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Cardiology Medical Medworm: Cardiogenic Shock

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Medworm: Cardiogenic Shock - Recent Medical Updates

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[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> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</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)


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</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> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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 ...


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


[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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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. ...


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


[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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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 [...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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...


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Find the best <a href="http://www.thejanuarysales.com/">Christmas Sales</a>, <a href="http://www.thejanuarysales.com/">Boxing Day Sales</a> and <a href="http://www.thejanuarysales.com/">January Sales</a> <a href="http://www.thejanuarysales.com/">here</a>.</p></div>


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)


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)