age (65 [57–74] vs 63 [53–71], p  3 h (63.7% vs 56.4%, p = 0.038), and a tren...


Lupus-Associated Transverse Myelitis Masquerading as Septic Shock (P4.026)
ConclusionsThis is the first description of lupus presenting as spinal shock. We showcase relative bradycardia as a marker for neurogenic shock, and highlight the importance of effective communication between neurologists, intensivists and emergency physicians.Study Supported by: not applicableDisclosure: Dr. Dave has nothing to disclose. Dr. Ramos Estebanez has nothing to disclose. (Source: Neurology)


Akinetic Mutism And Parkinsonian Features Progressing To Coma Following A Hypoxic Event With Extended Lucid Interval: Manifestations Of Delayed Post-Hypoxic Leukoencephalopathy (P4.033)
CONCLUSIONS: Clinical anticipation and recognition of DPHL should lead to earlier diagnosis and higher-value care.Disclosure: Dr. Doerner Rinaldi has nothing to disclose. Dr. Miller has nothing to disclose. Dr. Czeisler has nothing to disclose. Dr. Willey has nothing to disclose. Dr. John has nothing to disclose. Dr. Claassen has nothing to disclose. Dr. Mayer has received personal compensation for activities with Actelion, Baxter, Biogen Idec, Codman/Johnson & Johnson Company, CSL Behring, Cornerstone Therapeutics, CR Bard, Novartis, Orsan Technologies, Pfizer Inc, Sage Therapeutics, and Stryker. Dr. Mayer has received research support from Non-Invasive Medical Systems, Inc., and General Electric. Dr. Agarwal has nothing to disclose. (Source: Neurology)


Do two dissimilar cases represent a case series?
2 out of 5 stars High-dose Insulin and Intravenous Lipid Emulsion Therapy for Cardiogenic Shock Induced by Intentional Calcium-Channel Blocker and Beta-Blocker Overdose: A Case Series. Doepker B et al. J Emerg Med 2014 Apr;46:486-490. &nbsp; Abstract The problems with this confused and confusing paper start with the title, which suggests that it will describe a series patients who presented with overdose of a calcium-channel blocker (CCB) and beta-blocker (BB), who were treated with high-dose insulin (HDI) and intravenous lipid emulsion (ILE). Well, this may be a case series, but the series includes only 2 patients, and it would have been nice if this limitation was made clear in the title. In addition, only one patient took both a BB and CCBs: Patient 1: a 35-year-old man who took larg...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A new face of endocannabinoids in pharmacotherapy. Part I: Protective role of endocannabinoids in hypertension and myocardial infarction.
Authors: Zubrzycki M, Liebold A, Janecka A, Zubrzycka M Abstract Cannabinoids are compounds which were first isolated from the Cannabis sativa plant. For thousands of years they have been used for treatment of numerous diseases. Currently, synthetic cannabinoids and endocannabinoids are also known. Cannabinoid receptors, endocannabinoids and the enzymes that catalyze their synthesis and degradation constitute the endocannabinoid system which plays an important role in functioning of the cardiovascular system. The results obtained to date suggest the involvement of endocannabinoids in the pathology of many cardiovascular diseases, including myocardial infarction, hypertension and hypotension associated with hemorrhagic, endotoxic, and cardiogenic shock. Cardioprotective effect and d...


Takotsubo cardiomyopathy as a sequela of elective direct-current cardioversion for atrial fibrillation.
We present the case of a 67-year-old woman who experienced cardiogenic shock caused by takotsubo cardiomyopathy, immediately after undergoing elective direct-current cardio-version for atrial fibrillation. After a course complicated by left ventricular failure, cardiogenic shock, and ventricular tachycardia, she made a complete clinical and echocardiographic recovery. In addition to this case, we discuss the possible direct effect of cardioversion in takotsubo cardiomyopathy. PMID: 24808781 [PubMed - in process] (Source: Texas Heart Institute Journal)


Growth differentiation factor-15 in Takotsubo cardiomyopathy: Diagnostic and prognostic value
Conclusion: TTC patients showed markedly high, but transient elevation of GDF-15 levels. Biventricular ballooning was associated with particularly high GDF-15 concentrations. Elevated GDF-15 values on admission were a strong predictor of adverse clinical outcome. (Source: International Journal of Cardiology)


Arterial access site utilization in cardiogenic shock in the United Kingdom: Is radial access feasible?
Conclusions: Although the majority of PCI cases performed in patients with cardiogenic shock in the United Kingdom are performed through the TFA, the radial artery represents an alternative viable access site in this high-risk cohort of patients in experienced centers. (Source: American Heart Journal)


[Successful surgery for lateral left ventricular wall rupture with severe mitral insufficiency resulting in cardiogenic shock].
Authors: Michalski B, Lipiec P, Bochenek A, Kasprzak JD PMID: 24677044 [PubMed - in process] (Source: Polish Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure
Conclusions: We strongly recommend left ventricular decompression in refractory cardiogenic shock and lung failure to avoid pulmonary edema, left heart distension and facilitate myocardial recovery. (Source: Journal of Cardiothoracic Surgery)


Drug-eluting versus bare-metal stents in large coronary arteries of patients with ST-segment elevation myocardial infarction: Findings from the ICAS registry.
CONCLUSION: There was no advantage to using a DES in large vessels for preventing a hard endpoint, whereas DES use resulted in a significant reduction in TVR in the patients with STEMI in this registry. PMID: 24685689 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


Extracorporal life support (ECLS) in acute ischaemic cardiogenic shock
(Source: International Journal of Clinical Practice)


Does the timing of treatment with intra-aortic balloon counterpulsation in cardiogenic shock due to ST-elevation myocardial infarction affect survival?
Conclusion: In this non-randomized trial the treatment with insertion of IABP before primary PCI in patients with CS due to STEMI is not associated with a more favorable outcome as compared with IABP started after primary PCI. PMID: 24670205 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)


Case 1/2014 - Syncope Due to Cardiogenic Shock in a 25-year-old Male Patient
Os avanços nas técnicas de cirurgia cardíaca e o diagnóstico precoce têm possibilitado maior sobrevida de indivíduos com cardiopatias congênitas. A investigação da qualidade de vida em crianças e adolescentes com cardiopatias congênitas fornece informações complementares aos dados clínicos que podem auxiliar na tomada de decisão dos profissionais de saúde. Embora muitos estudos tenham sido realizados para investigar a qualidade de vida de crianças e adolescentes com cardiopatias congênitas, os resultados mostram-se contraditórios. Enquanto alguns estudos revelam que as cardiopatias podem impactar a qualidade de vida, outros descrevem melhor percepção da qualidade de vida entre crianças e adolescentes cardiopatas quando comparados com controles saudáveis. O objetivo d...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Percutaneous Closure of Post-Infarction Ventricular Septal Defect: In-Hospital Outcomes and Long-Term Follow-Up of UK Experience.
CONCLUSIONS: Percutaneous closure of PIVSD is a reasonably effective treatment for these extremely high-risk patients. Mortality remains high but patients who survive to discharge do well in the longer term. PMID: 24668286 [PubMed - as supplied by publisher] (Source: Circulation)


Short and Long-Term Outcome of Stress-Induced Cardiomyopathy: What Can We Expect?
Conclusion: In our cohort of pts, TC was associated with a high in-hospital complications rate. Physical stress, LV dysfunction and peak BNP could predict acute adverse outcomes. (Source: Arquivos Brasileiros de Cardiologia)


[Influence of age in short and long term prognostic of ischemic cardiogenic shock.]
CONCLUSIONS: Myocardial infarction complicated with cardiogenic shock in elderly patients is an entity with high mortality during hospitalization and continues to worsen during long term follow-up. PMID: 24656925 [PubMed - as supplied by publisher] (Source: Archivos de Cardiologia de Mexico)


Critical illness-related corticosteroid insufficiency in cardiogenic shock
(Source: British Journal of Anaesthesia)


Reprint of "Intra-aortic balloon counterpulsation - Basic principles and clinical evidence"
Reprint of "Intra-aortic balloon counterpulsation - Basic principles and clinical evidence" Vascul Pharmacol. 2014 Mar 18; Authors: de Waha S, Desch S, Eitel I, Fuernau G, Lurz P, Sandri M, Schuler G, Thiele H Abstract Intra-aortic balloon pump (IABP) counterpulsation has been the most widely used left ventricular assist device for nearly five decades. Due to diastolic inflation and systolic deflation, coronary blood flow is increased and afterload decreased translating into augmentation of oxygen supply and lowering of oxygen demand. However, IABP may be associated with serious complications, including major bleeding, stroke, local and systemic infections and vascular complications. These might counterbalance the potential beneficial hemodynamic effects. In clinical routin...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Cardiogenic shock following fulminant myocarditis: a pluri-complicated case report
(Source: The American Journal of Emergency Medicine)


Clinical Outcomes in Fulminant Myocarditis Requiring Extracorporeal Membrane Oxygenation: A Weighted Meta-Analysis of 170 Patients
Conclusion: More than two-thirds of patients with FM and either cardiogenic shock and/or cardiac arrest survive to hospital discharge with ECMO. These findings could be used in the risk-benefit analysis when initiation of a cardiopulmonary bypass system is being considered for FM. (Source: Journal of Cardiac Failure)


Cardiogenic shock following fulminant myocarditis: a pluri-complicated case report
We describe the case of a previously healthy young woman, that after few days of flu-like symptoms, was admitted for chest pain and dyspnea. She developped a fulminant myocarditis with rapid deterioration of haemodinamic and hepatorenal function, that was treated with inotropes and arterio-venous Extracorporeal Membrane Oxygenation. (Source: The American Journal of Emergency Medicine)


Trends in Door‐to‐Balloon Time and Outcomes Following Primary Percutaneous Coronary Intervention for ST‐elevation Myocardial Infarction – An Australian Perspective
ConclusionsThere has been a decline in median DTBT in the MIG registry over five years. DTBT of ≤90 minutes is associated with improved clinical outcomes at 12 months. (Source: Internal Medicine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Sunitinib in combination with trastuzumab for the treatment of advanced breast cancer: activity and safety results from a phase II study
Conclusions: Sunitinib plus trastuzumab demonstrated antitumor activity in patients with HER2-positive ABC, particularly those who were treatment-naive or had only received prior adjuvant treatment. Sunitinib plus trastuzumab had acceptable safety and tolerability in patients with HER2-positive ABC who had not received prior anthracycline therapy.Trial registration: NCT00243503. (Source: BMC Cancer)


Intra-aortic balloon pump (IABP) counterpulsation improves cerebral perfusion in patients with decreased left ventricular function.
CONCLUSIONS: IABP improves cerebral blood flow, particularly in patients with pre-existing heart failure and highly impaired LVEF. Hence, an IABP might be a treatment option to improve cerebral perfusion in selected patients with cerebral misperfusion and simultaneously existing severe heart failure. PMID: 24609841 [PubMed - as supplied by publisher] (Source: Perfusion)


One-Year Clinical Outcome of Elderly Patients Undergoing Angioplasty for ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: The Importance of 3-Vessel Disease and Final TIMI-3 Flow Grade
Section:&nbsp; Original Contribution Topics:&nbsp; Outcomes Issue Number:&nbsp; Volume 3 - Issue 26 - March 2014 Author(s):&nbsp; Francesco De Felice, MD, Elena Guerra, MD, Rosario Fiorilli, MD, Antonio Parma, MD, Carmine Musto, MD, Marco Stefano Nazzaro, MD, Roberto Violini, MD wm 114-118 DeFelice March 2014.pdf The influence of age on clinical results of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarctions complicated by cardiogenic shock is poorly investigated. We examine factors that may help identify patients at highest risk. read more (Source: The ...


Key recommendations and evidence from the NICE guideline for the acute management of ST-segment-elevation myocardial infarction
The acute management of ST-segment-elevation myocardial infarction (STEMI) has seen significant changes in the past decade. Although the incidence has been declining in the UK, STEMI still gives rise to around 600 hospitalised episodes per million people each year, with many additional cases resulting in death before hospital admission. In-hospital mortality following acute coronary syndromes has fallen over the past 30 years from around 20% to nearer 5%, and this improved outcome has been attributed to various factors, including timely access to an expanding range of effective interventional and pharmacological treatments. A formal review of the acute management of STEMI is therefore appropriate. The recently published NICE clinical guideline (CG167: The acute management of myocardial inf...


Routine angiography in survivors of out of hospital cardiac arrest with return of spontaneous circulation: a single site registry
Conclusions: Acute myocardial infarction was the commonest cause of OOHCA and a high rate of survival to discharge was seen with a strategy of routine angiography and revascularization. (Source: BMC Cardiovascular Disorders)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Outcomes among patients requiring unplanned intra-aortic balloon pump reinsertion in cardiogenic shock
Conclusion: Among patients with CS undergoing IABP removal, hemodynamic deterioration requiring IABP reinsertion is associated with extremely poor outcomes and, in appropriate patients, should prompt consideration of more advanced cardiac support. (Source: Cardiovascular Revascularization Medicine)


State of the art contemporary treatment of patients with ST elevation myocardial infarction: pre- and in-hospital organization, devices and drugs.
CONCLUSIONS: Optimal treatment of STEMI patients is best performed with a widely accessible reperfusion strategy, preferably primary PCI, with contemporary peri-procedural anti-thrombotic treatment and device implantation. Accessibility of reperfusion strategies is increased by efficient STEMI networks applying prehospital triage with digital tele-transmission of electrocardiograms (ECGs) and seamless patient transitions between health-care unities. Efficient treatments of complicated STEMI with out-of hospital cardiac arrest and/or cardiogenic shock underline the necessity of structured referral systems, preferably immediately after the initial STEMI diagnosis. PMID: 24622447 [PubMed - in process] (Source: Chinese Medical Journal)


Outcomes among patients requiring unplanned intra-aortic balloon pump reinsertion in cardiogenic shock
(Source: Cardiovascular Revascularization Medicine)


Percutaneous Mechanical Assist for Severe Cardiogenic Shock Due to Acute Right Ventricular Failure
Abstract Acute right ventricular failure can lead to severe cardiogenic shock and death. Recovery may be achieved with early supportive measures. In many patients, intravenous fluid and inotropic resuscitation is inadequate to improve cardiac output. In these cases, percutaneous mechanical assist may provide a non‐surgical bridge to recovery. Herein, we describe a case series of patients with severe, refractory cardiogenic shock due to acute right ventricular failure who received a continuous flow percutaneous ventricular device primarily utilizing the right internal jugular vein for out flow cannula placement. © 2014 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Diagnosis And Management Of Shock In The Emergency Department
This issue reviews the 4 primary categories of shock as well as special categories, including shock in pregnancy, traumatic shock, septic shock, and cardiogenic shock in myocardial infarction. Adherence to evidence-based care of the specific causes of shock can optimize a patient’s chances of surviving this life-threatening condition. (Source: Emergency Medicine Practice)


Recurrent lymphocytic myocarditis in a young male with ulcerative colitis
This report describes the case of a young Caucasian male, whose heart biopsy was tested negative for giant cells and bacterial or viral genomes or proteins. He was experiencing severe lymphocytic myocarditis (other than mesalamine-induced) along with cardiogenic shock during ulcerative colitis exacerbation. This is an extremely rare, if not unique, clinical constellation. We chose to study the epidemiologic grounds and all major aspects of differential pathogenesis and treatment of this serious health problem. (Source: BioMed Central)


Intra‐aortic balloon pump insertion through the right subclavian artery in a patient of anterior wall myocardial infarction with ventricular septal rupture and severe peripheral artery obstruction disease
Intra‐aortic balloon pump (IABP) is used in cardiogenic shock of different etiologies. Routinely, it is inserted through the transfemoral access, but in the patients with severe peripheral artery obstruction disease (PAOD), use of alternative approach is needed. In this case report, IABP insertion through the right subclavian artery with the help of cardiothoracic surgeon in a patient of anterior wall myocardial infarction (AWMI) with severe PAOD has been described. A 60‐years‐old male patient, with the history of chronic smoking, presented with progressing chest pain for last 3 days. On the basis of clinical examination and radiological findings, he was diagnosed with AWMI along with the ventricular septal rupture and PAOD. The patient was advised to undergo coronary artery bypass g...


Prognostic implications of atrio-ventricular block in patients undergoing primary coronary angioplasty in the stent era.
Conclusions: AVB in patients who underwent primary angioplasty is associated with a worse prognosis while is in-hospital. This risk is particularly high in patients who had persistent AVB at hospital discharge. PMID: 24552223 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)


Choosing wisely - when to mend a broken heart with ECMO?
Refractory cardiac shock in the cardiac surgical intensive care unit confers significant morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) has become a common intervention for refractory cardiogenic shock when other therapies have failed. However, it is difficult to predict who will benefit from this costly, resource-intensive, but potentially life-saving technology. Here, we discuss the utility of a novel biomarker, serum butylcholinesterase, in determining survival in patients supported with ECMO following cardiac surgery. (Source: Critical Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Short-term mechanical support and pharmacotherapy, a new strategy in cardiogenic shock?
Authors: Tseng CC, Chamuleau SA, De Jonge N, Ramjankhan FZ PMID: 24549485 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)


Noninvasive assessment of hemodynamic variables using near-infrared spectroscopy in patients experiencing cardiogenic shock and individuals undergoing venoarterial extracorporeal membrane oxygenation
Conclusions: Results of the present study suggest that CrSO2 and PrSO2 in particular can be used for noninvasive estimation and monitoring of global circulatory status in patients experiencing cardiogenic shock and individuals undergoing ECMO. (Source: Journal of Critical Care)


High-Dose Insulin and Intravenous Lipid Emulsion Therapy for Cardiogenic Shock Induced by Intentional Calcium-Channel Blocker and Beta-Blocker Overdose: A Case Series
Conclusions: HDI effectively reverses CS induced by CCBs and BBs due to its inotropic effects, uptake of glucose into cardiac muscle, and peripheral vasodilatation. ILE is theorized to sequester agents dependent on lipid solubility from the plasma, preventing further toxicity. To our knowledge, these are the first two successful cases reported using the combination of HDI and ILE for reversing CS induced by intentional ingestions of CCBs and BBs. (Source: The Journal of Emergency Medicine)


Refractory hypoglycemia and subsequent cardiogenic shock in starvation and refeeding: Report of three cases
(Source: Nutrition)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Percutaneous extracorporeal life support for patients in therapy refractory cardiogenic shock: initial results of an interdisciplinary team
CONCLUSIONS Due to the evolution of transportable ECLS systems and percutaneous techniques implantation on scene is feasible. Extracorporeal life support may serve as a bridge-to-decision and bridge-to-treatment device. Neurological evaluation before ventricular assist device implantation and PCI under stable conditions are possible. Despite substantial mortality, ECLS implantation in selected patients by an experienced team offers additional support to conventional therapy as well as CPR and allows survival in patients that otherwise most likely would have died. This concept has to be implemented in cardiac survival networks in the future. (Source: Interactive CardioVascular and Thoracic Surgery)


Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation
We describe the case of a patient with an intramural hematoma and floating thrombus after cardiopulmonary resuscitation. The 92-year old man had a cardiac arrest due to ventricular fibrillation and witnesses immediately initiated manual cardiopulmonary resuscitation. Transesophageal echocardiography was performed immediately on hospital admission because the patient was in cardiogenic shock. In addition to an akinetic anterior wall, examination of the descending thoracic aorta demonstrated an intramural hematoma and a floating intra-aortic thrombus at a distance of 40cm from the dental arch. There was no aortic dissection. The thrombus was attributed to aortic compression during cardiopulmonary resuscitation. Although the aortic thrombus and intramural hematoma were not associated with any...


Valve‐in‐valve implantation with a 23‐mm balloon‐expandable transcatheter heart valve for the treatment of a 19‐mm stentless bioprosthesis severe aortic regurgitation using a strategy of “extreme” underfilling
We report a case of valve‐in‐valve (ViV) implantation by transfemoral approach with a 23‐mm balloon‐expandable prosthesis inside a stentless 19‐mm acutely degenerated bioprosthesis, using a strategy of “extreme” underfilling. A 74‐year‐old patient presented to our institution in cardiogenic shock. An initial transesophageal echocardiography (TEE) showed severe central aortic regurgitation (AR) due to a torn leaflet. She was deemed inoperable and considered for urgent transcatheter aortic valve replacement. Given the fairly small true internal diameter, a strategy of 3‐cc underfilling of a 23‐mm transcatheter heart valve (THV) was planned. However, the final implantation was performed with 5‐cc underfilling due to the incapacity to deliver the entire amount of fluid ...


Counterpulsation: A concept with a remarkable past, an established present and a challenging future
Abstract: The intra-aortic balloon pump (IABP), which is the main representative of the counterpulsation technique, has been an invaluable tool in cardiologists' and cardiac surgeons' armamentarium for approximately half a century. The IABP confers a wide variety of vaguely understood effects on cardiac physiology and mechano-energetics. Although, the recommendations for its use are multiple, most are not substantially evidence-based. Indicatively, the results of recently performed prospective studies have put IABP's utility in the setting of post-infarction cardiogenic shock into question. However, the particular issue remains open to further research. IABP support in high-risk patients undergoing PCI is associated with favorable long-term clinical outcome. In cardiac surgery, the use of ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


HeartWare left ventricular assist device thrombosis including outflow graft
A 42-year-old man referred with refractory acute cardiogenic shock and ventricular arrhythmias after extensive anterior myocardial infarction underwent rescue implantation of a CentriMag (Levitronix LLC, Waltham, Mass) biventricular assist device. Because we were not able to match him with a suitable donor, he was implanted with a HeartWare left ventricular assist device (HeartWare International, Inc, Framingham, Mass). At 3 months after discharge, he was urgently readmitted with high pump flow, suggestive of pump thrombosis, for which he underwent thrombolysis. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Intraaortic Balloon Pump (IABP) insertion through the right subclavian artery in a patient of Anterior Wall Myocardial Infarction (AWMI) with Ventricular Septal Rupture (VSR) and severe Peripheral Artery Obstruction Disease (PAOD)
Abstract Intraaortic Balloon Pump (IABP) is used in cardiogenic shock of different aetiologies. Routinely, it is inserted through the trans–femoral access, but in the patients with severe Peripheral Artery Obstruction Disease (PAOD), use of alternative approach is needed. In this case report, IABP insertion through the right subclavian artery with the help of cardiothoracic surgeon in a patient of Anterior Wall Myocardial Infarction (AWMI) with severe PAOD has been described. A 60 years old male patient, with the history of chronic smoking, presented with progressing chest pain for last 3 days. On the basis of clinical examination and radiological findings, he was diagnosed with AWMI along with the Ventricular Septal Rupture (VSR) and PAOD. The patient was advised to undergo Coronary Art...


Hantaviruses and cardiopulmonary syndrome in South America.
Authors: Figueiredo LT, Souza WM, Ferrés M, Enria DA Abstract Hantavirus (Bunyaviridae) cardiopulmonary syndrome (HCPS) is an emerging health problem in South America due to urban growth and to the expansion of agriculture and cattle-raising areas into ecosystems containing most of the species of Sigmodontinae rodents that act as hantavirus reservoirs. About 4000 HCPS cases have been reported in South America up to 2013, associated with the following hantaviruses: Andes, Anajatuba, Araraquara (ARQV), Paranoá, Bermejo, Castelo dos Sonhos, Juquitiba, Araucária, Laguna Negra, Lechiguanas, Maripa, Oran, Rio Mamore and Tunari. The transmission of hantavirus to man occurs by contact with or through aerosols of excreta and secretions of infected rodents. Person-to-person transmission o...


Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock
(Source: The American Journal of Emergency Medicine)


Early 'in-lab' use of levosimendan in patients with cardiogenic shock unsuitable for intra-aortic balloon pump counterpulsation
We report the results of four patients with ST elevation myocardial infarction, complicated by cardiogenic shock unsuitable for intra-aortic balloon pump counterpulsation treated with early levosimendan infusion during primary percutaneous coronary intervention. (Source: Therapeutic Advances in Cardiovascular Disease)


A preliminary investigation into adrenal responsiveness and outcomes in patients with cardiogenic shock after acute myocardial infarction
Conclusions: A high baseline plasma TC was associated with a trend toward increased mortality in patients with cardiogenic shock post-AMI. Patients with lower baseline TC, but with an inducible adrenal response, appeared to have a survival benefit. A prognostic system based on basal TC and Δ max similar to that described in septic shock appears feasible in this cohort. Corticosteroid therapy was associated with adverse outcomes. These findings require further validation in larger studies. (Source: Journal of Critical Care)


[Correspondence] Management of acute myocardial infarction
Holger Thiele and colleagues reported the 12-month results of intra-aortic balloon pump (IABP) in acute myocardial infarction complicated by cardiogenic shock. IABP effects on cardiogenic shock could be at two levels: on the amount of left ventricular mass affected by infarction and on the vascular peripheral bed tone. The dysfunction of one of these mechanisms would negatively affect the other. We are probably expecting too much of IABP efficacy. (Source: LANCET)


Rituximab-vincristine chemotherapy-induced acute anterior wall myocardial infarction with cardiogenic shock.
We present a case of an elderly man with coronary artery disease who was diagnosed with non-Hodgkin lymphoma. Soon after the administration of chemotherapy, which included rituximab and vincristine, he developed acute myocardial infarction with cardiogenic shock. The condition was managed successfully with primary percutaneous coronary intervention. We briefly discuss the possible pathogenic mechanisms of chemotherapy-induced ischemic syndrome and the management of chemotherapy in patients with high cardiovascular risk. PMID: 24512409 [PubMed - in process] (Source: Texas Heart Institute Journal)


A unique access for the ablation catheter to treat electrical storm in a patient with extracorporeal life support
Conclusion Ablation of ventricular arrhythmias using a Y-connector to insert the ablation catheter into the arterial cannula is feasible in patients with a V-A ECMO system avoiding additional arterial puncture with potentially major vascular complications in critically ill patients. Manipulation of the catheter is not as easy as using a standard sheath but can well be performed after a short habituation. (Source: Europace)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Regional Variation Across the United States in Management and Outcomes of ST‐Elevation Myocardial Infarction: Analysis of the 2003 to 2010 Nationwide Inpatient Sample Database
ConclusionsDespite higher reperfusion and revascularization rates, STEMI patients in the Midwest, West, and South have paradoxically higher risk‐adjusted in‐hospital mortality as compared with patients in the Northeast. (Source: Clinical Cardiology)


Ischaemic cardiogenic shock
Abstract: Ischaemia is the most common underlying cause of cardiogenic shock. Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death. Myocardial ischaemia results in both systolic and diastolic dysfunction and triggers a maladaptive feedback loop that can ultimately result in tissue hypoxia, multi-organ dysfunction and death. Myocardial dysfunction can be complicated by a systemic inflammatory response syndrome (SIRS) as a result of systemic hypoxia. Echocardiography is key to diagnosis and to exclude conditions requiring urgent surgical intervention. Serial assessment can be used to monitor response to interventions and/or complications. Resuscitative aims are immediate cardiorespiratory stabilization to facilitate u...


Revascularization improves mortality in elderly patients with acute myocardial infarction complicated by cardiogenic shock
Cardiogenic shock (AMI-CS) occurs in 2.5–6% of hospitalized patients with acute myocardial infarction (AMI), and is associated with high morbidity and mortality . In the aftermath of the SHOCK trial , small observational studies reported on outcomes of elderly (≥75-year old) patients with AMI-CS (Supplement). Uncertainty however still exists regarding the benefits of early revascularization (ER) in elderly patients with AMI-CS. In the current report, we undertook aggregate data meta-analyses of short- and intermediate-term mortality outcomes to examine the impact of an ER strategy versus an initial medical stabilization (IMS) strategy in elderly patients with AMI-CS. (Source: International Journal of Cardiology)


Primary reperfusion in acute right ventricular infarction: An observational study.
CONCLUSION: PPCI is superior to TT and reduces short/long-term mortality for all RVI categories. RVI CS patients should be encouraged to undergo PPCI at a specialized center. PMID: 24527184 [PubMed] (Source: World Journal of Cardiology)


Strong ion approach in cardiogenic shock: formula and patients.
Authors: Attanà P, Lazzeri C, Chiostri M, Picariello C, Gensini GF, Valente S PMID: 24460382 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Myocardial infarction secondary to 5-fluorouracil: Not an absolute contraindication to rechallenge?
5-fluorouracil (5-FU) is one of the most commonly prescribed chemotherapeutic agents for the treatment of a variety of malignancies. 5-FU cardiotoxicity is uncommon but potentially serious: including cardiac arrhythmias, angina/myocardial infarction, ventricular dysfunction, cardiogenic shock, cardiac arrest, and sudden cardiac death . An estimated 2–10% of patients exposed to 5-FU will develop cardiovascular complications; and patients with known ischaemic heart disease or prior myocardial infarction appear to be at higher risk . (Source: International Journal of Cardiology)


Unusual cause of hypoxemia in myocardial infarction: Interventional management
An 86year-old woman was admitted in our institution for an inferior ST elevation myocardial infarction (STEMI) with a late presentation. She suffered from acute chest pain for 12h. She had hypertension and no other prior medical history. Cardiovascular examination at arrival was normal with no sign of heart failure. ECG showed ST elevation in inferior leads with Q waves. Due to persistent chest pain, an emergency coronary angiogram was performed and found a total occlusion of proximal right coronary without significant disease on the left coronary system. Two bare-metal-stents were implanted () with a good final result (TIMI 3 Flow). The day following admission, she developed shock combining hypotension, jugular venous distension, clear lung and oligoanuria which guided us to diagnose a ca...


Feasibility of transradial coronary intervention in patients with cardiac arrest caused by acute coronary syndrome
The radial versus femoral investigation in ST elevation acute coronary syndrome (ACS) study proved the usefulness of transradial coronary intervention (TRI) in patients with acute myocardial infarction (AMI) . Furthermore, the current european society of cardiology (ESC) guidelines recommend TRI even in patients with ST-elevation acute myocardial infarction (STEMI), on the condition that the PCI is performed by a skilled radial operator . However, patients with ACS sometimes present with cardiogenic shock or cardiac arrest, the difficulty of the arterial puncture becomes the problem. These difficulties could affect the procedure time and consequently the clinical outcome. So far, however, there is a paucity of available data concerning the feasibility of TRI in patients with cardiogenic sh...


Surgical Treatment of Complete Anterolateral Papillary Muscle Rupture Following Acute Myocardial Infarction.
We report the successful surgical management of complete anterolateral papillary muscle rupture associated with cardiogenic shock in an 80-year-old woman. The patient was admitted with the sudden onset of chest pain and dyspnea. After hemodynamics deteriorated rapidly, she was intubated and intra-aortic balloon pump was started immediately. Transthoracic echocardiography revealed severe mitral regurgitation due to complete anterolateral papillary muscle rupture associated with lateral myocardial infarction. Coronary angiography demonstrated complete occlusion of the first obtuse marginal artery. She underwent emergency mitral valve replacement and coronary artery bypass grafting. There were no complications of surgery and she was discharged on postoperative day 35. Rapid preoperative asses...


Preventing LVAD implantation by early short-term mechanical support and prolonged inodilator therapy : A case series with acute refractory cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation and optimised medical strategy.
In this report, we present a series of three cases with acute refractory cardiogenic shock ('crash and burn', INTERMACS profile 1) successfully treated by ECMO and early optimal medical therapy preventing a certain path towards LVAD and/or HTX, for which they were initially referred. This conservative approach in INTERMACS profile one patients warrants very early introduction of adequate medical heart failure therapy under the umbrella of a combination of short-term mechanical circulatory and inotropic support by phosphodiesterase inhibitors. Therefore, this novel combined medical-mechanical approach could have important clinical implications for this extremely challenging patient category, as it may avoid an unnecessary and costly clinical path towards LVAD and/or heart transplantation. ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Successful treatment of cardiogenic shock with an intra-aortic balloon pump following aluminium phosphide poisoning.
We report on the use of an intra-aortic balloon pump (IABP) in a 24-year-old woman brought to our hospital after an intentional ingestion of a tablet of AlP (3 g), which caused refractory AlP-induced cardiogenic shock and acute respiratory distress syndrome (ARDS). The patient underwent gastric lavage with potassium permanganate, received sodium bicarbonate intravenously, and was admitted to the intensive care unit. Echocardiography at 36 h post ingestion showed a left ventricular ejection fraction (LVEF) of &lt;20 %. An IABP was inserted and the patient's vital signs stabilised. After eight days, the IABP was removed and on day 20, the patient's LVEF increased to 50 %. IABP was successfully used and may improve future prognoses for severely poisoned AlP patients with refractory cardiogeni...


Characteristics and Outcomes in Patients Undergoing Percutaneous Coronary Intervention Following Cardiac Arrest (from the NCDR)
Outcomes in patients with out-of-hospital cardiac arrest (CA) who undergo percutaneous coronary intervention (PCI) have been limited to small, mostly single-center studies. We compared patients who underwent PCI after CA included in the CathPCI Registry with those without CA. Patients with ST elevation were classified as ST-elevation myocardial infarction (STEMI); all other patients having PCI were classified as without STEMI. Patients with CA in each group were compared with the corresponding non-CA groups for baseline characteristics, angiographic findings, and outcomes. A total of 594,734 patients underwent PCI, of whom 114,768 had STEMI, including 9,375 (8.2%) had CA, and 479,966 had without STEMI, including 2,775 (0.6%) had CA. Patients with CA were similar in age to patients with non...


Cardiogenic shock from acute ST-segment elevation myocardial infarction induced by severe multivessel coronary vasospasm
(Source: European Heart Journal)


Mechanical circulatory support in cardiogenic shock
In conclusion, despite the need for effective mechanical circulatory support in CSMI, current devices, as tested, have not been demonstrated to improve short- or long-term survival rates. RCTs testing the optimal timing of device therapy and optimal device design are needed to improve outcomes in CSMI. (Source: European Heart Journal)


Does remote ischaemic preconditioning with postconditioning improve clinical outcomes of patients undergoing cardiac surgery? Remote Ischaemic Preconditioning with Postconditioning Outcome Trial
Conclusion Remote ischaemic preconditioning with RIPostC by transient upper limb ischaemia did not improve clinical outcome in patients who underwent cardiac surgery. Clinical Trial Registration clinicaltrials.gov, NCT00997217. (Source: European Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The QT prolongation and clinical features in patients with takotsubo cardiomyopathy: Experiences of two tertiary cardiovascular centers.
CONCLUSION: The clinical features of takotsubo cardiomyopathy are different according to the presence of QT prolongation. The QT group was lesser likely to have preserved cardiovascular reserve and more likely to require hemodynamic support than the NQT group despite the entire prognosis of takotsubo cardiomyopathy is excellent regardless of QT prolongation. PMID: 24449633 [PubMed - as supplied by publisher] (Source: The Anatolian Journal of Cardiology)


Myocarditis, hepatitis, and pancreatitis in a patient with coxsackievirus A4 infection: a case report
We report here a case of viral myocarditis with liver dysfunction and pancreatitis. A 63-year-old man was admitted to our hospital with dyspnea. The initial investigation showed pulmonary congestion, complete atrioventricular block, left ventricular dysfunction, elevated serum troponin I, and elevated liver enzyme levels. He developed pancreatitis five days after admission. Further investigation revealed a high antibody titer against coxsackievirus A4. The patient's left ventricular dysfunction, pancreatitis, and liver dysfunction had resolved by day 14, but his troponin I levels remained high, and an endomyocardial biopsy showed T-lymphocyte infiltration of the myocardium, confirming acute myocarditis. The patient underwent radical low anterior resection five weeks after admission for adv...


Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives
Conclusions: For patients in CS requiring emergent hemodynamic support, pVAD therapy offers a less invasive alternative that can be deployed sooner, resulting in better outcomes, shorter LOS, lower costs and with no incremental cost, and a survival benefit when compared with traditional surgical hemodynamic support alternatives. PVAD therapy (and Impella 2.5 in particular) is emerging as a dominant strategy for this challenging patient population. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Trends in Incidence, Management, and Outcomes of Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction in the United States [Coronary Heart Disease]
Conclusions The incidence of cardiogenic shock complicating STEMI has increased during the past 8 years together with increased use of early mechanical revascularization and intra-aortic balloon pumps. There has been a concomitant decrease in risk-adjusted inhospital mortality, but an increase in total hospital costs during this period. (Source: JAHA:Journal of the American Heart Association)


Myxedema coma in a patient with type 1 neurofibromatosis: rare association
We describe a 51-year-old male patient who has discontinued hypothyroidism treatment 10 months earlier and developed lethargy, edema, and cold intolerance symptoms. He also had a previous diagnosis of neurofibromatosis. After admission, he progressed to respiratory insufficiency and coma. The prompt recognition of the condition, thyroid hormone replacement, and management of the complications (hypoventilation, cardiogenic shock associated with swinging heart, adrenal and renal insufficiency and sepsis), resulted in a favorable evolution. (Source: Arquivos Brasileiros de Endocrinologia e Metabologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Strong ion gap in cardiogenic shock-the calculation seems wrong.
Authors: Gatz R Abstract These formulae are erroneous and lead to predictably grossly wrong results. The authors find SIG values of mean -14 mEq/l in the non-survivors' and -10 mEq/l in the survivors' group. ' According to our data the SIG approach does not seem to add further information to usual parameters in acid-base evaluation or early risk stratification in cardiogenic shocks patients.' PMID: 24410273 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)


Gradual Decline in the Age-Adjusted In-Hospital Mortality Rate From STEMI-Related Cardiogenic Shock Irrespective of Cause, Race or Gender With Persistent Higher Mortality Rates in Women Despite Multivariate Adjustment
Section:&nbsp; Original Contribution Topics:&nbsp; Cardiogenic Shock Issue Number:&nbsp; Volume 26 - Issue 1 - January 2014 Author(s):&nbsp; Mohammad Reza Movahed, MD, PhD1,2,3, Muhammad F. Khan, MD2, Mehrtash Hashemzadeh, MS4, Mehrnoosh Hashemzadeh, PhD3 wm 7-12 Movahed JIC 0114.pdf An evaluation of the trends of age-adjusted mortality rates for all-cause and ST-elevation myocardial infarction (STEMI)-related cardiogenic shock in the United States. read more (Source: The Journal of Invasive Cardiology)


Valve‐in‐valve implantation with a 23mm balloon‐expandable transcatheter heart valve for the treatment of a 19mm stentless bioprosthesis severe aortic regurgitation using a strategy of “Extreme” underfilling
We report a case of valve‐in‐valve (ViV) implantation by transfemoral approach with a 23‐mm balloon‐expandable prosthesis inside a stentless 19‐mm acutely degenerated bioprosthesis, using a strategy of “extreme” underfilling. A 74‐year‐old patient presented to our institution in cardiogenic shock. An initial transesophageal echocardiography (TEE) showed severe central aortic regurgitation (AR) due to a torn leaflet. She was deemed inoperable and considered for urgent TAVR. Given the fairly small true internal diameter, a strategy of 3‐cc underfilling of a 23‐mm transcatheter heart valve (THV) was planned. However, the final implantation was performed with 5‐cc underfilling due to the incapacity to deliver the entire amount of fluid contained in the inflation syringe...


CardioPulse Articles * Biomarkers, genomics, telemetry, computational biology, and zebrafish: will one of these solve the problems of post-myocardial infarction heart failure? * Book Review * Fast facts: Cardiac Arrhythmias * Long-distance cross-country skiers at increased risk of arrhythmias * Heart and blood vessels * Controversies in acute cardiovascular care: cardiogenic shock
(Source: European Heart Journal)


Admission Hyperglycemia Predicts Inhospital Mortality and Major Adverse Cardiac Events After Primary Percutaneous Coronary Intervention in Patients Without Diabetes mellitus
Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose &lt;118 mg/dL (n = 166), tertile II: glucose 118 to 145 mg/dL (n = 168), and tertile III: glucose &gt;145 mg/dL (n = 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P &lt; .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P = .01). Multivariate logistic regression analysis revealed that pa...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


ST Elevation Myocardial Infarction Diagnosed after Hospital Admission.
CONCLUSIONS: Patients who develop STEMI while in-hospital represent a unique, high-risk subset of patients. They have increased treatment time and LOS and higher mortality than those presenting via EMS or who are self/family driven. PMID: 24389237 [PubMed - as supplied by publisher] (Source: Circulation)


Inotropic agents and vasodilator strategies for acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome.
CONCLUSIONS: At present there are no robust and convincing data to support a distinct inotropic or vasodilator drug based therapy as a superior solution to reduce mortality in haemodynamically unstable patients with CS or low cardiac output complicating AMI. PMID: 24385385 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)


Correlates for mortality in patients presented with acute myocardial infarct complicated by cardiogenic shock
Conclusions: In the era of primary PCI and IABP as standard of care in AMI complicated by CS, patients with low EF, those who necessitate IABP insertion pre-PCI, and those who necessitate cardiopulmonary resuscitation during PCI are at higher risk for in-hospital mortality and should be considered for more robust hemodynamic support devices with an attempt to improve their prognosis. (Source: Cardiovascular Revascularization Medicine)


Outcome of primary PCI - An Indian tertiary care center experience.
CONCLUSION: Our study has shown that PPCI is feasible with good outcomes in Indian scenario. Even though the recommended door-to-balloon time can be achieved, the total ischemic time remained long. CS in the setting of STEMI was associated with poor outcomes. PMID: 24581092 [PubMed - in process] (Source: Indian Heart J)


Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography
Conclusions In this large cohort of patients with angiographic surveillance we demonstrated the impact of device &nbsp;development on antirestenotic efficacy, with sequentially improved efficacy from BMS to first generation DES to second generation DES. Predictors of restenosis were small vessel size, increased stented length, complex lesion morphology, diabetes mellitus, and prior bypass surgery. (Source: Heart)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intra-aortic balloon counterpulsation - Basic principles and clinical evidence.
Authors: de Waha S, Desch S, Eitel I, Fuernau G, Lurz P, Sandri M, Schuler G, Thiele H Abstract Intra-aortic balloon pump (IABP) counterpulsation has been the most widely used left ventricular assist device for nearly five decades. Due to diastolic inflation and systolic deflation, coronary blood flow is increased and afterload decreased translating into augmentation of oxygen supply and lowering of oxygen demand. However, IABP may be associated with serious complications, including major bleeding, stroke, local and systemic infections and vascular complications. These might counterbalance the potential beneficial hemodynamic effects. In clinical routine, IABP is mainly used in high-risk patients with acute myocardial infarction, especially when complicated by cardiogenic shock. Fu...


Cause of Death Within 30 Days of Percutaneous Coronary Intervention in an Era of Mandatory Outcome Reporting: Bhuvnesh A, Ellis SG, Lincoff AM, et al. J Am Coll Cardiol 2013;62:409–15.
In anticipation of public reporting of outcomes after percutaneous coronary intervention (PCI) becoming standard practice, this study from a single tertiary care center sought to investigate the incidence and causes of death in patients who had undergone PCI. Death within 30 days post intervention was studied through a retrospective chart review of a PCI registry examining cardiac, noncardiac, PCI- and non-PCI-related causes of death from January 2009 to April 2011. Cardiac death was defined as myocardial infarction, low output failure, fatal dysrhythmia, unwitnessed death, death from unknown cause, procedure-related deaths, and all death that could not show clear noncardiac cause. Noncardiac causes were divided into respiratory, infectious, neurological, gastrointestinal, renal, and hem...


Acquired hemophilia complicated by cardiorenal syndrome type 3
Rakesh Sharma, Sananta Kumar Dash, Rajesh Chawla, Sudha Kansal, Devender Kumar Agrawal, Harsh DuaIndian Journal of Critical Care Medicine 2013 17(6):378-381Development of autoantibodies against coagulation factor VIII (FVIII) leads to a rare condition defined as acquired hemophilia (AH). If not diagnosed and treated early, AH may be associated with high mortality and morbidity. A 65-year-old woman presented with history of macrohematuria, acute renal failure, cardiogenic shock, and acute respiratory failure. Blood investigation revealed azotemia, prolonged activated partial thromboplastin time (aPTT), coagulation FVIII level of &lt;1&#x0025;, and presence of FVIII inhibitor. Echocardiography showed global hypokinesia and ultrasonography and computed tomography (CT) revealed bilateral hydro...


Mechanical ventilation in the early phase of ST elevation myocardial infarction treated with mechanical revascularization.
CONCLUSIONS: In a large series of consecutive STEMI patients submitted to MV, the need of MV is a strong prognostic indicator of mortality both at short and long term. Among mechanically ventilated STEMI patients infarct size (as inferred by TnI values) and PCI failure were independent predictors of early death, while the duration of MV was related to death at longterm. PMID: 24338538 [PubMed - in process] (Source: Cardiology Journal)


Thrombolytic Therapy for Thrombosis of Continuous Flow Ventricular Assist Devices
Conclusions: In the setting of LVAD thrombosis, thrombolytic therapy is an alternate treatment strategy in a subset of patients. Candidacy for this alternate procedure must carefully weigh the risks of complications, including hemorrhage and thromboembolism. (Source: Journal of Cardiac Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Ventricular assist device implantation with CentriMag VAS® for biventricular mechanical support
Apesar dos avanços no tratamento de portadores de insuficiência cardíaca aguda, os resultados permanecem insatisfatórios nos portadores de choque cardiogênico refratário. Uma opção para o tratamento dessa desafiadora e grave situação clínica é o implante de dispositivos de assistência ventricular temporária. O objetivo desta comunicação é apresentar um caso de choque cardiogênico refratário, com indicação de assistência ventricular, que evoluiu com falência ventricular direita após o implante de assistência esquerda com necessidade de conversão para o suporte biventricular.Despite recent advances in acute heart failure treatment, actual results remain limited in refractory cardiogenic shock. Temporary ventricular assist devices have emerged as an alternative in th...


Emergency median sternotomy and cardiopulmonary bypass during ruptured abdominal aortic aneurysm repair
We report the case of a patient who developed severe cardiogenic shock during the open repair of a ruptured abdominal aortic aneurysm. After controlling the bleeding from the ruptured aneurysm, the electrocardiogram exhibited ST-T elevation and bradycardia. A median sternotomy was performed, and cardiopulmonary bypass was established. Under cardiopulmonary bypass support, the patient successfully underwent a Y-shaped graft replacement. The venous and arterial cannulae were recannulated through the femoral artery and vein. The chest and abdomen were closed in the usual fashion. Five hours after admission to the intensive care unit, cardiopulmonary bypass was weaned successfully, and the patient was extubated 1 day after surgery. Postoperative coronary angiography showed severe vasospastic a...


Mechanical Ventilation With PEEP in Cardiogenic ShockMechanical Ventilation With PEEP in Cardiogenic Shock
PEEP, is it safe to use in severe LV dysfunction and cardiogenic shock? Heart (Source: Medscape Today Headlines)


Design and rationale of the TOTAL trial: A randomized trial of routine aspiration ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI
The objective of this study is to evaluate the efficacy of routine upfront manual aspiration thrombectomy during PPCI compared with percutaneous coronary intervention alone in patients with STEMI.Design: This is a multicenter, prospective, open, international, randomized trial with blinded assessment of outcomes. Patients with STEMI undergoing PPCI are randomized to upfront routine manual aspiration thrombectomy with the Export catheter (Medtronic CardioVascular, Santa Rosa, CA) or to percutaneous coronary intervention alone. The primary outcome is the composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening New York Heart Association class IV heart failure up to 180 days. The trial uses an event-driven design and will recruit 10,700 patien...


Characteristics, Management, and Outcomes of Cocaine-Positive Patients With Acute Coronary Syndrome (from the National Cardiovascular Data Registry)
We describe the characteristics, management, and outcomes of patients with MI and recent cocaine use from the Acute Coronary Treatment and Intervention Outcomes Network Registry—Get With The Guidelines (ACTION Registry-GWTG) program. The study population was 102,952 patients enrolled in the American College of Cardiology ACTION Registry-GWTG from July 2008 to March 31, 2010 from 460 sites across the United States. Cocaine exposure was defined as self-reported cocaine use within the last 72 hours or a positive urine test for cocaine. Demographics and medical history, presenting characteristics, treatments, and in-hospital outcomes were reported on a standard case record form. A total of 924 patients (0.9%) were cocaine positive. Compared with cocaine-negative patients, cocaine-positive p...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Mortality in the coronary care unit
ConclusionThis study provides additional mortality information for the modern-day CCU and should help identify factors that may predict survival. (Source: Coronary Artery Disease)


Incremental Value of Left Ventricular Systolic and Diastolic Function to Determine Outcome in Patients with Acute ST‐Segment Elevation Myocardial Infarction: The Echocardiographic Substudy of the OASIS‐6 Trial
ConclusionIn this large international trial, LV systolic and diastolic function, as determined by echocardiography early following STEMI, are incremental predictors of MACE. In addition, RDF is a strong independent predictor of MACE after STEMI across a broad range of LVEF. (Source: Echocardiography)


Influenza B-Induced Refractory Cardiogenic ShockInfluenza B-Induced Refractory Cardiogenic Shock
In this case report, a woman without known heart disease presented in profound cardiogenic shock. The cause? Influenza B. BMC Infectious Diseases (Source: Medscape Today Headlines)


A passionate endurance cyclist ultimately survives sudden death in right ventricular giant cell myocarditis
A previously healthy 50-year old male suffered out-of-hospital cardiac arrest (OHCA; ventricular fibrillation). Return of spontaneous circulation occurred after 12min of immediate resuscitation. Upon admission, recurrent ventricular tachyarrhythmias (VT) caused refractory cardiogenic shock, rescued by peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Urgent echocardiography and chest CT revealed right ventricular (RV) dilation and biventricular hypokinesia () in the absence of angiographic evidence of pulmonary embolism or coronary disease. RV endomyocardial biopsies (EMB) demonstrated extensive inflammatory infiltrates with multinucleated giant-cells indicating giant-cell myocarditis (GCM; ). Furthermore, reverse-transcriptase polymerase chain reaction showed presenc...


Acute Mitral Regurgitation: Unforeseen New Complication of the Impella LP 5.0 Ventricular Assist Device and Review of Literature
We report here the first case with acute mitral regurgitation due to chordal rupture and flail mitral valve leaflet as a result of Impella device displacement, a new complication. Review of literature is also reported. (Source: Heart, Lung and Circulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Delirium in patients admitted to a cardiac intensive care unit with cardiac emergencies in a developing country: incidence, prevalence, risk factor and outcome
Abstract: Aim: To assess the incidence, prevalence, risk factors and outcome of delirium in patients admitted to a cardiac intensive care unit (ICU) of a tertiary care hospital.Methods: Three hundred nine consecutive patients admitted to a 22-bed coronary care unit were screened for presence of delirium by using Confusion Assessment Method for Intensive Care Unit (CAM-ICU), and those found positive on CAM-ICU were further evaluated by a psychiatrist to confirm the diagnosis of delirium as per DSM-IV-TR criteria. Patients were also evaluated for the risk factors for delirium and outcome of delirium.Results: Incidence rate of delirium was 9.27%, and prevalence rate was 18.77%. The risk factors identified for delirium in binary logistic regression analysis were hypokalemia, Sequential Organ F...


The Current Use of Impella 2.5 in Acute Myocardial Infarction Complicated by Cardiogenic Shock: Results from the USpella Registry
ConclusionsThe results of our study suggest that early initiation of hemodynamic support prior to PCI with Impella 2.5 is associated with more complete revascularization and improved survival in the setting of refractory CS complicating an AMI. (Source: Journal of Interventional Cardiology)


Percutaneous occlusion of post-myocardial infarction ventricular septum rupture.
CONCLUSION: Percutaneous closure is a potential technique in a select group of patients. The presence of cardiogenic shock and closure in the acute phase after VSR diagnosis are important risk factors of mortality. Device implantation is in general successful with few procedure-related complications. Reduction of the shunt fraction has been reported frequently. This technique is a less invasive alternative to surgical treatment and should be applied on a case-by-case basis. PMID: 24287808 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)


Reply to Carev et al: “Useful Supplement to the Best Practice of Using Levosimendan in Cardiac Surgery Patients: 2.5 mg Intravenous Bolus for Cardiopulmonary Resuscitation During Perioperative Cardiac Arrest”
Carev et al are to be congratulated for their interesting case series regarding the use of levosimendan during cardiopulmonary resuscitation (CPR). Realistically, a sufficiently powered randomized controlled trial in this area will not be performed in the near future; therefore, an improved outcome (ie, reduction of mortality related to the use of levosimendan) cannot be confirmed for international guidelines. Nevertheless, a case series like this one is very important, because it demonstrates that clinicians in different countries observe similar things. Regarding the use of levosimendan during or shortly after CPR, for example, at the Medical University of Graz in Austria, we performed a guideline-conforming 90-minute postpartum reanimation after prostaglandin administration. After retur...


The Clinical Outcomes of Percutaneous Coronary Intervention Performed Without Pre-Procedural Aspirin
ObjectivesThe purpose of this study was to examine the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received pre-procedural aspirin.BackgroundAspirin is an essential component of peri-PCI pharmacotherapy. Previous studies suggest that pre-procedural aspirin is not administered to a clinically significant number of patients undergoing PCI.MethodsWe evaluated the incidence of PCIs performed without pre-procedural aspirin use among patients undergoing PCI from January 2010 through December 2011 at 44 hospitals in Michigan. Propensity-matched multivariate analysis was used to adjust for the nonrandom use of aspirin.ResultsOur study population comprised 65,175 patients, of whom 4,640 (7.1%) did not receive aspirin within 24 h before underg...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


State of the evidence: mechanical ventilation with PEEP in patients with cardiogenic shock
The need to provide invasive mechanical ventilatory support to patients with myocardial infarction and acute left heart failure is common. Despite the large number of patients requiring mechanical ventilation in this setting, there are remarkably few data addressing the ideal mode of respiratory support in such patients. Although there is near universal acceptance regarding the use of non-invasive positive pressure ventilation in patients with acute pulmonary oedema, there is more concern with invasive positive pressure ventilation owing to its more significant haemodynamic impact. Positive end-expiratory pressure (PEEP) is almost universally applied in mechanically ventilated patients due to benefits in gas exchange, recruitment of alveolar units, counterbalance of hydrostatic forces lead...


Precision in cardiology: should all cases of myocardial infarction with ventricular septal rupture require early repair?
Though the incidence of ventricular septal rupture (VSR) after myocardial infarction (MI) has reduced from 3%1 to 0.2%2 due to improvements in cardiac pharmacotherapy and intervention, the mortality rate still exceeds 87%1 in medically managed patients. The median time period between MI onset to VSR detection was 16&ndash;24&nbsp;h 2 It has been described to occur in a bimodal pattern&mdash;within 24&nbsp;h and between 3 and 5&nbsp;days after MI.3 It is considered a surgical emergency as it causes cardiogenic shock and worsens the haemodynamics and rapidly culminates in death. The mortality rate in surgically treated patients varies between 20% and 60%.4 5This heterogeneity is attributable to timing of surgery for VSR, cardiogenic shock and recurrence of VSR. Independent predictors of mort...


Differences in the Profile, Treatment, and Prognosis of Patients With Cardiogenic Shock by Myocardial Infarction Classification: A Report From NCDR [Original Articles]
Conclusions&mdash; Cardiogenic shock is associated with high mortality in patients with STEMI and NSTEMI. However, urgent revascularization is more commonly pursued in patients with STEMI presenting with shock than in patients with NSTEMI. More research is needed to improve the outcomes for patients with MI presenting with shock, particularly those presenting with NSTEMI. (Source: Circulation: Cardiovascular Quality and Outcomes)


Cardiogenic shock accompanied by dynamic left ventricular outflow tract obstruction and myocardial bridging after transient complete atrioventricular block mimicking ST-elevation myocardial infarction: a case report
Conclusion: The patient presented with a case of cardiogenic shock that mimicked ST-elevation myocardial infarction due to dynamic left ventricular outflow tract obstruction combined with myocardial bridging in the mid-left anterior descending artery. (Source: BMC Research Notes)


Sotalol-associated cardiogenic shock in a patient with asymptomatic transient rate-related cardiomyopathy.
Authors: Leslie SD PMID: 24237089 [PubMed - in process] (Source: Med J Aust)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Complete recovery after out-of-hospital cardiac arrest with prolonged (59 min) mechanical cardiopulmonary resuscitation, mild therapeutic hypothermia and complex percutaneous coronary intervention for ST-elevation myocardial infarction
We report on a 68 years old survivor of an out-of-hospital cardiac arrest with favorable neurological outcome following prolonged cardiopulmonary resuscitation (CPR 59 min) until return of spontaneous circulation (ROSC) due to ST-elevation myocardial infarction (STEMI). The case demonstrates the beneficial effect of an optimal rescue chain including basic life support performed by trained bystanders, short response time of the emergency medical service, uninterrupted CPR during transportation using a mechanical chest compression system (LUCAS®), in combination with optimal intensive care management of cardiogenic shock after ROSC including multivessel emergency percutaneous coronary intervention (PCI) and intravascular therapeutic hypothermia (Coolgard®-System). (Source: Heart and Lung)


[Comment] Is the intra-aortic balloon pump leaking?
Combined invasive and pharmacological treatment strategies have improved outcomes in acute myocardial infarction (MI) substantially. However, mortality in cardiogenic shock, which occurs in about 7% of patients admitted with acute MI, continues to be associated with high mortality (40–50%). Yet trials in the emergency setting of acute MI complicated by cardiogenic shock are exceptionally difficult to conduct. Therefore, Holger Thiele and colleagues should be commended for the rigorous IABP-SHOCK II trial, which is the largest trial in this setting to date. (Source: LANCET)


[Articles] Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial
In patients undergoing early revascularisation for myocardial infarction complicated by cardiogenic shock, IABP did not reduce 12 month all-cause mortality. (Source: LANCET)


Purulent pericarditis and pneumonia caused by Streptococcus equi subspecies zooepidemicus.
We report a case of purulent pericarditis with septic and cardiogenic shock, caused by Streptococcus equi subspecies zooepidemicus (group C) in a 51-year-old patient. The pathogen was possibly contracted through contact with horses. Most likely, it initially caused pneumonia before spreading to the pericardium, either directly or via the blood stream. A combined therapeutic approach, consisting of antibiotic therapy and repeated pericardial drainage, was necessary to ensure a clinical cure. After discharge, long-term follow-up for development of constrictive pericarditis is considered mandatory. PMID: 24243287 [PubMed - as supplied by publisher] (Source: Journal of Medical Microbiology)


BET 1: Levosimendan in cardiogenic shock secondary to acute myocardial infarction
A short-cut review was carried out to establish whether levosimendan improves outcome in cases of cardiogenic shock. Five studies were directly relevant to the question. One very general systematic review and meta-analysis is also included. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 1. The clinical bottom line is that there is no evidence that levosimendan improves outcome in cardiogenic shock. (Source: Emergency Medicine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


BET 3: Evaluation of intra-aortic balloon support in cardiogenic shock
A short-cut review was carried out to establish whether intra-aortic balloon pumps (IABP) improve mortality in cardiogenic shock after acute myocardial infarction (AMI). Two studies and one systematic review were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 3. The clinical bottom line is that the IABP does not improve mortality in cardiogenic shock after AMI when percutaneous coronary intervention is available. When only thrombolysis is possible then it may improve mortality. (Source: Emergency Medicine Journal)


Results of Primary Percutaneous Coronary Intervention in Patients ≥75 Years Treated by the Transradial Approach
In conclusion, TRA-PPCI was feasible in the vast majority of elderly patients with STEMI. In-hospital mortality, 1-year mortality, and 1-year MACE were lower than reported for transfemoral access, suggesting a benefit of the TRA in these patients. (Source: The American Journal of Cardiology)


Complications of Extracorporeal Membrane Oxygenation for Treatment of Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis of 1,866 Adult Patients.
CONCLUSIONS: Although ECMO can improve survival of patients with advanced heart disease, there is significant associated morbidity with performance of this intervention. These findings should be incorporated in the risk-benefit analysis when initiation of ECMO for cardiogenic shock is being considered. PMID: 24210621 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


Two dislodged and crushed coronary stents: treatment of two simultaneously dislodged stents using crushing techniques.
We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex artery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, because the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent. PMID: 24307849 [Pub...


[Case report: Extracorporeal life support for treatment of fulminant pulmonary embolism in a young woman during pregnancy].
We report the case of a thirty-one year old woman, who suffered severe pulmonary embolism with cardiogenic shock during pregnancy. Systemic fibrinolysis failed to improve hemodynamic deterioration. Finally, insertion of an extracorporeal life support system with subsequent pulmonary thromboendarterectomysaved the life of the patient. PMID: 24343139 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Successful pharmacomechanical intervention with ultrasonic-accelerated thrombolytic catheter for massive pulmonary embolism.
Authors: Porres-Aguilar M, Burgos JD, Munoz OC, Soto-Cora E, Mukherjee D Abstract An 86-year-old male with history of metastatic prostate carcinoma and hypertension was admitted due to acute onset dyspnea and lower extremity pain and swelling. Transthoracic echocardiography revealed a large right atrial thrombus extending in to the right ventricle. Within 12 h, the patient developed severe hypoxemia, tachypnea with sustained hypotension and cardiogenic shock due to presumed massive pulmonary embolism. The patient underwent emergency pulmonary angiography which showed large emboli in the right main pulmonary artery extending in to the middle and lower lobe branches. An ultrasonic-accelerated thrombolytic catheter was placed in the right main pulmonary artery for continuous infusion...


Computed Tomographic Imaging in Peripheral VA-ECMO: Where Has All the Contrast Gone?
VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (VA–ECMO) is used increasingly as an emergency support tool for patients suffering from refractory cardiogenic shock of varying etiologies. According to the most recent Extracorporeal Life Support Organization (ELSO) statistics, 709 adult patients underwent VA-ECMO support in 2012 (Extracorporeal Life Support Registry Report, International Summary, January, 2013). The exact number of cases treated in a peripheral femoro-femoral configuration is not known. Although the authors assume that a small percentage of these patients underwent CT imaging, there are no reports they could find in the literature discussing the specific appearances of contrast distribution that have to be expected during extracorporeal circulatory support. Previous retr...


An Unexpected Intracardiac Echocardiography Finding on the Cavotricuspid Isthmus
This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)


Intra-aortic balloon counterpulsation in acute myocardial infarction: old and emerging indications.
CONCLUSIONS: Mortality in patients admitted for primary PCI because of AMI complicated by CS is high despite IABP use. Outcome in patients treated with IABP for PI is favourable and mandates further prospective studies. PMID: 24170231 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)


New generation drug‐eluting stents for ST‐Elevation myocardial infarction: A new paradigm for safety
Conclusions: New generation DES in STEMI patients have less ST compared to BMS and trends for less ST compared to early generation DES. These data suggest a new safety paradigm and should encourage the use of new generation DES in most STEMI patients treated with primary PCI. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Central extracorporeal membrane oxygenation requiring pulmonary arterial venting after near-drowning
We present a case of a 14-year-old boy who required PA venting during ECMO support after resuscitation from near-drowning in freshwater. A biventricular assist device with an oxygenator implantation was intended on day 1; however, we were unable to proceed because of increasing of pulmonary vascular resistance from the acute lung injury. Central ECMO with PA venting was then performed. On day 13, central ECMO was converted to biventricular assist device with an oxygenator, which was removed on day 16. This case suggests that PA venting during ECMO support may be necessary in some cases of respiratory and circulatory failure with high pulmonary vascular resistance after near-drowning. (Source: The American Journal of Emergency Medicine)


Management of Cardiogenic Shock Complicating ACSManagement of Cardiogenic Shock Complicating ACS
Get up-to-date with current guidelines for best practices in the management of cardiogenic shock in the setting of acute coronary syndromes. Heart (Source: Medscape Today Headlines)


Sometimes an ounce of extracorporeal membrane oxygenation prevention is worth a pound of extracorporeal membrane oxygenation cure
We report here the management of a patient with severe prosthetic aortic stenosis in cardiogenic shock whom we treated with ECMO therapy to achieve clinical stabilization before urgent aortic valve replacement. (Source: The Journal of Thoracic and Cardiovascular Surgery)


The advantages of a consultant led primary percutaneous coronary intervention service on patient outcome
Conclusion: In this consecutive series of patients admitted to a high volume PPCI centre, there was no difference in mortality when patients were admitted at different times. The involvement of senior medical staff early in the patients&rsquo; admission may have contributed to these consistent outcomes. (Source: QJM)


Comparison of Procedural Complications With Versus Without Interventional Cardiology Fellows-in-Training During Contemporary Percutaneous Coronary Intervention
In conclusion, in contemporary practice at a large academic medical center, PCI complication rates were not adversely affected by the presence of an ICFIT. (Source: The American Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The effect of off-pump coronary artery bypass on mortality after acute coronary syndrome: A meta-analysis
This study aims to identify whether OPCAB may confer a mortality benefit over ONCAB in revascularisation for ACS. Secondly, we review the impact of OPCAB on completeness of revascularisation (CR) and long-term re-intervention.Methods: A systematic literature review identified 9 studies (1 randomised controlled trial) of which 8 fulfilled criteria for meta-analysis. Outcomes for a total of 3001 patients (n=817 OPCAB, 2184 ‘on-pump’ (ONCAB)) were meta-analysed using random effects modelling. Heterogeneity, subgroup analysis and quality scoring were assessed. Primary endpoints were 30-day and mid-term mortality. Secondary endpoints were CR, revascularisation index and re-intervention.Results: OPCAB conferred comparable mortality to ONCAB at both 30-days and mid-term follow up (p=0.08 and ...


Severe systemic vasospasm causing recurrent cardiac arrest after orthotopic heart transplantation
We report a case of refractory coronary and systemic vasospasm in a cardiac transplant recipient 10 years after transplantation, which ultimately required re-transplantation. (Source: The Journal of Heart and Lung Transplantation)


Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives: Cost‐effectiveness in the emergent setting
Conclusions: For patients in CS requiring emergent hemodynamic support, pVAD therapy offers a less invasive alternative that can be deployed sooner, resulting in better outcomes, shorter LOS, lower costs and with no incremental cost and a survival benefit when compared to traditional surgical hemodynamic support alternatives. PVAD therapy (and Impella 2.5 in particular) is emerging as a dominant strategy for this challenging patient population. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Intraaortic balloon pump use in high-risk percutaneous coronary intervention
Purpose of review: Despite the long-term availability and clinical usage of intraaortic balloon pump (IABP) counterpulsation, there is a paucity of randomized trial evidence for its use. Here, we will review the latest evidence for its usage in different clinical settings. Recent findings: There have been decades of nonrandomized and observational data available, but only in the last 3 years has there been availability of randomized evidence for IABP use in acute myocardial infarction (AMI) with cardiogenic shock, ST elevation acute coronary syndromes (STE-ACS) without shock and high-risk percutaneous coronary intervention (PCI) cohorts. Summary: To the surprise of many, despite the sound physiological benefits achieved by the use of IABP counterpulsation in these situations, all the recen...


Radial versus femoral approach comparison in percutaneous coronary intervention with intraaortic balloon pump support: The RADIAL PUMP UP Registry
Conclusions: In this observational registry, high-risk patients undergoing PCI and requiring IABP support appeared to have fewer NACEs if transradial access was used instead of transfemoral, mainly due to fewer access-related bleedings. Given the inherent limitations of this retrospective work, including the inability to adjust for unknown confounders, further controlled studies are warranted to confirm or refute these findings. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Auditory-evoked potentials during coma: Do they improve our prediction of awakening in comatose patients?
Conclusions: The MMN is a good predictor of awakening in comatose patients after cardiac arrest and cardiogenic shock and can be measured days before awakening encouraging ongoing life support. (Source: Journal of Critical Care)


Quantifying the effect of cardiorenal syndrome on mortality after left ventricular assist device implant
Conclusions: Pre-implant renal dysfunction predicts higher mortality after LVAD implant. The progressive reduction in survival with higher grades of renal dysfunction supports consideration of LVAD implant before cardiorenal syndrome is advanced. For patients with severe renal dysfunction and other major comorbidities, initial support with a temporary device while awaiting organ recovery before implanting a durable pump could be considered. (Source: The Journal of Heart and Lung Transplantation)


Management of cardiogenic shock complicating acute coronary syndromes
This article aims to review the available data relating to this important condition, and provide guidelines for current best practice in the management of CS. Definition CS is a condition characterised by inadequate tissue perfusion, usually in the setting of AMI. There have been many definitions applied to the diagnosis of CS, but the most uniformly accepted clinical definition of CS is decreased cardiac output and evidence of... (Source: Heart)


Orthotopic heart transplantation in two infants with histiocytoid cardiomyopathy and left ventricular non‐compaction
We report two rare cases of HC with LVNC in two infants presenting with cardiogenic shock, one requiring ECMO support who was successfully bridged to orthotopic heart transplantation with a Berlin Heart LVAD. (Source: Pediatric Transplantation)


Percutaneous coronary intervention in nonagenarian: a meta-analysis of observational studies
ConclusionOur meta-analysis, pooling the largest cohort ever of nonagenarians undergoing PCI with stents, confirms the feasibility of percutaneous coronary stenting even in this very frail patient subset, despite the expected severe event attrition during follow-up. Thus, nonagenarians with an acceptable risk profile, recent clinical instability and/or disabling symptoms should not be denied the possibility of percutaneous coronary revascularization. (Source: Journal of Cardiovascular Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The Impella Device for Acute Mechanical Circulatory Support in Patients in Cardiogenic Shock.
CONCLUSIONS: This is one of the largest series of patients undergoing placement of the Impella device for acute cardiogenic shock. Our outcomes showed improved results compared with historical data. Myocardial recovery was accomplished in most patients. Finally, the 30-day mortality and complication rate was acceptable in these critical patients. These benefits were all achieved with the Impella device in a less invasive method. PMID: 24090575 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


Anesthetic and hemodynamic management of a rare case of Brucella multivalvular endocarditis in cardiogenic shock undergoing emergency aortic valve replacement and mitral valve repair.
We describe a very rare case of human brucella multivalvular endocarditis. Patient presented in a state of cardiogenic shock with low urine output and a history of breathlessness. Patient was diagnosed to have brucellosis 2 months back by blood cultures and agglutination tests and was receiving doxycycline and rifampicin therapy. Echocardiography showed severe aortic regurgitation, moderate mitral regurgitation, severe left ventricular dysfunction and a mobile vegetation attached to the aortic valve. Patient was scheduled for emergency surgery; while preparing for surgery hemodynamic monitoring, non-invasive ventilation and inotropic supports were started. During surgery, the aortic valve was found perforated and the aortomitral continuity was disrupted. Aortic valve replacement and mitral...


Influenza B-induced refractory cardiogenic shock: a case report
Conclusions: Influenza B infection can be complicated by fulminant cardiomyopathy leading to cardiogenic shock in adults without preexisting cardiac disease. (Source: BMC Infectious Diseases)


Infective rhomboencephalitis and inverted Takotsubo: neurogenic-stunned myocardium or myocarditis?
Here we originally describe the clinical scenario of a young immune-competent patient affected by acute rhomboencephalitis with severe parenchymal edema and acute hydrocephalus who developed sudden life-threatening cardiac derangement. Hemodynamic and perfusion parameters revealed cardiogenic shock, so intensive circulatory support with epinephrine infusion and intra-aortic balloon pump was needed to restore organ perfusion. Transesophageal echocardiographic examination showed severe left ventricular dysfunction (ejection fraction as low as 20%) with wall motion abnormalities resembling a pattern of Takotsubo-inverted cardiomyopathy. Cultural investigations revealed infection by Listeria monocytogenes. Nevertheless, her conditions rapidly improved, and she had full cardiac recovery within ...


Impact of thrombus aspiration during primary percutaneous coronary intervention in cardiogenic shock complicating ST-segment elevation myocardial infarction
Abstract: Aim: To assess the impact on in-hospital and long-term survival of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS).Methods and Results: From September 2001 to May 2010 we collected data from 155 patients affected with STEMI complicated by CS undergoing PPCI (12.4% of all PPCI) including 70 patients (45.2%) in TA group and 85 patients (54.8%) in conventional PCI group. Patients in TA group were more likely to have right ventricular infarction (24.3% vs 5.9%, p=0.002), higher mean left ventricular ejection fraction (40%±9% vs 35%±7%, p (Source: Cardiovascular Revascularization Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Prognostic implications of left ventricular end-diastolic pressure during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: Findings from the Assessment of Pexelizumab in Acute Myocardial Infarction study
Conclusions: Left ventricular end-diastolic pressure measured during primary PCI for STEMI is an independent predictor of inhospital and longer term cardiovascular outcomes. Measuring LVEDP may be useful to stratify patient risk and guide postinfarct treatment. (Source: American Heart Journal)


Might rapid implementation of cardiopulmonary bypass in patients who are failing to recover after a cardiac arrest potentially save lives?
The question addressed was whether it might be beneficial to have a rapid-response emergency cardiopulmonary bypass service for patients who suffer an in-hospital or an out-of-hospital cardiac arrest of any aetiology. Eighty-five papers were reviewed using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The concept of using emergency cardiopulmonary bypass (ECPB) for the management of cardiogenic shock and refractory cardiac arrest was developed in the late 1990s. Since this time, a large number of centres worldwide have reported success with use of ECPB for cardiac arrest refractory to convention...


Characterization of untyped cardiac amyloidosis by mass spectrometry in a patient with Gly6Ser transthyretin polymorphism in fatal cardiogenic shock.
Authors: Damy T, Plante-Bordeneuve V, Dogan A PMID: 24070596 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)


Non–infarct-related artery revascularization during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A systematic review and meta-analysis
Conclusions: There is paucity of randomized data to guide management of STEMI patients with multivessel disease. SS-PCI group in cohort studies has higher baseline risk compared to IRA-PCI. The primary end point is higher for SS-PCI in observational cohort studies but this difference did not persist after exclusion of shock patients and for analysis limited to randomized controlled trials. These findings underscore the need of a large randomized controlled trial to guide therapy for a commonly encountered clinical situation. (Source: American Heart Journal)


Cardiogenic Shock
Cardiogenic shock (CS) is a condition in which a marked reduction in cardiac output and inadequate end-organ perfusion results from an array of cardiac insults, the most common of which is acute myocardial infarction. CS is a systemic disease involving a vicious cycle of inflammation, ischemia, and progressive myocardial dysfunction, which often results in death. This life-threatening emergency requires intensive monitoring accompanied by aggressive hemodynamic support; other therapies are tailored to the specific pathophysiology. The development of novel therapeutic strategies is urgently required to reduce the unacceptably high mortality rates currently associated with CS. (Source: Cardiology Clinics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The Clinical Outcomes of Percutaneous Coronary Intervention Performed Without Pre-Procedural Aspirin
Objectives: The purpose of this study was to examine the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received pre-procedural aspirin.Background: Aspirin is an essential component of peri-PCI pharmacotherapy. Previous studies suggest that pre-procedural aspirin is not administered to a clinically significant number of patients undergoing PCI.Methods: We evaluated the incidence of PCIs performed without pre-procedural aspirin use among patients undergoing PCI from January 2010 through December 2011 at 44 hospitals in Michigan. Propensity-matched multivariate analysis was used to adjust for the nonrandom use of aspirin.Results: Our study population comprised 65,175 patients, of whom 4,640 (7.1%) did not receive aspirin within 24 h befor...


Outcome After ST Elevation Myocardial Infarction in Patients With Cancer Treated With Primary Percutaneous Coronary Intervention
In conclusion, patients with cancer showed greater mortality after STEMI. A cancer diagnosis in the 6 months before primary PCI was strongly associated with early cardiac mortality. (Source: The American Journal of Cardiology)


Arterial Complications in Patients Undergoing Extracorporeal Membrane Oxygenation via Femoral Cannulation
Conclusions: Vascular complications occur in less then 20% of ECMO patients with the majority requiring femoral reconstruction. Development of vascular complications does not appear to increase risk of amputation or mortality. Among those patients who develop vascular complications, the most common indication for ECMO is cardiogenic shock. (Source: Annals of Vascular Surgery)


Hypereosinophilic syndrome masquerading as a myocardial infarction causing decompensated heart failure
Conclusion: Hypereosinophilic Syndrome can masquerade as a myocardial infarction causing decompensated heart failure. Early recognition and treatment with steroids can improve outcome. (Source: BMC Cardiovascular Disorders)


Effects of post-resuscitation administration with sodium hydrosulfide on cardiac recovery in hypoxia-reoxygenated newborn piglets.
Authors: Cheung PY, Miedzyblocki M, Lee TF, Bigam DL Abstract Hydrogen sulfide may protect multiple organ systems against ischemic-reperfusion injuries. It is unknown if treatment with sodium hydrosulfide (NaHS, a hydrogen sulfide donor) will improve myocardial function and minimize oxidative stress in hypoxic-reoxygenated newborn piglets. Mixed breed piglets (1-5 day, 1.5-2.5kg) were anesthetized and acutely instrumented for the measurement of systemic, pulmonary and regional (carotid, superior mesenteric and renal) hemodynamics and blood gas parameters. The piglets were induced with normocapnic alveolar hypoxia (10-15% oxygen, 2h) followed by reoxygenation with 100% (1h) then 21% oxygen (3h). At 10min of reoxygenation, either NaHS (10mg/kg, 5ml) or saline (5ml) was administered i...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


028 * extracorporeal membrane oxygenation system as salvage treatment for patients with refractory cardiogenic shock
Conclusions: Patients with a poor haemodynamic status may benefit from rapid central and peripheral insertion of ECMO. The blood lactate level, CK-MB relative index and PRBCs transfused should be strictly monitored during ECMO support. (Source: Interactive CardioVascular and Thoracic Surgery)


030 * preoperative patient optimization using extracorporeal membrane oxygenation support improves outcomes of intermacs level 1 patients receiving a permanent ventricular assist device
Conclusions: Preoperative patient optimization using ECMO support improves outcomes of INTERMACS level 1 patients receiving a permanent ventricular assist device. (Source: Interactive CardioVascular and Thoracic Surgery)


032 * overall five-year results of an extracorporeal membrane oxygenation programme in a university hospital
Conclusions: ECMO produced a satisfying survival of 47.5% at six months in this cohort of high-risk patients. Implantation during external cardiac massage or in patients older than 65 years resulted in a poor prognosis. (Source: Interactive CardioVascular and Thoracic Surgery)


033 * risk factors associated with adverse outcome following extracorporeal membrane oxygenation support: analysis from 360 consecutive patients
Conclusions: ECLS therapy offers survival to one-third of patients with otherwise fatal prognosis. Procedural mortality is low and morbidity at the implantation site typically controllable. Thus, prolonged metabolic deterioration in combination with high-dose vasopressor support prior to ECLS therapy should be avoided, particularly in younger patients. (Source: Interactive CardioVascular and Thoracic Surgery)


241 * elective use of femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation
Conclusions: The use of preoperatively planned CPB enhances the safety of the TAVI procedure in patients with severely reduced heart function or in cardiogenic shock. (Source: Interactive CardioVascular and Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


289 * extracorporeal membrane oxygenation in primary cardiogenic shock: the impact of acute versus chronic aetiology on outcome
Conclusions: In "chronic" heart failure ECMO represents a bridge to VAD or heart transplantation, while in "acute" settings it offers a considerable chance of recovery, thus often representing the only required therapy. (Source: Interactive CardioVascular and Thoracic Surgery)


290 * left ventricular assist device implantation with extracorporeal membrane oxygenator support in intermacs level 1 patients
Conclusions: Left ventricular assist device implantation with ECMO support and without cardiopulmonary bypass is feasible and safe in INTERMACS level 1 patients. Our encouraging results in a high-risk subgroup of LVAD patients warrant broader application of this approach. (Source: Interactive CardioVascular and Thoracic Surgery)


292 * percutaneous extracorporal life support for patients in therapy-refractory cardiogenic shock
Conclusions: Transportable ECLS systems provide sufficient circulatory support for patients in therapy-refractory shock and with early MOF. Despite the substantial mortality, ECLS implantation in selected patients by an experienced team offers additional support to CPR and conventional therapy. This concept has to be implemented in cardiac survival networks in the future. (Source: Interactive CardioVascular and Thoracic Surgery)


293 * extracorporeal life support for cardiogenic shock: influence of concomitant intra-aortic balloon counterpulsation
Conclusions: The use of IABP during ECLS increased successful ECLS weaning rate, but was not translated to improved survival. Studies on larger populations may verify the survival effect of IABP during ECLS. (Source: Interactive CardioVascular and Thoracic Surgery)


313 * transapical aortic valve implantation: predictors of five-year survival in 679 patients
Conclusions: There are no signs of negative impact of the concept of TAVI on five-year survival. After elimination of aortic stenosis, long-term results are solely determined by the patient's renal and pulmonary comorbidity profile as well as by the grade of preoperative heart failure symptoms. (Source: Interactive CardioVascular and Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Have We Given Up on Intra‐aortic Balloon Counterpulsation in Post–Myocardial Infarction Cardiogenic Shock?
Abstract The recently published Intra‐aortic Balloon Pump in Cardiogenic Shock II (IABP‐SHOCK II) trial concluded that intra‐aortic counterpulsation (IACP) does not reduce 30‐day mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) for whom early revascularization strategy was planned. The study resulted in downgrading IACP in post‐AMI CS patients by certain professional organizations like the European Society of Cardiology. Although this is the largest and most important CS study of this decade, it suffers from considerable shortcomings: (1) time intervals from chest‐pain onset or AMI recognition to revascularization, enrollment, and IACP initiation are not disclosed; (2) 86.6% of the treatment arm initiated IACP only post–percutan...


Acute coronary syndromes: Extended follow-up in IABP-SHOCK II shows no reduction in all-cause mortality with IABP
Nature Reviews Cardiology 10, 617 (2013). doi:10.1038/nrcardio.2013.149 In the multicentre, open-label, randomized, controlled trial IABP-SHOCK II, the previously reported 30-day data demonstrated no early mortality reduction with intra-aortic balloon pump (IABP) use in patients undergoing early revascularization for myocardial infarction complicated by cardiogenic shock. The 6-month and 12-month follow-up data have now (Source: Nature Reviews Cardiology)


Utility of Intra-Aortic Balloon Pump Support for Ventricular Septal Rupture and Acute Mitral Regurgitation Complicating Acute Myocardial Infarction
Clinical data on optimal management of mechanical complications of myocardial infarction are lacking. We retrospectively evaluated the effect of intra-aortic balloon pump (IABP) on 30-day survival in patients with postinfarction ventricular septal rupture (VSR, n = 55) or acute mitral regurgitation (MR, n = 26) who developed either cardiogenic shock (n = 46) or severe hemodynamic instability that did not fulfill the criteria of shock (n = 35). IABP was inserted in 83% of the patients with shock and 57% of those without shock. Thirty-five (76%) patients with shock and all unstable patients survived until surgical repair, which was performed within a median (interquartile range) of 1 (1 to 2) and 9 (2 to 18) days from the onset of the complication (p (Source: The American Journal of Card...


Minimally Invasive Mitral Valve Surgery: Influence of Aortic Clamping Technique on Early Outcomes.
CONCLUSIONS: Minimally invasive mitral valve surgery can be performed successfully using either the endoaortic balloon technique or the transthoracic clamp approach. However, the transthoracic technique results in shorter operation time, less perioperative bleeding and better myocardial protection. PMID: 24035304 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


Survival After Left Ventricular Assist Device With and Without Temporary Right Ventricular Support.
CONCLUSIONS: Biventricular support using a HeartMate II LVAD and CentriMag RVAD resulted in limited mortality at hospital discharge. However biventricular dysfunction does not have a favorable outcome at 1 year when compared with patients requiring isolated HeartMate II. PMID: 24035303 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma
Conclusions PPGL may present as ACC in 11% of cases, excluding patients dying from undiagnosed tumours. Left ventricular dysfunction is usually reversible before surgery. PPGL should be suspected in patients with acute heart failure without evidence of valvular or coronary artery disease. (Source: Heart)


Prognostic significance of presenting blood pressure in non–ST-segment elevation acute coronary syndrome in relation to prior history of hypertension
Conclusion: Low SBP on presentation, but not prior hypertension, was independently associated with in-hospital mortality in NSTEACS. The powerful prognostic value of SBP is similar regardless of a history of hypertension or pre-admission antihypertensive medication use. (Source: American Heart Journal)


ESC: Balloon Pump Still No Help at 1 Year (CME/CE)
AMSTERDAM (MedPage Today) -- One year out, intra-aortic balloon pump (IABP) support still did not reduce mortality among patients with acute MI complicated by cardiogenic shock, extended follow-up of the IABP-SHOCK II trial showed. (Source: MedPage Today Cardiovascular)


Effect of Early Metoprolol on Infarct Size in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary PCI: The METOCARD-CNIC Trial.
CONCLUSIONS: In patients with anterior Killip-class ≤II STEMI undergoing primary PCI, early i.v. metoprolol before reperfusion reduced infarct size and increased LVEF with no excess of adverse events during the first 24 hours after STEMI. CLINICAL TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov. Identifier: NCT01311700 & EUDRACT Number 2010-019939-35. PMID: 24002794 [PubMed - as supplied by publisher] (Source: Circulation)


Outcome of Percutaneous Coronary Intervention Following Recent Surgery
The objective of this study was to determine clinical outcomes of patients undergoing PCI within 7 days after a surgical procedure. We assessed outcomes of 517 patients who underwent PCI within 7 days after a surgery across 44 hospitals from January 2010 to December 2011 from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry. Patients with postoperative PCI were compared with all other patients with PCI using propensity-matched analysis. Of the 65,175 patients who underwent PCI within the study period, 517 patients had undergone surgery within the previous 7 days. In unadjusted analysis, patients with postsurgical PCI had higher in-hospital mortality (6.96% vs 1.33%), stroke (0.96% vs 0.26%), bleeding events (6.96% vs 2.6%), heart failure (6.96% vs 2.36%), and ca...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Wretched Excess: Stool-softener Abuse and Cardiogenic Shock
More is never better when patients exceed recommended dosages, but a 62-year-old woman with schizophrenia took self-medication to an extreme that might have proved fatal. She presented with acute-onset chest tightness and dyspnea after taking 40 docusate tablets, 100 mg, for constipation. Subsequently, she developed voluminous diarrhea, which precipitated progressive shortness of breath and angina. (Source: The American Journal of Medicine)


Cardiogenic Shock Post-percutaneous Coronary Intervention for Myocardial Infarction.
Authors: Lin W, Yeo TC, Poh KK PMID: 24162327 [PubMed - in process] (Source: Annals of the Academy of Medicine, Singapore)


Sick euthyroid syndrome is associated with poor prognosis in patients with STEMI undergoing primary percutaneous intervention.
Conclusion: Thyroid dysfunction, particularly sick euthyroid syndrome, was found to be related to in-hospital and long term mortality in patients with STEMI undergoing primary percutaneous intervention. PMID: 23990180 [PubMed - as supplied by publisher] (Source: Cardiology Journal)


Removal of impella® 2.5 while maintaining vascular access: A solution to a vascular quandary
This report highlights one potential solution to the dilemma of maintaining vascular access following removal of an Impella® 2.5 mechanical support device to allow safe transition to a TandemHeart system in a patient with refractory cardiogenic shock. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


[Extracorporeal membrane oxygenation support for tako-tsubo syndrome after urgent caesarean section.]
We presented the case of a 32-year-old woman victim of a tako-tsubo syndrome with severe cardiogenic shock during surgical procedure for urgent caesarean section. After refractory haemodynamic failure, the patient benefits from extracorporeal membrane oxygenation support device with success. PMID: 23993158 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Massive Pulmonary Embolism
Massive pulmonary embolism (PE) is a potentially lethal condition, with death usually caused by right ventricular (RV) failure and cardiogenic shock. Systemic thrombolysis (unless contraindicated) is recommended as the first-line treatment of massive PE to decrease the thromboembolic burden on the RV and increase pulmonary perfusion. Surgical pulmonary embolectomy or catheter-directed thrombectomy should be considered in patients with contraindications to fibrinolysis, or those with persistent hemodynamic compromise or RV dysfunction despite fibrinolytic therapy. Critical care management predominantly involves supporting the RV, by optimizing preload, RV contractility, and coronary perfusion pressure and minimizing afterload. Despite these interventions, mortality remains high. (Source: Ca...


Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography
Conclusions: The hTEE-guided ECMO weaning protocol accurately predicted the ability to wean ECMO to decision. This protocol can be applied by cardiac intensivists as a part of standard bedside intensive care unit assessment. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Comparison of bivalirudin with heparin versus abciximab with heparin for primary percutaneous coronary intervention in “Real World” practice
Conclusion: In this “real-world” observational study, there was no significant difference in the clinical outcome of PPCI for patients who had abciximab or bivalirudin after initial pre-treatment with UFH. (Source: Cardiovascular Revascularization Medicine)


Wretched Excess: Stool-softener Abuse and Cardiogenic Shock
More is never better when patients exceed recommended dosages, but a 62-year-old woman with schizophrenia took self-medication to an extreme that might have proved fatal. She presented with acute-onset chest tightness and dyspnea after taking 40 docusate tablets, 100 mg, for constipation. Subsequently, she developed voluminous diarrhea, which precipitated progressive shortness of breath and angina. (Source: The American Journal of Medicine)


Single-center trials tend to provide larger treatment effects than multicenter trials: a systematic review
Conclusion: The results of this study highlight a substantial difference in treatment effect estimates between single-center and multicenter trials. Therefore, we recommend that results from single-center trials should be cautiously used for decision making. (Source: Journal of Clinical Epidemiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The Case Files: Carbon Monoxide Intoxication Disguised as Atrial Fibrillation
By Punam Patel, DO, & Steven Sattler, DO A 62-year-old Caucasian woman presented to the emergency department with palpitations that had started that morning. She had no history of similar symptoms and denied medications, allergies, and alcohol or drug use. She had quit smoking cigarettes 13 years earlier. She initially denied all other symptoms, but staff overheard the patient and spouse complaining of headaches. They reported that they had been awakening with headaches and fatigue since moving into a new home a week earlier. Vital signs upon arrival were respiration, 20 breaths per minute; heart rate, 156 beats per minute; blood pressure, 113/78 mm Hg, and temperature 97F orally. Physical exam showed a well-appearing woman in no acute distress with a rapid irregularly irregular hea...


Cardiogenic shock following electro-cardioversion of new onset atrial flutter
Abstract: Transient hypotension and atrial stunning are known complications of electro-cardioversion for supra-ventricular tachyarrhythmias, however, a clinically significant cardiac failure is extremely rare in this setting.We, herein, present a 77-year-old African American male who underwent electro-cardioversion following an unremarkable transesophageal echocardiogram (TEE) for a symptomatic atrial flutter of a new onset. Immediately post-cardioversion, he suffered severe hypotension with a depressed LV systolic function. IV dobutamine stabilized his blood pressure. (Source: Heart and Lung)


Transformation of percutaneous venoarterial extracorporeal membrane oxygenation access to a safe peripheral arterial cannulation
Venoarterial extracorporeal membrane oxygenation (ECMO) support is an accepted lifesaving approach for cardiogenic shock both in and, more recently, out of the hospital setting. In these circumstances percutaneous cannulation of the groin vessels is frequently used to initiate extracorporeal support and stabilize the patient. Inadequate arterial flow distal to the cannulation site can cause limb ischemia and significant morbidity. A timely transformation of this percutaneous access to a safe peripheral arterial cannulation could possibly prevent the deleterious effect of distal limb ischemia. (Source: The Journal of Thoracic and Cardiovascular Surgery)


In-Hospital Major Bleeding and Its Clinical Relevance in Patients With ST Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
Advances in antithrombotic therapy for ST elevation myocardial infarction (STEMI) enhance the risk of bleeding. Therefore, the incidence, determinants, and prognostic implications of in-hospital major bleeding after primary percutaneous coronary intervention for STEMI were investigated. In 963 consecutive patients, the incidence of bleeding was evaluated according to commonly used classifications including Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines, Thrombolysis In Myocardial Infarction, Global Use of Strategies To Open coronary arteries, and Bleeding Academic Research Consortium. Multivariate regression analyses investigated determinants of bleeding and the relation between bleeding and 1-year all...


Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch
Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.A associação de interrupção do arco aórtico e doença coronária é rara. Entretanto, recentemente nos deparamos com um pacient...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Critical illness-related corticosteroid insufficiency in cardiogenic shock
(Source: British Journal of Anaesthesia)


Fatal Infant Myocardial Infarction Caused by Ball-IN-Valve Mechanism from a Dysplastic Aortic Valve
Conclusion: AMI is an important diagnostic consideration in any infant presenting with signs of unexplained cardiogenic shock. Practitioners who care for children should be aware of diagnostic and therapeutic strategies for AMI in infants. (Source: The Journal of Emergency Medicine)


Fondaparinux: An effective bridging strategy in heparin-induced thrombocytopenia and mechanical circulatory support
A 56-year-old Caucasian man with ischemic cardiomyopathy was admitted to the hospital for decompensated heart failure. Ensuing cardiogenic shock required peripheral extracorporeal membrane oxygenation (ECMO) resuscitation, followed by biventricular assist device (BiVAD) implantation with HeartWare devices (HeartWare International Inc, Framingham, MA) as a bridge to transplantation. (Source: The Journal of Heart and Lung Transplantation)


Cardiovascular toxicity and titin cross-reactivity of affinity-enhanced T cells in myeloma and melanoma
An obstacle to cancer immunotherapy has been that the affinity of T-cell receptors (TCRs) for antigens expressed in tumors is generally low. We initiated clinical testing of engineered T cells expressing an affinity-enhanced TCR against HLA-A*01&ndash;restricted MAGE-A3. Open-label protocols to test the TCRs for patients with myeloma and melanoma were initiated. The first two treated patients developed cardiogenic shock and died within a few days of T-cell infusion, events not predicted by preclinical studies of the high-affinity TCRs. Gross findings at autopsy revealed severe myocardial damage, and histopathological analysis revealed T-cell infiltration. No MAGE-A3 expression was detected in heart autopsy tissues. Robust proliferation of the engineered T cells in vivo was documented in bo...


Successful Ablation of Incessant AV Reentrant Tachycardia in a Patient on Extracorporeal Membrane Oxygenation
We present the first described case of an accessory pathway ablation, requiring a transseptal puncture, performed on ECMO for tachycardia-induced cardiomyopathy in the context of cardiogenic shock. The performance of a transseptal puncture in such a scenario is a feasible option and should be considered if the clinical situation dictates, despite the inherent risks. After ablation of the left lateral pathway the patient was successfully weaned off ECMO and made a complete recovery. (Source: Heart, Lung and Circulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Stress Cardiomyopathy: Case Series and the Review of Literature
Conclusions: The incidence and clinical features of ABS in our tertiary center are similar to those reported in other settings. Unusual precipitants were observed, but left ventriculograms were performed less frequently and could be contributory to the under-diagnosis of ABS. (Source: The Journal of Emergency Medicine)


[Patient with sudden cardiac arrest, peripartum cardiomyopathy and pulmonary embolism].
Authors: Lewandowski A, Syska-Sumińska J, Załęska-Zydlewska I, Grzywanowska-Łaniewska I, Wsól A, Dłużniewski M Abstract Peripartum cardiomyopathy is a type of dilatated cardiomyopathy, occuring with symptoms of heart failure (HF) during last month of pregnancy or within 5 months after labour. Authors are presenting the case of patient admitted to hospital primary with diagnosis of non-high risk pulmonary embolism 6 weeks after delivery, who developed episode of sudden cardiac death followed by symptoms of cardiogenic shock. Peripartum cardiomyopathy was additionally diagnosed. After HF treatment with bromocriptine supply, gradual clinical improvement was achieved. The patient was discharged after 15 days of hospitalisation with diagnosis of peripartum cardiomyopathy with non...


Central closed chest implantation of extracorporeal membrane oxygenation to prevent limb ischemia.
Conclusions: This alternative cannulation strategy offers effective cardiopulmonary support while minimizing the risk of limb hypo- or hyperperfusion without requiring reopening of the thorax. PMID: 23918275 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)


Using the Impella 5.0 with a right axillary artery 
approach as bridge to long-term mechanical 
circulatory assistance.
Conclusions: Our experience shows that an Impella 5.0 implanted through the right axillary artery 
approach is a valid option as bridge to long-term LVADs. PMID: 23918265 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)


Association between angiographic culprit lesion and out-of-hospital cardiac arrest in ST-elevation myocardial infarction patients
Conclusions: In the present STEMI population, coronary culprit lesion was associated with the occurrence of OHCA. Moreover, culprit lesion influenced the risk of cardiogenic shock and success of reperfusion, both of which were related to prognosis of OHCA patients. (Source: Resuscitation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Association between Natriuretic Peptides and Mortality among Patients Admitted with Myocardial Infarction: A Report from the ACTION Registry(R)-GWTG&trade; [Lipids, Lipoproteins, and Cardiovascular Risk Factors]
CONCLUSIONS: NPs are measured in almost 50% of patients in the US admitted with MI and appear to be used in patients with more comorbidities. Higher NP concentrations were strongly and independently associated with in-hospital mortality in the almost 30 000 patients in whom NPs were assessed, including patients without heart failure. (Source: Clinical Chemistry)


Intra-aortic balloon pump in high-risk percutaneous coronary interventions without cardiogenic shock: Trial sequential analysis of outcomes
In evaluating the effectiveness of intra-aortic balloon pump in high-risk percutaneous coronary interventions without cardiogenic shock, the best level of evidence in the meta-analysis by Romeo and co-workers was that obtained from randomized controlled studies (RCTs). With regard to the end-point of in-hospital major adverse cardiac events (MACEs), interpreting the results of the RCTs included in this meta-analysis is made difficult by the nonsignificant difference found between patients who were given intra-aortic balloon pump and the controls. Nonsignificant meta-analyses are increasingly being recognized to be a matter of controversy mainly because their results can be classified as either inconclusive (i.e., no proof of difference) or demonstrated futility (i.e., proof of no differenc...


Central venous oxygen saturation (ScVO2) facilitates the weaning of intra-aortic balloon pump in acute heart failure related to acute myocardial infarction
Intra-aortic balloon pump (IABP) counterpulsation can improve coronary blood flow by augmenting coronary diastolic blood pressure. IABP can also increase cardiac index by reducing left ventricular workload . The role of IABP in cardiogenic shock related to acute myocardial infarction (AMI) is well established in current practice guidelines . (Source: International Journal of Cardiology)


Cause of Death Within 30 Days of Percutaneous Coronary Intervention in an Era of Mandatory Outcome Reporting
ConclusionsLess than one-half of 30-day deaths are attributed to a PCI-related complication. Death certificates are inaccurate and do not report PCI-related deaths, which may represent a better marker of PCI quality. (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


Fulminant myocarditis: The role of cardiac magnetic resonance imaging
Fulminant myocarditis is an inflammatory process that progresses dramatically from a febrile respiratory syndrome to cardiogenic shock . Currently, Cardiac Magnetic Resonance Imaging (CMRI) is considered the best diagnostic approach for the noninvasive detection of myocarditis . Here, we report a case of fulminant myocarditis and discuss the value of CMRI in determining the diagnosis and prognosis. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Biomarkers and ST-elevation myocardial infarction
In the recent Heart paper, Cuculi et al1 from Oxford University challenge two conventional wisdoms in clinical cardiology: first, biomarkers do not have a role in the management of patients presenting with suspected ST-elevation myocardial infarction (STEMI); and second, in the absence of cardiogenic shock, there is no remaining unmet clinical need in STEMI as contemporary coronary reperfusion strategies yield excellent patient outcomes. In their investigation, the authors report the course of plasma neuropeptide Y levels in patients undergoing successful percutaneous coronary intervention (PCI) and relate these to non-invasive and invasive measures of the success of myocardial reperfusion and the coronary microcirculation.1 In the vast majority of patients with STEMI, a complete thromboti...


Immediate rescue operations after failed diagnostic or therapeutic cardiac catheterization procedures
CONCLUSIONS With rapid transfer to an operation room, minimizing the time of warm myocardial ischaemia, and by performing complete coronary revascularization, it is possible to obtain equally low operative mortality in patients with life-threatening cardiac catheterization-associated complications, as is the case with open cardiac operations in general. (Source: Interactive CardioVascular and Thoracic Surgery)


[Neonatal collapse: Diagnosis of myocarditis.]
Authors: Leroch M, Grisel C, Crucis Armangaud A, Parisot P, Ou P, Bergounioux J Abstract Enteroviruses are single-stranded RNA viruses of the picornavirus family. In the neonatal period, enterovirus can cause severe meningo-encephalitis, sepsis syndrome, hepatitis, or myocarditis. Neonatal enterovirus myocarditis remains a rare but severe cause of neonatal cardiac failure whose prognosis remains poor. Herein, we report the case of neonatal enterovirus myocarditis in a 14-day-old infant transferred to our intensive care unit for cardiogenic shock. Diagnosis and follow-up were confirmed using cardiac magnetic resonance imaging (MRI). We provide a detailed clinical, biological, and cardiac imaging description with specific comments on MRI diagnosis of myocarditis. PMID: 23871607 [...


Therapeutic Management Changes and Mortality Rates over 30 Years in Ventricular Septal Rupture Complicating Acute Myocardial Infarction
Recent studies have shown that the decrease in ventricular septal rupture (VSR) incidence after acute myocardial infarction is related to the improvement of reperfusion strategies. Our main objective was to explore the influence of therapeutic management changes on post-infarct VSR patient outcomes in a single reference center over a period of 30 years. We analyzed therapeutic management strategies and mortality rates in 228 patients with VSR after acute myocardial infarction admitted from 1981 to 2010. Patients were classified in 3 successive decades. There were no significant differences in clinical characteristics of patients with VSR at admission among those decades. Overall, surgery was performed in 159 patients (71.9%), primary transcatheter VSR closure was attempted in 5 patients ...


Letter by Maini Regarding Article, "Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock: Results of the Impella-EUROSHOCK-Registry" [Correspondence]
(Source: Circulation: Heart Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Response to Letter Regarding Article, "Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock Results of the Impella-EUROSHOCK-Registry" [Correspondence]
(Source: Circulation: Heart Failure)


Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation: Analysis of the Spanish National Heart Transplant Registry [Original Articles]
Conclusions&mdash; Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2. (Source: Circulation: Heart Failure)


NJ thallium murder, laundry pods repackaged, Dr. Oz claims redemption: Weekly Web Review in Toxicology
&nbsp; Was Dr. Oz right about arsenic and apple juice?: In 2011, Dr. Mehmet raised questions about levels of arsenic found in some commercial apple juices on his syndicated TV show.This week, ABC News reported that, for the first time, the U.S. Food and Drug Administration was considering establishing limits on the amount of inorganic arsenic allowed in apple juice. Apparently, Consumer Reports recently tested 88 juices and found that 10% had inorganic arsenic levels greater than that allowed in drinking water (10 parts per billion). Unfortunately, the ABC report does not make clear how much higher some levels were. This still seems to TPR to be many an public relations and political problem, and not a proven medical one. Although Dr. Oz says &#8220;we believe&#8221; that the small am...


Impact of intra-aortic balloon pump support initiated before versus after primary percutaneous coronary intervention in patients with cardiogenic shock from acute myocardial infarction
Conclusions: Early IABP insertion before primary PCI might be associated with higher peak CK levels, indicating a larger infarct size. A possible explanation may be the increased reperfusion delay. Our study suggests that early reperfusion could have priority over routine early IABP insertion in STEMI patients with cardiogenic shock. Randomized studies are needed to determine the optimal timing of IABP insertion relative to primary PCI. (Source: International Journal of Cardiology)


TandemHeart placement for cardiogenic shock in acute severe mitral regurgitation and right ventricular failure
We report a case of a patient with severe mitral regurgitation (MR) due to infective endocarditis with preserved left ventricular systolic function complicated by severe pulmonary hypertension, right ventricular (RV) dysfunction, and cardiogenic shock. He was evaluated by cardiothoracic surgery for mitral valve replacement (MVR). It appeared that the high pulmonary artery pressure (PAP) had been chronic with acute worsening, thus raising concerns that it may not promptly reverse after MVR, putting him at high risk for postoperative RV failure and increasing the risk of mortality. A TandemHeart percutaneous ventricular assist device (pVAD) was placed with improvement in hemodynamics following which MVR was done. To our knowledge, this is the first report of the preoperative use of the Tande...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction
Background: The number of patients presenting with acute myocardial infarction (AMI) and being untreatable by interventional cardiologists increased during the last years. Previous experience in emergency coronary artery bypass grafting (CABG) in these patients spurred us towards a more liberal acceptance for surgery. Following a prospective protocol, patients were operated on and further analysed. Methods: Within a two year interval, 127 patients (38 female, age 68+/-12 years, EuroScore (ES) II 6.7+/-7.2%) presenting with AMI (86 non-ST-elevated myocardial infarction (NSTEMI), 41 STEMI) were immediately accepted for emergency CABG and operated on within six hours after cardiac catheterisation (77% three-vessel-disease, 47% left main stem stenosis, 11% cardiogenic shock, 21% preoperative i...


Fulminant Myocarditis
Myocarditis is most often caused by a viral infection. Less common causes include other infectious agents and autoimmune diseases. Fulminant myocarditis is an unusual complication with a rapidly progressive course resulting in severe heart failure and cardiogenic shock. Fulminant myocarditis should be treated with full supportive care, using aggressive pharmacologic therapy and mechanical circulatory support, because significant improvement in left ventricular function will often occur. Cardiac transplantation is required in a small minority of patients. Cardiac magnetic resonance imaging is becoming a frequently used modality to aid in the diagnosis of myocarditis. (Source: Critical Care Clinics)


Pioneering Staff Nurse Education in Advanced Cardiac Support: Adult VA ECMO
Extracorporeal Membrane Oxygenation (ECMO) has been available at the Massachusetts General Hospital for several decades. Adult veno-arterial (VA) ECMO patients are managed in the Cardiac Surgical Intensive Care Unit. Recently, there has evolved a major focus to care for a population with cardiogenic shock refractory to medical management and those in need of resuscitation. During this evolution, the training requirements for nursing staff have been significant. (Source: Heart and Lung)


Factors inf luencing outcomes of intra-aortic balloon counterpulsation in elderly patients.
CONCLUSIONS: IABP may be successfully and safely employed in patients ≥80 years old, having severe heart disease, with few complications. Patients ≥80 years old who need IABP therapy are less likely to have a successful revascularization and are more likely to develop pulmonary infections than patients &lt;80 years old. PMID: 23876885 [PubMed - in process] (Source: Methods of Information in Medicine)


Fulminant Myocarditis
Myocarditis is most often caused by a viral infection. Less common causes include other infectious agents and autoimmune diseases. Fulminant myocarditis is an unusual complication with a rapidly progressive course resulting in severe heart failure and cardiogenic shock. Fulminant myocarditis should be treated with full supportive care, using aggressive pharmacologic therapy and mechanical circulatory support, because significant improvement in left ventricular function will often occur. Cardiac transplantation is required in a small minority of patients. Cardiac magnetic resonance imaging is becoming a frequently used modality to aid in the diagnosis of myocarditis. (Source: Critical Care Clinics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Reversible cardiogenic shock due to catecholamine-induced cardiomyopathy: a variant of takotsubo?
Catecholamine-induced cardiomyopathy, including takotsubo, neurogenic stunned myocardium, and pheochromocytoma-related cardiomyopathy, is a reversible and generally benign condition. We are reporting a case series of young women who had cardiogenic shock and pulmonary edema due to severe left ventricular systolic dysfunction, which completely recovered in the course of 2 to 3 weeks. Both patients had high catecholamine levels, due to pheochromocytoma in the first case and due to intravenous high-dose catecholamines in the second case. We suggest that screening for pheochromocytoma should be considered in patients who present with takotsubo cardiomyopathy without obvious cause. Most importantly, widely used intravenous catecholamines may cause severe transient left ventricular dysfunction, ...


Is Tako-tsubo syndrome in the postpartum period a clinical entity different from peripartum cardiomyopathy?
ConclusionWomen in the postpartum period, notably after Cesarean delivery, may represent another new vulnerable group at increased risk for TTS. TTS in the postpartum period should be considered a clinical entity different from peripartum cardiomyopathy with specific clinical, therapeutic and prognostic implications. (Source: Journal of Cardiovascular Medicine)


Strong-ion gap approach in patients with cardiogenic shock following ST-elevation myocardial infarction.
Conclusions: According to our data the SIG approach does not seem to add further information to usual parameters in acid-base evaluation or early risk stratification in CS patients. PMID: 23806089 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)


Mean platelet volume and its prognostic value in acute coronary syndrome complicated by cardiogenic shock.
CONCLUSIONS: The above results suggest that MPV cannot be considered a predictor of poorin-hospital outcome in patients with ACS complicated by cardiogenic shock. PMID: 23788299 [PubMed - in process] (Source: Cardiology Journal)


First Experience With Implantation of a Percutaneous Right Ventricular Impella Right Side Percutaneous Support Device as a Bridge to Recovery in Acute Right Ventricular Infarction Complicated by Cardiogenic Shock in the United States [Images and Case Reports in Interventional Cardiology]
(Source: Circulation: Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intestinal ischemia after cardiac surgery: analysis of a large registry
Conclusions: Intestinal ischemia after cardiac surgery is more common in patients with a poor cardiac state, but the use of steroids, peripheral vascular disease, postoperative kidney failure, and CVI were also predictive. GICS score, developed for all GI complications after cardiac surgery, is also of value in predicting this particular complication. The risk factors presented can be used as an aid in the diagnosis of these patients. (Source: Journal of Cardiothoracic Surgery)


Importance of Total Ischemic Time and Preprocedural Infarct-Related Artery Blood Flow in Predicting Infarct Size in Patients With Anterior Wall Myocardial Infarction (from the CRISP-AMI Trial)
The goal of this study was to characterize determinants of infarct size in the multicenter randomized Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP-AMI) trial. Contemporary determinants of infarct size in patients presenting with acute anterior myocardial infarction without shock and undergoing percutaneous revascularization have been incompletely characterized. In CRISP-AMI, 337 patients with acute anterior ST segment elevation myocardial infarction but without cardiogenic shock at 30 sites in 9 countries were randomized to initiation of intra-aortic balloon counterpulsation before primary percutaneous coronary intervention versus standard of care. The primary outcome was infarct size as measured by cardiac magnetic resonance imaging 3 to 5 days after...


Re-usage of external pacing electrodes results in skin burns
A 29 year old woman with a background of poorly controlled diabetes was admitted to our hospital in cardiogenic shock due to acute inferior myocardial infarction and complete heart block. Recycled external electrodes (“stat.padz®”) were placed to the right of the upper sternal border below the clavicle and to the left of the nipple with the centre of the electrode in the mid-axillary line. External pacing was commenced with an output of 90mA at a rate of 70 stimulations per minute. Mechanical capture was confirmed by echocardiography. Primary percutaneous coronary intervention to the right coronary artery was performed with insertion of a transvenous temporary pacemaker. The patient developed intra-procedurally ventricular fibrillation for which a shock of 200J was delivered through t...


Common hemodynamic problems in the neonate.
Authors: Barrington KJ Abstract Hemodynamic problems are common in neonatal intensive care. They occur in the context of incomplete myocardial and vascular development and in cardiovascular responses to interventions which are, as a result, limited and often uncertain and unpredictable. In this review, I outline the hemodynamic features of 4 neonatal conditions which often require intervention: (1) persistent pulmonary hypertension of the newborn, (2) cardiogenic shock (most commonly in the context of hypoxic ischemic injury), (3) sepsis and (4) low blood pressure in the transitional period of the extremely preterm infant. I also look at the evidence which exists for effective interventions and the most important research questions for the future. Copyright © 2013 S. Karger AG, Ba...


Long-term outcomes among older patients with non–ST-segment elevation myocardial infarction complicated by cardiogenic shock
Conclusions: Our results highlight the time-dependent hazard of risk during the early postdischarge period for older patients with non–ST-segment elevation MI and cardiogenic shock that appears to be mitigated after 6 months, thereby lending support for the examination of new therapies designed to ameliorate this early risk. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Percutaneous biventricular cardiac assist device in cardiogenic shock
(Source: European Heart Journal)


Circulating angiopoietins and cardiovascular mortality in cardiogenic shock
Conclusion Circulating Angs are closely related to outcome and severity in CS. Angiopoietin-2 emerged as an independent predictor of 28-day and 1-year mortality in CS. Larger studies are required to define the cut-off and predictive values for Ang-2. Angiopoietins may be prognostic biomarkers for survival in CS and might represent a novel therapeutic target. (Source: European Heart Journal)


Transition from ECMO to left ventricular support via trans-septal cannula using a single CentriMag device.
Authors: Denino W, Yeager C, Steinberg D, Toole J, Shackelford A, Peura J Abstract A 67-year-old male presented in cardiogenic shock and multi-system organ failure requiring emergent venous-arterial extracorporeal membrane oxygenation (ECMO). He was deemed ineligible for heart transplantation and a left ventricular assist device (LVAD) was thought to be high risk due to persistent right heart failure. To determine if he could tolerate left ventricular support alone, a trans-septal cannula was placed via the left femoral vein. Transition from veno-arterial ECMO to isolated left-sided support allowed for risk assessment for LVAD implantation and extubation, providing the patient an opportunity to participate in further clinical decision making. PMID: 23744848 [PubMed - as supplie...


Prehospital ECG signs of acute coronary occlusion are associated with reduced one-year mortality
Conclusions: Among patients with a suspected ACS, prehospital ECG-signs indicating an acute coronary occlusion were not only a predictor for direct admission to acute coronary care but also a predictor for increased survival. To improve future outcome in acute ischemic heart diseases we must find and treat not only the STEMI's but also the high-risk NSTEMIs that otherwise would have a poor prognosis. (Source: International Journal of Cardiology)


A 64-year-old man with refractory hypoxemia in cardiogenic shock.
Authors: Cawcutt KA, Wilson ME, Carter KJ, Maldonado F PMID: 23732594 [PubMed - in process] (Source: Chest)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


New 29-mm Balloon-Expandable Prosthesis for Transcatheter Aortic Valve Implantation in Large Annuli [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions The new 29-mm balloon-expandable prosthesis broadens the indication for transcatheter aortic valve implantation to include patients with large annuli. The outcome is very favorable. (Source: The Annals of Thoracic Surgery)


Is ivabradine suitable to control undesirable tachycardia induced by dobutamine in cardiogenic shock treatment?
Abstract: Inotropic treatment remains the cornerstone for cardiogenic shock, an emergency that requires immediate resuscitative therapy before shock irreversibly damages vital organs. Although the sympathomimetic drug dobutamine is the most widely-used inotropic drug worldwide, it has several side effects including sinus tachycardia. Dobutamine partly restores systolic heart failure (HF); however, it increases the heart rate (HR) which counterbalances the beneficial effects. Ivabradine, a new selective If inhibitor, provides specific HR reduction and is indicated in stable coronary artery disease and in stable chronic HF with left ventricular dysfunction. Despite scarce data indicating beneficial effects of ivabradine in sinus tachycardia in various clinical settings, this drug remains con...


Gender Comparisons in Cardiogenic Shock During ST Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention
In conclusion, this analysis demonstrates that in the contemporary PPCI era, there is a reduction in the incidence of CS with reduced hospital mortality rates and no gender difference. The absence of a gender difference is remarkable because higher proportions of women presented with CS and were older than their male counterparts. Long-term follow-up data are required to determine if this difference is sustained. (Source: The American Journal of Cardiology)


Impact of cardiac magnet resonance imaging on management of ventricular septal rupture after acute myocardial infarction.
Authors: Gassenmaier T, Gorski A, Aleksic I, Deubner N, Weidemann F, Beer M Abstract A 74-year-old man was admitted to the cardiac catheterization laboratory with acute myocardial infarction. After successful angioplasty and stent implantation into the right coronary artery, he developed cardiogenic shock the following day. Echocardiography showed ventricular septal rupture. Cardiac magnet resonance imaging (MRI) was performed on the critically ill patient and provided detailed information on size and localization of the ruptured septum by the use of fast MRI sequences. Moreover, the MRI revealed that the ventricular septal rupture was within the myocardial infarction area, which was substantially larger than the rupture. As the patient's condition worsened, he was intubated and ha...


Arrhythmogenic effect of flecainide toxicity.
We report the case of a 72-year-old woman admitted to our intensive care unit for a regular monomorphic wide complex tachycardia (QRS duration 240 ms, right bundle branch block and superior axis morphology) without apparent P waves. Clinical examination showed slight left congestive heart failure signs without cardiogenic shock. An intravenous bolus of 10 mg adenosine 5'-triphosphate (ATP) was ineffective to stop the tachycardia. The diagnosis of ventricular tachycardia induced by flecainide overdose was considered. 500 mL of intravenous 84‰ sodium bicarbonate was administrated. The patient's QRS narrowed immediately and 12-lead ECG showed sinus rhythm. Blood samples confirmed the flecainide overdose and the clinical status progressively improved. PMID: 23558880 [PubMed - in process]...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Acute myocardial infarction due to left main coronary artery disease: A large multicenter national registry.
CONCLUSIONS: No signifi cant differences in clinical course, treatment and prognosis between men and women were noted. Mortality remained very high in both genders. The most unfavorable prognostic factors were cardiogenic shock, pulmonary edema, STEMI and advanced age. Percutaneous coronary angioplasty is feasible and offers high success rate in this subset of patients. PMID: 23558878 [PubMed - in process] (Source: Cardiology Journal)


Deep sternal wound infection after cardiac surgery
Conclusions: The incidence of DSWI after cardiac surgery according to the data entered in the JACVSD registry during the period from 2004 to 2009 was 1.8%, and more complicated procedures were followed by higher incidence and mortality. When re-exploration for bleeding was performed, mortality was significantly higher than when it was not performed. Prevention of DSWI and establishment of an effective appropriate treatment for DSWI may improve the outcome of cardiac surgery. (Source: Journal of Cardiothoracic Surgery)


Abstract 90: Ten-year Trends in Mechanical Revascularization, Intra-Aortic Balloon Pump Use and In-Hospital Mortality in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock [Poster Session I]
Conclusion: Mechanical revascularization rates in patients with cardiogenic shock complicating AMI have increased during the past decade. This is also associated with a decrease in in-hospital mortality during this period. IABP use has also increased over the past 10 years; however, IABP use is associated with higher in-hospital mortality among patients with AMI and cardiogenic shock. (Source: Circulation: Cardiovascular Quality and Outcomes)


Major Pulmonary Embolism and Patent Foramen Ovale
The thrombus is localized in the pulmonary artery and its branches in most cases of major pulmonary embolism (MPE). Rare are the cases of biatrial thrombus entrapped in a patent foramen ovale (PFO). In such circumstances, MPE may be associated with cardiogenic shock, with a high risk of mortality. Fibrinolytic agents are the main treatment of MPE, but when they are contraindicated or failed to treat MPE, or in a patient with a risk of cardiac arrest by occlusion of cardiac blood flow, a surgical pulmonary embolectomy under cardiopulmonary bypass (CPB) remains the referred treatment. The authors report the case of a 59-year-old woman suffering from biatrial thrombus entrapped in a PFO with cardiogenic shock; she rapidly improved her respiratory and cardiac functions after an emergency surgi...


Management of severe aortic regurgitation in a patient with cardiogenic shock using a percutaneous left ventricular assist device and transcatheter occlusion of the failed aortic valve homograft as a bridge to surgical valve replacement
Abstract Acute hemodynamic compromise due to severe aortic regurgitation remains a difficult problem. The optimal management strategy and timing of surgery continues to evolve as new technologies become available. Here we report the case of a young woman presenting with severe regurgitation of an aortic homograft who developed precipitous cardiogenic shock and multi‐organ dysfunction. Her mortality risk with emergent surgery was prohibitive, and no percutaneous valve‐in‐valve device was available. We stabilized her condition by placing an Amplatz‐type ASD occluder across her aortic valve in conjunction with a percutaneous left ventricular assist device as a bridge to surgical valve replacement. She went on to a successful surgery and recovered well. © 2013 Wiley Periodicals, Inc. ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Post Myocardial Infarction Cardiogenic Shock: A Review of Current Therapies
Cardiogenic shock is often a devastating consequence of acute myocardial infarction (MI) and portends to significant mortality and morbidity. Despite improvements in expediting the time to treatment and enhancements in available medical therapy and reperfusion techniques, cardiogenic shock remains the most common cause of mortality following MI. Post-MI cardiogenic shock most commonly occurs as a consequence of severe left ventricular dysfunction. Right ventricular (RV) MI must also be considered. Mechanical complications including acute mitral regurgitation, ventricular septal rupture, and ventricular free-wall rupture can also lead to cardiogenic shock. Rapid diagnosis of cardiogenic shock and its underlying cause is pivotal to delivering definitive therapy. Intravenous vasoactive agents...


Cause of Death Within 30 Days of Percutaneous Coronary Intervention in an Era of Mandatory Outcome Reporting
Conclusions: Less than one-half of 30-day deaths are attributed to a PCI-related complication. Death certificates are inaccurate and do not report PCI-related deaths, which may represent a better marker of PCI quality. (Source: Journal of the American College of Cardiology)


Pulmonary hypertension and pulmonary artery dissection
A dissecção da artéria pulmonar é uma complicação fatal da hipertensão pulmonar de longa duração que se manifesta como dor torácica aguda e lancinante, dispneia progressiva, choque cardiogênico ou morte súbita. Sua incidência é subestimada, e as opções terapêuticas são ainda limitadas. O aparecimento de uma dor torácica aguda ou nova, choque cardiogênico ou morte súbita em pacientes portadores de hipertensão pulmonar deve alertar para o diagnóstico de dissecção da artéria pulmonar.Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients wi...


Efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in evaluating lung cancer recurrence
A dissecção da artéria pulmonar é uma complicação fatal da hipertensão pulmonar de longa duração que se manifesta como dor torácica aguda e lancinante, dispneia progressiva, choque cardiogênico ou morte súbita. Sua incidência é subestimada, e as opções terapêuticas são ainda limitadas. O aparecimento de uma dor torácica aguda ou nova, choque cardiogênico ou morte súbita em pacientes portadores de hipertensão pulmonar deve alertar para o diagnóstico de dissecção da artéria pulmonar.Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients wi...


Impending paradoxical embolism across the interatrial septum
A dissecção da artéria pulmonar é uma complicação fatal da hipertensão pulmonar de longa duração que se manifesta como dor torácica aguda e lancinante, dispneia progressiva, choque cardiogênico ou morte súbita. Sua incidência é subestimada, e as opções terapêuticas são ainda limitadas. O aparecimento de uma dor torácica aguda ou nova, choque cardiogênico ou morte súbita em pacientes portadores de hipertensão pulmonar deve alertar para o diagnóstico de dissecção da artéria pulmonar.Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients wi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Whole-body magnetic resonance imaging for the evaluation of thoracic involvement in disseminated paracoccidioidomycosis
A dissecção da artéria pulmonar é uma complicação fatal da hipertensão pulmonar de longa duração que se manifesta como dor torácica aguda e lancinante, dispneia progressiva, choque cardiogênico ou morte súbita. Sua incidência é subestimada, e as opções terapêuticas são ainda limitadas. O aparecimento de uma dor torácica aguda ou nova, choque cardiogênico ou morte súbita em pacientes portadores de hipertensão pulmonar deve alertar para o diagnóstico de dissecção da artéria pulmonar.Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients wi...


Successful thoracoscopic thymectomy in an infant
A dissecção da artéria pulmonar é uma complicação fatal da hipertensão pulmonar de longa duração que se manifesta como dor torácica aguda e lancinante, dispneia progressiva, choque cardiogênico ou morte súbita. Sua incidência é subestimada, e as opções terapêuticas são ainda limitadas. O aparecimento de uma dor torácica aguda ou nova, choque cardiogênico ou morte súbita em pacientes portadores de hipertensão pulmonar deve alertar para o diagnóstico de dissecção da artéria pulmonar.Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients wi...


Underdiagnosis of respiratory diseases during an economic downturn and the need for spirometry as a screening test
A dissecção da artéria pulmonar é uma complicação fatal da hipertensão pulmonar de longa duração que se manifesta como dor torácica aguda e lancinante, dispneia progressiva, choque cardiogênico ou morte súbita. Sua incidência é subestimada, e as opções terapêuticas são ainda limitadas. O aparecimento de uma dor torácica aguda ou nova, choque cardiogênico ou morte súbita em pacientes portadores de hipertensão pulmonar deve alertar para o diagnóstico de dissecção da artéria pulmonar.Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients wi...


Authors' reply
A dissecção da artéria pulmonar é uma complicação fatal da hipertensão pulmonar de longa duração que se manifesta como dor torácica aguda e lancinante, dispneia progressiva, choque cardiogênico ou morte súbita. Sua incidência é subestimada, e as opções terapêuticas são ainda limitadas. O aparecimento de uma dor torácica aguda ou nova, choque cardiogênico ou morte súbita em pacientes portadores de hipertensão pulmonar deve alertar para o diagnóstico de dissecção da artéria pulmonar.Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients wi...


Supraventricular Tachycardia in the Pediatric Trauma Patient: A Case Report
We describe the diagnostic challenge when evaluating persistent tachycardia in the setting of multiple system trauma with hemorrhagic shock. This is a unique case of a 17-year-old patient with the secondary condition of cardiogenic shock due to supraventricular tachycardia (SVT) complicating ongoing hemorrhagic shock from a facial laceration. She had sustained tachycardia despite aggressive resuscitation and required medical cardioversion 30 minutes after arrival to the emergency department. After successful conversion, she maintained normal sinus rhythm for the rest of her hospitalization. During her follow-up cardiac catheterization, she was found to have a left-sided accessory pathway, consistent with atrioventricular reciprocating tachycardia. This is a unique and rare case of SVT in t...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Left bundle branch block with acute thrombotic occlusion is associated with increased myocardial jeopardy score and poor clinical outcomes in primary percutaneous coronary intervention activations
Conclusions Our data suggests that despite its poor specificity for identifying acute coronary occlusion, LBBB should at the present time remain an activation criterion for PPCI and such patients should continue to be transferred to heart attack centres for assessment and treatment. (Source: Heart)


Acute coronary syndromes
Acute coronary syndrome (ACS) is a spectrum of disease ranging from undifferentiated chest pain to unstable angina to non-ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation myocardial infarction (STEMI) (see ). The management goal of acute coronary syndrome is to identify where the patient falls on the ACS spectrum to guide treatment and testing to reduce the amount of myocardial necrosis and thus preserve left ventricle function and to prevent and manage major adverse cardiac events: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), decompensated heart failure, and cardiogenic shock. (Source: Disease a Month)


Insertion of an Abiomed Impella® Left Ventricular Assist Device Following Bioprosthetic Aortic Valve Placement
ConclusionsThis is the first published report of successful use of an Impella 5.0 (ABIOMED; Danvers, MA) for post‐cardiotomy cardiogenic shock through a new implanted bioprosthetic aortic valve. (Source: Journal of Cardiac Surgery)


Stress Cardiomyopathy with an “Inverse” Takotsubo Pattern in a Patient with Acute Aneurysmal Subarachnoid Hemorrhage
We describe a case of stress cardiomyopathy in a patient following acute aneurysmal subarachnoid hemorrhage that showed an “inverse” or reverse takotsubo pattern on echocardiography. Case ReportThe patient was a 46‐year‐old female who presented with acute cardiogenic shock following acute subarachnoid hemorrhage necessitating aggressive cardiorespiratory in the ICU. Her admission echo showed a depressed left ventricular ejection fraction of 25%. The basal 2/3 of the left ventricle (LV) was severely hypokinetic and the apical 1/3 of the LV was hypercontractile, i.e. the reverse or inverse takotsubo pattern of regional wall motion abnormality. With ongoing aggressive support her cardiovascular function steadily improved and on day 6 her follow up echo showed LV ejection fraction incr...


Successful Management of Neonatal Myocardial Infarction with ECMO and Intracoronary r‐tPA lysis
We report on a 4‐day‐old full‐term male newborn presenting with acute MI and cardiogenic shock secondary to proximal thromboembolic occlusion of the left descending coronary artery. Hemodynamic stabilization could only be achieved after extracorporeal membrane oxygenation (ECMO) support. Coronary artery patency restoration was performed by selective intracoronary lysis with recombinant tissue plasminogen activator (r‐tPA). ECMO support could be discontinued and myocardial function recovered within 6 weeks. We discuss the potential etiologies of acute perinatal MI and the role of ECMO support in the immediate post‐MI period. Prompt recognition, timely referral to a cardiac center with availability of specialized advanced treatment options, and management in an orchestrated interdi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A Home-Birthed Neonate in Cardiogenic Shock
A father carried his 6-hour-old newborn son into the emergency department. After a planned home birth, the child appeared normal, but his respiration grew progressively more labored. Triage assessment identified a limp term neonate with circumoral cyanosis and grunting respiration. The father and infant were immediately escorted to a treatment room, where supplemental oxygen was applied through a reservoir mask. (Source: Journal of Emergency Nursing: JEN)


SynCardia Temporary Total Artificial Heart as Bridge to Transplantation: Current Results at La Pitie Hospital [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions The SynCardia t-TAH provided acceptable survival to transplantation rates with a remarkably low incidence of neurologic events. Posttransplant survival was similar to that of patients undergoing primary heart transplantation in France. (Source: The Annals of Thoracic Surgery)


Emergency Valve Re-Replacement for Embolization of Prosthetic Mitral Valve Disc During Catheterization Procedure [CASE REPORTS]
A 47-year-old woman with a mechanical mitral valve underwent a catheter-based atrial fibrillation ablation procedure, which was complicated by the dislodgment and immediate embolization of one of the valve leaflets. Acute severe mitral regurgitation and cardiogenic shock developed, necessitating emergency reoperative mitral valve re-replacement. She subsequently underwent a successful staged retrieval of the embolized leaflet from the abdominal aorta. (Source: The Annals of Thoracic Surgery)


[Interhospital transfer of ECMO-assisted patients in Martinique.]
CONCLUSION: Interhospital transfer of ECMO/ECLS-assisted patients by land or air is technically feasible under perfectly secure conditions in our area. Prior coordination of this activity has helped to make it affordable. PMID: 23643307 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)


The use of extracorporeal membrane oxygenation in pediatric patients with sickle cell disease.
We describe a patient with SCD and life-threatening cardiogenic shock who was successfully treated with VA ECMO. Furthermore, SCD patients have unique comorbidities that warrant particular consideration when utilizing ECMO. We discuss these considerations and review the documented experience with ECMO for pediatric SCD patients from the Extracorporeal Life Support Organization (ELSO) registry. From 1990 until 2012, 52% of the 65 pediatric patients with SCD placed on ECMO survived, with 85% of those receiving venovenous (VV) ECMO surviving and 43% of those receiving VA ECMO surviving. However, significant complications, such as bleeding, neurological injury and kidney injury, also occurred with both VV and VA ECMO. Ten percent of SCD patients receiving VA ECMO experienced either a cerebral ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Optical Coherence Tomography Imaging of Acute Stent Thrombosis After Stentys Stent Implantation
A 56-year-old man was referred to our catheterization laboratory for percutaneous coronary intervention because of stable angina caused by a stenosis of the proximal left anterior descending coronary artery (A, Online Video 1). The patient was pre-treated with aspirin and clopidogrel and heparin peri-procedural as per routine. After pre-dilation, a Stentys self-expandable drug-eluting stent (Stentys S.A., Paris, France) was placed in the left main coronary artery and proximal left anterior descending coronary artery, followed by post-dilation, with a good angiographic result (B, Online Video 2). Optical coherence tomography revealed an image of a freshly placed stent with uncovered stent struts. However, multiple small red (red blood cell–rich) thrombi on the stent struts were observed (...


Innominate truncal and arch blowout with left hemiparesis and right hemothorax followed by delayed cheese-wire perforation of innominate graft
We present the case of a 68 year old Caucasian woman, in extremis, with left hemiparesis and right hemothorax, in hypovolemic shock, secondary to a blow-out of a large penetrating ulcer at the junction of innominate trunk and aortic arch. She underwent interposition graft replacement of innominate trunk and repair of aortic arch, on cardiopulmonary bypass, employing total circulatory arrest and selective antegrade cerebral perfusion and had total resolution of hemiparesis. She, however, represented, 6 months later, with threatened exsanguination after a sternal wire cheese-wired through the sternum and perforated the anteriorly lying innominate graft. Following successful repair, she was found to have an old intramural hematoma of distal arch and descending thoracic aorta and changes sugge...


Optical Coherence Tomography Imaging of Acute Stent Thrombosis After Stentys Stent Implantation
A 56-year-old man was referred to our catheterization laboratory for percutaneous coronary intervention because of stable angina caused by a stenosis of the proximal left anterior descending coronary artery (A,Online Video 1). The patient was pre-treated with aspirin and clopidogrel and heparin peri-procedural as per routine. After pre-dilation, a Stentys self-expandable drug-eluting stent (Stentys S.A., Paris, France) was placed in the left main coronary artery and proximal left anterior descending coronary artery, followed by post-dilation, with a good angiographic result (B, Online Video 2). Optical coherence tomography revealed an image of a freshly placed stent with uncovered stent struts. However, multiple small red (red blood cell–rich) thrombi on the stent struts were observed (C...


Levosimendan in acute heart failure following primary percutaneous coronary intervention-treated acute ST-elevation myocardial infarction. Results from the LEAF trial: a randomized, placebo-controlled study
Conclusions Levosimendan treatment improved contractility in post-ischaemic myocardium in patients with PCI-treated STEMI complicated by HF. The treatment was well tolerated, without any increase in arrhythmias. Trial registration: NCT00324766 (Source: European Journal of Heart Failure)


Safety of β-blockers in the acute management of cocaine-associated chest pain
Dr Connors mentions legitimate limitations of our study; however, a few concepts deserve further discussion . First, it was noted that, in patients with cocaine-associated chest pain, evidence suggests that β-blockers (BB) should be withheld at least in the majority of them in the first hours after presentation. Nevertheless, there is limited evidence about this, with the exception of single case reports and studies done in the laboratory setting . The American Heart Association (AHA) considered this evidence “Level of Evidence C” in their statement . Second, it was pointed out that treatment with BB of patients with suspected myocardial infarction should be withheld within 24 hours from presentation because of no mortality benefit and slightly higher incidence of cardiogenic shock. T...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Clinical outcomes after percutaneous or surgical revascularisation of unprotected left main coronary artery-related acute myocardial infarction: a single-centre experience
Conclusions Thirty-day mortality was high in patients presenting with an ULMCA-related AMI, both in the PCI as in the CABG-treatment group. Presentation with cardiogenic shock, TIMI 0/1 flow on initial angiogram and diabetes mellitus were independently predicting of 30-day mortality, whereas treatment allocation was primarily determined by presentation with TIMI 0/1 flow. (Source: Heart)


Stroke After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction: Timing, Characteristics, and Clinical Outcomes [Coronary Artery Disease]
Conclusions&mdash; Stroke is an infrequent complication in the setting of ST-segment elevation myocardial infarction treated with primary PCI but is associated with increased morbidity and mortality. Studies to determine mechanisms that may be responsible for strokes that occur &gt;48 hours from primary PCI are warranted. Clinical Trial Registration&mdash; URL: http://www.clinicaltrials.gov. Unique identifier: NCT00091637. (Source: Circulation: Cardiovascular Interventions)


Transcatheter aortic valve implantation in a patient with mechanical mitral prosthesis: A lesson learned from an intraventricular clash
Abstract We hereby present the case of a patient with severe aortic stenosis who underwent in her previous medical history a mitral valve replacement with a mechanical valve (Omnicarbon 27), and progressively developed a severe aortic stenosis. This patient was judged inoperable and then scheduled for CoreValve Revalving System implantation. Despite a good positioning of the CoreValve, an acute, severe mitral regurgitation developed soon after implantation as a consequence of the impaired movement of the mitral prosthesis leaflet. A condition of cardiogenic shock quickly developed. A good mitral prosthesis function was restored disengaging the CoreValve from the aortic annulus. After few months, the patients underwent successful Edwards Sapien valve implantation through the Corevalve. This...


Acute hyperglycaemia and inflammation in patients with ST segment elevation myocardial infarction.
CONCLUSIONS: Acute hyperglycaemia is associated with worse in-hospital outcomes in patients with STEMI. More severe inflammation (defined as leukocyte count on admission) is noted in STEMI patients with adverse events. A significant positive correlation can be seen between glucose level and leukocyte count on admission, and concomitant presence of both acute hyperglycaemia and more severe inflammation in patients with STEMI was found to be an independent predictor of poor in-hospital outcomes. PMID: 23575781 [PubMed - in process] (Source: Polish Heart Journal)


Cardiotoxicity in cancer patients treated with 5-fluorouracil or capecitabine: A systematic review of incidence, manifestations and predisposing factors
Conclusion: Larger studies suggest an incidence of symptomatic cardiotoxicity of 1.2–4.3% during fluorouracil treatment, however subclinical cardiac influence are common. Possible risk factors are cardiac co-morbidity, continuous infusion schedules and concomitant cisplatin treatment, but existing evidence are of insufficient quality. (Source: Cancer Treatment Reviews)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A “no‐option” left main PCI registry: Outcomes and predictors of in hospital mortality—utility of the logistic EuroSCORE
ConclusionPCI appears to be a reasonable option in the high risk “no option” LM population, with the logistic EuroSCORE and peak CK levels being independent predictors of in‐hospital mortality. Specifically, the logistic EuroSCORE and peak CK level combined discriminate in‐hospital mortality with a high degree of certainty. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Bleeding outcomes after routine transradial primary angioplasty for acute myocardial infarction using eptifibatide and unfractionated heparin: A single‐center experience following the HORIZONS‐AMI trial
ConclusionsRoutine TR access for PPCI using UFH plus GPI is associated with a low 30‐day rate of major bleeding equivalent to the bivalirudin arm of HORIZONS‐AMI. Default transradial access for PPCI permits routine use of a GPI without the penalty of high bleeding rates. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


The prognostic value of pro-B-Type natriuretic peptide in acute pulmonary embolism
This study was ancillary to a recently published multicentre study including 570 patients with acute pulmonary embolism. ProBNP values were analysed using a new sandwich immunoassay proBNP1-108, Bioplex2200™ (Bio-Rade Laboratories). Data was compared with BNP and N-terminal (NT) proBNP values. Adverse outcomes at 30days were defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism.Résults: ProBNP values were analysed in 549 patients, with 39 (7.1%) presenting adverse outcomes. All three natriuretic peptides were significantly elevated in these 39 patients compared with the group without adverse outcomes (BNP: p (Source: Thrombosis Research)


Transradial PCI in Cardiogenic ShockTransradial PCI in Cardiogenic Shock
Why don't more patients in cardiogenic shock receive PCI -- via a transradial approach? American Heart Journal (Source: Medscape Today Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Emergency and prophylactic use of miniaturized veno‐arterial extracorporeal membrane oxygenation in transcatheter aortic valve implantation
Conclusions:Life‐threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. The use of prophylactic vaECMO in very high‐risk patients is safe and may be advocated in selected cases. © 2013 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)


Long‐term outcomes of complete versus incomplete revascularization after drug‐eluting stent implantation in patients with multivessel coronary disease
ConclusionCompared with IR, patients with CR had better clinical outcomes, supporting CR as first choice for patients with MVD. © 2013 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)


Delayed Postmyectomy Ventricular Septal Defect
A 72-YEAR-OLD MAN with a 5-year history of a cardiac murmur presented to the emergency room with severe dyspnea and chest pain. He was found to be hypotensive and tachycardic. Electrocardiogram revealed diffuse ST elevations, and the serum troponin level was slightly elevated. He was admitted to the intensive care unit with the diagnosis of cardiogenic shock. Transthoracic echocardiography revealed severe systolic anterior motion (SAM) of the mitral valve with severe eccentric mitral regurgitation (MR), a left ventricular outflow tract (LVOT) peak gradient of 80mmHg, and a septal thickness of 1.7cm. He was treated medically with good response to high-dose beta-blockers and intravenous phenylephrine and was discharged in good condition. After 2 further emergency room visits for chest pain a...


An unusual presentation of chest pain: Needle perforation of the right ventricle
Abstract: Foreign bodies in the heart are a rare occurrence and can result from intravenous drug abuse, trauma or iatrogenic causes. There are no current guidelines for the treatment of a cardiac foreign body. We hereby present a brief review of the available literature and report a case of a woman with chest pain subsequently complicated by cardiogenic shock due to tamponade secondary to a needle fragment perforating her right ventricular free wall. (Source: Heart and Lung)


Endovascular treatment of symptomatic true-lumen collapse of the downstream aorta after open surgery for acute aortic dissection type A.
CONCLUSION: After proximal aortic repair for AADA, early postoperative computed tomography should be demanded in all patients to exclude a TLC of the descending aorta. Mortality is still substantial in these patients despite instant TEVAR application. Thus, in case of TLC and malperfusion syndrome of the downstream aorta, TEVAR should be performed early to alleviate or even prevent ischemic injury. PMID: 23558651 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Pulmonary embolism and pregnancy].
CONCLUSION: Diagnostic approach is first based on the use of ultrasound- Doppler, and frequently on-to computed tomographic pulmonary angiography or ventilation-perfusion lung scanning. The treatment is based on low molecular weight heparin. Others therapeutics, such as thrombolysis or temporary vena cava filter, may be useful in certain circumstances. PMID: 23528288 [PubMed - in process] (Source: Annales Francaises d'Anesthesie et de Reanimation)


Should furosemide be avoided in acute right ventricular myocardial infarction?
CONCLUSIONS: Diuretics and fluid expansion provide similar efficiency for triggering diuresis in patients with right ventricular infarction and oligoanuria but only diuretics seem to be associated with improvement in hemodynamic status and venous congestion. PMID: 23561700 [PubMed - in process] (Source: Annales de Cardiologie et d'Angeiologie)


Severe cardiotoxicity associated with ixabepilone use in metastatic breast cancer.
CONCLUSIONS: Clinicians should maintain broad differential diagnoses that include adverse reactions to drugs relatively new to the market. Ixabepilone may have cardiotoxic effects that necessitate further study, particularly when the drug is administered after cardiotoxic chemotherapy. PMID: 23512664 [PubMed - in process] (Source: The Annals of Pharmacotherapy)


Improving Outcomes in Patients With Cardiogenic ShockImproving Outcomes in Patients With Cardiogenic Shock
Cardiogenic shock carries a grim prognosis. Can we turn it around? American Heart Journal (Source: Medscape Today Headlines)


The outcome of intra-aortic balloon pump support in acute myocardial infarction complicated by cardiogenic shock according to the type of revascularization: A comprehensive meta-analysis
Conclusion: The results show that IABP support is significantly effective in TT reperfusion but is associated with a significant increase of the inhospital mortality with primary PCI. The comparison of the meta-analyses demonstrates the key role of analysing primary clinical treatments to avoid systematic errors. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Gastrointestinal complications after cardiac surgery: 10‐year experience of a single Australian centre
ConclusionsGI complications after cardiac surgery remain an uncommon but dreadful complication associated with high mortality. Our findings should prompt a high degree of clinical vigilance in order to make an early diagnosis especially in high risk patients. Further studies aiming to identify independent predictors for GI complications after cardiac surgery are warranted. (Source: ANZ Journal of Surgery)


The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock
Conclusion In non-CS STEMI patients with MVD, the presence of a co-existing CTO in a non-infarct-related artery drives early and late mortality. In patients with CS, MVD with and without a CTO were predictors for short-term mortality. (Source: European Journal of Heart Failure)


The use of PTCA in acute mitral regurgitation and cardiogenic shock
(Source: Catheterization and Cardiovascular Interventions)


Wrist PCI Viable in Unstable Shock (CME/CE)
(MedPage Today) -- The radial artery approach was safe in patients with cardiogenic shock undergoing percutaneous coronary intervention, and was associated with a reduced mortality compared with transfemoral access, a single-center study found. (Source: MedPage Today Cardiovascular)


Risk Factors, Therapeutic Approaches, and In‐Hospital Outcomes in Mexicans With ST‐Elevation Acute Myocardial Infarction: The RENASICA II Multicenter Registry
ConclusionsLargely modifiable risk factors and preventable short‐term complications are responsible for most STEMI cases and outcomes in this Mexican population. (Source: Clinical Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The cardiovascular manifestations of influenza: A systematic review
Abstract: Influenza accounts for 3 to 5million cases of severe illness and up to 300,000 deaths annually, presenting a considerable burden to healthcare services. A spectrum of cardiovascular complications has been reported in association with influenza infection. This can occur through direct effects of the virus on the myocardium or through exacerbation of existing cardiovascular disease. Direct myocardial involvement presenting as myocarditis is not uncommon during influenza infection. Clinical presentation may vary from asymptomatic to fulminant myocarditis resulting in cardiogenic shock and death. Cardiovascular mortality is also increased during influenza epidemics in patients with pre-existing coronary artery disease. Rates of myocardial infarction have been shown to increase follow...


Refractory cardiogenic shock following idiopathic giant cell myocarditis in a 19-year-old woman
Clinical case A 19-year-old woman with no medical history except for facial acne treated with tetracyclines during the previous year presented to the emergency room referring 1-week history of worsening muscle weakness, palpitations and exertional dyspnoea. Physical examination revealed a tachycardic (130&nbsp;bpm), tachypnoeic and hypotensive (blood pressure 90/50 mm&nbsp;Hg) thin woman with fever of 38.5&deg;C, rash and jugular vein distention. An ECG showed sinus tachycardia with 0.5&nbsp;mm elevation of the ST segment in the anterior and inferior leads. In laboratory studies, she had leukocytosis with neutrophilia and eosinophilia and mild rise of troponin I (4.8&nbsp;&micro;g/l), creatine kinase (524&nbsp;U/l) and transaminases (aspartate aminotransferase of 765&nbsp;U/l and alanine a...


Safety of Reloading Prasugrel in Addition to Clopidogrel Loading in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
In conclusion, preloading with clopidogrel should not be prohibitive to reloading with prasugrel in patients presenting with acute coronary syndrome and undergoing PCI with respect to bleeding and vascular complications. (Source: The American Journal of Cardiology)


Transradial percutaneous coronary intervention in cardiogenic shock: A single-center experience
Conclusions: Transradial approach for PCI is possible and safe in up to two-thirds of patients with CS. Absence of radial pulse was the main factor preventing use of TRA. In multivariate analysis, TRA was associated with a lower risk of mortality. (Source: American Heart Journal)


The Comparison in Reduction of QT Dispersion After Primary Percutaneous Coronary Intervention According to Existence of Thrombectomy in ST‐Segment Elevation Myocardial Infarction
ConclusionsThrombectomy additional to PPCI helps more effective reperfusion at the microvascular level and provides additional prognostic information. (Source: Clinical Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Left main coronary artery aneurysm thrombosis in a young patient with acute myocardial infarction].
CONCLUSIONS: Left main coronary artery aneurysms are rare, finding ONE in an acute myocardial infarction is a serious situation because of the challenging reperfusion techniques that are implied, such as in this case. The search for genetic factors related with hypofibrinolysis could guide stratification and therapy towards medical surgical or interventional management. PMID: 23522315 [PubMed - in process] (Source: Cirugia y Cirujanos)


Atrial septostomy in cardiogenic shock related to H1N1 infection.
We report a case of percutaneous blade and balloon atrial septostomy (BAS) as an add-on to the circulatory assistance to unload the left heart in a cardiogenic shock related to H1N1 infection. PMID: 23425007 [PubMed - in process] (Source: Acute Cardiac Care)


Dextromethorphan/maprotiline interaction: Cardiogenic shock, Takotsubo cardiomyopathy and serotonin syndrome in an elderly patient: case report
(Source: Reactions)


Rebuttal: The Use of PTCA in Acute Mitral Regurgitation and Cardiogenic Shock: Revisited With Impella—Response from the Authors
(Source: Catheterization and Cardiovascular Interventions)


Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock
Conclusions: In TRI high volume center, TRI for STEMI was safe and feasible as a default approach. TRI could be applied to severe shock patients with similar clinical outcome to TFI. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intraaortic balloon support for myocardial infarction with cardiogenic shock
Approximately 5-10% of patients after an acute myocardial infarction present with cardiogenic shock. Since 1968 intraaortic balloon counterpulsation is used to support the failing heart in cardiogenic shock. Read the full report by Prof. Holger Thiele along with comments from Professors Marco Tubaro (PROS) and Uwe Zeymer (CONS). Topics: Acute Coronary Syndromes (ACS) (Source: ESC News and Press)


Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture [Myocardial Infarction]
Conclusions&mdash; Transcatheter closure of post-AMI VSR using CardioSEAL or STARFlex devices is feasible and effective. The MELD-XI score, a marker of multiorgan dysfunction, is a promising risk stratifier in this population of patients. Early closure of post-AMI VSR is advisable before establishment of multiorgan failure. (Source: Circulation: Cardiovascular Interventions)


Recurrent Left Atrial and Left Ventricular Thrombosis Due to Heparin-Induced Thrombocytopenia: Case Report and Short Review.
Authors: Kuhl T, Wendt S, Langebartels G, Kröner A, Wahlers T Abstract The combination of heparin-induced thrombocytopenia (HIT) II, left ventricular failure with extracorporeal membrane oxygenation (ECMO) therapy, and recurrent left ventricular thrombosis is rare and predicts a poor outcome. In this case, HIT II occurred after an ischemic cardiogenic shock. We initiated ECMO and intra-aortic balloon pump therapy during coronary artery bypass grafting and ventricular thrombectomy. Despite continued therapeutic therapy with heparin and later argatroban, the patient developed solid and recurrent thrombotic masses in the left atrium and left ventricle. PMID: 23424064 [PubMed - as supplied by publisher] (Source: The Thoracic and Cardiovascular Surgeon)


MGuard Mesh‐Covered Stent for Treatment of ST‐Segment Elevation Myocardial Infarction with High Thrombus Burden Despite Manual Aspiration
ConclusionsThe MGuard stent may be useful to prevent distal embolization in patients with STEMI and high thrombus burden despite mechanical aspiration. (Source: Journal of Interventional Cardiology)


PCI by Radial Approach Feasible in Cardiogenic ShockPCI by Radial Approach Feasible in Cardiogenic Shock
Percutaneous coronary intervention (PCI) by the radial approach appears safe and feasible in patients with acute ST-elevation myocardial infarction (STEMI) and cardiogenic shock. Reuters Health Information (Source: Medscape Medical News Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Incessant atrial tachycardia: Cause or consequence of heart failure, and the role of radiofrequency ablation
We report a challenging case of newly diagnosed catastrophic cardiogenic shock associated with incessant focal atrial tachycardia. We discuss the interaction between incessant arrhythmias and cardiogenic shock, and the role of its early recognition and management with an electrophysiology study and ablation. (Source: International Journal of Cardiology)


Impact of incomplete revascularization in patients undergoing PCI for unprotected left main stem stenosis
ConclusionsFor unselected patients with uLMS treated by PCI, completeness of revascularization is associated with superior survival. The rSYNTAX score, a novel index of completeness of revascularization, independently predicts survival. Baseline SYNTAX score does not. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Long-Term Outcome After Angiographically Proven Coronary Stent Thrombosis
The long-term outcomes of patients with angiographically proved stent thrombosis (ST) are insufficiently known. The aim of this study was to evaluate the presentation and in-hospital and long-term outcomes of patients with angiographically proved ST as well as predictors of unfavorable clinical outcomes. One hundred six consecutive patients (mean age 69 ± 12 years, 85 men) presenting from 2003 to 2011 with 117 angiographically proved STs were included in the analysis. The time interval from initial stent implantation to ST, antiplatelet therapy at presentation, and the frequency and predictors of adverse events (death, myocardial infarction, and recurrent ST) during long-term follow-up (mean 65 ± 30 months) were evaluated. Eighty-six patients (80.9%) had early ST, 7 patients (6.6%) had...


Bailout antegrade coronary reentry with the stingray™ balloon and guidewire in the setting of an acute myocardial infarction and cardiogenic shock
We report a case where the Stingray™ device was successfully used as a bailout strategy in the setting of an acute myocardial infarction complicated by cardiogenic shock. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass (OPCAB) grafting should be considered as an alternative to the conventional on-pump surgery (ONCAB) in patients presenting with acute coronary syndrome (ACS) requiring emergency revascularization. Eighty-two papers were identified by a systematic search, of which nine were judged to best answer the clinical question. Of these, one was a randomized controlled trial and the remaining eight were retrospective observational studies. The author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. In total, these nine studies included 3001 patients (n = 817 OPCAB, 2184 ONCAB) u...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intra-aortic balloon pump counterpulsation: are we optimizing the management of cardiogenic shock?
Intra-aortic balloon pump counterpulsation (IABPC) has been used in various forms for decades. The change in physiology brought about by their use is conceptually appealing in managing cardiogenic shock and mechanical complications of myocardial infarction. A common myth is that this method of managing acute cardiological emergencies is to be limited to the realms of this specialist field. However, as medical physicians an appreciation and understanding of this novel therapy is essential not only as a lifesaving measure but also as a bridging therapy to more definitive management in the acute medical setting. IABPC is a safe and under-utilized technique despite featuring in all major international guidelines (ESC and ACC) for the management of cardiogenic shock secondary to acute coronary ...


[Atrial chaotic tachycardia during a respiratory tract infection due to NL63 coronavirus.]
We report the case of a 3-month-old boy hospitalized with acute bronchiolitis. Respiratory distress was associated with cardiogenic shock caused by chaotic atrial tachycardia. The cause of bronchiolitis was a coronavirus NL63 viral infection, confirmed in nasopharyngeal aspirations. The patient required intensive care including diuretics (furosemide), anti-arrhythmic drugs (amiodarone and digoxin), and inotropic drugs (milrinone and levosimendan) associated with mechanical ventilation. The outcome was favorable in 10days and the sinusal cardiac rhythm was completely restored at discharge. PMID: 23394725 [PubMed - as supplied by publisher] (Source: Archives de Pediatrie)


A rare nonfatal presentation of disseminated Chromobacterium violaceum sepsis.
We present a case of disseminated Chromobacterium violaceum sepsis with multiple liver and splenic abscesses presenting with skin lesions and cardiogenic shock, and later diagnosed to have chronic granulomatous disease. The patient was treated with prolonged antimicrobial therapy, after which she recovered and remained asymptomatic on follow-up. PMID: 23380618 [PubMed - as supplied by publisher] (Source: Journal of Microbiology, Immunology, and Infection)


Takotsubo cardiomyopathy.
This article explores the clinical essentials for recognizing and managing this group of complex patients. PMID: 23411979 [PubMed - in process] (Source: British Journal of Hospital Medicine)


Early and late outcomes after primary percutaneous coronary intervention by radial or femoral approach in patients presenting in acute ST-elevation myocardial infarction and cardiogenic shock
Conclusion: Radial approach was safe and feasible in more than half of the patients with ST-elevation MI and cardiogenic shock treated by primary PCI. After adjustment for baseline and procedural characteristics, radial approach remained associated with better survival. However, prognosis of patients undergoing primary PCI in cardiogenic shock remains poor. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Long-Term Results of Aortomitral Fibrous Body Reconstruction With Double-Valve Replacement [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions The early and long-term results of aortomitral fibrous body reconstruction with double-valve replacement are promising, and bovine pericardium appears to have strong durability. (Source: The Annals of Thoracic Surgery)


Skin microvascular morphology and hemodynamics during treatment with veno-arterial extra-corporeal membrane oxygenation.
Conclusion: Skin microvascular pathology as detected with video microscopy (pericapillary bleedings or haloes, micro-thrombi/capillaries with "no flow", low FCD with high spatial distribution heterogeneity or low mean flow-categorial velocity seems to be associated with poor prognosis. PMID: 23357861 [PubMed - as supplied by publisher] (Source: Clinical Hemorheology and Microcirculation)


ECMO therapy after thrombotic left main occlusion bridges prolonged cardiac arrest
A 53 year old patient was admitted February, 8th to our hospital with ST-segment elevation myocardial infarction and severe cardiogenic shock. Because of cardiopulmonary instability, the patient was treated with catecholamins and was already intubated in the trauma room. He then underwent immediate coronary angiography and was treated with drug-eluting stenting because of a thrombotic occlusion of the left main coronary artery. After implantation of an intra-aortic balloon pump (IABP), the patient was transferred to our intensive care unite (ICU). Laboratory findings showed massive increase of cardiac enzymes (CK 14,465Ul−1 (≤190), CK-MB 1146Ul−1 (≤25) Troponin I>50.0ngml−1 (≤0.05)). Despite rapid and successful recanalization of the left main coronary artery and IABP support, ...


Bisoprolol/verapamil: Cardiogenic shock in an elderly patient: case report
(Source: Reactions)


Case 6: late cardiogenic shock after myocardial infarction in a 50 year-old hypertensive and diabetic man
This article aims to make a comprehensive review on the clinical outcomes of Contegra. Reports of Contegra published since 2002 were comprehensively retrieved, collected and analyzed. There were 1718 Contegra, applied in 1705 patients. The sizes of the conduits were 8-22 mm. The patients aged from newborn to 74.5 years, prevailed by pediatrics. The primary diagnosis was congenital heart defects in all cases, with Tetralogy of Fallot, truncus arteriosus and pulmonary atresia being the first three diagnoses, representing 25.6%, 16.7%, and 13.1%, respectively. Contegra was used as a tube graft in the pulmonary position in 1635 (95.9%) patients, as a monocuspid patch in 12 (0.7%), as a graft in the position of the pulmonary valve or a monocusps in 40 (2.3%), and as an inferior vena cava-pulmon...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intra‐arrest formation of right‐heart thrombi – a case illustrated by real‐time ultrasonography
We present the pre‐hospital case of a woman in the clinical setting of cardiogenic shock due to acute myocardial infarction who developed asystolic cardiac arrest on the scene. Recent implementation of ultrasonography into the regional pre‐hospital care protocol enabled sonographic investigation before and during cardiac arrest. This allowed detection of right atrial septal thrombus formation in the course of advanced life support and its migration through the tricuspid valve. The pathophysiological consequences, clinical significance and potential therapeutic options are discussed. (Source: Acta Anaesthesiologica Scandinavica)


What is the best timing of surgery in patients with post-infarct ventricular septal rupture?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was &lsquo;in which patients with a post-infarct ventricular septal rupture (PIVSR) might immediate surgery give better results than delayed surgery in terms of mortality&rsquo;? Altogether, 88 papers were found using the reported search criteria, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The recommendations are based on outcomes from 3238 patients undergoing surgery for PIVSR. Mean age was 67.5 &plusmn; 8.8 (40&ndash;88 years). Left ventricular function was compromised in most patients with mean eje...


Introducing transapical aortic valve implantation (part 1): Effect of a structured training program on clinical outcome in a series of 500 procedures
Conclusions: The structured training program can be used to introduce transapical transcatheter aortic valve implantation and then gradually dispersed by internal proctoring to other members of the team with no concomitant detriment to patients. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock: Results of the Impella-EUROSHOCK-Registry [Original Articles]
Conclusions&mdash; In patients with acute cardiogenic shock from acute myocardial infarction, Impella 2.5&ndash;treatment is feasible and results in a reduction of lactate levels, suggesting improved organ perfusion. However, 30-day mortality remains high in these patients. This likely reflects the last-resort character of Impella-2.5&ndash;application in selected patients with a poor hemodynamic profile and a greater imminent risk of death. Carefully conducted randomized controlled trials are necessary to evaluate the efficacy of Impella-2.5&ndash;support in this high-risk patient group. (Source: Circulation: Heart Failure)


Peripheral venoarterial extracorporeal membrane oxygenation improves survival in myocardial infarction with cardiogenic shock
Despite early revascularization, cardiogenic shock complicating acute myocardial infarction carries high mortality. Intra-aortic balloon pump (IABP) support was recently found to confer no mortality benefit over medical therapy in the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial. This communication focuses on our experience with venoarterial (VA) peripheral extracorporeal membrane oxygenation (pECMO) in patients with acute myocardial infarction complicated by cardiogenic shock. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Rapid onset of fulminant myocarditis portends a favourable prognosis and the ability to bridge mechanical circulatory support to recovery [TX [amp ] MCS]
CONCLUSIONS Fulminant myocarditis is a fatal condition without mechanical support. The rapid onset of symptoms is associated with a complete recovery of myocardial function and VAD explant. The absence of rapid recovery of myocardial function should prompt listing for a heart transplant. (Source: European Journal of Cardio-Thoracic Surgery)


Diltiazem/various drugs: Cardiogenic shock treated with lipid emulsion: case report
(Source: Reactions)


An Unusual Cause of Acute Cardiogenic Shock in the Operating Room
A 51‐year‐old man with a renal carcinoma with inferior vena cava (IVC) invasion was referred to our hospital for the performance of a radical nephrectomy with IVC thrombus excision. To prevent embolism, an IVC filter was implanted the day before surgery below the suprahepatic veins. On nephrectomy completion, the clinical status of the patient started to deteriorate and an unsuccessful attempt was made to excise the IVC thrombus. The patient developed profound refractory hypotension without significant bleeding and worsening splanchnic stasis was noted. A transesophageal echocardiogram was immediately performed in the operating room, revealing a hemispheric mass protruding from the IVC ostium to the right atrium, completely blocking all venous return. Volume depletion was evident by lo...


Percutaneous Closure of Complex Post-Infarct Ventricular Septal Defect Under 3-Dimensional Transesophageal Echocardiographic Guidance
A 52-year-old man presented in cardiogenic shock 3 days after experiencing an anteroseptal myocardial infarction and was found to have a large ventricular septal defect on transthoracic echocardiography. The free edge of the septum prolapsed into the right ventricle (A and B, arrows; Online Video 1). A left ventricular apical thrombus was also present. Three-dimensional transesophageal echocardiography demonstrated a 3.0 × 1.7-cm ovoid defect, with a rim of tissue adequate for deployment of an occluder device (C, arrow; Online Video 2). Under echocardiographic and fluoroscopic guidance, a multipurpose catheter was advanced across the aortic valve into the left ventricle, and a J-tip wire was advanced through the catheter and across the ventricular septal defect (D; Online Video 3). The wi...


Is Hospital Admission for Heart Failure Really Necessary? The Role of the Emergency Department and Observation Unit in Preventing Hospitalization and Rehospitalization
Approximately 800,000 times a year, an emergency physician admits a patient with symptomatic heart failure (HF). Yet only a minority of emergency department patients with HF are severely ill as a result of pulmonary edema, myocardial ischemia, or cardiogenic shock. The majority of patients are not in need of an acute intervention beyond decongestion, and few patients during hospitalization undergo invasive diagnostic testing or therapeutic procedures that require intense monitoring. Although hospitalization is clearly an inflection point, marking a threshold that independently predicts a worse outcome, the exact impact of hospitalization on post-discharge events has not been well elucidated. Thus, large subsets of patients with HF are hospitalized without a clear need for time-sensitive th...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Lack of intra-aortic balloon pump effectiveness in high-risk percutaneous coronary interventions without cardiogenic shock: A comprehensive meta-analysis of randomised trials and observational studies
Conclusions: The results suggest that PCI plus P-IABP support does not result in reduced in-hospital mortality or MACCE nor in significant higher access-site complications or stroke incidence compared with PCI alone in patients at high risk for peri-procedural PCI complications. (Source: International Journal of Cardiology)


Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program)
Conclusion Offering local ECMO support appears feasible in a majority of RCS patients hospitalized in remote hospitals. In this otherwise lethal situation, our pilot experience suggests that over one-third of such patients can survive to hospital discharge. (Source: European Heart Journal)


Associated factors with survivals in patients undergoing orthotopic heart transplant using retrograde blood microcardioplegia
CONCLUSION: The use of myocardial protection with retrograde cardioplegic solution may reduce the risks associated morbidity due to cold ischemia time during the heart transplant, and we suggest that this benefit may be even greater in cases of cold ischemia time longer ensuring protection to the myocardium. (Source: Revista Brasileira de Cirurgia Cardiovascular)


Intraaortic Balloon Support for Cardiogenic Shock
New England Journal of Medicine, Volume 368, Issue 1, Page 80-81, January 2013. (Source: New England Journal of Medicine)


Sternal traction: simple technique to prevent tamponade/compression of the heart [HOW TO DO IT]
We describe a full-thickness chest wall traction suture taken parasternally and tied to an intravenous fluid stand. Upward (outward) traction is applied to the anterior chest while the sternum is primarily closed, which allows physiologic improvement equivalent to delayed sternal closure. It is a safe and easily reproducible technique. (Source: Asian Cardiovascular and Thoracic Annals)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Perioperative Management of Adult Surgical Patients on Extracorporeal Membrane Oxygenation Support
EXTRACORPOREAL MECHANICAL support devices are used as an adjunct in the management of critically ill patients who are refractory to more conventional modes of therapy. Extracorporeal membrane oxygenation (ECMO) is one such device that has been used mainly in the management of patients in cardiogenic shock or respiratory failure who failed therapy on maximal ventilator settings and maximal pharmacologic support. ECMO has the advantage of being rapidly deployable, both at the bedside and in the operating room, and can be initiated without the need for general anesthesia. ECMO has been used as a bridging device to recovery or to more definitive therapy. In patients who are awaiting lung transplantation, ECMO has been used as a bridge to transplant when decompensation occurs and also as an adj...


Primary percutaneous coronary intervention without on-site cardiac surgery backup in unselected patients with ST-segment-Elevation Myocardial Infarction: The RIvoli ST-segment Elevation Myocardial Infarction (RISTEMI) registry
Abstract: Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI), but some concerns remain about its safety and efficacy in centers without on-site cardiac surgery (OCS).Methods: The Infermi Hospital in Rivoli, Italy, is a community hospital without OCS with a high volume catheterization laboratory (>800 PCI and >150 primary PCI per year), which provides a 24-hour primary PCI service to a population of 583.000 and is only 14 km far from the nearest OCS hospital. We analyzed clinical and procedural data, as well as 30-day outcome, of all STEMI patients treated by primary PCI within 12hours from symptom onset.Results: From September 2001 to June 2010, 1302 patients with a suspect ...


The spectrum of haemodynamic support in cardiogenic shock: how to choose and use.
Authors: Fuernau G, Thiele H PMID: 24479162 [PubMed - in process] (Source: Polish Heart Journal)


Transcatheter Aortic Valve Implantation in Very High-Risk Patients With EuroSCORE of More Than 40% [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Patients with comorbidities, as mirrored by a EuroSCORE of more than 40% should not be refused for TAVI. On the contrary, this is a supreme indication for the TAVI procedure. (Source: The Annals of Thoracic Surgery)


Initial Clinical Experience With the HeartWare Left Ventricular Assist System: A Single-Center Report [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Our experience with HVAD shows satisfying results with an excellent posttransplantation survival. Moreover, the stratified survival based on the level of preoperative stability shows better outcomes in patients undergoing elective HVAD implantation. (Source: The Annals of Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Percutaneous Closure of Complex Post-Infarct Ventricular Septal Defect Under 3-Dimensional Transesophageal Echocardiographic Guidance
A 52-year-old man presented in cardiogenic shock 3 days after experiencing an anteroseptal myocardial infarction and was found to have a large ventricular septal defect on transthoracic echocardiography. The free edge of the septum prolapsed into the right ventricle (A and B, arrows; Online Video 1). A left ventricular apical thrombus was also present. Three-dimensional transesophageal echocardiography demonstrated a 3.0 × 1.7-cm ovoid defect, with a rim of tissue adequate for deployment of an occluder device (C, arrow; Online Video 2). Under echocardiographic and fluoroscopic guidance, a multipurpose catheter was advanced across the aortic valve into the left ventricle, and a J-tip wire was advanced through the catheter and across the ventricular septal defect (D; Online Video 3). The wi...


Is Hospital Admission for Heart Failure Really Necessary? The Role of the Emergency Department and Observation Unit in Preventing Hospitalization and Rehospitalization
Approximately 800,000 times a year, an emergency physician admits a patient with symptomatic heart failure (HF). Yet only a minority of emergency department patients with HF are severely ill as a result of pulmonary edema, myocardial ischemia, or cardiogenic shock. The majority of patients are not in need of an acute intervention beyond decongestion, and few patients during hospitalization undergo invasive diagnostic testing or therapeutic procedures that require intense monitoring. Although hospitalization is clearly an inflection point, marking a threshold that independently predicts a worse outcome, the exact impact of hospitalization on post-discharge events has not been well elucidated. Thus, large subsets of patients with HF are hospitalized without a clear need for time-sensitive th...


What is the incidence of major adverse cardiac events in emergency department chest pain patients with a normal ECG, thrombolysis in myocardial infarction score of zero and initial troponin
Conclusion Risk stratification for early discharge based on ECG, TIMI score of 0 and presentation TnI &le;99th centile appears to identify a group at very low risk of MACE. Research to prospectively validate this is warranted. (Source: Emergency Medicine Journal)


IABP before cardiac surgery: clinical benefit compared to intraoperative implantation.
CONCLUSION: Considering the significant benefit for patients with preoperative compared to intraoperative IABP and the absence of vascular problems after IABP insertion, the results of this study indicate a more liberal indication for IABP in high-risk patients before coronary bypass surgery. PMID: 23271046 [PubMed - as supplied by publisher] (Source: Perfusion)


The influence of diabetes on in-hospital and long-term mortality in patients with myocardial infarction complicated by cardiogenic shock: results from the PL-ACS registry.
Conclusions: Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients. PMID: 23264238 [PubMed - in process] (Source: Polish Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


From extracorporeal membrane oxygenation to ventricular assist device oxygenation without sternotomy
Extracorporal membrane oxygenation (ECMO) is an effective first-line support to circulation in patients in refractory cardiogenic shock or cardiac arrest. However, due to its inability to effectively drain the left ventricle (LV), its effectiveness in assisting the heart and promoting myocardial recovery is limited. In fact, in a sizeable proportion of ECMO patients, the combination of severely reduced LV function, blood return to the left atrium via the bronchial circulation, and increased after-load from the arterial cannula results in a rise in left atrial and ventricular pressures. The consequent increase in LV wall stress reduces myocardial perfusion by inducing a persistent compression of the microvascular bed and increases oxygen consumption, leading to chronic ischemia and jeopardi...


Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era
Conclusions: In the current era, roughly half of the patients who need an MCSD for RCS survive, and roughly half of these survivors require an implantable VAD. Ongoing CPR is predictive of in-hospital mortality. (Source: The Journal of Heart and Lung Transplantation)


Direct Comparison of Percutaneous Circulatory Support Systems in Specific Hemodynamic Conditions in a Porcine Model [Original Articles]
Conclusions&mdash; Differences were seen in the hemodynamic efficacy of available percutaneous circulatory support systems, particularly under the most severe hemodynamic condition, ventricular fibrillation. (Source: Circulation: Arrhythmia and Electrophysiology)


Intraaortic balloon counterpulsation did not reduce mortality in acute MI with cardiogenic shock.
CONCLUSION Intraaortic balloon counterpulsation did not reduce mortality in patients with acute myocardial infarction with cardiogenic shock and planned early revascularization.Intraaortic balloon pump (IABP) vs no IABP in acute myocardial infarction complicated by cardiogenic shock and planned early revascularization†OutcomesIABPNo IABPDuring hospital stay unless otherwise statedRRR (95% CI)NNTMortality at 30 d40%41%4% (-17 to 21)Not significantStroke0.7%1.7%60% (-103 to 92)Not significantSepsis16%21%23% (-8 to 46)Not significantRRI (CI)NNHReinfarction3.0%1.3%124% (-30 to 618)Not significantPeripheral ischemic complications requiring intervention4.3%3.4%29% (-42 to 190)Not significant†Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from control event rates and...


5-FU-induced cardiac toxicity - an underestimated problem in radiooncology?
Conclusion: Cardiotoxicity caused by 5-FU is an underestimated problem in radiooncology. Especially patients without history of cardiac disease are often treated as out-patients and therefore without cardiac monitoring. Consequently asymptomatic and symptomatic cardiac events may be overlooked. The benefit of prophylactic agents remains unclear, so close cardiac monitoring is the most established method to prevent manifest cardiotoxic events. (Source: Radiation Oncology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Pulmonary embolism: risk assessment and management
This article critically reviews currently available and emerging tools for risk-stratifying acute PE, and particularly for distinguishing between elevated (intermediate) and low risk among normotensive patients. We focus on the potential value of risk assessment strategies for optimizing severity-adjusted management. Apart from reviewing the current evidence on advanced early therapy of acute PE (thrombolysis, surgery, catheter interventions, vena cava filters), we discuss recent advances in oral anticoagulation with vitamin K antagonists, and with new direct inhibitors of factor Xa and thrombin, which may contribute to profound changes in the treatment and secondary prophylaxis of venous thrombo-embolism in the near future. (Source: European Heart Journal)


A Review of Emergency Cardiopulmonary Bypass for Severe Poisoning by Cardiotoxic Drugs.
This article will review current ECPB techniques and explore its growing role in the treatment of severely hemodynamically compromised poisoned patients. PMID: 23238774 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)


Tissue-specific patterns of caspase-1 and cytokines in excisional wounds are altered by shock in rat skin and muscle
Skin and muscle wounds often lead to significant inflammation in the affected tissue. The primary mechanism by which inflammation is initiated, sustained, and terminated is cytokine-mediated immune signaling, but this can be altered by cardiogenic shock. The complexity and context sensitivity of immune signaling in general stymied a clear understanding of these signaling dynamics. We hypothesized that advanced numerical and biological function analysis methods would help elucidate the inflammatory response to skin and muscle wounds in rats, both with and without concomitant shock. (Source: Journal of Critical Care)


The role of the total artificial heart in the treatment of post–myocardial infarction ventricular septal defect
We report the cases of the first 2 patients treated with TAH-t implantation for unstable cardiogenic shock resulting from post-MI VSD rupture. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Improving outcomes in patients with cardiogenic shock: Achieving more through less
Cardiogenic shock carries a grim prognosis compared with less severe presentations of acute coronary syndromes. With such a hazard for mortality and morbidity, therapies that may only improve outcomes marginally in less severely ill patients may result in significant improvements in this high-risk subgroup. Despite this logical hope, progress has been slow despite advances in acute cardiovascular therapy. The SHOCK trial showed the importance of revascularization to improve outcomes, but the recent IABP-SHOCK II Trial failed to show any marginal benefit of adding hemodynamic support with intraaortic balloon (IABP) counterpulsation in the setting of shock, running counter to conventional wisdom and experimental dogma. Strategies to improve outcomes in these patients may rely more on applica...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Right Atrial Approach for Surgical Repair of Post Infarction Ventricular Septal Defect and Acute Tricuspid Regurgitation with Cardiogenic Shock
A complex case of inferior wall infarction with ventricular septal defect and severe tricuspid valve regurgitation due to acute papillary muscle rupture in a 65 year-old male is described. This constellation of pathological lesions and the surgical approach to the repair have not been previously described. (Source: Heart, Lung and Circulation)


Capecitabine caused cardiogenic shock through induction of global takotsubo syndrome
We describe here the case of a 55-year-old man who presented with cardiogenic shock and ECG signs of ST-elevation myocardial infarction. The symptoms began 28h after the commencement of capecitabine adjuvant therapy, following a radical right-sided hemicolectomy for low-differentiated adenocarcinoma of the caecum. Echocardiography showed severe global left ventricular dysfunction. Cardiac magnetic resonance imaging showed no signs of late gadolinium enhancement. These clinical, cardiac image study findings and the course of the disease with full recovery within one week were consistent with global TS triggered by the adjuvant therapy capecitabine and presenting with a life-threatening cardiogenic shock. Moreover, we have demonstrated the speedy dynamic of the left ventricular wall motion a...


Mechanical complications of myocardial infarction
Abstract: Acute myocardial infarction is responsible for a significant proportion of morbidity and mortality in patients with ischaemic heart disease. Apart from cardiogenic shock, important mechanical complications include myocardial rupture, mitral regurgitation, mural thrombosis, left ventricular true aneurysm and pericarditis. Such patients are likely to be older (more than 60 years of age), especially women with hypertension, single-vessel disease, first episode of transmural infarction, smaller area of infarction, and/or delayed thrombolytic therapy. The incidences of all these complications have significantly reduced due to availability of reperfusion techniques. Myocardial rupture includes rupture of the left ventricular free wall, interventricular septum or papillary muscles, whic...


Top medicine articles for November/December 2012
Here are my suggestions for some of the top articles in medicine for November/December 2012: The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students http://buff.ly/THrvOA Shocking News: Intraaortic Balloon Pumps May Not Help in Myocardial Infarction with Cardiogenic Shock http://buff.ly/QVzggF What Your Breath Reveals: Each Patient Has a Unique Breath 'Fingerprint' That Doctors Could Use to Diagnose http://buff.ly/Ravmkd Rilonacept for Colchicine-Resistant or -Intolerant Familial Mediterranean Fever http://buff.ly/QWJV76 Lowering LDL levels with statin reduces major vascular events regardless of baseline risk http://buff.ly/QWKuxU Radical prostatectomy and observation did not differ for mortality in localized prostate cancer http://buff.ly/QWLb...


Gender- and race-based utilization and outcomes of pulmonary artery catheterization in the setting of full-time intensivist staffing.
Conclusions: PAC use and in-hospital death were determined not by gender or race but by disease severity. Full-time intensivist staffing and the presence of definitive guidelines may reduce gender- and race-based treatment disparities. PMID: 23215747 [PubMed - in process] (Source: Acute Cardiac Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Impact of transfer time on mortality in acute coronary syndrome with ST-segment elevation treated by angioplasty.
CONCLUSIONS: In a well-organized urban network dedicated to pPCI, including unselected STEMI patients, transfer time does not appear to be a major contributor to mortality. The relationship of transfer time to mortality seems to be dependent on presentation time and patients' clinical severity. PMID: 23199619 [PubMed - in process] (Source: Archives of Cardiovascular Diseases)


Sternal traction: simple technique to prevent tamponade/compression of the heart
We describe a full-thickness chest wall traction suture taken parasternally and tied to an intravenous fluid stand. Upward (outward) traction is applied to the anterior chest while the sternum is primarily closed, which allows physiologic improvement equivalent to delayed sternal closure. It is a safe and easily reproducible technique. (Source: Asian Cardiovascular and Thoracic Annals)


Surgical Embolectomy of a Floating Right Heart Thrombus and Acute Massive Pulmonary Embolism: Report of a Case.
We present the case of an 80-year-old female with a floating right heart thrombus in conjunction with an acute massive pulmonary embolism, who presented in cardiogenic shock. We successfully carried out surgical embolectomy. The patient's postoperative course was uneventful, and she remained in good health without recurrence of pulmonary embolism. This success was based on rapid diagnosis by transthoracic echocardiography and computed tomography, prompt decision-making to proceed with surgical intervention and efficient postoperative care. In this case, surgical embolectomy was effective for a floating right heart thrombus with acute massive pulmonary embolism. PMID: 23196666 [PubMed - as supplied by publisher] (Source: Annals of Thoracic and Cardiovascular Surgery)


Primary Angioplasty in ST-Elevation Myocardial Infarction Due to Unprotected Left-Main Coronary Disease in a High-Volume Catheterization Center Without On-Site Surgery Facilities: Immediate and Medium-Term Outcome: The STEMI-Placet Registry
Conclusions.&nbsp;Primary angioplasty in patients presenting with ULMCA as the culprit lesion in a STEMI setting appears to be technically feasible and a good alternative to surgical revascularization. Mortality in this group of patients tends to be high, but lower than mortality of untreated patients; the majority of events are concentrated during the in-hospital phase. Procedural delay related to activation of operator’s staff in off-duty hours doesn’t correlate with a worse prognosis. read more (Source: The Journal of Invasive Cardiology)


Good News on Alternatives to the Femoral Approach for Hemodynamic Support
Section:&nbsp; Commentary Issue Number:&nbsp; Volume 24 - Issue 12 - December 2012 Author(s):&nbsp; Bruce Kuo, MD and H. Vernon Anderson, MD Intra-aortic balloon pumps (IABPs) are extremely useful for hemodynamic support in the setting of high-risk percutaneous coronary intervention (PCI), refractory ischemia despite intensive medical therapy, unstable hemodynamic states such as cardiogenic shock, and for mechanical complications of myocardial infarction. read more (Source: The Journal of Invasive Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A “no‐option” left main PCI registry: Outcomes and predictors of in hospital mortality – utility of the logistic EuroSCORE
Conclusion:PCI appears to be a reasonable option in the high risk “no option” LM population, with the logistic EuroSCORE and peak CK levels being independent predictors of in‐hospital mortality. Specifically, the logistic EuroSCORE and peak CK level combined discriminate in‐hospital mortality with a high degree of certainty. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


ST-Elevation myocardial infarction network: systematization in 205 cases reduced clinical events in the public health care system
CONCLUSION: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes. (Source: Arquivos Brasileiros de Cardiologia)


Endotoxin role in cardiogenic shock: A brief report
In chronic hypoperfusion settings, such as chronic heart failure (CHF), bowel dysfunction and a related higher intestinal permeability have already been demonstrated. It has been reported that in CHF, cardiac output decreases and CHF-associated gut mucosal edema compromises gut function, leading to the translocation of endotoxin and gut bacteria . There is a lack of data about bowel permeability behavior in an acute hypoperfusion setting, as cardiogenic shock (CS) following ST elevation myocardial infarction (STEMI). (Source: International Journal of Cardiology)


Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry
Conclusion&nbsp;&nbsp;In the current clinical practice in Germany, IABP is used only in one quarter of patients with cardiogenic shock treated with primary PCI. We observed no benefit of IABP on outcome, which supports the findings of the randomized IABP-Shock II trial. Content Type Journal ArticleCategory Original PaperPages 1-5DOI 10.1007/s00392-012-0523-4Authors Uwe Zeymer, Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, GermanyMathias Hochadel, Institut für Herzinfarktforschung Ludwigshafen, Bremser Str. 79, 67063 Ludwigshafen, GermanyKarl-Eugen Hauptmann, Krankenhaus der Barmherzigen Brüder, Innere Medizin 3, Trier, GermanyKlaus Wiegand, Chirurgische Praxis Braunschweig, Braunschweig, GermanyBurghard Schuhmacher, Westpfalz Klinikum, Klinik für Innere Medizin...


Rescue pulmonary vein isolation for hemodynamically unstable atrial fibrillation storm in a patient with an acute extensive myocardial infarction
Conclusions: To the best of our knowledge, this is the first report of pulmonary vein isolation for a rescue purpose applied in a patient with hemodymically unstable atrial fibrillation complicated with an acute myocardial infarction. This case demonstrates that ectopic activity in the pulmonary veins may be responsible for triggering atrial fibrillation in the critical setting of an acute myocardial infarction and thus pulmonary vein isolation could be an effective therapeutic option. (Source: BMC Cardiovascular Disorders)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Validating the acute heart failure index for patients presenting to the emergency department with decompensated heart failure
Conclusion The results are consistent with those previously reported for the low-risk subgroup of the AHFI. Further research is needed to determine the impact, safety and full range of generalisability of the AHFI as an adjunct to decision making. (Source: Emergency Medicine Journal)


Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction
Conclusions: In unselected STEMI patients, survival advantage from pPCI extends for a long term (8 years). This survival advantage is maintained at advanced ages, thus enforcing the importance of improving delivery of appropriate care to older STEMI patients. (Source: Journal of Cardiovascular Medicine)


The HEART study: a real-world experience using the CID Chrono Carbostent in primary and rescue PCI
Conclusions: In unselected patients with STEMI treated by urgent PCI, the Chrono Carbostent showed a low rate of events in those patients surviving the acute phase of myocardial infarction. Unfortunately, and especially for patients in cardiogenic shock, survival continued to be relatively independent of interventional treatment, even when successfully completed, thus strictly linking prognosis of STEMI to severity of clinical presentation. (Source: Journal of Cardiovascular Medicine)


Risk of Heart Failure Complication During Hospitalization for Acute Myocardial Infarction in a Contemporary Population: Insights From the National Cardiovascular Data ACTION Registry [Original Articles]
Conclusions&mdash; Patients with MI who develop HF during hospitalization have a higher risk clinical profile and greater mortality, but may be less likely to receive revascularization in a timely fashion. Targeting these highest risk patients may improve outcome post-MI. (Source: Circulation: Heart Failure)


High-flow oxygen, a therapeutic bridge while awaiting thrombolysis in pulmonary embolism?
We report a case of severe hypoxemia management in massive pulmonary embolism with cardiogenic shock using Optiflow oxygenation system (Fischer and Paykel, Auckland, New Zealand). This technique is an alternative to mechanical ventilation. Mechanical ventilation with positive airway pressure might reduce cardiac output in the presence of right ventricle failure. High-flow oxygen does not induce positive airway pressure, and the risk of heart failure is lower. We used high-flow oxygen to maintain Spo2 at an acceptable level without cardiac output reduce in a patient with massive pulmonary embolism while waiting for thrombolysis to take effect. (Source: The American Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Extracorporeal membrane oxygenation support as bridge to recovery in a patient with electrical storm related cardiogenic shock
We describe the case of a 50-year-old woman without a cardiac medical history, who developed incessant ventricular tachycardia refractory to medical therapy and leading to progressive severe cardiogenic shock. In this setting, the use of antiarrhythmic drugs with depressant cardiac contractility properties became highly risky and contraindicated. The institution of venoarterial ECMO ensured adequate vital organ perfusion and the weaning of catecholamine administration, thereby, ending the vicious cycle of catecholamine-driven electrical storm. Thanks to the cardiac assistance, the patient could be hemodynamically stabilized and received increasing doses of anti-arrhythmic therapy (verapamil) which stopped ventricular tachycardia. Within 3 days the patient could be weaned from ECMO. The pat...


Early intravenous beta-blockers in patients with acute coronary syndrome—A meta-analysis of randomized trials
Conclusions: Intravenous beta-blockers early in the course of appropriate patients with ACS appears to be associated with significant reduction in the risk of short-term cardiovascular outcomes, including a reduction in the risk of all-cause mortality. (Source: International Journal of Cardiology)


51 year old female CC: Near Syncopal Episode – Conclusion
This is the conclusion to a 51 year old female CC: Near Syncopal Episode. If you haven&#39;t read the first part we highly recommend it! When we left off, our crew was attending to a 51 year old female who had almost passed out in a stadium tunnel during a college football game. We received a few questions as to the type of football, which could be important to the diagnosis, so we will clarify that this was an American Football game. Our crew had found her to be hypotensive, first bradycardic and then tachycardic, with concerning changes on the 12-Lead. &nbsp;A nasal cannula at 4 L/min was initiated and&nbsp;they established bilateral IV&#39;s and were rapidly infusing nomal saline to restore perfusion. Let&#39;s take a look at the initial rhythm strip: The initial rhythm strip shows a n...


[Phaeochromocytoma revealed by a cardiogenic shock treated by extracorporeal life support.]
We report the use of central extracorporeal life support (ECLS) in a young man admitted to our department because of cardiogenic shock caused by phaeochromocytoma. PMID: 23164653 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)


Risk of in-hospital mortality identified according to the typology of patients with acute heart failure: Classification tree analysis on data from the Acute Heart Failure Database–Main registry
Conclusions: The presented classification model effectively stratified patients with all syndromes of acute heart failure into in-hospital mortality risk groups and might be of advantage for clinical practice. (Source: Journal of Critical Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Prevalence, predictors and clinical impact of unique and multiple chronic total occlusion in non-infarct-related artery in patients presenting with ST-elevation myocardial infarction
Conclusions Simple clinical factors are associated with the presence of CTO in non-infarct-related artery in patients presenting with STEMI. In these patients, long-term survival was independently associated with MVD, left ventricular ejection fraction and renal function, but not with CTO per se. (Source: Heart)


Perventricular closure of postinfarct septal rupture revisited
We read with great interest and sense of nostalgia the brief report on the technique of perventricular device closure in post–myocardial infarction septal defect by Love and colleagues in 2011. They reported 2 cases of cardiogenic shock after myocardial infarction with septal defects sized 25 and 28 mm. They used the Amplatzer septal occluder (St Jude Medical, Inc, St Paul, Minn) sized 34 mm through a 12F and 13-cm Cook (Cook Group Incorporated, Bloomington, Ind) sheath advanced over a guide wire. The large 50-mm left disk of the Amplatzer device was placed flush with the septum and delivered in the left ventricular cavity. Then, with traction on the delivery system and countertraction on the right ventricular free wall, the proximal disk was deployed exteriorly on the right ventricular ...


Mitraclip therapy and surgical mitral repair in patients with moderate to severe left ventricular failure causing functional mitral regurgitation: a single-centre experience [ADULT CARDIAC]
CONCLUSIONS Mitraclip therapy is a safe therapeutic option in selected high-risk patients with FMR, and it is associated with a lower hospital mortality and shorter length-of-stay compared with surgery, in spite of worse preoperative conditions. Early and 1-year rates of recurrent MR are higher with Mitraclip. Further studies are needed to determine the long-term clinical impact. (Source: European Journal of Cardio-Thoracic Surgery)


Prognostic significance of cardiac troponin I on admission for surgical treatment of acute pulmonary embolism: a single-centre experience over more than 10 years [ADULT CARDIAC]
CONCLUSIONS cTnI on admission may improve risk assessment of patients undergoing open surgical embolectomy due to acute PE. (Source: European Journal of Cardio-Thoracic Surgery)


Two electrocardiographic patterns in patients with sudden complete occlusion of the left main trunk without collateral circulation
I read with great interest the article entitled “Electrocardiographic changes of ST-elevation myocardial infarction in patients with complete occlusion of the left main trunk without collateral circulation: differential diagnosis and clinical considerations” by Fiol et al. in the Journal of Electrocardiology, which also inspired an editorial comment by Nikus. The authors describe the electrocardiogram (ECG) presentations of seven cases with complete occlusion of left main trunk (LMT) without collateral circulation. The authors conclude that the ECG pattern is similar to left anterior descending coronary artery (LAD) occlusion proximal to the first septal and diagonal branches, but without ST elevation in V1 and aVR because of left circumflex coronary artery compromise. In five (71%) of...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intra-Aortic Counterpulsation for Hemodynamic Support in Patients With Acute Ischemic Versus Non-Ischemic Heart Failure
Conclusion. IABP represents a safe technology for hemodynamic support and is associated with low complication rates. Parameters relating to early mortality include age &gt;70 years, respiratory failure requiring mechanical ventilation, and left ventricular function &lt;40%, which represent an additional risk of death. However, the etiology of CS had no effect on mortality in this analysis. This observation should encourage physicians to apply IABP for hemodynamic support in patients with non-ischemic left ventricular failure. read more (Source: The Journal of Invasive Cardiology)


Balloon Pump Support for Cardiogenic Shock After AMI
A new look at an old approach finds no harm, but no benefit. (Source: AJN)


Balloon Pump Support for Cardiogenic Shock After AMI.
Authors: Wallis L Abstract A new look at an old approach finds no harm, but no benefit. PMID: 23099571 [PubMed - in process] (Source: The American Journal of Nursing)


Long-term Outcome of High-urgency Heart Transplant Patients With and Without Temporary Ventricular Assist Device Support
Conclusions: In our experience, the long-term outcome of patients receiving HU-HTx under short-term VAD support is comparable to that of patients undergoing HU-HTx without VAD support. Patients with renal failure had an increased risk for overall mortality in this set of patients. (Source: Transplantation Proceedings)


Transient Symptomatic Severe Mitral Regurgitation after Electric Cardioversion of Atrial Fibrillation
Conclusion: In some patients, flash pulmonary edema seems to be due to transient severe functional MR, although the exact underlying physiopathologic mechanism remains unclear. An ischemic origin with papillary muscle dysfunction due to transient low perfusion could also be advocated. (Source: Echocardiography)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Management of acute coronary syndromes in Maghreb countries: The ACCESS (ACute Coronary Events - a multinational Survey of current management Strategies) registry.
CONCLUSIONS: In this observational study of ACS patients from three Maghreb countries, the use of evidence-based pharmacological therapies for ACS was quite high; however, 42% of the patients with STEMI were not given any form of reperfusion therapy. PMID: 23177485 [PubMed - in process] (Source: Archives of Cardiovascular Diseases)


[Primary percutaneous coronary intervention for acute myocardial infarction in elderly aged 75 years and over: in-hospital mortality and clinical outcome].
Conclusion: Our study revealed a high rate of MACE in patients older than 75 years admitted with STEMI regardless of undergoing primary PCI. PMID: 23363938 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)


Impact of Acute Kidney Injury on One-Year Survival After Surgery for Aortic Dissection [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Our study provides outcomes of postoperative aortic dissection. We found that AKI was a predictor of 1-year mortality by using the RIFLE criteria. Factors associated with increased 1-year mortality and AKI should be taken into consideration for surgery and postoperative care. (Source: The Annals of Thoracic Surgery)


Incidence and Outcomes of No-Reflow Phenomenon During Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction
Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center studies or small registries. To better characterize the incidence, predictors, and outcomes of the no-reflow phenomenon in a large contemporary population, we analyzed patients with AMI who were undergoing PCI of native coronary artery stenoses in the CathPCI Registry from January 1, 2004 through September 5, 2008 (n = 291,380). The angiographic no-reflow phenomenon was site reported using a standardized definition. No-reflow developed in 2.3% of the patients with AMI (n = 6,553) during PCI. Older age, ST-segment elevation AMI, prolonged interval from symptom onset to admission, and cardiogenic s...


Inflammatory activation is related to glucose impairment in diabetics with acute myocardial infarction
Diabetes mellitus (DM) is one of the leading causes of acute myocardial infarction (AMI) . Patients with DM who developed an acute coronary syndrome (ACS) are at increased risk for complications, cardiogenic shock, and death. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Use of a single-circuit CentriMag(R) for biventricular support in postpartum cardiomyopathy.
We present a case of 37-year-old Caucasian female who developed cardiogenic shock within 24 hours of the delivery of her twins. The echocardiogram demonstrated severe biventricular failure which necessitated biventricular device placement and support with a CentriMag® centrifugal pump. This biventricular support was employed, using a single-circuit CentriMag® pump, using a 'Y' connection which made weaning from right-sided support and conversion to univentricular support easier and feasible. The patient recovered four weeks later and was explanted off the CentriMag® support and did well. This technology allows for the CentriMag® to be considered as an early option for biventricular support in the treatment and management of these patients as a bridge to recovery. PMID: 23104581 [Pu...


Acute myocardial infarction without cardiogenic shock does not affect serum prostate specific antigen levels: A case control study
The prostate-specific antigen (PSA) serum level is of utmost diagnostic importance as probability of prostate cancer (PCa) increases with increasing serum PSA levels . Besides PCa, numerous factors which disrupt the integrity of epithelial cellular lining and basement membrane of prostate were shown to cause elevations in PSA serum levels such as prostatic hyperplasia (BPH), prostatitis, and prostatic infarcts . Serum PSA may also be elevated as a result of prostatic ischemia caused by extra-prostatic factors such as cardiogenic shock, cardiopulmonary resuscitation (CPR) and cardiac surgery . Recently, acute myocardial infarction (AMI) is suggested as a factor affecting serum PSA regardless of the presence of cardiogenic shock . The majority of the studies regarding the impact of AMI on PS...


Ramping Up Evidence-Based Ventricular Assist Device Care ⁎ ⁎
Over the past several decades, mechanical circulatory support has become an increasingly important treatment for patients with advanced heart failure. Initial proof-of-concept trials focused on reducing the mortality of critically ill patients in cardiogenic shock. Although the ultimate goal of mechanically assisted circulation was always long-term support as an alternative to cardiac transplantation, uncertainties about the durability of device performance and adverse events led to its early use in transplant candidates to provide a “bail-out” strategy in the event of device malfunction. With additional experience and technological advances, large-scale clinical trials have demonstrated the efficacy of ventricular assist device (VAD) in prolonging survival, improving quality of life, ...


A national survey on myocarditis associated with influenza H1N1pdm2009 in the pandemic and postpandemic season in Japan
We described the clinical features of patients with myocarditis associated with influenza H1N1pdm2009 in the pandemic and postpandemic seasons and demonstrated the high prevalence of fulminant myocarditis (17/29, 59&nbsp;%). The number of patients with myocarditis associated with influenza A virus seemed to increase in the pandemic season. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s10156-012-0499-zAuthors Akira Ukimura, Department of General Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 JapanYukimasa Ooi, Department of General Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 JapanYumiko Kanzaki, Third Department of Internal Medicine, Osaka Medical College, Takatsuki, JapanTakayuki In...


Extracorporeal Membrane Oxygenation As a Bridge Therapy for Massive Pulmonary Embolism After Esophagectomy
In this report, a patient with massive PE resuscitated by ECMO who had successful thrombolytic therapy is presented. (Source: Journal of Cardiothoracic and Vascular Anesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Acute coronary artery thrombosis during the postpartum period complicated by cardiogenic shock and AH1N1 infection.
Authors: Lewicki L, Stróżyk A, Jaguszewski M, Puchalski W, Rynkiewicz A, Targoński R PMID: 23080107 [PubMed - in process] (Source: Polish Heart Journal)


Transfemoral aortic valve implantation in a patient presenting with critical aortic stenosis and previously treated by endovascular aortic aneurysm repair
We report a case of transfemoral TAVI in a patient with critical aortic stenosis (AS) previously treated by endovascular aortic aneurysm repair (EVAR). An 89-year-old man was admitted for cardiogenic shock. This patient had a coronary artery bypass graft surgery in 1992 and EVAR for abdominal aortic aneurysm in 2011 (figure 1A,B). Echocardiography revealed a severe AS (mean aortic gradient: 40&nbsp;mm&nbsp;Hg, aortic valve area: 0.4&nbsp;cm2) and impaired left ventricular ejection fraction (20%). Balloon aortic valvuloplasty was immediately performed with favourable outcome. This high-risk patient (Logistic EuroSCORE: 63.9%) was declined for surgical aortic valve replacement. Coronary angiogram was thereafter performed showing a severe stenosis of a saphenous vein grafted on the left anter...


Intra-Aortic Balloon Support for Cardiogenic Shock, AMI
Despite relative scarce evidence to support their use, intra-aortic balloon pumps (IABPs) have received high-grade recommendations in both U.S. and European guidelines for use in the management of cardiogenic shock. In the October issue of The New England Journal of Medicine, Holger Thiele, MD, and the IABP-SHOCK II trial investigators conducted a controlled study to see whether IABP counterpulsation is associated with improved survival for patients with acute myocardial infarction (AMI) and cardiogenic shock... (Source: SCCM RSS News)


Acute heart failure patient profiles, management and in-hospital outcome: results of the Italian Registry on Heart Failure Outcome
Conclusion Our registry confirms that in-hospital mortality in AHF is still high, with a long length of stay. Pharmacological treatment seems to be practically unchanged in the last decades, and the adherence to HF guidelines concerning implantable cardioverter defibrillators/cardiac resynchronization therapy is still very low. Some AHF phenotypes are characterized by worst prognosis and need specific research projects. (Source: European Journal of Heart Failure)


Role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis of acute and chronic myocarditis
Abstract&nbsp;&nbsp;The aetiopathogenesis of acute and chronic myocarditis is rather complex as a great variety of infectious agents can induce cardiac inflammation. Moreover, many systemic and autoimmune diseases such as sarcoidosis, giant cell myocarditis and systemic lupus erythematodes, drugs and toxins have been described as non-infectious causes of inflammatory heart disorders. Myocarditis may cause sudden death and lead to dilated cardiomyopathy. The correct and timely diagnosis of myocarditis is still a difficult clinical challenge, since the clinical spectrum of myocarditis is broad and comprises (amongst others) even those patients with no symptoms or those presenting with acute cardiogenic shock. Although endomyocardial biopsy still represents the gold standard for the dia...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


TCT-385 Comparative Economic Outcomes in Cardiogenic Shock Patients Managed with the Minimally Invasive Impella or Extracorporeal Life Support
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


TCT-405 Transradial approach decreases in-hospital mortality in patients with cardiogenic shock. A single-center experience
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


Bleeding outcomes after routine trans‐radial primary angioplasty for acute myocardial infarction using eptifibatide and unfractionated heparin: A single‐center experience following the HORIZONS‐AMI trial
Conclusions:Routine TR access for PPCI using UFH plus GPI is associated with a low 30‐day rate of major bleeding equivalent to the bivalirudin arm of HORIZONS‐AMI. Default trans‐radial access for PPCI permits routine use of a GPI without the penalty of high bleeding rates. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Impact of incomplete revascularisation in patients undergoing PCI for unprotected left main stem stenosis
Conclusions.For unselected patients with uLMS treated by PCI, completeness of revascularisation is associated with superior survival. The rSYNTAX score, a novel index of completeness of revascularisation independently predicts survival. Baseline SYNTAX score did not. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries
Conclusions Cardiogenic shock remains a clinical concern, although early mortality has decreased. Improved survival is concomitant with a broader use of PCI and recommended medications at the acute stage. Beyond the acute stage, however, 1-year survival has remained unchanged. (Source: European Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The impact of intra-aortic balloon counter-pulsation on in-hospital mortality in patients presenting with anterior ST-elevation myocardial infarction without cardiogenic shock
This study aimed to determine whether the elective insertion of an intra-aortic balloon counter pulsation (IABP) device at the time of myocardial revascularization in patients presenting with an acute anterior ST-elevation myocardial infarction (STEMI) without cardiogenic shock has any impact on the in-hospital rate of cardiac mortality.Background: The role of IABP in patients presenting with an acute MI without cardiogenic shock remains ill defined.Methods: The present study comprised 605 consecutive patients who underwent primary percutaneous coronary intervention for an anterior STEMI without cardiogenic shock. Patients who received IABP at the time of their coronary revascularization (n=105) were compared to those who had not (n=500). Patients with stable angina, unstable angina, non-S...


Loffler endocarditis: a rare cause of acute cardiac failure
We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hypereosinophilic syndrome (Loffler endocarditis). At the echocardiography, there was a huge mass in the left ventricular cavity, resulting in inflow- and outflow tract obstruction. The posterior leaflet of the mitral valve apparatus was completely embedded in a big (organized) thrombus mass. The patient was treated with high dose corticosteroids, however without effect. Partial remission was achieved after treatment with hydroxycarbamide. He was also treated with anticoagulants and high dose beta-blockers. The patient's condition improved remarkably after correction of the mitral valve insufficiency by a mitral valve bioprothesis. (Source: Journal of Cardiothoracic Surgery)


Molecular Adsorbent Recirculating System Technique for Liver Failure due to Cardiogenic Shock.
Conclusion Inhospital mortality is still unsatisfying high in cardiogenic shock patients with liver failure. Future studies should clarify whether MARS can definitively improve survival in these patients. PMID: 23055403 [PubMed - as supplied by publisher] (Source: The Thoracic and Cardiovascular Surgeon)


Refractory cardiogenic shock in an infant with congenital hypothyroidism
We describe a 5-month-old female infant with congenital hypothyroidism and refractory cardiogenic shock. Cardiac function and hemodynamic stability were restored after starting levothyroxine therapy. (Source: Indian Journal of Critical Care Medicine)


Ramping Up Evidence-Based Ventricular Assist Device Care⁎
Over the past several decades, mechanical circulatory support has become an increasingly important treatment for patients with advanced heart failure. Initial proof-of-concept trials focused on reducing the mortality of critically ill patients in cardiogenic shock. Although the ultimate goal of mechanically assisted circulation was always long-term support as an alternative to cardiac transplantation, uncertainties about the durability of device performance and adverse events led to its early use in transplant candidates to provide a “bail-out” strategy in the event of device malfunction. With additional experience and technological advances, large-scale clinical trials have demonstrated the efficacy of ventricular assist device (VAD) in prolonging survival, improving quality of life, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Ischaemic cardiogenic shock. Where do we stand in 2012?]
Authors: Leurent G Abstract With a stable frequency (about 5% of acute coronary syndromes) and a mortality of nearly 45%, cardiogenic shock (CS), especially when it occurs in the immediate waning of myocardial infarction, still represents a therapeutic challenge. In this review, will be detailed the actual epidemiologic data of CS, its physiopathology and the different modalities of treatments available to the interventional cardiologist, especially the coronary revascularisation and the percutaneous left ventricular assistance, whether by intra-aortic balloon counterpulsation or by more complex systems. PMID: 23083801 [PubMed - as supplied by publisher] (Source: Annales de Cardiologie et d'Angeiologie)


The Impact of Stressor Patterns on Clinical Features in Patients With Tako‐tsubo Cardiomyopathy: Experiences of 2 Tertiary Cardiovascular Centers
Conclusions:The clinical features of TTC are different according to preceding stressor patterns. The TTC group with preceding physical stressors was less likely to have preserved cardiovascular reserve and more likely to require hemodynamic support than other groups. The overall prognosis of TTC is excellent, regardless of triggering stressors.The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)


Stress-Induced Cardiomyopathy (Takotsubo Cardiomyopathy) After Liver Transplantation—Report of Two Cases
In conclusion, stress-induced cardiomyopathy, an underestimated cause of heart complications, should be considered as a possible cause of cardiac failure in liver transplant patients. (Source: Transplantation Proceedings)


The Impact of Stressor Patterns on Clinical Features in Patients With Tako‐tsubo Cardiomyopathy: Experiences of Two Tertiary Cardiovascular Centers
Conclusions:The clinical features of TTC are different according to preceding stressor patterns. The TTC group with preceding physical stressors was less likely to have preserved cardiovascular reserve and more likely to require hemodynamic support than other groups. The overall prognosis of TTC is excellent, regardless of triggering stressors. Clin. Cardiol. 2011 DOI: 10.1002/clc.22053The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)


Hypophosphatemia in patients with cardiogenic shock
Kilic and colleagues concluded from their retrospective study that hypophosphatemia could be associated with prolonged mechanical ventilation and length of stay in a pediatric intensive care unit (ICU) . One must remember that one of the complications of hypophosphatemia is cardiac impairment . We would like to share our experience in our ICU in which 249 adult patients presenting with a cardiogenic shock were retrospectively reviewed during 2 years. Patients were 60 (±17) years old and had high SAPS2 scores 67 (±26). Although the mortality rate was high (46%), it was not associated with phosphorus level. Phosphatemia was available in 215 patients and 25 patients (12%) had moderate hypophosphatemia ( (Source: Journal of Critical Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Deadly association of cardiogenic shock and chronic total occlusion in acute ST-elevation myocardial infarction
Conclusion: In patients with STEMI, CTO was strongly associated with cardiogenic shock on admission. In this setting, mortality was substantially higher in patients with 1 CTO and exceedingly high in those with >1 CTO. The presence of CTO was an independent predictor of early mortality. (Source: American Heart Journal)


Acute aortic intramural hematoma presenting with painless recurrent syncope.
Authors: Droste J, Zadeh HZ, Arif M, Craig I, Thakur AK Abstract A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.It is important to recogni...


Prinzmetal angina or coronary spasm related to anaphylactoid reaction?
Authors: Dahdouh ZS, Roule V, Lognoné T, Grollier G Abstract Prinzmetal's angina is a challenging diagnostic of spontaneous brief episodes of chest pain. Anaphylactoid reactions to radiocontrast media are immediate hypersensitivity responses that can mediate coronary artery spasm. Herein, we report the case of a 61-year-old man who underwent a coronary angiography for angina. The right coronary artery (RCA) was first visualized as normal, but during the left coronary system injections, he developed ST segment elevation and cardiogenic shock. No iatrogenic dissection of the left coronary system, which was initially normal, was displayed, but surprisingly, a retrograde supply to the RCA was visualized. Thus, we re-catheterized the RCA, which indicated a total occlusion of its second...


Effects of l-NAME on coronary blood flow, infarct size and the extent of the no-reflow phenomenon
Conclusions: l-NAME administration started immediately before and maintained throughout reperfusion has no effect on NRP and MI size. l-NAME might stabilize patients with post-MI cardiogenic shock without adverse effects on infarct size. (Source: International Journal of Cardiology)


Assessment and Management of Cardiogenic Shock in the Emergency Department
Cardiogenic shock remains a major cause of morbidity and mortality in patients hospitalized with myocardial infarction, severe valvular disease, and other causes of cardiomyopathy. Emergency physicians play a pivotal role in the initial management of these patients, as they are most often the point of first contact with the medical system. This review discusses the initial assessment and management of cardiogenic shock, emphasizing the importance and role of the emergency physician. (Source: Cardiology Clinics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Coronary air embolism and cardiogenic shock during computed tomography-guided needle biopsy of the lung.
Authors: Kawaji T, Shiomi H, Togashi Y, Gunji D, Imai M, Doi T, Kimura T PMID: 23008473 [PubMed - in process] (Source: Circulation)


The use of PTCA in acute mitral regurgitation and cardiogenic shock: Revisited with impella. ‐ response from the authors
(Source: Catheterization and Cardiovascular Interventions)


The use of PTCA in acute mitral regurgitation and cardiogenic shock: Revisited with impella
(Source: Catheterization and Cardiovascular Interventions)


Papillary muscle rupture: small life-threatening myocardial infarction
We report the case of a 70&nbsp;years old man admitted to our coronary care unit because of atrial fibrillation, non-ST-elevation myocardial infarction and cardiogenic shock. Emergency coronary angiography showed a 99&nbsp;% stenosis of the circumflex coronary that was successfully treated with a bare metal stent. Atrial fibrillation was cardioverted to sinus rhythm. Nevertheless, no hemodynamic benefit was observed. Transesophageal echocardiography (TEE) showed rupture of the papillary muscle (PM). The patient underwent emergent mitral valve replacement. Surgical visualization of the mitral valve confirmed the rupture of the antero-lateral PM. The postoperative course was uneventful and the patient recovered fully. This case highlights that even small myocardial infarction may have ...


Temporary left ventricular resynchronization therapy in cardiogenic shock: A new pacing paradigm to fight an old foe?
Clinical cardiogenic shock is characterized by tissue hypoperfusion resulting from cardiac dysfunction. Severe left ventricular (LV) dysfunction (usually from myocardial infarction) is the most common cause; however, arrhythmias, acute valvular dysfunction,ventricular rupture, or ventricular septal defect may also result in shock. Hemodynamic criteria for cardiogenic shock include a systolic blood pressure (Source: Heart Rhythm)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Development of 2 Registry-Based Risk Models Suitable for Characterizing Hospital Performance on 30-Day All-Cause Mortality Rates Among Patients Undergoing Percutaneous Coronary Intervention [Original Articles]
Conclusions&mdash; These National Quality Forum endorsed registry-based models produce estimates of hospital risk-standardized mortality rates for patients undergoing PCI. (Source: Circulation: Cardiovascular Quality and Outcomes)


Salvage extensive coronary thromboendarterectomy for a ruptured left anterior descending artery
We describe a lifesaving emergent thromboendarterectomy of the entire left anterior descending artery in a 63-year old man. Four days earlier, he had undergone a coronary artery bypass grafting. The left anterior descending artery was not bypassed then due to severe diffuse disease and calcifications. After an uneventful recovery, syncope occurred during exercise. Emergency catheterization revealed patent grafts, but no flow over the left anterior descending artery. At rescue percutaneous coronary intervention, a perforation of the left anterior descending artery occurred, leading to cardiogenic shock. A successful thromboendarterectomy of the left anterior descending artery salvaged the patient's life. (Source: Interactive CardioVascular and Thoracic Surgery)


Optimization of Impella 5.0 Implantation Using Mini‐Sternotomy Approach in Postmyocardial Infarction Cardiogenic Shock
Abstract  The Impella Recover LP 5.0® (Abiomed, Inc. Danvers, MA, USA) is an aortic transvalvular microaxial pump designed to unload the left ventricle and to ensure a systemic flow in severe left ventricular dysfunction. Surgical implantation using femoral or right subclavian approach may be difficult in certain circumstances, such as encountered in peripheral vascular disease, patients with small vessels or during substantial use of vasoactive drugs responsible for vasospasm. We propose a simple and effective technique for implantation of the Impella 5.0 LVAD by means of a mini‐sternotomy in patients with postinfarction refractory cardiogenic shock. (J Card Surg 2012;27:605‐606) (Source: Journal of Cardiac Surgery)


Which fluid should be used for fluid therapy to protect kidneys in cardiogenic shock after cardiac arrest?
We read with great interest the study by Adler et al. investigating the effect of fluid management on the incidence of acute kidney injury (AKI) in patients with cardiogenic shock after cardiac arrest treated by mild therapeutic hypothermia. The authors compared two fluid management strategies: with and without hemodynamic and volumetric monitoring. Based on the RIFLE criteria, the incidence of AKI class I (kidney injury)/F (kidney failure) was significantly lower in the PICCO group, in comparison to the conventional group: 1/23 (4.3%) vs. 8/28 (28.6%), p=0.03. The authors concluded that volume therapy guided by PICCO could reduce the incidence of AKI in patients with cardiogenic shock after cardiac arrest. In the method section, the authors stated: “for fluid therapy crystalloids and co...


Reply to: Which fluid should be used for fluid therapy to protect kidneys in cardiogenic shock after cardiac arrest?
In this study we found the incidence of AKI class I to be significantly lower in patients where preload and hemodynamics were continuously monitored by pulse contour analysis (PICCO group) compared to patients under conventional monitoring, including CVP. Beside the issue of quantitative fluid resuscitation, Salvadori et al. emphasized the importance of qualitative volume substitution with reference to several studies showing an increased incidence of AKI after infusion of hydroxyethyl starch (HAES) as colloid solution. (Source: Resuscitation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Temporary left ventricular stimulation in patients with refractory cardiogenic shock and asynchronous left ventricular contraction: A safety and feasibility study
Conclusions: Our data indicate that there may be a role for temporary LV stimulation as rescue therapy in selected patients with refractory CS. In clinical situations where aggressive therapies are used for urgent hemodynamic stabilization, temporary LV stimulation may evolve as a further and less invasive treatment option. (Source: Heart Rhythm)


Interventional cardiology: Intra-aortic balloon support for MI and cardiogenic shock—time to change the guidelines?
Interventional cardiology: Intra-aortic balloon support for MI and cardiogenic shock&#8212;time to change the guidelines? Nature Reviews Cardiology 9, 551 (2012). doi:10.1038/nrcardio.2012.132 Author: Gregory B. Lim The results of the Intraaortic Balloon Pump in Cardiogenic Shock (IABP-SHOCK) II trial, presented at the 2012 European Society of Cardiology Congress and published in the New England Journal of Medicine, indicate that intra-aortic balloon pump (IABP) counterpulsation is safe, but does not reduce (Source: Nature Reviews Cardiology)


High Left Ventricular Vent Return After Left and Right Ventricular Assist Device Placement in a Patient With a Mechanical Aortic Valve
ALTHOUGH VENTRICULAR ASSIST DEVICES traditionally were intended for use as a bridge to transplant as well as temporary support during the period of reversible cardiogenic shock (eg, postcardiopulmonary bypass), the indications have broadened to include long-term “destination” therapy. With increased experience in providing mechanical circulatory support have come improved outcomes and, subsequently, the application of this therapy in a patient population with complex disease. For example, patients with aortic valve pathology represent a clinical challenge given the risks of prosthetic valve thrombosis and regurgitation-induced recirculation. This case describes the intraoperative management of a patient with nonischemic cardiomyopathy and a previous aortic valve replacement with a mech...


Long-term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock
Conclusion&nbsp;&nbsp;Although postcardiotomy cardiogenic shock requiring ECMO support is associated with high morbidity and mortality, the long-term survival rate is acceptable. Content Type Journal ArticleCategory Original articlePages 1-7DOI 10.1007/s00595-012-0322-6Authors Satoshi Unosawa, Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kami-machi, Itabashi-ku, Tokyo, 173-8610 JapanAkira Sezai, Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kami-machi, Itabashi-ku, Tokyo, 173-8610 JapanMitsumasa Hata, Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kami-machi, Itabashi-ku, Tokyo, 173-8610 JapanKinichi Nakata, Department of Cardiovascular Surgery, Ni...


Percutaneous transcatheter closure of the aortic valve to treat cardiogenic shock in a left ventricular assist device patient with severe aortic insufficiency.
Authors: Russo MJ, Freed BH, Jeevanandam V, Hashmi M, Paul JD, Anderson A, Lang RM, Shah AP Abstract In this case report, we present a patient status post left ventricular assist device implantation complicated by de novo aortic insufficiency. At 8 months postimplant, the patient underwent a reoperative aortic valve repair, without complete closure of the valve. Three months after reoperation, the patient developed cardiogenic shock secondary to recurrent, severe aortic insufficiency. Ultimately, the patient underwent percutaneous, transcatheter closure of the aortic valve with an Amplatzer Cribiform device (AGA Medical Corp, Plymouth, MN). Two months post procedure, the patient remains stable with improved symptoms and functional status, and without evidence of further aortic insu...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The acutely occluded left main coronary artery culprit in cardiogenic shock and initial percutaneous coronary intervention: a substudy of the Manitoba "no option" left main PCI registry.
The acutely occluded left main coronary artery culprit in cardiogenic shock and initial percutaneous coronary intervention: a substudy of the Manitoba "no option" left main PCI registry. Can J Physiol Pharmacol. 2012 Sep;90(9):1325-31 Authors: Hussain F, Nguyen T, Elmayergi N, Ducas J, Minhas K, Vo M, Kass M, Ravandi A, Parmar G, Jassal DS, Tam JW, Freed D, Menkis AH, Philipp RK Abstract We aim to describe the in-hospital outcomes of the first reported Canadian cohort of patients with cardiogenic shock and acute myocardial infarction (MI) due to acute and total occlusion of the left main coronary artery, treated with initial percutaneous coronary intervention (PCI). Acute left main thromboses with cardiogenic shock were identified (N = 8) from a retrospective consecutive c...


Neurogenic Stunned Myocardium and Cardiac Transplantation: A Case Report
We present the case of a 46-year-old woman referred to our center for urgent heart transplantation assessment, initially diagnosed as having cardiogenic shock of uncertain etiology. Some hours before she had suffered syncope without regaining consciousness. When she arrived at our hospital, the objective examination revealed bilateral unreactive mydriasis and absent brain-stem reflexes, and echocardiography showed global left ventricle wall hypokinesis sparing the apex. An urgent computed tomography (CT) imaging of the head was performed, which showed a massive subarachnoid hemorrhage and extensive cerebral edema. In the following hours, she fulfilled the criteria of brain-stem death and indeed became a multiorgan donor. The heart was rejected for transplantation because of the existence o...


Pulmonary Hypertension in the Intensive Care Unit
Abstract: Pulmonary hypertension, a condition that can lead to right ventricular failure and hemodynamic collapse, can be very challenging to manage in critically ill patients who require the intensive care unit. Because of the underlying structure of the right ventricle, significant increases in right ventricular afterload initiate a vicious cycle of degenerating right ventricular function, giving rise to right ventricular failure and cardiogenic shock. In patients with pulmonary hypertension, inciting factors such as sepsis and arrhythmias can exacerbate this process. Important management principles include close monitoring of hemodynamics with both noninvasive and invasive modalities, optimization of right ventricular preload, maintenance of systemic blood pressure, enhancement of right...


Management of cardiogenic shock
Janina Stepinska (Warsaw, Poland) (Source: European Society of Cardiology)


IABP-SHOCK II: Randomized comparison of intraaortic balloon counterpulsation versus optimal medical therapy in addition to early revascularization in acute myocardial infarction complicated by cardiogenic shock
Holger Thiele - UC Hoppe (Source: European Society of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intraaortic Balloon Pump Fails To Improve Mortality Rate In Cardiogenic Shock Patients: The IABP-SHOCK II Study
A balloon pump inserted in the aorta is currently the most widely used support device in the treatment of cardiogenic shock and, since its introduction in 1968, has been used in several million people. However, there is still only limited evidence that the intraaortic balloon pump (IABP), one of the oldest medical devices in cardiology, is actually beneficial for the patient. Only a few registry studies and clinical trials have shown that the IABP can improve blood pressure and the perfusion of the coronary arteries... (Source: Health News from Medical News Today)


Evidence for Overturning the Guidelines in Cardiogenic Shock
New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print. (Source: New England Journal of Medicine)


ESC: Trial Finds No Benefit For Intraaortic Balloon Counterpulsation In Cardiogenic Shock
Despite a lack of evidence, circulatory support with intraaortic balloon counterpulation (IABP) has a class 1 recommendation in the guidelines and is often used in patients in cardiogenic shock following myocardial infarction for whom early revascularization is planned. That situation may change soon, as no benefit was found for the use of IABP in the first large trial of the strategy. (Source: Forbes.com Healthcare News)


Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock
New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print. (Source: New England Journal of Medicine)


SHOCK II: IABP Use Questioned (CME/CE)
(MedPage Today) -- When myocardial infarction (MI) is complicated by cardiogenic shock, use of intraaortic balloon counterpulsation (IABP) did not reduce mortality among patients scheduled for revascularization--a finding that calls into question current guidelines for treating cardiogenic shock in this population. (Source: MedPage Today Cardiovascular)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The IABP-SHOCK II study
(European Society of Cardiology) A balloon pump inserted in the aorta is currently the most widely used support device in the treatment of cardiogenic shock and, since its introduction in 1968, has been used in several million people. However, there is still only limited evidence that the intraaortic balloon pump (IABP), one of the oldest medical devices in cardiology, is actually beneficial for the patient. (Source: EurekAlert! - Medicine and Health)


Aggressive Surgical Treatment of Acute Pulmonary Embolism With Circulatory Collapse [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Surgical pulmonary embolectomy is an excellent approach to treating acute pulmonary embolism with circulatory collapse. Providing immediate percutaneous cardiopulmonary support to patients with cardiogenic shock could help to resuscitate and stabilize cardiopulmonary function and allow for a good outcome of pulmonary embolectomy. (Source: The Annals of Thoracic Surgery)


Percutaneous Transcatheter Closure of the Aortic Valve to Treat Cardiogenic Shock in a Left Ventricular Assist Device Patient With Severe Aortic Insufficiency [CASE REPORTS]
In this case report, we present a patient status post left ventricular assist device implantation complicated by de novo aortic insufficiency. At 8 months postimplant, the patient underwent a reoperative aortic valve repair, without complete closure of the valve. Three months after reoperation, the patient developed cardiogenic shock secondary to recurrent, severe aortic insufficiency. Ultimately, the patient underwent percutaneous, transcatheter closure of the aortic valve with an Amplatzer Cribiform device (AGA Medical Corp, Plymouth, MN). Two months post procedure, the patient remains stable with improved symptoms and functional status, and without evidence of further aortic insufficiency or device migration. (Source: The Annals of Thoracic Surgery)


Aortic balloon pump ineffective against cardiogenic shock
NEW YORK (Reuters Health) - Intra-aortic balloon pumps do not improve survival in people getting artery-opening treatment for a heart attack, a team of German doctors reported Monday morning. (Source: Modern Medicine)


Predictors of hyperglycemia after cardiac surgery in nondiabetic patients
This study included 1453 patients with hyperglycemia and 2205 patients without hyperglycemia. Hyperglycemic patients were older, were more likely to be men, had higher body mass index, were more likely to be hypertensive and hypercholesterolemic, and had lower left ventricular ejection fractions; in addition, a greater proportion had a history of cardiovascular disease and renal failure. Multivariate logistic regression analysis showed age, gender, body mass index, preoperative serum creatinine, left ventricular ejection fraction, previous cardiac surgery, and preoperative cardiogenic shock to be independently associated with hyperglycemia (P  (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The French airbridge for circulatory support in the Carribean
CONCLUSIONS CSMUs can be very efficient in providing support to patients in refractory shock, when remote from a cardiac surgery centre. The airborne transfer of patients on ECMO/ECLS can be achieved safely, even over long distances. (Source: Interactive CardioVascular and Thoracic Surgery)


Successful surgical treatment of a gigantic congenital coronary artery fistula immediately after birth
A foetus was prenatally diagnosed with a gigantic (12&nbsp;mm) coronary artery fistula (CAF) from the left anterior descending (LAD) coronary artery to right ventricular apex at 38&nbsp;weeks of gestation. LAD was dilated to 10&nbsp;mm with partial aneurysmal changes. Because of concern for sudden ischaemic cardiogenic shock soon after birth, the child was electively delivered by caesarean section, with surgical fistula closure subsequently performed 1&nbsp;h after birth. We also highly suspected the presence of a clinically significant accessory diagonal branch just around the fistula, thus direct fistula closure from outside the heart without cardiopulmonary bypass was abandoned and cardiopulmonary bypass was initiated. The terminal end of LAD was carefully opened, and the fistula was di...


Diltiazem/verapamil overdose: Cardiogenic shock: 3 case reports
(Source: Reactions)


Immediate and one-year outcome of patients presenting with Acute Coronary Syndrome complicated by stroke: Findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2)
Conclusion: There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication. (Source: BMC Cardiovascular Disorders)


A contemporary case series of lupus myocarditis.
Conclusions: A high index of suspicion is necessary in suspected LM. Higher frequency of elevated SS-A and anti-RNP antibody levels in our series than in the literature is suggestive of an LM association. Echocardiography is a useful initial investigation for LM, but patients should be referred early for cardiac magnetic resonance imaging or endomyocardial biopsy to confirm diagnosis if it is clinically indicated in difficult cases. PMID: 22892209 [PubMed - as supplied by publisher] (Source: Lupus)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Interleukin-6 is the strongest predictor of 30-day mortality in patients with cardiogenic shock due to myocardial infarction
Conclusions: In patients with MI complicated by CS, IL-6 represented a reliable independent early prognostic marker of 30-day mortality. PCT revealed a significant value at later points of time whereas Nt-proBNP seemed to be of lower relevance. (Source: Critical Care)


Survival after surgical repair of ischemic ventricular septal rupture [ORIGINAL ARTICLE]
Conclusions: Despite advances, the surgical mortality from ventricular septal rupture remains high. Age remains the most important predictor of outcome, and concomitant coronary artery bypass grafting does not appear to have a demonstrable benefit. Interestingly, anterior ventricular septal rupture had poorer long-term outcome than inferior ventricular septal rupture. (Source: Asian Cardiovascular and Thoracic Annals)


[Aspiration thrombectomy during percutaneous coronary intervention in a patient with cardiogenic shock caused by left main occlusion].
Authors: Malinowski M, Drewniak W, Kotlarska J, Jarząbek K, Nowak J, Dybczyńska E, Dąbrowski M Abstract Case study: 56-year-old male patient in cardiogenic shock with a large thrombus in LM, succesfully treated by PTCA with aspiration thrombectomy. Follow-up: 9 months control angiography. PMID: 22528727 [PubMed - indexed for MEDLINE] (Source: Kardiologia Polska)


Successful management of cardiogenic shock with intracoronary nitroglycerin in a patient with left main coronary artery lesion
Variant angina rarely involves the left main coronary artery . A 46 year-old caucasian male was admitted to hospital with chest pain. He was using ramipril/hydrochlorothiazide for hypertension for four years. He presented with presumed cardiogenic shock with blood pressure of 80/40mmHg, heart rate of 110beat/min and 5mm depression of ST segment on precordial leads on electrocardiography (A). After administration of heparin, clopidogrel and acetyl salicylic acid patient was transferred to the catheterisation laboratory with dopamine infusion at 5mcg/kg/min and titrated up to 40mcg/kg/min over 4min while the haemodynamics worsened further. Coronary angiography demonstrated occlusion of the left main coronary artery (B, ). A 3.0mm×15mm balloon was introduced over the soft tipped coronary gui...


Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: a single-center experience
Conclusions: ECMO therapy provides a valuable therapeutic strategy for postcardiotomy myocardial failure but is still limited by high complication rates with fewer than 30% of patients discharged from the hospital. Patient age appears to be an essential preoperative predictor for mortality, and the blood lactate level is a relevant marker for the assessment of efficient ECMO support. (Source: Journal of Surgical Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Central venous to arterial pCO(2) difference in cardiogenic shock.
Authors: Markota A, Sinkovič A Abstract In normal circumstances central venous to arterial pCO(2) difference is approximately 1 kPa (7.5 mmHg). In shock states it is usually increased. We sought to evaluate the agreement between admission central venous to arterial pCO(2) difference and mortality in patients with acute myocardial infarction and cardiogenic shock. We hypothesized that patients with higher central venous to arterial pCO(2) difference on admission would have higher mortality. We retrospectively included 30 patients with acute myocardial infarction and cardiogenic shock (mean age 67 ± 10 years, 73 % men), of which 20 (67 %) died. Nonsignificant differences between survivors and nonsurvivors were observed in age, gender, admission mean blood pressure, heart ra...


Continuous levosimendan infusion for refractory cardiogenic shock complicating severe acute dichlorvos poisoning.
This study represents the first reported cardiogenic shock resulting from organophosphorus poisoning in the literature, clarifying its hemodynamic features with invasive hemodynamic monitoring (PiCCO; Pulsion Medical Systems AG, Munich, Germany). Additional levosimendan infusion was commenced after insufficient conventional therapies, resulting in an increase in cardiac power index by 236% and a decrease in systemic vascular resistance by 69% after 24 hours of continuous infusion. Despite the immense hemodynamic improvement after levosimendan treatment, the patient died of multiple organ failure 6 days after admission. The authors also discussed the inotropic and vasodilatory effects of levosimendan in this clinical scenario. PMID: 22771967 [PubMed - in process] (Source: The American J...


In-hospital mortality among patients with takotsubo cardiomyopathy: A study of the National Inpatient Sample 2008 to 2009
Conclusions: The presence of underlying critical illness was the main driver of mortality, as these patients comprised >80% of patients with in-hospital mortality. Male patients, who were significantly more likely to have underlying critical illness, had significantly higher mortality rates than female patients. The presence of underlying critical illness likely explains the higher mortality rate among male patients. (Source: American Heart Journal)


Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock.
CONCLUSION: In our cohort of patients with STEMI complicated by CS treated with primary PCI we observed a difference in mortality between those treated with IABP and those treated without IABP in favour of the 'no IABP' group. The mortality difference was eliminated after adjustment for differences in case mix by propensity stratification or by logistic regression analysis. Neither did we observe any difference in mortality between patients whose IABP treatment was initiated before or immediately after PCI. PMID: 22847042 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)


Dobutamine/dopamine/nitroglycerin: Aggravation of cardiogenic shock in a septic elderly patient with basal septal hypertrophy: case report
(Source: Reactions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Acute hemodynamic effects of landiolol, an ultra-short-acting beta-blocker, in patients with acute coronary syndrome: Preliminary study.
CONCLUSIONS: Landiolol was safe and effective in reducing oxygen demand of the ischemic heart by reducing only HR without lowering blood pressure in patients with ACS undergoing PCI. PMID: 22835733 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


Successful Treatment of a Newborn With Acute Myocardial Infarction on the First Day of Life
In this report, we present a newborn with severe MI secondary to thrombus formation within the left anterior descending coronary artery. There also proved to be a Factor V Leiden heterozygotic mutation. The patient initially presented with cardiogenic shock. After resuscitation and thrombolytic therapy were administered, coronary artery patency was restored resulting in myocardial revitalization and recovery of left-ventricular function within 4&nbsp;weeks. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00246-012-0417-2Authors S. Cesna, Vilnius University, Vilnius, LithuaniaA. Eicken, Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, 80636 Munich, GermanyH. Juenger, Department...


Ischemic Mitral Regurgitation: An Intraoperative Echocardiographic Perspective
A SEQUEL OF MYOCARDIAL INFARCTION (MI), ischemic mitral regurgitation (IMR), can present acutely as cardiogenic shock (papillary muscle rupture), insidiously with symptoms of congestive heart failure (CHF), or as an incidental finding on a clinical or echocardiographic examination. Irrespective of presentation, IMR poses a clinical challenge in terms of diagnosis and treatment. Because of the ambiguity in terminology, there is considerable variation in the diagnosis and management. The incidence of IMR has been postulated to be as high as 1.2 to 2.1 million patients, with a significant proportion having moderate or severe mitral regurgitation (MR). Furthermore, almost one third of the patients presenting for coronary artery bypass graft (CABG) surgery have concomitant IMR. Although clinica...


Percutaneous cardiac support devices for cardiogenic shock: current indications and recommendations
Cardiogenic shock (CS) is a physiological state in which inadequate tissue perfusion results from cardiac dysfunction, most commonly following acute myocardial infarction. Non-ischaemic causes include myocarditis, end-stage cardiomyopathy or sustained arrhythmias. The use of reperfusion therapy has substantially reduced 30-day mortality in acute ST-segment elevation myocardial infarction (STEMI) patients.w1&ndash;w3 Currently, the optimal reperfusion therapy is timely primary percutaneous coronary intervention (PCI). The improvement in clinical outcome has been mostly observed in STEMI patients without cardiogenic shock. Despite reperfusion therapy, approximately 6&ndash;10% of STEMI patients develop cardiogenic shock during initial hospitalisation.1 2 w4 The large multicentre Should we Em...


A ventricular assist device as a bridge to recovery, decision making, or transplantation in patients with advanced cardiac failure
Abstract&nbsp;&nbsp;Despite many advances in the management of patients with heart failure, acute cardiogenic shock and progressive congestive heart failure remain serious problems with dismal prognoses. Both temporary and permanent mechanical support has been gaining wide clinical application in this patient population. Although mechanical circulatory support technology is rapidly evolving, this approach is associated with multiple issues such as the optimal duration of temporary support, ideal timing to bridge these patients to a long-term device, and selection of the right device for the right patient. The currently available devices are categorized into two major groups: temporary and long-term devices (including destination therapy). Heart failure is a dynamic condition, and the...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Predictive factors for successful weaning from percutaneous cardiopulmonary support in patients with cardiogenic shock complicating acute myocardial infarction.
CONCLUSIONS: A reduction in PCPS flow without hemodynamic collapse may allow for successful weaning from PCPS. BE may be a potent factor in determining when to terminate PCPS. PMID: 22819038 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


Inappropriate restrictions on life saving technology
When a patient dies it is of considerable consolation to relatives if they can be reassured that everything possible and appropriate was done. For many acute heart failure patients in the UK, this approach cannot be taken with honesty. This is because the NHS will not fund circulatory support equipment to treat cardiogenic shock in the majority of cardiac tertiary centres. Affected are 2% of 40 000 cardiac surgical patients who fail to separate from cardiopulmonary bypass and around 5% of 25 000 myocardial infarction patients who progress to cardiogenic shock.1 2 These disparate groups suffer ischaemia followed by reperfusion injury, then lethal but potentially recoverable myocardial stunning.3 Young patients with myocarditis or postpartum cardiomyopathy may experience a similar fate throu...


[The choked heart].
Authors: Furrer F, Giambarba C Abstract A couple of days after increasing the dosage of betaadrenergic- and adding calcium channel blockers due to an increased heart rate in atrial fibrillation, a 77 year old female was found in cardiogenic shock. After exclusion of further causes a therapy with catecholamines, calcium, high dose insulin and phosphodiesterase inhibitors was initiated. Despite this combined therapy the shock persisted. Only after administration of levosimendan, a calcium sensitizer, a normalization of the heart function could be observed. We discuss the danger of combining drugs with negative inotropic properties for rate control in atrial fibrillation and review the therapy with focus on the effects on cardiac cells of all recommended drugs in the treatment of into...


Radiofrequency Ablation under Extracorporeal Membrane Oxygenation for Atrial Tachycardia in Postpartum
We report an unusual case of cardiogenic shock with atrial tachycardia in postpartum; the patient underwent successful radiofrequency ablation under extracorporeal membrane oxygenation (ECMO). Radiofrequency ablation is usually used to treat this clinical situation. The use of ECMO has been described only in pediatric case. (J Card Surg 2012;**:1‐3) (Source: Journal of Cardiac Surgery)


Fluid therapy and acute kidney injury in cardiogenic shock after cardiac arrest
Conclusion: The presented data suggest that volume therapy guided by volumetric (ELWI, GEDI) and arterial waveform derived variables (PPV, SVV) can reduce the incidence of AKI in patients with cardiogenic shock after cardiac arrest treated with mild therapeutic hypothermia. (Source: Resuscitation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intra-aortic balloon counterpulsation in patients with acute myocardial infarction without cardiogenic shock. A meta-analysis of randomized trials
Conclusions: Counterpulsation does not reduce death, CHF, or reinfarction in patients with AMI without CS. The significant reduction of recurrent myocardial ischemia associated with IABC use is offset by a higher risk of CVAs and bleeding. (Source: American Heart Journal)


Simultaneous aortic valve replacement in left ventricular assist device recipients: single-center experience.
Conclusions: In stable patients, simultaneous aortic valve replacement and LVAD implantation are not associated with an impaired outcome. In patients with cardiogenic shock an additional aortic valve replacement may impair outcome; therefore alternative techniques should be considered. PMID: 22661109 [PubMed - in process] (Source: The International Journal of Artificial Organs)


Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock.
Authors: Soleimani B, Pae W Abstract The application of peripheral veno-arterial extracorporeal membrane oxygenation in the management of inotrope-refractory cardiogenic shock has proven controversial because of concerns about sub-optimal drainage of the left heart, resulting in left ventricular distension and pulmonary oedema. In this article, we will discuss the pathophysiological basis and clinical implications of left ventricular distension following institution of peripheral extracorporeal life support. We will also review the clinical strategies used to circumvent left ventricular distension and pulmonary oedema in these patients. PMID: 22473862 [PubMed - in process] (Source: Perfusion)


Extracorporeal Life Support for Cardiogenic Shock or Cardiac Arrest Due to Acute Coronary Syndrome [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Despite hemodynamic support with ECLS, patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional treatment had high mortality. However, the higher than 30% in-hospital survival rate in this extremely critical population indicates that ECLS might improve outcomes in ACS by saving the lives of patients in this specialized category. Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications were predictors of in-hospital mortality. (Source: The Annals of Thoracic Surgery)


Successful Treatment of Early Thrombosis of HeartWare Left Ventricular Assist Device With Intraventricular Thrombolytics [CASE REPORTS]
In the last few years, left ventricular assist devices (LVADs) have moved to the forefront in the management of patients with advanced heart failure. Pumps have gradually become smaller and more efficient and have clearly demonstrated survival benefits and improvement in functional status and quality of life in patients with advanced heart failure. Despite impressive advances in device technology, risk of severe complications remains, such as device thrombosis. A 62-year-old man who underwent HeartWare LVAD implantation as a bridge to cardiac transplant was admitted 18 days after device implantation with severe shortness of breath, fatigue and lethargy; he was found to have increased pump flows with high power demands and evidence of cardiogenic shock. An echocardiogram showed an echo dens...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


External Validation of the GRACE Freedom from Events Score
Conclusion: In this single site prospective validation, GFFES showed good discrimination, sensitivity and negative predictive value. It may be a useful tool for assigning patients to appropriate levels of care based on risk. (Source: Heart, Lung and Circulation)


Risk stratification and prognostic effects of internal thoracic artery grafting during acute myocardial infarction
Objective: Surgeons are occasionally requested to perform coronary artery bypass grafting during acute myocardial infarction. We intended to test the safety of coronary artery bypass grafting and internal thoracic artery grafting early after myocardial infarction using the Society of Thoracic Surgeons database.Methods: The database was queried for isolated coronary artery bypass grafting less than 24 hours after a myocardial infarction from 2002 to 2008. By using multivariable logistic regression and classification trees, risk models were created to stratify this group of patients. The independent prognostic effect of internal thoracic artery grafting was examined using standard risk-adjusted mortality comparisons.Results: A total of 44,141 patients were identified, with an overall operati...


Speckle tracking echocardiography in acute myocarditis
Abstract&nbsp;&nbsp;To evaluate 2-dimensional speckle tracking echocardiography as a diagnostic and prognostic tool in patients with acute myocarditis. In this retrospective cohort study, 45 patients (age, 39&nbsp;±&nbsp;15&nbsp;years; 32 male) with suspected acute myocarditis and 83 healthy controls (age, 39&nbsp;±&nbsp;13&nbsp;years; 27 male) underwent 2-dimensional speckle tracking echocardiography. Main outcome measures were circumferential and longitudinal strain and strain rate as prognostic and diagnostic markers. Patients with myocarditis had lower circumferential strain (−13.3&nbsp;±&nbsp;5.6&nbsp;% vs. −22.3&nbsp;±&nbsp;4&nbsp;%), circumferential strain rate (−0.9&nbsp;±&nbsp;0.3 vs. −1.4&nbsp;±&nbsp;0.3&nbsp;s−1), longitudinal strain (−11.7&nbsp;±&nbsp;4&n...


Marital Status and Outcome of Patients Presenting with Acute Coronary Syndrome: An Observational Report
Conclusion:Widowed marital status was associated with worse cardiovascular risk profile, and worse in‐hospital and 1‐year outcome. Future work should be focused on whether the provision of psychosocial support will result in improved outcomes among this high‐risk group. Clin. Cardiol. 2011 DOI: 10.1002/clc.22034Gulf RACE is a Gulf Heart Association (GHA) project and was financially supported by the GHA, Sanofi Aventis, and the College of Medicine Research Center at King Khalid University Hospital, King Saud University, and Riyadh, Saudi Arabia.The authors have no other funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)


Acute myocardial infarction: Clinical features and outcomes in young adults in Singapore.
CONCLUSION: Young AMI patients in Singapore are characterized by male predominance, high incidence of smoking and obesity. Overall in-hospital clinical outcomes are favourable. Among the 3 ethnic groups, Indians have the highest risk of developing premature AMI. PMID: 22761974 [PubMed - in process] (Source: World Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A prospective, randomized trial of continuous lateral rotation (“kinetic therapy”) in patients with cardiogenic shock
Conclusion&nbsp;&nbsp;The use of KT reduces rates of pneumonia and pressure ulcers as compared to SC. Moreover, in this study, patients with KT had a better outcome. The study suggests that KT should be used in patients with cardiogenic shock requiring ventilator therapy for a prolonged time. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00392-012-0484-7Authors Gregor Simonis, Department of Medicine/Cardiology, Heart Center, Dresden University of Technology, Fetscherstr. 76, 01307 Dresden, GermanyKerstin Steiding, Department of Medicine/Cardiology, Heart Center, Dresden University of Technology, Fetscherstr. 76, 01307 Dresden, GermanyKerstin Schaefer, Department of Medicine/Cardiology, Heart Center, Dresden University of Technology, Fetscherstr. 76, ...


Complications of temporary vena cava filter placement.
CONCLUSION: Temporary filter placement was associated with a high incidence of device-related complications. The benefit of temporary filter placement should be judiciously weighed against the risk of complications. PMID: 22727629 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


Outcome of Patients Presenting with ST Elevation Myocardial Infarct and Cardiogenic Shock: A Contemporary Single Center’s Experience
Cardiology 2012;122:83–88 (DOI:10.1159/000338165) (Source: Karger Publishers)


Prognostic significance of ST segment changes in lead aVR in patients with acute inferior myocardial infarction with ST segment elevation.
CONCLUSIONS: ST segment changes in lead aVR occurred in approximately half of inferior wall STEMI patients. The presence of such ST segment changes was associated with a poorer prognosis during the hospital stay, and the changes were not associated with the type of reperfusion treatment. PMID: 22427072 [PubMed - indexed for MEDLINE] (Source: Kardiologia Polska)


Failed repeated thrombolysis requiring left ventricular assist device pump exchange
AbstractA 51 year‐old male with untreated hepatitis C infection, cirrhosis and dilated cardiomyopathy with a HeartMate II LVAD presented with right heart failure and cardiogenic shock, INR of 7, hemolysis and renal failure. Acute LVAD thrombosis was suspected. Alteplase was injected into the inflow cannula of the LVAD with little effect. Intravenous Alteplase was given but failed to restore an adequate pump output, resulting in the need for emergency pump exchange. The patient had an uncomplicated post‐operative recovery and was discharged uneventfully. Inspection of the pump identified a thrombus wedged between the spines of the impeller. Our case highlights the challenges in managing pump thrombosis which is often resistant to thrombolysis and may instead rely upon prompt surgical in...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Early acute thrombosis of bioprosthetic mitral valve presenting with cardiogenic shock
We present an unusual case of a patient with polycythemia presenting with cardiogenic shock, secondary to acute thrombosis of a bioprosthetic mitral valve which was placed 14&nbsp;months prior to presentation. Our report also reviews predisposing factors and treatment options for bioprosthetic mitral valve thrombosis. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s11748-012-0121-4Authors Athanasios Tsiouris, Division of Cardiothoracic Surgery, Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202, USAHassan Nemeh, Division of Cardiothoracic Surgery, Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202, USAJamil Borgi, Division of Cardiothoracic Surgery, Department of Surgery, Henry Ford Hospital, ...


The Syrian hamster model of hantavirus pulmonary syndrome.
Authors: Safronetz D, Ebihara H, Feldmann H, Hooper JW Abstract Hantavirus pulmonary syndrome (HPS) is a relatively rare, but frequently fatal disease associated with New World hantaviruses, most commonly Sin Nombre and Andes viruses in North and South America, respectively. It is characterized by fever and the sudden, rapid onset of severe respiratory distress and cardiogenic shock, which can be fatal in up to 50% of cases. Currently there are no approved antiviral therapies or vaccines for the treatment or prevention of HPS. A major obstacle in the development of effective medical countermeasures against highly pathogenic agents like the hantaviruses is recapitulating the human disease as closely as possible in an appropriate and reliable animal model. To date, the only animal mo...


Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning.
Authors: Lippi G, Rastelli G, Meschi T, Borghi L, Cervellin G Abstract The toxicity of carbon monoxide has been recognized for long throughout history and is unquestionably the leading cause of unintentional poisoning deaths in the Western countries. The severity of poisoning is dependent upon environmental and human factor. The leading pathophysiological mechanism resides in the ability of carbon monoxide to bind to hemoglobin molecules with high affinity, displacing oxygen and generating carboxyhemoglobin, which is virtually ineffective to deliver oxygen to the tissues. The organs with the highest demand for oxygen such as the brain and the heart are more vulnerable to injury. Myocardial involvement is commonplace in moderate to severe carbon monoxide poisoning and is associated ...


Early and late results of entire septal patch technique for post infarction ventricular septal rupture
Conclusions&nbsp;&nbsp;Entire septal patch technique proved to be an easily reproducible method for anterior VSR that demonstrated stable early and late results. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s11748-012-0084-5Authors Toshiaki Ito, Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, Nagoya, 453-8511 JapanHiroaki Hagiwara, Department of Cardiovascular Surgery, Kasugai Municipal Hospital, 1-1-1, Takaki-cho, Kasugai, 486-8510 JapanAtsuo Maekawa, Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, Nagoya, 453-8511 Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 (Sour...


Tachycardia induced cardiomyopathy presenting with cardiogenic shock.
Authors: Kourti M, Sdougka M PMID: 22796698 [PubMed - in process] (Source: Indian Pediatrics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Hypothermia in cardiogenic shock
No description available (Source: BioMed Central)


Electrocardiographic changes of ST-elevation myocardial infarction in patients with complete occlusion of the left main trunk without collateral circulation: Differential diagnosis and clinical considerations
We present a series of 7 patients with total left main trunk occlusion without collateral circulation showing ST-elevation myocardial infarction pattern. The electrocardiographic pattern is similar to left anterior descending coronary artery proximal occlusion to first septal and first diagonal but without ST elevation in V1 and aVR because of left circumflex coronary artery compromise. In 4 (60%) of 7 of cases, there is also advanced right bundle-branch block plus superoanterior hemiblock. Despite severe clinical state at entrance (5/7 presented cardiac arrest/cardiogenic shock), 3 patients (43%) survived after percutaneous coronary intervention. (Source: Journal of Electrocardiology)


Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: Design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial
Conclusions: The IABP-SHOCK II trial addresses important questions regarding the efficacy and safety of IABP in addition to early revascularization in patients with cardiogenic shock complicating myocardial infarction. (Source: American Heart Journal)


Use of Impella 5L for Acute Allograft Rejection Postcardiac Transplant.
We present a 45-year-old patient with cardiogenic shock secondary to acute allograft rejection after orthotopic heart transplantation. Patient continued to have poor hemodynamics and low cardiac output despite being on high doses of inotropes and an aggressive immunosuppression. Hence, a decision was made to support the hemodynamics with an Impella LP 5.0 (Abiomed Inc, Danvers, MA) left ventricular assist device (LVAD). PMID: 22547305 [PubMed - in process] (Source: The Thoracic and Cardiovascular Surgeon)


Balloon Aortic Valvuloplasty under Temporary Mechanical Circulatory Support as a Bridge to Aortic Valve Replacement in a Patient with Hemodynamic Failure Secondary to Critical Aortic Valve Stenosis.
We present the case of a patient with critical aortic valve stenosis and cardiogenic shock who received a short period of percutaneous mechanical support and balloon aortic valvuloplasty that resulted in rapid clinical improvement. The patient then underwent uneventful aortic valve replacement. We believe that temporary mechanical circulatory support coupled with balloon aortic valvuloplasty helped to restore hemodynamic stability before surgery, leading to a better outcome. PMID: 22698612 [PubMed - in process] (Source: The Heart Surgery Forum)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Rescue transcatheter aortic valve implantation and simultaneous percutaneous coronary intervention on cardiopulmonary bypass in a patient with an extreme risk profile.
We report on successful emergency transcatheter aortic valve implantation combined with percutaneous coronary revascularization in a polymorbid and preterminal patient in profound cardiogenic shock and with multiorgan failure. The risk scores were almost unbelievably high (Society of Thoracic Surgeons mortality score, 83.9%; Society of Thoracic Surgeons morbidity and mortality score, 96.8%; logistic EuroSCORE, 96.7%). Two and a half years after the procedure, the patient is doing very well. PMID: 22698607 [PubMed - in process] (Source: The Heart Surgery Forum)


Mechanical circulatory support – Preface
The number of patients with a new diagnosis of advanced heart failure is increasing worldwide. Heart-failure patients are no longer treated only with digitalis and diuretics. When drug treatment is not effective, implanted mechanical devices can take over or support the function of the failed heart. Mechanical support is useful in both acute cardiogenic shock and chronic end-stage heart failure. Mechanical circulatory support is provided to end-stage heart-failure patients with various purposes; in a small group of patients, temporary support is provided until the native heart recovers its function. In another patient group, mechanical devices support the heart until a donor heart is available for transplantation as organ shortage is a significant limiting factor for heart transplantation....


Mechanical circulatory support for cardiogenic shock
Cardiogenic shock (CS) is a syndrome of progressive depression of myocardial function with systemic hypoperfusion. It occurs due to various aetiologies such as acute myocardial infarction, myocarditis, acute decompensated heart failure and postcardiotomy. Cardiogenic shock carries poor prognosis, and medical therapy alone is not effective. Mechanical circulatory support is required to unload the ventricles, decrease the myocardial demand, prevent further injury, improve the coronary perfusion, stabilise the haemodynamics and maintain the end-organ perfusion before definitive interventions such as coronary reperfusion can take place. Currently, there are several methods of mechanical circulatory support. These include extracorporeal life support, paracorporeal or extracorporeal ventricular-...


Postoperative care and complications after ventricular assist device implantation
In this article, the routine postoperative care and complications of patients with ventricular assist devices are reviewed. Routine postoperative care encompasses patients who have undergone emergency ventricular assist device (VAD) implantation for acute cardiogenic shock, as a bridge to decision making, and semi-elective patients who have undergone VAD implantation for end-stage heart failure, either as destination therapy or as a bridge to heart transplantation. Early postoperative management should focus on haemodynamic optimisation, including fluid and inotrope therapy, VAD settings and support of right ventricular function. Echocardiography is an essential tool in optimising haemodynamics and identifying complications. Early postoperative complications include bleeding, arrhythmias, ...


Percutaneous left ventricular support in cardiogenic shock and severe aortic regurgitation
We report two cases of medically‐refractory cardiogenic shock in patients with severe aortic regurgitation who were successfully bridged to surgical left ventricular assist device implantation by percutaneous left atrial to femoral artery (pLA‐FA) mechanical bypass. Further investigation into the clinical utility of percutaneous mechanical support in the setting of aortic regurgitation and shock is required. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Mortality in Patients With ST-Segment Elevation Myocardial Infarction Who Do Not Undergo Reperfusion
In conclusion, at a high-volume percutaneous coronary intervention center, most patients presenting with STEMI underwent immediate catheterization. The decision for no reperfusion was multifactorial, with advanced age reported as the most common factor. Outcomes were poor in this population, and fewer than half of these patients survived to hospital discharge. (Source: The American Journal of Cardiology)


What is the evidence for IABP in STEMI with and without cardiogenic shock?
Intraaortic balloon pump (IABP) is the most widely used left ventricular support device in a variety of indications. This review focuses on the current literature and discusses the evidence of IABP in ST-elevation myocardial infarction (STEMI) with and without cardiogenic shock. In high-risk STEMI patients without cardiogenic shock several randomized clinical trials have been performed. The majority of the studies could not demonstrate an efficacy benefit for IABP as adjunctive therapy in comparison to standard treatment alone. Hence, recent meta-analyses could not reveal diverging mortality rates at a higher incidence of stroke and major bleedings with IABP use independent of the type of reperfusion therapy. IABP in STEMI patients with cardiogenic shock is recommended according to current...


A rare cause of cardiogenic shock
Content Type Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-012-2602-4Authors Thomas Clark, Intensive Care Unit, Derriford Hospital, Plymouth, Devon, UKDarcy Pearson, Intensive Care Unit, Derriford Hospital, Plymouth, Devon, UKPeter Macnaughton, Intensive Care Unit, Derriford Hospital, Plymouth, Devon, UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)


Utility of atrial temporary pacing as an acute treatment for bradyarrhythmias and tachyarrhythmias in the intensive care setting with preservation of atrioventricular synchrony
We present a series where temporary right atrial pacing was used as an acute treatment for both bradyarrhythmias and tachyarrhythmias. (Source: Internal Medicine Journal)


A 22-year old female with cardiogenic shock due to transplant vasculopathy with severe left main stenosis
A 22-year old female was admitted to our emergency room following cardiopulmonary resuscitation (CPR) due to cardiac arrest. Her medical history included orthotopic cardiac transplantation at the age of 11 due to severe Marfan's disease; this procedure and serial follow-up exams had been performed in another transplant center. She had undergone routine cardiac catheterization and endomycardial biopsy 12months earlier, which excluded a relevant rejection and demonstrated the presence of a transplant vasculopathy without hemodynamically significant stenosis. She was on optimal medical therapy including tacrolimus (serum levels 5.5ng/ml). (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Salvage Peripheral Extracorporeal Membrane Oxygenation Using Cobe Revolution® Centrifugal Pump as a Bridge to Decision for Acute Refractory Cardiogenic Shock
Conclusions: Salvage peripheral cardiopulmonary support is a useful tool to rapidly stabilize acute refractory cardiogenic shock permitting an assessment of neurologic and end‐organ viability. (J Card Surg 2012; **:1‐7) (Source: Journal of Cardiac Surgery)


A stepwise progression in the treatment of cardiogenic shock
We present a case of a young woman with a massive anterior wall MI and subsequent cardiogenic shock who was treated with advanced mechanical circulatory support. This case serves as an illustration of the stepwise escalation of mechanical support that can be applied in a patient with an acute MI complicated by refractory cardiogenic shock. We also review the literature with regard to the use of percutaneous left ventricular assist devices in the setting of cardiogenic shock. (Source: Heart and Lung)


Extracorporeal membrane oxygenation–assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock
Conclusion: Extracorporeal membrane oxygenation–assisted PCI for patients with AMI that is complicated by profound CS may improve the 30-day and 1-year survival rates. (Source: Journal of Critical Care)


Ventricular assist device implantation in patients on percutaneous extracorporeal life support without switching to conventional cardiopulmonary bypass system [TX [amp ] MCS]
CONCLUSIONS Our experience suggests that VAD implantation using percutaneous ECLS without switching to conventional CPB is a safe alternative in the bridge to bridge concept, especially in high-risk patients with cardiogenic shock who would benefit from the avoidance of the adverse sequels associated with conventional CPB. (Source: European Journal of Cardio-Thoracic Surgery)


Cardiogenic shock complicating acute coronary syndromes: Insights from the Global Registry of Acute Coronary Events
Conclusion: Continued efforts are needed to reduce the incidence and CFRs of CS complicating ACS. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Early versus delayed cyclosporine treatment in cardiac recovery and intestinal injury during resuscitation of asphyxiated newborn piglets
Conclusion&nbsp;&nbsp;This study demonstrates that treating asphyxiated newborn piglets with cyclosporine within 2&nbsp;h of resuscitation is effective with superior cardioprotection and intestinal injury attenuation with early treatment. Content Type Journal ArticleCategory ExperimentalPages 1-9DOI 10.1007/s00134-012-2577-1Authors Richdeep S. Gill, Department of Surgery, University of Alberta, Edmonton, AB, CanadaTze-Fun Lee, Department of Pediatrics, University of Alberta, Edmonton, AB, CanadaConsolato Sergi, Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, CanadaDavid L. Bigam, Department of Surgery, University of Alberta, Edmonton, AB, CanadaPo-Yin Cheung, Department of Surgery, University of Alberta, Edmonton, AB, Canada Journal ...


Oxygen transport and mitochondrial function in porcine septic shock, cardiogenic shock, and hypoxaemia
ConclusionWe conclude that despite shock and renal hypoperfusion, tissue hypoxia is not a major pathophysiological issue in early and established faecal peritonitis. The reasons for reduced skeletal muscle tissue ATP levels in the presence of well‐preserved in‐vitro muscle mitochondrial respiration should be further investigated. (Source: Acta Anaesthesiologica Scandinavica)


Tako-tsubo syndrome soon after caesarean delivery: two case reports
We describe two unusual cases of TTS with midventricular ballooning complicated by cardiogenic shock requiring the use of intra-aortic balloon pump (IABP) in two young women with no history of cardiovascular disorders, occurring early after cesarean delivery. (Source: International Journal of Cardiology)


A Case of Spontaneous Coronary Artery Dissection: It is Not Always Plaque Rupture
Conclusion: This case highlights the fact that although SCAD is a rare entity, it is increasingly being recognized as a significant cause of ACS. Urgent angiography should be considered if SCAD is suspected, because early diagnosis and appropriate management significantly improve the outcome in these patients. (Source: The Journal of Emergency Medicine)


Acute Major Prosthetic Aortic Valve Dehiscence Secondary to Staphylococcus Aureus Endocarditis Presenting as ST-Segment Elevation Myocardial Infarction
An 86-year-old woman presented as an emergency with chest pain and breathlessness. An electrocardiogram recorded by the paramedics showed anterior ST-segment elevation, and she was brought directly to the heart attack center for primary percutaneous coronary intervention. She had undergone a mechanical aortic valve replacement 18 years previously for aortic stenosis. Clinical examination confirmed a collapsing pulse and an early diastolic murmur. Bedside transthoracic echocardiography confirmed severe aortic incompetence and a possible vegetation (A, Online Video 1). We considered it was appropriate to proceed to emergency coronary angiography to delineate coronary anatomy. During angiography, which showed unobstructed coronaries, we noticed major abnormal motion of the prosthetic aortic v...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Lidocaine/epinephrine: Kounis syndrome (first report) presenting with cardiogenic shock: case report
(Source: Reactions)


Ischaemia-induced up-regulation of Toll-like receptor 2 in circulating monocytes in cardiogenic shock
Conclusion We demonstrate TLR2 up-regulation and increased proinflammatory cytokine expression in circulating monocytes in AMI/CS depending on disease severity, implying an important role of TLR2 expression in ischaemic injury. (Source: European Heart Journal)


Prosthetic Endocarditis Treated by Repeated Heart Transplantation: Report of a Successful Case
This report described a patient who had under gone four conventional valve surgeries and three HTs successfully. In May 2000, a 14-year-old boy suffered from endocarditis with severe aortic valve regurgitation. He underwent aortic valve replacement (AVR) at another hospital. Due to prosthetic valve endocarditis, he displayed a severe paravalvular leakage and was transferred to our hospital where he underwent Bentall's operation in October 2000. Despite a full antibiotic course, he experienced a relapse of the prosthetic endocarditis with significant deterioration of the heart function and a progressively more severe paravalvular leak. Considering the difficulties of repair and the poor heart function, he underwent an HT in June 2003 and recovered well. Unfortunately, endocarditis with aort...


Intra‐Aortic Balloon Counterpulsation in the Treatment of Infarction‐Related Cardiogenic Shock—Review of the Current Evidence
AbstractThe European ST‐elevated myocardial infarction (STEMI) guideline suggested the intra‐aortic balloon pump (IABP) with a recommendation level I and a level of evidence C as an effective measure in combination with balloon angioplasty in patients with cardiogenic shock (CS), stent implantation, and inotropic and vasopressor support. Similarly, upon mechanical complication due to myocardial infarction (MI), the guideline suggests that in patients with a ventricular septal defect or in most patients with acute mitral regurgitation, preoperative IABP implantation is indicated for circulatory support. The American College of Cardiology/American Heart Association STEMI guideline recommends the use of the IABP with a recommendation level I and a level of evidence B if CS does not respon...


Impact of anemia on in-hospital, one-month and one-year mortality in patients with acute coronary syndrome from the middle East.
Conclusions Admission anemia in patients with ACS from six Middle-Eastern countries was strongly associated with mortality at in-hospital, one-month, and at one-year. Hence, admission anemia must be considered in the initial risk assessment of ACS patients along with other risk scores. PMID: 22593012 [PubMed - in process] (Source: Clinical Medicine and Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Use of Impella 5L for Acute Allograft Rejection Postcardiac Transplant
We present a 45-year-old patient with cardiogenic shock secondary to acute allograft rejection after orthotopic heart transplantation. Patient continued to have poor hemodynamics and low cardiac output despite being on high doses of inotropes and an aggressive immunosuppression. Hence, a decision was made to support the hemodynamics with an Impella LP 5.0 (Abiomed Inc, Danvers, MA) left ventricular assist device (LVAD).[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: The Thoracic and Cardiovascular Surgeon)


Use of Impella 5L for Acute Allograft Rejection Postcardiac Transplant.
We present a 45-year-old patient with cardiogenic shock secondary to acute allograft rejection after orthotopic heart transplantation. Patient continued to have poor hemodynamics and low cardiac output despite being on high doses of inotropes and an aggressive immunosuppression. Hence, a decision was made to support the hemodynamics with an Impella LP 5.0 (Abiomed Inc, Danvers, MA) left ventricular assist device (LVAD). PMID: 22547305 [PubMed - as supplied by publisher] (Source: The Thoracic and Cardiovascular Surgeon)


Emergency Surgery for Native Mitral Valve Endocarditis: The Impact of Septic and Cardiogenic Shock [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Our study suggests that emergency surgery for ANMVE in patients with CS achieved satisfactory early and late results. In contrast, the presence of SS was linked to dismal early prognosis. Our findings need to be confirmed by further larger studies. (Source: The Annals of Thoracic Surgery)


Read the June issueof the European Heart Journal - Acute Cardiovascular Care
Read the June issue of the European Heart Journal - Acute Cardiovascular Care, the official Journal of the Working Group on Acute Cardiac Care. The journal aims to publish the highest quality material, both clinical and scientific, on all aspects of acute cardiac care, such as acute coronary syndromes, cardiogenic shock, cardiac arrest, cardiac arrhythmias and acute heart failure. Topics: Acute Coronary Syndromes (ACS) (Source: European Society of Cardiology)


Ventricular assist device therapy in post-cardiotomy cardiogenic shock: historical outcomes and current trends
Ventricular assist device (VAD) therapy has been used successfully as a bridge to recovery, bridge to transplant and in the last decade as a destination therapy. The use of VAD for post-cardiotomy cardiogenic shock (PCCS) is not currently reported in national databases in the UK and Ireland. Data were collected through a telephone survey of chief perfusionists from all the cardiac surgery units in the UK and Ireland between October 2007 and October 2008. Approximately 28&nbsp;000 adult cardiac surgical procedures were performed at 45 cardiac centres, of which 33 (73%) reported using VAD. The total number of patients supported was 66, of which 41% (n&nbsp;=&nbsp;27) survived to be discharged home. About 42.5% (n&nbsp;=&nbsp;28) died during VAD in place, and 16.5% died after successful weani...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Severe hemolysis associated with use of the impella LP 2.5 mechanical assist device
We report a case of a 66‐year‐old woman with hemodynamic collapse during an elective PCI who was successfully resuscitated with an Impella device. She developed marked biochemical evidence of intravascular hemolysis. This necessitated device removal which resulted in prompt resolution of the hemolysis. We advise routine measurement of biochemical markers of hemolysis and serial hemoglobin values during Impella device support to allow timely detection and treatment of this important complication. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


[Acute myocarditis.]
Authors: Combes A Abstract Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent-onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role bu...


Cardiogenic Shock as the Initial Presentation of Systemic Lupus Erythematosus: A Case Report and Review of the Literature.
Authors: Baquero G, Banchs JE, Naccarelli GV, Gonzalez M, Wolbrette DL PMID: 22507209 [PubMed - as supplied by publisher] (Source: Congestive Heart Failure)


Update on mechanical circulatory support in heart failure
Temporary mechanical support technology has advanced, and the miniaturisation of these devices has permitted their use with less operative morbidity and more rapid functional recovery following operation. At present a broad range of devices are available. The most comprehensive mechanical support for both the systemic and the pulmonary circulation is still best provided by extracorporeal membrane oxygenation for extremely ill patients with lung and heart failure, which remains a cumbersome and invasive but extremely effective form of short term mechanical support.w1 However, the development of devices such as the Impella and the Tandem-Heart has allowed less invasive forms of temporary support of the systemic circulation typically applied during high risk percutaneous intervention procedur...


The effect of combined treatment with Impella® and landiolol in a swine model of acute myocardial infarction
Abstract&nbsp;&nbsp;Cardiogenic shock is associated with a high mortality rate in patients with acute myocardial infarction (AMI). We developed a new treatment approach named heart rest therapy (HRT) for complete revascularization in the early stage of AMI using an ultra-short-acting β-blocker (landiolol) and an Impella® left ventricular assist device and verified the effect of this therapy in a swine model. In 18 male pigs, AMI was induced by left anterior descending coronary artery occlusion at the level of the second diagonal branch for 120&nbsp;min, followed by 240&nbsp;min of reperfusion. The animals were divided into three groups: group A had no support, group B was supported with the Impella®, and group C was treated with HRT from 90&nbsp;min after ischemia to 240&nbsp;min a...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Ventricular Assist Device Support in Children and Adolescents With Heart Failure: The Children's Medical Center of Dallas Experience
AbstractChildren with heart failure unresponsive to medical therapy are left with few options for survival. Ventricular assist devices (VADs) are life‐saving options for such patients, allowing for bridge to transplantation or cardiac recovery. Retrospective review of cases from May 2006 to October 2010 was undertaken. Fourteen patients underwent implantation of VADs for refractory heart failure. Mean age was 9 years (range 1–17 years), and weight was 41 kg (range 9.7–71 kg). Indications for support: end‐stage cardiomyopathy (n = 8), myocarditis (n = 3), univentricular failure (n = 2), and congenital heart disease/postcardiotomy (n = 1). Level of limitation at time of implant included critical cardiogenic shock in six (43%) and progressive decline in eight (57%)...


Percutaneous circulatory support in cardiogenic shock: interventional bridge to recovery.
Authors: Kar B, Basra SS, Shah NR, Loyalka P PMID: 22492948 [PubMed - in process] (Source: Circulation)


A general theory of acute and chronic heart failure
Abstract: Current concepts of heart failure propose multiple heterogeneous pathophysiological mechanisms. Recently a theoretical framework for understanding chronic heart failure was suggested. This paper develops this framework to include acute heart failure syndromes.We propose that all acute heart failure syndromes may be understood in terms of a relative fall in left ventricular stroke volume. The initial compensatory mechanism is frequently a tachycardia often resulting in a near normal cardiac output. In more severe forms a fall in cardiac output causes hypotension or cardiogenic shock. In chronic heart failure the stroke volume and cardiac output is returned to normal predominantly through ventricular remodeling or dilatation. Ejection fraction is simply the ratio of stroke volume a...


Long-term follow-up after coronary stenting with the sirolimus-eluting stent in clinical practice: results from the prospective multi-center German Cypher Stent Registry
Conclusions&nbsp;&nbsp;Long-term follow-up of the SES in clinical practice showed clinical event rates that were comparable to randomized trials with a MACCE rate of 16.3&nbsp;% and TVR rate of 20.3&nbsp;%. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00392-012-0448-yAuthors Ralf Zahn, Kardiologie/Pneumologie/Angiologie/Internistische Intensivmedizin, Herzzentrum Ludwigshafen, Kardiologie, Bremserstraße 79, 67063 Ludwigshafen, GermanyFranz-Josef Neumann, Herzzentrum, Abteilung für Kardiologie, Bad Krozingen, GermanyHeinz-Joachim Büttner, Herzzentrum, Abteilung für Kardiologie, Bad Krozingen, GermanyGert Richardt, Segeberger Kliniken, Kardiologie, Bad Segeberg, GermanySteffen Schneider, Institut für Herzinfarktforschung Ludwigshafen an der Univer...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Predictor of Early Mortality for Severe Heart Failure Patients With Left Ventricular Assist Device Implantation.
Conclusions: LVAD implantation in a stable condition contributes to better clinical outcome for severe heart failure patients. If critical cardiogenic shock occurs, LVAD implantation must be considered immediately before other organs' functions, especially renal function, deteriorate. PMID: 22484979 [PubMed - as supplied by publisher] (Source: Circulation Journal)


Outcomes According to Presentation With Versus Without Cardiogenic Shock in Patients With Left Main Coronary Artery Stenosis and Acute Myocardial Infarction
This study is aimed at evaluating 1-year clinical outcomes and their predictors in patients with unprotected left main coronary artery (ULMCA)-related acute myocardial infarction (AMI). In total 248 patients diagnosed with AMI involving the ULMCA as the culprit vessel and registered in the Korean Acute Myocardial Infarction database were enrolled in this study. Patients were divided according to the absence (shock−, n = 206) or presence (shock+, n = 42) of cardiogenic shock at initial presentation. Independent risk factors of in-hospital cardiac death associated with ULMCA-related AMI were elucidated by multivariate regression analysis. In-hospital mortality rates were 8.7% in the shock− group and 47.6% in the shock+ group (p = 0.001). During 1-year follow-up after discharge, major adv...


Extra-corporeal life support, transradial thrombus aspiration and stenting, percutaneous blade and balloon atrioseptostomy, all as a bridge to heart transplantation to save one life
Abstract: In patients with cardiogenic shock, the Extra-Corporeal Life Support (ECLS) has been shown to be lives saving. But, in some situations, it proves inadequate for the discharge of the left heart. Several device-based techniques have been proposed to decompress the left side either surgically or percutaneously, each of them with the proper potential risks and complications. One technique, the percutaneous blade and balloon atrioseptostomy that requires transseptal catheter based experience and consists of creating an atrial septal defect (ASD) could be an elegant technique as an “add on” to the classic assistance making together a bridge to partial recovery or to heart transplantation. Herein, we present a case of an adult patient who presented with inaugural resistant cardiac a...


Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock.
Authors: Soleimani B, Pae WE Abstract The application of peripheral veno-arterial extracorporeal membrane oxygenation in the management of inotrope-refractory cardiogenic shock has proven controversial because of concerns about sub-optimal drainage of the left heart, resulting in left ventricular distension and pulmonary oedema. In this article, we will discuss the pathophysiological basis and clinical implications of left ventricular distension following institution of peripheral extracorporeal life support. We will also review the clinical strategies used to circumvent left ventricular distension and pulmonary oedema in these patients. PMID: 22473862 [PubMed - as supplied by publisher] (Source: Perfusion)


Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy
Conclusion Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors. (Source: European Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Safety and efficacy of rescue angioplasty for ST-elevation myocardial infarction with high utilization rates of glycoprotein IIb/IIIa inhibitors
Conclusions: Rescue PCI with contemporary treatments can achieve mortality rates similar to rates for contemporary primary PCI in patients without pre-PCI shock. Whether rates of bleeding can be reduced by different pharmacotherapies and interventional techniques needs clarification in future studies. (Source: American Heart Journal)


[Acute anterior myocardial infarction presented with cardiogenic shock in a patient on herbal medication].
Authors: Güneş H, Küçükdurmaz Z, Karapınar H, Gül İ Abstract Uncontrolled usage of herbal medications may cause problems that can lead to serious complications, including death. Panax is thought to have hypocholesterolemic, anticarcinogenic, antiinflammatory, and antimicrobial effects via its saponin ingredient and positive inotropic effects via its panax ginseng effect. However, clinical studies have shown that it can increase the low-density lipoprotein (LDL) levels secondary to its hypocholesterolemic effect, have a hypertensive effect in chronic users via ginseng abuse syndrome, and also have hypotensive effects. Here, we present a case with typical angina pectoris in which coronary angiography was suggested but refused. The male patient initiated panax therapy and pres...


Abstract 4: The Impact of an Emergency Medical Services Hospital Bypass Protocol on Reperfusion Time for Patients with ST-elevation Myocardial Infarction (STEMI) [Session Title: Concurrent I: Session A Young Investigator Award Oral Abstract Presentations]
Conclusions: After implementation of a statewide STEMI regionalization program, 2/3 of EMS transported patients bypassed a closer non-PCI center and went directly to a PCI-capable center. Patients who bypassed and went directly to PCI capable centers had significantly more rapid reperfusion times and lower mortality compared with patients not undergoing EMS. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 143B: Association between Insurance Type and Long Term Outcomes in Patients with ST-Elevation Myocardial Infarction [Session Title: Poster Session II]
Conclusion: Timeliness of reperfusion was similar across all insurance groups. After adjustment for baseline clinical variables, there was no significant difference in long-term survival according to insurance type. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 298: Incidence, Treatment and Outcomes of Cardiogenic Shock in STEMI and NSTEMI: Results from the NCDR(R) [Session Title: Poster Session III]
Conclusion: In the contemporary era, after ACCF/AHA Class IA guidelines endorsing early revascularization for STEMI related CS, most STEMI patients with CS undergo revascularization, and death is significantly lower in comparison to earlier pre-guideline data. However, compared to STEMI CS, a majority of NSTEMI CS patients do not undergo revascularization, and death rates are significantly higher. In-hospital development of CS carries a higher mortality rate in both MI subtypes compared to CS on admission. (Source: Circulation: Cardiovascular Quality and Outcomes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Abstract 321: A Validated Model to Identify Patients at High Risk for 30-Day Readmission After Percutaneous Coronary Intervention [Session Title: Poster Session III]
Conclusions: These validated models, developed in a large and broadly generalizable population, can be used to identify patients at high risk for readmission after PCI. Such a model could be used to target high risk patients for interventions to prevent readmission. (Source: Circulation: Cardiovascular Quality and Outcomes)


Large Interatrial Thrombus-In-Transit Resulting in Acute Myocardial Infarction Complicated by Atrioventricular Block and Cardiogenic Shock
A 63-year-old man presented with chest pain, dyspnea, and severe hypotension (blood pressure 80/50 mm Hg). He had a history of severe chronic obstructive pulmonary disease and bladder cancer. Electrocardiogram showed complete atrioventricular block, and ST-segment elevation in inferior and right pre-cordial leads (A). He underwent temporary cardiac stimulation. Coronary angiography showed a thrombotic occlusion of the proximal right coronary artery (B and C). Balloon angioplasty after previous thrombus aspiration was unsuccessfully performed. Transesophageal echocardiography revealed an aneurysmatic interatrial septum with a large mobile mass crossing the patent foramen ovale (PFO) (D, Online Video 1) into the left chambers (E and F, Online Videos 2 and 3). Emergent surgery was performed a...


Central Extracorporeal Life Support in Pheochromocytoma Crisis [CASE REPORTS]
We report the use of central extracorporeal life support (ECLS) in a young woman admitted to the intensive care unit with cardiogenic shock. Her medical history included neurofibromatosis type I and pheochromocytoma. ECLS was needed because of severe left ventricular failure and inotropic therapy unresponsiveness. ECLS permitted full recovery of left ventricular function. Right adrenelectomy was performed 4 months later. In this case, central ECLS was used to treat pheochromocytoma-induced cardiogenic shock complicated by pulmonary edema. (Source: The Annals of Thoracic Surgery)


Acute Dysfunction of Mechanical Aortic Valve as Electrocardiographic Mimic of Acute Left Main Coronary Artery Occlusion [CASE REPORTS]
We report three patients with acute dysfunction of mechanical aortic valve prosthesis resulting in chest pain, concomitant cardiogenic shock, and electrocardiographic changes mimicking acute occlusion of the left main coronary artery whereas emergency coronary angiography revealed normal coronary arteries. During operation, abnormal proliferation of subvalvular pannus overgrowth on the inflow aspect of the prosthesis was found to impede normal prosthesis closure. We discuss the possible underlying mechanisms of electrocardiographic presentations. (Source: The Annals of Thoracic Surgery)


Preliminary experience with a new device for delayed sternal closure strategy in cardiac surgery.
Conclusions: Despite the limited number of patients enrolled, the NTSS proved safe and effective in allowing complete myocardial recovery after SPCCS, avoiding hemodynamic instability related to abrupt sternal closure, with no occurrence of infective complications. PMID: 22466992 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A Family History of Dilated Cardiomyopathy Induced by Viral Myocarditis
We report the cases of two DCM induced by acute and past myocarditis in the same family and expressed by its two main complications within few weeks: an hemodynamic presentation as a fulminant myocarditis rapidly leading to cardiac tranplantation and a rythmologic presentation as an electrical storm leading to catheter ablation of ventricular tachycardia. These cases ask the question of the family predisposition to viral myocarditis leading to DCM. (Source: Diagnostic and Therapeutic Endoscopy)


Usefulness of Sum of ST-Segment Elevation on Electrocardiograms (Limb Leads) for Predicting In-Hospital Complications in Patients With Stress (Takotsubo) Cardiomyopathy
Although the prognosis of patients with stress (takotsubo) cardiomyopathy is relatively favorable, serious complications occur in some patients. It is generally accepted that electrocardiography is an essential tool for the diagnosis of stress cardiomyopathy, with findings highly suggestive of the characteristics of myocardial damage. We tested the hypothesis that the quantitative analysis of electrocardiograhic changes can predict complications in stress cardiomyopathy. The study subjects were 85 patients with stress cardiomyopathy. A total of 34 patients developed ≥1 in-hospital complications (heart failure, intraventricular pressure gradient [>30 mm Hg], cardiogenic shock, ventricular tachycardia/fibrillation, and embolism). Patients with complications were likely to have a higher hea...


Transapical transcatheter aortic valve replacement in patients with cardiogenic shock
Transcatheter aortic valve implantation (TAVI) has been introduced to treat patients at high risk for conventional surgery; however, cardiogenic shock is considered a contraindication for TAVI. The aim of the present study was to evaluate early and intermediate mortality of patients in cardiogenic shock undergoing TAVI as a rescue procedure. Patients in cardiogenic shock underwent transapical TAVI with Edwards SAPIEN (Edwards Lifesciences, Irvine, CA, USA) prosthetic valves. Preoperative, perioperative and 1-year follow-up data were analysed. Analysis included 358 patients. Preoperative cardiogenic shock was present in 21 (5.9%) patients. EuroSCORE (cardiogenic shock 73.1&nbsp;&plusmn;&nbsp;18.9% vs. non-cardiogenic shock 36.0&nbsp;&plusmn;&nbsp;18.7%; P&nbsp;&lt;&nbsp;0.0001) and Society ...


The science behind percutaneous hemodynamic support: A review and comparison of support strategies
AbstractPatients in a variety of cardiovascular disease states may benefit from temporary percutaneous cardiac support, including those in acute decompensated heart failure, fulminant myocarditis, acute myocardial infarction with or without cardiogenic shock and those undergoing high‐risk percutaneous coronary intervention. The ideal percutaneous cardiac support device is safe, easy to use and versatile enough to meet the needs of various clinical situations and patient cohorts. In addition, it must provide maximal hemodynamic support and protection against myocardial ischemia. With these goals in mind, the scientific principles that govern hemodynamic effectiveness and myocardial protection as they pertain to acute support devices are reviewed. © 2012 Wiley Periodicals, Inc. (Source: C...


6 Months of “Temporary” Support by Levitronix Left Ventricular Assist Device
AbstractAn otherwise healthy 47‐year‐old man presented to the emergency department in cardiogenic shock after suffering a massive myocardial infarction due to left main occlusion. He was initially supported by extracorporeal membrane oxygenation and subsequently was converted to paracorporeal support with a Levitronix left ventricular assist device. He experienced multiple postoperative complications including renal failure, respiratory failure, retroperitoneal hematoma requiring suspension of anticoagulation, and fungal bloodstream infection precluding transition to an implantable device. He was reconditioned and successfully underwent orthotopic heart transplant 183 days after presentation. A discussion of the relevant issues is included. (Source: Artificial Organs)


Clinical outcomes following radial versus femoral artery access in primary or rescue percutaneous coronary intervention in Scotland: retrospective cohort study of 4534 patients
Conclusion Use of the radial artery for primary or rescue PCI is associated with improved clinical outcomes. (Source: Heart)


Cardiac valve replacement in patients with antiphospholipid syndrome
Conclusions:Morbidity and mortality was high in APS patients undergoing valve replacement surgery. Most complications were related to thrombosis and bleeding. Anticoagulation must be carefully monitored to prevent hemorrhagic and thrombotic complications. © 2012 by the American College of Rheumatology (Source: Arthritis Care and Research)


Two-Dimensional Strain Rate and Doppler Tissue Myocardial Velocities: Analysis by Echocardiography of Hemodynamic and Functional Changes of the Failed Left Ventricle during Different Degrees of Extracorporeal Life Support
Conclusions: VVI parameters are not useful in characterizing the failed left ventricle with rapidly varying load conditions. Tissue Doppler systolic velocities appear to be load independent and thus could help in the management of ECLS patients. (Source: Journal of the American Society of Echocardiography)


Metoclopramide: Fatal cardiogenic shock: case report
(Source: Reactions)


A Small Circular Structure in the Right Atrium: A Cause for Right Atrial and Ventricular Dilatation?
A 31-YEAR-OLD, 71-kg, 170-cm man was transferred emergently to the authors' institution for the management of cardiogenic shock and multisystem organ failure. He complained of a 2-day history of continuous left-sided chest pain, progressive dyspnea at rest, and orthopnea. The patient previously had undergone mitral valve, tricuspid valve, aortic root, and right coronary cusp repairs for endocarditis 16 months before the current admission. The physical examination revealed a harsh grade III of VI holosystolic murmur heard best along the right sternal border, tachypnea, coarse bilateral breath sounds with rales, jugular venous distention with hepatojugular reflux, and hepatomegaly. A laboratory analysis indicated that the hepatic transaminases (alanine and aspartate transaminases >1,000 IU/L...


The RECOVER I: A multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support
Objectives: Cardiogenic shock after cardiac surgery is accompanied by a high mortality rate. Early institution of hemodynamic support with a versatile, easy to insert left ventricular assist device might help bridge patients to recovery or to the next therapy, and improve the outcomes.Methods: Patients developing cardiogenic shock or low cardiac output syndrome after being weaned off cardiopulmonary bypass were enrolled in a prospective single-arm feasibility study (RECOVER I). The primary safety endpoint was the frequency of major adverse events (death, stroke) at 30 days or discharge, whichever was longer. The primary efficacy endpoint was survival of the patient to implementation of the next therapy, which included recovery at 30 days after device removal and bridge-to-other-therapy.Res...


Elective femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation: A useful tool
Conclusions: The use of cardiopulmonary bypass enhances safety in critical transcatheter aortic valve implantation procedures. Furthermore, transcatheter aortic valve implantation with cardiopulmonary bypass seems to provide better results than medical therapy or conventional aortic valve replacement in critically ill patients. The need for cardiopulmonary bypass emphasizes that the procedure should be performed only in cooperation between cardiologists and cardiac surgeons. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Percutaneous left ventricular support for high-risk PCI and cardiogenic shock: who gets what?
Conclusions: IABP compared with PLVAD use for high-risk PCI and CS is associated with significantly different baseline patient, clinical, procedural, and angiographic characteristics. In-hospital clinical outcome was similar between both groups in both the high-risk PCI and the CS cohorts. When physicians have access to each of these devices, short-term clinical outcome appears to be similar. (Source: Cardiovascular Revascularization Medicine)


EU approval for heart drug ivabradine
A pill costing £1.40 a day “could save the lives of thousands of heart disease patients”, according to the Daily Mail. Several other newspapers have reported on the drug ivabradine, known by the brand name Procoralan, as European drug regulators have today approved it for the treatment of chronic heart failure. In heart failure, the heart is unable to pump sufficient blood to the limbs and organs, causing a range of unpleasant symptoms such as weakness and breathlessness. The drug is already used to treat some patients with a form of heart-related chest pain called angina. After an examination of evidence by the European Medicines Agency (EMA), ivabradine has also been granted a “marketing licence” for the treatment of chronic heart failure. This will allow ivabradine’s manufact...


Cardiogenic shock induced by basal septal hypertrophy and left ventricular outflow tract dynamic obstruction in a critically ill patient with sepsis
Left ventricular outflow tract (LVOT) dynamic obstruction has been typically described in hypertrophic cardiomyopathy . However, basal septal hypertrophy (BSH), a frequently observed cardiac structural abnormality in elderly patients with hypertension, can also cause LVOT dynamic obstruction . In some cases, LVOT dynamic obstruction may result in a stroke volume reduction and hemodynamic deterioration . On the other hand, hypotension in sepsis is primarily caused by peripheral vasodilation rather than reduced cardiac output . Therefore, the proper identification of hemodynamic changes associated with hypotension is of clinical importance and therapies should be individualized in critically ill patients. Here, we report a case of cardiogenic shock induced by BSH and LVOT dynamic obstruction...


Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock
Conclusion: In patients with refractory cardiogenic shock of potentially reversible cause receiving ECMO support, early measurements of cardiac biomarkers are not useful for identifying those who would recover. (Source: Journal of Critical Care)


Case 2/2012: eleven-day-old infant with marked coarctation of the aorta in cardiogenic shock
O exercício físico mobiliza Células Progenitoras Endoteliais (CPE) para o sangue periférico. Entretanto, esse efeito parece depender de características do exercício, como duração e intensidade. O objetivo do presente trabalho foi verificar, por meio de revisão sistemática, o impacto de uma única sessão de exercício aeróbico sobre a mobilização de CPE em indivíduos sadios e os potenciais mecanismos envolvidos. A busca bibliográfica foi realizada nas bases de dados eletrônicas SciELO, LILACS, Cochrane, ClinicalTrials.gov, SPORTDiscus e Medline, em maio de 2011. Dos 178 estudos inicialmente identificados, 12 atenderam aos critérios de inclusão e foram classificados quanto à qualidade mediante critérios da escala PEDro. A magnitude e a duração da resposta de mobilizaç...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Plasma lactate as a predictor of survival from gastric dilatation-volvulus
Gastric dilatation-volvulus (GDV) in dogs is acute gastric distension with gas and rotation of the stomach along its mesenteric axis. The outcome can be fatal. The distended stomach impairs venous return, causing a decrease in stroke volume, cardiac output, and mean arterial pressures. Potential consequences include tissue hypoxia, gastric necrosis, myocardial ischemia, systemic inflammatory response syndrome, reperfusion injury, acid base and electrolyte disturbances, sepsis, endotoxemia, cardiogenic shock, circulatory collapse, and eventually death. (Source: Advances in Small Animal Medicine and Surgery)


Percutaneous ventricular assist device in hypertrophic obstructive cardiomyopathy with cardiogenic shock: bridge to myectomy.
We present the case of a 69-year-old woman with end-stage hypertrophic obstructive cardiomyopathy who developed cardiogenic shock. She underwent emergent placement of a percutaneous left ventricular assist device (TandemHeart) in the catheterization lab as a bridge support device until a septal myectomy could be performed as definitive treatment. This case suggests a novel and promising use of the TandemHeart as a bridge to myectomy. PMID: 22364991 [PubMed - in process] (Source: The Annals of Thoracic Surgery)


Implantation of the HeartWare HVAD in a Child After a Recent Thromboembolic Stroke.
We report the implantation of a HeartWare left ventricular assist device in a child. A 9-year-old girl presented in cardiogenic shock complicated by an embolic stroke. Catheter-based thrombolysis partially reversed the neurologic deficit, but worsening cardiac failure prompted consideration of mechanical circulatory support (MCS). Limited available pericardial space, anticoagulation requirements, and thromboembolic potential favored the use of the HeartWare left ventricular assist device (HeartWare International, Inc, Framingham, MA). After device implantation and intensive physical rehabilitation, the patient underwent successful cardiac transplantation after 60 days of support. PMID: 22364990 [PubMed - in process] (Source: The Annals of Thoracic Surgery)


A Systematic Review of Aluminium Phosphide Poisoning.
This article reviews the epidemiological, toxicological, and clinical/pathological aspects of AlP poisoning and its management. PMID: 22450207 [PubMed - as supplied by publisher] (Source: Arhiv za Higijenu Rada i Toksikologiju)


Gradual decline in the age-adjusted in-hospital mortality rate from STEMI-related cardiogenic shock irrespective of gender, with persistent higher mortality rate in women
Recent improvements in the care of critically ill patients should lead to better outcome. The goal of this study was to evaluate the age-adjusted mortality rate from STEMI-related cardiogenic shock in the United States over the last 10 years using a large database based on gender. (Source: Cardiovascular Revascularization Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Cardiogenic shock].
Authors: Rasche S, Georgi C Abstract Cardiogenic shock is most commonly a complication of acute myocardial infarction. The ischemic loss of functional myocardium triggers distinct cardiovascular responses which can deteriorate to global pump failure with a mortality rate of more than 50%. Causes of cardiogenic shock beyond myocardial ischemia are very diverse. Decisive management with rapid evaluation, identification of the underlying disease and urgent initiation of supportive measures as well as definitive therapy is of prognostic value. Causal treatment of the cardiac disease is crucial but has to be weighed against the specific surgical circumstances of perioperative patients, particularly concerning anticoagulation, platelet inhibition and bleeding risks. Hemodynamic stabiliza...


Cardiogenic shock in acute coronary syndromes-miles to go?
Authors: Salahuddin S, Bhargava B PMID: 22572492 [PubMed - in process] (Source: Indian Heart J)


Percutaneous coronary intervention in cardiogenic shock complicating acute ST-elevation myocardial infarction-a single centre experience.
CONCLUSION: Mortality remains high even with PCI. Achieving IRA patency with TIMI 3 flow is the main determinant of survival. Survival and functional status are good in patients who are discharged from hospital. PMID: 22572491 [PubMed - in process] (Source: Indian Heart J)


Short- and Long-Term Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention with Stenting for Acute Myocardial Infarction Complicated by Cardiogenic Shock
Cardiology 2012;121:47–55 (DOI:10.1159/000336154) (Source: Cardiology)


Cardiogenic Shock and Awe
Cardiology 2012;121:43–46 (DOI:10.1159/000336150) (Source: Karger Publishers)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Have Changes in ECMO Technology Impacted Outcomes in Adult Patients Developing Postcardiotomy Cardiogenic Shock?
Abstract  Extracorporeal membrane oxygenation (ECMO) technology has undergone several advancements over the last decade. We sought to compare current ECMO technology to older ones to determine how these technological improvements have impacted outcomes in patients suffering from postcardiotomy cardiogenic shock (PCS). Between 2005 and 2010, 49 patients received ECMO as support for PCS following elective cardiac surgery. Patients were divided into three groups. Group 1 (Gp 1, n = 11) patients received a Biomedicus pump with an Affinity oxygenator, Group 2 (Gp 2, n = 11) patients received a Biomedicus pump with a Quadrox D oxygenator, and Group 3 (Gp 3, n = 27) patients received a Rotaflow pump with a Quadrox D oxygenator. Groups were compared with regards to adverse events and ability to ...


Clinical Predictors for Failure of Percutaneous Coronary Intervention in ST‐elevation Myocardial Infarction
Conclusion: In patients with STEMI, primary PCI failure is uncommon. It is associated with worse short‐ and long‐term clinical outcome compared with a successful procedure. Special care should be taken when PCI is performed in women at higher risk for failure when presenting with STEMI. (J Interven Cardiol 2012;25:111–117) (Source: Journal of Interventional Cardiology)


Have Changes in ECMO Technology Impacted Outcomes in Adult Patients Developing Postcardiotomy Cardiogenic Shock?
Abstract  Extracorporeal membrane oxygenation (ECMO) technology has undergone several advancements over the last decade. We sought to compare current ECMO technology to older ones to determine how these technological improvements have impacted outcomes in patients suffering from postcardiotomy cardiogenic shock (PCS). Between 2005 and 2010, 49 patients received ECMO as support for PCS following elective cardiac surgery. Patients were divided into three groups. Group 1 (Gp 1, n = 11) patients received a Biomedicus pump with an Affinity oxygenator, Group 2 (Gp 2, n = 11) patients received a Biomedicus pump with a Quadrox D oxygenator, and Group 3 (Gp 3, n = 27) patients received a Rotaflow pump with a Quadrox D oxygenator. Groups were compared with regards to adverse events and ability to...


Implantation of the HeartWare HVAD in a Child After a Recent Thromboembolic Stroke [CASE REPORTS]
We report the implantation of a HeartWare left ventricular assist device in a child. A 9-year-old girl presented in cardiogenic shock complicated by an embolic stroke. Catheter-based thrombolysis partially reversed the neurologic deficit, but worsening cardiac failure prompted consideration of mechanical circulatory support (MCS). Limited available pericardial space, anticoagulation requirements, and thromboembolic potential favored the use of the HeartWare left ventricular assist device (HeartWare International, Inc, Framingham, MA). After device implantation and intensive physical rehabilitation, the patient underwent successful cardiac transplantation after 60 days of support. (Source: The Annals of Thoracic Surgery)


Percutaneous Ventricular Assist Device in Hypertrophic Obstructive Cardiomyopathy With Cardiogenic Shock: Bridge to Myectomy [CASE REPORTS]
We present the case of a 69-year-old woman with end-stage hypertrophic obstructive cardiomyopathy who developed cardiogenic shock. She underwent emergent placement of a percutaneous left ventricular assist device (TandemHeart) in the catheterization lab as a bridge support device until a septal myectomy could be performed as definitive treatment. This case suggests a novel and promising use of the TandemHeart as a bridge to myectomy. (Source: The Annals of Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: A pilot study.
Conclusions: In patients with CS following STEMI, 12-h lactate clearance &lt; 10% identifies a subset of patients at higher risk for death at short and long-term. PMID: 22356569 [PubMed - in process] (Source: Acute Cardiac Care)


Factors Predicting Early‐ and Long‐Term Survival in Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO)
Conclusions: Early ECMO application before catastrophic clinical deterioration and weaning as soon as possible may enhance overall survival.(J Card Surg 2012; **:1‐9) (Source: Journal of Cardiac Surgery)


Left heart bypass support with the Rotaflow Centrifugal Pump® as a bridge to decision and recovery in an adult
Abstract&nbsp;&nbsp;Since left heart bypass or biventricular circulatory assist with an extracorporeal centrifugal pump as a bridge to decision or recovery sometimes requires long-time support, the long-term durability of extracorporeal centrifugal pumps is crucial. The Rotaflow Centrifugal Pump® (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) is one of the centrifugal pumps available for long-term use in Japan. However, there have been few reports of left heart bypass or biventricular circulatory support over the mid-term. This is a case report of left heart bypass support with the Rotaflow Centrifugal Pump® as a bridge to decision and recovery for an adult patient who could not be weaned from cardiopulmonary bypass and percutaneous cardiopulmonary support after cardiac surgery. W...


Early and Mid‐Term Clinical Outcome of Emergency PCI in Patients with STEMI due to Unprotected Left Main Coronary Artery Disease
Conclusions:In patients with STEMI and ULMCA as culprit lesion, emergency PCI is a valuable therapeutic strategy. Early and mid‐term survival depends on cardiogenic shock, advanced age, and PCI failure. Patients surviving the first month have good mid‐term prognosis. (J Interven Cardiol 2012;**:1–8) (Source: Journal of Interventional Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Cystatin C as Prognostic Biomarker in ST-Segment Elevation Acute Myocardial Infarction
In conclusion, cystatin C is a new biomarker with significant added prognostic value for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, predicting both short- and long-term outcomes. (Source: The American Journal of Cardiology)


Scrub typhus in children at a tertiary hospital in southern India: Clinical profile and complications
Conclusions: High incidences of myocarditis and acute kidney injury were observed, which indicates that the children were treated at a late stage of the disease. Clinicians should be cognizant that myocarditis and acute kidney injury are serious manifestations of pediatric scrub typhus. (Source: Journal of Infection and Public Health)


Repeat Percutaneous Epicardial Mapping and Ablation of Ventricular Tachycardia:
Conclusions: Repeat access can be obtained after prior epicardial ablation. Adhesions from prior procedures may limit mapping, but can usually be disrupted mechanically and allow for ablation of recurrent VT. IPTA may not completely prevent adhesions. (J Cardiovasc Electrophysiol, Vol. pp. 1‐6) (Source: Journal of Cardiovascular Electrophysiology)


Repeat Percutaneous Epicardial Mapping and Ablation of Ventricular Tachycardia: Safety and Outcome
Conclusions: Repeat access can be obtained after prior epicardial ablation. Adhesions from prior procedures may limit mapping, but can usually be disrupted mechanically and allow for ablation of recurrent VT. IPTA may not completely prevent adhesions. (J Cardiovasc Electrophysiol, Vol. 23, pp. 744‐749, July 2012) (Source: Journal of Cardiovascular Electrophysiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Milrinone is preferred to levosimendan for mesenteric perfusion in hypoxia-reoxygenated newborn piglets treated with dopamine.
In conclusion, adding milrinone or levosimendan to dopamine similarly improved systemic hemodynamics in H-R newborn piglets. Milrinone also improved mesenteric perfusion and attenuated myocardial oxidative stress.Methods:Twenty-eight piglets (1-4 d, 1.5-2.5 kg) were instrumented for continuous monitoring of systemic MAP and pulmonary arterial pressure (PAP), CI, and carotid, superior mesenteric, and renal arterial flows. Piglets were randomized with blinding to sham-operated, H-R control (saline), and H-R dopamine (10 μg/kg/min) with D+M or D+L groups. H-R piglets underwent H-R followed by 2 h of drug infusion after reoxygenation. Tissue was collected for biochemical/oxidative stress testing and histological analysis. PMID: 22337258 [PubMed - in process] (Source: Pediatric Research)


Transthoracic Real Time Three‐Dimensional Echocardiography in Impella Placement
A 33‐year‐old patient with nonischemic cardiomyopathy presented with cardiogenic shock requiring percutaneous left ventricular assist device placement despite inotropic support. Under transthoracic two‐dimensional echocardiographic guidance, an Impella 2.5 L heart pump was placed. The inflow catheter was distal to the aortic valve, however patient remained in shock. Real time three‐dimensional transthoracic echocardiography showed the inflow catheter imbedded into the papillary muscle causing inlet occlusion. By cropping 3D data set in multiple planes, a better spatial visualization of the inflow catheter and its distance from the aortic valve was easily obtained and the device was adjusted. (Echocardiography 2012;29:E105‐E106) (Source: Echocardiography)


The prognostic impact of in-hospital worsening of renal function in patients with acute coronary syndrome
Abstract: Background: Renal impairment is strongly linked to adverse cardiovascular (CV) events. Baseline renal dysfunction is a strong predictor of CV mortality and morbidity in patients admitted with acute coronary syndrome (ACS). However, the prognostic importance of worsening renal function (WRF) in these patients is not well characterized.Methods: ACS patients enrolled in the SPACE (Saudi Project for Assessment of Coronary Events) registry who had baseline and pre-discharge serum creatinine data available were eligible for this study. WRF was defined as a 25% reduction from admission estimated glomerular filtration rate (eGFR) within 7days of hospitalization. Baseline demographics, clinical presentation, therapies, and in-hospital outcomes were compared.Results: Of the 3583 ACS patien...


Emergency Surgery for Native Mitral Valve Endocarditis: The Impact of Septic and Cardiogenic Shock.
CONCLUSIONS: Our study suggests that emergency surgery for ANMVE in patients with CS achieved satisfactory early and late results. In contrast, the presence of SS was linked to dismal early prognosis. Our findings need to be confirmed by further larger studies. PMID: 22342063 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain?
Conclusion: The Heart Foundation risk classification shows only fair predictive performance for MI, 7 and 30 day MACE. With specificity of approximately 50%, the recommendation for coronary care admission for all high‐risk patients is hard to justify. (Source: Emergency Medicine Australasia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Complex Ventricular Septal Rupture with Dissection of the Right Ventricular Wall in Ischemic Context
A 72‐year‐old man was admitted to the local hospital with non‐ST elevation myocardial infarction. In the first 24 hours, a new onset apical murmur was heard. Transthoracic and transesophageal echocardiography showed interventricular septal (IVS) rupture and dissection of the right ventricle (RV) wall forming an echolucent pseudocavity that partially occupied the RV and communicated with the true RV cavity. Multislice computed tomography characterized in detail the IVS and RV wall dissection, and further showed the right coronary artery in the outer border of the RV and pseudocavity, excluding pericardial fluid. Despite surgical correction, progression to cardiogenic shock and death occurred 33 days after admission.(Echocardiography ****;**:E1‐E4) (Source: Echocardiography)


Trends in the Incidence of Acute Kidney Injury in Patients Hospitalized With Acute Myocardial Infarction [Original Investigation]
Conclusions&nbsp; In a large national study, AKI incidence in patients hospitalized with AMI declined significantly from 2000 to 2008 despite the aging population and rising prevalence of AKI risk factors. These findings may reflect increased clinician awareness, better risk stratification, or greater use of AKI prevention efforts during this time period. (Source: Archives of Internal Medicine)


Complex Ventricular Septal Rupture with Dissection of the Right Ventricular Wall in Ischemic Context
A 72‐year‐old man was admitted to the local hospital with non‐ST elevation myocardial infarction. In the first 24 hours, a new onset apical murmur was heard. Transthoracic and transesophageal echocardiography showed interventricular septal (IVS) rupture and dissection of the right ventricle (RV) wall forming an echolucent pseudocavity that partially occupied the RV and communicated with the true RV cavity. Multislice computed tomography characterized in detail the IVS and RV wall dissection, and further showed the right coronary artery in the outer border of the RV and pseudocavity, excluding pericardial fluid. Despite surgical correction, progression to cardiogenic shock and death occurred 33 days after admission.(Echocardiography ****;**:E1‐E4) (Source: Echocardiography)


Hemodynamic Effects of Dexmedetomidine in Critically Ill Neonates and Infants With Heart Disease
Abstract&nbsp;&nbsp;The primary objective of this study was to evaluate the hemodynamic effects of dexmedetomidine (DEX) infusion on critically ill neonates and infants with congenital heart disease (CHD). The secondary objective of the study was to evaluate the safety and efficacy profile of the drug in this patient population. A retrospective observational study was conducted in the cardiovascular intensive care unit (CVICU) of a single tertiary care university children’s hospital. The charts of all neonates and infants who received DEX in the authors’ pediatric CVICU between August 2009 and June 2010 were retrospectively reviewed. The demographic data collected included age, weight, sex, diagnosis, and Risk Adjustment in Congenital Heart Surgery (RACHS-1) score. To evaluate th...


Correlation between clinical presentation and delayed-enhancement MRI pattern in myocarditis
Conclusions&nbsp;&nbsp;Contrast-enhanced MRI is useful both in the diagnosis and as a prognostic indicator in the clinical suspicion of myocarditis. Content Type Journal ArticleCategory Cardiac Radiology / CardioradiologiaPages 1-11DOI 10.1007/s11547-012-0790-xAuthors L. Natale, Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica S. Cuore, Rome, ItalyA. De Vita, Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica S. Cuore, Rome, ItalyC. Baldari, Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica S. Cuore, Rome, ItalyA. Meduri, Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica S. Cuore, Rome, ItalyM. Pieroni, Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica S. Cuore, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Post-Myocardial Infarction Cardiogenic Shock Is a Systemic Illness in Need of Systemic Treatment: Is Therapeutic Hypothermia One Possibility?
Early observations of cardiogenic shock as a systemic clinical syndrome were first described in 1942. Today, cardiogenic shock remains the leading cause of death among patients hospitalized for myocardial infarction (MI). Mortality rates in post-MI cardiogenic shock approach 50% despite rapid revascularization, optimal medical care, and use of mechanical support. New therapeutic strategies with global systemic effects may offer advances in treatment and outcome in post-MI cardiogenic shock. Therapeutic hypothermia for post-MI cardiogenic shock has multiple potentially beneficial physiologic effects, including the potential to improve post-ischemic cardiac function and hemodynamics, decrease myocardial damage, and reduce end-organ injury from prolonged hypoperfusion. Available data in anima...


Bridging cardiogenic shock patients with short-term ventricular support at a community hospital to long-term ventricular support at a tertiary hospital
Conclusion: Patients with cardiogenic shock in whom a STVAD was implanted in a CH and then were bridged to a LTVAD in a TH had similar long-term survival as those bridged to LTVAD at the TH. (Source: The Journal of Heart and Lung Transplantation)


Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock
Conclusion: ECMO support could improve survival in patients who suffer AMI associated with CS, and early ECMO initiation yields better outcomes (successful ECMO weaning). (Source: Resuscitation)


Hypothermia Might Boost Survival in MI ShockHypothermia Might Boost Survival in MI Shock
Some data suggest therapeutic hypothermia might reduce the currently high mortality from cardiogenic shock; let's do the necessary clinical studies to see whether it might be true, urges a published viewpoint. Heartwire (Source: Medscape Today Headlines)


MI-shock proposal is cold comfort: Hypothermia might boost survival
Some data suggest therapeutic hypothermia might reduce the currently high mortality from cardiogenic shock; let's do the necessary clinical studies to see whether it might be true, urges a published viewpoint. (Source: theHeart.org)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Feasibility and efficacy of bypassing the right ventricle and pulmonary circulation to treat right ventricular failure: an experimental study
Conclusions: Bypassing the right ventricle and pulmonary circulation with an oxygenating assist device, which may offer the advantages of enhanced right ventricular decompression and augmented left atrial filling, is feasible and effective in the treatment of acute RVF. Long time experiments are needed. (Source: Journal of Cardiothoracic Surgery)


Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock: A Meta-Analysis
Conclusion: The present meta-analysis suggests that patients with high-risk AMI without cardiogenic shock do not seem to benefit from the use of IABP as measured by in-hospital mortality, rate of reinfarction, and recurrent angina. However, in patients with AMI with cardiogenic shock (systolic blood pressure [SBP] &lt; 90), there was significant reduction in mortality using IABP. The use of IABP is associated with increase in the rate of both moderate and severe bleeding. (Source: Journal of Cardiovascular Pharmacology and Therapeutics)


Fluoxetine/venlafaxine overdose: Cardiogenic shock and serotonin syndrome: case report
(Source: Reactions)


Emergency Cardiopulmonary Bypass: A Promising Rescue Strategy for Refractory Cardiac Arrest
Emergency cardiopulmonary bypass (ECPB) has been investigated experimentally and clinically as an advanced resuscitation method that may rescue patients with refractory cardiac arrest or cardiogenic shock unresponsive to traditional medical interventions. By diverting blood flow from the patient to an extracorporeal heart and lung system capable of providing full cardiac output, ECPB can provide blood flow and gas exchange to the patient when there is not the capability of the patient's heart or lungs to sustain these functions intrinsically. This method extends the time window for successful interventions to correct the underlying pathophysiology leading to arrest or shock. (Source: Critical Care Clinics)


Intra-aortic Balloon Counterpulsation and Infarct Size in Patients with Acute Anterior Myocardial Infarction without Shock: The CRISP AMI Randomized Trial: Patel MR, Smalling RW, Thiele H, et al. JAMA 2011;206:1329–37.
In animal models, use of intra-aortic balloon counterpulsation (IABC) before reperfusion after myocardial infarction augments coronary blood flow, unloads the left ventricle, and reduces myocardial oxygen demand, thereby reducing infarct size. The CRISP AMI (Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction) trial was a prospective, open, international, multicenter (n=30) randomized controlled trial to determine whether routine use of IABC before percutaneous coronary intervention (PCI) in patients with anterior ST-segment elevation myocardial infarction (STEMI) without shock would reduce MI size compared to PCI alone. Inclusion criteria were adult patients within 6h of chest pain onset with an electrocardiogram demonstrating ST-segment elevation of 2mm or higher ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Miedema MD, Newell, MC, Duval S. Circulation 2011;124:1636–44.
Primary percutaneous coronary intervention (PCI) has been shown to decrease mortality in a linear fashion, yet only 25% of United States hospitals have PCI capabilities. The European Society of Cardiology guidelines have recently adopted a goal for total door-to-balloon time of 120min for transferred ST-segment-elevation myocardial infarction (STEMI) patients, whereas the American College of Cardiology/American Heart Association gives no recommendation for transferred patients, but states a door-to-balloon time of 90min for primary PCI. This was a single-center prospective, observational study of patients with the diagnosis of STEMI, who were transferred for PCI. There were 2034 patients over 5 years from 31 hospitals, including 11 hospitals within 60 miles of the PCI center (designated zo...


Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction.
We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung. PMID: 22323871 [PubMed - in process] (Source: J Korean Med Sci)


How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain?
Conclusion: The Heart Foundation risk classification shows only fair predictive performance for MI, 7 and 30 day MACE. With specificity of approximately 50%, the recommendation for coronary care admission for all high‐risk patients is hard to justify. (Source: Emergency Medicine Australasia)


Transthoracic Real Time Three‐Dimensional Echocardiography in Impella Placement
A 33‐year‐old patient with nonischemic cardiomyopathy presented with cardiogenic shock requiring percutaneous left ventricular assist device placement despite inotropic support. Under transthoracic two‐dimensional echocardiographic guidance, an Impella 2.5 L heart pump was placed. The inflow catheter was distal to the aortic valve, however patient remained in shock. Real time three‐dimensional transthoracic echocardiography showed the inflow catheter imbedded into the papillary muscle causing inlet occlusion. By cropping 3D data set in multiple planes, a better spatial visualization of the inflow catheter and its distance from the aortic valve was easily obtained and the device was adjusted. (Echocardiography ****;**:E1‐E2) (Source: Echocardiography)


Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation
AbstractThe novel Permanent Life Support (PLS; Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) as peripheral veno‐arterial extracorporeal membrane oxygenation (ECMO) support system has been investigated as treatment for patients with refractory cardiogenic shock (CS). Between January 2007 and July 2011, 73 consecutive adult patients were supported on peripheral PLS ECMO system at our institution (55 men; age 60.3 ± 11.6 years, range: 23–84 years). Indications for support were failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 50) and primary donor graft failure (n = 8), post‐acute myocardial infarction CS (n = 12), and CS on chronic heart failure (n = 3). Mean support time was 10.9 ± 7.6 days (range: 2–34 days)...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Early and Mid‐Term Clinical Outcome of Emergency PCI in Patients with STEMI due to Unprotected Left Main Coronary Artery Disease
Conclusions:In patients with STEMI and ULMCA as culprit lesion, emergency PCI is a valuable therapeutic strategy. Early and mid‐term survival depends on cardiogenic shock, advanced age, and PCI failure. Patients surviving the first month have good mid‐term prognosis. (J Interven Cardiol 2012;**:1–8) (Source: Journal of Interventional Cardiology)


Clinical Predictors for Failure of Percutaneous Coronary Intervention in ST‐elevation Myocardial Infarction
Conclusion: In patients with STEMI, primary PCI failure is uncommon. It is associated with worse short‐ and long‐term clinical outcome compared with a successful procedure. Special care should be taken when PCI is performed in women at higher risk for failure when presenting with STEMI. (J Interven Cardiol 2012;**:1–7) (Source: Journal of Interventional Cardiology)


Refractory Spasm of Coronary Arteries and Grafted Conduits After Isolated Coronary Artery Bypass Surgery [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Diffuse RVS after CABG is a rare but lethal condition. Our experience, although limited, indicates that in such cases an aggressive treatment, that is, prompt extracorporeal membrane oxygenation institution and controlled cardiocirculatory assistance, represents the preferred solution to face such a dramatic event and may save patient lives. (Source: The Annals of Thoracic Surgery)


Resuscitation of non-postcardiotomy cardiogenic shock or cardiac arrest with extracorporeal life support: The role of bridging to intervention
Abstract: Background: To investigate the predictors of adverse outcomes of extracorporeal life support (ECLS) in rescuing adult non-postcardiotomy cardiogenic shock or cardiac arrest (non-PC CS/CA).Materials and methods: This retrospective study included 60 adult patients receiving ECLS for non-PC CS/CA in a single institution between June 2003 and June 2010. The exclusion criteria were (1) pre-ECLS cardiac surgeries in the same admission and (2) age (Source: Resuscitation)


Reply
We welcome Drs. Kalra and Fenster's interest in our work delineating the association between renal function–based contrast dose and the risk of renal complications in patients undergoing percutaneous coronary intervention (). They argued that in high-risk patients, and especially among patients with cardiogenic shock, the incidence of contrast-induced nephropathy (CIN) is unacceptably high, even when the ratio of contrast volume to creatinine clearance is (Source: Journal of the American College of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Giant congenital cervical teratoma: case report and review about therapeutic options
OBJETIVO:Relatar um caso de teratoma cervical congênito, destacando a gravidade e as dificuldades terapêuticas associadas. DESCRIÇÃO DO CASO: Mãe de 30 anos, com gestação por fertilização assistida. Com 23 semanas, diagnosticada malformação cervical fetal à direita. Parto cesáreo por indicação fetal com 31 semanas. Recém-nascido masculino, peso ao nascer de 1800g, Apgar 4 e 9, com volumoso processo expansivo à direita, ocupando toda a região cervical, comprometendo a mandíbula e estendendo-se para o terço superior do tórax. Com 40 horas de vida, apresentou insuficiência cardíaca congestiva de alto débito por roubo de fluxo pelo tumor. A partir de 54 horas de vida, houve progressiva deterioração hemodinâmica e respiratória, com hipotensão, anúria e labilidade d...


High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: A pilot randomized controlled trial
Conclusion: This study found no evidence of benefit or harm from high-concentration compared with titrated oxygen in initially uncomplicated STEMI. However, our estimates have wide CIs, and as a result, large randomized controlled trials are required to resolve the clinical uncertainty. (Source: American Heart Journal)


Surgical Outcomes for Type-A Aortic Dissection in Septuagenarians and Octogenarians
Conclusions: Data suggest that despite high morbidity and mortality, satisfactory long-term survival can be achieved for 70- and 80-year-old patients requiring surgical treatment for TAAD. However, interpretation of this study, and other similar ones, must account for a likely high degree of bias in selection of only the good-risk (elderly) patients for surgery. in elderly patients treated surgically for TAAD, EF predicts mortality in the younger portion of this (elderly) group. This trend diminishes as age increases. (Source: Journal of Surgical Research)


Characteristics, management and outcomes of patients with acute coronary syndrome and prior coronary artery bypass surgery: findings from the second Gulf Registry of Acute Coronary Events{star}
Conclusions: ACS patients from Middle East countries with prior CABG have adverse baseline characteristics, reported higher GRACE risk score, multivessel disease, more severe LV dysfunction, cardiogenic shock, in-hospital major bleeding, but with less incidence of STEMI with less prominent surge of cardiac biomarkers. However, there was no significant difference in mortality during hospitalization, at 30&nbsp;days and at one year between ACS patients with and without prior CABG. The reasons for this 'risk-mortality' paradox need to be further evaluated. (Source: Interactive CardioVascular and Thoracic Surgery)


Basilar artery occlusion after acute myocardial infarction
We recognize the article “concomitant acute right ventricular infarction and ischemic cerebrovascular stroke; possible explanations” by Omar et al. as an interesting and important report of combined myocardial infarction and ischemic cerebrovascular insult. Of notice, the exceptionally short interval between the two events and the circumstance of a prolonged cardiogenic shock suggests a water shed infarction – possibly on the basis of preexisting cerebrovascular disease – as the mechanism of disease. In contrast, in our case myocardial infarction proceeded cerebral insult by twelve hours and the patient was hemodynamically stable which makes a cardioembolic insult more likely. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Use and Outcomes of Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the EHS-PCI Registry)
In conclusion, MV-PCI is currently used in only 1/4 of patients with CS and MVD. An additional nonculprit PCI was not associated with a survival benefit in these high risk patients. (Source: The American Journal of Cardiology)


Mechanical circulatory support for elderly heart failure patients
Abstract&nbsp;&nbsp;End-stage systolic heart failure is an increasingly common problem in elderly patients and is associated with high cost, poor quality of life, and poor outcomes. Mechanical circulatory support is a promising therapy as both a bridge to transplantation and destination therapy. Elderly patients are frequently ineligible for heart transplantation because of their age and comorbidities, and the application of mechanical circulatory support for destination therapy in this population is not well defined. A review of the literature was undertaken to better characterize our experience to date with mechanical circulatory support in older heart failure populations. Mechanical circulatory support is being employed increasingly for destination therapy indications in older pat...


Outcomes of primary percutaneous coronary intervention for acute myocardial infarction with unprotected left main coronary artery occlusion
Conclusions: Despite performance of primary PCI, patients with AMI due to LMCA occlusion were associated with &gt;50% in‐hospital mortality. Hemodynamic deficit upon arrival was the major determinant of their poor hospital outcomes. The hospital survivors, however, were associated with favorable long‐term outcomes. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Complete Heart Block during Potassium Therapy in Thyrotoxic Periodic Paralysis
Conclusion: A paradoxical fall in serum K+ concentration with potentially life-threatening complication is still underappreciated in patients with TPP on KCl supplementation. Early recognition and prompt therapy prevent untoward consequences. (Source: The Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Interleukin-6, -7, -8 and -10 predict outcome in acute myocardial infarction complicated by cardiogenic shock
Conclusion&nbsp;&nbsp;The inflammatory response in patients with myocardial infarction complicated by cardiogenic shock, as reflected by the inflammatory markers IL-6, IL-7, IL-8 and IL-10, demonstrates a clinically relevant prognostic contribution to clinical outcome. Content Type Journal ArticleCategory Original PaperPages 1-10DOI 10.1007/s00392-011-0403-3Authors Roland Prondzinsky, Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, GermanySusanne Unverzagt, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, GermanyHenning Lemm, Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, GermanyNikolas-Arne Wegener, Department of Medicine III, Martin...


Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?
Conclusion Acute myocardial infarction with RBBB is frequently caused by the complete occlusion of the infarct-related artery and is more frequently treated with primary PCI when compared with AMI + LBBB. In-hospital mortality of patients with AMI and RBBB is highest from all ECG presentations of AMI. Restoration of coronary flow by primary PCI may lead to resolution of the conduction delay on the discharge ECG. Right bundle branch block should strongly be considered for listing in future guidelines as a standard indication for reperfusion therapy, in the same way as LBBB. (Source: European Heart Journal)


Temporary Mechanical Circulatory Support for Takotsubo Cardiomyopathy Secondary to Primary Mediastinal B‐Cell Lymphoma
Conclusions: This is the first report of temporary MCS to treat inverted TC and diffuse PMBL. (J Card Surg 2012;27:119–121) (Source: Journal of Cardiac Surgery)


Cardiogenic shock: do not forget the possibility of Kawasaki disease.
We report the case of a six-year-old boy who presented with cardiogenic shock due to Kawasaki disease (KD). He was misdiagnosed at first as septic shock. After careful examination, he was diagnosed as KD complicated with acute coronary syndrome, which leads to cardiogenic shock. Cardiogenic shock is often neglected as a complication of KD, and it tends to be misdiagnosed. We hereby call attention to KD, in some cases of which, it can lead to acute coronary syndrome in the acute phase. PMID: 22397053 [PubMed - in process] (Source: The Turkish Journal of Pediatrics)


Electrocardiographic pattern combined with echocardiographic wall motion abnormalities in stress related cardiomyopathies: clinical and pathophysiological insights.
We report five cases of stress related cardiomyopahies that occurred in post-menopausal women (age range from 49 to 90) consecutively admitted to our Department in the last year in different clinical settings: typical anginal pain, carotid endarterectomy, pulmonary edema, cardiogenic shock, and severe asthenia. Apical left ventricular involvement was observed in three patients in conjunction with ECG mild ST segment elevation in anterior precordial leads resembling acute anterior myocardial infarction; isolated mid ventricular dysfunction was present in two patients in conjunction with ST segment depression in the anterior precordial leads. The ECG evolved showing T wave inversion in four cases and normalized in one. In all cases, blood chemistry showed mild elevation of CK-MB and TN. The ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing primary angioplasty.
Conclusions: The TIMI risk score for STEMI prior to primary PCI can predict in hospital mortality and identifies a group of high-risk patients who might develop adverse events. PMID: 22452860 [PubMed - as supplied by publisher] (Source: Archivos de Cardiologia de Mexico)


Submitral aneurysm of the left ventricle.
Authors: Baruah DK, Kumar PV, Reddy GS, Babu VR Abstract Submitral aneurysm is a rare cardiac pathology of uncertain origin with varied clinical manifestations. Recent studies have revealed a congenital basis of this pathology, although genetic link has been suspected because of the racial predilection. The other suggested aetiologies are infection and inflammation. The case reported here is that of a young female with a large submitral aneurysm presenting in a state of cardiogenic shock. In addition, the presence of raised inflammatory parameters indicates that the cause of origin of this aneurysm is related to inflammation. PMID: 22572430 [PubMed - in process] (Source: Indian Heart J)


Electrocardiographic pattern combined with echocardiographic wall motion abnormalities in stress related cardiomyopathies: clinical and pathophysiological insights.
We report five cases of stress related cardiomyopahies that occurred in post-menopausal women (age range from 49 to 90) consecutively admitted to our Department in the last year in different clinical settings: typical anginal pain, carotid endarterectomy, pulmonary edema, cardiogenic shock, and severe asthenia. Apical left ventricular involvement was observed in three patients in conjunction with ECG mild ST segment elevation in anterior precordial leads resembling acute anterior myocardial infarction; isolated mid ventricular dysfunction was present in two patients in conjunction with ST segment depression in the anterior precordial leads. The ECG evolved showing T wave inversion in four cases and normalized in one. In all cases, blood chemistry showed mild elevation of CK-MB and TN. The ...


The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing primary angioplasty.
Conclusions: The TIMI risk score for STEMI prior to primary PCI can predict in hospital mortality and identifies a group of high-risk patients who might develop adverse events. PMID: 22452860 [PubMed - as supplied by publisher] (Source: Archivos de Cardiologia de Mexico)


Cardiogenic shock: do not forget the possibility of Kawasaki disease.
We report the case of a six-year-old boy who presented with cardiogenic shock due to Kawasaki disease (KD). He was misdiagnosed at first as septic shock. After careful examination, he was diagnosed as KD complicated with acute coronary syndrome, which leads to cardiogenic shock. Cardiogenic shock is often neglected as a complication of KD, and it tends to be misdiagnosed. We hereby call attention to KD, in some cases of which, it can lead to acute coronary syndrome in the acute phase. PMID: 22397053 [PubMed - indexed for MEDLINE] (Source: The Turkish Journal of Pediatrics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Stent Thrombosis Presenting With Cardiogenic ShockStent Thrombosis Presenting With Cardiogenic Shock
This 68-year-old man complained of chest pain and rapidly developed cardiogenic shock 48 hours after primary percutaneous coronary intervention. What was the cause? Journal of Medical Case Reports (Source: Medscape Today Headlines)


Neurogenic stunned myocardium as a manifestation of encephalitis involving cerebellar tonsils
Neurogenic stunned myocardium is defined as a myocardial injury or dysfunction after neurological insults. It is most commonly reported in patients with subarachnoid hemorrhage, and the presenting symptoms may mimic an acute myocardial infarction or myocarditis. In severe cases, cardiogenic shock and acute pulmonary edema may occur and lead to a devastating event. Therefore, it requires prompt recognition and proper intervention. We herein report the case of a 25-year-old woman who presented to our hospital with the symptoms of acute pulmonary edema, shock, and consciousness disturbance. The diagnosis of encephalitis of cerebellar tonsils complicated with acute hydrocephalus and neurogenic stunned myocardium was made. Detailed neurologic examinations, neuroimaging studies, and characterist...


Impact of preoperative percutaneous cardiopulmonary support on outcome following left ventricular assist device implantation.
Conclusions: Despite adequate hemodynamic support after LVAD implantation, patients with preoperative PCPS had significantly worse survival. LVAD should be used for patients with end-stage heart failure, before PCPS is required for hemodynamic support. (Circ J 2012; 76: 88-95). PMID: 22139359 [PubMed - in process] (Source: Circulation Journal)


Gender differences in the manifestation of tako-tsubo cardiomyopathy
Conclusions: In this large TTC registry, males and females showed a similar clinical profile. In males, physical stress as a trigger event and shock or cardiac arrest as presenting symptoms were more frequent. The QTc interval was longer in females only on admission but similar in males and females during the following days. (Source: International Journal of Cardiology)


Giant Syphilitic Aortic Aneurysm Presenting With Pericardial Tamponade as an Initial Sign
A previously healthy 38-year-old man presented to our hospital with sudden-onset dyspnea, sharp, stabbing chest pain, and a clinical picture of cardiogenic shock. Echocardiography revealed a severely dilated ascending aorta beyond the sinotubular junction (A, Online Video 1), with moderate aortic insufficiency (Online Video 2). There was a large pericardial effusion with thrombus inside (Online Videos 1 and 3). Computed tomographic angiography was performed, with a presumptive diagnosis of aortic dissection with rupture into the pericardium, and demonstrated a dilated ascending aorta 100 mm in diameter (B, C) compressing the right atrium, with no visible intimal tear or flap. (Source: Journal of the American College of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Reimplantation of Anomalous Single Coronary Artery From Pulmonary Artery: Diagnosis and Surgical Management [CASE REPORTS]
A newborn presented in cardiogenic shock with the diagnosis of anomalous single coronary artery from pulmonary artery and was successfully revived with prostaglandin (PGE1) infusion. She underwent surgical implantation of her coronary arteries while receiving PGE1 infusion to maintain high oxygen tension for the coronaries during cardiopulmonary bypass. She was discharged in 2 weeks with good biventricular function and moderate mitral regurgitation. At 2 months follow-up, she was gaining weight with preserved ventricular function and moderate mitral regurgitation. (Source: The Annals of Thoracic Surgery)


Extracorporeal membrane oxygenation with hemoconcentration in a hypervolemic patient with critical aortic stenosis.
Authors: Gregoric ID, Kar B, Gholkar G, Patel S, Crane T, Nathan S, Loyalka P Abstract Herein, we describe the case of a 60-year-old man with severe nonischemic cardiomyopathy and hypervolemia. By means of venoarterial extracorporeal membrane oxygenation at the bedside, along with hemoconcentration, the patient was resuscitated from severe cardiogenic shock and normal blood volume was restored. Within 24 hours, he was able to undergo a high-risk aortic valve replacement for severe aortic stenosis, with a successful outcome. To our knowledge, this is the first reported case in which hemoconcentration with extracorporeal membrane oxygenation has been used to support a patient with severe hypervolemia. PMID: 22163137 [PubMed - in process] (Source: Texas Heart Institute Journal)


Usefulness of Transient and Persistent No Reflow to Predict Adverse Clinical Outcomes Following Percutaneous Coronary Intervention
The no reflow phenomenon is reported to occur in >2% of all percutaneous coronary interventions (PCIs) and portends a poor prognosis. We analyzed data from 5,286 consecutive patients who underwent PCI from the Melbourne Interventional Group (MIG) registry from April 2004 through January 2008 who had 30-day follow-up completed. Patients without no reflow (normal reflow, n = 5,031) were compared to 255 (4.8%) with no reflow (n = 217 for transient no reflow, n = 38 for persistent no reflow). Patients with transient or persistent no reflow were more likely to present with ST-elevation myocardial infarction (MI) or cardiogenic shock (p (Source: The American Journal of Cardiology)


Random plasma glucose measurement may improve the diagnostic specificity of highly sensitive troponin in the emergency department
Hyperglycemia is frequently observed in patients with acute myocardial infarction (AMI) and is associated with an increased hospital mortality, in both diabetic and non-diabetic patients, and especially in the younger subjects . The concentration of random plasma glucose at emergency department (ED) admission is also an independent predictor of cardiac outcome, including congestive heart failure, cardiogenic shock, and death after acute myocardial infarction . Nevertheless, the usefulness of random plasma glucose assessment has not been previously investigated in the diagnostic workout of AMI to the best of our knowledge. (Source: International Journal of Cardiology)


Quiz Page January 2012: Acute Kidney Injury With Hematuria, a Positive ANCA Test, and Low Levels of Complement
A 74-year-old man with a history of ischemic heart disease, atrial fibrillation, implanted cardiac defibrillator, congestive heart failure, pulmonary embolus, type 2 diabetes mellitus, and benign prostatic hypertrophy was admitted in cardiogenic shock. He described feeling unwell with intermittent fevers and increasing breathlessness during the past year. On presentation, he received inotropic support and aggressive diuresis. Transthoracic echocardiography showed ejection fraction of 25%-30% with normal valves and no vegetation, changed from a previous echocardiogram that showed ejection fraction of 40%-45% and no vegetation. (Source: American Journal of Kidney Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy
Conclusions: Patients undergoing PDT have significant short-term mortality with 11% dying within 14 days and an in-hospital mortality rate of 30%. We identified an index diagnosis of ventilator-associated pneumonia and trauma to be associated with a higher survival rate, whereas older age, oncological diagnosis, cardiogenic shock, and ventricular-assist devices were associated with higher mortality. There is significant heterogeneity in both underlying diagnosis and patient outcomes, and these factors should be considered when deciding to perform this procedure and discussed with patients/family members to provide a realistic expectation of potential prognosis. (Source: Journal of Critical Care)


Single-bolus tenecteplase plus heparin compared with heparin alone for normotensive patients with acute pulmonary embolism who have evidence of right ventricular dysfunction and myocardial injury: Rationale and design of the Pulmonary Embolism Thrombolysis (PEITHO) trial
Conclusions: By determining the benefits vs risks of thrombolysis in submassive or intermediate-risk PE, this trial is expected to answer a long-standing query on the management of this patient population. (Source: American Heart Journal)


On-pump versus off-pump coronary artery bypass surgery in high-risk patients: Operative results of a prospective randomized trial (on-off study)
Conclusions: Off-pump coronary artery bypass grafting reduces early mortality and morbidity in high-risk patients. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Acute kidney injury after cardiac arrest
We examined the renal outcomes of adult patients admitted to the intensive care unit (ICU), who survived for more than 48h following successful resuscitation after CA.Results: Of 105 patients (median age 65 years; 69% male), 58 (55.2%) had PRCS and were on vasoactive drugs beyond 24h; and 9 (8.6%) (all of whom had PRCS) received renal replacement therapy. Only 3 (6.4%) of 47 patients without PRCS had RIFLE-‘I’/‘F’ AKI, compared to 30 (51.7%) of 58 patients with PRCS (p (Source: Resuscitation)


Randomized Study on the Efficacy and Safety of Landiolol, an Ultra-Short-Acting β1-Adrenergic Blocker, in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
Conclusions: Early intravenous administration of landiolol in patients with AMI undergoing PCI is safe and has the potential to improve cardiac function and inhibit cardiac remodeling in the chronic phase. PMID: 22156314 [PubMed - as supplied by publisher] (Source: Circulation Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Stress-Induced Cardiomyopathy Caused by Heat Stroke
Heat stroke is defined by central nervous system abnormalities and failure of proper maintenance of thermoregulation as a result of high core body temperature ensuing from exposure to high environmental temperatures or strenuous exercise. Common complications include acute respiratory distress syndrome, disseminated intravascular coagulation, acute renal injury, hepatic injury, and rhabdomyolysis. Myocardial injury may also occur during heat stroke, resulting in cardiac enzyme increase and ST-segment changes on the ECG. Such findings might behave as diagnostic pitfalls by mimicking the presentation of coronary artery occlusive myocardial infarction. A previous case report described a patient with heat stroke and ST-segment elevation, in which the definite cause of the ST-segment elevation ...


Concurrent drug eluting/bare metal stent implantation during percutaneous coronary intervention in target vessel: outcomes and 1-year follow-up
Conclusions&nbsp;&nbsp;Concurrent BMS/DES stenting is associated with an increase in in-hospital but not long-term mortality. Further, there was a significant increase in recurrent myocardial infarction and TVR, but absolute differences were low. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00392-011-0390-4Authors Alessandro Cuneo, Abteilung für Kardiologie, Asklepios Klinik St-Georg, Hamburg, GermanyPeter Bramlage, Institut für Pharmakologie und präventive Medizin, Mahlow, GermanyMatthias Hochadel, Stiftung Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, GermanyJochen Senges, Stiftung Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, GermanyChristoph Nienabe...


Bleeding complications in primary percutaneous coronary intervention of ST‐elevation myocardial infarction in a radial center
Conclusions: In the setting of radial primary PCI, the rates and types of bleeding complications are somewhat different from those observed with femoral primary PCI. The gastro‐intestinal tract has become the most frequent site of bleeding after radial primary PCI. The use of radial access appears independently associated with survival. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)


Bilateral coronary ostial stenoses post‐bentall procedure causing hemodynamic collapse and requiring mechanical assist device placement: Successful intervention using the Szabo technique
We report an unusual case of a patient who developed acute cardiogenic shock within hours following a Bentall procedure, requiring urgent mechanical assist device support. Coronary angiography revealed significant bilateral coronary ostial stenoses; suggesting global cardiac hypoperfusion as the cause for this acute hemodynamic collapse. Given the disturbed coronary anatomy, the novel Szabo technique was used to accurately position and deploy an ostial right and then an ostial left main coronary stent, with excellent angiographic results. We conclude that even in situations with altered coronary anatomy, the Szabo technique should be considered for any patient requiring precise aorto‐ostial stent placement. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventi...


Cyclosporine treatment improves mesenteric perfusion and attenuates necrotizing enterocolitis (NEC)-like intestinal injury in asphyxiated newborn piglets during reoxygenation
Conclusions&nbsp;&nbsp;This is the first study to demonstrate that post-resuscitation administration of cyclosporine improves mesenteric perfusion and attenuates NEC-like intestinal injury in newborn piglets following asphyxia-reoxygenation. Content Type Journal ArticleCategory Pediatric OriginalPages 1-9DOI 10.1007/s00134-011-2436-5Authors Richdeep S. Gill, Department of Surgery, University of Alberta, Edmonton, AB, CanadaNamdar Manouchehri, Department of Surgery, University of Alberta, Edmonton, AB, CanadaTze-Fun Lee, Department of Pediatrics, University of Alberta, Edmonton, AB, CanadaWoo Jung Cho, Department of Molecular Biology, Princeton University, Princeton, NJ, USAAducio Thiesen, Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, Cana...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intraaortic Balloon Pump: Incidence and Predictors of Complications in the Florence Registry
Conclusions:In consecutive patients treated with IABP support, the degree of hemodynamic impairment and the decrease in platelet count were independent predictors of complications, whose development was associated with higher in‐ICCU mortality. © 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)


Characteristics, management and outcomes of patients with acute coronary syndrome and prior coronary artery bypass surgery: findings from the second Gulf Registry of Acute Coronary Events{star} [Follow-up papers - Cardiac general]
Conclusions: ACS patients from Middle East countries with prior CABG have adverse baseline characteristics, reported higher GRACE risk score, multivessel disease, more severe LV dysfunction, cardiogenic shock, in-hospital major bleeding, but with less incidence of STEMI with less prominent surge of cardiac biomarkers. However, there was no significant difference in mortality during hospitalization, at 30&nbsp;days and at one year between ACS patients with and without prior CABG. The reasons for this 'risk-mortality' paradox need to be further evaluated. (Source: Interactive CardioVascular and Thoracic Surgery)


Relationship Between White Blood Cell Count and In-Hospital Outcomes in Acute Coronary Syndrome Patients From the Middle East
We evaluated the relationship between admission white blood cell (WBC) count and in-hospital outcomes in acute coronary syndrome (ACS) patients from the Middle East. Data were analyzed from 7806 consecutive patients with ACS who were divided into 4 groups (G) according to their WBC count (x109/L; G1: &lt;6.00; G2: 6.00-9.99; G3: 10.00-11.99; G4: &ge;12.00). After significant covariate adjustment, those in G4 were 68% more likely to have cardiogenic shock than those in G1 (95% confidence interval [CI]: 1.05-2.68; P = .030) and G2 (odds ratio [OR], 2.02; 95% CI: 1.51-2.71; P &lt; .001). Those in G4 were 2.02 times (95% CI: 1.11-3.67; P = .021) and 65% (95% CI: 1.17-2.32; P = .004) more likely to die in hospital than those in G1 and G2, respectively. Admission WBC count is an independent risk...


Fentanyl/propofol: Cardiogenic shock: case report
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Fosphenytoin: Cardiogenic shock: case report
(Source: Reactions)


Trends and predictors of length of stay after primary percutaneous coronary intervention: A report from the CathPCI Registry
Conclusions: While the predicted risk profile has remained stable, there has been a significant decrease in LOS after PPCI. Nevertheless, hospitals vary in discharging low-risk and uncomplicated patients early. Discharge within 2 days was associated with specific patient, procedure, and hospital factors. Further study is needed to determine the safety of early discharge among patients undergoing PPCI. (Source: American Heart Journal)


Successful Use of the TandemHeart Percutaneous Ventricular Assist Device as a Bridge to Recovery for Acute Cellular Rejection in a Cardiac Transplant Patient
In this report, we presented a patient who benefited from hemodynamic support with the TandemHeart Percutaneous Ventricular Assist Device (pVAD; Cardiac Assist, Inc) implantation in the setting of early acute graft rejection 2 months after orthotopic heart transplant. The TandemHeart initially had been used for temporary hemodynamic assistance during postcardiotomy heart failure and high-risk coronary interventions. More recently, its use in patients with cardiogenic shock from acute myocardial infarction, fulminant myocarditis, and critical aortic stenosis has been reported. To our knowledge, this is one of the first reported cases in which the TandemHeart pVAD served as a successful device for support during acute cardiac transplant rejection. (Source: Transplantation Proceedings)


Takotsubo cardiomyopathy as a complication of electroconvulsive therapy.
CONCLUSIONS: Takotsubo cardiomyopathy is a serious but transient potential complication of electroconvulsive therapy. Limited evidence indicates that β-adrenergic receptor blocking agents may help prevent its reoccurrence in patients needing further electroconvulsive treatment. Health care providers in psychiatry should be aware of this potential complication of electroconvulsive therapy, especially in postmenopausal women. However, many questions remain regarding this issue. PMID: 22116995 [PubMed - in process] (Source: The Annals of Pharmacotherapy)


Percutaneous revascularization of total or subtotal left main occlusion in the setting of acute myocardial infarction.
CONCLUSION: Percutaneous coronary intervention in patients with LMCO complicated by AMI is feasible and effective, and offers a good mid-term outcome for hospital survivors. PMID: 22257804 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Amplatzer septal occluder to treat iatrogenic cardiac perforations
Conclusions: Percutaneous device occlusion of iatrogenic heart perforation seems to be a safe and efficient method to treat iatrogenic heart perforation. In order to perform this elegant method, it is however imperative not to prematurely withdraw the perforating catheter to maintain access to the hole for closure. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


The presence of ST-elevation in lead aVR predicts significant left main coronary artery stenosis in cardiogenic shock resulting from myocardial infarction: The Manitoba cardiogenic shock registry
Conclusion: In CGS due to acute myocardial infarction, aVR-STE>1mm proves to be an important predictor of LMCS>50%. Such data could be helpful in further risk stratification for optimal management during CGS. (Source: International Journal of Cardiology)


Can a meta-analysis that mixes apples with oranges be used to demonstrate that levosimendan reduces mortality after coronary revascularization?
In conclusion, we believe that this meta-analysis does not give any scientifically proven conclusion and creates only conclusion. (Source: Critical Care)


Heart transplantation following myocardial infarction due to Takayasu’s arteritis
We report a 14‐yr‐old girl who presented with cardiogenic shock because of compression of the left main coronary artery secondary to Takayasu’s arteritis. The patient required cardiac transplantation with hemi‐arch replacement at the time of transplant because of ascending aortitis. To our knowledge, this is the first case of cardiac transplantation in Takayasu’s arteritis to be reported in the literature. (Source: Pediatric Transplantation)


Cardiogenic Shock
This article provides a review of the current understanding of the etiologies, pathophysiology, and recommendations for management of cardiogenic shock. (Source: Critical Care Nursing Clinics of North America)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Cor Triatriatum With Partial Anomalous Pulmonary Venous Return: A Rare Case of Parallel Obstruction and Successful Staged Treatment
We present a case of such rare anatomy with multilevel obstruction that presented in infancy as cardiogenic shock. The patient underwent staged treatment with extracorporeal membrane oxygenation stabilization, catheter-based balloon dilatation of the cor triatriatum and atrial septostomy, followed by definitive surgical repair, with excellent result. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00246-011-0148-9Authors Ofer Schiller, Division of Cardiology, Children’s National Medical Center, Washington, DC 20010, USAKristin M. Burns, Division of Cardiology, Children’s National Medical Center, Washington, DC 20010, USAPranava Sinha, Department of Cardiovascular Surgery, Children’s National Medical Center, Washington, DC 20010, USASusan D. Cummings, D...


Heart transplantation following myocardial infarction due to Takayasu’s arteritis
We report a 14‐yr‐old girl who presented with cardiogenic shock because of compression of the left main coronary artery secondary to Takayasu’s arteritis. The patient required cardiac transplantation with hemi‐arch replacement at the time of transplant because of ascending aortitis. To our knowledge, this is the first case of cardiac transplantation in Takayasu’s arteritis to be reported in the literature. (Source: Pediatric Transplantation)


Extracorporeal Membrane Oxygenation for Advanced Refractory Shock in Acute and Chronic Cardiomyopathy [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Extracorporeal membrane oxygenation in advanced refractory AMI-CS is associated with acceptable outcomes in a well-selected population. The ECMO in patients with an acute decompensation of a chronic CM should be carefully considered, to avoid futile support. (Source: The Annals of Thoracic Surgery)


Left Ventricular Decompression During Peripheral Extracorporeal Membrane Oxygenation Support With the Use of the Novel iVAC Pulsatile Paracorporeal Assist Device [CASE REPORTS]
We describe a minimally invasive technique for decompressing the left ventricle in this setting using a novel pulsatile paracorporeal assist device, the iVAC 3L (PulseCath, Groningen, The Netherlands). It is implanted through the right axillary artery and provides hemodynamic support while directly off-loading the left ventricle. (Source: The Annals of Thoracic Surgery)


Antihypertensives/bupropion/insulin/soya oil emulsion: Cardiogenic shock and bradyasystolic arrest: 2 case reports
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Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction
Conclusion:Patients with STEMI and a LMCA had poor clinical outcomes, which is attributable to hemodynamic deterioration during the peri‐procedural period. However, after that time, mid‐term MACEs of the survivors following the peri‐procedural period may not be different between STEMI due to LMCA and non‐LMCA. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)


What has changed in the treatment of ST-segment elevation myocardial infarction in Poland in 2003-2009? Data from the Polish Registry of Acute Coronary Syndromes (PL-ACS).
Conclusions: The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock. Kardiol Pol 2011; 69, 11: 1109-1118. PMID: 22090216 [PubMed - in process] (Source: Kardiologia Polska)


Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study
This study investigated feasibility and safety of early PCI after successful half-dose alteplase reperfusion in a Chinese population. Patients with STEMI received half-dose alteplase if expected time delay to PCI was ≥90&nbsp;min. Patients who reached clinical criteria of successful thrombolysis reperfusion were recommended to undergo diagnostic angiography within 3–24&nbsp;h after thrombolysis. Patients with residual stenosis ≥70% in the infarct-related artery underwent PCI, regardless of flow or patency status. Epicardial arterial flow was assessed using thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (CTFC). Myocardial perfusion was assessed using myocardial blush grade (MBG) and TIMI myocardial perfusion frame count (TMPFC). Forty-nine patients ...


Does previous hypertension affect outcome in acute heart failure?
CONCLUSION: Antecedent hypertension is frequent in patients with acute HF and contributes to organ and vascular impairment. However its presence has no independent influence on short- and medium-term mortality, which is influenced by other related co-morbidities. PMID: 22075286 [PubMed - in process] (Source: European Journal of Internal Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Mortality of patients with ST-segment elevation myocardial infarction and cardiogenic shock treated by PCI is correlated to the infarct-related artery – Results from the PL-ACS Registry
Abstract: Background: Mortality of patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS) on admission remains high despite invasive treatment. The aim of this analysis was to assess the relationship between the infarct-related artery (IRA) and the early and 12-month outcomes of patients with STEMI and CS treated by percutaneous coronary intervention (PCI).Methods: Two thousand ninety patients with STEMI and CS registered in the prospective Polish Registry of Acute Coronary Syndromes from October 2003 to November 2009 were included.Results: The in-hospital mortality in the left main (LM), left anterior descending artery (LAD), circumflex artery (Cx), and right coronary artery (RCA) groups was 64.7%, 41.0%, 36.0%, and 30.8%, respectively, with p (Source...


Transradial PCI in cardiogenic shock, the final frontier?
(Source: Catheterization and Cardiovascular Interventions)


Multiple drugs overdose/insulin: Cardiogenic shock, hypoglycaemia and hypokalaemia: 12 case reports
(Source: Reactions)


Pulmonary edema following scorpion envenomation: Mechanisms, clinical manifestations, diagnosis and treatment
Abstract: Scorpion envenomation is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary edema, are the leading causes of death after scorpion envenomation. The mechanism of pulmonary edema remains unclear and contradictory conclusions were published. However, most publications confirm that pulmonary edema has been attributed to acute left ventricular failure. Cardiac failure can result from massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Factors usually associated with the diagnosis of pulmonary edema were young age, tachypnea, agitation, sweating, or the presence of high plasma protein concentrations. Treatment of scorpion envenomation has two components: antivenom administra...


Percutaneous cardiopulmonary support in pulmonary embolism with cardiac arrest
Abstract: Objective: To assess the role of percutaneous cardiopulmonary support (PCPS) for the resuscitation of patients with massive pulmonary embolism (PE) with circulatory collapse. We also compared outcomes for PCPS between patients with massive PE with circulatory collapse and patients with AMI with cardiogenic shock.Background: The effectiveness of PCPS for acute myocardial infarction (AMI) complicated with cardiogenic shock has been reported, but there are few reports on the use of PCPS for massive PE with circulatory collapse.Method: We studied 12 consecutive patients with massive PE and 16 patients with AMI, who required PCPS for resuscitation either during cardiopulmonary resuscitation (CPR) or after successful CPR.Results: Twelve patients with PE and 16 patients with AMI were id...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Routine use of the transradial approach in primary percutaneous coronary intervention: procedural aspects and outcomes in 2209 patients treated in a single high-volume centre
Conclusions Systematic use of the TRA in PPCI yields low access site crossover, high procedural success rates and excellent procedural performances. It can therefore represent the primary access site in the vast majority of STEMI patients. (Source: Heart)


Primary percutaneous coronary intervention for the treatment of a patient with cardiogenic shock due to acute total occlusion of unprotected left main coronary artery without supportive collateral flow
Future Cardiology , November 2011, Vol. 7, No. 6, Pages 749-755. (Source: Future Cardiology)


Predictors of Low Cardiac Output Syndrome After Isolated Coronary Artery Bypass Surgery: Trends Over 20 Years [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions The impact of LVEF less than 0.20 on development of postoperative LCOS has increased markedly in the latest era of our study. Prudent preoperative evaluation in patients with severe left ventricular dysfunction is critical. Further innovative research in myocardial protection and circulatory support is warranted in patients with severe left ventricular dysfunction. (Source: The Annals of Thoracic Surgery)


Management of acute coronary syndromes in developing countries: ACute Coronary Events—a multinational Survey of current management Strategies
Conclusions: In this observational study of patients with ACS, the use of evidence-based pharmacologic therapies for ACS was quite high, yet 39% of eligible patients with STEMI received no reperfusion therapy. These findings suggest opportunities to further reduce the risk of long-term ischemic events in patients with ACS in developing countries. (Source: American Heart Journal)


l‐Carnitine Increases Survival in a Murine Model of Severe Verapamil Toxicity
Conclusions:  When compared with saline, IV l‐carnitine increases survival and MAP in a murine model of severe verapamil toxicity. (Source: Academic Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


l-Carnitine Increases Survival in a Murine Model of Severe Verapamil Toxicity.
Conclusions:  When compared with saline, IV l-carnitine increases survival and MAP in a murine model of severe verapamil toxicity. PMID: 22092894 [PubMed - in process] (Source: Accident and Emergency Nursing)


Impella LP 2.5 for Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation Support
We report the use of the Impella LP 2.5 for LV decompression in a 70‐year‐old man with decompensated heart failure who was placed on VA‐ECMO for cardiogenic shock with severe pulmonary edema and respiratory failure. Both devices were successfully weaned on day 5 of VA‐ECMO support, after myocardial recovery. (J Card Surg 2011;26:666‐668) (Source: Journal of Cardiac Surgery)


Differences in Clinical Features and In‐Hospital Outcomes of Older Adults with Tako‐Tsubo Cardiomyopathy
ConclusionThe clinical profile of participants aged 75 and older with TTC was different from that of those younger than 75 with TTC, and they had a higher in‐hospital complication rate. (Source: Journal of the American Geriatrics Society)


The Clinical Characteristics, Laboratory Parameters, Electrocardiographic, and Echocardiographic Findings of Reverse or Inverted Takotsubo Cardiomyopathy: Comparison With Mid or Apical Variant
Conclusions:Inverted TTC presents at a younger age and has a higher prevalence of triggering stress, whereas other TTC has a higher prevalence of heart failure symptoms, significant reversible MR, and T‐wave inversion and higher NT‐proBNP levels despite other clinical features that are mostly similar. © 2011 Wiley Periodicals, Inc.This study was supported by the Samsung Changwon Hospital Hyoseok Research Fund. The authors have no other funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)


Long Term use of the Centrimag(R) Ventricular Assist System as a Right Ventricular Assist Device: a Case Report.
Authors: Griffith KE, Jenkins E, Paugh T, Stulak J, Pagani F Abstract Right ventricular failure (RVF) following implantation of a left ventricular assist system (LVAS) is associated with high morbidity and mortality.(1-4) Numerous centers have reported short-term use of the CentriMag® Ventricular Assist System (CVAS) (Levitronix LLC, Waltham, MA) for treatment of cardiogenic shock, decompensated heart failure and right ventricular failure (RVF) following LVAS implantation.(5-9) The present report reviews the clinical course of a patient requiring long-term right ventricular support utilizing the CVAS, following a HeartMate® II LVAS (Thoratec Corp. Pleasanton, CA) implantation. Elevated cytotoxic antibody levels complicated the patient's treatment plan by precluding orthotropic he...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Left main coronary artery transradial rescue percutaneous coronary intervention for acute myocardial infarction complicated by cardiogenic shock with Impella ventricular mechanical support
We report a case of transradial rescue percutaneous intervention for cardiogenic shock in a young man with support of an Impella device via femoral access. (Source: Cardiovascular Revascularization Medicine)


Transesophageal Echocardiographic Image of a Retained Fibrin Sleeve After Removal of a Venous Extracorporeal Membrane Oxygenation Cannula
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) has gained widespread acceptance and success in improving the outcome of patients in cardiogenic shock and/or respiratory failure. Technologic advances in ECMO have decreased overall morbidity and mortality, but the risks of thrombogenic complications and bleeding are still present. The role of echocardiography in the evaluation of thrombus formation on large venous cannulae in the setting of ECMO is poorly described. Transesophageal echocardiographic (TEE) characteristics of a retained fibrin sheath after removal of a right atrial venous cannula are reported. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Surface cooling for induction of mild hypothermia in conscious healthy volunteers - a feasibility trial
Conclusions: Cooling to body temperature below 35degreesC by the use of a non invasive surface cooling is feasible and safe in conscious healthy volunteers. Further studies are needed to investigate an altered cooling protocol to achieve temperatures below 35degreesC. (Source: BioMed Central)


Clinical characteristics and predictors of in-hospital mortality in 270 consecutive patients hospitalised due to acute heart failure in a single cardiology centre during one year.
Conclusions: In our registry, in-hospital mortality in patients admitted due to acute HF was slightly higher compared to other reports. Baseline values of some parameters (e.g. blood pressure, serum Na(+), renal function) as well as their changes during hospitalisation (e.g. serum K(+), renal function, plasma NT-proBNP) can help identify acute HF patients at a higher risk of in-hospital mortality. Kardiol Pol 2011; 69, 10: 997-1005. PMID: 22006596 [PubMed - in process] (Source: Kardiologia Polska)


High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass
Conclusions&nbsp;&nbsp;Massive thrombosis following cardiac surgery is a highly lethal event with limited treatment options. Particular attention should be paid to the status of thrombin regulatory proteins before protamine and other hemostatic interventions in patients undergoing complex cardiac surgery with antifibrinolytic agents. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s00540-011-1253-xAuthors Satoru Ogawa, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USAJames E. Richardson, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USATetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAMasahiro Ide, Anesthesia Associates of Kobe, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


[Cardiogenic shock after venlafaxine poisoning.]
Authors: Malfroy S, Tassin C, Attof R, Perdrix JP, Piriou V PMID: 22014535 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)


Churg–Strauss Syndrome Presenting with Acute Myocarditis and Cardiogenic Shock
We report the case of a 22 year-old man admitted to the intensive care unit for acute myocarditis complicated with cardiogenic shock. Eosinophilia, history of asthma, lung infiltrates, paranasal sinusitis, glomerulonephritis, and abdominal pain suggested the diagnosis of CSS. Cardiac MRI confirmed cardiac involvement with a diffuse subendocardial delayed enhancement of the left ventricular wall, and a left ventricular ejection fraction (LVEF) of 30%. Acute myocarditis was confirmed with myocardial biopsy. The patient was successfully treated with systemic corticosteroids, intravenous cyclophosphamide, vasopressor inotropes, intra-aortic balloon pump and mechanical ventilation, and was discharged 21 days later. One year after diagnosis, the patient was asymptomatic. The eosinophilic cell co...


Residual Platelet Reactivity, Bleedings, and Adherence to Treatment in Patients Having Coronary Stent Implantation Treated With Prasugrel
In conclusion, in clinical practice, major and minor bleeding event rates associated with prasugrel therapy are comparable to those reported in controlled randomized trials. The minimal bleeding event rate is higher than reported but does not seem to affect adherence to treatment. (Source: The American Journal of Cardiology)


Cardiogenic Shock Following Propofol and FentanylCardiogenic Shock Following Propofol and Fentanyl
A healthy 32-year-old woman experienced sudden, severe hemodynamic deterioration after undergoing a minor surgical procedure. What was the cause? Journal of Medical Case Reports (Source: Medscape Today Headlines)


A simple method of vascular access to perform emergency coronary angiography in patients with veno-arterial extracorporeal membrane oxygenation
Conclusion&nbsp;&nbsp;Cardiac catheterization using a Y-shaped adapter introduced into the arterial ECMO cannula is feasible. In a resuscitation setting, a new puncture of the femoral artery always carries the risk of complications, wherefore this new technology can be regarded as fast alternative. Content Type Journal ArticleCategory Physiological and Technical NotesPages 1-4DOI 10.1007/s00134-011-2383-1Authors Dierk H. Endemann, Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyAlois Philipp, Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, GermanyChristian Hengstenberg, Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyAndreas Luchner, Department of Interna...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Cardiovascular Failure and Cardiogenic Shock
Semin Respir Crit Care Med 2011; 32: 598-606DOI: 10.1055/s-0031-1287869ABSTRACTCardiovascular system failure is commonly faced by the intensivist. Heart failure can occur due to a host of predisposing cardiac disorders or as secondary effects of systemic illness. When the heart is unable to provide an adequate cardiac output to maintain adequate tissue perfusion, cardiogenic shock ensues. Without prompt diagnosis and appropriate management, these patients have significant morbidity and mortality, with in-hospital mortality approaching 60% for all age groups. Accurate and rapid identification of cardiogenic shock as a medical emergency, with expeditious implementation of appropriate therapy, can lead to improved clinical outcomes. In this review, we discuss optimal strategies for diagnosis ...


Ventricular tachycardia in English bulldogs with localised right ventricular outflow tract enlargement
Objectives: To describe the electrocardiographic characteristics of ventricular tachycardia arising from the right ventricular outflow tract and the particular association between this arrhythmia and the presence of localised right ventricular outflow tract enlargement in English bulldogs.Methods: Five English bulldogs were referred with a history of syncope or cardiogenic shock. In all dogs, 12‐lead surface ECG, thoracic radiograph and echocardiography were collected. In all but one dog 24‐hours Holter monitoring and signal‐averaged ECGs was examined and in one dog electrophysiological study and radiofrequency catheter ablation of the VT substrate was performed.Results: Documented arrhythmias included a single sustained monomorphic wide QRS tachycardia in four dogs, and an alternans...


Deep Vein Thrombosis/Pulmonary Embolism: Prophylaxis, Diagnosis, and Management
Thoracic surgery patients should be regarded at high risk for postoperative venous thromboembolism (VTE). VTE mechanical and pharmacologic prophylaxis with low molecular weight heparin, or low-dose unfractionated heparin or fondaparinux (Arixtra) is therefore strongly recommended. Pharmacologic prophylaxis should be extended to 4 weeks after major cancer surgery. Pulmonary embolism should be always managed with anticoagulation, in addition to thrombolytic therapy, in patients presenting with cardiogenic shock or persistent arterial hypotension. (Source: Thoracic Surgery Clinics)


Transseptal Catheter Decompression of the Left Ventricle During Extracorporeal Membrane Oxygenation
We present the case of a 13-year-old girl who presented with cardiogenic shock. VA-ECMO was initiated, but after 6&nbsp;days, severe left-ventricular distension resulted in decreased VA-ECMO flows. With guidance by bedside transesophageal echocardiography, a percutaneous atrial transseptal cannula was placed and connected to the venous circuit, thus decompressing the left ventricle. The patient improved, was weaned from VA-ECMO 5&nbsp;days later, and was discharged from the hospital. Bedside transseptal catheter insertion is an effective method of left-ventricular decompression. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00246-011-0113-7Authors Michael F. Swartz, Department of Surgery, Strong Memorial Hospital, University of Rochester, Rochester, NY 14...


Cardiogenic shock secondary to severe acute ischemic mitral regurgitation managed with an impella 2.5 percutaneous left ventricular assist device
We report a case of a patient successfully treated with an Impella Recover LP 2.5 (ABIOMED, Danvers, MA) left ventricular assist device, in the setting of cardiogenic shock secondary to severe acute mitral regurgitation associated with an acute myocardial infarction. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock
Conclusions&nbsp;&nbsp;Patients who tolerated a full ECMO weaning trial and had aortic VTI ≥10&nbsp;cm, LVEF &gt;20–25%, and TDSa ≥6&nbsp;cm/s at minimal ECMO flow were all successfully weaned. However, further studies are needed to validate these simple and easy-to-acquire Doppler echocardiography parameters as predictors of subsequent ECMO weaning success in patients recovering from severe cardiogenic shock. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-011-2358-2Authors Nadia Aissaoui, Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, Paris, FranceCharles-Edouard Luyt, Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistan...


Left Anterior Descending Artery Revascularization in Low-Risk Patients: Early Outcomes after Off-Pump versus On-Pump Surgery.
Conclusions: Among low-risk patients (defined according to EuroSCORE criteria) who underwent left anterior descending coronary artery bypass, the results obtained with the on-pump and off-pump methods showed no significant differences with respect to morbidity or mortality. PMID: 21997654 [PubMed - in process] (Source: The Heart Surgery Forum)


Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging.
CONCLUSION: CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution. PMID: 22044703 [PubMed - in process] (Source: Archives of Cardiovascular Diseases)


Is high-dose insulin better than vasopressors in treating toxin-induced cardiogenic shock?
3 out of 5 stars High-dose insulin: A consecutive case series in toxin-induced cardiogenic shock. Holger JS et al. Clin Toxicol 2011;49:653-658. Abstract   This observational case series, from Regions Hospital in St. Paul MN, retrospectively reviewed charts of patients seen by the toxicology service and treated for toxin-induced cardiogenic shock over an approximately 3 year period (February 2007 &#8211; March 2010). Cardiogenic shock was diagnosed if a patient exhibited signs or symptoms of organ hypoperfusion. Treatment of these patients was guided by a protocol that used high-dose insulin as the primary intervention and attempted to  avoid vasopressors. The authors identified 12 cases. Cardiovascular toxins included: beta-blockers (BB, 5 patients) calcium-channel blockers (CCB, 2 ...


Med Sci Monit 2011; 17(10):CQ9-12 &quot;A severe complication after ST-segment elevation myocardial infarction (Part 2)&quot;
We report the case of a 70-year-old woman with ST-segment elevation myocardial infarction of the anterior wall, complicated by ventricular septal rupture (two septal defects – VSDs) with symptoms of cardiogenic shock. After 6 weeks of conservative treatment with inotropes and intra-aortic balloon support, the patient underwent surgical repair of VSDs with good clinical outcome. (Source: Medical Science Monitor)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Analysis of Survival in 300 High-Risk Patients up to 2.5 Years After Transapical Aortic Valve Implantation [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions The outcome of transapical aortic valve implantation in very high-risk patients was very favorable not only early after the procedure but also later on. Preoperative risk scores were not indicators for early mortality but were for later mortality. Survival was mainly influenced by noncardiac (renal, pulmonary, and vascular) comorbidities as well as by signs of advanced cardiac failure. (Source: The Annals of Thoracic Surgery)


Intermittent Coronary Artery Occlusion Caused by a Floating Thrombus in the Left Coronary Sinus of Valsalva of a Patient With a Normal Aorta and Protein C Deficiency [CASE REPORTS]
We report a case in which a floating mass in the left coronary sinus of Valsalva caused intermittent left main coronary trunk occlusion, leading to myocardial ischemia and cardiogenic shock. The mass was surgically resected. Macroscopically, the aortic wall and leaflets were normal. On histologic examination the mass was found to be a thrombus. This patient had a low level of protein C; therefore, it was presumed that the thrombus was due to protein C deficiency. (Source: The Annals of Thoracic Surgery)


Out-of-hospital cardiac arrest in patients treated with primary PCI for STEMI. Long-term follow up data from EUROTRANSFER registry
Conclusions: STEMI patients treated with primary PCI with out-of-hospital cardiac arrest have higher long-term mortality than no OHCA patients. However, resuscitation prior to cathlab admission is not an independent predictor of long-term adverse outcome. No differences in in-hospital mortality were noticed. (Source: Resuscitation)


Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock: The CRISP AMI Randomized Trial [Original Contribution]
Conclusion Among patients with acute anterior STEMI without shock, IABC plus primary PCI compared with PCI alone did not result in reduced infarct size. Trial Registration clinicaltrials.gov Identifier: NCT00833612 (Source: JAMA)


Early implementation of continuous venovenous haemodiafiltration improves outcome in patients with heart failure complicated by acute kidney injury.
Conclusions: An early introduction of CVVHDF significantly diminished the need to use mechanical ventilation and indicated a positive trend in the reduction of in-hospital mortality in patients with HF complicated by AKI. Kardiol Pol 2011; 69, 9: 891-896. PMID: 21928193 [PubMed - in process] (Source: Kardiologia Polska)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


A Rare Shock
In this case, a patient with no history of coronary artery disease presented with cardiogenic shock and eosinophilia. Her history of adult-onset asthma proved key to the eventual diagnosis. (Source: The American Journal of Medicine)


Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment-Elevation Myocardial Infarction.
Conclusions-Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay. PMID: 21931079 [PubMed - as supplied by publisher] (Source: Circulation)


Long-Term Predictors of Mortality After Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents
The aim was to examine timing, causes, and predictors of death during long-term follow-up after contemporary percutaneous coronary intervention (PCI) using a large multicenter Australian registry. The cohort consisted of 10,682 consecutive patients from the Melbourne Interventional Group registry undergoing PCI (February 2004 through November 2009). For the first time in Australia, long-term mortality rates of a PCI cohort were defined by linkage to the National Death Index database. The cohort (mean age 64 ± 12 years) comprised 75% men, 24% diabetics, 59% with multivessel disease, 4.4% with renal failure, 25% with ST-elevation myocardial infarction (STEMI), 2.5% with cardiogenic shock, and 5.1% with heart failure. Drug-eluting stents (DES) were used in 43% of cases. Mean follow-up was 3....


Hantavirus pulmonary syndrome.
This article briefly reviews the knowledge on HPS-associated hantaviruses accumulated since their discovery, less than 20 years ago. PMID: 21945215 [PubMed - as supplied by publisher] (Source: Virus Research)


Myxedema Coma: A New Look into an Old Crisis
Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


One‐year Outcomes with Angiographic Follow‐Up of Paclitaxel‐Eluting Balloon for the Treatment of In‐Stent Restenosis: Insights from Spanish Multicenter Registry
Conclusion: In a real‐world population, treatment of ISR (including 48% DES‐ISR) with this DEB provides good mid‐term results with 12% TLR at 1 year, especially in ISR pattern IC (9% MACE). (J Interven Cardiol 2011;00:1–11) (Source: Journal of Interventional Cardiology)


Hypocalcemic cardiomyopathy presenting as cardiogenic shock
We describe 5 infants presenting with cardiogenic shock over 3 years, who were found to have severe hypocalcemia as a sole cause of myocardial dysfunction. The patients responded to calcium and vitamin D supplementation promptly and left ventricular systolic function normalized within months of treatment. In any case of cardiogenic shock, hypocalcemia should be included in the differential diagnosis and must be investigated. (Source: Annals of Pediatric Cardiology)


Vitamin D deficiency presenting with cardiogenic shock in an infant
Manish Kumar, Diganta Saikia, Vishal Kumar, Ruchi TomarAnnals of Pediatric Cardiology 2011 4(2):207-209A 2-month-old child was referred as a case of dilated cardiomyopathy with cardiogenic shock. On evaluation, hypocalcemia secondary to severe vitamin D deficiency was found. There were no clinical or radiological features of rickets. The child had developed multiorgan failure due to cardiogenic shock at the time of admission and could not be saved despite adequate ventilatory and pharmacologic support. Hypocalcemia should be considered as an important differential diagnosis in cases of dilated cardiomyopathy in infants. (Source: Annals of Pediatric Cardiology)


Recurrent Urosepsis and Cardiogenic Shock in an Elderly Patient with Pheochromocytoma
We describe a hypertensive elderly patient with incidentally diagnosed pheochromocytoma complicated by recurrent urosepsis, cardiomyopathy, and fatal myocardial infarction. Our case demonstrates that, in older hypertensive patients without classical symptoms, orthostatic hypotension and urinary retention, which are common in the elderly, may indicate catecholamine excess and that the deleterious cardiovascular consequences of catecholamine excess in the elderly are not prevented by pharmacological &#x03B1;- and &#x03B2;-blockade. (Source: Clinical and Developmental Immunology)


Extremely localized aortic dissection and intussusception of the intimal flap into the left ventricle.
Authors: Yamabi H, Imanaka K, Sato H, Matsuoka T Abstract Stanford type A aortic dissection frequently deforms the aortic root and causes aortic regurgitation (AR). On the rare occasion, massive AR can occur due to circumferential intimal disruption and prolapse of the cylinder-shaped intimal flap into the left ventricle. Because of the critical, general, and hemodynamic state of such patients, surgery for this condition carries a high risk. A 62-year-old woman suffered acute chest pain and fell into cardiogenic shock. Computed tomography and transthoracic echocardiography failed to identify the etiology of this rapid hemodynamic collapse. Transesophageal echocardiography (TEE) demonstrated circumferential intimal disruption, 3 centimeters above the aortic valve annulus; a very loc...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Timely Use of a CentriMag Heart Assist Device Improves Survival in Postcardiotomy Cardiogenic Shock
Conclusion: In patients with PCS, timely placement of a CentriMag LVAD may increase the chance of eventual recovery. (J Card Surg 2011;26:548‐552) (Source: Journal of Cardiac Surgery)


Comparison of clinical outcomes of hydrophilic and lipophilic statins in patients with acute myocardial infarction.
CONCLUSIONS: Although short-term cardiovascular outcomes were better in the lipophilic-statin group, 1-year outcomes were similar in patients with AMI who were administered hydrophilic and lipophilic statins. In other words, the type of statin did not influence 1-year outcomes in patients with AMI. PMID: 22016590 [PubMed - in process] (Source: The Korean Journal of Internal Medicine)


Successful bridge to recovery using a microaxial blood pump in a patient with electrical storm and cardiogenic shock
Abstract A 59-year-old patient with dilated cardiomyopathy and incessant ventricular tachycardia leading to progressive cardiogenic shock is presented. Due to hemodynamic instability, high dose catecholamines were required in addition to the implantation of an intraaortic balloon pump (IABP), which, however, appeared to further augment the frequency and duration of ventricular tachycardias. The implantation of a microaxial blood pump allowed catecholamine administration to be terminated, thereby, ending this vicious circle of catecholamine-driven electrical storm. Within 5 days, the patient was hemodynamically stabilized and kidney and liver function recovered with the support of intensive antiarrhythmic therapy (amiodarone, mexiletine, sotalol). During a 24-month follow-up, the...


Massive and Submassive Pulmonary Embolism: Experience With an Algorithm for Catheter-Directed Mechanical Thrombectomy
Conclusion: CDMT as primary treatment of MPE and SMPE has a high rate of technical and clinical success in a high-risk patient population. Experience and strict patient selection criteria may improve therapeutic outcomes. (Source: Annals of Vascular Surgery)


Anemia Before Coronary Artery Bypass Surgery as Additional Risk Factor Increases the Perioperative Risk [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions In our patient group undergoing CABG surgery, preoperative anemia increased the mortality risk by 3.4, even when taking the higher perioperative risk of anemic patients into consideration. (Source: The Annals of Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Results of mechanical circulatory support in France [Original articles]
Conclusions: MCS is an essential therapeutic tool to save the life of young patients with cardiogenic shock or advanced cardiac failure. Early MCS implantation and the availability of a device that is adapted to the patient's clinical status are prerequisites for reducing overall mortality rates. (Source: European Journal of Cardio-Thoracic Surgery)


Hand-held minimised extracorporeal membrane oxygenation: a new bridge to recovery in patients with out-of-centre cardiogenic shock [Original articles]
Conclusions: The use of hand-held Mini-ECMO systems enables for the first time the rapid onset of extracorporeal life support independent from the patient's current location. However, success is extremely time- and team dependent. Highly skilled interdisciplinary patient management is essential to let minimised-ECMO become a new and highly effective bridge to recovery in out-of-centre cardiogenic shock patients. (Source: European Journal of Cardio-Thoracic Surgery)


Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock: The CRISP AMI Randomized Trial [Original Contribution]
Conclusion Among patients with acute anterior STEMI without shock, IABC plus primary PCI compared with PCI alone did not result in reduced infarct size.Trial Registration clinicaltrials.gov Identifier: NCT00833612 (Source: JAMA)


Lipid Resuscitation Reverses Multidrug-Induced Cardiogenic Shock.
Authors: Rubinstein I, Zider B, Weinberg G PMID: 21874380 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)


Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure
Conclusion: Use of a pRVSD for MR-RVF is feasible and associated with improved hemodynamics. Algorithms promoting earlier pRVSD use in MR-RVF warrant further investigation. (Source: The Journal of Heart and Lung Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Med Sci Monit 2011; 17(9):CQ7-8 &quot;A severe complication after ST-segment elevation myocardial infarction (Part 1)&quot;
We report the case of a 70-year-old woman with ST-segment elevation myocardial infarction of the anterior wall, complicated by ventricular septal rupture (two septal defects – VSDs) with symptoms of cardiogenic shock. After 6 weeks of conservative treatment with inotropes and intra-aortic balloon support, the patient underwent surgical repair of VSDs with good clinical outcome. key words: ST-elevation myocardial infarction • myocardial injury markers • anticoagulant treatment • acute heart failure (Source: Medical Science Monitor)


Extracorporeal Albumin Dialysis in Three Cases of Acute Calcium Channel Blocker Poisoning With Life-Threatening Refractory Cardiogenic Shock
We describe 3 patients admitted to the medical-surgical ICU in a university hospital with life-threatening cardiogenic shock after the ingestion of high doses of calcium channel blockers (8.4 g sustained-release diltiazem, 4.2 g sustained-release diltiazem, and 14.4 g slow-release verapamil). Cardiovascular failure and cardiac conduction disturbances were unresponsive to the usual therapy (eg, intravenous injection of high doses of calcium, glucagon, hyperinsulinemia-euglycemia therapy, fluid resuscitation) and to increasing doses of simultaneous infusions of adrenergic agonists. Albumin dialysis with Molecular Adsorbents Recirculating System (MARS) therapy was performed because of its unique ability to selectively remove from circulation protein-bound toxins (and potentially drugs) that a...


Successful use of a percutaneous miniaturized extracorporeal life support system as bridge and assistance to left ventricular assist device implantation in a patient with severe refractory cardiogenic shock.
We present a 51-year-old man with cardiogenic shock in whom a percutaneous extracorporeal life support system (ECLS) was inserted to restore cardiopulmonary stability. After successful stabilization, a left ventricular assist device was implanted, using the ECLS without switching to a conventional cardiopulmonary bypass system to reduce its side effects. PMID: 21859786 [PubMed - as supplied by publisher] (Source: Perfusion)


Delayed cardiac metastasis from phyllodes breast tumor presenting as cardiogenic shock.
Authors: Garg N, Moorthy N, Agrawal SK, Pandey S, Kumari N Abstract Malignant metastases to the heart and pericardium, which occur far more often than do primary cardiac neoplasms, typically lead to fatal outcomes. The phyllodes tumor is a rare, predominantly benign fibroepithelial breast neoplasm with variable malignancy potential. Herein, we describe the case of a 35-year-old woman who, 3 years after undergoing a simple mastectomy for a rapidly enlarging breast neoplasm, presented with cardiogenic shock and was found to have a large right ventricular tumor that obstructed the right ventricular outflow tract. Despite successful resection of the ventricular mass and a right atrial mass of organized thrombus, the patient died 8 days postoperatively of multiorgan failure due to sever...


Successful use of the impella device in giant cell myocarditis as a bridge to permanent left ventricular mechanical support.
Authors: Suradi H, Breall JA Abstract Idiopathic giant cell myocarditis is a rare condition with a poor prognosis. Patients with giant cell myocarditis typically die of refractory ventricular arrhythmias or progressive congestive heart failure in about 3 months. The benefit of immunosuppressive therapy varies among patients with giant cell myocarditis, and no factors that would predict which patients will respond to therapy have been identified. Mechanical circulatory support devices, from intra-aortic balloon pumps to more permanent systems, have been used for ventricular support in cases of acute heart failure.Herein, we describe a case of giant cell myocarditis in a previously healthy 44-year-old woman who presented with cardiogenic shock. She was supported hemodynamically with ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Left Stellate Ganglion Block for Continuous Ventricular Arrhythmias during Percutaneous Left Ventricular Assist Device Support.
Authors: Loyalka P, Hariharan R, Gholkar G, Gregoric ID, Tamerisa R, Nathan S, Kar B Abstract A 58-year-old man presented with chest pain and tightness and was diagnosed with a Q-wave anterior myocardial infarction. He then developed pulseless ventricular arrhythmias, which were treated with repeated direct-current shocks and intravenous amiodarone. He underwent emergency cardiac catheterization: stents were deployed in the left anterior descending coronary artery and right coronary artery, and an intra-aortic balloon pump was inserted. Severe refractory cardiogenic shock and incessant ventricular arrhythmias compelled us to place a TandemHeart percutaneous left ventricular assist device 4 hours later. The patient's hemodynamic status stabilized, but the arrhythmias persisted for 3...


[Myocardial infarction without coronary arteries stenoses in a patient with Jervell and Lange-Nielsen syndrome - diagnostic dilemmas.]
Authors: Wójcik T, Kobusiak-Prokopowicz M, Sciborski K, Mysiak A Abstract According to the rules of differential diagnostics an acute coronary syndrome (ACS) often constitutes an initial diagnosis while a subsequent patient's follow-up with troponin determination results in further verification of the diagnosis. A 55 year-old female with congenital hearing loss, poorly controlled hypertension, type 2 diabetes treated with oral medications, and hypothyreosis was admitted to the Department of Cardiology with 6 h long severe chest pain radiating over her back with concomitant dyspnea. She underwent urgent coronary angiography which showed no epicardial coronary narrowing. Acute heart failure symptoms occurred immediately after coronary angiography in the form of cardiogenic shock. Ev...


Transapical aortic valve implantation in patients with severely depressed left ventricular function
Conclusions: Transapical aortic valve implantation can be performed safely in patients with decompensated heart failure or even in the presence of cardiogenic shock. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock.
CONCLUSIONS. Aortic counterpulsation may be successfully employed providing significant hemodynamic support with rare major complications in a high-risk patient population. A unique finding of this study is a high rate of successful applications of aortic counterpulsation. PMID: 21829053 [PubMed - as supplied by publisher] (Source: Medicina (Kaunas))


Transposition of a pericardial-derived vascular adipose flap for myocardial salvage after infarct
Conclusions Our results indicate that a vascular fat flap exerts beneficial effects on LV function and limits myocardial remodelling. Future studies must confirm whether these findings provide an alternative therapeutic approach for myocardial salvage after infarction. (Source: Cardiovascular Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


In Vitro Comparison of Support Capabilities of Intra‐Aortic Balloon Pump and Impella 2.5 Left Percutaneous
AbstractThe Impella 2.5 left percutaneous (LP), a relatively new transvalvular assist device, challenges the position of the intra‐aortic balloon pump (IABP), which has a long record in supporting patients after myocardial infarction and cardiac surgery. However, while more costly and more demanding in management, the advantages of the Impella 2.5 LP are yet to be established. The aim of this study was to evaluate the benefits of the 40 cc IABP and the Impella 2.5 LP operating at 47 000 rpm in vitro, and compare their circulatory support capabilities in terms of cardiac output, coronary flow, cardiac stroke work, and arterial blood pressure. Clinical scenarios of cardiogenic preshock and cardiogenic shock (CS), with blood pressure depression, lowered cardiac output, and constant he...


Incessant Ventricular Tachycardia and Cardiogenic Shock: A Common Presentation of an Uncommon Diagnosis.
Authors: Drafts BC, Sutton BJ, Dubose TD, Thohan V Giant cell myocarditis is a rare and highly lethal disease that is characterized by a rapidly progressive course of biventricular dysfunction. The authors present a case of giant cell myocarditis that presented with incessant ventricular tachycardia and cardiogenic shock in which clinical improvement was achieved with immunosuppressive therapy. PMID: 21817876 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)


Percutaneous Ventricular Assist Devices: New Deus Ex Machina?
The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support. (Source: Advances in Pharmacological Sciences)


Morphine: Cardiogenic shock: case report
(Source: Reactions)


Preliminary experience with Impella Recover(®) LP5.0 in nine patients with cardiogenic shock: A new circulatory support system in the intensive cardiac care unit.
CONCLUSION: Left ventricular assistance with the Impella LP5.0 appears to be well tolerated. It may be especially useful in patients with acute myocardial infarction complicated by cardiogenic shock who achieve INTERMACS Profile 3 with initial treatment. PMID: 21944148 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction
Conclusions: In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature. (Source: American Heart Journal)


Cardiogenic shock secondary to severe acute ischemic mitral regurgitation managed with an impella 2.5 percutaneous left ventricular assist device
We report a case of a patient successfully treated with an Impella Recover LP 2.5 (ABIOMED, Inc., Danvers, MA) left ventricular assist device, in the setting of cardiogenic shock secondary to severe acute mitral regurgitation associated with an acute myocardial infarction. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)


Long-term Extracorporeal Membrane Oxygenator Support in Resuscitation for Intractable Hibernating Myocardium after Coronary Artery Bypass Grafting.
We report our experience of long-term extracorporeal membrane oxygenator (ECMO) support to resuscitate a 62-year-old man who had critical three-vessel disease of coronary artery complicating intractable hibernating myocardium (HM) and sudden cardiogenic shock. Intra-aortic balloon pump and ECMO were deployed to restore the circulatory support while emergent revascularization surgery was performed.The patient was weaned from ECMO successfully after 15 days of support and discharged with recovered left ventricular function. ECMO is effective in resuscitation of patients with cardiogenic shock and HM. To our knowledge the present case necessitated the longest term of ECMO support to get rid of HM. PMID: 21881363 [PubMed - as supplied by publisher] (Source: Annals of Thoracic and Cardiovas...


Emergency Coronary Artery Bypass Grafting for Left Main Shock Syndrome.
Conclusions: AMI complicated by cardiogenic shock and left main coronary artery disease can be effectively treated with emergency CABG, with acceptable mortality and morbidity. Emergency CABG for MIs within 8 hours can improve survival in patients with left main shock syndrome. PMID: 21881355 [PubMed - as supplied by publisher] (Source: Annals of Thoracic and Cardiovascular Surgery)


Medication Use Pattern and Predictors of Optimal Therapy at Discharge in 8176 Patients With Acute Coronary Syndrome From 6 Middle Eastern Countries: Data From the Gulf Registry of Acute Coronary Events
We evaluated the use of quadruple evidence-based medication (EBM) combination consisting of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, &beta;-blocker, and lipid-lowering agent concurrently at discharge among patients (n = 8154) with acute coronary syndrome (ACS) in 6 Middle Eastern countries. In all, 49% of the patients received the quadruple EBM combination concurrently at discharge. An adjusted model demonstrated that old age, diabetes mellitus, hyperlipidemia, hypertension, ST-segment elevation myocardial infarction, cardiac catheterization, as well as cardiologists as care providers and hospitals with cardiac catheterization facilities were all positively correlated with the use of the quadruple EBM combination. However, patients w...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


C-Reactive Protein and the Risk of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention.
Conclusion: Elevated preprocedural CRP is associated with an increased risk for CI-AKI in patients undergoing PCI. Preprocedural risk stratification with CRP as an adjunct to established clinical risk factors might be useful. PMID: 21791916 [PubMed - as supplied by publisher] (Source: American Journal of Nephrology)


Seizure‐associated takotsubo cardiomyopathy
SummaryTakotsubo cardiomyopathy is characterized by chest pain, dyspnea, electrocardiographic changes resembling an acute coronary syndrome, and transient wall‐motion abnormalities without identifiable coronary culprit lesion explaining the wall‐motion abnormality. Takotsubo cardiomyopathy occurs frequently after emotional or physical stress. Seizures have been reported as triggers of takotsubo cardiomyopathy. It is unknown if seizure‐associated takotsubo cardiomyopathy differs from takotsubo cardiomyopathy associated with other triggers. Seizure‐associated takotsubo cardiomyopathy cases from the literature were compared with takotsubo cardiomyopathy series comprising 30 or more patients. Thirty‐six seizure‐associated takotsubo cardiomyopathy cases (6 male, mean‐age 61.5 year...


Is it safe to perform coronary angiography during acute endocarditis? [Best evidence topic - Cardiac general]
A best evidence topic was written according to a structured protocol. The question addressed was &lsquo;Is it safe to perform coronary angiography (CA) in acute endocarditis?&rsquo; Three hundred and ninety-seven papers were found using the reported search, of which six represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, key results and limitations of these papers are tabulated. One of the papers is a case report, which reported a fatal vegetation embolism from an infected aortic valve into the left main coronary artery 14&nbsp;h after angiography. The remaining five papers are cohort studies. Four of these studies were performed between 1970 and 1980 before the era of ec...


Clinical use of temporary percutaneous left ventricular assist devices
Conclusion:TPLVADs can support the failing heart with acceptable risk. Outcome is better in prophylactic use than in patients with cardiogenic shock. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)


Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock.
Authors: Unverzagt S, Machemer MT, Solms A, Thiele H, Burkhoff D, Seyfarth M, de Waha A, Ohman EM, Buerke M, Haerting J, Werdan K, Prondzinsky R Intra-aortic balloon pump counterpulsation (IABP) is currently the most commonly used mechanical assist device for patients with cardiogenic shock due to acute myocardial infarction.Although there is only limited evidence by randomised controlled trials, the current guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology strongly recommend the use of the intra-aortic balloon counterpulsation in patients with infarction-related cardiogenic shock on the basis of pathophysiological considerations as also non-randomised trials and registry data.    PMID: 21735410 [PubMed - in process...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Aortic regurgitation causd by the proximal dissecting flap invagintion to the left ventricle
Abstract&nbsp;&nbsp;A 68-year-old male with sudden back pain and cardiogenic shock status transferred to our ward. Transthoracic echocardiography revealed that the abnormal rond shape string was in the left ventricular outflow tract. The continuity from the string to the aortic valve was unclear. Intimal flap could not be detected at the level of the ascending aorta. Color Doppler flow imaging showed that the severe AR jet extended into the round string. TEE showed that the intimal tear and flap was seen just above the left subclavian artery. Preoperative diagnosis was acute Stanford type A dissection and acute severe AR due to the inversion of the proximal intimal flap to the left ventricular outflow tract through the aortic valve. At operation, the proximal intimal flap was dissect...


Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: Evaluation of a Regional System to Increase Access to Cooling.
Conclusions- A comprehensive TH protocol can be integrated into a regional ST-segment elevation myocardial infarction network and achieves broad dispersion of this essential therapy for OHCA. PMID: 21747066 [PubMed - in process] (Source: Circulation)


Successful extracorporeal membrane oxygenation treatment for pheochromocytoma-induced acute cardiac failure
The aim of this study is to report the case of a catecholamine-induced cardiogenic shock bridged to curative adrenalectomy using extracorporeal membrane oxygenation (ECMO) and medical management. A 37-year-old woman presented an acute cardiogenic shock due to a left-sided pheochromocytoma. Echocardiography revealed a severe global hypokinesia with a left ventricular ejection fraction of 15%. Despite maximal ionotropic support, adequate perfusion could not be achieved; and ECMO was used to bridge the patient during medical management with calcium-channel blockers. The left ventricular ejection fraction improved to 65%, and ECMO was discontinued after 11 days. An open left adrenalectomy was performed 10 days after ECMO. At 1-year follow-up, the patient is in good health with normal cardiac f...


Percutaneous blade and balloon atrioseptostomy as a supplement to extracorporeal membrane oxygenation as a bridge to heart transplantation
We present a case of a young male who presented for cardiogenic shock with a huge thrombus in the left main coronary artery in whom blade and balloon atrioseptostomy in addition to the ECMO was helpful to bail out and to perform heart transplantation. (Source: Cardiovascular Revascularization Medicine)


Association of Prenatal and Postnatal Exposure to Lopinavir-Ritonavir and Adrenal Dysfunction Among Uninfected Infants of HIV-Infected Mothers [Preliminary Communication]
Conclusion Among newborn children of HIV-1&ndash;infected mothers exposed in utero to lopinavir-ritonavir, postnatal treatment with a lopinavir-ritonavir&ndash;based regimen, compared with a zidovudine-based regimen, was associated with transient adrenal dysfunction. (Source: JAMA)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Intermittent cardiogenic shock in a man with mechanical prosthesis of the aortic valve.
Authors: Melenovsky V, Al Hiti H, Lupinek P, Marek T, Veiser T, Skalsky I, Kettner J PMID: 21730310 [PubMed - in process] (Source: Circulation)


Cardiogenic shock and heart failure post–percutaneous coronary intervention in ST-elevation myocardial infarction: Observations from “Assessment of Pexelizumab in Acute Myocardial Infarction”
Background: Mortality after ST-elevation myocardial infarction (STEMI) has reduced with reperfusion by primary percutaneous coronary intervention (PCI), which may have impacted on the adverse outcomes of cardiogenic shock (CS) and congestive heart failure (CHF).Methods and Results: In the APEX-AMI trial, 5,745 patients with STEMI and planned primary PCI were randomly assigned pexelizumab or matching placebo. Post-randomization CS or CHF was adjudicated by a clinical endpoints committee. Treatment assignment to pexelizumab did not influence either endpoint or mortality rates. Cardiogenic shock developed in 196 patients (3.4%) at a median of 6.0 hours (interquartile range 3.9-28.3) post-randomization, and mortality at 90 days was 54.6%. Congestive heart failure occurred in 254 of patients (4...


Intra‐Aortic Balloon Counterpulsation 50 Years Later: Initial Conception and Consequent Ideas
AbstractFor nearly 50 years, intra‐aortic balloon counterpulsation (IABC) has been the most widely applied temporary assistance method, operating in series with the heart. It helps wean patients from the heart–lung machine after cardiac operations. It is also used in patients with advanced coronary heart disease before and during cardiac and noncardiac operations as well as during percutaneous interventions. Cases of post‐acute myocardial infarction severe cardiogenic shock can also benefit from IABC until or during revascularization or if the latter is impractical. A brief review of mostly experimental attempts is reported as “derivatives” of IABC, as they yielded interesting and sometimes intriguing results that need further investigation. (Source: Artificial Organs)


A 2-h Diagnostic Protocol to Assess Patients with Chest Pain Symptoms in the Asia-Pacific region (ASPECT): A Prospective Observational Validation Study: Than M, Cullen L, Reid C, et al. Lancet 2011;377:1077–84.
This multi-national, prospective observational study was designed to validate a new diagnostic protocol that used a combination of the Thrombolysis in Myocardial Infarction (TIMI) score, electrocardiogram (ECG), and biomarkers to identify low-risk patients that do not require traditional work-up to evaluate for acute coronary syndrome. The study aimed to validate the safety of a 2-h chest pain protocol for low-risk patients, which the authors termed the accelerated diagnostic protocol (ADP) and was conducted in 14 urban emergency departments in nine countries (Australia, China, India, Indonesia, New Zealand, Singapore, South Korea, Taiwan, and Thailand). All patients aged 18 years or older with chest pain who were deemed to need evaluation with serial biomarkers were included. The protocol...


Reversal of Acute Systolic Dysfunction and Cardiogenic Shock in Hypertrophic Cardiomyopathy by Surgical Relief of Obstruction
A 70‐year‐old male with known hypertrophic cardiomyopathy (HCM) and latent obstruction presented with new onset of cardiogenic shock. He had a new resting left ventricular (LV) outflow gradient of 90 mmHg, and new severe LV systolic dysfunction. Because of rapid deterioration despite medical management he was urgently sent for surgical relief of obstruction, which immediately reversed both the LV dysfunction and shock. A second patient, a 58‐year‐old male also with hypertrophic cardiomyopathy and latent obstruction presented with collapse, cardiogenic shock, 135 mmHg resting LV outflow gradient and new severe LV systolic dysfunction. His profound shock was irreversible with pharmacologic management, but surgical relief of obstruction reversed both his LV dysfunction and shock. Echo...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Conclusions:The proportion of elderly patients referred for PCI is increasing. Procedural complications increase with age, and patients presenting with unstable symptoms are at the highest risk. © 2011 Wiley Periodicals, Inc.This work was supported by Blue Cross Blue Shield of Michigan. The authors have no other funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)


Rescue extracorporeal life support as a bridge to reflection in fulminant stress-induced cardiomyopathy
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as rescue therapy in severe cardiogenic shock refractory to medical treatment and intra-aortic balloon pump (IABP). Yet, indications and benefits of VA-ECMO in acute heart failure remain to be fully established. Importantly, it is unclear whether major clinical uncertainties related to potential reversibility of cardiac dysfunction and contraindications for bridging to transplantation justify refusal of VA-ECMO support in an emergency setting. (Source: International Journal of Cardiology)


One-year clinical outcome of patients treated with or without abciximab in rescue coronary angioplasty
Conclusion: There were no differences in MACE at 30days and 1year in patients treated with or without abciximab during rescue PCI after a clopidogrel loading dose of 300mg. Cardiogenic shock, age and TIMI flow 0 and 1 after PCI were predictors of MACE.Research highlights: ► Patients undergoing rescue angioplasty after clopidogrel loading dose of 300mg. ► Treatment with or without abciximab. ► Major adverse cardiac events evaluated at 30days or 1year. ► Abciximab administration does not improve clinical outcome. (Source: International Journal of Cardiology)


Cardiogenic shock due to pheochromocytoma rescued by extracorporeal membrane oxygenation [Case report - Assisted circulation]
This is the case of a 49-year-old female presenting in sustained cardiogenic shock due to an adrenal pheochromocytoma. She was rescued by venoarterial extracorporeal membrane oxygenation. The presence of a catecholamine-secreting tumor was confirmed by highly elevated plasma metanephrines and catecholamines. Successful open adrenalectomy was performed under protective extracorporeal life support and full anticoagulation early after cardiogenic shock. The patient could be weaned off mechanical support rapidly and made a full cardiopulmonary recovery. (Source: Interactive CardioVascular and Thoracic Surgery)


A simple clinical model for planning transfusion quantities in heart surgery
Conclusions: The regression model proved reliable for quantitative planning of number of PRBC in patients undergoing heart surgery. Besides enabling more rational resource allocation of costly blood-conservation strategies and blood bank resources, the results indicated a strong association between some essential postoperative variables and differences between the model estimate and the actual number of packs transfused. (Source: BMC Medical Informatics and Decision Making - Latest articles)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease as Culprit Lesion in Patients With Acute Myocardial Infarction
Conclusions Patients with acute myocardial infarction and thrombosis of the unprotected left main coronary artery are a high-risk subgroup with a substantial mortality, particularly if they present in cardiogenic shock. We demonstrate that in these patients, PCI is a feasible treatment option associated with reasonably good outcomes. Long-term prognosis is excellent in hospital survivors with an 89.5% survival rate at 1 year. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)


Primary Percutaneous Coronary Intervention for Unprotected Left Main Disease in Patients With Acute ST-Segment Elevation Myocardial Infarction: The AMIS (Acute Myocardial Infarction in Switzerland) Plus Registry Experience
Conclusions Emergent LM PCI in the context of acute myocardial infarction, even including 12% cardiogenic shock, appears to have a remarkably high (89%) in-hospital survival. Concurrent LM and non-LM PCI has worse outcomes than isolated LM PCI. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)


Heart transplant recipients supported with extracorporeal membrane oxygenation: Outcomes from a single-center experience
Conclusions: ECMO support is a viable option for adult heart transplant recipients with severe rejection and refractory cardiogenic shock. To maximize the benefit of this aggressive approach in heart transplant recipients requires early intervention, with a heightened awareness of this option to facilitate expedited use. (Source: The Journal of Heart and Lung Transplantation)


The Romanian Acute Heart Failure Syndromes (RO-AHFS) Registry
Conclusions: The RO-AHFS study found substantial variation both among sites and between Romania and other European countries. National and regional registries have important clinical implications for patient care and the design and conduct of global clinical trials. (Source: American Heart Journal)


Short-Term Mechanical Management of Cardiogenic Shock
Opinion statement&nbsp;&nbsp;Cardiogenic shock (CS), a state of cardiac dysfunction that results in systemic hypoperfusion and end-organ dysfunction, is associated with high in-hospital mortality. Various forms of mechanical circulatory support have been used to treat CS. First employed in the 1960s, the intra-aortic balloon pump (IABP) has been a mainstay in the treatment of acute CS. However, the IABP is unable to provide adequate support in many patients, and newer technologies, including extracorporeal membrane oxygenation and percutaneous ventricular assist devices, appear to be more effective in reversing CS. These devices are also useful for supporting patients during complex percutaneous coronary intervention. Perhaps most importantly, they can be used as a bridge to decision...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> MedWorm Search is coming back soon. <a href="http://www.MedWorm.com/" target="_blank">Watch this space...</a></p></div>


Dipyridamole-Associated Shock and Pulmonary Edema (July/August).
CONCLUSIONS While hypotension has been previously associated with intravenous use of dipyridamole, ours is the first report to suggest a noncardiogenic mechanism for shock. To our knowledge, this is the first reported case of noncardiogenic pulmonary edema following dipyridamole infusion. PMID: 21672887 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)


Cardiac resynchronization therapy for critically ill patients with left ventricular systolic dysfunction
Conclusions: CRT may assist weaning from circulatory and respiratory support in critically ill patients with left ventricular systolic dysfunction. (Source: International Journal of Cardiology)


[The impact of chronic kidney disease on in-hospital clinical outcomes in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction.]
CONCLUSION: Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality. PMID: 21646828 [PubMed - as supplied by publisher] (Source: Turk Kardiyoloji Dernegi arsivi)


First experience with the ultra compact mobile extracorporeal membrane oxygenation system Cardiohelp in interhospital transport [Institutional report - Cardiopulmonary bypass]
We report on our first experience with the new Cardiohelp system for interhospital transfer of cardiopulmonarily compromised patients. The Cardiohelp system was used for transportation and in-house treatment in six male patients with a mean age of 41&plusmn;17&nbsp;years. Five patients suffered respiratory failure; one patient with acute myocardial infarction was in profound cardiogenic shock. Accordingly, the Cardiohelp system was implanted as a venovenous extracorporeal membrane oxygenation (ECMO) in five patients and as a venoarterial system in one patient. The preECMO ventilation time was 0.5&ndash;4&nbsp;days. The patients were transported to our institution by car (n=1) or helicopter (n=5) over a distance of 80&ndash;5850&nbsp;km. The subsequent in-house ECMO support was continued wi...