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Cardiology Medical Medworm: Cardiogenic Shock

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Medworm: Cardiogenic Shock - Recent Medical Updates

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The Impella(R) Recover mechanical assist device in acute cardiogenic shock: a single-centre experience of 66 patients
CONCLUSIONS The Impella&reg; Recover device improved haemodynamics in patients with acute cardiogenic shock. Still, 30-day mortality remains high and future studies must focus on the optimal timing of placement of the device. (Source: Interactive CardioVascular and Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Oral Nitrate Administration Ameliorates Cardiogenic Shock due to Eclipsed Mitral Regurgitation
Eclipsed mitral regurgitation (MR) has been reported as transient massive functional MR caused by a sudden coaptation defect in the absence of left ventricular remodeling or epicardial coronary artery stenosis. Coronary spasm or microvascular dysfunction has been suggested to be associated with the pathogenesis. Here, we present a 68-year-old woman with eclipsed MR with cardiogenic shock ameliorated by nitrate. She was admitted for transient shock with massive functional MR. Transient MR was associated with a complete absence of mitral leaflet coaptation owing to tethering of the lateral posterior mitral leaflet. The leaflet tethering was triggered by transient myocardial ischemia around the anterolateral papillary muscle, which could have been caused by coronary spasm and/or microvascular...


Hemiarch replacement with concomitant antegrade stent grafting of the descending thoracic aorta versus total arch replacement for treatment of acute DeBakey I aortic dissection with arch tear [AORTIC SURGERY]
CONCLUSION In treating DeBakey I aortic dissection with arch tear, hemiarch replacement with primary tear repair and concomitant TEVAR is a safe alternative to conventional TAR, with improved distal aortic remodelling. (Source: European Journal of Cardio-Thoracic Surgery)


Acute myocardial infarction complicated by cardiogenic shock: results of primary percutaneous coronary interventions are insufficient [LETTERS TO THE EDITOR]
(Source: European Journal of Cardio-Thoracic Surgery)


Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology
Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a ca...


Decade-Long Trends (2001-2011) in the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction [Original Articles]
Conclusions&mdash; We found suggestions of a decline in the death, but not incidence, rates of cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop cardiogenic shock. (Source: Circulation: Cardiovascular Quality and Outcomes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Multidisciplinary approach for primary cardiac lymphoma associated with hemodynamic failure caused by tricuspid valve obstruction
We report the case of a 65-year-old man with PCL associated with unstable hemodynamics caused by tricuspid valve obstruction. Generally, chemotherapy is the first choice of treatment for patients with PCL. This patient required emergency tumor reduction as he was at risk of having acute hemodynamic failure caused by tricuspid valve obstruction. Therefore, he underwent a 2-staged treatment: urgent surgery to avoid sudden death by tricuspid valve obstruction as well as pulmonary embolism during chemotherapy, followed by early chemotherapy. Pathological findings showed diffuse large B-cell lymphoma, and rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone (R-CHOP) therapy was initiated to treat any residual tumor infiltrating the myocardial wall. The patient showe...


Sequential Organ Failure Assessment Score at Presentation Predicts Survival in Patients Treated With Percutaneous Veno-Arterial Extracorporeal Membrane Oxygenation.
CONCLUSIONS: Lower presenting SOFA score and smaller cannula size were associated with increased survival in patients with cardiogenic shock (CS) or CA who underwent percutaneous VA-ECMO placed in the cardiac catheterization laboratory using a portable system. Calculation of the SOFA score at presentation may help physicians determine which patients may derive benefit from ECMO. Smaller cannula size, while decreasing the amount of flow, may result in decreased bleeding and increased survival. PMID: 26887027 [PubMed - as supplied by publisher] (Source: The Journal of Invasive Cardiology)


Bail-Out Use of Impella CP as a Bridge to TAVI in a Cardiogenic Shock Patient: The "Pump-Rewiring" Technique.
CONCLUSION: This case example demonstrates how a tailored step-by-step strategy including PCI, BAV, peripheral angioplasty, percutaneous ventricular assistance, and transcatheter aortic valve implantation (TAVI) allowed the successful treatment of a critical patient with CS. Impella CP could be considered an effective bridge to TAVI in patients developing aortic regurgitation after BAV, since maintaining arterial access can be achieved using the pump-rewiring technique. PMID: 26716594 [PubMed - in process] (Source: The Journal of Invasive Cardiology)


Contemporary Use of Veno-Arterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Acute Coronary Syndrome.
CONCLUSION: VA-ECMO is infrequently used in patients for cardiopulmonary resuscitation in the AMI setting. When used judiciously, it has good clinical outcomes in this group of patients. However, use of VA-ECMO should be individualized based on vascular anatomy for best results. Close cooperation among interventional cardiologists, cardiovascular surgeons, cardiologists, cardiac intensivists, and perfusionists is essential for success of this therapy for RCS in AMI. PMID: 26689415 [PubMed - in process] (Source: The Journal of Invasive Cardiology)


Catheter Ablation of Ischemic Ventricular Tachycardia With Remote Magnetic Navigation: STOP‐VT Multicenter Trial
ConclusionsThis first prospective, single‐procedure, multicenter study indicates that remote magnetic navigation is a safe and effective method for catheter ablation of post‐infarction VT. (Source: Journal of Cardiovascular Electrophysiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Use of Mechanical Support Devices in Percutaneous Coronary Interventions: The Controversy?
We read with great interest the report by Khera et al describing the use of mechanical support (MCS) devices in percutaneous coronary interventions (PCI) using the Nationwide Inpatient Sample (NIS) data.1 The authors did not find any evidence of clear benefit with the use of percutaneous ventricular assist devices (PVADs), i.e. Impella and TandemHeart, when compared with intraaortic balloon pump (IABP) in patients undergoing PCI in the propensity matched population or in the subgroups of patients with cardiogenic shock, acute myocardial infarction (AMI) without cardiogenic shock and non- AMI/non cardiogenic shock (elective high-risk PCI). (Source: The American Journal of Cardiology)


Mechanical Circulatory Support in Pediatrics.
Authors: Steffen RJ, Miletic KG, Schraufnagel DP, Vargo PR, Fukamachi K, Stewart RD, Moazami N Abstract End-stage heart failure affects thousands of children yearly and mechanical circulatory support is used at many points in their care. Extracorporeal membrane oxygenation supports both the failing heart and lungs, which has led to its use as an adjunct to cardiopulmonary resuscitation as well as in post-operative cardiogenic shock. Continuous-flow ventricular assist devices (VAD) have replaced pulsatile-flow devices in adults and early studies have shown promising results in children. The Berlin paracorporeal pulsatile VAD recently gained U.S. Food and Drug Administration approval and remains the only VAD approved in pediatrics. Failing univentricular hearts and other congenitally...


Complete versus culprit-only revascularization in ST-elevation myocardial infarction and multivessel disease
In conclusion, the current available evidence from the randomized clinical trials, with a total sample size of only 2000 patients, is not robust enough to firmly recommend complete revascularization in STEMI patients. This uncertainty lends support to the continuation of the COMPLETE trial. This ongoing trial is anticipated to enroll 3900 patients with STEMI from across the world, and will be powered for the hard outcomes of death and myocardial infarction. Until the results of the COMPLETE trial are reported, physicians need to individualize care regarding the opportunity and the timing of the non-IRA PCI. (Source: Internal and Emergency Medicine)


Radial vs. femoral approach in STEMI: what do we know so far?
Authors: Santucci A, Gargiulo G, Ariotti S, Marino M, Magnani G, Baldo A, Piccolo R, Franzone A, Valgimigli M Abstract Radial approach has been used since 1989 to perform coronary angiography as an alternative to femoral access. During past decades, the development of dedicated equipment led to high efficacy also in complex procedures. ST elevation myocardial infarction (STEMI) is known to be a high bleeding risk setting and in turn bleeding events can negatively impact on outcomes. Observational studies have demonstrated feasibility, efficacy and safety of radial approach when compared to femoral access in STEMI patients, with benefit in bleeding rates. These advantages have been described also in specific populations as elderly or patients in cardiogenic shock. Some large randomi...


Cardiac complications in a metamizole-induced type I Kounis syndrome
We present the case of a patient who suffered Kounis syndrome with cardiogenic shock and asystole after intravenous infusion of Metamizole, and in which no lesions were observed in coronariography. (Source: Brazilian Journal of Anesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Hemodynamic effects, safety and feasibility of intravenous esmolol infusion during Takotsubo cardiomyopathy with left ventricular outflow tract obstruction: Results from a multicenter registry
ConclusionsEsmolol infusion was temporally associated with reduction in intra‐ventricular gradient and systemic blood pressure in patients with TTC and LVOTO. Further controlled studies are warranted to confirm these preliminary findings.This article is protected by copyright. All rights reserved. (Source: Cardiovascular Therapeutics)


Scorpion envenomation-induced acute thrombotic inferior myocardial infarction - Baykan AO, Gür M, Acele A, Şeker T, Çaylı M.
The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalanc... (Source: SafetyLit)


One-year cardiovascular outcomes of drug-eluting stent versus bare-metal stent implanted in diabetic patients with acute coronary syndrome
Conclusion The results of this study support the use of DES over BMS in Taiwanese patients with DM and ACS, providing the clinical benefits of lower rates of total mortality and MACE, and without increased TVR at 1 year in a real-world setting. (Source: Journal of the Chinese Medical Association)


Initial Experience of Transaortic Catheter Venting in Patients with Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock
Extracorporeal membrane oxygenation (ECMO) has become one of the often applied mechanical support for acute cardiogenic shock. During venoarterial (VA) ECMO support, left heart decompression should be considered when left ventricular (LV) distension develops with pulmonary edema and LV dysfunction. The aim of this study was to report the results of transaortic catheter venting (TACV), as an alternative venting method, performed during VA-ECMO in patients with acute cardiogenic shock. We retrospectively reviewed the records of seven patients who underwent both ECMO and TACV between February 2013 and February 2014. Extracorporeal membrane oxygenation was performed uneventfully, and TACV was introduced under transthoracic echocardiographic guidance in all cases. Hemodynamic parameters, LV eje...


Toward catecholamine responsiveness in cardiogenic shock: insights from the CRASH score.
CONCLUSIONS: In patients with cardiogenic shock, the CRASH score (= CPI/square root (IS + 1)) &lt;0.0375 allowed patients at high risk of adverse outcome to be identified. PMID: 26953902 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Percutaneous Coronary Intervention for Older Adults Who Present with Syncope and Coronary Artery Disease? Insights from the National Cardiovascular Data Registry®
Conclusions In patients presenting with syncope and obstructive CAD, PCI was not associated with significant improvements in the risk of readmission, but was associated with lower long-term mortality compared with medical therapy, suggesting the need to more definitively assess the benefit of PCI among elderly syncope patients. (Source: American Heart Journal)


Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction
Conclusions Supplemental oxygen exposure in the first 12&nbsp;h after STEMI was associated with a clinically significant increase in cTnI and CK release. (Source: Heart)


Abstract 268: Using Lean Methodology to Reduce Variation in Care of Acute Coronary Syndrome Patients [Session Title: Abstract Poster Session II]
Discussion: BC is attempting to reduce unexplained variation in coronary revascularization using the Lean methodology to take a systematic approach to the analysis of the process of ACS care across the province. Involving physicians and point of care staff in the detailed mapping process has proven to be a significant step in engaging key stakeholders in the project by allowing input into the process of describing the factors affecting variation of practice at each site. The next step is to convene provincially to determine where to improve standardized practice in order to improve patient outcomes at key points along the value stream. (Source: Circulation: Cardiovascular Quality and Outcomes)


An unusual case of cardiogenic shock late following surgical aortic valve replacement
Publication date: Available online 24 February 2016 Source:Journal of Cardiology Cases Author(s): Maria Chiara Todaro, Alfonso Ielasi, Antonio Silvestro, Davide Personeni, Giulietta Grigis, Antonio Saino, Maurizio Tespili The present case describes a rare but potentially life-threatening complication following surgical aortic valve replacement (AVR): iatrogenic coronary ostial stenosis (ICOS). The incidence of ICOS is estimated to be between 0.3% and 5% of all AVR and it generally occurs within 6 months after the procedure. In most cases, either the left main stem or the ostium of the right coronary artery (RCA) is affected, although stenosis of the ostium of the left anterior descending artery can also occur. However, to the best of our knowledge, the simultaneous involvement of ...


Spontaneous coronary artery dissection resulting in very late stent thrombosis
A 58-year-old man with a history of coronary angioplasty done to right coronary artery 6&nbsp;years back presented to the hospital with sudden-onset chest pain for 1&nbsp;h. His ECG on admission revealed ST elevation in leads II, III and augmented vector foot (aVF). The patient was thrombolysed with streptokinase, which resulted in resolution of chest pain and ECG changes. Three hours later there was reappearance of ST elevation in same leads with cardiogenic shock. It was decided to take the patient for rescue angioplasty. Angiogram revealed significant luminal stenosis of proximal right coronary artery along with in-stent thrombotic occlusion (see online supplementary video 1). The optical coherence tomography (OCT) study showed evidence of coronary dissection with intramural haematoma p...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction.
CONCLUSIONS: STEMI patients with an elevated admission shock index had more pronounced myocardial and microvascular damage. Moreover, the shock index was independently associated with MACE at 12 months. PMID: 26902549 [PubMed - as supplied by publisher] (Source: Circulation Journal)


Severe Acute Traumatic Mitral Regurgitation, Cardiogenic Shock Secondary to Embolized Polymethylmethracrylate Cement Foreign Body After a Percutaneous Vertebroplasty.
We report the case of a 61-year-old woman with acute decompensated heart failure secondary to acute traumatic mitral regurgitation, resulting from polymethylmethacrylate cement found in the left ventricle less than 24 hours after fluoroscopic percutaneous vertebroplasty. The patient had a history of ovarian cancer and had undergone treatment for symptomatic osteoporotic compression fractures of the vertebrae (T11, L1, and L3). The patient underwent a successful emergency open-heart operation, mitral valve replacement, closure of an atrial septal defect, and video-assisted removal of the cement foreign body from the left ventricle. The patient was later discharged with a good outcome. PMID: 26897199 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


How should I treat refractory cardiogenic shock in a patient with chronic biventricular heart failure and mitral regurgitation with difficult valve characteristics?
Authors: Salaun E, Pankert M, Habib G, Bonnet JL, Vahanian A, Himbert D, Brochet E, Nataf P, D'Ancona G, Kische S, Öner A, Ince H PMID: 26897293 [PubMed - as supplied by publisher] (Source: EuroIntervention)


Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching children's hospital
ConclusionDespite recent improvements in safety of pediatric anesthesia, many preventable factors still remain that can lead to critical incidents. (Source: Pediatric Anesthesia)


Advanced mechanical circulatory support for post-cardiotomy cardiogenic shock: a 20-year outcome analysis in a non-transplant unit
Post-cardiotomy cardiogenic shock (PCCS) has an incidence of 2–6 % after routine adult cardiac surgery. 0.5–1.5 % are refractory to inotropic and intra-aortic balloon pump (IABP) support. Advanced mechanical c... (Source: Journal of Cardiothoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Severe Bilateral Ocular Hypotony after Emergent Coronary Artery Bypass Graft Surgery Complicated with Cardiogenic Shock
Intraocular hypotony (IH), defined as a decrease in intraocular pressure (IOP) below 5 mmHg, is sometimes seen after ocular surgeries, but it is rarely clinically significant unless IOP decreases to the 0 to 4 mmHg range.1 Severe IH after cardiac surgery is exceedingly rare.2 The figure shows a marked bilateral distortion of the corneas with an almost “sucked-in effect” in an elderly patient who underwent an emergent coronary artery bypass grafting with hypothermic cardiopulmonary bypass complicated by cardiogenic and vasoplegic shock with severe lactic acidosis. (Source: Anesthesiology)


Intra-aortic balloon counterpulsation in cardiogenic shock: is it really the end of an indication?
Authors: Hermansen SE, Myrmel T PMID: 25426756 [PubMed - indexed for MEDLINE] (Source: Scandinavian Cardiovascular Journal)


Primary Angioplasty For Patients in Cardiogenic Shock – Optimal Management
Cardiogenic shock is a clinical condition of inadequate end-organ perfusion due to cardiac dysfunction (see Table 1). It most commonly occurs in the setting of acute MI with left ventricular failure (~80 % cases),1,2 but can also be caused by right ventricular infarction or late mechanical complications, such as acute mitral regurgitation or ventricular rupture (septal or free wall). Non-infarct-related cardiogenic shock is comparatively rare, and may result from decompensated valvular heart disease and arrhythmias, to name a few mechanisms. (Source: Radcliffe Cardiology)


Early Risk Period Seen for Survivors of Cardiogenic Shock
(MedPage Today) -- In-hospital mortality declining but a vulnerable time follows for rehospitalization, studies say (Source: MedPage Today Cardiovascular)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock Findings From the NCDR
ConclusionsHospital survivors of AMI who had cardiogenic shock have a higher risk of death and/or hospitalization during the first year after discharge. The risk is time-dependent and is clustered in the early post-discharge period, after which the prognosis is similar in patients with and without cardiogenic shock. (Source: Journal of the American College of Cardiology)


Cardiogenic Shock How Long Does the Storm Last? ∗
Cardiogenic shock, the most common cause of in-hospital mortality following acute myocardial infarction (AMI), complicates between 5% and 10% of cases (1). Although the past few decades have seen a decline in early mortality in patients with cardiogenic shock—largely due to increased rates of early revascularization (2) and improved adjunctive pharmacotherapy—in-hospital mortality remains high, at up to 50% (3). Although cardiogenic shock is more common among patients with ST-segment elevation myocardial infarction (STEMI), patients with non–ST-segment elevation myocardial infarction (NSTEMI) tend to have higher baseline risk profiles. Some registries report no difference in early mortality according to AMI subtype in patients with cardiogenic shock (4). Others report higher mortal...


Effective percutaneous “edge‐to‐edge” mitral valve repair with mitraclip in a patient with acute post‐MI regurgitation not related to papillary muscle rupture
A 65‐year‐old woman was admitted to our institution for rest dyspnea and hypotension. EKG showed sinus tachycardia with signs of infero‐posterior STEMI. 2D‐echocardiogram showed severe left ventricular systolic dysfunction with a‐ diskynesia of the inferior and posterior walls and severe functional mitral regurgitation (MR). The patient underwent urgent coronary angiography that showed 3‐vessels disease with total occlusion of both first obtuse marginal (OM) branch of the left circumflex artery and right coronary artery (RCA) and critical stenosis of left anterior descending (LAD). Because of extremely high surgical risk, we performed a staged totally percoutaneous approach. First, we reopened the presumed culprit vessels (RCA and OM) and then, after 48 hr, we performed angiopl...


Perforation of the Anterior Mitral Leaflet following Impella LP 5.0 Therapy in Cardiogenic Shock
The Impella is an axial rotary pump used for cardiogenic shock as temporary support for recovery or bridge to heart transplantation. It has an inlet area in the left ventricle and the outlet area in the ascending aorta cranial to the aortic valve 1. Three sizes exist: 2.5 l/min, 3.5 l/min og 5.0 l/min. The two smaller sizes are implanted with trans-femoral access. Impella LP 5.0 (21 French) is implanted surgically through the right subclavian artery 1. The volume output of the Impella 5.0 is higher and allows a longer period of mechanical support2. (Source: The American Journal of Cardiology)


Experts’ recommendations for the management of cardiogenic shock in children
Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no internationa... (Source: Annals of Intensive Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Perforation of the Anterior Mitral Leaflet After Impella LP 5.0 Therapy in Cardiogenic Shock
A 52-year old man was admitted with out-of-hospital cardiac arrest, and he was resuscitated after 100 minutes. The initial hemodynamic condition was critical due to cardiogenic shock (left ventricular ejection fraction 10 % and mean arterial pressure 60 mmHg on inotropics). Acute coronary angiography did not reveal any new lesions. Due to persistent hemodynamic instability, mechanical support with Impella LP 5.0 was decided. The surgical procedure guided by fluoroscopy and transesophageal echocardiography was uncomplicated. (Source: The American Journal of Cardiology)


Heart attack patients with cardiogenic shock fair well 60 days post-discharge
Heart attack patients who experience cardiogenic shock have a higher risk of death or rehospitalization than non-shock patients in the first 60 days post-discharge, but by the end of the first year, the gap between the two groups narrows, according to a study. (Source: ScienceDaily Headlines)


Long-term intravenous inotropes in low-output terminal heart failure?
Abstract Intravenous inotropic therapy may be necessary to achieve short-term survival in end-stage heart failure patients with cardiogenic shock or extreme low output and severe organ hypoperfusion. However, mid- or long-term intravenous inotropic therapy is associated with an increased mortality in advanced stage D heart failure patients using β-adrenoceptor agonists (dobutamine) or PDE-3-inhibitors (milrinone). Intermittent levosimendan may evolve as a reasonable therapeutic option. Randomized trials or other meaningful scientific evidence addressing the optimal treatment of exclusively the most threatened subgroup of hospitalized patients with persistent severe organ hypoperfusion are missing, but urgently needed. Despite a lack of other beneficial pharmacological options, th...


Understanding cardiogenic shock: a nursing approach to improve outcomes.
Authors: Warise L Abstract Shock is a common complication associated with cardiac hospitalization post-myocardial infarction. Although shock is considered a physiologic response rather than a disease state, the lack of adequate pumping function leads to decreased tissue perfusion and initiation of the general shock response. Regardless of the etiology, the effects of shock are the same. Shock is essentially a widespread impairment of cellular metabolism, specifically, resulting from anaerobic metabolism related to inadequate tissue oxygenation leading to tissue dysfunction and necrosis. The purpose of this article is based on an actual clinical case study, precipitating factors, pathophysiology, common medical diagnosis and therapy, and nursing implications. PMID: 25650490 [Pu...


Diagnosis of hantavirus infection in humans.
Authors: Mattar S, Guzmán C, Figueiredo LT Abstract Rodent-borne hantaviruses (family Bunyaviridae, genus Hantavirus) cause hantavirus pulmonary syndrome in the Americas and hemorrhagic fever with renal syndrome in Europe and Asia. The viruses are transmitted to humans mainly by inhalation of virus-contaminated aerosols of rodent excreta and secreta. Classic clinical hemorrhagic fever with renal syndrome occurs in five phases: fever, hypotension, oliguria, polyuria, and convalescence. Hantavirus pulmonary syndrome is a severe acute disease that is associated with respiratory failure, pulmonary edema and cardiogenic shock. The diagnosis of hantavirus infections in humans is based on clinical and epidemiological information as well as laboratory tests. We review diagnosis for hantav...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Takotsubo Cardiomyopathy: What we have learned in the last 25 years? A comparative literature review.
Authors: Said SM, Saygili E, Rana OR, Genz C, Hahn J, Bali R, Varshney S, Albouaini K, Prondzinsky R, Braun-Dullaeus RC Abstract We performed a comparative literature review, to elucidate the major features of the Takotsubo (stress) cardiomyopathy (TCM) collected in last 25 years. TCM is characterized by left- or biventricular apical ballooning with a clinical presentation, electrocardiographic abnormalities, and biomarker profils similar to those seen in acute myocardial infarction. Epidemiological studies have shown that TCM is more common in postmenopausal women; however exact figures are not available. The underlying aetiology is still largely undetermined. Elevated catecholamine levels, lack of estrogen, disturbed myocardial fatty acid metabolism and plaque rupture with sponta...


Acute Myocardial Infarction/Thrombectomy
This article focuses on specialized techniques and devices used in the most challenging cases of acute myocardial infarction. Areas where high-quality evidence is either clear or absent are avoided. Controversies in the use of support or thrombectomy devices, the addition of adjunct pharmacology, and the decision to treat nonculprit lesions are discussed. Recent years have seen a shift in guidelines to downgrading the use of assist devices in cardiogenic shock and aspiration thrombectomy, whereas consideration of nonculprit coronary intervention has been revived. These changes come in the wake of a series of large, practice-changing clinical trials. (Source: Interventional Cardiology Clinics)


Severe bupropion overdose and ECMO: two great saves
ChaNaWiT/shutterstock.com 3.5 out of 5 stars Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrance Oxygenation. Heise CW et al. J Med Toxicol 2016 Feb 8 [Epub Ahead of Print] Abstract This awesome, exciting paper from Banner University Medical Center in Phoenix describes two teenagers with severe bupropion overdose who survived refractory cardiac arrest after veno-arterial extracorporeal membrane oxygenation (VA-ECMO): Case 1: A 15-year-old girl was brought to hospital after ingesting up to 90 150-mg bupropion tablets. She had a seizure en route and arrived with pulseless electrical activity (PEA). Return of spontaneous circulation was achieved after 20 minutes of cardiopulmonary resuscitation. She was sent by a...


A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery
Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB. (Source: Indian Journal of Anaesthesia)


Cardiogenic shock from atypical Takotsubo cardiomyopathy attributed to acute disseminated encephalomyelitis lesion involving the medulla
We present here a case of atypical Takotsubo cardiomyopathy arising as a result of a lesion in the medulla oblongata. The patient was diagnosed with acute disseminated encephalomyelitis, and had improvement with intravenous steroids. (Source: Clinical Autonomic Research)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Patients With Acute Myocardial Infarction–Related Cardiogenic Shock
To the Editor We read with great interest the Viewpoint by Tchantchaleishvili et al calling for organized statewide networks for the management of acute myocardial infarction–related cardiogenic shock. We applaud the authors’ insights into one of the major current challenges in cardiovascular care. Despite advances in the treatment of coronary artery disease and in the technology of mechanical circulatory support devices (MCSDs), patients with myocardial infarction complicated by cardiogenic shock still have mortality rates in the range of 40% to 50%. While no trial since the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial has demonstrated a clear benefit to any intervention beyond early revascularization, observational data suggest that impro...


Incessant fascicular VT presenting as cardiogenic shock with multi-organ dysfunction syndrome
We report a rare clinical presentation of incessant idiopathic fascicular ventricular tachycardia (FVT), presenting as multi-organ dysfunction (MOD) syndrome with cardiogenic shock. Our patient was a 19-year-old male who presented with slowly progressive dyspnea from New York Heart Association (NYHA) II to NYHA IV at the time of presentation, palpitations, and dilated cardiomyopathy due to drug-refractory FVT. The patient was in cardiogenic shock with raised central venous pressures and required inotropic support for maintaining systolic blood pressure above 90mmHg. The MOD was seen in the form of deranged liver and kidney parameters. Echocardiography showed a dilated left ventricle (LV, 58mm at end-diastole, 52mm at end-systole) and decreased ejection fraction (20%). Electrocardiography s...


Is Extracorporeal Membrane Oxygenator a New Weapon to Improve Prognosis in Patients With Profound Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention?
Authors: Sung PH, Wu CJ, Yip HK Abstract Despite advancements in pharmacological therapy and refinement of the tools and technique of primary percutaneous coronary intervention (PCI) and coronary artery bypass surgery, patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock (CS) still have unacceptably high in-hospital mortality and unfavorable long-term outcome. Thus, there is an imminent need of a new and safe treatment modality in the management of AMI complicated by profound CS. Growing evidence suggests that extracorporeal membrane oxygenator (ECMO)-supported primary PCI is an effective therapeutic option for saving lives under such conditions. In this review, we describe and interpret the potential role of circulatory mechanical support by EC...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation.
We report two cases of severe bupropion toxicity resulting in refractory cardiogenic shock, cardiac arrest, and repeated seizures treated successfully. Patients with cardiovascular failure related to poisoning may particularly benefit from extracorporeal membrane oxygenation (ECMO). These are the first cases of bupropion toxicity treated with veno-arterial EMCO (VA-ECMO) in which bupropion toxicity is supported by confirmatory testing. Both cases demonstrate the effectiveness of VA-ECMO in poisoned patients with severe cardiogenic shock or cardiopulmonary failure. PMID: 26856351 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)


When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock [TRANSPLANTATION AND MECHANICAL CIRCULATORY SUPPORT]
CONCLUSIONS ECLS serves as a bridge-to-decision and bridge-to-treatment device. Our interdisciplinary ECLS programme achieved acceptable survival of critically ill patients despite a substantial percentage of patients having been resuscitated and no absolute exclusion criteria. Further studies defining inclusion- and exclusion criteria might additionally improve outcome. (Source: European Journal of Cardio-Thoracic Surgery)


Mitral clip–looking back and moving forward
This article will review current evidence supporting the use of MitraClip across the spectrum of patient risk and discuss future directions for this technology. Recent findings: Both randomized and registry studies have demonstrated the efficacy and safety of MitraClip for mitral regurgitation reduction, with significant improvements in functional class and reductions in heart failure hospitalizations. With increasing global experience, a broader scope of patients and diseases can now be successfully treated, ranging from patients with failed surgical annuloplasty rings to those in cardiogenic shock. Ongoing randomized trials will further define the role of MitraClip in the management of heart failure patients with secondary mitral regurgitation. Summary: MitraClip is a useful therapeuti...


Clinical characteristics and outcomes after unplanned intraaortic balloon counterpulsation in the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction trial
Conclusions The most significant predictor of crossover to IABC in the setting of anterior STEMI was relative hypotension at the time of hospital admission, and crossover to IABC in CRISP AMI was associated with significantly worse clinical outcomes. (Source: American Heart Journal)


Histological examination of the right atrial appendage after failed catheter ablation for focal atrial tachycardia complicated by cardiogenic shock in a post-partum patient
Publication date: Available online 3 February 2016 Source:Journal of Arrhythmia Author(s): Akira Mizukami, Makoto Suzuki, Rena Nakamura, Shunsuke Kuroda, Maki Ono, Yuya Matsue, Ryota Iwatsuka, Taishi Yonetsu, Akihiko Matsumura, Yuji Hashimoto A 26-year-old woman in her first pregnancy presented with persistent atrial tachycardia (AT). AT was resistant to medications, cardioversions, and the first attempt of catheter ablation. Two months after delivery she developed severe systolic dysfunction and circulatory collapse. Emergent catheter ablation was performed with the support of percutaneous cardiopulmonary bypass and intraaortic balloon pump. The AT originated in the apex of the right atrial appendage (RAA). Repeated attempts at ablation were unsuccessful, prompting surgical RA...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Electrocardiogram in a patient with “acute intermittent porphyria”–triggered Takotsubo syndrome
I read with great interest the report of Messas et al. [1], published ahead of print on January 6, in the Journal, about the 44year-old woman, who suffered Takotsubo syndrome (TTS), triggered by an attack of acute intermittent porphyria (AIP), precipitating an abdominal pain crisis. Under the care of the authors the patient had a complete recovery of her severe left ventricular (LV) dysfunction, leading to cardiogenic shock which required among others, the implementation of intra-aortic balloon pump. (Source: International Journal of Cardiology)


Ablation of an electrical storm in a patient with giant cell myocarditis using continuous flow left ventricular assist device and percutaneous right ventricular assist device
A 35-year old female patient was transferred to our hospital with cardiogenic shock due to a multifocal giant cell myocarditis revealing severe myocyte necrosis, inflammation and fibrosis (Fig. 1A). At the time of admittance to our intensive care unit the left-ventricular ejection fraction was not quantifiable, due to the lack of significant contraction. Significant coronary stenosis had already been ruled out before the transfer to our hospital. To stabilize the patient an extracorporeal life support system (ECLS) had been implanted and an immunosuppressive regime with prednisolone and cyclosporine was started. (Source: International Journal of Cardiology)


Levosimendan meta-analyses: Is there a pattern in the effect on mortality?
Levosimendan is an inodilator developed for treatment of acute heart failure and other cardiac conditions where the use of an inodilator is considered appropriate. Levosimendan has been studied in different therapeutic settings including acutely decompensated chronic heart failure, advanced heart failure, right ventricular failure, cardiogenic shock, septic shock, and cardiac and non-cardiac surgery. This variety of data has been re-analysed in 25 meta-analyses from 15 different international research groups, based on different rationales to select the studies included. (Source: International Journal of Cardiology)


Electrocardiogram in a patient with “acute intermittent porphyria”-triggered Takotsubo syndrome
I read with great interest the report of Messas et al. [1], published ahead of print on January 6, in the Journal, about the 44year-old woman, who suffered Takotsubo syndrome (TTS), triggered by an attack of acute intermittent porphyria (AIP), precipitating an abdominal pain crisis. Under the care of the authors the patient had a complete recovery of her severe left ventricular (LV) dysfunction, leading to cardiogenic shock which required among others, the implementation of intra-aortic balloon pump. (Source: International Journal of Cardiology)


Shock, acute disseminated intravascular coagulation, and microvascular thrombosis: is ‘shock liver’ the unrecognized provocateur of ischemic limb necrosis?
Summary For unknown reasons, a small minority of critically ill patients with septic or cardiogenic shock, multiorgan failure, and disseminated intravascular coagulation develop symmetrical acral (distal extremity) limb loss due to microvascular thrombosis (‘limb gangrene with pulses’). Case reports have described preceding ‘shock liver’ in some critically ill patients who developed such a picture of ischemic limb necrosis. This suggests that profoundly disturbed procoagulant–anticoagulant balance featuring uncontrolled generation of thrombin—resulting from failure of the protein C and antithrombin natural anticoagulant systems due to insufficient hepatic synthesis of these crucial proteins—could explain the microvascular thrombosis and associated limb loss. We hypothesize th...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


In-Hospital Outcome of Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction: Results from Royal Hospital Percutaneous Coronary Intervention Registry, Oman.
CONCLUSIONS: CS in AMI patients presenting to a tertiary hospital in Oman have high in-hospital mortality despite the majority undergoing PCI. Even though the in-hospital mortality is comparable to other studies and registries, there is an urgent need to determine the causes and find any remedies to provide better care for such patients, specifically concentrating on the early transfer of patients from regional hospitals for early PCI. PMID: 26814946 [PubMed] (Source: Oman Medical Journal)


ShockOmics: multiscale approach to the identification of molecular biomarkers in acute heart failure induced by shock
DiscussionShockOmics will provide new insights into the pathophysiological mechanisms underlying shock as well as new biomarkers for the timely diagnosis of cardiac dysfunction in shock and quantitative indices for assisting the therapeutic management of shock patients. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)


The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis: intermediate-term efficacy and durability
Conclusions: Our 5-year experience indicates that the Magna valve offers excellent intermediate-term durability and substantial echocardiographic improvement; its low-profile design make it ideal for reoperations and for concomitant cardiac procedures, including valve replacement. (Source: Journal of Cardiothoracic Surgery)


Percutaneous Decompression of the Left Ventricle in Cardiogenic Shock Patients on Venoarterial Extracorporeal Membrane Oxygenation
ConclusionAntegrade transseptal left ventricular decompression is feasible in patients on extracorporeal membrane oxygenation and persistent pulmonary edema. (Source: Journal of Cardiac Surgery)


Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients
Conclusions Severe hyperlactatemia (&gt;10 mmol/L) is associated with extremely high ICU mortality especially when there is no marked lactate clearance within 12 h. In such situations, the benefit of continued ICU therapy should be evaluated. (Source: Intensive Care Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis.
CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP. PMID: 26839661 [PubMed] (Source: World Journal of Cardiology)


Cyclosporine A in Reperfused Myocardial Infarction The Multicenter, Controlled, Open-Label CYCLE Trial
ConclusionsIn the CYCLE (CYCLosporinE A in Reperfused Acute Myocardial Infarction) trial, a single intravenous CsA bolus just before primary percutaneous coronary intervention had no effect on ST-segment resolution or hs-cTnT, and did not improve clinical outcomes or LV remodeling up to 6 months. (CYCLosporinE A in Reperfused Acute Myocardial Infarction [CYCLE]; NCT01650662; EudraCT number 2011-002876-18) (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


Registry Finds Mounting Deaths With Cardiogenic Shock (CME/CE)
(MedPage Today) -- Worrying trend despite years of clinician experience (Source: MedPage Today Cardiovascular)


Acute myocardial infarction due to left main coronary artery disease in men and women: does ST-segment elevation matter?
CONCLUSIONS: There were no gender-related differences in the management within the STEMI or NSTEMI group. Although acute myocardial infarction due to ULMCA disease is associated with high mortality in both genders, STEMI was a negative prognostic factor of in-hospital and 12-month mortality. Despite poor baseline characteristics and clinical presentation in women, female gender itself did not influence mortality. PMID: 26788080 [PubMed] (Source: Archives of Medical Science)


Efficacy of early invasive management post-fibrinolysis for ST-segment elevation myocardial infarction in relation to initial troponin status
Conclusions Patients with STEMI and abnormal initial troponin have worse short-term and long-term outcomes. Accounting for overall baseline risk with the GRACE risk score, troponin status did not modulate the efficacy of pharmacoinvasive management. Clinical Trial Registration http://www.clinicaltrials.gov/ct2/show/NCT00164190 (Source: Canadian Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and survival in patients requiring prolonged resuscitation efforts
Conclusions: Among patients suffering CA treated with mechanical CC in the cath-lab, 25 % had a good neurological outcome at hospital discharge compared to 10 % treated with manual CC. Long term survival in patients discharged from hospital is good. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)


Pulsatile-flow mechanical circulatory support (MCS) as a bridge to transplantation or recovery. Single-centre experience with the POLCAS system in 2014.
CONCLUSIONS: The POLCAS heart assist system is an effective method of treatment as a bridge to transplantation or recovery in patients with end-stage heart failure. Early survival after the treatment remains at a satisfactory level. The main problem is the large number of complications related to the therapy. PMID: 26702278 [PubMed] (Source: Polish Journal of Cardio-Thoracic Surgery)


A large pseudoaneurysm of the left cardiac ventricle in a 57-year-old patient after urgent coronary artery bypass grafting and surgical mitral valve replacement due to acute myocardial infarction.
We present a rare case of a left ventricular pseudoaneurysm in a patient after inferior wall myocardial infarction. The infarction was complicated with acute mitral insufficiency, pulmonary edema, and cardiogenic shock. Urgent surgical mitral valve replacement and coronary artery bypass grafting were performed. After several months, the patient was hospitalized again because of deterioration of exercise tolerance and symptoms of acute congestive heart failure. A large pseudoaneurysm of the left ventricle was recognized and successfully treated surgically. PMID: 26336464 [PubMed] (Source: Polish Journal of Cardio-Thoracic Surgery)


Oxygenator in short-term LVAD circuit: a rescue in post-LVAD pulmonary complications.
Authors: Mohite PN, Patil NP, Popov AF, Bahrami T, Simon AR Abstract Pulmonary complications after left ventricular assist device (LVAD) implantation, though infrequent, can be potentially catastrophic. A 62-year-old female with cardiogenic shock, supported on short-term LVAD, developed pulmonary oedema. An oxygenator was introduced into the LVAD circuit, which improved the gas exchange and, eventually, after weaning off the oxygenator, the patient received long-term LVAD. The introduction of an oxygenator into the short-term LAVD circuit is a lifesaving manoeuvre in such a situation. It offers freedom of introducing and removing the oxygenator into the LVAD circuit without opening the chest and competing for LVAD flow. PMID: 26791273 [PubMed - as supplied by publisher] (Source...


Bilateral pleural effusion, cardiogenic shock, renal failure, and generalized anasarca: A dreaded iatrogenic complication of umbilical venous catheterization
Gaurav Garg, Gaurav Mandhan, Poonam SidanaAnnals of Pediatric Cardiology 2016 9(1):108-109 (Source: Annals of Pediatric Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of Randomized Controlled Trials of Coronary Artery Bypass Grafting and Stenting Era
Conclusion In patients undergoing high-risk coronary revascularization, IABP did not significantly decrease mortality. But high-risk CABG patients may be benefit from IABP. Rigorous criteria should be applied to the use of IABPs. (Source: PLoS One)


Management Strategies and Outcomes of ST‐Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States
ABSTRACT Fibrinolytic therapy is still used in patients with ST‐segment elevation myocardial infarction (STEMI) when the primary percutaneous coronary intervention cannot be provided in a timely fashion. Management strategies and outcomes in transferred fibrinolytic‐treated STEMI patients have not been well assessed in real‐world settings. Using the Nationwide Inpatient Sample from 2008 to 2012, we identified 18 814 patients with STEMI who received fibrinolytic therapy and were transferred to a different facility within 24 hours. The primary outcome was in‐hospital mortality. Secondary outcomes included gastrointestinal bleeding, bleeding requiring transfusion, intracranial hemorrhage (ICH), length of stay, and cost. The patients were divided into 3 groups: those who received medic...


Postinfarction ventricular septal rupture: can we improve clinical outcome of surgical repair?
Abstract Postinfarction ventricular septal rupture (VSR) is a lethal structural complication following acute myocardial infarction (AMI). Surgical repair of VSR was first reported in 1957 by Cooley. Since then, many methods have been introduced, variously using right and/or left ventriculotomy. Daggett used infarctectomy and septal reconstruction via left ventriculotomy, reporting 52 % operative mortality when repair was attempted within 21 days, but only 7 % when done after 3 weeks. Komeda and David described single pericardial patch infarct exclusion without infarctectomy through a left ventriculotomy in 1990. It seemed conceptually simple, and became a standard technique. Modifications of that technique and development of other methods have been reported by many surgeons. N...


Use of venoarterial extracorporeal membrane oxygenation in fulminant chagasic myocarditis as a bridge to heart transplant
RESUMO Jovem com 17 anos de idade atendido com dispneia progressiva há 15 dias e piora nas últimas 24 horas. Foi admitido em estado de insuficiência respiratória e choque cardiogênico com disfunção de múltiplos órgãos. O ecocardiograma mostrou fração de ejeção ventricular esquerda de 11%, grave hipocinesia difusa e pressão sistólica da artéria pulmonar de 50mmHg. Houve necessidade de suporte hemodinâmico com uso de dobutamina (20mcg/kg/minuto) e noradrenalina (1,7mcg/kg/minuto). Após 48 horas, o paciente não apresentou melhora hemodinâmica nem clínica, optando-se, então, pela implantação de membrana de oxigenação extracorpórea. Ocorreu melhora do ponto de vista hemodinâmico, da perfusão sistêmica, da função renal e hepática, porém, após 72 horas, não ho...


Left ventricular thrombus associated with arteriovenous extra corporeal membrane oxygenation.
Authors: Makdisi G, Hashmi ZA, Wozniak TC, Wang IW Abstract Extra corporeal membrane oxygenation (ECMO) has remarkably progressed over the recent years. It has become an invaluable tool in the care of adults and pediatric patients with severe cardiogenic shock. At the initiation of ECMO support, the left ventricular contractility is profoundly impaired. Inadequate right ventricular drainage and bronchial circulation can lead to left ventricular distension, with potential deleterious consequences, ranging from inadequate myocardial rest, pulmonary edema, or intracardiac clot formation. Therefore, it is of extreme importance to ensure an adequate left ventricular drainage. Here we present a case of LV thrombus developed while the patient is on central venoarterial (VA) ECMO. PMI...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Spinal Cord Infarct During Concomitant Circulatory Support With Intra-Aortic Balloon Pump and Veno-Arterial Extracorporeal Membrane Oxygenation
Conclusions: The timeline of events suggests a causal relation between intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, and significant neurologic deficits. This is likely due to hypoperfusion of the spinal cord, which is multifactorial in origin, including small aortic calibre, low cardiac output states, high vasopressor requirements causing vasospasm of the artery of Adamkiewicz, occlusion of retrograde oxygenated blood flow from peripheral veno-arterial extracorporeal membrane oxygenation due to intra-aortic balloon pump being in situ, and possible thromboembolic phenomena. The thoracic spinal cord is intrinsically susceptible to ischemia due to the anatomy of the arterial supply, which is described here. We identify several risk factors and make several rec...


An unusual case of fulminant myocarditis closely mimicking ST-segment elevation myocardial infarction and presenting as refractory cardiogenic shock complicated by multiple life-threatening arrhythmiasAn unusual case of fulminant myocarditis
We report a case of severe fulminant myocarditis that closely mimicked acute inferior ST-segment elevation myocardial infarction (STEMI) and presented with refractory cardiogenic shock, multiple life-threatening arrhythmias and rapidly progressive liver failure. This case was successfully differentiated from STEMI by emergency coronary angiography. Recurrent cardiogenic shock was reversed by intra-aortic balloon pumping (IABP). Life-threatening arrhythmias including ventricular tachycardia, ventricular fibrillation, and high-degree atrioventricular block (AVB) were terminated by immediate cardioversion and temporary pacemaker. High-dose hydrocortisone effectively attenuated the inflammatory injury to the myocardium. The patient recovered and was well at the follow-up visit four months afte...


Clinical Characteristics and Outcomes of Patients With Myocardial Infarction and Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery: Data From The Society of Thoracic Surgeons National Database
Conclusions Most patients undergoing CABG for AMI-CS have a sizeable but not prohibitive risk. Patients who require MCS and those undergoing operation as a salvage procedure reflect higher risk populations. (Source: The Annals of Thoracic Surgery)


The Ankle-Brachial Index is Associated With Cardiovascular Complications After Noncardiac Surgery
Conclusions: In patients submitted to noncardiac surgery, abnormal ABI is associated with a higher occurrence of a cardiovascular event. (Source: Angiology)


Paraganglioma masquerading as acute myocardial infarction and cardiogenic shock
Publication date: Available online 14 January 2016 Source:Indian Heart Journal Author(s): Tanveer Ahmad, Shankaragouda Patil, Ashwini Kumar Pasarad, Nandakumar Neralakere Maheshwarappa, Kolkebaile Sadanand Kishore Paragangliomas, extra-adrenal pheochromocytomas, are rare catecholamine-secreting tumor. A 34-year-old lady admitted with diagnosis of ST elevation acute myocardial infarction with cardiogenic shock. Left ventricular function, severely depressed, returned to normal after initial stabilization. Coronary angiogram was normal. A para-aortic paraganglioma was diagnosed during the patient's work-up with biochemical studies, computed tomography of abdomen and functional radioisotopes imaging and was eventually surgically resected. This case shows that acute myocardial infarction...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


STEMI vs NSTEACS management trends in non-invasive hospital
Conclusion NSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors. (Source: Indian Heart Journal)


Characteristics of 1‐day postoperative mortality: a comparison with 2‐ to 7‐day postoperative mortality
ConclusionsThe characteristics of POD 1 mortality were different from those of POD 2–7 mortality. A large proportion of early postoperative deaths were due to POD 1 mortality. Human factor‐related causes were more associated with POD 1 mortality, indicating much room for improvement. (Source: Acta Anaesthesiologica Scandinavica)


Percutaneous Mechanical Circulatory Support for Cardiogenic Shock
Opinion statement The use of percutaneous, non-durable mechanical circulatory support (MCS) for cardiogenic shock (CS) is growing; however, large, randomized clinical trials confirming benefit in this population do not exist. Guidelines and recommendations regarding optimal timing for MCS implementation, patient selection, device selection, and post-implantation management are beginning to emerge. A better understanding of (1) the distinct hemodynamic effects of each device option, (2) the need for early implementation of the appropriate device option for a particular clinical scenario, (3) the definition of non-salvageable CS to help clinicians know when to say “no” to non-durable MCS, and (4) best practices to monitor, wean, and optimize metabolic parameters while using non...


Double organ transplantation in cardiac amyloidosis
We report here the remarkable case of a 63-year-old man with heart failure caused by AL amyloidosis. After a long course, which included rapid deterioration of preexisting heart failure, cardiac arrest, cardiogenic shock, biventricular assist device support, heart transplantation, renal failure, kidney transplantation and finally a life-threatening H1N1 virus pneumonia, the patient managed not only to survive but also to return fully to his previous demanding duties and lifestyle. Discussion: Early use of left ventricular or biventricular mechanical circulatory support may be beneficial as a bridge to transplantation in patients with cardiac AL amyloidosis. (Source: Journal of Cardiovascular Medicine)


Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia
We describe the surgical technique and treatment of a 59-year-old male with cardiogenic shock, who underwent a minimally invasive off-pump ventricular assist device (VAD) implantation with the aid of paravertebral regional analgesia in bilateral mini-thoracotomies as first procedure described in the literature. He was extubated soon after the procedure, in the operating room, with the aim to reduce the right ventricle impairment. These issues are particularly true for patients suffering from pulmonary hypertension and disease, in whom the shortest time of postoperative intubation is fundamental to allow self-inotropic support and recovery of the right ventricle. We illustrate how a minimally invasive implant may improve the clinical outcomes of VAD patients shortening their return time to ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Epidemiology, pathophysiology, and in-hospital management of pulmonary edema: data from the Romanian Acute Heart Failure Syndromes registry
Conclusions: In this national registry, the PE profile was found to be a high-acuity clinical presentation with distinctive treatment patterns and a poor short-term prognosis. Advances in the management of PE may necessitate both the development of novel targeted therapies as well as systems-based strategies to identify high-risk patients early in their course. (Source: Journal of Cardiovascular Medicine)


Complete occlusion of the left main trunk coronary artery by a cardiac papillary fibroelastoma in a hemodynamically unstable patient
We present the case of a 60-year-old woman who underwent stent placement in the LMT three years prior to developing chest pain and cold sweats. On coronary arteriography, the catheter could not be advanced into the LMT due to resistance in the ostium. Insertion of the catheter was achieved after the resolution of resistance via catheterization of the LMT by means of an intra-aortic balloon pump drive system. The LMT was normal, and the patient's circulatory failure improved. The cause of the LMT embolism was a cardiac papillary fibroelastoma. Primary surgical excision is the recommended therapy for symptomatic cardiac papillary fibroelastoma. If the patient is hemodynamically stable, it may be possible to delay surgery. However, the patient in question developed cardiogenic shock secondary...


Coronary artery vasospasm and cardiogenic shock as the initial presentation for eosinophilic granulomatosis with polyangiitis
We present a case of refractory coronary artery vasospasm in the setting of eosinophilic granulomatosis with polyangiitis (EGPA). Typically, calcium channel blockers and nitrates are used to treat hyperreactive narrowing of the coronary vasculature but we propose this case was refractory to standard treatment due to the underlying pathology of EGPA. Alternative causes of coronary vasospasm when standard therapies fail should be considered.&gt; (Source: Journal of Cardiology Cases)


Epinephrine administration and Takotsubo syndrome: Lessons from past experiences
The objective of the present study was to explore the particulars (age, gender, dose, route of injection, and circumstances) of EPI administration triggered-TTS. Accordingly, a review was undertaken of 29 entries available as of 1/3/16 in Pubmed, in response to the MeSH term “epinephrine administration and Takotsubo” [1–29], plus a recent report with a fatal outcome [30], not accessed as described above, which provided 20 papers (22 patients). (Source: International Journal of Cardiology)


Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction
Publication date: Available online 8 January 2016 Source:Journal of Acute Disease Author(s): Rengin Çetin Güvenç, Tolga Sinan Güvenç Acute mitral regurgitation (MR) is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary oedema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cardiogenic shock secondary to methamphetamine induced cardiomyopathy requiring veno-arterial extra-corporeal membrane oxygenation
A 31year old male with no significant past medical history was transferred to our institution for management of cardiogenic shock after presenting with new severe bi-ventricular dysfunction. Previously, he had smoked regular crystal-methamphetamine, with heavy daily usage for 8years until becoming abstinent 2months prior to presentation. He had also used intermittent gamma hydroxyl-butymate with occasional heavy alcohol binges. Throughout this period of substance use, he had maintained regular employment and had a supportive social network. (Source: International Journal of Cardiology)


Cardiogenic Shock Following Amplatzer Device Embolization Due to Left Ventricular Outflow Tract Obstruction
(Source: Journal of Cardiac Surgery)


Successful left ventricular assist device re-implantation with omental covering for MDRP device infection
We present a case of paracorporeal left ventricular assist device (p-LVAD)-related infection, caused by multi-drug resistant Pseudomonas aeruginosae (MDRP), and successfully treated by p-LVAD re-implantation with omental covering. A 59-year-old man underwent p-LVAD implantation and coronary artery bypass grafting after percutaneous cardiopulmonary support and intra-aortic balloon pumping for cardiogenic shock due to acute myocardial infarction. Then, he was registered for heart transplantation. He suffered from blood stream infection causative organism of Pseudomonas aeruginosa, 2 months after that operation. He underwent re-median sternotomy and open drainage, 15 months after the p-LVAD implantation. However, he suffered from septic shock due to MDRP. He underwent p-LVAD re-implantation...


Sub-acute transcatheter aortic valve implantation as bridge to recovery from cardio-pulmonary support following ST-elevation myocardial infarction and cardiogenic shock
Cardiogenic shock is a serious complication to myocardial infarction with a high mortality rate [3], and is complicated by concomitant aortic stenosis. Immediate management of both conditions is crucial for the clinical outcome. (Source: International Journal of Cardiology)


Role of endomyocardial biopsy in the diagnostic procedure of pheochromocytoma induced cardiogenic shock
We read with great interest Kodama and coworkers' paper, discussing the use of endomyocardial biopsy (EMB) in acute cardiogenic shock [1] therefor we wish to respond and offer our opinion. Pheochromocytoma induced cardiogenic shock should be indeed considered in young patients presenting with normal coronary arteries; and without sign of systemic inflammation at admission [1,2], as fulminant myocarditis usually presents with a recent history of infection, high level of C-reactive protein and significant release of cardiac enzymes [3]. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Individualized real-time clinical decision support to monitor cardiac loading during venoarterial ECMO
Veno-arterial extracoporeal membrane oxygenation (VA ECMO) is increasingly used for acute and refractory cardiogenic shock. Yet, in clinical practice, monitoring of cardiac loading conditions during VA ECMO can be cumbersome. To this end, we illustrate the validity and clinical applicability of a real-time cardiovascular computer simulation, which allows to integrate hemodynamics, cardiac dimensions and the corresponding degree of VA ECMO support and ventricular loading in individual patients over time. (Source: Journal of Translational Medicine)


Active Versus Passive Anchoring Vascular Closure Devices Following Percutaneous Coronary Intervention: A Safety and Efficacy Comparative Analysis
ConclusionsAngioSeal and Mynx appear to be equally safe and efficacious VCDs following PCI. The passive anchoring system may prove desirable as no intra‐arterial anchor remains upon device removal. (Source: Journal of Interventional Cardiology)


Treatment and outcomes of patients with recurrent myocardial infarction: A prospective observational cohort study.
CONCLUSIONS: Although patients with reMI are high-risk patients, they were less likely to receive evidence-based treatment and had worse in-hospital and 1-year outcomes compared to patients with first MI. Short- and long-term management of patients with recurring MI should be improved. PMID: 26778745 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


Impact of Chronic Total Occlusion in a Noninfarct-related Artery on Clinical Outcomes in Patients With Acute ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Abstract: In the setting of primary percutaneous coronary intervention (PCI), encountering with chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is not a rare situation. Limited information on the impact of CTO on clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI has raised more concerns. The aim of the present study was to evaluate the effect of concurrent CTO in a non-IRA on the clinical outcomes in patients with STEMI undergoing primary PCI. In the present prospective study, 555 consecutive patients with STEMI who underwent early primary PCI from January 2010 to December 2013 were included. The patients were divided into 2 groups: no CTO and CTO. Data on 12 months follow-up was obtained from 449 patients. The primary...


Scorpion envenomation-induced acute thrombotic inferior myocardial infarction.
We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome. PMID: 26875137 [PubMed - as supplied by publisher] (Source: Turk Kardiyoloji Dernegi arsivi)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Acute kidney injury treated with renal replacement therapy and 5-year mortality after myocardial infarction-related cardiogenic shock: a nationwide population-based cohort study
Conclusion: AKI-RRT following myocardial infarction-related cardiogenic shock predicted elevated short-term mortality and long-term risk of chronic dialysis and mortality. The impact of AKI-RRT declined with increasing comorbidity suggesting that intensive treatment of AKI-RRT should be accompanied with optimized treatment of comorbidity when possible. (Source: Critical Care)


Incidence of Hemolysis in Patients with Cardiogenic Shock Treated with Impella Percutaneous Left Ventricular Assist Device
This study aims to assess the incidence of hemolysis when Impella support is used longer than 6 hours in CS. We retrospectively studied all patients who required Impella between April 2009 and September 2013. Demographic data and hemolysis indicators were sampled and analyzed using paired t-test. A total of 118 devices were placed and 40 used longer than 6 hours. The average time of support was 86.63 hours, and the 30 and 90 days of survival were 65% and 60%, respectively. After 24 hours of support, the hemoglobin (Hb) decreased significantly despite 17% of patients receiving blood transfusion (p = 0.0001). By the time of removal, 65% of patients were transfused to maintain a Hb of 10 mg/dl (p = 0.0014). The lactate dehydrogenase (LDH) increased to 5,201 U/L (n = 22; p = 0.0096), the bilir...


Clinical Outcomes of Advanced Heart Failure Patients with Cardiogenic Shock Treated with Temporary Circulatory Support Before Durable LVAD Implant
Temporary circulatory support (TCS) is used to improve hemodynamics in patients with cardiogenic shock as a bridge to durable ventricular assist device (dVAD). Data from dVAD recipients with or without TCS (extracorporeal membranous oxygenation [ECMO], n = 14; TandemHeart [TH], n = 26) were evaluated. Clinical characteristics and hemodynamics were analyzed for patients before and after TCS and compared with profile 1 (n = 29) or profile 2–3 (n = 269) patients without TCS before dVAD. Extracorporeal membranous oxygenation patients had the highest use of preoperative mechanical ventilation, vasopressors, and the highest HeartMate II risk score before dVAD (p < 0.01). Patients receiving TCS before dVAD implant had hemodynamics comparable with patients in Profiles 2–3 and superior to that ...


Surgeon-Performed Hemodynamic Transesophageal Echocardiography in the Burn Intensive Care Unit
The use of transesophageal echocardiography (TEE) for resuscitation after burn injury has been reported in small case studies. Conventional TEE is invasive and often requires a subspecialist with a high level of training. The authors report a series of surgeon-performed hemodynamic TEE with an indwelling, less bulky, user-friendly probe. Records of patients treated in a regional burn center who underwent hemodynamic TEE between October 1, 2012 and May 30, 2014 were reviewed. The clinical course of each patient was recorded. All bedside interpretations were retrospectively reviewed for accuracy by a cardiac anesthesiologist. Eleven patients were included in the study. Median age was 68.5 years (interquartile range, 49.5–79.5). Median burn size was 37% TBSA (interquartile range: 16.3–53%...


Spontaneous Coronary Artery Dissection
ConclusionsIn general, the long‐term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life‐threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


ADP receptor antagonists in patients with acute myocardial infarction complicated by cardiogenic shock: a post hoc IABP-SHOCK II trial subgroup analysis.
CONCLUSIONS: This IABP-SHOCK II trial subgroup analysis shows that the use of potent P2Y12 receptor inhibitors like prasugrel or ticagrelor is feasible and might not be harmful in selected patients with cardiogenic shock complicating acute myocardial infarction. However, the superiority in comparison to clopidogrel remains to be proven. PMID: 26690314 [PubMed - as supplied by publisher] (Source: EuroIntervention)


Coronary Revascularization in Cardiogenic Shock
Opinion statement Early revascularization in acute myocardial infarction (MI) complicated by cardiogenic shock (CS) reduces mortality with a life saved for every eight patients treated. Percutaneous coronary intervention (PCI) has become the mainstay of treatment for CS, particularly for ST-segment elevation MI, due to the ability to achieve rapid reperfusion; with coronary artery bypass graft (CABG) operations reserved for patients with mechanical complications or anatomy that poses challenges for timely PCI. Mortality remains high even in patients with successful revascularization, and interventional cardiologists must consider additional treatment options. Recent data supports the performance of multi-vessel PCI to achieve complete revascularization in this setting. In additio...


Fragmented QRS Complex Predicts In‐Hospital Adverse Events and Long‐Term Mortality in Patients with Acute Pulmonary Embolism
ConclusionsThe presence of fQRS complex, as a simple and feasible ECG marker, seems to be a novel predictor of in‐hospital adverse events and long‐term all‐cause mortality in PE patient population. This parameter may utilize the identification of patients whom at higher risk for mortality and individualization of therapy. (Source: Annals of Noninvasive Electrocardiology)


Cardiogenic shock induced by Takotsubo cardiomyopathy: A new therapeutic option
We report the use of extracorporeal life support (ECLS) in a patient with TC and refractory cardiogenic shock. With ECLS it was possible to reduce inotropic support, and a normal left ventricular ejection fraction was documented by echocardiography on day 2. This is, to our knowledge, the first reported case of TC with refractory cardiogenic shock treated with ECLS in Portugal. (Source: Revista Portuguesa de Cardiologia)


The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Conclusion RPR is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk parameters in predicting long-term MACE and cardiovascular mortality in STEMI. (Source: Revista Portuguesa de Cardiologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Impact of Coronary Collateral Circulation on In-Hospital Death in Patients with Inferior ST Elevation Myocardial Infarction.
Conclusion. Presence of angiographically detectable CCC was associated with better in-hospital outcomes including RV infarction, complete AV block, cardiogenic shock, and VT/VF in patients with inferior STEMI. PMID: 26689135 [PubMed] (Source: Cardiology Research and Practice)


A hospital‐wide system to ensure rapid treatment time across the entire spectrum of emergency percutaneous intervention
ConclusionA hospital‐wide systems approach applied across the entire spectrum of emergency PCI leads to rapid door‐to‐balloon time, reduced infarct size and hospitals costs, and low myocardial infarction 30‐day all‐cause mortality. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


EaRly-start ExerciSe training afTer acute hemodynAmic decompensation in patients with chRonic hearT failure (RE-START). A multicenter, randomized, controlled trial on short-term feasibility and impact on functional capacity, symptoms and neurohumoral activation .
Authors: Mezzani A, Cacciatore F, Catanzaro R, Gualco A, Guzzetti D, Leosco D, Monelli M, Tarro Genta F, Totaro P, Traversi E, Zanelli E, Giannuzzi P Abstract RE-START is a multicenter, randomized, prospective, open, controlled trial aiming to evaluate the feasibility and the short- and medium-term effects of an early-start AET program on functional capacity, symptoms and neurohormonal activation in chronic heart failure (CHF) patients with recent acute hemodynamic decompensation. Study endpoints will be: 1) safety of and compliance to AET; 2) effects of AET on i) functional capacity, ii) patient-reported symptoms and iii) AET-induced changes in beta-adrenergic receptor signaling and circulating angiogenetic and inflammatory markers. Two-hundred patients, randomized 1:1 to training...


Cardiotoxic and Arrhythmogenic Effects of Hemiscorpius lepturus Scorpion Venom in Rats.
CONCLUSION: Our study paves the way for further in vivo investigation of cardiovascular effects of this venom for finding suitable treatments instead of its ordinary antivenom medication in cardiogenic shock induced by the venom. PMID: 26623433 [PubMed] (Source: Iranian Journal of Arthropod-Borne Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


An unfortunate case of subaortic left ventricular diverticulum
Publication date: Available online 20 December 2015 Source:Indian Heart Journal Author(s): P. Vinodh Kumar, Asha Moorthy A 38-year-old man presented with exertional angina of 1-year duration. Treadmill was strongly positive. Coronary angiogram revealed a significant phasic systolic compression of the left main and the proximal left circumflex artery. Echo and MRI revealed a subaortic left ventricle diverticulum causing compression of the coronary vessels. Before the planned surgery, the patient had sudden deterioration with cardiogenic shock and could not be saved. (Source: Indian Heart Journal)


Extracorporeal Membrane Oxygenation as a Resuscitation Measure in the Pediatric Emergency Department.
CONCLUSIONS: Extracorporeal life support has enormous potential in the emergency department and warrants further assessment. PMID: 26665320 [PubMed - in process] (Source: The Israel Medical Association Journal)


[Takotsubo Cardiomyopathy: Cause of a Cardiogenic Shock].
We present the case of a 59 year old woman admitted to the emergency room with sudden chest pain and dyspnea. At presentation: acute hypotensive pulmonary edema requiring aminergic support and invasive ventilation. Blood tests showed elevated necrosis myocardial enzymes. Serial electrocardiograms: sinus rhythm with progressive inversion of the T wave through the precordial leads (v2 - v6). Control echocardiograms: overall decreasedsystolic function with apical akinesia, and full reversal of the changes in 2 weeks. Cardiogenic shock of unknown etiology was admitted and a coronary computed tomography angiography was performed excluding coronary heart disease, supporting the diagnosis of Takotsubo cardiomyopathy. PMID: 26667873 [PubMed - in process] (Source: Acta Medica Portuguesa)


Deep sedation versus general anesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system
Conclusions In comparison to GA, DS reduces the ICU length of stay in PMVR without negative effects on safety and efficacy. Prospective randomized trials are needed to confirm these findings. (Source: Clinical Research in Cardiology)


Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions
Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department. (Source: Critical Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Clinical Characteristics and Outcomes after Unplanned Intra-Aortic Balloon Counterpulsation in the CRISP AMI Trial
Conclusions The most significant predictor of crossover to IABC in the setting of anterior STEMI was relative hypotension at the time of hospital admission, and crossover to IABC in CRISP AMI was associated with significantly worse clinical outcomes. (Source: American Heart Journal)


Surgical Outcomes of a Modified Infarct Exclusion Technique for Post-Infarction Ventricular Septal Defects.
CONCLUSION: The use of a multiple-patch technique with sealants appears to be a reliable method of reducing early mortality and the risk of significant residual shunting in patients with pVSDs. PMID: 26665103 [PubMed] (Source: Korean Journal of Thoracic and Cardiovascular Surgery)


Right ventricular assist device with membrane oxygenator support for right ventricular failure following implantable left ventricular assist device placement [TRANSPLANTATION AND MECHANICAL CIRCULATORY SUPPORT]
CONCLUSIONS Patients with a RVAD with membrane oxygenation support for acute RV failure after continuous-flow left ventricular assist device implantation had a lower 30-day mortality than those with a RVAD alone. Patients who survive to discharge have a reasonable 1-year survival. Combining membrane oxygenation with RVAD support appears to offer a short-term survival benefit in patients with RV failure after continuous-flow left ventricular assist device implantation. (Source: European Journal of Cardio-Thoracic Surgery)


Surgical management of destructive aortic endocarditis: left ventricular outflow reconstruction with the Sorin Pericarbon Freedom stentless bioprosthesis [ADULT CARDIAC]
CONCLUSIONS The Sorin Pericarbon Freedom stentless prosthesis, with the modified technique herein described, seems to be a good option in most of cases of destructive aortic valve endocarditis. It is promptly available in different sizes, easy to implant and, due to its pericardial inflow skirt, ideal for extensive reconstruction of the LVOT with good haemodynamic performance and low risk of relapse. (Source: European Journal of Cardio-Thoracic Surgery)


Magnitude, treatment, and impact of diabetes mellitus in patients hospitalized with non-ST segment elevation myocardial infarction: A community-based study
Purpose of the study: To examine differences in the characteristics, treatment practices and in-hospital outcomes of patients with and without previously diagnosed diabetes hospitalized for non-ST segment elevation myocardial infarction. Key methods: The study cohort consisted of 3916 patients diagnosed with non-ST segment elevation myocardial infarction at all 11 central MA medical centres between 1999 and 2009, of whom 1475 (38%) had been previously diagnosed with diabetes. Main results: Diabetic patients were more likely to have received treatment with effective cardiac medications, and to have undergone coronary bypass surgery, but were less likely to have received a percutaneous coronary intervention, than non-diabetic patients. Patients with a history of diabetes were more likely t...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature
Rupture of the ventricular septum following acute myocardial infarction (AMI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is the only definitive treatment for this condition. (Source: International Journal of Cardiology)


Rapidly progrediating aortic valve infective endocarditis in an intravenous drug user treated by antibiotics and surgery.
We report the case of a 22-year old male, a self-confessed recreational drug user who developed cardiogenic shock because of severe destruction of the aortic valve by rapidly progressive aortic valve endocarditis. The disease progression was acute; in a matter of days, the clinical manifestations were life-threatening necessitating urgent aortic valve replacement surgery. Cultivation revealed Streptococcus viridans as the microbial agent. Subsequent recovery with antibiotic treatment was without complication. This case report shows that immediately performed transoesophageal echocardiography and early consultation with a cardiac surgeon has fundamental importance in diagnosis and management of acute infective endocarditis in haemodynamically instable patients. PMID: 23101277 [PubMed - ...


Traumatic Coronary Artery Dissection in a Young Woman after a Kick to Her Back.
We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive car...


Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting.
Authors: Hong TH, Byun JH, Yoo BH, Hwang SW, Kim HY, Park JH Abstract Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV) is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV) was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance. The patient was successfully weaned from VA ECMO. Percutaneous TACV is an effective, relatively noninvasive, and rapid ...


Association of Hyperglycemia with In-Hospital Mortality and Morbidity in Libyan Patients with Diabetes and Acute Coronary Syndromes.
CONCLUSION: In patients with diabetes and acute coronary syndrome, hyperglycemia during hospitalization predicted a worse outcome in terms of the rates of in-hospital complications and in-hospital mortality. Hyperglycemia at the time of admission was also associated with higher rate of complications particularly at the time of presentation. PMID: 26421112 [PubMed] (Source: Oman Medical Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Shock, acute disseminated intravascular coagulation and microvascular thrombosis: is ‘shock liver’ the unrecognized provocateur of ischemic limb necrosis?
This article is protected by copyright. All rights reserved. (Source: Journal of Thrombosis and Haemostasis)


Shock, acute disseminated intravascular coagulation and microvascular thrombosis: is 'shock liver' the unrecognized provocateur of ischemic limb necrosis?
This article is protected by copyright. All rights reserved. PMID: 26662371 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)


In-hospital major cardiovascular events between STEMI receiving thrombolysis therapy and primary PCI.
CONCLUSION: the in-hospital major cardiovascular events between STEMI receiving thrombolysis therapy and primary PCI is not significantly different. Heart failure is significantly higher in thrombolysis therapy and the primary PCI reduces the risk. PMID: 25053685 [PubMed - indexed for MEDLINE] (Source: Acta medica Indonesiana)


High-degree atrioventricular block complicating ST segment elevation myocardial infarction in the contemporary era
Conclusions Patients with HAVB had a higher mortality rate than patients without. However HAVB is not an independent predictor of inhospital mortality. (Source: Heart)


Thin strut bare metal stents in patients with atrial fibrillation: Is there still a need for BMS?
ConclusionBare metal stenting in AF patients delivered acceptably low TLR and MACE rates while having the benefit of a significantly shorter DAPT duration in a DES dominated clinical practice. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Percutaneous Coronary Interventions and Hemodynamic Support in the USA: A 5 Year Experience
ConclusionThis largest and the most contemporary study on the use of hemodynamic support demonstrates significantly reduced mortality with PVADs when compared to IABP in patients undergoing PCI. The results are largely driven by the improved outcomes in non‐AMI and non‐cardiogenic shock patients. (J Interven Cardiol 2015;28:563–573) (Source: Journal of Interventional Cardiology)


Use of Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock
Cardiogenic shock is a condition marked by low cardiac output and end-organ hypoperfusion frequently requiring hemodynamic support, and it carries a high mortality. Extracorporeal membrane oxygenation (ECMO) is an effective tool in providing mechanical circulatory support in patients with cardiogenic shock refractory to conventional medical therapies. ECMO can be an essential bridge to recovery, ventricular assist device implantation or transplant. A multidisciplinary team approach is needed in managing such patients and intensive monitoring is required to avoid complications from ECMO. Nevertheless, randomized clinic trials are warranted to prove a survival benefit. (Source: Cardiology in Review)


Xenios expands manufacturing, R&D footprint
Xenios said today it expanded its research & development and manufacturing operations to include a new combined facility. The Reutlingen, Germany R&D and manufacturing facility was added as the company continues on what it calls an &#8220;aggressive growth strategy.&#8221; &#8220;Given that no other company except Xenios is offering minimally invasive lung and heart therapies on 1 platform, and given that the Xenios platform provides fundamental advantages for patients with its minimally invasive lung and heart therapies, Xenios is growing rapidly. As a direct result of the recent significant cash infusion from existing investors led by Zukunftsfonds Heilbronn (ZFHN), which we announced in September, Xenios is able to enlarge its commercial operations per plan,&#8221; mana...


Multivessel versus culprit lesion only percutaneous revascularization plus potential staged revascularization in patients with acute myocardial infarction complicated by cardiogenic shock -Design and rationale of CULPRIT-SHOCK trial
Conclusions The CULPRIT-SHOCK trial will address the question of optimal revascularization strategy in patients with multivessel disease and acute myocardial infarction complicated by cardiogenic shock. (Source: American Heart Journal)


Takotsubo Cardiomyopathy Following Cardiac Surgery
ConclusionsAfter cardiac surgery takotsubo cardiomyopathy should be suspected if clinical and instrumental criteria are met, and promptly differentiated from the more frequent acute myocardial infarction. Prognosis may be favorable if appropriate conservative medical treatment is promptly started. (Source: Journal of Cardiac Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Thoughts on the Intra-aorta Balloon Pump
A RECENT META-ANALYSIS on the use of the intra-aortic balloon pump came to the conclusion that the use of the device did not improve the survival in patients with acute myocardial infarction, irrespective of whether cardiogenic shock was present or not.1 This analysis is at variance with retrospective data reported from a single institution and reported in this Journal2 and from data on the use of the intra-aortic balloon pump in cardiac surgery reported by Zangrillo and colleagues.3 These different results should naturally be interpreted within the context of their respective studies. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Hypertensive emergency due to pheochromocytoma crisis complicated with refractory hemodynamic collapse.
Authors: Hayıroğlu Mİ, Yıldırımtürk Ö, Bozbay M, Eren M, Pehlivanoğlu S Abstract Hypertensive emergency usually appears in older patients with previous recurrent episodes, and is among the most frequent admissions to emergency departments. A 29-year-old woman was referred to our clinic with the diagnosis of hypertensive emergency. The patient complained of severe headache, dyspnea, palpitation, diaphoresis, and confusion due to hypertensive encephalopathy. Her blood pressure was 250/150 mmHg on admission. At the referral hospital, the patient had undergone cranial CT because of her confused state and this excluded acute cerebral hemorrhage. Also at that hospital, thoracoabdominal CT for differential diagnosis depicted an adrenal mass with a necrotic core. After admission t...


Risk stratification of pulmonary embolism: clinical evaluation, biomarkers or both?
The concept of risk-stratification is one of the cornerstones of the recent guidelines on pulmonary embolism (PE), which were issued by the European Society of Cardiology (ESC) and endorsed by the European Respiratory Society [1]. According to these guidelines, patients with PE are divided in three groups with increasing risk of death or adverse outcome following a three-step process that is based on clinical data, assessment of anatomical right ventricular dysfunction on echocardiography or spiral computed tomography (CT), and of myocardial injury by dosage of cardiac biomarkers [1]. The first step is based on the measurement of blood pressure to determine whether cardiogenic shock is present, or not. For the vast majority of patients with acute PE who present with normal blood pressure, ...


Fibroblast growth factor 23 (FGF-23) is an early predictor of mortality in patients with cardiac arrest
Post-cardiac arrest management has seen significant advances with profound improvements in survival and neurologic outcome. However, early prognostication after return of spontaneous circulation remains most challenging. Biomarkers have evolved as helpful tools in identifying patients who are at increased risk of adverse outcome. While fibroblast growth factor 23 (FGF-23) has recently emerged as a promising predictor of mortality in patients with cardiogenic shock, its role in risk stratification in post-resuscitation management remains unresolved. (Source: Resuscitation)


Severe iatrogenic bradycardia related to the combined use of beta-blocking agents and sodium channel blockers.
CONCLUSION: Although wide QRS ventricular tachyarrhythmia is a better known proarrhythmic effect of Na channel blockers, life-threatening bradycardia may also occur in combination with beta-blockers in the elderly, even months after the start of medication, and at plasma concentrations that do not prolong QRS width. PMID: 25733934 [PubMed] (Source: Clinical Pharmacology: Advances and Applications)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Tetanus in Ho Chi Minh City, Vietnam: epidemiological, clinical and outcome features of 389 cases at the Hospital for Tropical Diseases].
The objective of this study is to describe the different aspects of tetanus during the past recent years in southern Vietnam: epidemiology, clinical picture, management, and death risk factors. It is a retrospective study concerning 389 cases admitted in 2007 and 2008 at the reference Hospital for Tropical Diseases in Ho Chi Minh City. 93% of all cases were generalized tetanus, and 50% were severe cases. A majority of patients were adult males (medium age 43, M/ F sex-ratio 2.9). Half of them underwent tracheotomy and 39% assisted ventilation. Case fatality rate was 6.4%, the lowest reported rate worldwide in the last ten years. Fatalities resulted mainly from neuro-vegetative disorders, essentially cardiogenic shock (28% of all deaths) [OR = 16.95; p &lt; 0.001], sepsis (24%) [OR = 3.25; ...


The PulseCath iVAC 2L left ventricular assist device: conversion to a percutaneous transfemoral approach.
CONCLUSIONS: The percutaneous PulseCath iVAC 2L is driven by a genuine IABP console and provides more left ventricular support. PMID: 26603991 [PubMed - in process] (Source: EuroIntervention)


Cardiovascular highlights from non-cardiology journals
The Natural History of Takotsubo Cardiomyopathy In the 25 years since first being described, takotsubo (stress) cardiomyopathy has gained increasing recognition as a common clinical entity. Despite this, our understanding of the natural history of takotsubo cardiomyopathy remains limited. The International Takotsubo Registry has been gathering data on takotsubo cases since 1998 and this publication describes their findings to date. Among 1,750 patients with takotsubo cardiomyopathy, 90% were women, the mean age was 66.8 years, and psychiatric or neurological disorders were common (56%). Approximately one-quarter of presentations were triggered by an emotional event, slightly more than one-third by a physical event, and the remainder had no identified trigger. Rates of in-hospital cardiogen...


Xenios wins CE Mark for I-Cor cardiac assist device
Xenios said yesterday that it won CE Mark approval in the European Union for its I-Cor synchronized cardiac assist device, touting it as the world&#8217;s 1st &#8220;heartbeat-synchronized&#8221; cardiac assist for cardiogenic shock and high-risk interventions. Heilbronn, Germany-based Xenios, which claimed in September to have drummed up an 8-figure funding round, said the I-Cor system is designed to provide &#8220;beat-to-beat&#8221; cardiac assistance using a miniature pump &#8220;with synchronized pulses that are superimposed over the patient&#8217;s weakened heartbeats.&#8221; &#8220;European regulatory approval of the I-Cor synchronized cardiac assist system now makes possible a whole new era for percutaneous cardiac assist,&#8221; managing director Dr. Georg Matheis said in pr...


Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction
Conclusions Nonculprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The influence of advancing age on implantation of drug‐eluting stents
ConclusionIn patients aged ≥ 65 years, the use of DES decreased with increasing age. This observation was apparent in both the first and second DES era. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Complete recovery of acute kidney injury in native kidney following heart kidney transplantation
We report the case of a 23-year-old female who developed severe acute kidney injury (AKI) in the setting of recent onset congestive heart failure secondary to viral cardiomyopathy, cardiogenic shock unresponsive to placement of a biventricular assist device with continued requirement of multiple intravenous pressors, recurrent ventricular tachycardia/fibrillation, and rhabdomyolysis secondary to ischemic necrosis of left leg muscles. Daily slow, low-efficiency dialysis was instituted shortly after admission. Given the possibility of irreversible AKI and the inferior outcomes following heart transplantation alone in patients with perioperative renal dysfunction, she was listed for urgent combined heart-kidney transplantation. Dual transplantation was performed after 9 days of AKI and 7 days...


Percutaneous coronary intervention with the TandemHeart™ percutaneous left ventricular assist device support: Six years of experience and outcomes
ConclusionsTandemHeart™ assisted PCI is a viable option for revascularization in cases of profound cardiogenic shock or extremely risky intervention due to complex anatomy. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation.
CONCLUSION: An initial low eGFR may predict worse clinical outcome in patients undergoing VA-ECMO for cardiogenic shock and cardiac arrest. PMID: 26611934 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


Clinical experience of infective endocarditis complicated by acute cerebrovascular accidents.
CONCLUSION: Early surgical intervention for IE with ischemic stroke may prevent adverse events, particularly in patients with impaired renal function, diabetes, or staphylococcal infection. A delay in operation of &gt; 30 days is recommended after hemorrhagic stroke. PMID: 26610865 [PubMed - as supplied by publisher] (Source: Asian Journal of Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Safety research of extracorporeal membrane oxygenation treatment on cardiogenic shock- multicenter clinical study.
CONCLUSION: The ECMO treatment can decrease the mortality rate with a low occurrence rate of complication, effective to rescue cardiogenic shock. PMID: 26080684 [PubMed - as supplied by publisher] (Source: Minerva Cardioangiologica)


Management of cardiogenic shock in the setting of ST-elevation myocardial infarction: controversies and future directions.
Authors: Kohl LP, Jones WS Abstract The treatment of patients with ST-segment elevation myocardial infarction (STEMI) has changed dramatically since reperfusion therapy has been adopted more commonly, yet 5-10% of patients still develop cardiogenic shock and remain a therapeutic challenge in the setting of STEMI. In this review, we outline the available evidence from randomized controlled trials and registries, including risk factors, diagnostic tools, and various treatments. The main focus of this report is on the currently available treatment options (revascularization, intra-aortic balloon counterpulsation), emerging treatment options (percutaneous hemodynamic support, extracorporeal membrane oxygenation), and ongoing efforts to design systems of care to more efficiently care fo...


The fundamentals of extra-corporeal membrane oxygenation.
Authors: Aghili N, Kang S, Kapur NK Abstract During the past 50 years, pharmacologic advancements for cardiovascular risk factors and device innovation for the management of coronary disease, including acute myocardial infarction have radically changed the landscape of heart disease. At present, nearly 25% of individuals develop chronic heart failure after an acute myocardial infarction. It is estimated that nearly 2.6% of the American population suffers from heart failure. In the modern era, miniaturized continuous flow ventricular assist devices are now demonstrating nearly 75% 2-year survival rates with improved patient functionality. As a result, elderly patients with cardiogenic shock for whom medical treatment held minimal promise, may now be viable candidates for advanced me...


Contemporary use and results of intra-aortic balloon pump counterpulsation.
Authors: Gargiulo G, Stabile E, Perrino C, Scudiero F, Scudiero L, Schiattarella GG, Franzone A, Sannino A, Trimarco B, Esposito G Abstract Intra--aortic balloon pump (IABP) counterpulsation is the most widely used form of left ventricular mechanical support today, with more than 160000 patients worldwide receiving this therapy annually. Currently, IABP support is indicated in patients with acute left ventricular systolic failure and cardiogenic shock whose management remains particularly complex and still today characterized by high mortality rates. While the available clinical practice guidelines support the indication to IABP placement in acute myocardial infarction (MI) with cardiogenic shock, recent clinical studies have questioned the benefits of IABP in these clinical settin...


Trends in Hospitalization for Takotsubo Cardiomyopathy in the United States
Conclusions We found a marked increase in the hospitalization for takotsubo cardiomyopathy in the U.S. in recent years, suggesting higher incidence than prior reports. Although outcomes have remained favorable, there is an increasing burden of cardiovascular and psychiatric disorders in this population with growing cost of care. Risk of mortality is higher in men and in patients with underlying critical illness. The excess mortality in these groups appears to be mediated by greater severity of disease. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Primary cardiac lymphoma complicated by cardiogenic shock: successful treatment with chemotherapy delivered under extracorporeal membrane oxygenation support [CASE REPORT]
We report the case of a 65-year old immunocompetent man with cardiogenic shock requiring emergent extracorporeal membrane oxygenation (ECMO). Soon after, a diagnosis of PCL was given and chemotherapy was delivered under ECMO support. The patient was progressively weaned from the mechanical support. Six months later, he had fully recovered. (Source: European Journal of Cardio-Thoracic Surgery)


Ten year experience of using a novel metabolic protocol in 'off pump' coronary artery bypass revascularization
Conclusions: Off-pump coronary artery bypass coupled with this novel metabolic protocol was associated with a low operative mortality and acceptable perioperative morbidities, including patients with left main coronary artery disease. These benefits are apparent at both short- and medium-term follow up. (Source: Therapeutic Advances in Cardiovascular Disease)


Cerebrovascular Accidents After Percutaneous Coronary Interventions From 2002 to 2014: Incidence, Outcomes, and Associated Variables
Conclusion Neurologic events post-PCI are associated with markedly worse in-hospital outcomes. The incidence of CVA and TIA post-PCI, however, remained stable over the last 12 years despite an increase in risk factors for CVA. (Source: American Heart Journal)


Impact of the Presence of Chronic Total Occlusion in a Non-Infarct-Related Coronary Artery in Acute Myocardial Infarction Patients.
Authors: Mizuguchi Y, Takahashi A, Hashimoto S, Yamada T, Taniguchi N, Nakajima S, Hata T Abstract Chronic total occlusion (CTO) in a non-infarcted-related artery was reported to worsen immediate clinical outcome in acute myocardial infarction (AMI) patients. However, the prognosis of such patients with preserved left ventricular function after successful primary percutaneous coronary intervention (PCI) has not yet been clarified. The aim of the present study was to evaluate whether the presence of CTO contributes to a worse prognosis even in patients with preserved left ventricular function after primary PCI.We retrospectively analyzed 353 consecutive patients with acute myocardial infarction, whose left ventricular ejection fraction (LVEF) was not less than 40% in the echocardiog...


Aortic chondroid neoplasia in two Labrador Retriever dogs
This report presents the contrasting clinical disease progression and findings in two dogs with aortic neoplasia, with a proposed pathogenesis of cardiac failure secondary to aortic neoplasia. (Source: Journal of Veterinary Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Thromboaspiration in the treatment of ST segment elevation myocardial infarction].
Authors: Brasselet C, Duval S, Leroux M, Davienne Y Abstract Routine manual thrombectomy during primary percutaneous coronary intervention might be intuitively justified. While older registers reported contradictory results, interventional cardiologists remained interested in using such devices during the mechanical treatment of acute myocardial infarction. The first studies were congruent to demonstrate a significant relationship between thromboaspiration and significant improvement of ST-segment elevation, lower distal embolization, despite TAPAS was the only to significantly reduce the mortality. Later studies were unable to confirm these promising data, avoiding routine manual thrombectomy prior to primary angioplasty to decrease cardiovascular mortality, recurrent myocardial i...


Extracorporeal life support in polytraumatized patients
Major trauma is a leading cause of death, particularly amongst young patients. Conventional therapies for post-traumatic cardiovascular shock and acute pulmonary failure may sometimes be insufficient and even dangerous.New approaches to trauma care and novel salvage techniques are necessary to improve outcomes. Extracorporeal life support (ECLS) has proven to be effective in acute cardiopulmonary failure from different aetiologies, particularly when conventional therapies fail.Since 2008 we have used ECLS as a rescue therapy in severe poly-trauma patients with refractory clinical setting (cardiogenic shock, cardiac arrest, and/or pulmonary failure): the rationale for using ECLS in trauma patients is to support cardiopulmonary function, providing adequate systemic perfusion and, therefore, ...


Kounis syndrome with cardiogenic shock during transfemoral transcatheter aortic valve replacement
No abstract available (Source: Coronary Artery Disease)


Collaborative quality improvement vs public reporting for percutaneous coronary intervention: A comparison of percutaneous coronary intervention in New York vs Michigan
Conclusions Public reporting of PCI data is associated with fewer high-risk patients undergoing PCI compared with CQI. However, in comparable samples of patients, PR is also associated with a lower risk of mortality and adverse events. The optimal quality improvement method may involve combining these 2 strategies to protect access to care while still driving improvements in patient outcomes. (Source: American Heart Journal)


A team‐based approach to patients in cardiogenic shock
Cardiogenic shock is a common clinical condition with high in‐hospital mortality. Early application of appropriate interventions for cardiogenic shock—including medical therapies, revascularization, temporary hemodynamic support devices, and durable mechanical circulatory support—may improve outcomes. The number and complexity of therapies for cardiogenic shock are increasing, making time‐dependent decision‐making more challenging. A multidisciplinary cardiogenic shock team is recommended to guide the rapid and efficient use of these available treatments. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Decade-Long Trends in 30-Day Rehospitalization Rates After Acute Myocardial Infarction [Epidemiology]
Conclusions While the likelihood of subsequent short-term rehospitalizations remained frequent, we observed an encouraging decline during the most recent years under study. Several high-risk groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of being readmitted. (Source: JAHA:Journal of the American Heart Association)


Going Beyond the Hard Endpoints “Quality of Life” May Be Dependent on Quality of Available Data ∗
We have made remarkable progress in the treatment of ST-segment elevation myocardial infarction (STEMI) over the last 2 decades, mostly through the introduction of acute percutaneous coronary intervention (PCI). However, important issues remain, including how we should manage the approximate 40% to 60% of patients shown to have multivessel coronary artery disease (MVCAD). To date, clinicians presented with this common clinical problem have surprisingly little robust evidence-based guidance on optimal management. Until recently, most data came from observational studies, registries, or selected patients from randomized clinical trials designed to answer different questions. Based on these limited (and confounded) data, PCI of a noninfarct vessel in hemodynamically stable STEMI patients r...


Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure
In conclusion, procedural and non-procedural blood loss may often be observed in critically ill patients on RRT. In CVVH-treated patients, procedural blood loss was increased but overall transfusion rates remained unchanged. Our data show that IHD and CVVH may be regarded as equivalent approaches in critically ill patients with dialysis-dependent acute renal failure in this regard. (Source: Anaesthesia and Intensive Care)


Temporal trends and in-hospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction.
CONCLUSIONS: The number of nonagenarian STEMI patients who have undergone primary PCI has increased. Although a final TIMI flow &lt; 3 and cardiogenic shock are independent predictors of in-hospital mortality, primary PCI can be performed with a high success rate and an acceptable in-hospital mortality rate. PMID: 26552457 [PubMed - in process] (Source: The Korean Journal of Internal Medicine)


Simultaneous occlusion of left anterior descending and left circumflex arteries by very late stent thrombosis: vascular response to drug-eluting stents assessed by intravascular ultrasound
Abstract Very late stent thrombosis (VLST) is a catastrophic complication after implantation of a drug-eluting stent (DES). It has been reported that VLST is associated with pathological changes, which often include late acquired incomplete stent apposition (LAISA) with thrombus formation. In addition, the vascular response to the stent (evaginations, neointimal growth, and thrombosis) and the incidence of LAISA are reported to vary among the different types of DES. We experienced a patient with cardiogenic shock induced by simultaneous VLST of both the left anterior descending artery (LAD) and the left circumflex artery (LCX) at 3 years after implantation of two sirolimus-eluting stents. Intravascular ultrasound (IVUS) showed LAISA of both arteries. A paclitaxel-eluting stent, ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


“Ballooning” patterns in takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study
In conclusion, approximately 20 % of TCM patients show non-apical left ventricular ballooning, and female sex and MVO are less frequent in this type than in apical ballooning type TCM. Low body mass index and MVO are risk factors of recurrence, and advanced age and cardiogenic shock are risk factors of cardiac death in TCM. (Source: Heart and Vessels)


Takotsubo cardiomyopathy caused by epinephrine-treated bee sting anaphylaxis: a case report
Conclusions A Hymenoptera sting may be a specific cause of catecholamine cardiac depression. The presence of cardiogenic shock and its etiology should prompt aggressive management including extracorporeal membrane oxygenation as a bridge to cardiac functional recovery in such rare scenarios. (Source: Journal of Medical Case Reports)


Predicting survival in hospitalized pulmonary hypertension patients
Conclusion: Survival appears related to better stroke volumes and cardiac function. Further analysis of continuous trends will enable the development of goal directed therapies for acute RVF cardiogenic shock in PH patients. (Source: European Respiratory Journal)


Calcium channel antagonist and beta‐blocker overdose: antidotes and adjunct therapies
Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta‐adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs can also produce vasodilatory shock. Additionally, CCBs, such as verapamil and diltiazem, are commonly ingested in sustained‐release formulations. This can also be the case for some BBs. Peak toxicity can be delayed by several hours. Provision of early gastrointestinal decontamination with activated charcoal and whole‐bowel irrigation might mitigate this. Treatment of shock requires a multimodal approach to inotropic therapy that can be guided by echocardiographic or invasive haemodynamic assessment of myocardial function. High...


Long-Term Survival and Quality of Life of Patients Undergoing Emergency Coronary Artery Bypass Grafting for Postinfarction Cardiogenic Shock
Conclusions The long-term survival and quality of life of patients who undergo eCABG for cardiogenic shock after acute myocardial infarction are good, and eCABG should be considered a valuable therapeutic option in this setting. The use of cardiopulmonary bypass and the internal thoracic artery at the time of the operation are strongly advocated. (Source: The Annals of Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Refractory cardiogenic shock due to extensive anterior STEMI with covered left ventricular free wall rupture treated with awake VA-ECMO and LVAD as a double bridge to heart transplantation - collaboration of three cardiac centres.
CONCLUSION: The interhospital collaboration can be essential in the context of patients with RCSMI. The use of ECMO enables safe interhospital transport and gains time for further diagnostic and therapeutic steps in such critically ill patients. PMID: 26498212 [PubMed - as supplied by publisher] (Source: Biomedical Papers of the Medical Faculty of the Univ Palacky Olomouc Czech Repub)


Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience
Conclusions Cardiopulmonary support with VA-ECMO provides an invaluable tool in the treatment of AFM, although major complications may characterize the hospital course. Long-term outcome appears favorable with rare episodes of recurrent myocarditis or cardiac-related events. (Source: The Annals of Thoracic Surgery)


Long-Term Survival and Quality of Life of Patients Undergoing Emergency Coronary Artery Bypass Grafting for Postinfarction Cardiogenic Shock.
CONCLUSIONS: The long-term survival and quality of life of patients who undergo eCABG for cardiogenic shock after acute myocardial infarction are good, and eCABG should be considered a valuable therapeutic option in this setting. The use of cardiopulmonary bypass and the internal thoracic artery at the time of the operation are strongly advocated. PMID: 26518374 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience.
CONCLUSIONS: Cardiopulmonary support with VA-ECMO provides an invaluable tool in the treatment of AFM, although major complications may characterize the hospital course. Long-term outcome appears favorable with rare episodes of recurrent myocarditis or cardiac-related events. PMID: 26518372 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


Multivessel Versus Culprit-only Percutaneous Coronary Intervention Among Patients 65 Years of Age or Older With Acute Myocardial Infarction
Conclusions Non-culprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Frequency and Outcomes of Severe Hyperlactatemia after Elective Cardiac Surgery
The frequency and outcome of patients with severe hyperlactatemia after cardiac surgery was investigated through a retrospective review. Over 5 years, 121 patients (1.26%) developed serum lactates levels > 10 mmol/L. Hospital mortality was 40.5%, and 33.1% were dismissed home. The most common cause of hyperlactatemia was cardiogenic shock. (Source: The Journal of Thoracic and Cardiovascular Surgery)


[Women and acute coronary syndrome with ST elevation: Excess mortality related to longer delays and spontaneous coronary dissection].
Authors: Benamer H, Motreff P, Jessen P, Piquet M, Haziza F, Chevalier B Abstract The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negative...


The optimal hemodynamics management of post-cardiac arrest shock
Publication date: Available online 14 October 2015 Source:Best Practice &amp; Research Clinical Anaesthesiology Author(s): Tommaso Pellis, Filippo Sanfilippo, Giuseppe Ristagno Patients resuscitated from cardiac arrest develop a pathophysiological state named “post–cardiac arrest syndrome”. Post-resuscitation myocardial dysfunction is a common feature of this syndrome and many patients eventually die from cardiovascular failure. Cardiogenic shock accounts for most deaths in the first three days, a time when post resuscitation myocardial dysfunction peaks. Thus identification and treatment of cardiovascular failure is one of the key therapeutic goals during hospitalization of post-cardiac arrest patients. Patients with hemodynamic instability may require advanced cardiac outp...


Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial
Publication date: Available online 22 October 2015 Source:The Lancet Author(s): Sanjit S Jolly, John A Cairns, Salim Yusuf, Michael J Rokoss, Peggy Gao, Brandi Meeks, Sasko Kedev, Goran Stankovic, Raul Moreno, Anthony Gershlick, Saqib Chowdhary, Shahar Lavi, Kari Niemela, Ivo Bernat, Warren J Cantor, Asim N Cheema, Philippe Gabriel Steg, Robert C Welsh, Tej Sheth, Olivier F Bertrand, Alvaro Avezum, Ravinay Bhindi, Madhu K Natarajan, David Horak, Raymond C M Leung, Saleem Kassam, Sunil V Rao, Magdi El-Omar, Shamir R Mehta, James L Velianou, Samir Pancholy, Vladimír Džavík Background Two large trials have reported contradictory results at 1 year after thrombus aspiration in ST elevation myocardial infarction (STEMI). In a 1-year follow-up of the largest r...


Safety and efficacy of glucose-insulin-potassium treatment in coronary artery bypass graft surgery and percutaneous coronary intervention
The purpose of this meta-analysis was to evaluate protective effects of glucose&ndash;insulin&ndash;potassium (GIK) on outcomes after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). We systematically searched Medline/Pubmed, Elsevier, Embase, Web of Knowledge and Google Scholar. A total of 1206 studies were retrieved during the extensive literature search of all major databases; however, 38 trials reporting the end-point of interest were selected. We performed a pooled analysis of outcomes following PCI: incidence of cardiac arrest [odds ratio (OR) of 0.91; 95% confidence interval (CI): 0.76&ndash;1.09; P = 0.3], stroke (OR of 1.71; 95% CI: 0.37&ndash;1.37; P = 0.3), cardiogenic shock (OR of 1.02; 95% CI: 0.92&ndash;1.14; P = 0.6), reinfarction (OR of 0....<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction
Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating NSTEMI are limited. We used the 2006-2012 Nationwide Inpatient Sample databases to identify patients ≥18 years of age with non-ST-elevation myocardial infarction (NSTEMI) with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. (Source: The American Journal of Cardiology)


[Mechanical cardiac-assist devices in ST segment elevation myocardial infarction].
Authors: Spaulding C Abstract A 49-year-old woman was admitted for an anterior ST segment elevation myocardial infarction (STEMI). At hospital arrival, she presented with cardiogenic shock. An immediate coronary angiogram showed an occluded ostial left anterior descending artery. During percutaneous coronary intervention (PCI), ventricular fibrillation occurred requiring multiple electrical counter-shocks. The coronary artery was opened during cardiopulmonary resuscitation and two drug-eluting stents were implanted. At the end of the procedure, an Impella CP(®) mechanical cardiac-assist device was inserted. Rapid and marked improvement in the hemodynamic status was noted in the following days. The Impella CP(®) was withdrawn after five days and the patient was discharged two w...


TCT 2015 Roundup: St. Jude Medical’s new HeartMate PHP pump
St. Jude Medical (NYSE:STJ) said today that its newly acquired HeartMate PHP heart pump met its safety and efficacy endpoints in the Shield I trial used to back its CE Mark approval last summer. The results from Shield I&#8217;s 1st 30 patients led to the CE Mark nod in July. Today St. Jude said data from 46 subjects passed the primary safety endpoint of a composite of major adverse events and the primary efficacy endpoint of freedom from hemodynamic compromise during percutaneous coronary intervention. The study results, released today at the annual Transcatheter Cardiovascular Therapeutics conference in San Francisco, also showed low complication rates, including no incidence of device-related cardiac death, myocardial infarction or intraprocedural hypotension. St. Jude acquired the...


The contemporary role of Impella in a comprehensive mechanical circulatory support program: a single institutional experience
Conclusions: Our data suggest that a multi-device approach, encompassing active LV support with Impella, is safe and can significantly improve survival in patients with cardiogenic shock. (Source: BMC Cardiovascular Disorders)


[Primary angioplasty in diabetic and non-diabetic patients with acute myocardial infarction: Predictors of mortality].
CONCLUSION: This group of diabetic patients was older, and with a higher prevalence of 2 or more vessel disease. Cardiogenic shock on admission was the only independent predictor of in-hospital death and along with age and angiotensin-converting enzyme inhibitor use, an independent predictor of mortality during long term follow-up. PMID: 26476483 [PubMed - as supplied by publisher] (Source: Archivos de Cardiologia de Mexico)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


TCT 2015: Thrombectomy no benefit in Medtronic’s Export studies
Thrombus aspiration in heart attack patients showed no benefit and raised the risk of stroke, according to a pair of studies of percutaneous coronary interventions using Medtronic&#8216;s (NYSE:MDT) Export aspiration catheter, presented today at the annual Transcatheter Cardiovascular Therapies conference in San Francisco. Early thrombectomy&#8217;s promise Totaled? The 10,064-patient Total study compared PCI alone and PCI with thrombectomy in ST-elevated myocardial infarctions within 12 hours of onset. The primary endpoint (a composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or class IV heart failure) at 1 year was 8% for both arms of the trial (395 of 5,035 thrombectomy patients, 394 of 5,029 PCI-only patients). Cardiovascular death occurred in 4...


Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock
In this study, we describe our experience with the Impella 5.0 device used in the setting of refractory cardiogenic shock. Methods: In this observational, retrospective, single-center study we included all the consecutive patients supported with Impella 5.0, between May 2008 and December 2013, for refractory cardiogenic shock. Patients’ baseline and procedural characteristics, hemodynamics and outcome to the first 48 h of support, to ICU discharge and day-28 visit were collected. Results: A total of 40 patients were included in the study. Median age was 57 years and 87.5 % were male. Cardiogenic shock resulted from acute myocardial infarction in 17 patients (43 %), dilated cardiomyopathy in 12 (30 %) and postcardiotomy cardiac failure in 7 (18 %). In 15 patients Impella 5.0 was add...


The optimal hemodynamics management of post-cardiac arrest shock
Patients resuscitated from cardiac arrest develop a pathophysiological state named “post–cardiac arrest syndrome”. Post-resuscitation myocardial dysfunction is a common feature of this syndrome and many patients eventually die from cardiovascular failure. Cardiogenic shock accounts for most deaths in the first three days, a time when post resuscitation myocardial dysfunction peaks. Thus identification and treatment of cardiovascular failure is one of the key therapeutic goals during hospitalization of post-cardiac arrest patients. (Source: Best Practice and Research. Clinical Anaesthesiology)


Endomyocardial Biopsy in acute cardiogenic shock: Diagnosis of pheochromocytoma
Acute cardiogenic shock is a clinical emergency. Once the most common causes including acute myocardial ischemia and acute valve dysfunction are excluded, less common causes such as toxic cardiomyopathy or fulminant myocarditis remain to be investigated [1–3]. Endomyocardial biopsy (EMB) is the gold standard to diagnose or rule out myocarditis [4] and to suspect toxic acute myocardial damage in patients presenting with cardiogenic shock. (Source: International Journal of Cardiology)


Experience from a randomized controlled trial with Impella 2.5 versus IABP in STEMI patients with cardiogenic pre-shock
Cardiogenic shock occurs in approximately 6–10% of patients with acute ST-segment elevation myocardial infarction (STEMI) [1]. Anterior STEMI patients with high heart rate or low systolic blood pressure may qualify as pre-shock patients and until recently these patients were frequently supported with an intra-aortic balloon pump (IABP). However, routine usage of the IABP patients with anterior STEMI and cardiogenic shock is not associated with clinical benefit and is no longer recommended [2–4]. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Low-dose oral pimobendan emancipates patients with severe ischemic pump failure from intravenous catecholamine infusion for cardiogenic shock
We present 3 cases of severe ischemic heart disease with catecholamine-dependent pump failure that were successfully treated with low-dose oral pimobendan. Patient characteristics before pimobendan administration are summarized in Table 1. (Source: International Journal of Cardiology)


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


[Evolution of the interventional reperfusion strategy and reperfusion times in acute ST-segment elevation myocardial infarction].
CONCLUSIONS: The D2B and M2B times significantly decreased in our centre between 2007 and 2012, and reached the recommended values in &gt;60% of the cases. This may be explained by better coordination between emergency medical units and interventional cardiologists, and by the presence of two paramedics in the catheterization laboratory for 24/24 7/7 pPCI since 2010 in France, in accordance with recent national regulation. PMID: 26442656 [PubMed - as supplied by publisher] (Source: Annales de Cardiologie et d'Angeiologie)


A Rare Complication of Scorpion Venom: Atrial Fibrillation
Although the clinical findings of scorpion stings are often mild, they may lead to multi-organ failure and even cardiogenic shock. The toxin has both local and systemic effects. Local effects include oedema, bruising (ecchymosis), and burning pain, while systemic effects include nausea, vomiting, hypotension or hypertension, cardiovascular toxicity, renal failure, and haemorrhage at different areas. The toxins have been implicated in a number of cardiac arrhythmias, including torsade de pointes, Long QT syndrome, and atrial fibrillation. (Source: The American Journal of Emergency Medicine)


A Case Report of Churg–Strauss Syndrome Presenting With Cardiogenic Shock Treated With Extracorporeal Membrane Oxygenation
Abstract: Churg–Strauss Syndrome (CSS) complicated with cardiogenic shock is rare. Few case reports have described successful treatment of this rare disease. However, no one has reported on the application of mechanical life support with extracorporeal membrane oxygenation (ECMO) to treat this life-threatening disease. A 36-year-old female with limb numbness for >10 days, chest tightness for 2 days, and worsening dyspnea for 5 h presented in the emergency room. Vital signs showed a low blood pressure (104/60 mm Hg), increased heart rate (158 bpm), and respiration rate (28 bpm). Laboratory tests revealed that eosinophil was significantly increased (WBC: 34.46 × 109/L, neutrophil: 7.56 × 109/L[21.9%], eosinophil: 23.84 × 109/L[69.2%]), and serum myocardial enzymes was abno...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Accuracy and precision of transcardiopulmonary thermodilution in patients with cardiogenic shock
In this study we prospectively compare the accuracy and precision of pulmonary thermodilution (PTD) by PAC and transcardiopulmonary thermodilution (TC-PTD) in patients with cardiogenic shock following an acute cardiac event. In this prospective study 77 hemodynamic measurements were taken in 11 patients presenting cardiogenic shock (CS) treated at the medical intensive care unit of our university hospital. Hemodynamic parameters were measured simultaneously by PTD and by TC-PTD. Both techniques assessed showed a strong correlation in the obtained hemodynamic parameters. The mean bias of cardiac index between measured by PTD (CIpa) and by TC-PTD (CIpi) was 0.04 ± 0.35 L/min/m2. During intra-aortic balloon pump (IABP) counterpulsation and therapeutic hypothermia (TH) in post-resuscitatio...


Myocardial infarction with ventricular septal rupture and cardiogenic shock.
Authors: Glancy DL, Khuri BN, Mustapha JA, Menon PV, Hanna EB PMID: 26424959 [PubMed] (Source: Baylor University Medical Center Proceedings)


Myxedema coma with cardiac tamponade and severe cardiomyopathy.
We present a rare case of previously undiagnosed hypothyroidism presenting in cardiogenic shock from pericardial tamponade and depressed myocardial contractility in myxedema coma. Here, we focus on cardiovascular complications associated with the condition. PMID: 26424958 [PubMed] (Source: Baylor University Medical Center Proceedings)


Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry
Conclusions The use of thrombectomy in patients with STEMI is heterogenous between hospitals. Overall, there was no impact of thrombectomy on TIMI 3 patency or mortality after PCI. In the subgroup of STEMI patients with TIMI 0 flow before PCI individualized thrombectomy had a positive impact on restoration of normal blood flow. (Source: Clinical Research in Cardiology)


19. Disparities in health care delivery and hospital outcomes between expatriates and nationals presenting with acute coronary syndromes in Saudi Arabia
Conclusion Our findings indicate disparities in hospital care between NS, and SN ACS patients. NS patients had worse hospital outcomes potentially reflecting unequal health coverage, and access to care issues. (Source: Journal of the Saudi Heart Association)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sex Differences in the Presentation, Diagnosis, and Management of Acute Coronary Syndromes
Conclusions In Kerala, even though women with ACS were older and more likely to have previous myocardial infarction, there were no significant differences in in-hospital and discharge management, in-hospital mortality, or major adverse cardiovascular events between sexes. Whether these results apply to other parts of India or acute presentations of other chronic diseases in low- and middle-income countries warrants further study. (Source: Global Heart)


What is Optimal Conversion from PCPS to VAD in Acute Cardiogenic Shock?
Although PCPS is an useful systemic circulatory support system in emergent cardiogenic shock, it also increases afterload in failing heart. In most severely failing heart, optimal timing of conversion to ventricular assist device (VAD) is still controversial. (Source: Journal of Cardiac Failure)


Xenios claims ‘significant’ 8-figure funding round
Lung and heart therapy device developer XENiOS AG said today it received a &#8220;significant&#8221; round of funding, claiming the amount was in the 8-figure range. The Heilbronn, Germany-based company is developing a minimally invasive combined lung and heart therapy device on a single platform. &#8220;No other company except XENiOS is offering minimally invasive disposable lung and heart therapies on 1 platform. The XENiOS platform provides fundamental advantages with its minimally invasive lung and heart therapies. Patients are awake and mobile. Self-determined patients facilitate improved outcomes. There is no ventilator-associated lung injury and pneumonia. Additionally, the XENiOS platform maintains a physiologic natural pulse designed to protect the heart,&#8221; managing directo...


Acute Complications of Myocardial Infarction in the Current Era: Diagnosis and Management
Abstract: Coronary heart disease is a major cause of mortality and morbidity worldwide. The incidence of mechanical complications of acute myocardial infarction (AMI) has gone down to less than 1% since the advent of percutaneous coronary intervention, but although mortality resulting from AMI has gone down in recent years, the burden remains high. Mechanical complications of AMI include cardiogenic shock, free wall rupture, ventricular septal rupture, acute mitral regurgitation, and right ventricular infarction. Detailed knowledge of the complications and their risk factors can help clinicians in making an early diagnosis. Prompt diagnosis with appropriate medical therapy and timely surgical intervention are necessary for favorable outcomes. (Source: Journal of Investigative Medicine)


Glomerular filtration rate (GFR) during and after STEMI: a single-centre, methodological study comparing estimated and measured GFR
Conclusions In acute STEMI, CKD-EPI showed the best CKD-classification ability followed by MDRD-IDMS, whereas CG performed the worst. STEMI altered the performance of the cystatin C equation during the acute phase, suggesting that other factors might be involved in the rise of cystatin C. (Source: BMJ Open)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Erratum to: Experts&#8217; recommendations for the management of adult patients with cardiogenic shock
No description available (Source: Annals of Intensive Care)


Erratum to: Experts¿ recommendations for the management of adult patients with cardiogenic shock
No description available (Source: Annals of Intensive Care)


Erratum to: Experts’ recommendations for the management of adult patients with cardiogenic shock
(Source: Annals of Intensive Care)


Systolic Anterior Motion of the Mitral Valve Triggered by the Intra-Aortic Balloon Pump
THE INTRA-AORTIC balloon pump (IABP) is the simplest and most widely used mechanical assist device in the setting of cardiogenic shock.1 The use of the IABP is currently a class IIa indication in the American College of Cardiology/American Heart Association guidelines for the management of ST-elevation myocardial infarction who do not respond to pharmacotherapy.2 There are patients, however, in whom its use may be more detrimental than beneficial. The authors present a case where the IABP did not give the desired effect. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Aortic balloon valvuloplasty before transcatheter valve replacement in high-risk patients with aortic stenosis : Cardiac catheterization and echocardiographic hemodynamic study.
CONCLUSION: A 30-day post-BAV period may be considered a bridge to TAVR. Furthermore, invasive assessment of PCWP before BAV is an independent hemodynamic predictor of events after BAV. PMID: 26383045 [PubMed - as supplied by publisher] (Source: Herz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Adverse event burden and mechanical circulatory support: Looking toward the future
A significant milestone in the field of mechanical circulatory support has been the introduction of durable continuous-flow (CF) left ventricular assist devices (LVADs) for the treatment of cardiogenic shock and advanced stage heart failure (HF). CF technology has enabled smaller device designs with markedly improved durability that have translated into significant clinical benefits, including improvements in survival, functional status, and quality of life and reduction in adverse events relative to older pulsatile pumps. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Optimal Graft Size of Modified Blalock-Taussig Shunt for Biventricular Circulation in Neonates and Small Infants.
In this study, a small shunt graft (3.0-mm diameter) was estimated to determine the optimal shunt graft size of BTS as an initial palliation for ultimate biventricular circulation. Eighteen patients weighing an average 3.5 kg who underwent mBTS from July 2004 to January 2013 at our institute were reviewed. We divided the study cohort into two groups: group S (n = 10) included patients with 3.0-mm diameter shunt grafts, and group L (n = 8) included patients with 3.5-mm diameter shunt grafts. There were no hospital deaths or shunt occlusion in either group. One group L patient (12.5%) had cardiogenic shock due to excessive pulmonary blood flow. There were no differences in postoperative arterial oxygen saturation (SaO2) between the groups. There were no differences in body weight at intracar...


Collaborative Quality Improvement versus Public Reporting for Percutaneous Coronary Intervention: A comparison of PCI in New York versus Michigan
Conclusions Public reporting of PCI data is associated with fewer high risk patients undergoing PCI compared to CQI. However, in comparable samples of patients, public reporting is also associated with a lower risk of mortality and adverse events. The optimal quality improvement method may involve combining these two strategies to protect access to care while still driving improvements in patient outcomes. (Source: American Heart Journal)


Statewide Networks for Acute Cardiogenic Shock Management
This Viewpoint discusses the current state of acute cardiogenic shock management and proposes a 3-level statewide network model. (Source: JAMA Surgery)


Behavioral and Psychiatric Emergencies
I’ll admit that we emergency physicians (and likely many other acute care providers as well) are a strange lot. We tend to relish caring for the sickest of patients, often even those on the verge of death. We often talk about that “great case” we saw during a shift: the cardiac arrest, the crashing asthmatic with a difficult airway, the patient with sepsis or diabetic ketoacidosis with a pH of 6.9, or the patient with cardiogenic shock requiring dobutamine and norepinephrine. It’s unlikely you’ll ever hear one of us refer to the patient with an uncomplicated ankle sprain or gastroenteritis or migraine headache or simple pneumonia as a “great case.” None of these patients tend to suffer much morbidity, and they are at low risk of mortality. (Source: Emergency Medicine Clinics ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance
Conclusion A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF. (Source: Intensive Care Medicine)


Case report: use of ECMO in colchicine poisoning
Colchicum autumnale (Autumn crocus) 3.5 out of 5 stars Extracorporeal life support in the treatment of colchicine poisoning. Boisramé-Helms J et al. Clin Toxicol 2015;53:827-829. Abstract Colchicine toxicity occurs roughly in 3 phases. During the initial 24 hours, severe gastrointestinal symptoms — nausea, vomiting, and diarrhea — can cause hypotension and shock if fluid losses are not adequately replaced. During the second phase, severe toxicity can manifest with pancytopenia, sepsis, rhabdomyolysis, and renal failure. In addition, within days after ingestion, patients can develop cardiogenic shock and sudden cardiac death. This fascinating case report — from the Nouvel Hôpital Civil in Strasbourg, France — describes the use of veno-arterial extracorporeal membrane oxygenation ...


Rare cause of abdominal pain and shock: Rupture of a sinus of Valsalva aneurysm
We report a 46 year-old male who suffered from SVA rupture triggering acute RV failure and cardiogenic shock. (Source: Journal of Acute Medicine)


Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies.
CONCLUSION: The transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres. PMID: 26365478 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)


Left Ventricular Assist Device (LVAD) as a Bridge to Recovery for Tachycardia‐Mediated Cardiomyopathy
Abstract A case is described of cardiogenic shock that occurred following use of sotalol in a patient with severe left ventricular dysfunction. The patient required left ventricular assist device (LVAD) placement with subsequent myocardial recovery to a degree that allowed eventual device removal following 140 days of support. (Source: Journal of Cardiac Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Secondary Hemochromatosis and Mechanical Circulatory Support With A Total Artificial Heart
A 62 year old man with non-ischemic cardiomyopathy developed cardiogenic shock and TAH was implanted due to profound biventricular failure. Within days of device implantation the patient developed severe hemolysis. Over the subsequent weeks, despite aggressive anticoagulation with bivalirudin, aspirin, dipyridamole and pentoxyfilline, he continued to experience hemolytic anemia (mean hemoglobin (Hgb) 5.7 g/dL, nadir Hgb 3.1 g/d; mean lactate dehydrogenase (LDH) 1,693 U/L, peak LDH 2,628 U/L) (Figure 1) receiving 37 units of packed red blood cells (RBC) and several infusions of intravenous iron sucrose over the 130 days of TAH support. (Source: The Journal of Heart and Lung Transplantation)


Calcium channel and beta‐blocker antagonist antidotes and adjunct therapies
Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta‐adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs may also produce vasodilatory shock. Additionally, CCBs, such as verapamil and diltiazem, are commonly ingested in sustained‐release formulations. This may also be the case for some BBs. Peak toxicity may be delayed by several hours. Provision of early gastrointestinal decontamination with activated charcoal and whole bowel irrigation may mitigate this. Treatment of shock requires a multimodal approach to inotropic therapy that can be guided by echocardiographic or invasive haemodynamic assessment of myocardial function. High‐d...


Pathological Substratum for a Case of Fulminant Myocarditis Treated with Extracorporeal Membrane Oxygenation and Subsequent Heart Transplantation.
We report on the case of a 23-yr-old woman with pathology-proven fulminant lymphocytic myocarditis presenting shock with elevated cardiac troponin I and ST segments in V1-2, following sustained ventricular tachycardia and a complete atrioventricular block. About 55 min of intensive cardio-pulmonary resuscitation, with extracorporeal membrane oxygenation support, bridged the patient to orthotopic heart transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls. Aggressive mechanical circulatory support may be an essential bridge for recovery or even transplantation in patients with fulminant myocarditis with shock. PMID: 26339181 [PubMed - in process] (Source: Journal of Korean Medical Science)


Microvascular reactivity and clinical outcomes in cardiac surgery
Conclusion: Microvascular reactivity largely recovered on postoperative day 1 in the patients without composite complications, but this restoration was attenuated in patients with composite complications.Trial registrationClinicalTrials.gov NCT01713192. Registered 22 October 2012. (Source: Critical Care)


Angiopoietin‐2 in acute myocardial infarction complicated by cardiogenic shock—a biomarker substudy of the IABP‐SHOCK II‐Trial
ConclusionIn CS, high levels of Ang‐2 are independently associated with poor short‐ and long‐term outcome and associated with the reperfusion success as well as complications. Clinical Trial RegistrationURL: www.clinicaltrials.gov; unique identifier: NCT00491036 (Source: European Journal of Heart Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Direct Transfer From the Referring Hospitals to the Catheterization Laboratory to Minimize Reperfusion Delays for Primary Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry [Myocardial Infarction]
Conclusions&mdash; Direct transfer of STEMI patients to the cath lab for primary percutaneous coronary intervention was associated with significantly faster reperfusion and lower mortality risk compared with transfer first to the emergency department/ward. (Source: Circulation: Cardiovascular Interventions)


Early glucose variability in cardiogenic shock following acute myocardial infarction: a pilot study
Conclusions: According to our results, in patients with CS following acute myocardial infarction, early glycaemic variability is an independent predictor of mortality. Further studies are needed to confirm our results in larger cohorts and eventually to assess the effect of strategies specifically targeting glucose variability reduction on mortality. (Source: Therapeutic Advances in Cardiovascular Disease)


Clinical Features and Outcomes in Adults with Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation (ECMO) is an increasingly utilized supportive measure for patients with refractory cardiogenic shock (CS). Despite its increasing use, there remains minimal data regarding which patients with refractory CS are most likely to benefit from ECMO. We retrospectively studied all patients (n=123) who underwent initiation of ECMO for CS between February 2009 and September 2014 at a single center. Baseline patient characteristics, including demographics, comorbid illness, etiology of CS, available laboratory values, and patient outcomes were analyzed. (Source: The American Journal of Cardiology)


Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score
Conclusions The SAVE-score may be a tool to predict survival for patients receiving ECMO for refractory cardiogenic shock (www.save-score.com). (Source: European Heart Journal)


Early Assistance With Left Ventricular Assist Device Limits Left Ventricular Remodeling After Acute Myocardial Infarction in a Swine Model
In this study, we aimed to explore the effects of an LVAD on left ventricular (LV) remodeling and function at the postinfarction stage in a swine model. AMI was induced by ligation of the circumflex artery or its branches for 120 min, followed by 120 min of reperfusion. In the assist group (n = 6), LVAD was initiated at 90 min after ischemia and was maintained for support until 120 min after reperfusion, whereas the control group (n = 6) received no support. LV pressure, volume, wall stress, and stroke work were all decreased by LVAD assistance at the ischemia and reperfusion stages, and blood pressure and cardiac output were maintained. All swine were studied 1 month after the procedure, and those in the assist group showed less increased end‐diastolic volumes (assist vs...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Orthotopic Heart Transplant Facilitated Autologous Hematopoietic Stem Cell Transplantation in Light-chain Amyloidosis
Dominant cardiac involvement by primary systemic amyloidosis (AL) precludes effective AL treatment and is associated with short survival. Between January 2009 and June 2015, total of 9 patients who presented with severe cardiac dysfunction as their major manifestation of AL underwent orthotopic heart transplantation (OHT). Four of these 9 patients were able to complete the planned second phase of treatment with autologous hematopoietic stem cell transplantation (ASCT) 13-16 months after OHT. All patients had end stage heart failure and developed cardiogenic shock requiring intra-aortic balloon pump support (median 20 days, range 10-165) as a bridge to OHT. (Source: Clinical Lymphoma, Myeloma and Leukemia)


Clinical significance of lactate in acute cardiac patients.
Authors: Lazzeri C, Valente S, Chiostri M, Gensini GF Abstract Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate levels in acute cardiac patients (that is with acute coronary syndrome, cardiogenic shock, cardiac arrest, non including post cardiac surgery patients). In patients with ST-elevation myocardial infarction treated with mechanical revascularization, hyperlactatemia identified a subset of patients at higher risk for early death and in-hospital complications, being strictly related mainly to hemodynamic derangement. The prognostic impact of hyperlactatemia on mortality has been documented in patients with card...


Balloon aortic valvuloplasty - ups and downs - do we face the procedure comeback?
CONCLUSIONS: Treatment of advanced and haemodynamically unstable aortic stenosis, bridge to non-cardiac surgery and palliative therapy are the main reasons for BAV in recent years. BAV as bridge to TAVI or aortic valve replacement may be an option for some patients. Short-term results are good with relatively low mortality and morbidity related to the procedure. Mortality in hemodynamically unstable patients presenting with cardiogenic shock or pulmonary oedema treated with BAV is very high. PMID: 26305364 [PubMed - as supplied by publisher] (Source: Polish Heart Journal)


Circulatory support devices: fundamental aspects and clinical management of bleeding and thrombosis.
This article is protected by copyright. All rights reserved. PMID: 26302994 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)


Infarct Size, Shock, and Heart Failure: Does Reperfusion Strategy Matter in Early Presenting Patients With ST-Segment Elevation Myocardial Infarction? [Coronary Heart Disease]
Conclusion A PI strategy appears to alter the pattern of IS after ST-segment elevation myocardial infarction, resulting in more medium and fewer large infarcts compared with PPCI. Despite a comparable number of small infarcts, PI patients in this group had more aborted myocardial infarctions and less 30-day shock and congestive heart failure. Clinical Trial Registration URL: http://ClinicalTrials.gov. Unique identifier: NCT00623623. (Source: JAHA:Journal of the American Heart Association)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Extracorporeal life support is 'bridge-to-life' for patients with sudden onset cardiogenic shock
The ideal management strategy for primary cardiogenic shock is a matter of debate. After some early discouraging experiences, the use of extracorporeal life support for patients with cardiogenic shock is having a resurgence. A report finds that patients who have an acute onset of cardiogenic shock, for example following a heart attack, and are placed on extracorporeal life support, fare better than those who have a chronic cardiac pathology. (Source: ScienceDaily Headlines)


Utilization of Mechanical Circulatory Support in Patients Undergoing Percutaneous Coronary Intervention: Insights From the NCDR.
CONCLUSIONS: -In this large national registry, use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS utilization. The probability of IABP and O-MCS use varied across hospitals and the use of O-MCS was clustered at a small number of hospitals. PMID: 26286905 [PubMed - as supplied by publisher] (Source: Circulation)


Finding Traction for Mechanical Circulatory Support During Coronary Interventions.
Authors: Stewart GC Abstract The management of acute cardiogenic shock remains one of the great challenges of contemporary cardiovascular care. Cardiogenic shock manifests as a vicious cascade of systemic hypoperfusion leading to multi-organ system dysfunction and is a hallmark of severe ventricular failure in the wake of extensive myocardial damage following acute infarction.(1) Shock complicates between 5-8% of ST-segment elevation myocardial infarctions (STEMI) and 2-3% of non-STEMI.(2) More than 80% of the time, shock arises from direct myocardial injury downstream from an occluded artery, with the remaining cases coming from later mechanical complications such as acute mitral regurgitation or ventricular septal defect. Despite remarkable advances in medical therapy for acute c...


Pheochromocytoma-Induced Inverted Takotsubo-Like Cardiomyopathy Leading to Cardiogenic Shock Successfully Treated With Extracorporeal Membrane Oxygenation
We report a case of pheochromocytoma-induced inverted takotsubo-like cardiomyopathy leading to shock and cardiac arrest successfully treated with extracorporeal membrane oxygenation (ECMO) as a bridge to pharmacological therapy and curative adrenalectomy. A previously healthy 46-year-old woman presented to the emergency department with abdominal pain, dyspnea, nausea, and vomiting. Clinical evaluation revealed cardiorespiratory failure with hypoxia and severe metabolic acidosis. Computed tomography (CT) scan showed pulmonary edema and a left adrenal mass. Transthoracic echocardiography (TTE) displayed severe left ventricular dysfunction with inverted takotsubo contractile pattern. Despite mechanical ventilation and inotropic and vasopressor support, asystolic cardiac arrest ensued. The pat...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock
Background: The aim of this study was to assess the relationship between extracorporeal blood flow (EBF) and left ventricular (LV) performance during venoarterial extracorporeal membrane oxygenation (VA ECMO) therapy. Methods: Five swine (body weight 45 kg) underwent VA ECMO implantation under general anesthesia and artificial ventilation. Subsequently, acute cardiogenic shock with signs of tissue hypoxia was induced. Hemodynamic and cardiac performance parameters were then measured at different levels of EBF (ranging from 1 to 5 L/min) using arterial and venous catheters, a pulmonary artery catheter and a pressure–volume loop catheter introduced into the left ventricle. Results: Myocardial hypoxia resulted in a decline in mean (±SEM) cardiac output to 2.8 ± 0.3 L/min and systolic...


Case 02/2015 - A 67 Year-Old Woman with Sudden Cardiogenic Shock in the 7th Day after Acute Myocardial Infarction
Conclusion:On the basis of the selected studies, the following are potentially involved in the cardioprotective response to exercise: increased heat shock protein production, nitric oxide pathway involvement, increased cardiac antioxidant capacity, improvement in ATP-dependent potassium channel function, and opioid system activation. Despite all the previous investigations, further research is still necessary to obtain more consistent conclusions.Fundamento:O infarto agudo do miocárdio é a principal causa de mortalidade e de morbidade na população mundial. Por outro lado, pesquisas já demonstraram que o exercício físico, além de reduzir os fatores de risco cardiovascular, também é capaz de promover cardioproteção contra lesões por isquemia e reperfusão, por meio de um efeito ...


Transcatheter closure of ruptured sinus of Valsalva: Different techniques and mid‐term follow‐up
ConclusionsDifferent approaches and devices may be used for transcatheter closure of RSOV. We prefer antegrade closure using duct occluders in most cases while muscular VSD occluders may be used in select situations. ADO II devices should hardly ever be used on their own for device closure of RSOV. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Women in interventional cardiology: Update in percutaneous coronary intervention practice patterns and outcomes of female operators from the National Cardiovascular Data Registry®
ConclusionsFemale interventional cardiologists remain uncommon in contemporary U.S. practice. Performing only a very small proportion of PCI cases, female interventionalists are often low‐volume operators, yet no significant differences in patient mortality were observed in low‐ versus high‐volume operators. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Kawasaki disease in the state of Jammu and Kashmir: A decade of experience
Conclusion KD is infrequently diagnosed in the state of Jammu and Kashmir. All clinicians, especially pediatricians need to update knowledge regarding KD, so that patients are diagnosed and treated early. (Source: Indian Journal of Rheumatology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Ventricular Support With Extracorporeal Membrane Oxygenation: Beyond Cardiogenic Shock Treatment
Publication date: Available online 6 August 2015 Source:Revista Española de Cardiología (English Edition) Author(s): Soraya Merchán, Javier Martín-Moreiras, Aitor Uribarri, Javier López, Leyre Reta, Pedro L. Sánchez (Source: Revista Espanola de Cardiologia)


Upstream therapeutic strategies of Valsartan and Fluvastatin on Hypertensive patients with non-permanent Atrial Fibrillation (VF-HT-AF): study protocol for a randomized controlled trial
This study was designed to examine whether valsartan or fluvastatin can reduce the risk of non-permanent AF in patients with hypertension.Methods/designThe VF-HT-AF study is a multicenter, randomized, open-label, four-arm parallel group study with comparative evaluation of valsartan and fluvastatin as upstream therapies for the treatment of non-permanent AF complicated by hypertension. The primary outcome measure is change in the development of paroxysmal AF into persistent or permanent AF, the development of persistent AF to permanent AF, and change in incidence of overall and persistent AF recurrence, as evaluated by 7-days ambulatory electrocardiograph monitoring (Holter) and patients’ diaries during 2 years’ follow-up. Secondary outcome measures of this study include the occurrence...


Discordant Electrocardiogram Left Ventricular Wall Thickness and Strain Findings in Influenza Myocarditis
We report this case as it highlights the discordance between echocardiographic ventricular wall thickening as a result of myocardial edema, and electrocardiographic findings at presentation, with a reversal in findings at time of resolution. Additionally, there was some suggestion of a regional pattern to the reduced longitudinal strain. (Source: Echocardiography)


Cardiogenic Shock.
This article discusses pharmacologic and surgical interventions, their indications and contraindications, management strategies, and treatment algorithms. PMID: 26226871 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)


Congestive Heart Failure.
Authors: Scott MC, Winters ME Abstract Patients with acute decompensated heart failure are usually critically ill and require immediate treatment. However, most are not volume overloaded. Emergency department (ED) management is based on rapid initiation of noninvasive positive-pressure ventilation and aggressive titration of nitrates. Afterload reduction with an angiotensin-converting enzyme inhibitor can be considered. A diuretic should not be administered before optimal preload and afterload reduction has been achieved. Short-term inotropic therapy can be considered in select patients with cardiogenic shock and acute decompensated heart failure (ADHF) who fail to respond to standard therapy. PMID: 26226866 [PubMed - as supplied by publisher] (Source: The Medical Clinics of No...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Late Cardiac Tamponade as a Result of Parietal Pericardium Erosion.
We present a case of a late tamponade leading to cardiogenic shock, which occurred 1,164 days after implantable cardioverter-defibrillator (ICD) implantation. Open repair revealed unusual and, to our knowledge, not yet reported mechanism of the disease. A pressure sore caused by an ICD lead was found in the parietal layer of pericardium with no visible damage to the visceral layer. Conservative management in the described clinical scenario could be fatal, thus awareness of this pathomechanism of tamponade is critical. PMID: 26234848 [PubMed - in process] (Source: The Annals of Thoracic Surgery)


Circulatory support devices: fundamental aspects and clinical management of bleeding and thrombosis
This article is protected by copyright. All rights reserved. (Source: Journal of Thrombosis and Haemostasis)


Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes
ConclusionsOver the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate. (Source: European Journal of Heart Failure)


Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction
ConclusionsIn contemporary practice with primary PCI, definite LV thrombus following anterior STEMI with LV dysfunction is challenging to predict. Further investigation is needed to determine if there is a subset of patients that should be treated with prophylactic warfarin. (Source: Clinical Cardiology)


Heterogeneous populations in non‐ischaemic cardiogenic shock
(Source: European Journal of Heart Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Successful application of extracorporeal membrane oxygenation and pulmonary thromboembolectomy in a patient with a life-threatening pulmonary embolism
Pulmonary embolism is a leading cause of maternal mortality. It can occur abruptly and progress rapidly. In patients with acute massive pulmonary emboli, right ventricular failure is followed by left ventricular dysfunction and cardiogenic shock. Prompt identification of patients at risk of pulmonary embolism and early resuscitation with cardiopulmonary support are vital for survival. (Source: Taiwanese Journal of Obstetrics and Gynecology)


The acute management of ST-segment-elevation myocardial infarction .
Authors: Carville SF, Henderson R, Gray H Abstract Acute ST-segment-elevation myocardial infarction (STEMI) results from complete obstruction to coronary artery blood flow accompanied by the appearance of ST-segment-elevation on the electrocardiogram. Emergency treatment is required to restore coronary perfusion, thereby limiting the extent of damage to the myocardium and the likelihood of early death or future heart failure. This concise guideline summarises key recommendations from the National Institute for Health and Care Excellence clinical guideline on acute management of STEMI (CG167), of relevance to all healthcare professionals involved. Guidance is presented on choice of reperfusion strategies, procedural aspects, use of additional drugs before and alongside reperfusion t...


Use of a Vascular Sheath in the Axillary Artery as an Alternative Access Approach for Placing an Impella 5.0 Device.
Authors: Shah AS, Lee R, Hui DS, Lim MJ, Neumayr RH, Stolker JM Abstract Many patients who are in cardiogenic shock need mechanical support for clinical stabilization after acute insults such as myocardial infarction. However, the placement of advanced devices can be hindered by anatomic constraints or the physiologic sequelae of shock, as we describe in this report. A 67-year-old woman with prior coronary artery bypass grafting and extensive chest-wall scarring from previous defibrillator implantations presented with myocardial infarction and refractory cardiogenic shock. The patient's vascular anatomy and prior surgery precluded conventional percutaneous implantation of an Impella 5.0 ventricular support device. We delivered the Impella device through the patient's tortuous, vaso...


Fatal complication after transsphenoidal surgery of pituitary adenoma: case report
The objective of this study was to report a rare fatal complication in the postoperative period of transsphenoidal surgery of the pituitary gland (adenoma), with a brief review of the subject. The patient was a 54-year-old white man with acromegaly and severe heart failure, who after microsurgery developed blood pressure instability within 32 hours after the procedure and died. The autopsy revealed: hypertrophy and ventricular dilation with myocarditis, pericarditis and myocardial fibrosis; mesenteric ischemia with transmural coagulation necrosis of the intestinal loops; acute tubular necrosis; and hepatic steatosis. The findings are consistent with cardiogenic shock and abdominal sepsis due to necrosis of the intestinal loops.RESUMO O objetivo deste estudo é relatar uma rara complicaçã...


Increased Risk of LVAD Thrombosis in Patients With a Previous History Thromboembolic Event
Heart failure is a clinical syndrome that affects more than 5.1 million Americans and over 23 million individuals worldwide. With the likely substantial growth in the incidence and prevalence of heart failure patients over the next 20-40 years, there will also likely be a corresponding increasein the need for left ventricular assist devices (LVADs). Complications occur and consist primarily of infection, stroke or other thromboembolic event, device malfunction, bleeding, and pump thrombosis. Since LVAD thrombosis can have devastating consequences, including central or peripheral thromboembolism, LVAD malfunction or failure with resultant cardiogenic shock, and death, early identification of pump thrombosis as well as identification of those patients at increased risk for thrombosis prior t...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Potential Utility of Longitudinal Radial Strain Imaging in the Routine Assessment of Patients on Mechanical Circulatory Support: A Feasibility Study
The use of intraortic balloon pumps (IABP) and left ventricular assist devices (LVAD) have become increasingly important in the routine management of patients with either cardiogenic shock or advanced heart failure. The use of echocardiography can be somewhat challenging in these patients. Since speckle tracking imaging has been shown to help in the evaluation of left ventricular remodeling and myocardial recovery; we decided to use velocity vector imaging (VVI) and determine if this imaging modality would be feasible in evaluating myocardial ventricular mechanics in these patients with limited acoustic windows. (Source: Journal of Cardiac Failure)


Long Term Support of Acute, Refractory Cardiogenic Shock with an Extracorporeal, Continuous Flow Ventricular Assist Device: A Seven Year Experience
We report our seven-year experience with an extracorporeal, continuous flow ventricular assist device (ecfVAD). (Source: Journal of Cardiac Failure)


Race, Gender and Clinical Characteristics Do Not Predict Outcomes in End-Stage Heart Failure Patients Requiring Inotropes
Current guidelines recommend inotropes as a bridge in cardiogenic shock and low output acute decompensated heart failure (ADHF) or as palliation. However, there is little data on current usage of inotropes or outcomes of those requiring inotropes for ADHF or shock. Recent literature has also indicated possible disparity in outcomes between races after heart transplant. Race or gender disparities have not been well studied in end-stage heart failure or cardiogenic shock. (Source: Journal of Cardiac Failure)


Acute myocardial infarction and cardiogenic shock: pharmacologic and mechanical hemodynamic support pathways
Cardiogenic shock (CS) is still the predominant cause of in-hospital death in patients with acute myocardial infarction, although mortality has been reduced in recent years. Early percutaneous coronary intervention and coronary artery bypass grafting are causal therapies implemented in CS, supported by catecholamines, fluids, intra-aortic balloon pumping, and also active percutaneous assist devices. There is only limited evidence from randomized studies of any of these treatments in CS, except for early revascularization and the relative ineffectiveness of intra-aortic balloon pumping. This review will present treatment pathways of CS complicating acute myocardial infarction, with a major focus on revascularization, intensive care unit treatment, and mechanical support devices. (Source: Co...


[Treatment of acute heart failure].
This article discusses the differential use of these treatment modalities. PMID: 26216540 [PubMed - as supplied by publisher] (Source: Herz)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Emphysematous Gastritis In A Patient With Coxsackie B3 Myocarditis And Cardiogenic Shock Requiring Veno-Arterial Extra-Corporeal Membrane Oxygenation
Conclusion We believe, this is a unique case of a veno-arterial ECMO causing emphysematous gastritis. (Source: International Journal of Surgery Case Reports)


Utilizing Natriuretic Peptides for Selection of Patients in Acute Heart Failure Clinical Trials
Acute heart failure (AHF) is a complex syndrome with presentations ranging from hypotensive cardiogenic shock to hypertensive emergency with pulmonary edema. The majority of AHF patients present with worsening of chronic HF signs and symptoms over days to weeks and significant heterogeneity exists. It can therefore be challenging to characterize the overall population. The complexity of defining the AHF phenotype has been cited as a contributing cause for neutral results in the majority of pharmacologic trials in AHF patients. (Source: The American Journal of Cardiology)


Outcome in Patients Having Salvage Coronary Artery Bypass Grafting
Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, i.e. a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theatre or before induction of anesthesia. (Source: The American Journal of Cardiology)


Using Natriuretic Peptides for Selection of Patients in Acute Heart Failure Clinical Trials
Acute heart failure (AHF) is a complex syndrome with presentations ranging from hypotensive cardiogenic shock to hypertensive emergency with pulmonary edema. Most patients with AHF present with worsening of chronic HF signs and symptoms over days to weeks, and significant heterogeneity exists. It can, therefore, be challenging to characterize the overall population. The complexity of defining the AHF phenotype has been cited as a contributing cause for neutral results in most pharmacologic trials in patients with AHF. (Source: The American Journal of Cardiology)


Outcome in Patients Having Salvage Coronary Artery Bypass Grafting
Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, that is, a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia. (Source: The American Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Impella-Assisted Balloon Aortic Valvuloplasty as a Bridge to Transcatheter Aortic Valve Replacement: Non-Contrast Approach.
Authors: Singh V, Yarkoni A, Gallegos C, O'Neill WW Abstract Patients with severe aortic stenosis (AS) and left ventricular dysfunction are susceptible to hemodynamic decompensation due to limited myocardial reserve. Recent reports have suggested a role for hemodynamic assist devices such as the Impella or TandemHeart for improved in-hospital outcomes. However, the use of iodinated contrast during this vulnerable period poses a high risk for the development of contrast-induced nephropathy. A strategic approach is described for the treatment of high-risk patients with severe AS and cardiogenic shock, utilizing Impella-assisted balloon aortic valvuloplasty (BAV), without the administration of iodinated contrast as a bridge to transcatheter aortic valve replacement. PMID: 26204681...


Imaging of Left Ventricular Assist Devices
Abstract Left ventricular assist devices (LVADs) are electromechanical pumps that aid the failing heart and are essential option in the modern management of heart failure that may serve as a bridge to transplantation and provide destination therapy or short-term recovery for cardiogenic shock. As a complement to echocardiography, computed tomography (and to a lesser extent radiography or nuclear scintigraphy) plays an essential role in the evaluation of LVAD complications in both the perioperative and late post-operative time periods. These complications and their imaging appearances are reviewed in this article. (Source: Current Radiology Reports)


Mostly Early Invasive Management May Improve Outcomes in Patients with Myocardial Infarction and Cardiogenic Shock
Dr Bangalore et al1 reported improved in-hospital mortality when invasive management (coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft) was performed in patients hospitalized for cardiogenic shock due to myocardial infarction. All subgroups benefited from this invasive strategy. However, as acknowledged, propensity analysis did not account for unmeasured confounders, for example, do not reanimate orders, pulmonary hypertension, and acute renal failure.2 The last situation may be dramatic and prevent injection of iodine products. (Source: The American Journal of Medicine)


The Reply
Champion contends that early invasive management may improve outcomes in patients with myocardial infarction and cardiogenic shock. We fully agree. The SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial compared an invasive strategy of emergent revascularization versus a conservative strategy of initial medical stabilization.1,2 In the conservative strategy, 66.7% of patients received coronary angiography with 25.3% of patients receiving angioplasty or coronary artery bypass graft surgery with a median time to revascularization from randomization of 102.8 hours. (Source: The American Journal of Medicine)


A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery
The aim of this study was to compare outcomes in cardiac surgery patients aged ≥ or < 60 years after implementation of a restrictive or a liberal transfusion strategy. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Risk factors and in-hospital outcome of acute ST segment elevation myocardial infarction in young Bangladeshi adults
Conclusion: Younger AMI patients have a different risk profile and better in-hospital outcomes compared to the older patients. Control of preventable risk factors such as smoking, unhealthy diet, obesity and dyslipidemia should be reinforced at an early age in Bangladesh. (Source: BMC Cardiovascular Disorders)


Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002-2012
This study evaluates contemporary trends in the use and outcomes of adult patients undergoing extracorporeal membrane oxygenation (ECMO) in U.S. hospitals. All adult discharges in the Nationwide Inpatient Sample database during the years 2002-2012 that included ECMO were used to estimate the total number of U.S. ECMO hospitalizations (n = 12,407). Diagnostic codes were used to group patients by indication for ECMO use into postcardiotomy, heart transplant, lung transplant, cardiogenic shock, respiratory failure, and cardiopulmonary failure. (Source: Seminars in Thoracic and Cardiovascular Surgery)


Study: Manual thrombectomy increases stroke risk
Routine percutaneous coronary interventions with manual thrombectomies increase the risk of stroke compared to PCI alone, according to a new substudy published last month. The substudy, published online already and set to go to print in the European Heart Journal, examined a 10,058-patient cohort from the earlier Total study of PCI and manual thrombectomies to better understand the increase in stroke rate. The new analysis reported that the stroke difference was evident in as little as 48 hours, with 15 thrombectomy patients reporting an event versus 5 treated with only PCI. The overall risk was still low however, with a 0.3% risk associated with thrombectomy treatment and a 0.1% risk from PCI alone, according to the study. At 30-days, stroke rates in thrombectomy patients were more than d...


Culprit-Only vs. Complete Revascularization During ST-Segment Elevation Myocardial Infarction
Primary percutaneous intervention ( PCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Patients with STEMI frequently have obstructive non-culprit lesions. In addition, STEMI patients with multivessel disease are at increased risk of major adverse cardiac events. However, current guidelines do not recommend revascularization of non-culprit lesions unless complicated by cardiogenic shock. Prior observational and small randomized controlled trials (RCTs) have demonstrated conflicting results pertaining to the optimal revascularization strategy in STEMI patients with multivessel disease undergoing primary PCI. (Source: Progress in Cardiovascular Diseases)


National assessment of early β-blocker therapy in patients with acute myocardial infarction in China, 2001-2011: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)–Retrospective AMI Study
Conclusions The use of early β-blocker therapy for patients with AMI in China is suboptimal, with underuse in patients who could benefit and substantial use among those who might be harmed. Patterns of use have not changed over time, thus creating an important target of efforts to improve quality of care for AMI. (Source: American Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) [Epidemiology]
Conclusions Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST-segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence-based treatment. (Source: JAHA:Journal of the American Heart Association)


Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock [TX & MCS]
CONCLUSIONS Short-term MCS therapy with subsequent aggressive use of durable MCS device may improve the unacceptably high mortality rate in AMI/CS. Rigorous prospective studies of MCS therapy in AMI/CS are warranted. (Source: European Journal of Cardio-Thoracic Surgery)


[Diagnostic value of left bundle branch block in patients with acute myocardial infarction : A prospective analysis].
CONCLUSION: LBBB with acute chest pain characterizes a cohort of patients with high morbidity and mortality. For the triage of these patients at first contact, additional criteria should be evaluated, which could increase the specificity of LBBB for the diagnosis of STEMI. PMID: 26159450 [PubMed - as supplied by publisher] (Source: Herz)


Lack of &#8220;obesity paradox&#8221; in patients presenting with ST-segment elevation myocardial infarction including cardiogenic shock: a multicenter German network registry analysis
Conclusion: Our data from two network systems in Germany revealed no evidence of an “obesity paradox”in an all-comer STEMI population including patients with cardiogenic shock. (Source: BMC Cardiovascular Disorders)


Venous thromboembolism prevention and treatment: expanding the rivaroxaban knowledge base with real-life data
This article will consider these uncertainties, along with data on rivaroxaban use from a number of key non-interventional studies and registries, namely XAMOS, ORTHO-TEP, the Dresden NOAC registry, RIETE, and PREFER in VTE. These data suggest that outcomes with NOACs such as rivaroxaban in RCTs are reproducible in real-life, making these agents a simple, effective treatment choice for a wide range of patients at risk of, or suffering from, VTE. (Source: European Journal of Heart Failure Supplements)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Computer misses it, but the medic catches it.
True fact: I failed out/dropped out of grad school in mathematics. But despite having little enthusiasm for topology or complex analysis, nothing drives me more nuts than people who say stuff like “I’m not good at math – just not a math person, I guess.” This attitude is not just incorrect, it’s harmful. Most mathematics is quite straight-forward, if you practice and study conscientiously. Same with ECGs. Stratford EMS was called for a (quite) elderly woman who wasn’t feeling well. And of course, she lived on the 5th floor of a building with narrow, twisting stairs. Nonetheless, the paramedic Jay and his crew humped all their gear, including the Like-Pak, up those stairs. Good thing too. There was a small language barrier, but Jay ascertained that the woman was complaining of a...


Complete revascularisation or culprit artery only in cardiogenic shock: the real shock is the lack of data!
Approximately 40&ndash;65% of patients presenting with ST elevation myocardial infarction (STEMI) have multivessel disease (MVD). These patients have higher mortality and worse clinical outcomes than patients with STEMI with single vessel disease irrespective of haemodynamic status.1&ndash;3 Despite this common clinical scenario, the data available to guide management of these patients is remarkably sparse. The recommendations from the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and the European Society of Cardiology (ESC) Guidelines have been stronger than the data supporting those guidelines, but that is changing. For patients with STEMI presenting without cardiogenic shock, Percutaneous Coronary Intervention (PCI) of a non-culprit vessel is currently ...


Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock
Conclusions This study showed that, compared with culprit vessel revascularisation, multivessel revascularisation at the time of primary PCI was associated with better outcomes in patients with STEMI with cardiogenic shock. Our results support the current guidelines regarding revascularisation in these patients. (Source: Heart)


Intra-Aortic Balloon Counterpulsation in Patients with Chronic Heart Failure and Cardiogenic Shock: Clinical Response and Predictors of Stabilization
To characterize the clinical response and identify predictors of clinical stabilization after intra-aortic balloon counterpulsation (IABP) support in patients with chronic systolic heart failure in cardiogenic shock prior to implantation of a left ventricular assist device (LVAD). (Source: Journal of Cardiac Failure)


Comparison of 4 Admission Blood Pressure Indexes for Predicting 30-Day Mortality in Patients With ST-Segment Elevation Myocardial Infarction.
CONCLUSIONS: Pulse pressure was an independent predictor of mortality in patients with STEMI, and low admission blood pressure should serve as a warning sign. PMID: 26158853 [PubMed - as supplied by publisher] (Source: American Journal of Hypertension)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


[Cardiorenal syndrome type 1 in the intensive coronary care unit of the Hospital Nacional Arzobispo Loayza].
CONCLUSIONS: The incidence of CRS type 1 in the coronary care unit found in our study is similar to those found in foreign studies. The history of stroke and the higher values of hemoglobin were associated with a higher incidence of cardiorenal syndrome type 1. Patients with CRS type 1 had a higher hospital mortality within 30 days of admission. PMID: 26164703 [PubMed - as supplied by publisher] (Source: Archivos de Cardiologia de Mexico)


Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup: An Updated Meta-Analysis of 23 Studies.
CONCLUSIONS: -Clinical outcomes and complication rates of PCI at centers without on-site surgery did not differ from those with on-site surgery, for both primary and non-primary PCI. Temporal trends indicated improving clinical outcomes in non-primary PCI at centers without on-site surgery. PMID: 26152708 [PubMed - as supplied by publisher] (Source: Circulation)


Yes, We Can! (Should We?).
Authors: Aversano TR Abstract Historically, percutaneous coronary intervention (PCI) was relegated to hospitals with co-located cardiac surgery because of the potential need for emergent surgical treatment of PCI-related complications. In the current issue of Circulation, Lee and colleagues(1) compare outcomes of PCI at hospitals with and without on-site cardiac surgery and show that emergency cardiac surgery is, in fact, rarely needed (&lt;1%). This meta-analysis summarizes 23 studies that include over one million patients and demonstrates the incidence of other PCI-related complications including myocardial infarction, stroke, cardiogenic shock, aortic dissection, and tamponade, as well as early (within 30 days) and late (after 30 days) all-cause mortality, are not different at h...


Impella 5.0 Support in INTERMACS II Cardiogenic Shock Patients Using Right and Left Axillary Artery Access
Abstract The catheter‐based Impella 5.0 left ventricular assist device (LVAD) is a powerful and less invasive alternative for patients in cardiogenic shock. The use of this device as a primary mechanical circulatory support strategy in INTERMACS II patients should be evaluated. From April 2014 to August 2014, eight Impella 5.0 devices were implanted in seven patients via the axillary artery access (six right and two left). We analyzed the outcome of the four patients in whom the Impella 5.0 device was implanted for the purpose of primary stabilization of cardiogenic shock (INTERMACS II). The remaining three patients had a contraindication for a permanent LVAD and received the device for prolonged weaning from extracorporeal life support (ECLS) system. The implantation of the Impella 5.0 ...


Acute Myocardial Infarction Complicated by Cardiogenic Shock: An Algorithm‐Based Extracorporeal Membrane Oxygenation Program Can Improve Clinical Outcomes
Abstract Extracorporeal membrane oxygenation (ECMO) in our institution resulted in near total mortality prior to the establishment of an algorithm‐based program in July 2010. We hypothesized that an algorithm‐based ECMO program improves the outcome of patients with acute myocardial infarction complicated with cardiogenic shock. Between March 2003 and July 2013, 29 patients underwent emergent catheterization for acute myocardial infarction due to left main or proximal left anterior descending artery occlusion complicated with cardiogenic shock (defined as systolic blood pressure &lt;90 mm Hg despite multiple inotropes, with or without intra‐aortic balloon pump, lactic acidosis). Of 29 patients, 15 patients were treated before July 2010 (Group 1, old program), and 14 patients were ...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center
Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients ...


Percutaneous Aortic Balloon Valvuloplasty and Intracardiac Adrenaline in Electromechanical Dissociation as Bridge to Transcatheter Aortic Valve Implantation
This report describes an emergent balloon aortic valvuloplasty (BAV) procedure performed under cardiopulmonary resuscitation in a 79-year-old man with severe symptomatic aortic stenosis (mean gradient 78 mm Hg, valve area 0.71 cm2, and left ventricular ejection fraction 40%) awaiting surgery and who was admitted for heart failure rapidly evolving to cardiogenic shock and multiorgan failure. Decision was made to perform emergent BAV. After crossing the valve with a 6 French catheter, the patient developed an electromechanical dissociation confirmed at transesophageal echocardiography and cardiac arrest. Manual chest compressions were initiated along with the application of high doses of intravenous adrenaline, and BAV was performed under ongoing resuscitation. Despite BAV, transoesophag...


Use of the Impella 5.0 Device as a Bridge to Recovery in Adult Fulminant Viral Myocarditis
We present a case of a 48-year-old female patient successfully bridged to recovery with the Impella 5.0 microaxial pump (Abiomed, Danvers, MA USA) after presenting with cardiogenic shock secondary to acute fulminant viral myocarditis. After 1 week of flu-like symptoms, the patient presented to her community emergency department with chest pain and hypotension. A diagnosis of inferior ST elevation myocardial infarction was made; subsequent angiography demonstrated normal coronary arteries and a left ventricular ejection fraction of 10%. A provisional diagnosis of viral myocarditis was made. As her condition deteriorated further, she underwent insertion of an Impella 5.0 after failure of supportive medical therapy. Myocardial recovery occurred, and the Impella was removed after 1 week. After...


Experts&#8217; recommendations for the management of adult patients with cardiogenic shock
We present herein recommendations for the management of cardiogenic shock in adults, developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF)), with the participation the French Society of Anesthesia and Intensive Care (SFAR), the French Cardiology Society (SFC), the French Emergency Medicine Society (SFMU), and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV). The recommendations cover 15 fields of application such as: epidemiology, myocardial infarction, monitoring, vasoactive drugs, prehospital care, cardiac arrest, mechanical assistance, general treatments, cardiac surgery, poisoning, cardiogenic shock c...


Acute heart failure in patients with acute aortic syndrome: pathophysiology and clinical–prognostic implications
ConclusionAHF occurs in more than a quarter of patients with AAS of both type A and type B, is due to a variety of pathophysiological mechanisms, and is associated with increased surgical delay and in‐hospital mortality. (Source: European Journal of Heart Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Percutaneous management of patients with acute coronary syndromes from unprotected left main disease: A comprehensive review and presentation of a treatment algorithm
The patient with acute coronary syndrome, particularly with myocardial infarction, from an unprotected left main coronary stenosis represents one of the highest risk subgroups with mortality exceeding 25–50%. Once a patient develops cardiogenic shock, the risk of death during index hospitalization is exceedingly high. Percutaneous coronary intervention may improve short‐ and long‐term outcome, particularly if performed prior to shock development. Should the patient survive index hospitalization, survival tends to be rather good. This review summarizes current knowledge and proposes a clinical algorithm for evaluation and treatment. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Novel Uses of Extracorporeal Membrane Oxygenation in Adults
Extracorporeal membrane oxygenation (ECMO) has been available for decades, with its use steadily expanding in the setting of advances in technology. The most common indications for venovenous and venoarterial ECMO remain severe hypoxemic respiratory failure and cardiogenic shock, respectively. Refinements in extracorporeal circuitry and cannulation strategies have led to novel indications for ECMO in cardiopulmonary failure, including pulmonary hypertension, extracorporeal cardiopulmonary resuscitation, and less severe forms of the acute respiratory distress syndrome. There is hope for the development of destination device therapy, which could have significant implications for acute and chronic management of severe respiratory and cardiac disease. (Source: Clinics in Chest Medicine)


Factors Associated with the Use of Drug-Eluting Stents in Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction.
Conclusions. In this analysis, BMS implantation was associated with illicit drug or alcohol abuse and presence of cardiogenic shock. This study did not confirm previous observations that non-White race, insurance, or income predicts BMS use. PMID: 26106504 [PubMed] (Source: Cardiology Research and Practice)


Ventricular assist devices for treatment of acute heart failure and chronic heart failure
Despite therapeutic advances that improve longevity and quality of life, heart failure (HF) remains a relentless disease. At the end stage of HF, patients may become eligible for mechanical circulatory support (MCS) for the indications of stabilising acute cardiogenic shock or for chronic HF management. MCS use is growing rapidly in the USA and some countries of the European Union, especially in transplant-ineligible patients. In others, it remains largely a tool to stabilise patients until heart transplant. MCS comprises a heterogeneous group of temporary and durable devices which augment or replace the pumping function of one or both ventricles, with postimplant 2&nbsp;year survival rivalling that of transplant in selected, lower-risk patients. In transplant-eligible and non-transplant-e...


Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism
CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed. (Source: Clinics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bridge-to-recovery strategy using extracorporeal membrane oxygenation for critical pulmonary hypertension complicated with cardiogenic shock
CONCLUSIONS ECMO provides a therapeutic window for the medical stabilization of critically decompensated PH patients. Prompt ECMO intervention before haemodynamic collapse and careful patient selection are critical for successful BTR outcomes. (Source: Interactive CardioVascular and Thoracic Surgery)


Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
CONCLUSIONS: AKI was frequent and serious complication of STEMI in patients treated by primary PCI. Heart failure was the strongest predictor of AKI. Other risks factors including contrast medium volume, baseline renal function, diabetes and age failed to predict AKI. PMID: 26101023 [PubMed - as supplied by publisher] (Source: Polish Heart Journal)


Mechanical circulatory support with optimal coronary reflow in a cardiogenic shock complicating acute myocardial infarction.
CONCLUSIONS: Mechanical circulatory support may face some critical limitations to provide clinical benefits even in patients successfully treated with PCI for a cardiogenic shock complicating AMI. PMID: 26116210 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


Resuscitated out-of-hospital cardiac arrest with normal post resuscitation 12 lead electrocardiography
A 50-year-old man experienced ventricular fibrillation (VF) in the early morning. A 12-lead electrocardiogram obtained immediately after resuscitation showed normal findings. However, an emergent coronary angiogram revealed the acute thrombotic obstruction in the high lateral branch. Following emergent percutaneous coronary intervention was successfully implemented. During observation in the intensive care unit, the patient developed spontaneous prominent ST elevation in the inferior leads, III degree atrio-ventricular (AV) block and cardiogenic shock. (Source: The American Journal of Emergency Medicine)


Resuscitated out-of-hospital cardiac arrest with normal postresuscitation 12-lead electrocardiography
A 50-year-old man experienced ventricular fibrillation in the early morning. A 12-lead electrocardiogram obtained immediately after resuscitation showed normal findings. However, an emergent coronary angiogram revealed the acute thrombotic obstruction in the high lateral branch. Following emergent percutaneous coronary intervention was successfully implemented. During observation in the intensive care unit, the patient developed spontaneous prominent ST elevation in the inferior leads, third-degree atrioventricular block, and cardiogenic shock. (Source: The American Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Reversible left bundle branch block due to carbon monoxide poisoning: A case report
Carbon monoxide is known as a potent poisonous gas. The clinical features of CO poisoning are not specific.Cardiac disorders due to changes in cellular and subcellular levels, cardiomyopathy, angina pectoris, acute myocardial infarction, arrhythmias, heart failure, pulmonary edema, cardiogenic shock and sudden death may occur.Myocardial damage has been determined as an indicator of increased mortality in patient with CO poisoning in the long-term.The ECG changes that may be detected in carbon monoxide intoxication are repolarization disorders, flattening and inversion of T-waves, ischemic changes, QT interval prolongation, P wave elevation, QRS widening, newly onset bundle branch block in two consecutive derivations. (Source: The American Journal of Emergency Medicine)


MY APPROACH to the Management of Cardiogenic Shock
“There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be 3 days or 2 weeks later but something has happened to your body that is irreparable.” – Dr. Adams Cowley—pioneer on the management of shock (Source: Trends in Cardiovascular Medicine)


Reversible left bundle-branch block due to carbon monoxide poisoning: a case report
Carbon monoxide (CO) is known as a potent poisonous gas. The clinical features of CO poisoning are not specific. Cardiac disorders due to changes in cellular and subcellular levels, cardiomyopathy, angina pectoris, acute myocardial infarction, arrhythmias, heart failure, pulmonary edema, cardiogenic shock, and sudden death may occur. Myocardial damage has been determined as an indicator of increased mortality in patient with CO poisoning in the long term. The electrocardiographic (ECG) changes that may be detected in carbon monoxide intoxication are repolarization disorders, flattening and inversion of T waves, ischemic changes, QT-interval prolongation, P-wave elevation, QRS widening, and new-onset bundle-branch block in 2 consecutive derivations. (Source: The American Journal of Emergenc...


Heart Failure and the Renoprotective Effect of Statins
We read with great interest the meta-analysis by Gandhi et al,1 highlighting the protective role of statins in contrast-induced nephropathy. We would like to comment on the potential benefit of but lack of evidence on the role of statins in cardiogenic shock and nonischemic congestive heart failure. (Source: The American Journal of Medicine)


The Reply
We thank Vallabhajosyula et al for their interest in our study.1 Patients with cardiogenic shock represent the highest risk patients, with strong evidence for early revascularization in the setting of acute coronary syndrome. Patients may be prone to developing contrast-induced acute kidney injury due to renal hypoperfusion, acidosis, and the toxic effects of radiocontrast material. Early initiation of statin therapy in such patients is supported because of lipid-lowering and pleiotropic effects. (Source: The American Journal of Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


An inspection of therapeutic hypothermia preceding coronary reperfusion in patients with a cardiogenic shock complicating anterior ST-segment elevation myocardial infarction
Conclusions The present study may imply a crucial possibility of clinical benefits of pre-PCI procedural therapeutic hypothermia in patients with a cardiogenic shock complicating anterior STEMI. (Source: IJC Heart and Vasculature)


Antiplatelet Therapy Considerations in Ischemic Cardiogenic Shock: Implications of Metabolic Bioactivation
Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist remains a mainstay in the prevention of ischemic events following coronary stent placement. Significant controversy exists regarding the optimal management of high platelet reactivity despite antiplatelet therapy; however this finding has been consistently associated with poor clinical outcomes including greater risk of stent thrombosis and myocardial infarction. Variability in antiplatelet effects of clopidogrel and prasugrel has been linked to genetic polymorphisms and potential drug&ndash;drug interactions. Both of these factors have significant influence on the cytochrome P-450 enzyme system activity of the liver responsible for their biotransformation to the active form of both drugs. Very little has been publicize...


Surgical repair of pulmonary artery dissection in a patient with 10-year history of Takayasu’s arteritis
We report a case of surgical repair of PA dissection in a patient with 10-year history of Takayasu’s arteritis and with no diagnosis of pulmonary hypertension. (Source: General Thoracic and Cardiovascular Surgery)


Carotid Stump Syndrome in a 6 Year-Old Child after Extracorporeal Membrane Oxygen Therapy and Carotid Ligation
We present the case of a 6 year-old child with rheumatic endocarditis, who required venoatrial ECMO therapy for biventricular heart failure. The right common carotid artery was used for arterial access. When ECMO was terminated, ligation of his right common carotid artery was performed after removal of the cannula. (Source: Annals of Vascular Surgery)


Drinking to Near Death- Acute water intoxication leading to neurogenic stunned myocardium: A Case Report
Neurogenic stunned myocardium (NSM) is a rare disease entity that has been typically described as a consequence of subarachnoid hemorrhage, and less commonly, seizures. Here we describe a case of a healthy young woman who drank excessive free water causing acute hyponatremia complicated by cerebral edema and seizure, leading to cardiogenic shock from NSM. Two days later, she had complete return of her normal cardiac function. (Source: The American Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bupropion overdose presenting as status epilepticus in an infant
Bupropion is a monocyclic antidepressant in the aminoketone class, structurally related to amphetamines. The FDA withdrew this product from the market in 1986 after seizures were appreciated in bulimic patients. It was later reintroduced in 1989 as the incidence of seizures was shown to be dose related for the immediate release preparation. Massive bupropion ingestion has been associated with status epilepticus and cardiogenic shock in adults. Seizures have been reported in children but not status epilepticus. (Source: Pediatric Neurology)


Drinking to near death—acute water intoxication leading to neurogenic stunned myocardium: a case report
Neurogenic stunned myocardium is a rare disease entity that has been typically described as a consequence of subarachnoid hemorrhage and, less commonly, seizures. Here we describe a case of a healthy young woman who drank excessive free water causing acute hyponatremia complicated by cerebral edema and seizure, leading to cardiogenic shock from neurogenic stunned myocardium. Two days later, she had complete return of her normal cardiac function. (Source: The American Journal of Emergency Medicine)


Drinking to near death—acute water intoxication leading to neurogenic stunned myocardium
Neurogenic stunned myocardium is a rare disease entity that has been typically described as a consequence of subarachnoid hemorrhage and, less commonly, seizures. Here we describe a case of a healthy young woman who drank excessive free water causing acute hyponatremia complicated by cerebral edema and seizure, leading to cardiogenic shock from neurogenic stunned myocardium. Two days later, she had complete return of her normal cardiac function. (Source: The American Journal of Emergency Medicine)


Effects of aortic counterpulsation in 6 cases of fulminant myocarditis
Myocarditis is a myocardial inflammatory disorder characterized by different etiology and clinical manifestations [1]. The clinical course of patients can vary from asymptomatic/paucisymptomatic forms to fulminant myocarditis (FM), characterized by serious hemodynamic compromise at presentation that can evolve towards cardiogenic shock (CS). It has been reported that FM has better long-term survival rate than acute myocarditis if the patient survives the acute phase and left ventricular function recovers completely within 1 month [2]. (Source: The American Journal of Emergency Medicine)


High positive fluid balance could be harmful for the brain in shock patients
Background/Purpose: High positive fluid balance aggravates kidney and lung injury in critically ill patients, but it is not known if this could be harmful to the brain. We investigated whether high positive fluid balance was associated with brain dysfunction and delirium in shock patients including septic and cardiogenic shock. (Source: Journal of Critical Care)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Congestive Heart Failure
Patients with acute decompensated heart failure are usually critically ill and require immediate treatment. However, most are not volume overloaded. Emergency department (ED) management is based on rapid initiation of noninvasive positive-pressure ventilation and aggressive titration of nitrates. Afterload reduction with an angiotensin-converting enzyme inhibitor can be considered. A diuretic should not be administered before optimal preload and afterload reduction has been achieved. Short-term inotropic therapy can be considered in select patients with cardiogenic shock and acute decompensated heart failure (ADHF) who fail to respond to standard therapy. (Source: Emergency Medicine Clinics of North America)


Device therapy: Where next in cardiogenic shock owing to myocardial infarction?
Nature Reviews Cardiology 12, 383 (2015). doi:10.1038/nrcardio.2015.81 Author: Daniel Burkhoff Intra-aortic balloon pumping has recently been shown to be ineffective in treating cardiogenic shock due to myocardial infarction. Other, more potent percutaneous pumps have been developed, and their use is growing substantially, but they have not been studied in randomized trials. Two new reports provide provocative information about these devices. (Source: Nature Reviews Cardiology)


“Awake Veno-arterial Extracorporeal Membrane Oxygenation” in Pediatric Cardiogenic Shock: A Single-Center Experience
Abstract In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without cont...


Late Silent Stent Abscess
Background: Coronary stent infections in general and stent abscesses (SAs) in particular are rare but often deadly complications. Most SAs manifest with fever and chest pain within 30 days after intervention and require antibiotics and stent removal. Case Report: A 45-year-old man with second ST elevated myocardial infarction and cardiogenic shock was admitted to a hospital that had no cardiac catheterization laboratory. The patient underwent fibrinolytic therapy with alteplase but died 1 h later. His medical history revealed posterior myocardial infarction 7 years before, which had been successfully treated with a bare metal stent of the right coronary artery. The post-discharge observation had been unremarkable with no evidence of ischaemia or infection but gross non-compliance. Autopsy ...


Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation.
We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified heart failure therapy was closely monitored with a pulmonary artery catheter and allowed gradual weaning off the ECMO support without additional invasive measures, notably without mechanical ventilation. Neurological assessment was possible at all times and complete physical mobilisation was straightforward directly after weaning from ECMO. This limited invasive approach may encourage a more widespread use of percutaneous VA-ECMO. PMID: 26043927 [PubMed - as supplied by publisher] (Source: Ne...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


De novo acute heart failure and acutely decompensated chronic heart failure.
CONCLUSION: The treatment of acute heart failure is markedly less evidence-based than that of chronic heart failure. Newer treatment approaches that are intended to improve outcomes still need to be tested in multicenter trials. PMID: 26008893 [PubMed - in process] (Source: Deutsches Arzteblatt International)


Atrial fibrillation and cor triatriatum sinister: a case report.
Authors: Tran HJ, Gordon R, Alloggiamento T, Nagi SK, Krishnaswami A Abstract A 29-year-old man presented to our hospital with palpitations, shortness of breath, and orthopnea. After being admitted, he progressed to cardiogenic shock and respiratory failure, which required ventilator support and cardioversion. Subsequent evaluation revealed a fibromuscular membrane across the left atrium, requiring urgent corrective surgery. PMID: 25902348 [PubMed - in process] (Source: The Permanente journal)


Stent thrombosis--mythy and facts.
Authors: Yildiz M, Yildiz BS, Aydin E, Akin I Abstract Stent thrombosis is a serious complication in stent era. It can be presented as death, cardiogenic shock or a large non-fatal myocardial infarction, usually with ST elevation. Risks of stent thrombosis, stent thrombosis incidence and predictors are controversial issues due to sparse and controversial data. But all attending physicians should have knowledge of the risk of stent thrombosis, predisposing and protective factors before and after the intervention. This issue is discussed in detail in this review. PMID: 25174712 [PubMed - in process] (Source: Cardiovascular and Hematological Disorders Drug Targets)


Cardiogenic Shock
This article discusses pharmacologic and surgical interventions, their indications and contraindications, management strategies, and treatment algorithms. (Source: Emergency Medicine Clinics of North America)


Intraaortic balloon pump in patients with cardiogenic shock complicating myocardial infarction: a systematic review and meta-analysis of randomized trials.
CONCLUSIONS: The use of IABP in patients with cardiogenic shock complicating myocardial ischemia does not reduce mortality (moderate confidence) and is not associated with a higher risk of complications (very low to low confidence). The results should be interpreted with caution owing to limitations such as imprecision, risk of bias, and clinical heterogeneity. PMID: 25698226 [PubMed - in process] (Source: Polskie Archiwum Medycyny Wewnetrznej)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Complete recovery of a patient with cardiogenic shock due to parvovirus B19 fulminant myocarditis after treatment with extracorporeal membrane oxygenation and intravenous immunoglobulin.
Authors: Drwiła R, Rubiś P, Kapelak B, Rudnicka-Sosin L, Pankuweit S, Gackowski A PMID: 25666442 [PubMed - in process] (Source: Polskie Archiwum Medycyny Wewnetrznej)


Rescue balloon pulmonary angioplasty under veno-arterial extracorporeal membrane oxygenation in a patient with acute exacerbation of chronic thromboembolic pulmonary hypertension.
We describe a case of a 41-year-old woman with acute exacerbation of chronic thromboembolic pulmonary hypertension (CTEPH) complicated by rapidly progressive respiratory failure and right heart failure with cardiogenic shock. A computed tomography (CT) showed thrombi in the right main pulmonary artery and bilateral peripheral pulmonary arteries, and echocardiography showed right ventricular dilatation and tricuspid regurgitation, with an estimated pressure gradient of 80 mmHg. The patient was initially diagnosed with acute pulmonary thromboembolism, and thrombolytic therapy was administered. Her condition subsequently deteriorated, however, necessitating mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We performed emergency catheter-directed thrombec...


Fulminant type 1 diabetes mellitus and fulminant viral myocarditis. A case report and literature review.
Authors: Ohara N, Kaneko M, Kuwano H, Ebe K, Fujita T, Nagai T, Furukawa T, Aizawa Y, Kamoi K Abstract A 35-year-old Japanese woman was admitted with coma following flu-like symptoms. She was diagnosed with diabetic ketoacidosis and fulminant type 1 diabetes (FT1D) and received intravenous infusion of insulin and saline. The next day, the ketoacidosis disappeared, and she recovered consciousness. However, extensive ST-segment elevations in the electrocardiogram appeared with a positive troponin test, and the patient developed pulmonary edema on day 3. An echocardiogram showed globally reduced wall motion of the left ventricle and mild pericardial effusion. Despite medical therapy with intravenous furosemide, carperitide, and catecholamines, her cardiac function deteriorated rapidly...


Long Term Survival of Adults with Cardiogenic Shock after Veno-Arterial Extra Corporeal Membrane Oxygenation
This study was designed to examine the long-term survival of patients who survived to be weaned from Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO), and to determine which factors present at initiation and during ECMO predict long term survival. We further sought to develop the preliminary LOVE (Long Term Outcome After VA-ECMO) Score that would predict patient outcome, and to assess its accuracy at various time points. (Source: Journal of Critical Care)


Intense Adrenal Enhancement: A CT Feature of Cardiogenic Shock
In this report, images of intense adrenal enhancement in a 79-year-old female patient with right-sided heart failure and severe tricuspid insufficiency are presented. Only two cases of intense adrenal enhancement as a sign of cardiogenic shock were previously reported in the literature. Intense adrenal enhancement could be one of the earliest CT signs of cardiogenic shock. Its presence should be immediately reported to the referring physician as a sign of significant hemodynamic instability warranting early critical-care management. (Source: CardioVascular and Interventional Radiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation
This study was designed to examine the long-term survival of patients who survived to be weaned from venoarterial extracorporeal membrane oxygenation (VA ECMO) and to determine which factors present at initiation and during ECMO predict long-term survival. We further sought to develop the preliminary long-term outcome after VA ECMO score that would predict patient outcome and to assess its accuracy at various time points. (Source: Journal of Critical Care)


The Novel Use of Heart Transplantation for the Management of a Case With Multiple Complications After Acute Myocardial Infarction
We report the case of a 63-year-old man in whom VSD developed after an inferior MI. The patient presented with shortness of breath and a recent ST-elevation inferior MI. Transthoracic echocardiography revealed a 50% left ventricular ejection fraction with mild-moderate right ventricular dysfunction. A posterior VSD (diameter ≥ 12 mm), moderate ischemic mitral regurgitation (MR), and a posterior pseudoaneurysm were also seen. The operative risk was considered to be too high for VSD repair because the surgery would have to include bypass grafting, mitral valve replacement, and pseudoaneurysm correction. Consequently, an urgent heart transplantation was considered the best option. The patient underwent heart transplantation 9 days after initial symptoms, and the recovery was unremarkable. T...


Intra-Aortic Balloon Pump in Myocardial Infarction
In this meta-analysis, intra-aortic balloon pump therapy was not found to improve mortality among patients with acute myocardial infarction in randomized clinical trials, regardless of whether patients had cardiogenic shock. (Source: JAMA Internal Medicine)


High-Risk Medical Devices
The intra-aortic balloon pump (IABP), a mechanical device designed to increase both myocardial perfusion and cardiac output, was pioneered in the 1960s to treat patients in cardiogenic shock. An innovation at the time, the device was made available for use prior to passage of the 1976 Medical Device Amendments, which gave the US Food and Drug Administration (FDA) authority to require evidence of effectiveness and safety for high-risk medical devices before granting market clearance. It is likely that no clinical data were submitted for FDA review prior to market clearance of the IABP. More than 70 000 IABPs are inserted annually in the United States for a broad array of indications including acute coronary syndromes, cardiac surgery, complications of heart failure, and cardiogenic shock....


Novel use of the AngioVac® system to remove thrombus during simultaneous extracorporeal membrane oxygenation life support.
Authors: Griffith KE, Jenkins E, Copenhaver W, Williams DM Abstract Extracorporeal membrane oxygenation (ECMO) was introduced to clinical medicine over 40 years ago. While initially used as a treatment for acute respiratory failure in infants, the use of ECMO has grown to include respiratory and circulatory failure in both children and adults, cardiogenic shock, pulmonary embolism, sepsis, trauma, malignancy, pulmonary hemorrhage and as a treatment for hypothermic drowning.(1) Recent technological improvements in ECMO circuitry make it possible to minimize anticoagulation of the ECMO patient, decreasing the incidence of bleeding. Thrombus deposition within the ECMO circuit can be a life-threating complication. ECMO circuit thrombus can be contained in the circuit, adherent to cannu...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Comparison of radial to femoral PCI in acute myocardial infarction and cardiogenic shock: a systematic review
Abstract In randomized control trials and meta-analyses in patients with acute MI undergoing PCI, the radial artery (RA) approach compared to the femoral artery (FA) approach has shown to safely reduce access site related bleeding, length of hospitalization, and major adverse cardiac event (MACE) rates. However, these studies have excluded patients with cardiogenic shock. A systematic search was conducted to retrieve studies that investigated the safety of RA to FA PCI in patients with AMI and cardiogenic shock. Primary outcomes of interest was the pooled relative risk ratio (RR) of access site related bleeding. Secondary outcomes included (i) 30-day all cause mortality, (ii) major bleeding, (iii) final TIMI 3 flow, (iv) fluoroscopy time, and (v) amount of contrast volume adminis...


Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience
ConclusionsWe have found that RA and stenting is feasible and viable in an elderly high‐risk population, with exceptional procedural success and acceptable long‐term results. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience
ConclusionsTranscatheter closure of post‐MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non‐ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow‐up. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Extracorporeal life support in patients with refractory cardiogenic shock: keep them awake
CONCLUSIONS ECLS as a bridge to decision in RCS is effective in restoring adequate systemic perfusion and recovering end-organ function. ECLS can be initiated in awake patients with RCS and patients can be awakened on ECLS. The &lsquo;awake ECLS&rsquo; strategy may avoid complications related to mechanical ventilation, sedation and immobilization. RCS patients supported on ECLS without severe metabolic acidosis, multiorgan failure, intra-aortic balloon pump or uncertain neurological status are more likely to be weaned from the ventilator. Patients that are awake at the time of ECLS implantation are more likely to remain awake during ECLS. (Source: Interactive CardioVascular and Thoracic Surgery)


Percutaneous Mechanical Support in Cardiogenic Shock: A Review
Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. Pharmacological therapy is often the first line of treatment but mechanical support can provide substantial hemodynamic improvement in refractory CS. Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance to the failing myocardium. We review the percutaneous devices currently available, the evidence behind their use, and the new advances in percutaneous technology being evaluated for the treatment of CS. (Source: Clinical Medicine Insights: Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Emergent transcatheter mitral valve‐in‐valve implantation in a patient with cardiogenic shock secondary to a failed mitral bioprosthesis
Transcatheter valve‐in‐valve (VIV) implantation is emerging as a therapeutic option for treatment of failed bioprosthesis in patients that are deemed high‐risk or inoperable for redo‐valve replacement. It can be carried out in suitable bioprosthetic valves in any position and usually performed as an elective or semi‐elective procedure. Here, we report a case of emergent transcatheter VIV implantation in a failed mitral bioprosthesis in a critically ill patient with cardiogenic shock. We conclude that transcatheter VIV implantation may also be an option for critically ill patients with failing bioprosthesis. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


A case of catastrophic antiphospholipid syndrome: first report with advanced cardiac imaging using MRI.
Authors: Rosenbaum AN, Anavekar NS, Ernste FC, Mankad SV, Le RJ, Manocha KK, Barsness GW Abstract This present case pertains to a 48-year-old woman with a history of antiphospholipid syndrome, who presented with progressive fatigue, generalized weakness, and orthopnea acutely. She had a prior diagnosis of antiphospholipid syndrome with recurrent deep vein thromboses (DVTs) and repeated demonstration of lupus anticoagulants. She presented in cardiogenic shock with markedly elevated troponin and global myocardial dysfunction on echocardiography, and cardiac catheterization revealed minimal disease. Cardiac magnetic resonance imaging was performed, which revealed findings of perfusion defects and microvascular obstruction, consistent with the pathophysiology of catastrophic antiphosph...


Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves.
CONCLUSIONS: Ischemic ECG patterns are common ECG manifestations of APE and predict worse evolution and 30-day mortality. Additionally, relatively normal ECGs may associate with favorable clinical outcomes. PMID: 26004940 [PubMed - as supplied by publisher] (Source: Cardiology Journal)


National Assessment of Early Beta-Blocker Therapy in Patients with Acute Myocardial Infarction in China, 2001-2011: The China PEACE-Retrospective AMI Study
Conclusions The use of early beta-blocker therapy for patients with AMI in China is suboptimal, with underuse in patients who could benefit and substantial use among those who might be harmed. Patterns of use have not changed over time, thus creating an important target of efforts to improve quality of care for AMI. (Source: American Heart Journal)


Once-weekly dulaglutide versus bedtime insulin glargine, both in combination with prandial insulin lispro, in patients with type 2 diabetes (AWARD-4): a randomised, open-label, phase 3, non-inferiority study
Publication date: 23–29 May 2015 Source:The Lancet, Volume 385, Issue 9982 Author(s): Lawrence Blonde , Johan Jendle , Jorge Gross , Vincent Woo , Honghua Jiang , Jessie L Fahrbach , Zvonko Milicevic Background For patients with type 2 diabetes who do not achieve target glycaemic control with conventional insulin treatment, advancing to a basal–bolus insulin regimen is often recommended. We aimed to compare the efficacy and safety of long-acting glucagon-like peptide-1 receptor agonist dulaglutide with that of insulin glargine, both combined with prandial insulin lispro, in patients with type 2 diabetes. Methods We did this 52 week, randomised, open-label, phase 3, non-inferiority trial at 105 study sites in 15 countries. Patients (aged ≥18 years) with type 2 diabetes inadequately...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A case of coronary rupture and pseudoaneurysm formation after fracture of implanted paclitaxel-eluting stents
Abstract A 48-year-old man who had undergone implantation of two paclitaxel-eluting stents (PESs) at the right coronary artery was admitted to our hospital with progressive dyspnea. In the coronary care unit, he developed cardiogenic shock due to cardiac tamponade treated by pericardiocentesis. A coronary angiogram showed a large pseudoaneurysm at the site of the previously implanted stents, suggesting coronary rupture due to implanted stent fracture. The pseudoaneurysm was completely sealed by polytetrafluoroethylene-covered stent implantation. Although this case is very rare, coronary rupture by stent fracture should be considered when cardiac tamponade occurs after drug-eluting stent implantation, especially PES. (Source: Cardiovascular Intervention and Therapeutics)


Impact of access site choice on outcomes of patients with cardiogenic shock undergoing percutaneous coronary intervention: A systematic review and meta-analysis
Conclusions Transradial access is associated with reduced mortality and MACCE at 30 days in patients with CS undergoing PCI. Considering the possible influence of selection bias on the effect estimate in our analysis, randomized controlled trials are needed to better assess this association. (Source: American Heart Journal)


Management of cardiogenic shock
Cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction although mortality could be reduced from formerly ~80% to 40&ndash;50%. In addition to percutaneous coronary intervention or coronary artery bypass grafting, catecholamines, fluids, intraaortic balloon pumping (IABP), and also active assist devices are widely used for CS management. However, there is only limited evidence for any of the above treatments except for early revascularization and the relative ineffectiveness of IABP. This updated review will therefore outline the management of CS complicating acute myocardial infarction with major focus on evidence-based revascularization techniques, intensive care unit treatment including ventilation, transfusion regimens, adjunctive medi...


A rare cause of cardiogenic shock
(Source: European Heart Journal)


Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock
The long-term benefit of early percutaneous coronary intervention (PCI) for cardiogenic shock (CS) in elderly patients remains unclear. We sought to assess the long-term survival of elderly patients (age ≥75years) with myocardial infarction (MI) complicated by CS undergoing PCI. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Prehospital administration of P2Y12 inhibitors and early coronary reperfusion in primary PCI: a non-randomized comparative study.
In conclusion, this large observational, non-randomised study is the first to show that prehospital loading with the newer P2Y12 inhibitors does not improve early coronary reperfusion as compared to prehospital loading with clopidogrel in a PPCI cohort excluding cardiac arrest and cardiogenic shock. PMID: 25994355 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)


Unconventional use of the Fogarty embolization catheter for retrieval of a disjointed endovascular ventricular assist device
A 68-year-old man was admitted with acute coronary syndrome after acute myocardial infarction with cardiorespiratory arrest and ventricular arrhythmic storm. A double primary angioplasty was performed, and an intra-aortic balloon pump was inserted. Iliofemoral angiography showed no stenosis, narrowing, or tortuosity of the arteries. Despite the interventions and the high doses of vasopressors and inotropes, the arrhythmia persisted and the patient experienced progressive cardiogenic shock. For these reasons, an Impella 5.0 (Abiomed Inc, Danvers, Mass) device was implanted via the left common femoral artery through a 10-mm Dacron graft. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Extrinsic compression of the left main coronary artery by a contained aortic annular rupture following trans-catheter aortic valve implantation
We report the successful management of this complication. (Source: Cardiovascular Revascularization Medicine)


Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis 1-Year Results From the All-Comers NOTION Randomized Clinical Trial
ConclusionsIn the NOTION trial, no significant difference between TAVR and SAVR was found for the composite rate of death from any cause, stroke, or MI after 1 year. (Nordic Aortic Valve Intervention Trial [NOTION]; NCT01057173) (Source: Journal of the American College of Cardiology)


A multifaceted approach to calcium channel blocker overdose: a case report and literature review
Key Clinical Message Calcium channel blocker toxicity can be devastating. Initial therapy with fluid, calcium, and adrenoreceptor agonists should be prompt and novel therapies can be added if no response. Determining cardiogenic shock versus vasoplegia with echocardiogram or other hemodynamic monitoring may guide treatment options. Calcium channel blocker toxicity can be devastating. Initial therapy with fluid, calcium, and adrenoreceptor agonists should be prompt and novel therapies can be added if no response. Determining cardiogenic shock versus vasoplegia with echocardiogram or other hemodynamic monitoring may guide treatment options. (Source: Clinical Case Reports)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Resurgence Of Extracorporeal Support For The Primary Management Of Cardiogenic Shock
(Source: The Journal of Thoracic and Cardiovascular Surgery)


Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection
Conclusions In our experience TAR and CAM were associated with similar hospital mortality and morbidity rates. Nevertheless, the more extensive arch interventions were not protective for long-term survival and freedom from aortic re-intervention. Thus, in TAAD patients TAR remains indicated by site of intimal tear and patient-specific factors. (Source: The Annals of Thoracic Surgery)


Management of Intra-Aortic Balloon Pumps
Intra-aortic balloon pumps (IABPs) continue to be the most widely used cardiac support devices with an annual estimate of 200 000 IABPs placed worldwide. IABPs enhance myocardial function by maximizing oxygen supply and minimizing oxygen demand. The use of IABPs is not without risk, with major vascular injury, ischemia, and infection being the most common complications, especially in high-risk patients. While recent studies have questioned the use of IABPs in patients with cardiogenic shock secondary to myocardial infarction, these studies have limitations making it difficult to formulate definitive conclusions. This review will focus on the mechanisms of counterpulsation, the management of IABPs and the evidence supporting this ventricular support therapy. (Source: Seminars in Cardiothora...


Clinical outcomes of the intra-aortic balloon pump for resuscitated patients with acute myocardial infarction complicated by cardiac arrest.
CONCLUSION: The use of IABP did not show clinical benefits in patients with AMI complicated by severe cardiogenic shock after propensity matching analysis. PMID: 25982668 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)


H2S induced coma and cardiogenic shock in the rat: Effects of phenothiazinium chromophores
Clinical Toxicology, Ahead of Print. (Source: Clinical Toxicology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection.
CONCLUSIONS: In our experience TAR and CAM were associated with similar hospital mortality and morbidity rates. Nevertheless, the more extensive arch interventions were not protective for long-term survival and freedom from aortic re-intervention. Thus, in TAAD patients TAR remains indicated by site of intimal tear and patient-specific factors. PMID: 25979238 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)


2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d’intervention ∗
Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock,...


Impact of Access Site Choice on Outcomes of Cardiogenic Shock Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis
Conclusions TRA is associated with reduced mortality and MACCE at 30 days in CS patients undergoing PCI. Considering the possible influence of selection bias on the effect estimate in our analysis, randomized controlled trials are needed to better assess this association. (Source: American Heart Journal)


0100 : Incidence and predictors of bleeding events in ST-Elevation Myocardial infarction (STEMI) revascularized within the first 12 hours
Conclusion The incidence of bleedings in STEMI remains stable despite more powerful antithrombotic agents, probably in relation with radial access and awareness of the bleeding risk by the clinician. Our study also confirms that bleeding events are strongly associated with in-hospital mortality. (Source: Archives of Cardiovascular Diseases Supplements)


Delayed sternal closure after total artificial heart implantation
One of the issues of greatest concern in total artificial heart (TAH) therapy is excessive bleeding in the early postoperative setting. Impaired perfusion, in cases of extended myocardial infarction and cardiogenic shock, and increased filling pressures, in cases of chronic biventricular heart failure, result in hepatic dysfunction and coagulation disorders.1 It is therefore not surprising that reexploration rates are still high.2 Although delayed sternal closure (DSC) is a well-established option for the management of refractory bleeding after routine and especially pediatric cardiac surgery,3-5 its safety and efficacy have still not been evaluated in the context of TAH therapy. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Respect the aorta
A severely atherosclerotic aorta (Figure 1) frightens most cardiac surgeons. Placement of a clamp on the heavily diseased aorta can lead to stroke or embolic events to any organ. To address the question of whether placement of 1 or 2 clamps on the aorta for coronary artery bypass surgery (CABG) reduces the risk of stroke or mortality, Araque and colleagues1 retrospectively report on 9797 patients who underwent isolated on-pump CABG between 1993 and 2010. They excluded high-risk patients (off-pump CABG, reoperative surgery, cardiogenic shock, inotrope medications, and emergency or salvage surgery), leaving a cohort of 8497 patients. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: Results from the ALKK PCI registry
ConclusionsThe radial approach for PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Regional Thrombolysis with Tenecteplase During Extracorporeal Membrane Oxygenation: A New Approach for Left Ventricular Thrombosis
We present the case of a woman assisted with veno‐arterial extracorporeal membrane oxygenation (v‐a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter. (Source: Journal of Cardiac Surgery)


Temporary Left Ventricular Assist Device Through an Axillary Access is a Promising Approach to Improve Outcomes in Refractory Cardiogenic Shock Patients
Cardiogenic shock (CS) causes significant morbidity and mortality and such patients can deteriorate rapidly. Temporary left ventricular assist devices (LVADs) are a promising approach to manage these patients. The following is a case series in which patients stabilized with a temporary LVAD for CS improvement were analyzed retrospectively. Between June 2011 and January 2014, 15 patients received temporary devices through an axillary approach (mean age: 53 ± 15, 93% male). Mean survival time was 317.8 ± 359.5 days (range: 6–936 days). During support there were no major bleeding events, infectious complications at the axillary access site, upper extremity edema, or emboli. The most of the patients recovered from CS (93%) were mobilized (67%) and were extubated (73%) while on temporary de...


Impact of waist circumference on hospital outcome and coronary angiographic findings of patients with acute ST-segment elevation myocardial infarction
Conclusion A high WC, had no favorable impact on in-hospital mortality, cardiovascular complications or coronary angiographic extent in STEMI patients. (Source: The Egyptian Heart Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cardiogenic Shock
(Source: Pediatrics in Review)


Prognostic Impact of Established and Novel Renal Function Biomarkers in Myocardial Infarction with Cardiogenic Shock: A Biomarker substudy of the IABP-SHOCK II-Trial
In cardiogenic shock (CS) renal dysfunction is an important parameter of inadequate end-organ perfusion and an independent predictor of adverse outcome. Early detection of renal dysfunction is therefore important, and novel biomarkers such as Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM1) and Cystatin C (CysC) have been suggested. However, in high-risk CS patients their role for assessing renal injury has not yet been investigated in comparison to the most widely used serum creatinine. (Source: International Journal of Cardiology)


Intra‐Aortic Balloon Pump Support in the Isolated Beating Porcine Heart in Nonischemic and Ischemic Pump Failure
Abstract The blood pressure changes induced by the intra‐aortic balloon pump (IABP) are expected to create clinical improvement in terms of coronary perfusion and myocardial oxygen consumption. However, the measured effects reported in literature are inconsistent. The aim of this study was to investigate the influence of ischemia on IABP efficacy in healthy hearts and in shock. Twelve slaughterhouse porcine hearts (hearts 1–12) were connected to an external circulatory system, while physiologic cardiac performance was restored. Different clinical scenarios, ranging from healthy to cardiogenic shock, were simulated by step‐wise administration of negative inotropic drugs. In hearts 7–12, severe global myocardial ischemia superimposed upon the decreased contractile states was created....


Transapical mitral valve-in-valve implantation for patients in cardiogenic shock.
We describe 2 patients in acute cardiogenic shock from prosthetic mitral valve failure treated with transcatheter mitral valve-in-valve implantation. Transcatheter mitral valve therapies should be considered in patients in cardiogenic shock from prosthetic mitral valve failure, although, larger studies are needed to make any strong recommendation. PMID: 25952241 [PubMed - in process] (Source: The Annals of Thoracic Surgery)


Is Implantation of a Left Ventricular Assist Device in Patients With Critical or Impending Cardiogenic Shock an Absolute Contraindication? Looking Back at Our Past Experience Trying to Identify Contraindicative Risk Factors


The impact of therapeutic hypothermia on on-treatment platelet reactivity and clinical outcome in cardiogenic shock patients undergoing primary PCI for acute myocardial infarction: Results from the ISAR-SHOCK registry
Mild therapeutic hypothermia (TH) is standard of care after cardiac arrest of any cause. However, its impact on on-treatment platelet reactivity and clinical outcome in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock and undergoing PCI with P2Y12 receptor inhibitor treatment is less clear. (Source: Thrombosis Research)


Abstract 1: Incidence and Predictors of Cognitive Decline in Patients with Left Ventricular Assist Devices [Session Title: Concurrent Session IB: Oral Abstracts - QCOR Young Investigator Awards]
Conclusion: In a large LVAD registry, cognitive decline occurred in over a quarter of patients in the year after LVAD and was associated with older age, renal disease, higher baseline cognitive function, and more stable heart failure at implant. These results define the frequency of an important adverse event and provide new insights regarding outcomes after LVAD. Future studies are needed to explore the association of transient and permanent cognitive decline with subsequent stroke, health status, and mortality in patients after LVAD placement. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 8: Health Status and Outcomes Following Left Ventricular Assist Device Placement [Session Title: Concurrent Session IC: Oral Abstracts - Outcomes]
Conclusions: Pre-operative health status among patients undergoing LVAD implantation is not associated with 2-year mortality or rehospitalization, suggesting that very poor health status alone should not be used to exclude patients from treatment. In contrast, health status measured 3 months after LVAD is associated with subsequent outcomes. Furthermore, the KCCQ significantly improves the discrimination of a previously validated risk model, suggesting that systematic health status assessment can improve prognostication and might be helpful in directing care following device implantation. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 114: Mechanical Circulatory Support in Percutaneous Coronary Intervention: A Propensity-matched Analysis [Session Title: Poster Session I]
Conclusion: The lower unadjusted mortality in patients undergoing PCI with PVAD support compared to IABP support may be due to selective use of PVADs in a lower risk population. Randomized trials are necessary to establish the clinical effectiveness of PVADs to support high-risk PCI. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 119: Daily Cardiac Catheterization Procedural Volume and Complications [Session Title: Poster Session I]
Conclusions: There is a U-shaped association between CC volume and rates of CC related complications. Unlike prior studies which identified high annual volumes were associated with lower complication rate, our study results suggests that this relationship does not hold true for daily volume. There appears to be a daily limit at which complication rates begin to rise in proportion to volume. Higher complication rates were seen on days with very low CC volume (&lt;5 procedures) and days with very high CC volume (&gt;12 procedures). It is important that individual high volume CC labs consider a quality control analysis of their daily CC volume to determine the optimal volume associated with the fewest complications. (Source: Circulation: Cardiovascular Quality and Outcomes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Abstract 161: National Trends in Use of Radial Access for Percutaneous Coronary Intervention in China: 2001-2011 [Session Title: Poster Session I]
Conclusion: Over a recent ten-year period, radial access became the predominant strategy for PCI in China, even among high-risk patients. This study demonstrates the responsiveness of the interventional cardiology community to emerging evidence. A deeper understanding of the factors facilitating r-PCI adoption in China may help increase its usage in countries in which r-PCI use remains low. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 169: Contemporary Trends in Utilization and Outcomes of Percutaneous Ventricular Assist Devices in Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction in the United States [Session Title: Poster Session I]
Conclusion: In recent years, there has been an increase in utilization of pVAD in patients with cardiogenic shock complicating STEMI. However, this trend was not accompanied with a decrease in overall in-hospital mortality among patients who underwent pVAD implantation. There were also adverse temporal trends in the average length of stay and average hospital cost in STEMI patients with cardiogenic shock undergoing pVAD implantation. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 225: Frequency and Assessment of Poor Global Outcome in Patients with Left Ventricular Assist Devices [Session Title: Poster Session II]
Conclusion: In this large, single-center study assessing global outcome after LVAD implantation, we found that about a third of all patients had experienced a poor global outcome at 1 year. While LVAD therapy remains life-saving and the standard of care for many patients with advanced heart failure, these findings could help guide discussions with eligible patients and families. Future work should compare patients&rsquo; pre-LVAD expectations with likely outcomes and create risk models to estimate the probability of poorer outcomes for individual patients using pre-procedural factors. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 244: Association of Chest Pain versus Dyspnea as Presenting Symptom for Coronary Angiography with Demographics, Coronary Anatomy, and 2-Year Mortality [Session Title: Poster Session II]
Conclusions: Patients undergoing coronary angiography who presented with dyspnea were older, had a higher serum creatinine, lower LVEF, more frequent cardiogenic shock, less obstructive CAD, and less percutaneous coronary intervention compared to patients presenting with CP. However, the difference in clinical presentation was not associated with a higher 2-year mortality. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 265: Survival Analysis of Extracorporeal Life Support Under Different Indications - A Nation-wide Cohort Study in Taiwan [Session Title: Poster Session II]
Conclusion: The overall survival was worst in the patients who required ECLS due to myocardial infarction and cardiogenic shock. Patients with infection, adult respiratory distress syndrome, and septic shock had a higher possibility of surviving through the first month, but the overall mortality was not necessarily better. Further analysis regarding the cost and benefit of ECLS is warranted. (Source: Circulation: Cardiovascular Quality and Outcomes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Abstract 309: Trends in LVAD Use and Outcomes Among Patients Admitted with Acute Myocardial Infarction [Session Title: Poster Session III]
Conclusion: Among patients with AMI, LVAD use remains low and has not increased as has LVAD use for other indications. Although LVAD use in this population was initially associated with higher in-hospital mortality, our analysis suggests a narrowing of this gap. Future studies are needed to determine how long-term survival is affected and which patients are appropriate candidates for LVAD implantation after AMI. (Source: Circulation: Cardiovascular Quality and Outcomes)


Abstract 374: Characteristics and Clinical Outcomes of Patients with Long-term Left Ventricular Assist Devices in Quebec Compared with the INTERMACS Registry [Session Title: Poster Session III]
Conclusions: In comparison with INTERMACS, Quebec LVAD patients were younger, more likely to be inotrope-dependent and less likely to be implanted as destination therapy. Despite relatively low center volumes, clinical outcomes for Quebec were very similar to INTERMACS. Results according to transplant list status at time of implant support the recommendation that transplant eligibility should not be an essential criterion for selection of patients for LVAD. Continued independent monitoring of LVAD patients, even after explant or transplant, will be important to optimize the value and quality of care of end-stage heart failure patients. (Source: Circulation: Cardiovascular Quality and Outcomes)


Emergent balloon aortic valvuloplasty as a bridge to transcatheter aortic valve implantation with marked risk reduction of perioperative and postoperative mortality
We report the case of an 87-year-old woman with severe aortic stenosis who presented acutely with cardiogenic shock. Considering her severe condition, we concluded that she would not be able to undergo aortic valve replacement. Life-saving emergent balloon aortic valvuloplasty was performed under general anesthesia. There were no postoperative complications, and she was discharged on the 36th hospital day. Shortness of breath with severe aortic stenosis recurred 5 months later. Elective transcatheter aortic valve implantation was performed successfully, and the patient was discharged without complications. Sixteen months on, she is enjoying an active life without disease symptoms. (Source: Cardiovascular Intervention and Therapeutics)


TCTAP C-010 Successful Primary PCI in Acute Anterior Myocardial Infarction with Cardiogenic Shock and Thrombocytopenia
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


TCTAP C-007 Unprotected Left Main Trifurcation Treated with VV Four Stent Technic During Anterior STEMI Complicated with Cardiogenic Shock
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


TCTAP C-002 Primary Percutaneous Coronary Intervention in Acute Anterior Wall Myocardial Infarction with Cardiogenic Shock Due to Left Main Coronary Artery Thrombus
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


TCTAP C-110 PCI in Impending Cardiogenic Shock Tackling Multiple Culprit Lesions
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


TCTAP A-038 Acute Myocardial Infarction with Left Main Disease Combined with Chronic Renal Insufficiency and Cardiogenic Shock: A Double-Edge Sword
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


TCTAP C-063 Successful Management of LM STEMI Complicated with Cardiogenic Shock and Multiple Organ Failure
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)


TCTAP C-049 80 Years Old Man with Acute Coronary Syndrome and Cardiogenic Shock
(Source: Journal of the American College of Cardiology: Cardiovascular Imaging)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
CONCLUSION: In our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline. PMID: 25937358 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)


Early vascular complications after percutaneous cannulation for Extracorporeal Membrane Oxygenation for cardiac assist.
CONCLUSIONS: The majority of ischemic episodes were resolved with the insertion of a distal perfusion catheter. We didn't observe any mortal vascular complication, nor any of the observed complications was related to increased mortality. PMID: 25907578 [PubMed - as supplied by publisher] (Source: Minerva Anestesiologica)


Reperfusion Times for Radial Versus Femoral Access in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Observations From the Cardiac Care Network Provincial Primary PCI Registry [Myocardial Infarction]
Conclusions&mdash; This contemporary multicenter registry demonstrates that the time to first balloon inflation is slightly longer with radial access than with femoral access, although the 3 minute difference is unlikely to be clinically relevant. There is no difference in treatment times at hospitals that frequently use radial access for primary percutaneous coronary intervention. Short-term mortality and reinfarction rates are similar with radial and femoral access. (Source: Circulation: Cardiovascular Interventions)


Effect of Abciximab Therapy in Patients Undergoing Coronary Angioplasty for Acute ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock.
CONCLUSIONS: Patients with STEMI complicated by CS undergoing PCI treated with or without abciximab have similar 1-year survival rates; age, final TIMI 0-1 and oro-tracheal intubation are predictors of death. PMID: 25912694 [PubMed - as supplied by publisher] (Source: Circulation Journal)


Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) with pulmonary embolism in surgical patients - a case series.
CONCLUSIONS: Veno-arterial cannulation for ECLS can be feasibly achieved and should be established during active CPR for cardiac arrest. In the case of PE, the immediate diagnosis and rapid implantation of the system are decisive for therapeutic success. PMID: 25906777 [PubMed - as supplied by publisher] (Source: Perfusion)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Evolution of Temporary Percutaneous Mechanical Circulatory Support Devices: a Review of the Options and Evidence in Cardiogenic Shock
Abstract Temporary percutaneous mechanical circulatory support (MCS) devices were introduced in the 1960s and have developed into a diverse portfolio of options currently available for left, right, and biventricular support. Patients undergoing high-risk percutaneous coronary interventions (PCI), patients with acute myocardial infarction (AMI), and patients with cardiogenic shock in particular may benefit from these options. In this review, we will discuss the currently available devices and the evidence supporting their use in cardiogenic shock. (Source: Current Cardiology Reports)


Nationwide Analysis of Patients With ST-Segment-Elevation Myocardial Infarction Transferred for Primary Percutaneous Intervention: Findings From the American Heart Association Mission: Lifeline Program [Myocardial Infarction]
Conclusions&mdash; More than one third of US STEMI patients transferred for primary PCI fail to achieve first door-to-device time &le;120 minutes, despite estimated transfer times &lt;60 minutes. Delays are related to process variables, comorbidities, and lower annual PCI hospital STEMI volumes. (Source: Circulation: Cardiovascular Interventions)


Safety of Ventricular Tachycardia Ablation in Clinical Practice: Findings from 9699 Hospital Discharge Records [Original Articles]
Conclusions&mdash; VT ablation&ndash;associated AE rates in clinical practice are similar to those reported in the literature. Over time rates have increased as have the number of AE risk factors per patient. Ablations done electively and at hospitals with higher procedural volume are associated with lower incidence of AEs. (Source: Circulation: Arrhythmia and Electrophysiology)


[Venoarterial extracorporeal membrane oxygenation in an awake patient : Use of the mobile ECMO team for fulminant pulmonary embolism].
Authors: Keller D, Lotz C, Kippnich M, Adami P, Kranke P, Roewer N, Kredel M, Schimmer C, Leyh R, Muellenbach RM Abstract The current report highlights the use of venoarterial extracorporeal membrane oxygenation (va-ECMO) in a case of pulmonary embolism complicated by right ventricular failure. A 38-year-old woman was admitted to a secondary care hospital with dyspnea and systemic hypotension. Diagnostic testing revealed a massive pulmonary embolism. Thrombolytic therapy was unsuccessful necessitating thromboendarterectomy in the presence of cardiogenic shock. To allow the necessary transport of the highly unstable patient to a tertiary care center a mobile ECMO team was called in. The team immediately initiated awake va-ECMO as a bridge to therapy. Extracorporeal support subsequen...


Impairment of the Endothelial Glycocalyx in Cardiogenic Shock and its Prognostic Relevance
ABSTRACT: In cardiogenic shock (CS), pathophysiological changes include microcirculatory dysfunction, vascular leakage, and an increase in platelet and leukocyte adhesion to the endothelium, as well as endothelial activation and dysfunction. The endothelial glycocalyx has been recognized as a central modulator of these processes. Glycosaminoglycan heparan sulfate is a major component of the glycocalyx of endothelial cells, and syndecan-1 (S1) represents the most prevalent proteoglycan. The aim of the current study was to investigate circulating levels of the glycocalyx components in patients with infarct-related CS. In 184 patients with CS complicating acute myocardial infarction, blood samples were collected at admission and after one day. Intra-aortic balloon pumping was used in 94 patie...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Bypassing the Emergency Room to Reduce Door‐to‐Balloon Time and Improve Outcomes of ST Elevation Myocardial Infarction Patients: Analysis of Data from 2004–2010 ACSIS Registry
ConclusionBypassing the ER is associated with significant shortening of DBT. This reduction, however, is not associated with any change in 30‐day MACCE and 30‐day or 1‐year mortality. (Source: Journal of Interventional Cardiology)


Incidence, Management, Immediate and Long-Term Outcomes Following Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures.
CONCLUSIONS: -Iatrogenic catheter dissection of the aorta is a rare complication that carries an excellent short and long-term prognosis, adopting a conservative approach. When a coronary artery is involved as an entry point, usually it can be safely sealed with a stent with good long-term outcomes. PMID: 25888682 [PubMed - as supplied by publisher] (Source: Circulation)


Prediction of the impact of venoarterial extracorporeal membrane oxygenation on hemodynamics
In this study, we developed a framework in which we incorporated ECMO into the extended Guyton's model of circulatory equilibrium and predicted hemodynamic changes in response to ECMO. We first determined the cardiac output (CO) curves of left and right heart (to generate the integrated CO curve) without ECMO in eight normal and seven dogs with left ventricular dysfunction. Using the CO curves obtained and standard parameters for the venous return surface, we predicted the circulatory equilibrium under various levels of ECMO support. The predicted total flow (native left heart flow plus ECMO flow), right atrial pressure (PRA), and left atrial pressure (PLA) matched well with those measured [total flow: coefficient of determination (r2) = 0.99, standard error of estimate (SEE) = 5.8 ml&midd...


Discordant changes in peak O consumption and peak cardiac power during weight loaded treadmill exercise
Clinicians recognise that heart failure (HF) patients suffer from exercise intolerance to varying degrees, and those with the worst organ failure such as cardiogenic shock have the greatest limitation. Exercise duration has been shown to correlate well with cardiac pump dysfunction [1]. Nowadays, exercise intolerance is usually quantified as aerobic exercise capacity measured as peak O2 consumption (VO2max) during cardiopulmonary exercise testing (CPX) previously introduced into cardiology by Weber and colleagues as a tool to evaluate patients with HF [2]. (Source: International Journal of Cardiology)


Immediate coronary artery bypass graft surgery for acute coronary syndrome – Outcomes and trends over the past eight years
Conclusions The analysis of our patient file shows a decreasing trend in the number of patients undergoing emergency surgery due to ACS in our centre in the course of the last eight years. Between 2010 and 2013, the proportional representation of patients undergoing surgery due to UA decreased, while the percentage of patients undergoing surgery due to AMI and CS increased. Within the population of patients with ACS, we were also able to determine an increased frequency of some risk factors and increased thirty-day mortality among patients undergoing surgery. (Source: Cor et Vasa)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cardiotoxicity of yew
Publication date: Available online 23 December 2014 Source:Cor et Vasa Author(s): Ondřej Piskač , Jan Stříbrný , Hana Rakovcová , Martin Malý The Common Yew (Taxus baccata) is an ornamental tree. The taxine alkaloids contained in yew berries, needles or bark are poisonous. The lethal dose for an adult is reported to be 50g of yew needles. Patients who ingest a lethal dose frequently die due to cardiogenic shock, in spite of resuscitation efforts. Although no specific therapy exists, in some patients the asystole phase can be overcome by instituting extracorporeal membrane oxygen therapy (ECMO). Therapeutic procedures reported in the literature are only referred to in published case reports and it is not self-evident whether they have been effective or whether the patient had inges...


Extracorporeal Membrane Oxygenation Support in Postcardiotomy Elderly Patients: The Mayo Clinic Experience
Conclusions Postcardiotomy ECMO support in elderly patients is associated with high postoperative morbidity and mortality. Nevertheless, it often provides the last line of therapy for these critically ill patients and may provide positive outcomes in selected subgroups. (Source: The Annals of Thoracic Surgery)


Impact of a pharmacoinvasive strategy when delays to primary PCI are prolonged
Conclusions As P-RD increased, PI outcomes became superior to P-PCI when P-RD is prolonged and exceeds guideline-mandated times. In such circumstances, a PI strategy may provide an alternative reperfusion option. Adverse time delays for delivery of P-PCI should be considered when evaluating reperfusion strategies. Trial registration number NCT00623623. (Source: Heart)


Heart block or cardiac arrest is not a contraindication for intravenous treatment with diltiazem in the setting of coronary spasm
We report a 54-year-old male who had a complete atrioventricular block with ST-segment elevation and a witnessed cardiac arrest with ventricular tachycardia/ventricular fibrillation, which could not be controlled effectively by defibrillations and positive inotropic action drugs. (Source: The American Journal of Emergency Medicine)


Catheter-Based VAD an Option for Cardiogenic Shock
(MedPage Today) -- Multi-society consensus statement also calls for national registries. (Source: MedPage Today Cardiovascular)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Understanding cardiogenic shock
(Source: European Journal of Heart Failure)


Phenotypic spectrum and management of 25 patients ATTR Val122Ile (P5.073)
CONCLUSIONS: Diagnosis of ATTR amyloidosis should be suspected in patients with late onset severe hypertrophic cardiomyopathy. Val122Ile mutation can also be found in Caucasian individual. A mild to severe small and large fiber sensory and autonomic neuropathy is frequently associated as well as carpal tunnel syndrome. Tafamidis oral treatment or combined liver and heart transplant are current therapeutic options in these patients. Prognosis ATTR-Val122Ile is linked to the prominent cardiac amyloidosis. Early diagnosis is desirable. Study Supported by:Disclosure: Dr. Salhi has nothing to disclose. Dr. Lefaucheur has nothing to disclose. Dr. Gorram has nothing to disclose. Dr. Rappeneau has nothing to disclose. Dr. Funalot has nothing to disclose. Dr. Fanen has nothing to disclose. Dr. Cost...


Takotsubo Cardiomyopathy Due To Status Epilepticus - An Underreported and Lethal Sequela (P5.081)
CONCLUSIONS:TCS is a rare and lethal adverse effect of seizures that warrants heightened vigilance for close cardiac monitoring. Study Supported by:Disclosure: Dr. Khan has nothing to disclose. Dr. Mirchandani has nothing to disclose. Dr. Pushchinska has nothing to disclose. (Source: Neurology)


Acute ischemic stroke in acute myocardial infarction patients receiving IV rt-PA: An analysis of Thrombolysis in Myocardial Infarction (TIMI) II trial (P6.228)
Conclusions: Ischemic stroke in the immediate period following IV rt-PA for MI is rare but associated with very high rates of intracranial hemorrhage and in hospital mortality.Disclosure: Dr. Jahangir has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Qureshi has nothing to disclose. (Source: Neurology)


2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (Endorsed by the American heart assocation, the cardiological society of India, and sociedad latino Americana de cardiologia intervencion; Affirmation of value by the canadian association of interventional cardiology–association canadienne de cardiologie d'intervention)
Although historically the intra‐aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high‐risk percutaneous coronary intervention, those presenting with cardiogenic sh...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Risk factors for transient dysfunction of gas exchange after cardiac surgery
Conclusion: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures. Objetivo: Estudo de coorte retrospectivo com objetivo de verificar a presença de disfunção transitória da troca gasosa no pós-operatório de cirurgia car...


Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: Design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial
Publication date: April 2015 Source:American Heart Journal, Volume 169, Issue 4 Author(s): Holger Thiele , Gerhard Schuler , Franz-Josef Neumann , Jörg Hausleiter , Hans-Georg Olbrich , Bettina Schwarz , Marcus Hennersdorf , Klaus Empen , Georg Fuernau , Steffen Desch , Suzanne de Waha , Ingo Eitel , Rainer Hambrecht , Michael Böhm , Volkhard Kurowski , Bernward Lauer , Hans-Heinrich Minden , Hans-Reiner Figulla , Rüdiger C. Braun-Dullaeus , Ruth H. Strasser , Kristin Rochor , Sebastian K.G. Maier , Helge Möllmann , Steffen Schneider , Henning Ebelt , Karl Werdan , Uwe Zeymer (Source: American Heart Journal)


Reduced Dose Tenecteplase and Outcomes in Elderly ST-segment Elevation Myocardial Infarction Patients: Insights from the STrategic Reperfusion Early after Myocardial Infarction (STREAM) Trial
Conclusions Our data, from a modest sized population of elderly STEMI patients, indicates that half-dose TNK reduces the likelihood of ICH without compromising reperfusion efficacy. These observations are hypothesis generating and warrant further confirmation in randomized clinical trials in the elderly. (Source: American Heart Journal)


Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock.
CONCLUSIONS: Available evidence suggests that IABP may have a beneficial effect on some haemodynamic parameters. However, this did not result in survival benefits so there is no convincing randomised data to support the use of IABP in infarct-related cardiogenic shock. PMID: 25812932 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)


Pharmacologic approaches to weaning from cardiopulmonary bypass and extracorporeal membrane oxygenation
This article focuses on the proper diagnosis of the underlying pathophysiology, an understanding of the pharmacology of available agents, and a rational approach to the management of patients weaning from CPB and ECMO. (Source: Best Practice and Research Clinical Anaesthesiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


ECMO as a Bridge-to-Transplant in Patients With Cardiogenic Shock
The role of short-term circulatory support as a bridge-to transplant remains controversial. We sought to evaluate the outcome of patients with cardiogenic shock who were bridged to transplant using ECMO. (Source: The Journal of Heart and Lung Transplantation)


Extracorporeal Membrane Oxygenation Is an Effective Bridge Strategy to Rescue Cardiovascular Collapse for Subsequent Transplant, Ventricular Assist Device, or Recovery
For patients with severe cardiogenic shock limited options exist. Extracorporeal membrane oxygenation (ECMO) is utilized for patients with cardiovascular collapse as a bridge for either end-organ recovery and subsequent definitive therapy or recovery. We hypothesize that ECMO is an effective bridge strategy for subsequent transplant, ventricular assist device (VAD), or recovery. (Source: The Journal of Heart and Lung Transplantation)


CentriMag Short Term Ventricular Assist Device as a Bridge to Decision in Critical Cardiogenic Shock (INTERMACS 1) - The Manchester Experience
The CentriMag ventricular assist device (VAD) is a magnetically levitated rotary pump designed for temporary extracorporeal support. Aim of our study is to investigate the results of Centrimag short term support in patients presenting with critical cardiogenic shock (INTERMACS Level 1) as a bridge to decision. (Source: The Journal of Heart and Lung Transplantation)


Medium-Term Circulatory Support for Cardiogenic Shock in a Developing Country: Do We Need a Long-Term Device?
Bridge-to-transplant long-term devices are commonly not affordable for our health system and usually they are not suitable for critically ill patients. Centrimag® may be an alternative for a one-step bridge-to-transplant surgical procedure. (Source: The Journal of Heart and Lung Transplantation)


High Mortality With Acute Kidney Injury After Mechanical Support for Cardiogenic Shock
This study examines the attributes of renal injury and its association with outcomes in MCS therapy for CS. (Source: The Journal of Heart and Lung Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Impella 5.0: Effective Short-Term Support in Acute Refractory Cardiogenic Shock of Various Etiologies
Impella 5.0 is a microaxial left ventricle assist device (LVAD). Impella has been used for short-term mechanical circulatory support in a variety of low cardiac output states. (Source: The Journal of Heart and Lung Transplantation)


Choice of Initial Device Implant for INTERMACS Profiles 1 and 2 Patients in Cardiogenic Shock Determines Survival to Transplant or Recovery
Implant of durable devices in patients with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles 1 and 2 is associated with poor outcomes. It is not known if initial implant of durable devices remains the best option for patients (pts) in these profiles. (Source: The Journal of Heart and Lung Transplantation)


The Impact of Acute Kidney Injury in Patients With Postcardiotomy Cardiogenic Shock Requiring Mechanical Circulatory Support
This study aims to demonstrate the impact of acute kidney injury (AKI) on the outcomes of patients with PCS. (Source: The Journal of Heart and Lung Transplantation)


MELD XI Successfully Predicts Thirty Day Mortality in Patients Who Received Centrimag VAD for Acute Decompensated Heart Failure
The composite Model for End-Stage Liver Disease excluding INR (MELD-Xi) has previously been used to prognosticate outcomes of patients in advanced heart failure, on long-term ventricular assist devices and post-heart transplantation. We calculated the MELD-Xi score in patients immediately prior to receiving a rescue ventricular assist device with a continuous-flow short-term ventricular assist device (ST-VAD) for cardiogenic shock due to acute decompensated heart failure (ADHF) and evaluated its relationship to 30-day mortality. (Source: The Journal of Heart and Lung Transplantation)


Extracorporeal Membrane Oxygenation Support in Refractory Cardiogenic Shock: Outcome, Treatment Strategies and Analysis of Risk Factors
The RotaFlow and Levitronix CentriMag veno-arterial extracorporeal membrane oxygenation (ECMO) support systems have been investigated as treatment strategies for refractory cardiogenic shock (CS). (Source: The Journal of Heart and Lung Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Use of Extra-Corporeal Membrane Oxygenation in Patients Listed for Heart Transplantation
Extra-corporeal membrane oxygenation (ECMO) is used as rescue therapy for patients with cardiogenic shock. Its use in end-stage heart failure patients requiring heart transplant is less commonly reported. We aim to use United Network of Organ Sharing (UNOS) database to report and compare outcomes of patients supported with ECMO. (Source: The Journal of Heart and Lung Transplantation)


Mid-Term Outcome of Acute Fulminant Myocarditis Presenting With Cardiogenic Shock: A Single Centre Experience
We describe survival and changes in left ventricular ejection fraction (LVEF) in a single center retrospective series of FM. (Source: The Journal of Heart and Lung Transplantation)


Survival Benefit of Heart Transplantation in Patients on Veno-Arterial Extra-Corporeal Membrane Oxygenation: Results From a French National Cohort
This study aimed to determine whether or not transplantation is beneficial for patients on ECMO at registration. (Source: The Journal of Heart and Lung Transplantation)


Outcomes of Patients Receiving Temporary Circulatory Support Prior to Durable LVAD
Temporary circulatory support (TCS) is used to stabilize patients in critical cardiogenic shock and is used as a bridge to-LVAD strategy. The TCS modifier can be added to patients categorized as INTERMACS Profiles 1-3. It is unknown if TCS improves mortality for those in shock beyond published INTERMACS 1 estimates. (Source: The Journal of Heart and Lung Transplantation)


Update on Temporary Mechanical Circulatory Support for Right Ventricular Failure
This study describes our clinical experience with temporary RV MCS in patients following post-cardiotomy cardiogenic shock (PCCS), cardiac transplant (CTx), or left ventricular assist device (LVAD) placement. (Source: The Journal of Heart and Lung Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Outcome of the Impella Device for Mechanical Circulatory Support in Patients With Refractory Cardiogenic Shock
We report the outcome of the Impella device for acute circulatory support in cardiogenic shock from a large-volume single institution. (Source: The Journal of Heart and Lung Transplantation)


Early Crossover From Extracorporeal Membrane Oxygenation to More Durable Mechanical Circulatory Support Improves Survival
Veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock and/or cardiac arrest is associated with significant morbidity and is not durable. The appropriate timing to crossover from ECMO to more durable mechanical circulatory support (MCS) as a bridge to transplant or recovery is not known. (Source: The Journal of Heart and Lung Transplantation)


Functional Outcomes and Quality of Life in Heart Transplant Patients Requiring Extracorporeal Membrane Oxygenation
This study aimed to describe early physical function, health-related quality of life (HRQOL) and lower limb complications in patients that received ECMO either pre or post HTx. (Source: The Journal of Heart and Lung Transplantation)


Low Cardiac Power Index (CPI) Is Associated With Higher Mortality in Cardiogenic Shock: Stratifying INTERMACS 1 and 2 Patients Undergoing Continuous-Flow LVAD (CF-LVAD) Implantation
Cardiac power output has been demonstrated to be an important hemodynamic predictor of mortality in patients with cardiogenic shock. INTERMACS 1 and 2 profiles reflect cardiogenic shock or impending cardiogenic shock, but these profiles are sometimes subjective. The purpose of this study was to evaluate the prognostic role of CPI in INTERMACS 1 and 2 patients undergoing CF-LVAD. (Source: The Journal of Heart and Lung Transplantation)


Ventricular Assist Device in Acute Myocardial Infarction-Findings From INTERMACS
Patients with acute myocardial infarction (AMI) complicated by acute heart failure or cardiogenic shock have high mortality with conventional management. The purpose of this study was to evaluate outcomes with long-term mechanical circulatory support in this population. (Source: The Journal of Heart and Lung Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Combined etiology of anaphylactic cardiogenic shock: Amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome.
Authors: Kounis NG, Soufras GD, Davlouros P, Tsigkas G, Hahalis G Abstract Anaphylactic shock is a life-threatening condition which needs detailed and mediculous clinical assessment and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone which is an iodine-containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial involvement due to vasospasm-induced coronary blood flow reduction m...


Periprocedural myocardial infarction resulting in a ventricular septal defect.
We present a patient with a postinfarction ventricular septal defect, with cardiogenic shock, that developed 7 days after a percutaneous coronary intervention. Emergency surgical repair combined with coronary artery bypass grafting saved the patient, without complications. PMID: 25841858 [PubMed - in process] (Source: The Annals of Thoracic Surgery)


Pharmacologic approaches to weaning from cardiopulmonary bypass and extracorporeal membrane oxygenation
Cardiopulmonary bypass (CBP) and extracorporeal membrane oxygenation (ECMO) are two modalities of mechanical circulatory support. They provide hemodynamic stability for patients undergoing invasive cardiothoracic interventions and can be life-saving in emergencies resulting from cardiogenic shock or respiratory failure. Unlike implantable ventricular assist devices, CPB and ECMO are short-term solutions meant to last from hours to days, and the patient will need to be weaned from the mechanical support once the intervention has completed or when the underlying condition has improved. (Source: Best Practice and Research. Clinical Anaesthesiology)


High-Risk Medical Devices Why Do We Not Better Understand Effectiveness and Safety?
The intra-aortic balloon pump (IABP), a mechanical device designed to increase both myocardial perfusion and cardiac output, was pioneered in the 1960s to treat patients in cardiogenic shock. An innovation at the time, the device was made available for use prior to passage of the 1976 Medical Device Amendments, which gave the US Food and Drug Administration (FDA) authority to require evidence of effectiveness and safety for high-risk medical devices before granting market clearance. It is likely that no clinical data were submitted for FDA review prior to market clearance of the IABP. More than 70 000 IABPs are inserted annually in the United States for a broad array of indications including acute coronary syndromes, cardiac surgery, complications of heart failure, and cardiogenic shock....


Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction A Meta-analysis
ImportanceIntra-aortic balloon pump (IABP) therapy is a widely used intervention for acute myocardial infarction with cardiogenic shock. Guidelines, which previously strongly recommended it, have recently undergone substantial change.ObjectiveTo assess IABP efficacy in acute myocardial infarction.Data SourcesHuman studies found in Pubmed, Embase, and Cochrane libraries through December 2014 and in reference lists of selected articles. Search strings were “myocardial infarction” or “acute coronary syndrome” and “intra-aortic balloon pump” or “counterpulsation.”Study SelectionRandomized clinical trials (RCTs) and observational studies comparing use of IABP with no IABP in patients with acute myocardial infarction.Data Extraction and SynthesisTwo reviewers independently extrac...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Off-Hour Admission and Outcomes for Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Interventions
Previous research has demonstrated that patients with acute myocardial infarction (AMI) admitted to the hospital during off hours (weekends or nights) have higher in-hospital, 30-day, and 1-year mortality. While these studies have identified mortality differences in patients treated during off hours, limited data are available on mortality outcomes adjusted for important clinical variables, such as cardiogenic shock. Additionally, the information on complications or readmission rates for AMI patients treated during off hours is limited. (Source: The Journal of Emergency Medicine)


[Use of ECMO in adult patients with cardiogenic shock: a position paper of the Austrian Society of Cardiology.]
Authors: Pichler P, Antretter H, Dünser M, Eschertzhuber S, Gottardi R, Heinz G, Pölzl G, Pretsch I, Rajek A, Wasler A, Zimpfer D, Geppert A Abstract The use of ECMO to stabilize critically ill patients with severely depressed cardiac function and hemodynamics increased in the last years due to broader availability, better performance and easier implantation of the devices. The present guidelines of the Austrian Society of Cardiology focus on the use of ECMO in adult non-operated patients with cardiac diseases. Not only indications and contraindications are highlighted, but also the equally important issues of monitoring, complication management, measures during implantation and operation, and weaning of the devices are treated in detail. Thereby the present guidelines aim to opt...


Case report of Tako-Tsubo cardiomyopathy associated with repetitive anaesthesia in a female patient with Tako-Tsubo cardiomyopathy
Conclusions: TTC may initially present in the perioperative period with pulmonary oedema, electrocardiographic (ECG) changes, elevation of cardiac enzymes, and cardiogenic shock or cardiac arrest.Since the risk of recurrence is considered to be low in TTC, this case report is of high interest. In each procedure similar clinical signs were found which resulted in severe haemodynamic derangements in every manifestation and cardiac arrest in two of the manifestations. Despite cardiopulmonary resuscitation twice, the patient survived without any neurological deficiency. (Source: BMC Anesthesiology)


Acute peripartum cardiomyopathy rapidly evolving in cardiogenic shock
Peripartum cardiomyopathy (PPCM) is a rare disease, which affects women in the last month of their pregnancy or in the early puerperium without any identifiable cause of heart failure. (Source: International Journal of Cardiology)


[Hypereosinophilic syndrome with cardiogenic shock: First Mexican case].
Authors: Anguiano-Alvarez VM, Troyo-Barriga P, de la Peña R, García-Graullera M, Gutiérrez-Romero A PMID: 25818035 [PubMed - as supplied by publisher] (Source: Archivos de Cardiologia de Mexico)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry
Conclusions The use of thrombectomy in patients with STEMI is heterogenous between hospitals. Overall, there was no impact of thrombectomy on TIMI 3 patency or mortality after PCI. In the subgroup of STEMI patients with TIMI 0 flow before PCI individualized thrombectomy had a positive impact on restoration of normal blood flow. (Source: Clinical Research in Cardiology)


Prevalence and Prognosis of Percutaneous Coronary Intervention-associated Nephropathy in Patients With Acute Coronary Syndrome and Normal Kidney Function
Conclusions Percutaneous coronary intervention-associated nephropathy in patients with acute coronary syndrome and normal preexisting renal function is not uncommon and influences long-term survival. (Source: Revista Espanola de Cardiologia)


Effect of Coronary Thrombectomy in Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction
Optimal coronary reflow is the critical key issue to ameliorate clinical outcomes in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (Shock-STEMI). We investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural coronary thrombectomy may provide clinical advantages to attempt optimal coronary reflow in patients with Shock-STEMI. Of 7,650 patients with acute myocardial infarction registered in the Tokyo CCU Network Council between January 2009 and December 2011, a total of 180 consecutive patients (144 male, 68 ± 13 years) with Shock-STEMI who showed pre-PCI procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 (absent initial coronary flow) were recruited. (Source: The American Journal of Cardiology)


Hospital Length of Stay and Clinical Outcomes in Older STEMI Patients After Primary PCI A Report From the National Cardiovascular Data Registry
ConclusionsPatients discharged as early as 48 h after PPCI have outcomes similar to patients who stay in the hospital for 4 to 5 days. Early, but not very early ( (Source: Journal of the American College of Cardiology)


[Aortic infective endocarditis: Value of surgery. About 48 cases].
CONCLUSION: The prognosis of infective endocarditis of the aortic valve is severe due to the fast progression to heart failure. Early medical and surgical approach provides good results on morbidity and mortality in the short- and mid-terms. PMID: 25813653 [PubMed - as supplied by publisher] (Source: Annales de Cardiologie et d'Angeiologie)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


&ldquo;Reverse McConnell&rsquo;s Sign&rdquo;: Interpreting Interventricular Hemodynamic Dependency and Guiding the Management of Acute Heart Failure during Takotsubo Cardiomyopathy
Although most patients with Takotsubo cardiomyopathy (TTC) have benign clinical course and prognosis, TTC can induce acute heart failure and hemodynamic instability. TTC mimics the clinical features of acute anterior wall myocardial infarction (AMI). Bedside clinicians often have a diagnostic dilemma when cardiac catheterization and angiography are either contraindicated or can cause potential adverse consequences. Misdiagnosing TTC as AMI will lead to initiation of harmful pharmacological or device-based treatment, which worsens hemodynamic compromise. Therefore, understanding and interpreting the unique pathophysiological and hemodynamic features of TTC in a better manner becomes crucial to guide effective clinical management of acute heart failure/cardiogenic shock during TTC. We review...


The successful treatment of cardiogenic shock with primary percutaneous coronary intervention (T-stenting) of total occluded unprotected left main performed during cardiopulmonary resuscitation.
Authors: Lewicki Ł, Jaguszewski M, Masiewicz E, Targoński R, Rynkiewicz A PMID: 25791970 [PubMed - in process] (Source: Polish Heart Journal)


Proposed case of mesalazine-induced cardiomyopathy in severe ulcerative colitis.
This report aims to highlight this serious but rare adverse reaction. We report here a case of a young man presenting with cardiogenic shock in the context of recent mesalazine treatment in severe ulcerative colitis. PMID: 25805947 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)


Positive predictive value of International Classification of Diseases, 10th revision diagnosis codes for cardiogenic, hypovolemic, and septic shock in the Danish National Patient Registry
Conclusions: Overall, we found a moderately high PPV for shock in the DNPR. The PPV was highest for cardiogenic shock but lower for hypovolemic and septic shock. Combination diagnoses of shock with codes for inotropic/vasopressor therapy further increased the PPV of shock overall, and for cardiogenic and septic shock diagnoses. (Source: BMC Medical Research Methodology)


Positive predictive value of International Classification of Diseases, 10th revision, diagnosis codes for cardiogenic, hypovolemic, and septic shock in the Danish National Patient Registry
Conclusions: Overall, we found a moderately high PPV for shock in the DNPR. The PPV was highest for cardiogenic shock but lower for hypovolemic and septic shock. Combination diagnoses of shock with codes for inotropic/vasopressor therapy further increased the PPV of shock overall, and for cardiogenic and septic shock diagnoses. (Source: BMC Medical Research Methodology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Acute phase treatment of venous thromboembolism: advanced therapy. Systemic fibrinolysis and pharmacomechanical therapy.
Authors: Konstantinides SV, Wärntges S Abstract Venous thromboembolism, which encompasses deep-vein thrombosis and acute pulmonary embolism (PE), represents a major contributor to global disease burden worldwide. For patients who present with cardiogenic shock or persistent hypotension (acute high-risk PE), there is consensus that immediate reperfusion treatment applying systemic fibrinolysis or, in the case of a high bleeding risk, surgical or catheter-directed techniques, is indicated. On the other hand, for the large, heterogeneous group of patients presenting without overt haemodynamic instability, the indications for advanced therapy are less clear. The recently updated guidelines of the European Society of Cardiology emphasise the importance of clinical prediction rules in c...


Con: Prophylactic Preoperative Use of an Intra-aortic Balloon Pump Is Not Indicated in High-Risk Coronary Patients Undergoing Coronary Artery Bypass Grafting
THE PRIMARY EFFECT of the intra-aortic balloon pump (IABP) is to optimize the precarious balance between myocardial oxygen supply and demand, a vital component of the management of patients with coronary artery disease. Myocardial oxygen supply is improved through an enhancement of diastolic coronary blood flow and subendocardial perfusion, while a reduction in left ventricular afterload reduces oxygen demand. Whereas use of the IABP as a therapeutic intervention in patients with ongoing acute coronary syndromes and cardiogenic shock is of physiologic benefit, the prophylactic preoperative application of the IABP for high-risk hemodynamically stable patients undergoing coronary artery bypass surgery lacks a consensus. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Pro: Prophylactic Preoperative Use of an Intra-aortic Balloon Pump Is Indicated in High-Risk Coronary Patients Undergoing Coronary Artery Bypass Grafting
THE INTRA-AORTIC BALLOON PUMP (IABP) has evolved as a means of providing mechanical circulatory support in patients with coronary artery disease that has progressed into cardiogenic shock. Using a counter-inflation mechanism, balloon inflation in early diastole augments coronary perfusion pressure, and its deflation at end diastole decreases left ventricular afterload, thus increasing cardiac output at a lower oxygen debt. The prophylactic use of a preoperative IABP in patients with cardiogenic shock undergoing surgical coronary revascularization has been a matter of debate, with some studies showing a benefit,1 others showing no benefit,2 and still others demonstrating harm with its use. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Association Between Public Reporting of Outcomes With Procedural Management and Mortality for Patients With Acute Myocardial Infarction
ConclusionsPublic reporting is associated with reduced percutaneous revascularization and increased in-hospital mortality among patients with AMI, particularly among patients not selected for PCI. (Source: Journal of the American College of Cardiology)


Septic Shock Sera Containing Circulating Histones Induce Dendritic Cell–Regulated Necrosis in Fatal Septic Shock Patients
Conclusions: The study demonstrates a differential mechanism of dendritic cell death in patients with septic shock that is dependent on the severity of the disease. (Source: Critical Care Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Myocarditis causing severe heart failure - an unusual early manifestation of leptospirosis: a case report
Conclusions: We describe a rare and unusual early complication of leptospirosis which has not been reported before. It is important to bear in mind that leptospirosis could present as myocarditis during the early phase of illness. (Source: BMC Research Notes)


Biventricular failure with low pulmonary vascular resistance was managed by left ventricular assist device alone without right-sided mechanical support
Abstract How to manage preoperative right ventricular dysfunction (RVD) in heart failure patients without cardiogenic shock remains as a matter to be debated because implantable biventricular assist device treatment has not been established thus far. We here presented a patient with significant RVD indicated by low RV stroke work index (0.3 g/m) and RV dilatation as well as low pulmonary vascular resistance (PVR, 0.8 Wood Unit), who was managed by the introduction of pimobendan and sildenafil after the implantation of DuraHeart and tricuspid annuloplasty without right VAD, although his New York Heart Association symptom remained class III. Preoperative low PVR may be a key for successful LVAD treatment alone without right VAD in patients with INTERMACS profile 3 suffering RVD. (S...


OP-010 Does Intra Aortic Balloon Pump Implantation Influence Survival after Angioplasty of Left Main Coronary Artery in Patients Presented in Cardiogenic Shock
Patients with cardiogenic shock and left main coronary artery stenosis have an extremely high mortality rate. Sparse evidence for benefit of intra aortic balloon pump implantation (IABP) is present. Our purpose was to establish the possible positive long-term benefit of IABP implantation for patients who underwent emergent angioplasty of left main coronary artery stenosis presented with cardiogenic shock. (Source: The American Journal of Cardiology)


PP-014 Emergency Coronary Artery Bypass Graft Surgery (CABG) Following Complicated Primary Percutaneous Coronary Intervention in a Patient Who Survived Cardiac Arrest
We reported a case of primary percutaneous intervention (PCI) of occluded proximal left anterior descending artery(LAD) complicated with distal embolization to left circumflex artery(LCX) followed by cardiogenic shock associated with incessant ventricular fibrillation and subsequent coronary artery bypass grafting(CABG). (Source: The American Journal of Cardiology)


PP-073 Suspected Diagnosis: Pulmoner Embolism
We presented a case of acute Pulmonary embolism with Right Heart Trombus and hemodynamic instability, and successfully treated with systemic thrombolysis. (Source: The American Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis.
Conclusions: TAVR should be considered a reasonable rescue therapy in patients with cardiogenic shock secondary to decompensated aortic stenosis. PMID: 25751886 [PubMed - as supplied by publisher] (Source: EuroIntervention)


Stroke volume variation compared with pulse pressure variation and cardiac index changes for prediction of fluid responsiveness in mechanically ventilated patients
Conclusions Baseline stroke volume variation ⩾8.15% predicted fluid responsiveness in mechanically ventilated patients with acute circulatory failure. The study also confirmed the ability of pulse pressure variation to predict fluid responsiveness. (Source: The Egyptian Journal of Critical Care Medicine)


17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden
Cardiogenic shock remains the leading cause of in hospital death in acute myocardial infarction (AMI) and is associated with a mortality rate of approximately 50%. Here we investigated the 17-year trends in incidence and prognosis of AMI-induced cardiogenic shock in Västra Götaland in western Sweden, an area with approximately 1.6 million inhabitants. The study period includes the transition from thrombolysis to primary percutaneous coronary intervention (PCI) as the region-wide therapy of choice for patients with ST-elevation myocardial infarction (STEMI). (Source: International Journal of Cardiology)


Refractory cardiogenic shock in a patient with β‐thalassemia major requiring mechanical circulatory support: Case report and literature review
We describe our experience, and challenges faced, in a pediatric patient with iron overload cardiomyopathy secondary to β‐thalassemia major, requiring biventricular MCS. (Source: Pediatric Transplantation)


Impact of initial 24-hour urine output on short-term outcomes in patients with ST-segment elevation myocardial infarction admitted without cardiogenic shock and renal dysfunction
Our study aims to evaluate the prognostic value of initial 24-hour urine output (UO) in patients with ST-segment elevation myocardial infarction (STEMI) admitted without cardiogenic shock and renal dysfunction, and to determine the additional risk stratification offered by adding initial 24-hour UO to TIMI risk score (TRS). (Source: Atherosclerosis)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cardiogenic shock due to Gemella morbillorum native mitral valve endocarditis
Key Clinical Message Gemella morbillorum is a rare cause of infective endocarditis. Consequently, little is known about the natural course of endocarditis secondary to this pathogen. Herein, we report a case of cardiogenic shock as a complication of acute mitral valve regurgitation following Gemella morbillorum native valve endocarditis. Gemella morbillorum is a rare cause of infective endocarditis. Consequently, little is known about the natural course of endocarditis secondary to this pathogen. Herein, we report a case of cardiogenic shock as a complication of acute mitral valve regurgitation following Gemella morbillorum native valve endocarditis. (Source: Clinical Case Reports)


Impact of initial 24-h urine output on short-term outcomes in patients with ST-segment elevation myocardial infarction admitted without cardiogenic shock and renal dysfunction
Our study aims to evaluate the prognostic value of initial 24-h urine output (UO) in patients with ST-segment elevation myocardial infarction (STEMI) admitted without cardiogenic shock and renal dysfunction, and to determine the additional risk stratification offered by adding initial 24-h UO to TIMI risk score (TRS). (Source: Atherosclerosis)


Short-Term Mechanical Circulatory Support The Problem of the Uninsured
We read with interest the recent report by Stretch et al. (1) regarding the increase in the use of short-term mechanical circulatory support (MCS) in the United States. The investigators demonstrated that the increased use of MCS has occurred together with improved in-hospital survival and decreased hospital costs. Both aspects will need to demonstrate favorable trends for MCS to continue to gain widespread acceptance for the treatment of cardiogenic shock. The financial implication of short-term MCS is the topic we would like to discuss further. (Source: Journal of the American College of Cardiology)


Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism
Conclusion A standardized catheter intervention approach using fixed low-dose USAT for the treatment of intermediate- and high-risk PE was associated with rapid improvement in haemodynamic parameters and low rates of bleeding complications and mortality. (Source: European Heart Journal)


Electrocardiographic Findings in Patients with Pulmonary Embolism
We have read the recently published article entitled “Electrocardiographic abnormalities in patients with acute pulmonary embolism(APE) complicated by cardiogenic shock(CS)” by Kukla and coworkers(1). In that very well-designed and presented study by Kukla and coworkers tried to compare electrocardiography (ECG) parameters in patients with APE presenting with or without CS. They have concluded that in patients with APE, low QRS voltage, RBBB, and ST-segment elevation in lead V1 were associated with CS. (Source: The American Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Sequential management of post-myocardial infarction ventricular septal defects.
CONCLUSION: Vigorous pursuit of closure of post-myocardial infarction VSD with a sequential surgical and/or percutaneous approach is recommended for improved outcomes. PMID: 25754906 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)


A quick bailout ongoing of cardiogenic shock and iatrogenic dissection of left main coronary artery
Acute occlusion of the left main coronary artery (LMCA) is a catastrophic clinical circumstance rarely observed, as most patients die before seeking medical attention. It manifests as an acute myocardial infarction (AMI) with cardiogenic shock (CS), usually known as left main shock syndrome [1,2]. Left main shock syndrome is undoubtedly the nightmare of every cardiologist because it carries a high rate of mortality despite when appropriate treatment is administered [3,4]. The etiology of left main shock syndrome can be generally classified as spontaneous or iatrogenic, both related to thrombosis or dissection of LMCA. (Source: International Journal of Cardiology)


Cardiogenic shock: how to overcome a clinical dilemma. Unmet needs in Emergency Medicine
Critical cardiogenic shock patients experience an ominous prognosis [1]. In spite of the multiple pharmacological chances, the in-hospital mortality rate is still very high (around 60% of patients) [2]. The poorest results are achieved in patients with refractory cardiogenic shock, who are currently graded as Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) Level I or ‘crash and burn’ patients [3]. However, although the worst clinical outcome, according to the downshifting risk concept [4], these patients have the most to gain in terms of absolute benefits throughout a rapid escalation of all available therapy, both pharmacological and mechanical. (Source: International Journal of Cardiology)


Outcome of patients admitted with acute coronary syndrome on palliative treatment: insights from the nationwide AMIS Plus Registry 1997-2014
Conclusions Patients with ACS treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. While refraining from more active therapy may often constitute the most humane and appropriate approach, we think it is important to also evaluate these patients and include them in registries and outcome evaluations. Clinical trial number ClinicalTrials.gov Identifier: NCT01&nbsp;305&nbsp;785. (Source: BMJ Open)


Severity of End-Organ Damage as a Predictor of Outcomes After Implantation of Left Ventricular Assist Device
The optimal timing of left ventricular assist device (LVAD) implantation in the management of advanced heart failure remains controversial. We hypothesize that in patients with cardiogenic shock, the severity of end-organ dysfunction as determined by the sequential organ failure assessment (SOFA) score is a determinant of outcomes after LVAD implantation. We determined the preoperative SOFA score and short- and long-term outcomes of 97 consecutive patients who received HeartMate II or HeartWare LVAD at our institution since January 2007. Kaplan-Meier analysis was used to compare long-term survival across SOFA score subgroups. The overall 30 day mortality was 10.1%, with no significant difference among SOFA score subgroups. Patients with scores ≥9 had significantly longer hospital stay (2...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Effectiveness of Protocol Guided Heparin Anticoagulation in Patients with the TandemHeart Percutaneous Ventricular Assist Device
The purpose of this analysis is to assess the effectiveness of heparin anticoagulation in cardiogenic shock patients with TandemHeart percutaneous ventricular assist device support for which the institution’s TandemHeart heparin protocol was implemented compared to those managed without protocol. This retrospective analysis included 15 patients in the protocol group and 10 patients in the nonprotocol group. Patients in the protocol group had a higher percentage of therapeutic activated partial thromboplastin time (aPTT) and lower percentage of supra-therapeutic aPTT values compared to the nonprotocol group. We conclude that TandemHeart anticoagulation may be more effectively managed through the use of a protocol than without any protocol. (Source: ASAIO Journal)


Special issue: nursing home nurses conceptualize how to care for residents with cardiac vulnerability
Conclusions and relevance to clinical practiceWe found that nurses conceptualized critical nursing care for cardiac problems at nursing homes, which are different from those of general hospitals. The results of this study will provide basis for the development of care guidelines and educational materials that can be used by novice nurses or nursing students. (Source: Nursing in Critical Care)


Clinical picture and risk prediction of short‐term mortality in cardiogenic shock
ConclusionAlthough most commonly due to ACS, other causes account for one‐fifth of cases with shock. ACS is independently associated with in‐hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short‐term mortality. It might facilitate early decision‐making in intensive care or guide patient selection in clinical trials. Trial registrationNCT01374867. (Source: European Journal of Heart Failure)


The Role of Percutaneous Haemodynamic Support in High-risk Percutaneous Coronary Intervention and Cardiogenic Shock
The main goal of mechanical cardiac assistance is to provide haemodynamic support in case of an endangered coronary or systemic circulation by increasing or maintaining coronary and systemic blood flow. In addition to haemodynamic support, mechanical cardiac assistance may also provide myocardial protection by unloading the ventricle. The experience with percutaneous mechanical support devices is mainly gathered in patients with cardiogenic shock (CS) or during high-risk percutaneous coronary intervention (PCI). (Source: Radcliffe Cardiology)


Extracorporeal life support in cardiogenic shock: impact of acute versus chronic etiology on outcome
Our analysis of 64 ECLS as treatment for primary cardiogenic shock demonstrates that in decompensated “chronic” heart-failure ECLS represents a bridge to VAD or heart-transplantation, while in “acute” settings it offers a considerable chance of recovery. Better outcomes are observed with shorter and partial support. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Intraaortic balloon counterpulsation and microcirculation in cardiogenic shock complicating myocardial infarction: an IABP-SHOCK II substudy
Conclusions In patients with CS, there is no effect of IABP treatment on microvascular perfusion. Parameters of the microcirculation might be helpful to identify high risk patients. (Source: Clinical Research in Cardiology)


Treatment for Diabetic Foot Ulcers Complicated by Major Cardiac Events
Conclusion MACE should be prevented during treatment for limb-threatening DFU in high-risk patients. Acute stress might have caused MACE during the first 10 days after admission or a major procedure. (Source: Canadian Journal of Diabetes)


Coronary stenting with cardiogenic shock due to acute ascending aortic dissection.
Authors: Hanaki Y, Yumoto K, I S, Aoki H, Fukuzawa T, Watanabe T, Kato K Abstract A 65-year-old man developed chest pain under cardiogenic shock. Coronary angiography revealed severe stenosis from the ostium of the left main coronary artery (LMCA) to the left anterior descending artery (LAD). Intravascular ultrasound (IVUS) identified a large hematoma that originated from the aorta and extended into the LAD, thereby compressing the true lumen. Type A aortic dissection (TAAD) that involved the LMCA was diagnosed by IVUS. Coronary stenting was performed via the LMCA to the proximal LAD, which resulted in coronary blood flow restoration and no further propagation of dissection. Elective surgical aortic repair was performed 2 wk after the stenting. LMCA stenting under IVUS guidance is ...


Extracorporeal membrane oxygenation support in acute coronary syndromes complicated by cardiogenic shock
ConclusionsIn patients with severe shock or refractory ventricular arrhythmias due to ACS, VA‐ECMO likely offers an alternative form of biventricular support albeit with significant resource utilization and morbidity. A better understanding of how to manage patients with ACS requiring VA‐ECMO support including the associated morbidities such as bleeding is necessary. © 2015 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


Cardiogenic shock induced reduction in cellular O2 delivery as a hallmark of acute H2S intoxication
Clinical Toxicology, Ahead of Print. (Source: Clinical Toxicology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Inhibition of iNOS as a novel effective targeted therapy against triple negative breast cancer
Conclusions: Based on the effectiveness of L-NMMA in decreasing tumor growth and enhancing survival rate in TNBC, we propose a targeted therapeutic clinical trial by re-purposing the pan-NOS inhibitor L-NMMA, which has been extensively investigated for cardiogenic shock as an anti-cancer therapeutic. (Source: Breast Cancer Research)


Impact of Clinical Characteristics and Management on the Prognosis of Unselected Heart Failure Patients
Conclusions These real-life HF data provide insight into prognostic factors and “real-world” pharmacological management in this unselected HF population, confirming the benefit of ACEi/ARB + BB ± MRAs on patient survival. (Source: Cardiovascular Drugs and Therapy)


Emergency transcatheter aortic valve implantation for acute and early failure of sutureless Perceval aortic valve
We report the case of a 78-year-old woman admitted for cardiogenic shock related to acute and early failure (severe aortic regurgitation) of a Perceval sutureless aortic bioprosthesis. Clinical stability was achieved by rescue transfemoral transcatheter aortic valve-in-valve implantation using an Edwards SAPIEN 3 prosthesis. To our knowledge, we report herein the first case of successful valve-in-valve implantation using a SAPIEN 3 transcatheter heart valve in a sutureless bioprosthetic aortic valve with acute and early deterioration. Teaser We report the case of a 78-year-old woman admitted for cardiogenic shock related to acute and early failure (severe aortic regurgitation) of a Perceval sutureless aortic bioprosthesis. Clinical stability was achieved by rescue transfemoral transcathete...


Role of intravenous lipid emulsions in the management of calcium channel blocker and β-blocker overdose: 3 years experience of a university hospital.
Conclusion: There was 93.3% survival in patients receiving ILE for drug-induced cardiovascular collapse. Clinically significant adverse effects were uncommon. We suggest ILE administration for the treatment of cardiogenic shock due to CCB and BB overdose. PMID: 25684131 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)


Transcatheter Aortic Valve Replacement for Patients with Heart Failure
Older patients suffering severe heart failure related to aortic stenosis (AS) undergo transcatheter aortic valve replacement (TAVR), owing to their high surgical risk. The diagnosis is made based on echocardiographic examination, but may require a multimodality imaging approach in patients with low gradients. In severely decompensated heart failure or cardiogenic shock, rescue percutaneous balloon aortic valvuloplasty as a bridge to TAVR seems reasonable. Emergent TAVR has been reported. Efforts should be made to avoid late diagnosis or referring patients with severe AS to offer them timely interventions, reduce the risk of TAVR, and predict whether left ventricular function will improve. (Source: Heart Failure Clinics)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Extracorporeal membrane oxygenation in adults with cardiogenic shock.
Authors: Lawler PR, Silver DA, Scirica BM, Couper GS, Weinhouse GL, Camp PC PMID: 25691703 [PubMed - in process] (Source: Circulation)


Competencies in Palliative Care for Cardiology Fellows
An 87-year-old man with a history of coronary artery disease, and having had 1-vessel coronary artery bypass surgery 10 years prior to admission, was admitted in a severe coma to the cardiovascular intensive care unit (CCU) for an acute myocardial infarction complicated by cardiogenic shock. He was intubated and started on inotropic and vasopressor support along with insertion of an intra-aortic balloon pump. Cardiac catheterization revealed 90% stenosis of the proximal left anterior descending artery, and a drug-eluting stent was implanted. However, he remained comatose and dependent on mechanical circulatory support. He rapidly developed acute kidney injury, requiring initiation of continuous venovenous hemodialysis. (Source: Journal of the American College of Cardiology)


The Use of Impella 2.5 in Severe Refractory Cardiogenic Shock Complicating an Acute Myocardial Infarction
ConclusionImpella 2.5 was initiated as a last resort therapy to support very sick patients with refractory CS after failed conventional therapy. The use of the device yielded favorable short and mid‐term survival results with recovery being the most frequently observed outcome. (J Interven Cardiol 2015;28:41–50) (Source: Journal of Interventional Cardiology)


Too Much of a Good Thing? Reducing Cannula Size and Flow Rates during Extracorporeal Life Support
Extracorporeal life support is increasingly utilized for circulatory support for cardiogenic shock but is associated with complications attributed to cannulation strategies. Recent evidence from this study supports the use of a smaller arterial cannula size that provides equivalent circulatory support and survival and greater ability to deploy percutaneous techniques at the bedside with fewer bleeding complications. (Source: The Journal of Thoracic and Cardiovascular Surgery)


0443: Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians: a multicentre study
Conclusions In our study, primary PCI in nonagenarians with STEMI was successful and feasible through a transradial approach. It is associated with a high rate of successful reperfusion of the infarct-related artery and nearly 50% survival at one year. These results suggest that primary PCI should be offered in selected nonagenarians with acute myocardial infarction (table next page). Abstract 0443 – Table Procedural Findings Time from symtoms to PCI (h) 5.8±7.6 Catheterizzation access (%) Radial 60 Single Vessel Coronary Disease (%) 53 Single Vessel Coronary PCI (%) 74 Infarct-related coronary artery (%) Left main 4 Left anterior descending 41 Circumflex 14 Right 45 CABG 3 Thrombus aspiration (%) 14 TMI flow grade after procedure (%) 0 12 1 1 2 6 3 81 Coronar...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


0120: B-type Nt-proBNP as a marker for contrast induced nephropathy in patients with primary percutaneous coronary intervention for ST segment elevation myocardial infarction
Conclusion From this large contemporary prospective study, our work suggests that Nt-proBNP levels at admission could help to identify patients at risk of CIN beyond traditional risk factors. (Source: Archives of Cardiovascular Diseases Supplements)


Inverted-Takotsubo cardiomyopathy: severe refractory heart failure in poly-trauma patients saved by emergency extracorporeal life support
CONCLUSIONS Rapid heparin-free ECLS may improve outcome in the most severe cases of poly-traumatized patients demonstrating refractory inverted-Takotsubo cardiomyopathy. (Source: Interactive CardioVascular and Thoracic Surgery)


Platelet mitochondrial dysfunction in critically ill patients: comparison between sepsis and cardiogenic shock
IntroductionPlatelet mitochondrial respiratory chain enzymes (that produce energy) are variably inhibited during human sepsis. Whether these changes occur even during other acute critical illness or are associated with impaired platelet aggregation and secretion (that consume energy) is not known. The aims of this study were firstly to compare platelet mitochondrial respiratory chain enzymes activity between patients with sepsis and those with cardiogenic shock, and secondly to study the relationship between platelet mitochondrial respiratory chain enzymes activity and platelet responsiveness to (exogenous) agonists in patients with sepsis. Methods: This was a prospective, observational, case?control study. Platelets were isolated from venous blood of 16 patients with severe sepsis or sept...


Prognosis of patients with fulminant myocarditis managed by peripheral venoarterial extracorporeal membranous oxygenation support: a retrospective single-center study
Conclusions: Fulminant myocarditis is associated with high mortality rates despite ECMO. An older age and complications related to ECMO are associated with poor prognosis. (Source: BioMed Central)


Understanding Cardiogenic Shock: A Nursing Approach to Improve Outcomes
Shock is a common complication associated with cardiac hospitalization post–myocardial infarction. Although shock is considered a physiologic response rather than a disease state, the lack of adequate pumping function leads to decreased tissue perfusion and initiation of the general shock response. Regardless of the etiology, the effects of shock are the same. Shock is essentially a widespread impairment of cellular metabolism, specifically, resulting from anaerobic metabolism related to inadequate tissue oxygenation leading to tissue dysfunction and necrosis. The purpose of this article is based on an actual clinical case study, precipitating factors, pathophysiology, common medical diagnosis and therapy, and nursing implications. (Source: Dimensions of Critical Care Nursing)


Prediction of the impact of veno-arterial extracorporeal membrane oxygenation on hemodynamics.
In this study, we developed a framework in which we incorporated ECMO into the extended Guyton's model of circulatory equilibrium, and predicted hemodynamic changes in response to ECMO. We first determined the cardiac output (CO) curves of left and right heart (to generate the integrated CO curve) without ECMO in 8 normal and 7 dogs with left ventricular dysfunction. Using the CO curves obtained and standard parameters for the venous return surface, we predicted the circulatory equilibrium under various levels of ECMO support. The predicted total flow (native left heart flow plus ECMO flow), right atrial pressure (PRA) and left atrial pressure (PLA) matched well with those measured (total flow: coefficient of determination [r(2)]=0.99, standard error of estimate [SEE]=5.8 ml•min(-1)•k...


Cardiac Arrest and Clinical Characteristics, Treatments and Outcomes Among Patients Hospitalized with ST-Elevation Myocardial Infarction in Contemporary Practice: A Report from the NCDR®
Conclusions Almost 8% of STEMI patients present with CA. More than 25% die during the hospitalization, despite high use of primary PCI. Cardiogenic shock and CA frequently co-exist. Our results suggest that development of systems of care and treatments for both STEMI and CA are needed to reduce the high mortality in these patients. (Source: American Heart Journal)


Letter to the Editor: Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: Design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial
Publication date: Available online 30 January 2015 Source:American Heart Journal Author(s): Holger Thiele , Gerhard Schuler , Franz-Josef Neumann , Jörg Hausleiter , Hans-Georg Olbrich , Bettina Schwarz , Marcus Hennersdorf , Klaus Empen , Georg Fuernau , Steffen Desch , Suzanne de Waha , Ingo Eitel , Rainer Hambrecht , Michael Böhm , Volkhard Kurowski , Bernward Lauer , Hans-Heinrich Minden , Hans-Reiner Figulla , Rüdiger C. Braun-Dullaeus , Ruth H. Strasser , Kristin Rochor , Sebastian K.G. Maier , Helge Möllmann , Steffen Schneider , Henning Ebelt , Karl Werdan , Uwe Zeymer (Source: American Heart Journal)


Feasibility of Smaller Arterial Cannulas in Veno-arterial Extracorporeal Membrane Oxygenation
To facilitate veno-arterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15-Fr arterial cannula in all patients, rather than one designed to maximize flow. The aim of this study is to compare the clinical outcomes of these two strategies. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation
To facilitate venoarterial extracorporeal membrane oxygenation (ECMO) insertion for cardiogenic shock, we recently adopted a strategy of using a 15F arterial cannula in all patients, rather than 1 designed to maximize flow. We aimed to compare the clinical outcomes of these 2 strategies. (Source: The Journal of Thoracic and Cardiovascular Surgery)


Drug-eluting stents vs. bare metal stents in patients with cardiogenic shock: a comparison by propensity score analysis
Background: In patients with cardiogenic shock, data on the comparative safety and efficacy of drug-eluting stents (DESs) vs. bare metal stents (BMSs) are lacking. We sought to assess the performance of DESs compared with BMSs among patients with cardiogenic shock undergoing percutaneous coronary intervention (PCI). Methods: Out of 236 patients with acute coronary syndromes complicated by cardiogenic shock, 203 were included in the final analysis. The primary endpoint included death, and the secondary endpoint of major adverse cardiac and cerebrovascular events (MACCEs) included the composite of death, myocardial infarction, any repeat revascularization and stroke. Patients were followed for a minimum of 30 days and up to 4 years. As stent assignment was not random, we performed a propensi...


Outcomes following primary percutaneous coronary intervention for unprotected left main-related ST-segment elevation myocardial infarction
Introduction: Unprotected left main (ULM) related ST-segment elevation myocardial infarction (STEMI) is a severe event, often leading to circulatory failure and/or sudden cardiac death. Although high-risk ULM thrombosis populations treated by primary percutaneous coronary intervention (PPCI) have been previously described, very little is known regarding the outcomes following PPCI for ULM-related STEMI in a hospital without on-site surgical back-up. Methods: A retrospective cohort analysis was performed on all consecutive patients who underwent PPCI for ULM-related STEMI in a single center. The primary end-point was to assess in-hospital mortality in the overall population and according to the presence/absence of cardiogenic shock at admission. Results: Between October 2006 and December 20...


Economic implications of intra-aortic balloon support for myocardial infarction with cardiogenic shock: an analysis from the IABP-SHOCK II-trial
Conclusion IABP support is associated with higher healthcare costs as compared to conservative treatment regimens. Clinically, IABP support cannot generally be recommended in AMI complicated by cardiogenic shock in the absence of a mortality benefit. However, economically considering the relatively little contribution to overall costs generated by IABP therapy it may still be considered if clinical scenarios with an IABP-induced benefit may be identified in the future. (Source: Clinical Research in Cardiology)


Efficacy and Safety of a Routine Early Invasive Strategy in Relation to Time from Symptom Onset to Fibrinolysis (A Subgroup Analysis of TRANSFER-AMI)
The aim of this study was to assess the efficacy and safety of an early invasive strategy in relation to time from symptom onset to fibrinolysis in patients undergoing reperfusion therapy for ST-elevation myocardial infarction (STEMI). TRANSFER-AMI randomized 1059 patients receiving fibrinolysis for STEMI to an early invasive strategy versus standard therapy. The primary endpoint was the composite of death, re-infarction, recurrent ischemia, new or worsening heart failure, or cardiogenic shock at 30 days. (Source: The American Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The use of extracorporeal membrane oxygenation support in acute coronary syndromes complicated by cardiogenic shock
Conclusions: In patients with severe shock or refractory ventricular arrhythmias due to ACS, VA‐ECMO likely offers an alternative form of biventricular support albeit with significant resource utilization and morbidity. A better understanding of how to manage patients with ACS requiring VA‐ECMO support including the associated morbidities such as bleeding is necessary. This article is protected by copyright. All rights reserved. (Source: Catheterization and Cardiovascular Interventions)


The novel use of heart transplantation for the management of a case with multiple complications following acute myocardial infarction
We report the case of a 63-year-old man who developed VSD following an inferior MI. The patient presented with shortness of breath and a recent ST elevation inferior MI. Transthoracic echocardiography revealed a 50% left ventricular ejection fraction with mild-to-moderate right ventricular dysfunction. A posterior VSD (diameter ≥ 12mm), moderate ischemic mitral regurgitation (MR) and a posterior pseudoaneurysm were also demonstrated. The operative risk was considered to be too high for VSD repair since the surgery would have to include bypass grafting, mitral valve replacement and pseudoaneurysm correction. Consequently, an urgent heart transplantation was considered the best option. The patient had heart transplantation nine days after initial symptoms and the recovery was unremarkable....


The efficacy and safety of mechanical hemodynamic support in patients undergoing high-risk percutaneous coronary intervention with or without cardiogenic shock: bayesian approach network meta-analysis of 13 randomized controlled trials
Studies have reported conflicting results regarding efficacy of mechanical hemodynamic support using intra-aortic balloon pump (IABP) or percutaneous ventricular assisted device (pVAD) in patients undergoing high-risk PCI. We performed a Bayesian network meta-analysis comparing the safety and efficacy of mechanical hemodynamic support devices and medical therapy (MT). (Source: International Journal of Cardiology)


3D transesophageal echocardiography is a decision-making tool for the management of cardiogenic shock following a large postinfarction ventricular defect
Postinfarction ventricular septal defect (PIVSD) is a devastating mechanical complication following acute myocardial infarction. The management of this pathology is quite challenging, especially in case of complicated cardiogenic shock. The difficulties lie in the timing and type of intervention. Debates exist with regard to immediate versus deferring repair, as well as open repair versus percutaneous closure. The anatomic characteristics and hemodynamic consequence of PIVSD are important elements determining which strategy to adopt, since large septal defect (>15 mm) cannot be appropriately treated by percutaneous occluder devices limiting by their available size, while compromised hemodynamics usually require emergent repair or mechanical support “bridging to surgery”. Herein, we re...


Cardiogenic shock induced by bisoprolol in a patient with CYP2D6 variant. A case report
Publication date: Available online 19 January 2015 Source:Journal of Cardiology Cases Author(s): Masafumi Nakayama , Koichi Fuse , Masahito Sato , Masaaki Okabe , Yasushi Komatsu , Akira Yamashina , Yoshifusa Aizawa A 66-year-old man was admitted for congestive heart failure with tachycardiac atrial fibrillation (AF). Heart failure was improved by diuretics, but control of heart rate by verapamil was insufficient, and bisoprolol was prescribed. After taking 2.5mg of bisoprolol, he developed a general malaise followed by sinus bradycardia and shock. In addition to catecholamines, the patient was treated with intra-aortic balloon pumping and a pacemaker. With intensive therapy, the general condition was improved, and acute elevation of liver enzymes after bisoprolol was normalized by the 1...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cardiogenic Shock in Takotsubo Cardiomyopathy: A Focus on Management
We present a case of 1 such patient in a branched self-assessment format designed to challenge the reader's clinical management skills. (Source: Canadian Journal of Cardiology)


Adenosine for sinus tachycardia: Try to avoid this!
This is the feedback I gave the student on this case. (Recall that this was a young adult male who presented with dyspnea, chest pain, as well as pre-syncope, whose initial ECG showed a brisk tachycardia which went up to the 170s at points): At 150, about to speed up. Bottom line: &#8220;As you point out, this was sinus tachycardia. When you have sinus tachycardia, you have to look for causes and treat those. I encourage you to read David Baumrind’s excellent essay on this topic for a different explanation. Here&#8217;s mine. Sinus Tachycardia &#8220;Sinus tachycardia can be caused by hypovolemia, cardiogenic shock, hypoxia, thyroid storm, cocaine intoxication, alcohol withdrawal, or massive pulmonary embolism. Sinus tachycardia is not an arrhythmia, it’s a symptom. The patient is te...


An embryonic heart cell line is susceptible to dengue virus infection.
Authors: Angel-Ambrocio AH, Soto-Acosta R, Tammineni ER, Carrillo ED, Bautista-Carbajal P, Hernández A, Sánchez JA, Del Angel RM Abstract Dengue virus (DENV) is the causative agent of dengue fever. In recent years, patients with more severe form of the disease with acute heart failure or progression to cardiogenic shock and death have been reported. However, the pathogenesis of myocardial lesions and susceptibility of cardiomyocytes to DENV infection have not been evaluated. Under this perspective, the susceptibility of the myoblast cell line H9c2, obtained from embryonic rat heart, to DENV infection was analyzed. Our findings indicate that H9c2 cells are susceptible to the infection with the four DENV serotypes. Moreover, virus translation/replication and viral production in thi...


Back from the brink: catastrophic antiphospholipid syndrome
Cardiogenic shock was the first sign of a devastating disorder in a 27-year-old woman with multiple medical problems. She presented to an outside hospital after 2 days of nausea, epigastric pain, and worsening dyspnea on exertion. Her medical history included systemic lupus erythematosus, autoimmune hepatitis, immune thrombocytopenia, autoimmune hemolytic anemia, attention deficit hyperactivity disorder, anxiety, and migraines. (Source: The American Journal of Medicine)


Taurine Concentrations Decrease in Critically Ill Patients With Shock Given Enteral Nutrition.
Conclusions: Several amino acids were deficient in plasma on ICU admission but increased during EN. Taurine concentrations declined and were associated with longer periods of mechanical ventilation and ICU support. Fast taurine decline correlated with severity of organ failure. These findings support the role of taurine during ischemia, reperfusion, and inflammation. Taurine may be an essential candidate to enrich nutrition support for critically ill patients, although more research is required. PMID: 25587009 [PubMed - as supplied by publisher] (Source: JPEN Journal Of Parenteral And Enteral Nutrition)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Mechanical Chest Compressions in Prolonged Cardiac Arrest due to ST Elevation Myocardial Infarction Can Cause Myocardial Contusion
We present a case report of a 60-year-old man without a history of coronary artery disease who presented with ST-elevation myocardial infarction. During transportation to the hospital, he developed ventricular fibrillation (VF) and later pulseless electrical activity. Chest compressions with LUCAS 2 (Medtronic, Minneapolis, MN) automated mechanical compression–decompression device were initiated. Coronary angiography showed total occlusion of the left main coronary artery and primary percutaneous coronary intervention (PCI) was performed. After the PCI, his heart started to generate effective contractions and LUCAS could be discontinued. Return of spontaneous circulation was achieved after 90 minutes of cardiac arrest. The patient died of cardiogenic shock 11 hours later. An autopsy reve...


Results of heart transplantation in the urgent recipient - who should be transplanted?
Conclusions: The results obtained in patients hospitalized under inotropic support were similar to those of patients awaiting transplantation at home. Allocation of donors to the first group does not seem to compromise the benefit of transplantation. These results may not be extensible to more critical patients. Objetivo: Avaliar os resultados imediatos e de longo prazo do transplante cardíaco em dois níveis diferentes de urgência. Métodos: De novembro de 2003 a dezembro de 2012, 228 pacientes foram submetidos a transplante cardíaco. Crianças e os pacientes em choque cardiogênico foram excluídos do estudo. Do grupo final (n=212), 58 pacientes (27%) estavam hospitalizados e em suporte inotrópico (Grupo A), enquanto 154 (73%) aguardavam transplante em casa (Grupo B). Os pacientes d...


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


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


Successful Use of Extracorporeal Membrane Oxygenation in an Adult Patient With Toxic Shock-Induced Heart Failure
We report the case of a 51-year-old male who presented with profound cardiogenic shock and multiorgan failure that could not be managed by conventional therapy with intravenous fluids, vasopressors and inotropes. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was instituted as a bridge to recovery. After administration of antibiotics and intravenous immunoglobulin, the patient&rsquo;s condition improved and he was successfully weaned off ECMO after 6 days. The patient recovered from multiorgan failure, and left ventricular ejection fraction improved from &lt;10% pre-ECMO to 65% 8 months after discharge. This case supports the view that VA ECMO can be used successfully to support vital organ perfusion in patients with profound but reversible cardiomyopathy attributed to TSS. (So...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Coiled Impella Drive Line in the Left Ventricle: A Rare Complication of a Left Ventricular Assist Device
A 71-YEAR-OLD .MAN with congestive heart failure secondary to cardiac amyloidosis in cardiogenic shock not responsive to pharmacologic interventions required an urgent insertion of a left ventricular mechanical support device. A microaxial flow device (Impella® 5.0) was inserted surgically inserted through the left axillary artery using transesophageal echocardiography (TEE) guidance. In the intensive care unit, it was noted on a chest x-ray that a large portion of the Impella drive line coiled inside the left ventricle. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Transapical aortic valve implantation: predictors of survival up to 5 years in 730 patients. An update [ADULT CARDIAC]
CONCLUSIONS We identified three main causes of follow-up mortality: non-cardiac comorbidity, advanced stages of heart failure and procedure-related complications. Further improvements of the TAVI technique should concentrate on the complete exclusion of the latter. (Source: European Journal of Cardio-Thoracic Surgery)


Relation of Atrial Fibrillation and Right-Sided Cardiac Thrombus to Outcomes in Patients with Acute Pulmonary Embolism
Atrial Fibrillation (AF) can induce a hypercoagulable state in both the left and right atria. Thrombus in the right side of the heart (RHT) may lead to acute pulmonary embolism (APE). The aim of the study was to determine the prevalence of RHT and AF, and to assess their impact on outcomes in patients with APE. The retrospective cohort included 1006 patients (598 females), with a mean age 66 ±15 years. The primary endpoint was all-cause mortality. The secondary endpoint was incidence of complications (death, cardiogenic shock, cardiac arrest, vasopressor/inotrope treatment or ventilatory support). (Source: The American Journal of Cardiology)


Effect of Cardiogenic Shock Hospital Volume on Mortality in Patients With Cardiogenic Shock [Health Services and Outcomes Research]
Conclusions We demonstrated an association between lower CS case volume and higher mortality. There is more frequent use of both standard supportive and revascularization techniques at the higher volume centers. Future directions may include examining whether early stabilization and transfer improve outcomes of patients with CS who are admitted to lower volume centers. (Source: JAHA:Journal of the American Heart Association)


Anesthetic Management of the Patient With Low Ejection Fraction
The number of patients with heart failure presenting for surgery continues to rise, and anesthesiologists are increasingly being called upon to provide quality, safe care in the operating room for patients with low ejection fraction (EF). Perioperative goals in the management of these patients include maintaining forward flow, promoting inotropy without inducing or exacerbating ischemia, and returning patients to their preoperative level of function after surgery. Oftentimes, these goals can be met with pharmacologic support, including the use of calcium channel blockers, phosphodiesterase inhibitors, and novel agents, such as nesiritide and levosimendan. Many patients with diminished EF have implantable cardioverter–defibrillators (ICDs) in place. These devices can be complex to manage,...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Removal notice to “Erratum to: Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: Design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial” [Am Heart J. 169/1 (2014) 185]
Publication date: January 2015 Source:American Heart Journal, Volume 169, Issue 1 (Source: American Heart Journal)


REMOVED: “Erratum to: Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: Design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial”
Publication date: January 2015 Source:American Heart Journal, Volume 169, Issue 1 (Source: American Heart Journal)


Device sizing for transcatheter closure of ruptured sinus of Valsalva as per echocardiography color Doppler turbulent flow jet diameter
Abstract Rupture of sinus of Valsalva (SV) is a rare occurrence with a wide spectrum of presentation, ranging from an asymptomatic murmur to cardiogenic shock or even sudden cardiac death. We hereby report a case which was successfully closed by transcatheter technique. In this case, ruptured SV was entered from the aorta, an arteriovenous loop was created and device was implanted using a venous approach. The procedure was safe, effective and uncomplicated, obviating the need for surgery. In this case, the authors report for the first time the use of echo color Doppler turbulent flow jet diameter as a reference value for sizing the device. (Source: Cardiovascular Intervention and Therapeutics)


Case report: necrosis of the anterolateral papillary muscle-an unusual mechanical complication of myocardial infarction.
We report the case of a 66-year-old woman with no significant past medical history who presented to the Emergency Department at Houston Methodist Hospital with 24 hours of chest pain. An electrocardiogram was done, an electrocardiogram confirmed a posterolateral ST elevation myocardial infarction. An immediate and successful percutaneous coronary intervention of a totally occluded ramus intermedius was performed. Six hours later she developed pulmonary edema, cardiogenic shock, severe acidosis, and anuria. Echocardiography showed severe mitral regurgitation due to a ruptured anterolateral papillary muscle, and emergency surgery revealed necrosis of this muscle. A bioprosthetic mitral valve was placed, and extracorporeal membrane oxygenation was needed for 3 days. This is a rare mechanical ...


Successful Treatment of Acute Left Ventricular Assist Device Thrombosis and Cardiogenic Shock with Intraventricular Thrombolysis and a Tandem Heart
We present a case of LVAD thrombosis with emphasis on recognition and treatment of acute pump thrombosis, and discuss a potentially novel strategy using percutaneous mechanical circulatory support for pump salvage. (Source: ASAIO Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Influence of Cardiogenic Shock With or Without the use of Intra-Aortic Balloon Pump on Mortality in Patients With ST-segment Elevation Myocardial Infarction
Conclusion Patients with STEMI and cardiogenic shock had substantial short-and long-term mortality that may be improved with IABP implantation. More studies on use of IABP in such patients are warranted. (Source: IJC Heart and Vasculature)


“Atypical Pneumonia”: Acute Mitral Regurgitation Presenting with Unilateral Infiltrate.
Acute mitral regurgitation is a medical and surgical emergency. It rapidly leads to cardiogenic shock and death if not promptly treated.1 (Source: The American Journal of Medicine)


“Atypical Pneumonia”: Acute Mitral Regurgitation Presenting with Unilateral Infiltrate
Acute mitral regurgitation is a medical and surgical emergency. It rapidly leads to cardiogenic shock and death if not promptly treated.1 (Source: The American Journal of Medicine)


‘Atypical Pneumonia’: Acute Mitral Regurgitation Presenting with Unilateral Infiltrate
Acute mitral regurgitation is a medical and surgical emergency. It rapidly leads to cardiogenic shock and death if not promptly treated.1 (Source: The American Journal of Medicine)


Outcomes with Invasive versus Conservative Management of Cardiogenic Shock Complicating Acute Myocardial Infarction
In the SHOCK trial an invasive strategy of early revascularization was associated with a significant mortality benefit at 6-months when compared with initial stabilization in patients with cardiogenic shock complicating acute myocardial infarction. Our objectives were to evaluate the data on real world practice and outcomes of invasive vs. conservative management in patients with cardiogenic shock. (Source: The American Journal of Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Outcomes with Invasive vs Conservative Management of Cardiogenic Shock Complicating Acute Myocardial Infarction
In the SHOCK trial, an invasive strategy of early revascularization was associated with a significant mortality benefit at 6 months when compared with initial stabilization in patients with cardiogenic shock complicating acute myocardial infarction. Our objectives were to evaluate the data on real-world practice and outcomes of invasive vs conservative management in patients with cardiogenic shock. (Source: The American Journal of Medicine)


Expanding Pseudoaneurysm Compressing the Coronary Arteries and Causing Cardiogenic Shock
A 37-year-old male who recently underwent aortic valve replacement following endocarditis presented with cardiogenic shock. A large expansile pseudoaneurysm was subsequently discovered using multiple imaging modalities. Although TEE is important in diagnosing valve endocarditis, Coronary CTA of prosthetic valves is feasible and image quality is good. In this case, Coronary CTA allowed for better understanding of TEE images and earlier diagnosis of coronary involvement as cause for LV dysfunction. (Source: Journal of Cardiovascular Computed Tomography)


Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis
To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on survival and complication rates in adults with refractory cardiogenic shock or cardiac arrest. (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Hemodynamic instability in patients undergoing pulmonary embolectomy: institutional experience
Acute pulmonary embolism is a major cause of morbidity and mortality in patients presenting for emergent cardiac surgery with overall mortality ranging from 6% to as high as 85%. While the initial focus of treatment is nonsurgical or percutaneous interventions, surgical treatment continues to be a treatment for patients with refractory thrombus burden or cardiogenic shock. Our institution regularly performs surgical pulmonary embolectomy with improved outcomes compared to current reports. We thus performed a retrospective analysis of outcomes of pulmonary embolectomy patients and anesthetic management. (Source: Journal of Clinical Anesthesia)


Heart failure prognosis and management in over-80-year-old patients: data from a French national observational retrospective cohort
Conclusions These real-life HF data provide insight into prognostic factors and demonstrate that over-80-year-old HF patients displaying several comorbidities are poorly managed, despite the confirmed clinical benefit of HF drugs. (Source: European Journal of Clinical Pharmacology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Percutaneous Thrombectomy with the AngioVac Aspiration Device: a Single-Center Experience
Conclusions In our experience, aspiration thrombectomy using the AngioVac device is safe and effective in removing central caval thromboses. The use of the AngioVac device to remove thrombus in the right heart is effective but may carry a higher risk of severe complication. Pulmonary artery thrombectomy is the most challenging because of the complexity of advancing the cannula through the heart and the high likelihood of an unstable patient. (Source: Journal of Vascular and Interventional Radiology)


An overview of thrombolytic treatment for pulmonary embolism: A single center experience
Conclusions: Pulmonary embolism is a disease that may lead to death within hours secondary to acute right heart failure. Early diagnosis and treatment can be life saving. Thrombolytic therapy has been shown to improve hemodynamic parameters in the early period post-PE. An increased risk of bleeding is one of the most important drawbacks of thrombolytic therapy. Nonetheless, it can be a life-saving therapy in properly selected patients. (Source: European Respiratory Journal)


A perilous cause for cardiogenic shock
A 34-year-old man with no conventional coronary risk factors was admitted with inferoposterior and right ventricular myocardial infarction with evidence of cardiogenic shock. Patient was taken for emergency primary percutaneous coronary intervention. Because the patient was hemodynamically unstable, direct cannulation of right coronary artery was done, which showed ostioproximal thrombotic occlusion of right coronary artery. After wiring the vessel, thrombus aspiration and subsequent stenting was done. Thrombolysis in myocardial infaction (TIMI) III flow was observed with rapid stabilisation of haemodynamic parameters (figure 1A&ndash;C). On cannulating left main coronary artery, definite thrombus was observed in proximal left anterior descending artery and noted haziness suggestive of thr...


Fibroblast growth factor 23 in acute myocardial infarction complicated by cardiogenic shock: a biomarker substudy of the intra-aortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial
IntroductionCardiogenic shock (CS) is the leading cause of death in patients hospitalized with acute myocardial infarction (AMI). Biomarkers might help in risk stratification and understanding of pathophysiology. Preliminary data suggests that patients with CS face a profound increase in the osteocyte-derived hormone fibroblast growth factor 23 (FGF-23), which acts as a negative regulator of serum phosphate levels. The present study aimed to assess the predictive role of FGF-23 for clinical outcome in a large cohort of CS patients with and without renal dysfunction. Methods: In the randomized intra-aortic balloon pump in cardiogenic shock II (IABP-SHOCK II)-trial, 600 patients with CS complicating AMI were assigned to therapy with or without IABP. Our predefined biomarker substudy included...


Glucagonoma-induced acute heart failure
Neuroendocrine tumours (NET) cover a broad spectrum of different hormone-secreting tumours of which, the glucagon-producing tumours of the pancreas are fairly rare and can be associated with syndromes such as MEN1. Zhang et al., report on a patient with glucagonoma who presented with left ventricular heart failure and developed cardiogenic shock despite therapy. Heart failure eventually regressed after initialising i.v. treatment with the somatostatin analogue octreotide. They therefore suggest that cardiac function should be monitored in a routine manner in all NET patients. Read full Case report by Zhang et al. (2014) Endocrinology, Diabetes, Metabolism Case Reports. Article ID: 14-0061; DOI:10.1530/EDM-014-0061 (Source: Society for Endocrinology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan
Conclusion: TTC is classically triggered by an acute illness or by extreme stress and a triggering incident may not always be identified. It usually presents in the guise of an acute coronary syndrome (ACS). Our data was congruent with the existing literature, except for more heart failure and cardiogenic shock. Average Troponin-I (Tn-I) levels were also higher as compared to western population. The reason for more severity in our patients may be late presentation or different level of response to stress. (Source: BMC Research Notes)


Congenital Gerbode Defect in a Patient With an Acute Myocardial Infarction and Cardiogenic Shock Masquerading as an Acute Ventricular Septal Defect
LEFT VENTRICLE-TO-RIGHT ATRIUM (LV-RA) shunts are rare congenital or acquired defects of the membranous septum described by Gerbode in 1958; their natural history can lead to enlargement of the right atrium and right ventricle failure. Often the defects go unnoticed at birth, and diagnosis is made in adulthood. The authors report a case of a 75-year-old woman with an acute myocardial infarction and cardiogenic shock for whom preoperative echocardiograms were read incorrectly as an infarct-related ventricular septal defect (IRVSD). (Source: Journal of Cardiothoracic and Vascular Anesthesia)


Electrical Storm Induced by Cardiac Resynchronization Therapy Is Determined by Pacing on Epicardial Scar and Can be Successfully Managed by Catheter Ablation [Original Articles]
Conclusions&mdash; CRT-induced proarrhythmia presented early with electrical storm and was associated with an LV lead positioning within epicardial scar. Catheter ablation allowed for resumption of biventricular stimulation in all patients. (Source: Circulation: Arrhythmia and Electrophysiology)


Validated Contemporary Risk Model of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: Insights From the National Cardiovascular Data Registry Cath-PCI Registry [Health Services and Outcomes Research]
Conclusion The NCDR AKI prediction models can successfully risk-stratify patients undergoing PCI. The potential for this tool to aid clinicians in counseling patients regarding the risk of PCI, identify patients for preventative strategies, and support local quality improvement efforts should be prospectively tested. (Source: JAHA:Journal of the American Heart Association)


Fatal Sulfasalazine-Induced Eosinophilic Myocarditis in a Patient with Periodic Fever Syndrome
Conclusion: This was a case of drug-induced EM in a patient with PFS that had an atypical presentation, rapid evolution and poor outcome.Med Princ Pract (Source: Medical Principles and Practice)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Recurrent ST-segment elevation in infarct-associated leads
Clinical introduction Early recurrence of focal ST-segment elevation after acute ST-elevation myocardial infarction (STEMI) usually indicates myocardial reinfarction. However, it can be seen in threatened myocardial rupture, a situation in which administration of potent antithrombotic and thrombolytic therapy may be catastrophic. Herein, we present the case of an 84-year-old woman with STEMI undergoing urgent stenting who had a recurrence of chest pain with cardiogenic shock and new ST elevation in the infarct-related leads mimicking myocardial ischaemia. A patent stent showed by repeated angiography, presence of pericardial effusion and absence of recurrent rise in cardiac marker suggest the diagnosis of a contained left ventricular rupture. The experience of any clinician in dealing with...


Prolonged resuscitation and cardiogenic shock after intoxication with European yew (Taxus baccata): Complete recovery after intermittent mechanical circulatory support
We present a clinical case report of a 24-year-old woman with suicidal yew ingestion, subsequent prolonged cardiopulmonary resuscitation, and complete recovery of biventricular function under intermittent mechanical circulatory support. (Source: International Journal of Cardiology)


Acute arsenic poisoning - Montelescaut E, Vermeersch V, Commandeur D, Huynh S, Danguy Des Deserts M, Sapin J, Ould-Ahmed M, Drouillard I.
We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature ... (Source: SafetyLit: All (Unduplicated))


Elective use of femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation [ADULT CARDIAC]
CONCLUSIONS The use of preoperatively planned CPB may increase the safety of the TAVI procedure in patients with severely reduced heart function or in cardiogenic shock. (Source: European Journal of Cardio-Thoracic Surgery)


A regional pharmacoinvasive PCI strategy incorporating selected bleeding avoidance strategies
ConclusionBleeding and ischemia rates were similar between the PIT and primary PCI strategies in the setting of routine use of selected BAS; further study on a broader range of BAS including the radial approach may be warranted. Cardiac arrest and bailout glycoprotein IIb/IIIa inhibitor, but not PIT in conjunction with selected BAS, are independent predictors of bleeding risk in a regional ST-segment elevation myocardial infarction population. (Source: Coronary Artery Disease)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions
Conclusions Patients who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at an academic medical center. (Source: American Heart Journal)


β-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: a case–control study
Extracorporeal membrane oxygenation (ECMO) has become an essential means of support for severe cardiorespiratory failure in critically ill patients [1]. Venovenous (VV) ECMO may play a key role in the advanced management of severe respiratory failure [2] with reported survival rates of up to 71% [3], and venoarterial (VA) ECMO has been associated with survival rates of >50% in adult patients with cardiogenic shock [4]. Some of these patients have serious infections that require effective antibiotic therapy. (Source: International Journal of Antimicrobial Agents)


Evaluation and Management of ST-elevation Myocardial Infarction and Shock
Cardiogenic shock is the leading cause of death in patients with acute ST-elevation myocardial infarction (STEMI). Characterised by a state of low cardiac output leading to end-organ hypoperfusion, cardiogenic shock complicates approximately 5–8 % of STEMIs and is associated with a mortality rate approaching 50 percent.1–3 Prompt recognition and therapeutic intervention for cardiogenic shock due to STEMI are critical for patient survival. (Source: Radcliffe Cardiology)


Ivabradine in cardiogenic shock: Fact or fiction?
Publication date: Available online 6 December 2014 Source:Heart &amp; Lung: The Journal of Acute and Critical Care Author(s): Kadir Uğur Mert , Gurbet Özge Mert , İbrahim Altun , Murat Biteker (Source: Heart and Lung: The Journal of Acute and Critical Care)


Mechanical support of Patients with heart failure: What are the future Hurdles?
The paper, “Ventricular Assist Devices: The Future is Now” by Lima, Mack, and Gonzalez presents the current status of mechanical circulatory support for treatment of patients with chronic heart failure [1] .The authors review patient selection, discuss the basic technical aspects of current assist devices including the total artificial heart, and give an overview of expected outcomes including patient survival and quality of life. Indeed, it is remarkable that for over 40 years surgeons and physiologists have explored many aspects of cardiac assist device design, biomaterials compatibility, and physiologic responses, but until the last decade, use of mechanical cardiac support was limited largely to patients with postcardiotomy cardiogenic shock or candidates for cardiac transplantatio...


Techniques for Venoarterial ECMO support and Conversion to Temporary Left Ventricular Assist Device
Veno-arterial ECMO is a powerful tool for resuscitating patients in refractory cardiogenic shock. However, outcomes are poor unless it is implemented correctly and converted to more long term devices in a stepwise and timely fashion. In this article we detail the steps required to guarantee the highest survival rate for these critically ill patients. (Source: Operative Techniques in Thoracic and Cardiovascular Surgery: A Comparative Atlas)


Techniques for Venoarterial Extracorporeal Membrane Oxygenation Support and Conversion to Temporary Left Ventricular Assist Device
Veno-arterial ECMO is a powerful tool for resuscitating patients in refractory cardiogenic shock. However, outcomes are poor unless it is implemented correctly and converted to more long term devices in a stepwise and timely fashion. In this article we detail the steps required to guarantee the highest survival rate for these critically ill patients. (Source: Operative Techniques in Cardiac and Thoracic Surgery)


RotaFlow and CentriMag Extracorporeal Membrane Oxygenation Support Systems as Treatment Strategies for Refractory Cardiogenic Shock
ConclusionsPatients with a poor hemodynamic status may benefit by rapid insertion of veno‐arterial ECMO. The blood lactate level, CK‐MB relative index and PRBCs transfused should be strictly monitored during ECMO support. (Source: Journal of Cardiac Surgery)


Myxedema coma: a new look into an old crisis.
Authors: Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, Mukhopadhyay S, Chowdhury S Abstract Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be in...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


New Impella Cardiac Power Device Used in Patient with Cardiogenic Shock due to Nonischemic Cardiomyopathy
We present the first documented case of a patient that was transitioned from the Impella 2.5 to Impella CP. A 48-year-old male patient with no medical history was transferred to our institution with a one day history of worsening shortness of breath. The patient was unstable and found to have monomorphic ventricular tachycardia at 220 beats/min that was cardioverted to normal sinus rhythm. An emergent right and left heart catheterization was performed showing nonobstructive coronary artery disease, biventricular failure with a left ventricular ejection fraction (LVEF) of 5 to 10%, high pulmonary capillary wedge pressure (PCWP) 22 mm Hg, right atrial (RA) pressure 22 mm Hg, and a very low cardiac index of 1.0 L/min/m2. Because of severe cardiogenic shock, Impella 2.5 was inserted provid...


Mechanical circulatory support in acute cardiogenic shock.
Authors: Khan MH, Corbett BJ, Hollenberg SM Abstract Cardiogenic shock complicates about 5% to 8% of all admissions for acute myocardial infarction, and despite advancement in treatment over the past 50 years, mortality remains unacceptably high. Management with vasoactive agents after revascularization can have its limitations and thus mechanical circulatory support is often initiated. Intra-aortic balloon pumps (IABPs) are the devices most commonly used worldwide. IABPs appeared to improve mortality when used along with fibrinolytic therapy but may not when used along with percutaneous coronary interventions. Extracorporeal membrane oxygenation (ECMO) is utilized in the setting of worsening tissue perfusion despite inotropes and IABP utilization. Although retrospective studies sh...


Extracorporeal membrane oxygenation.
Authors: Butt W, Maclaren G Abstract Extracorporeal membrane oxygenation (ECMO) is an advanced form of life support technology whereby venous blood is oxygenated outside of the body and returned to the patient. ECMO was initially used as last-resort rescue therapy for patients with severe respiratory failure. Over the last four decades, it has developed into a safe, standard therapy for newborns with progressive cardiorespiratory failure, as a resuscitation therapy after cardiac arrest, and in combination with other treatments such as hypothermia and various blood filtration therapies. ECMO has also become routine for children and adults with all forms of cardiogenic shock and is also routine in early graft failure after transplantation. The one area of ongoing debate is the role o...


Combined percutaneous coronary intervention and transcatheter aortic valve implantation in cardiogenic shock.
In conclusion, a single-stage combined approach is reasonable even in an emergency setting, and can lead to a good shortterm outcome. However, further reports and experience are needed to evaluate the feasibility of this approach. PMID: 24597404 [PubMed - indexed for MEDLINE] (Source: Journal of Heart Valve Disease)


Board #127 - Research Abstract Long-Term Outcomes of Pre-clinical HFMS: Emerging Third-year Medical Students Retain Second-year Cardiopulmonary Pharmacology Taught in High-fidelity Simulation Six Months After the Simulation Experience (Submission #9962).
Hypothesis: Medical schools have begun incorporating pharmacology into high-fidelity medical simulations (HFMS) to integrate basic and clinical science,1-2 but limited studies have been published on the long-term value of teaching pharmacology in HFMS. Evidence suggests HFMS can improve initial learning.3-5 While students perceive value in learning pharmacology in HFM6-7 limited data exists on whether applying pharmacology in HFMS improves retention of critical concepts for clinical years. Pharmacology retention is a concern in the clinical years8-9 and literature supports that long-term retention is more likely to occur in moderately stressful10 active learning experiences that allow realistic applications.11 We hypothesize that pharmacology reinforced in second-year HFMS will be retained...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cardiac injury as a rare cause of cardiogenic shock following polytrauma
(Source: European Heart Journal)


The right ventricle in pulmonary arterial hypertension
Pulmonary arterial hypertension (PAH) is a right heart failure syndrome. In early-stage PAH, the right ventricle tends to remain adapted to afterload with increased contractility and little or no increase in right heart chamber dimensions. However, less than optimal right ventricular (RV)&ndash;arterial coupling may already cause a decreased aerobic exercise capacity by limiting maximum cardiac output. In more advanced stages, RV systolic function cannot remain matched to afterload and dilatation of the right heart chamber progressively develops. In addition, diastolic dysfunction occurs due to myocardial fibrosis and sarcomeric stiffening. All these changes lead to limitation of RV flow output, increased right-sided filling pressures and under-filling of the left ventricle, with eventual ...


Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction
To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA). (Source: Resuscitation)


Mitigation of autophagy ameliorates hepatocellular damage following ischemia-reperfusion injury in murine steatotic liver
Ischemia-reperfusion injury (IRI) is a common clinical consequence of hepatic surgery, cardiogenic shock, and liver transplantation. A steatotic liver is particularly vulnerable to IRI, responding with extensive hepatocellular injury. Autophagy, a lysosomal pathway balancing cell survival and cell death, is engaged in IRI, although its role in IRI of a steatotic liver is unclear. The role of autophagy was investigated in high-fat diet (HFD)-fed mice exposed to IRI in vivo and in steatotic hepatocytes exposed to hypoxic IRI (HIRI) in vitro. Two inhibitors of autophagy, 3-methyladenine and bafilomycin A1, protected the steatotic hepatocytes from HIRI. Exendin 4 (Ex4), a glucagon-like peptide 1 analog, also led to suppression of autophagy, as evidenced by decreased autophagy-associated protei...


Acute arsenic poisoning.
We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment. PMID: 25486670 [PubMed - as supplied by publisher] (Source: Annales de Biologie Clinique)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pheochromocytoma-induced atrial tachycardia leading to cardiogenic shock and cardiac arrest: resolution with atrioventricular node ablation and pacemaker placement.
We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature. PMID: 25593537 [PubMed - in process] (Source: Texas Heart Institute Journal)


Bubbles in the heart as first sign of gastric pneumatosis
Conclusion: The suspected NEC was located in the stomach enabling the intramural air to pass through connecting veins to the right atrium. The first specific sign of NEC in our case was air bubbles in the right atrium on echocardiography. (Source: European Journal of Pediatrics)


Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock.
CONCLUSIONS: Hyperglycemia on admission is a clinical feature of patients with ACS who develop cardiogenic shock, however its prognostic value requires further studies. PMID: 25428733 [PubMed - as supplied by publisher] (Source: Cardiology Journal)


Intra-aortic balloon counterpulsation in cardiogenic shock: Is it really the end of an indication?
Scandinavian Cardiovascular Journal, Volume 48, Issue 6, Page 325-327, December 2014. (Source: Scandinavian Cardiovascular Journal)


In-hospital Outcomes of Patients with Cardiogenic Shock due to ST-Segment Elevation Myocardial Infarction
Conclusions Cardiogenic shock remains a frequent and serious condition with almost 50% of in-hospital mortality despite the therapeutic advances. (Source: Revista Brasileira de Cardiologia Invasiva)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


A meta-analysis of complications and mortality of extracorporeal membrane oxygenation.
CONCLUSIONS: Even with conditions usually associated with a high chance of death, almost 50% of patients receiving ECMO survive up to discharge. Complications are frequent and most often comprise renal failure, pneumonia or sepsis, and bleeding. PMID: 23944202 [PubMed - indexed for MEDLINE] (Source: Critical Care and Resuscitation)


The clinical features and emotional stressors in korean patients with tako-tsubo cardiomyopathy.
Conclusion. The clinical features of TTC are different between groups with and without preceding emotional stressors. The TTC group with preceding emotional stressors was more likely to have preserved cardiovascular reserve and lesser likely to require hemodynamic support than other group although the entire prognosis of TTC is excellent regardless of triggering stressors. PMID: 23008757 [PubMed] (Source: Cardiovascular Psychiatry and Neurology)


Acute heart failure management in a young patient requiring complex left main percutaneous coronary intervention, Impella 2.5 and transcatheter aortic valve implantation
The Impella device (Abiomed Inc., Danvers, Massachusetts), a percutaneously placed microaxial pump serving as a partial circulatory assist device, is increasingly used in high risk coronary interventional procedures [1], refractory cardiogenic shock [2,3] and as a bridge to destination therapy (transplantation) [4]. In the current case we describe the use of Impella 2.5 for the management of refractory cardiogenic shock, pulmonary oedema and recurrent ventricular tachycardias in a young patient with complex coronary artery disease and mixed aortic valve disease. (Source: International Journal of Cardiology)


The early dynamic behavior of lactate is linked to mortality in post-cardiotomy patients with extracorporeal membrane oxygenation support: A retrospective observational study
ECMO is used in to support post-cardiotomy cardiogenic shock (PCS) patients. In addition to age and gender (female), early lactate behavior after ECMO support is strongly associated with in-hospital mortality in post-cardiotomy patients. Early lactate behavior is also predictive of successful weaning from ECMO. (Source: The Journal of Thoracic and Cardiovascular Surgery)


The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: A retrospective observational study
This study examined the association between the early dynamic behavior of lactate and mortality after ECMO support. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Cardiogenic shock and coronary endothelial dysfunction predict cardiac allograft vasculopathy after heart transplantation
Abstract Cardiac allograft vasculopathy remains one of the major causes of death post‐heart transplantation. Its etiology is multifactorial and prevention is challenging. The aim of this study was to prospectively determine factors related to cardiac allograft vasculopathy after heart transplantation. This research was planned on 179 patients submitted to heart transplant. Performance of an early coronary angiography with endothelial function evaluation was scheduled at three‐month post‐transplant. Patients underwent a second coronary angiography after five‐yr follow‐up. At the 5‐ ± 2‐yr follow‐up, 43% of the patients had developed cardiac allograft vasculopathy (severe in 26% of them). Three independent predictors of cardiac allograft vasculopathy were identified: cardi...


Does the placement of an Amplatzer septal occluder device confer benefit in patients with a post-infarction ventricular septal defect?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was &lsquo;Is the placement of an Amplatzer septal occluder device across a post-infarction ventricular septal defect a suitable alternative for patients not eligible for surgical repair?&rsquo; Altogether, 31 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the insertion of an Amplatzer occluder device in patients with a post-infarction ventricular septal defect (VSD) not amenable to surgical repair can offer benefit in selected patients. Patie...


Percutaneous mitral valve repair as rescue procedure after post myocardial infarction papillary muscle rupture and acute cardiogenic shock
(Source: Clinical Research in Cardiology)


Traumatic rupture of the coronary sinus following blunt chest trauma: a case report
We present the case of a 57-year-old male who developed cardiac arrest because of extensive pericardial tamponade after a falling injury. We decided to perform an exploratory sternotomy in the operating room (OR). The patient was transported to the OR on extracorporeal membrane oxygenation (ECMO) support. We found a rupture of the coronary sinus after evacuation of an extensive hematoma in the pericardium and primarily repaired the injured site. After 2?days, the patient died due to refractory cardiogenic shock. To our knowledge, this is the first reported case of rupture of the coronary sinus after blunt chest trauma. (Source: Journal of Cardiothoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


The Significance of Negative MPO-ANCA and The Role of Cyclophosphamide in Eosinophilic Granulomatosis with Polyangiitis
We read with great interest the article by Dr. Bouabdallaoui et al. (1) on “Cardiogenic shock, asthma, and hypereosinophilia” published in The American Journal of Emergency Medicine. The authors described a case of eosinophilic granulomatosis with polyangiitis (EGPA) or formerly known as Churg-Strauss Syndrome (CSS) presenting with cardiogenic shock. The patient's condition was markedly improved with high doses of corticosteroids and intravenous cyclophosphamide (CYP). (Source: The American Journal of Emergency Medicine)


The significance of negative myeloperoxidase antineutrophil cytoplasmic antibodies and the role of cyclophosphamide in eosinophilic granulomatosis with polyangiitis
We read with great interest the article by Dr Bouabdallaoui et al [1] on “Cardiogenic shock, asthma, and hypereosinophilia” published in The American Journal of Emergency Medicine. The authors described a case of eosinophilic granulomatosis with polyangiitis (EGPA) or formerly known as Churg-Strauss syndrome presenting with cardiogenic shock. The patient's condition was markedly improved with high doses of corticosteroids and intravenous cyclophosphamide (CYP). (Source: The American Journal of Emergency Medicine)


Shall We Consider More of the Intra-Aortic Balloon Pump Effects on Microcirculation in Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation?
No abstract available (Source: Critical Care Medicine)


Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients: Design and Rationale of the ROADMAP Clinical Trial
The objective of this study is to examine the impact of mechanically assisted circulation using the HeartMate II left ventricular assist device in patients who meet current FDA-defined criteria for treatment but are not yet receiving intravenous inotropic therapy. Methods This is a prospective, non-randomized clinical trial of 200 patients treated with either optimal medical management or a mechanical circulatory support device. Clinical Context This trial will be the first prospective clinical evaluation comparing outcomes of patients with advanced ambulatory heart failure treated with either ongoing medical therapy or a left ventricular assist device. It is anticipated to provide novel insights regarding relative outcomes with each treatment and an understanding of patient and provider...


Neurogenic Shock Immediately following Posterior Lumbar Interbody Fusion: Report of Two Cases
Conclusion Incarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex.[...]Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Global Spine Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Early outcome of liver transplantation performed with organs procured from brain death donors with transient or sustained cardio-circulatory collapse.
CONCLUSION: The use of livers procured from donors after brain death that experienced transient or sustained cardio--circulatory collapse was associated with early graft function comparable to that of standard donors. PMID: 25319135 [PubMed - as supplied by publisher] (Source: Minerva Anestesiologica)


Predicting outcome in patients under extracorporeal membrane oxygenation due to cardiogenic shock through dynamic change of lymphocytes and interleukins
Conclusions Combination of the GAM plots and GLM models overcame the complexity of different disease categories. The systemic irreversible damages from cardiogenic shock ECMO cases might be detected from several peripheral blood parameters. (Source: IJC Metabolic and Endocrine)


A review of the role of nurses and technicians in ST-elevation myocardial infarction (STEMI).
Authors: Zughaft D, Harnek J Abstract The role of nurses and technicians in the treatment of ST-elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI) is vital for the success of the multidisciplinary Heart Team. Several editorials have emphasised the importance of a holistic treatment which links each step of care to the next, a chain that is essential for quality and efficacy in the management of STEMI patients. In pre-hospital acute coronary care, the first medical contact is most commonly a nurse and/or a paramedic. The time from symptom onset to reperfusion is crucial for the long-term outcome. On arrival at the hospital, it is important for the nurse or paramedic to share an overview of what has been done to the patient so far, in a struc...


Shock management in acute myocardial infarction.
CONCLUSIONS: CS mortality remains unacceptably high. In the light of very limited evidence regarding most treatment modalities, there is a clear need for adequately designed studies in order to answer the numerous unsettled issues. PMID: 25256538 [PubMed - in process] (Source: EuroIntervention)


Management of ST-elevation myocardial infarction according to European and American guidelines.
CONCLUSIONS: The majority of recommendations for the management of STEMI according to ESC and ACCF/AHA guidelines were identical or overlapping. Differences were explained by gaps in available evidence, in which case expert consensus differed between European and American guidelines due to divergence in interpretation, perception, and culture of medical practice. Systematic comparisons of European and American guidelines are valuable and indicate that interpretation of available evidence leads to agreement in the vast majority of topics. The latter is indirect support for the process of review and guideline preparation on both sides of the Atlantic. PMID: 25256530 [PubMed - in process] (Source: EuroIntervention)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Intra-aortic balloon counterpulsation reduces mortality in large anterior myocardial infarction complicated by persistent ischaemia: a CRISP-AMI substudy.
Conclusions: In this substudy, use of IABP was associated with decreased six-month mortality in large STEMI complicated by persistent ischaemia after PCI. PMID: 25254356 [PubMed - as supplied by publisher] (Source: EuroIntervention)


How should I treat refractory cardiogenic shock in acute STEMI with multivessel occlusion?
Authors: Achtchi A, Ibrahim AW, Rahman A, Rab ST, Noc M, Thiele H PMID: 25244461 [PubMed - as supplied by publisher] (Source: EuroIntervention)


Extracorporeal membrane oxygenation for profound cardiogenic shock due to cocaine toxicity
We present a case in which extracorporeal membrane oxygenation effectively stabilized a patient with ongoing hemodynamic instability who experienced repeated episodes of myocardial injury and ventricular tachyarrhythmias due to cocaine toxicity. &lt;Learning objective: In many urban settings, cocaine-induced angina is not uncommon. The pathogenesis of its manifestation includes coronary artery vasospasm and decreased left ventricular function. Treatment typically involves systemic vasodilators, such as nitrates and calcium channel blockers. However, in patients with substantial hemodynamic instability, these agents might result in a worsening of systemic perfusion. Accordingly, extracorporeal membrane oxygenation should be considered in such cases to promote myocardial recovery.&gt...


A rare cause of cardiogenic shock: variant angina
Variant angina (VA) is a clinical syndrome caused by spontaneous vasospasm of the epicardial coronary artery which is characterized by episodes of angina. Endothelial dysfunction and neurohormonal hyperactivity are important factors in pathogenesis of VA. Although patient prognosis is good, VA may be one of the reasons of sudden cardiac death (SCD) in case of persistent ST segment elevation and malignant arrhythmias. Therefore, early treatment of VA is crucial for prevention of malignant arrhythmias and SCD. In this case report we describe a case of VA presented with cardiogenic shock and malignant ventricular arrhythmia. (Source: Therapeutic Advances in Cardiovascular Disease)


Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI
BackgroundShort-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown.ObjectivesThe goal of this study was to describe the association between time and cause of death in patients with STEMI undergoing primary PCI.MethodsA centralized civil registration system, patient files, and public disease and death cause registries with an accurate record linkage were used to trace time and cause of death in 2,804 consecutive patients with STEMI (age 63 ± 13 years, 72% males) treated with primary PCI.ResultsPatients were followed up for a median of 4.7 years. During a total of 13,447 patient-years, 717 patients died. Main...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Acute kidney injury in adults receiving extracorporeal membrane oxygenation
Publication date: November 2014 Source:Journal of the Formosan Medical Association, Volume 113, Issue 11 Author(s): Yung-Chang Chen , Feng-Chun Tsai , Ji-Tseng Fang , Chih-Wei Yang Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as patients with postcardiotomy cardiogenic shock or life-threatening respiratory failure. Acute kidney injury (AKI) that develops during ECMO is associated with a very poor outcome, possibly because of accumulated extravascular water causing interstitial overload, impaired oxygen transport through tissues, and increased extravascular lung water volume with impaired O2 transport. Increased water is associated with subsequent organ dysfunction, particularly of the heart, lungs, and brain. Based on single-center studies...


Selenium deficiency associated porcine and human cardiomyopathies
Publication date: Available online 24 October 2014 Source:Journal of Trace Elements in Medicine and Biology Author(s): Marianne Oropeza-Moe , Helene Wisløff , Aksel Bernhoft Selenium (Se) is a trace element playing an important role in animal and human physiological homeostasis. It is a key component in selenoproteins (SeP) exerting multiple actions on endocrine, immune, inflammatory and reproductive processes. The SeP family of glutathion peroxidases (GSH-Px) inactivates peroxides and thereby maintains physiological muscle function in humans and animals. Animals with high feed conversion efficiency and substantial muscle mass have shown susceptibility to Se deficiency related diseases since nutritional requirements of the organism may not be covered. Mulberry Heart Disease (MHD) in pig...


Abciximab‐induced alveolar hemorrhage treated with rescue extracorporeal membranous oxygenation
We describe a case of a 75 year‐old woman presenting emergently with an anterior S‐T elevation myocardial infarction that deteriorated into ventricular fibrillation requiring prompt resuscitation, resulting in cardiogenic shock. Emergency primary percutaneous coronary intervention of the left anterior descending coronary artery with adjunctive abciximab and heparin resulted in adequate coronary flow, and intraaortic balloon pump was used to support hemodynamics. Within 12 hours of intervention, she developed acute respiratory distress with four‐quadrant opacification of lung fields, difficulty with oxygenation, and hypotension. Emergency bronchoscopy revealed diffuse erythematous proximal airways with bloody secretions bilaterally confirming diffuse alveolar hemorrhage. An emergency ...


Death of a 23-year-old man from cardiac conduction system injury through a blunt chest impact after a car accident
Publication date: Available online 6 November 2014 Source:Egyptian Journal of Forensic Sciences Author(s): S. Zerbo , E. Maresi , F. Portelli , C. Sortino , E. Ventura Spagnolo , P. Procaccianti , A. Argo Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent causes of cardiac contusion resulting from a direct blow to the chest. Myocardial contusion is difficult to diagnose; the clinical presentation varies greatly, ranging from a lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. The authors report a case of death due to a cardiac conduction system injury from a blunt chest impact following a car accident. The autopsy sh...


Results of heart transplantation in the urgent recipient - who should be transplanted?
Conclusions: The results obtained in patients hospitalized under inotropic support were similar to those of patients awaiting transplantation at home. Allocation of donors to the first group does not seem to compromise the benefit of transplantation. These results may not be extensible to more critical patients. Objetivo: Avaliar os resultados imediatos e de longo prazo do transplante cardíaco em dois níveis diferentes de urgência. Métodos: De novembro de 2003 a dezembro de 2012, 228 pacientes foram submetidos a transplante cardíaco. Crianças e os pacientes em choque cardiogênico foram excluídos do estudo. Do grupo final (n=212), 58 pacientes (27%) estavam hospitalizados e em suporte inotrópico (Grupo A), enquanto 154 (73%) aguardavam transplante em casa (Grupo B). Os pacientes d...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Early Treatment of Refractory Cardiogenic Shock With Percutaneous Veno-arterial ECMO Implanted in the Cardiac Catheterization Laboratory
Publication date: Available online 30 October 2014 Source:Revista Española de Cardiología (English Edition) Author(s): Pablo Díez-Villanueva , Iago Sousa , Alberto Núñez , Felipe Díez , Jaime Elízaga , Francisco Fernández-Avilés (Source: Revista Espanola de Cardiologia)


Platelet aggregation inhibition by Eptifibatide versus high dose Tirofiban during primary percutaneous interventions
Conclusions • Platelet aggregation inhibition during PCI was significantly correlated with STR and MBG. Platelet aggregation inhibition cut-off point as a predictor of STR &gt;70% was 89.5%, and as a predictor of MBG 2–3 was 87.5%. • Eptifibatide achieves better platelet aggregation inhibition 60min after bolus and 6h after PCI than high dose Tirofiban. • Eptifibatide is associated with better myocardial perfusion as indicated by post procedural mean MBG and STR &gt;70% than high dose Tirofiban. • There was no significant differences between Eptifibatide and high dose Tirofiban regarding thrombocytopenia, major or minor bleeding, MACE and 30days mortality. (Source: The Egyptian Heart Journal)


Severe Spontaneous Coronary Artery Dissection in a 42-Year-Old Male:
Spontaneous coronary artery dissection (SCAD) is a rare and potentially lethal acute coronary event. Its presentation can vary from mild ischemia symptoms to ST-elevated myocardial infarction (STEMI), cardiogenic shock, ventricular fibrillation (VF), and even sudden cardiac death (SCD) [1]. The incidence of SCAD detection lies between 0,07 and 1,1% of all coronary angiograms performed [1]. SCAD affects mostly women (75%) and the mean age of all SCAD patients is around 40years old [1,2]. (Source: International Journal of Cardiology)


Prognostic value of T peak-to-end interval for risk stratification after acute myocardial infarction
Conclusion TpTe was significantly and independently associated with increased odds of SCD and is linked to deterioration of Lv functions and myocardial aneurysms. It's highly correlated to presence of LAS and associate with severity of coronary lesions. Patients with prolonged TpTe intervals and dispersions were likely to develop fatal arrhythmias. (Source: The Egyptian Journal of Critical Care Medicine)


Severe spontaneous coronary artery dissection in a 42-year-old male: A treatment strategy challenge
Spontaneous coronary artery dissection (SCAD) is a rare and potentially lethal acute coronary event. Its presentation can vary from mild ischemia symptoms to ST-elevated myocardial infarction (STEMI), cardiogenic shock, ventricular fibrillation (VF), and even sudden cardiac death (SCD) [1]. The incidence of SCAD detection lies between 0,07 and 1,1% of all coronary angiograms performed [1]. SCAD affects mostly women (75%) and the mean age of all SCAD patients is around 40years old [1,2]. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


MitraClip for Papillary Muscle Rupture in Patient With Cardiogenic Shock
We report the successful use of the MitraClip device (Abbott Vascular, Santa Clara, CA) in a 68-year-old man with posterolateral ST-elevation myocardial infarction complicated by papillary muscle rupture and cardiogenic shock. (Source: Canadian Journal of Cardiology)


Ivabradine during cardiogenic shock: A clinical case and review of the literature
We report a case of cardiogenic shock treated by adding ivabradine to the currently used therapy. (Source: Heart and Lung: The Journal of Acute and Critical Care)


Transcatheter mitral paravalvular leakage closure: A beautiful last resort
We describe a case of a 54-year-old patient with rheumatic heart valve disease who was treated with double valve replacement (both aortic and mitral) twice. Two months after the second operation she developed a severe mitral paravalvular leakage (PVL) leading to cardiogenic shock for which she was hospitalized in the intensive care unit. Multiple weaning efforts proved to be unsuccessful because of persistent hemodynamic instability caused by the severe PVL. Since re-redo cardiac surgery would have meant an unacceptable high peri-operative risk it was decided in the heart team to close the PVL by a transcatheter technique. This was done successfully and led to a spectacular hemodynamic improvement. Just 24h after closure of the PVL she could be discharged from the intensive care unit and t...


Value of N-terminal pro brain natriuretic peptide in predicting prognosis and severity of coronary artery disease in acute coronary syndrome
Conclusion NT-proBNP is a valuable marker for predicting prognosis and severity of coronary artery disease in patients with acute coronary syndrome. (Source: Journal of the Saudi Heart Association)


Successful treatment of fulminant myocarditis with biventricular mechanical circulatory support: A two-year follow-up
Publication date: October 2014 Source:Cor et Vasa, Volume 56, Issue 5 Author(s): Jiri Maly , Zora Dorazilova , Milos Kubanek , Ivan Netuka , Martin Pokorny , Josef Besik , Jan Burkert , Ondrej Szarszoi Fulminant myocarditis (FM) is an inflammation of the myocardium characterized by progressive acute heart failure leading to cardiogenic shock that develops over several hours. In this article, we present a case of a female patient with acute fulminant lymphocytic myocarditis who was successfully treated with biventricular MCS. (Source: Cor et Vasa)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Rescue venoarterial ECMO in cardiogenic shock complicated by refractory cardiac arrest during percutaneous coronary intervention
We describe a case of profound cardiac shock due to complicated coronary artery disease, recurrent cardiac arrest during PCI, intraarrest PCI intra-aortic balloon pump insertion and successful resuscitation after venoarterial ECMO placement. Complete revascularization was achieved following ECMO insertion and patient was discharged home on day 29 with no neurological sequelae with ejection fraction of 40%. (Source: Cor et Vasa)


Dedicated Tryton Side Branch Stents used in the treatment of coronary bifurcation lesions
Conclusion The usage of a dedicated bifurcation Tryton Side Branch Stent for PCI of the bifurcation lesions is technically feasible with satisfactory long-term results. (Source: Cor et Vasa)


Monitoring the microcirculation in critically ill patients
Publication date: Available online 28 September 2014 Source:Best Practice &amp; Research Clinical Anaesthesiology Author(s): Daniel De Backer , Arthur Durand Alterations in microvascular perfusion have been identified in critically ill patients, especially in sepsis but also in cardiogenic shock, after cardiac arrest, and in high risk surgery patients. These alterations seem to be implicated in the development of organ dysfunction and are associated with outcome. Even though microvascular perfusion can sometimes be homogenously decreased as in acute hemorrhage or in non-resuscitated cardiogenic shock, heterogeneity of perfusion is observed in sepsis and in resuscitated hemorrhagic/cardiogenic shock. Heterogeneity of perfusion has major implications for monitoring, as many techniques ...


Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture
We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery. (Source: Brazilian Journal of Anesthesiology)


The Impact of Processes of Care on Myocardial Infarct Size in Patients With ST‐Segment Elevation Myocardial Infarction: Observations From the CRISP‐AMI Trial
ConclusionsIn CRISP‐AMI, reperfusion was accomplished in a timely fashion while incorporating informed consent and randomization among patients with anterior myocardial infarction. Further study of patients' comprehension and preferences during the informed‐consent process in STEMI patients is warranted so that innovative drugs and devices can be safely and ethically tested. (Source: Clinical Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Pulsatile Venoarterial Perfusion Using a Novel Synchronized Cardiac Assist Device Augments Coronary Artery Blood Flow During Ventricular Fibrillation
Abstract Patients with cardiogenic shock have a very high mortality. Here we report the first use of a percutaneous pulsatile cardiac assist device, based on a diagonal pump synchronized with the heart cycle by means of an electrocardiographic signal in adult pigs. Eight domestic pigs underwent mandatory ventilation. During sinus rhythm, there were no differences between pulsatile and nonpulsatile perfusion with regard to pulmonary artery pressure, pulmonary wedge pressure, central venous pressure, mean arterial pressure (MAP), mean pulse pressure, and mean coronary artery flow (CAF). After 2 min of complete cardiac arrest (ventricular fibrillation), circulatory support with the i‐cor in venoarterial nonpulsatile extracorporeal membrane oxygenation (ECMO) mode (3 L/min) restored syst...


Incorporating patient preferences into clinical trial design: Results of the Opinions of Patients on Treatment Implications of New Studies (OPTIONS) project Stafinski: Patient Opinions on Clinical Trial Design
Conclusions While patients’ preferences appear to be comparable to those of clinicians, patients may be less willing than clinicians to tolerate potential treatment complications. The methods used in this study offer a feasible approach to incorporating patient preferences into cardiovascular trials and warrant further investigation in broader patient populations. (Source: American Heart Journal)


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


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


Cardiogenic shock after use of fluoroamphetamine confirmed with serum and urine levels - Al-Abri SA, Meier KH, Colby JM, Smollin CG, Benowitz NL.
Context. 4-Fluoroamphetamine (4-FA) is a para-substituted phenethylamine-type synthetic stimulant that has in recent years gained popularity through internet blogs and market share according to confiscated drug data. No serious toxicity has previously been... (Source: SafetyLit: All (Unduplicated))<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Cardiogenic shock after use of fluoroamphetamine confirmed with serum and urine levels
Clinical Toxicology, Ahead of Print. (Source: Clinical Toxicology)


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


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


Support with intra-aortic balloon pump vs. Impella2.5® and blood flow to the heart, brain and kidneys – an experimental porcine model of ischaemic heart failure
Cardiogenic shock as a complication to an acute myocardial infarction has an unacceptably high death rate that has not changed for the last 15years. Mortality is partly related to organ hypoperfusion and mechanical assist devices are used for the most severe cases but we do not know which assist device is the best option. Therefore, we have investigated how an IABP and an Impella®-pump influenced blood flow to the brain, heart and kidneys, in a closed-chest porcine model of severe left ventricular failure. (Source: International Journal of Cardiology)


The Effect of the Sequential Therapy in End-Stage Heart Failure (ESHF) - from ECMO, Through the Use of Implantable Pump for a Pneumatic Heart assist System, Religa Heart EXT, as a Bridge for Orthotopic Heart Transplant (OHT). Case Study.
Conclusions Application of short-term ECMO as a bridge-to-bridge helped save the patient from severe cardiogenic shock caused by increased left ventricular afterload. The experimental implantation of an innovative Religa Heart EXT prosthesis was a safe and efficacious bridge to transplantation. Too short time of Religa Heart EXT implantation in the discussed patient prevented the possibility to evaluate the occurrence of thromboembolic complications and infections compared to the documented complications of POLVAD implanted until now. OHT is a safe and efficacious method of treatment of patients previously supported by ECMO and Religa Heart EXT. PMID: 25330851 [PubMed - in process] (Source: Annals of Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Prevalence, associated factors and management implications of left ventricular outflow tract obstruction in takotsubo cardiomyopathy: a two-year, two-center experience
Background: Some patients with Takotsubo cardiomyopathy (TTC) develop cardiogenic shock due to left ventricular outflow tract (LVOT) obstruction - there is, however, a paucity of data regarding this condition. Methods: Prevalence, associated factors and management implications of LVOT obstruction in TTC was explored, based on two-year data from two Belgian heart centres. Results: A total of 32 patients with TTC were identified out of 3,272 patients presenting with troponin-positive acute coronary syndrome. In six patients diagnosed with TTC (19%), a significant LVOT obstruction was detected by transthoracic echocardiography. Patients with LVOT obstruction were older and had more often septal bulging, and presented more frequently in cardiogenic shock as compared to those without LVOT obstr...


Mitral prosthetic valve thrombosis and cardiogenic shock in a limited resources setting in sub-Saharan Africa: A tailored treatment approach
We thank Dr Dogan and Colleagues for their comment on our previously described case [1] and for their contribution on the therapy of prosthetic valve thrombosis (PVT) during pregnancy [2–4]. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Does ivabradine really limit dobutamine-induced tachycardia in stable heart failure patients: Parallax in significance
We have recently read with great interest the article by Gallet et al. which is assessing the effects of dobutamine and ivabradine in patients with stable heart failure and in refractory cardiogenic shock patients [1]. We, however, would like to address three major aspects. Although the authors claimed that the current study is the first to evaluate hemodynamic effects of ivabradine in addition to dobutamine in patients with severe systolic dysfunction, we have recently shown in a randomized, placebo-controlled trial that the dobutamine-induced increase in heart rate (HR) was blunted by ivabradine treatment in patients hospitalized with acute decompensated heart failure [2]. (Source: International Journal of Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


Adjunctive mild hypothermia therapy to primary percutaneous coronary intervention in patients with ST segment elevation myocardial infarction complicated with cardiogenic shock: A pilot feasibility study.
Conclusion: TH as adjunctive therapy in STEMI patients complicated with CS is feasible and safe. Based on these preliminary observations there appears to be no significant clinical advantage to this form of therapy. PMID: 25299501 [PubMed - as supplied by publisher] (Source: Cardiology Journal)


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


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


Cardiogenic Shock And Coronary Endothelial Dysfuction Predict Cardiac Allograft Vasculopathy After Heart Transplantation
This article is protected by copyright. All rights reserved. (Source: Clinical Transplantation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Diagnosis of coronary affection in patients with AADA and treatment of postcardiotomy myocardial failure using extracorporeal life support (ECLS).
CONCLUSION: Besides preoperative evaluation of the extent of the dissection, focus on coronary affection in CT-scans helps to triage the operative procedure. Hybrid operating rooms allow for immediate interventional and/or surgical treatment and enable for immediate control of revascularization results. The use of ECLS over other types of ventricular support systems may allow for myocardial recovery in selected cases. PMID: 25367237 [PubMed - in process] (Source: The Heart Surgery Forum)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up [TX & MCS]
CONCLUSIONS Despite most critical baseline conditions, ECMO therapy is confirmed useful for the treatment of patients with acute cardiopulmonary failure refractory to conventional treatments. The ECMO modality (VA vs VV), as well as indications to support, identifies different patient profiles and dissimilar outcomes. Preimplantation markers of gravity and end-organ damage are useful in the stratification of expected survival. These may facilitate clinical decision-making and appropriate allocation of hospital resources. (Source: European Journal of Cardio-Thoracic Surgery)


Acute tamponade of the left paracorporeal pump house due to membrane defect in a patient with a Berlin Heart EXCOR(C) biventricular assist device [CASE REPORT]
We report a case of acute tamponade of the left paracorporeal pump house in a patient supported by a Berlin Heart EXCOR biventricular assist device (BiVAD) caused by mechanical defect in the membrane of the arterial chamber. A 36-year old male was admitted for composite graft surgery due to a large aortic regurgitation and consecutive heart failure, decompensated postoperatively and was rescued by with an extracorporeal membrane oxygenation (ECMO) device. He was accepted for heart transplantation, and a BiVAD (Berlin Heart EXCOR) was implanted as bridge-to-transplantation. Two months after discharge, he experienced dyspnoea and received error signals from his BiVAD. Relatives released him from his BiVAD companion driver, connected him to the hand pump and transported him to our institution...


Abstract 4024: iNOS inhibition increases survival in triple negative breast cancer by targeting metastasis and epithelial-mesenchymal transition
In conclusion, targeted therapy with iNOS inhibitor impacts cell migration and changes in epithelial-mesenchymal transition might influence metastatic events. Based on these findings, we have planned a phase Ib/II targeted therapeutic trial by re-purposing L-NMMA as an anti-cancer indication. Targeting TNBC with L-NMMA could significantly alter clinical practice for treatment of breast cancer in the near future. Citation Format: Sergio M. Granados, Yi Liu, Bhuvanesh Dave, Melissa D. Landis, Steven S. Gross, Jenny C. Chang. iNOS inhibition increases survival in triple negative breast cancer by targeting metastasis and epithelial-mesenchymal transition. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philad...


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


The Changing Landscape of Advanced Heart Failure Therapeutics ∗
The past decade has witnessed a rapid evolution in the tools available to treat patients with severe left ventricular systolic dysfunction. Gone are the days of managing advanced heart failure with medical therapy alone. Patients with heart failure who present for tertiary and quaternary cardiovascular care are often those who have received evidence-based medical and electrical therapies but have residual hemodynamic compromise. The intra-aortic balloon pump (IABP), historically used for its relative simplicity, has not withstood the vicissitudes of rigorous clinical trials. The modest hemodynamic support IABP provides has not been associated with survival improvements in either acute myocardial infarction (AMI) or cardiogenic shock (1,2). (Source: Journal of the American College of Cardi...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs
Abstract The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups—control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P &lt; 0.05). At the end of the experiments, LV − dp/dt among t...


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


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


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


125 * total arch replacement versus more conservative management in type a acute aortic dissection
Conclusion: In our experience TAR and CAM were associated with similar hospital mortality and morbidity rates. Nevertheless, the more extensive arch interventions were not protective for long-term survival and freedom from aortic re-intervention. Thus, in TAAD patients, TAR remains indicated by site of intimal tear and patient-specific factors. (Source: Interactive CardioVascular and Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


258 * predictors of prolonged intensive care unit stay in patients undergoing minimally invasive right thoracotomy valve surgery: a single institution analysis with 2272 patients
Conclusion: Eight independent preoperative risk factors for a prolonged ICU stay following right thoracotomy valve surgery were identified. Using this risk model, one can predict whether a patient will have a prolonged ICU stay or not. The knowledge of risk factors may facilitate organisational procedures and rational bed management. (Source: Interactive CardioVascular and Thoracic Surgery)


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


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


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


Giant right ventricular metastasis of hypopharyngeal cancer complicated by ventricular tachycardia and cardiogenic shock
(Source: European Journal of Echocardiography)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction: a landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) Registry
IntroductionThere are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). The aim of this study was to assess long-term (5-year) mortality among early survivors of AMI, according to the presence of CS at the acute stage. Methods: We analyzed 5-year follow-up data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 registry, a nationwide French survey including consecutive patients admitted for ST or non-ST-elevation AMI at the end of 2005 in 223 institutions. Results: Of 3670 patients enrolled, shock occurred in 224 (6.1%), and 3411 survived beyond 30?days or hospital discharge, including 99 (2.9%) with shock. Early survivors with CS had a more severe clinical profile, ...


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


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


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


A Case of Cardiogenic Shock Treated with Paracorporeal Left Ventricular Assisted Device Caused by Acute Myocardial Infarction
Case: A 42-years-old man was suffered from chest pain and transferred to our hospital with cardiogenic shock. Under intraaortic balloon pumping (IABP) support, emergency coronary angiography was performed. Left anterior descending (LAD) and left circumflex branch (LCX) were chronic total occlusion, and right coronary artery (RCA) was total thrombotic occlusion. Percutaneous coronary intervention (PCI) was performed on RCA. However, cardiogenic shock was sustained and incessant ventricular tachycardia was occurred. (Source: Journal of Cardiac Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


Importance of Aortic Valve Opening Under Percutaneous Cardiopulmonary Support (PCPS) in Patients with Fulminant Myocarditis; from the 2 Distinctive Cases
A 48-year-old male, who was diagnosed as fulminant myocarditis was transferred to the intensive-care unit in our hospital. Echocardiography showed progressive decline of left ventricular function after admission. The 2nd day, intraaortic balloon pumping (IABP) and PCPS were introduced due to cardiogenic shock. Under cardiopulmonary support, we paid careful attention to keeping aortic valve open in systole to prevent thromboembolic complications. After 10 days of cardiopulmonary support, his cardiac function improved gradually and he weaned from IABP and PCPS. (Source: Journal of Cardiac Failure)


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


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


Thyroid hormone and the stunned myocardium
Acute critically ill patients experience a rapid decline in plasma free thyroid hormone levels (free triiodothyronine (FT3) and free levothyroxine (FT4)), with a marked elevation of reverse T3, recognized as the euthyroid sick syndrome (ESS) or low-T3 syndrome. The ESS is also often associated with depressed myocardial function, sometimes referred to as the &lsquo;stunned myocardium&rsquo;. Its clinical effects may vary from minimal hemodynamic impairment to cardiogenic shock. Medical management may range from aspirin alone to placement of a left ventricular assist device. With adequate supportive therapy, recovery usually occurs within days or weeks. The effect of T3/T4 therapy has been studied in three conditions in which the ESS and myocardial functional depression have been documented ...


Overview of Extracorporeal Membrane Oxygenation in Cardiogenic Shock
In recent years, the use of extracorporeal membrane oxygenators (ECMO) has proliferated in cardiovascular intensive care units (ICUs) partially due to advances in technology with the development of smaller, more portable machines, and the increasing numbers of patients with end-stage heart failure and cardiogenic shock. The use of ECMO has been found to improve survival rates in this deadly situation. Due to higher volumes of patients requiring ECMO, additional qualified resources for providing ECMO services may be necessary. The purpose of this article was to review cardiogenic shock etiologies, the role of ECMO, and to discuss the transition process of implementing a nurse-run ECMO program. (Source: Critical Care Nursing Clinics of North America)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Overview of Extracorporeal Membrane Oxygenation in Cardiogenic Shock
In recent years, the use of extracorporeal membrane oxygenators (ECMO) has proliferated in cardiovascular intensive care units (ICUs) partially due to advances in technology with the development of smaller, more portable machines, and the increasing numbers of patients with end-stage heart failure and cardiogenic shock. The use of ECMO has been found to improve survival rates in this deadly situation. Due to higher volumes of patients requiring ECMO, additional qualified resources for providing ECMO services may be necessary. The purpose of this article was to review cardiogenic shock etiologies, the role of ECMO, and to discuss the transition process of implementing a nurse-run ECMO program. (Source: Critical Care Nursing Clinics of North America)


Electrocardiogram attenuation of QRS complexes in association with Takotsubo syndrome
The interesting case report by Rojas-Marte et al. [1], published ahead of print in the Journal on July 31, 2014, about a 31year-old woman who suffered Takotsubo syndrome (TTS), complicated by cardiac arrest and cardiogenic shock, following an overdose of ibuprofen and diphenhydramine, and was treated successfully with extracorporeal membrane oxygenation, provides me with the opportunity to bring to the attention of the authors a newly described association of TTS with early transient electrocardiogram (ECG) attenuation of the QRS complexes (ATTQRS) [2,3]. (Source: Cardiovascular Revascularization Medicine)


Reverse Takotsubo cardiomyopathy after iatrogenic epinephrine injection requiring percutaneous extracorporeal membrane oxygenation.
CONCLUSION: Takotsubo cardiomyopathy following an injection of epinephrine remains a rare but increasingly described occurrence. The severity of the symptoms appears to be patient dependent, but refractory cardiogenic shock may occur and require significant circulatory support. If this situation occurs in a hospital where this necessary equipment is lacking, a mobile ECMO unit appears to be a viable solution to optimize the patient's chances of survival. PMID: 25187250 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Thoratec CentriMag for Temporary Treatment of Refractory Cardiogenic Shock or Severe Cardiopulmonary Insufficiency: A Systematic Literature Review and Meta-Analysis of Observational Studies
The aim of the study was to systematically evaluate effect of CentriMag heart pump (Thoratec Corporation) as temporary ventricular assist device (VAD) and part of extracorporeal membrane oxygenation (ECMO) system on outcomes in patients with cardiac or cardiac-respiratory failure. A systematic search was conducted in five databases for the period 2003 to 2012. Fifty-three publications with data for 999 patients, supported with CentriMag, were included. In 72% studies, CentriMag was used as a VAD and in 25% as part of ECMO circuit. Mean duration of VAD support was 25.0 days in precardiotomy group, 10.9 days in postcardiac surgery cardiogenic shock group, 8.8 days in post-transplant graft failure and rejection group, and 16.0 days in post-LVAD placement right ventricular failure group. Survi...


Perioperative Use of TandemHeart Percutaneous Ventricular Assist Device in Surgical Repair of Postinfarction Ventricular Septal Defect
We report our experience regarding utilization of TandemHeart, a percutaneous ventricular assist device (pVAD) as an adjunct to the treatment of these patients. Retrospective case series study design included a total of 11 patients with post-AMI VSD and severe refractory cardiogenic shock who received pVAD support at our institution. Three patients underwent immediate surgical repair and received pVAD support for postcardiotomy cardiogenic shock for 2, 4, and 7 days, respectively. However, all three died. The other eight patients had pVAD implanted prior to surgical repair in order to rest the myocardium before operation. Hemodynamics improved immediately after pVAD placement, and after receiving pVAD support for 7 ± 3 days, they underwent surgical VSD repair. Their total pre- and post-su...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Less-invasive off-pump ventricular assist device implantation in regional paravertebral analgesia
We describe the clinical course and treatment of a 58-year-old male with a primary cardiogenic shock, who underwent a minimally invasive off-pump ventricular-assist-device (VAD) implantation with the aid of paravertebral regional analgesia. He was extubated soon after the procedure, in the operating room, with the aim to reduce the right ventricle impairment. We illustrate how a minimally invasive implant may improve the clinical outcomes of VAD patients shortening their return time to active life. (Source: Journal of Artificial Organs)


Prevalence and 1-year prognosis of transient heart failure following coronary revascularization
Abstract The occurrence of heart failure during the whole pre-discharge course of coronary revascularization, as far as its influence on subsequent prognosis, is poorly understood. The present study examined the effect of transient heart failure (THF) developing in the acute and rehabilitative phase on survival after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI). Patients in the Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization (ICAROS) were analyzed for THF, the latter being defined either as signs and symptoms consistent with decompensation or cardiogenic shock. ICAROS was a prospective, multicenter registry of 1,262 consecutive patients discharged from 62 cardiac rehabilitation (CR) faci...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Emergent double valve replacement in Austrian syndrome
We present a case of a woman found to have Austrian syndrome who presented to the emergency department (ED) with dehydration and radiographical signs of lobar pneumonia and quickly deteriorated to fulminant cardiogenic shock in less than four hours. An early echocardiogram in the ED confirmed a diagnosis of bi-valvular endocarditis with severe aortic and mitral valve insufficiency and large vegetations on the valve leaflets requiring emergent surgical intervention with double valve replacement. (Source: The American Journal of Emergency Medicine)


Transapical Aortic Valve Implantation: Predictors of Leakage and Impact On Survival: An Update.
CONCLUSIONS: In transapical TAVI, the risk of relevant paravalvular leakage may be eliminated completely. There is no negative impact on survival in patients with lesser, irrelevant grades of regurgitation. PMID: 25149051 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


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


Transapical aortic valve implantation in patients with poor left ventricular function and cardiogenic shock
In line with our institutional no exclusion policy we accept patients with very poor left ventricular performance and cardiogenic shock for transcatheter aortic valve implantation (TAVI). The purpose of our study was to analyze outcome in these patients and to identify what happens to the left ventricular function after TAVI in patients with failing ventricles. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Single-center experience with a minimally invasive apicoaxillary external ventricular assist device
Mechanical circulatory support (MCS) devices have become more popular in the treatment of cardiogenic shock (CS). Options for emergency support include venoarterial extracorporeal membrane oxygenation, percutaneous ventricular assist devices (VADs), and surgical VADs. Among MCS devices, surgical VADs have the advantage of providing sufficient circulatory support1; however, the standard technique requires implantation through a median sternotomy.2 (Source: The Journal of Thoracic and Cardiovascular Surgery)


Epidemiology and Clinical Profile of Takotsubo Cardiomyopathy.
Authors: Sharkey SW, Maron BJ Abstract First described in Japan over 2 decades ago, takotsubo cardiomyopathy (TTC) has emerged as a unique cardiomyopathy with world-wide recognition, mimicking acute coronary syndrome. In early TTC experience, typical patients were older women, with a triggering emotional event, ST-segment elevation, and apical ballooning left ventricular (LV) contraction pattern. However, TTC is now more heterogeneous, occurring in males and younger individuals, without ST-segment elevation, as a spontaneous event in the absence of a trigger, and with diverse LV contraction patterns. Furthermore, TTC is more common than initially thought, now constituting 10% of women with suspected acute coronary syndrome. TTC is also associated with a broader range of psychologic...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Outcomes of Patients Placed on VA ECMO Stratified by Indication
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be a life-saving strategy for patients with refractory cardiogenic shock. Whether the outcomes differ by indication for VA-ECMO has not been well studied. (Source: Journal of Cardiac Failure)


Fulminant Myocarditis
Fulminant myocarditis is a rare condition with acute onset, rapid clinical deterioration and cardiogenic shock We identified all adult patients with fulminant myocarditis referred to our institution over an eleven-year period and describe their initial management and clinical outcomes. (Source: Journal of Cardiac Failure)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Mechanical Circulatory Support in Cardiogenic Shock Following an Acute Myocardial Infarction: A Systematic Review
We present a systematic review of this treatment alternative and suggest guidelines to be considered in the treatment of these patients. (Source: Journal of Cardiac Surgery)


Lateral Left Ventricular Wall Rupture Following Acute Myocardial Infarction: Pathophysiological Interpretation by Multimodality Imaging Approach
Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in‐hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three‐dimensional echocardiography showed a pseudoaneurysm. (Source: Echocardiography)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Medication-induced Takotsubo Cardiomyopathy presenting with cardiogenic shock—utility of extracorporeal membrane oxygenation (ECMO): case report and review of the literature
We report the case of a young female with medication-induced TTC, who presented with cardiogenic shock as initial manifestation, treated successfully with extracorporeal membrane oxygenation (ECMO). To our knowledge, this is the first case in the literature describing the use of ECMO in cardiogenic shock due to medication-induced TTC. (Source: Cardiovascular Revascularization Medicine)


Predictive factors of contrast-induced nephropathy in patients undergoing primary coronary angioplasty.
CONCLUSION: Renal failure and cardiogenic shock at admission were independent predictors of CIN in our acute myocardial infarction population. Mehran's score added little to the discrimination of patients undergoing primary coronary angioplasty, particularly high-risk individuals. PMID: 25082735 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Awake Extracorporeal Membrane Oxygenation (ECMO) as Bridge to Recovery After Left Main Coronary Artery Occlusion: A Promising Concept of Haemodynamic Support in Cardiogenic Shock
Cardiogenic shock following acute myocardial infarction is associated with high mortality rate. Different management concepts including fluid management, inotropic support, intra aortic balloon counterpulsation (IABP) and extracorporeal membrane oxygenation (ECMO) mainly in mechanically ventilated patients have been used as cornerstones of management. However, success rates have been disappointing. Few reports suggested that ECMO when performed under circumvention of mechanical ventilation, may offer some survival benefits. (Source: Heart, Lung and Circulation)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis
Sinus of Valsalva-right atrial fistulas are abnormal connections between the aorta and the right atrium, and present challenging surgical conditions. An extremely rare etiology of aorto-right atrial fistula is infective endocarditis. This case report presents a 21 year old Caucasian female patient who had native aortic valve Staphylococcus aureus endocarditis complicated by sinus of Valsalva abscess perforation associated with an acute heart block, an aorto-right atrial fistula, severe heart failure, and cardiogenic shock. She underwent emergent aortic valve replacement and complex sinus of Valsalva fistula pericardial patch reconstruction and repair. This case report further explores the advantages and disadvantages of different valves for different patient populations, and evaluates the ...


Minimally Invasive Access for Central Extracorporeal Life Support: How We Do It
We present our minimally invasive technique for central ECLS through a nonsternotomy incision. Minimized right‐sided thoracotomy is performed. Flexible arterial and venous cannulas are tunneled toward the right thoracotomy incision through the eighth intercostal space. A sewing ring is secured to the right atrium and a tube graft is anastomosed to the ascending aorta. Following full‐dose heparinization, the arterial cannula is inserted with the tip into the vascular graft of the ascending aorta and the venous cannula via the ring into the right atrium. After meticulous deairing, the central ECLS is set at full flow. (Source: Artificial Organs)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Intra-Aortic Balloon Pump During Extracorporeal Life SupportIntra-Aortic Balloon Pump During Extracorporeal Life Support
Does the use of an intra-aortic balloon pump during extracorporeal life support improve survival in patients with myocardial infarction and cardiogenic shock? BMC Anesthesiology (Source: Medscape Today Headlines)


International differences in acute coronary syndrome patients' baseline characteristics, clinical management and outcomes in Western Europe: the EURHOBOP study
Conclusions Inhospital mortality rates of STEMI and NSTEMI patients were two to three times higher in Finland, Germany and Portugal than in Greece and Spain, with intermediate values for France. Differences in baseline characteristics and clinical management partly explain differences in outcome. Our data also suggest an impact of the healthcare system organisation. (Source: Heart)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Swallowed a needle stuck in heart.
Authors: Yolcu M, Aydın A, Korkmaz AF, Dağ O, Ipek E, Erkut B Abstract Cardiac tamponade (CT) is a clinical entity characterized by hemodynamic insufficiency resulting from increased intrapericardial pressure due to accumulation of contents such as serous fluid, blood, and pus. CT is a treatable cause of cardiogenic shock, which can be fatal unless diagnosed promptly. Dyspnea, chest pain, hypotension, tachycardia, pulsus paradoxus, raised jugular venous pressure, muffled heart sounds, decreased electrocardiographic voltage, and enlarged cardiac silhouette on chest X-ray are the major clinical signs in CT. Idiopathic or viral pericardititis, iatrogenic trauma during percutaneous coronary interventions or coronary artery bypass grafting, external trauma, malignancies, acute or chro...


Clinical outcomes of patients with acute myocardial infarction complicated by severe refractory cardiogenic shock assisted with percutaneous cardiopulmonary support.
CONCLUSION: In spite of PCPS management, AMI patients complicated by severe refractory cardiogenic shock demonstrated high mortality. Older age, CPR, lower lactate clearance for 48 hours, and unsuccessful revascularization were independent predictors of in-hospital mortality. PMID: 24954319 [PubMed - in process] (Source: Yonsei Medical Journal)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


[Ischemic heart failure making the diagnosis of a Vaquez disease: A rare event.]
We present the case of a 46-year-old patient without any past medical history, admitted to our ICU for cardiogenic shock complicating acute coronary syndrome. The blood tests found polycethemia, a polycethemia vera was suspected and confirmed by genetic analysis. Ischemic heart failure as an initial symptom of polycethemia vera and its treatment by arterial bleeding is a rare event that we describe in this article. PMID: 24953661 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)


Transradial vs Transfemoral Coronary Intervention for AMITransradial vs Transfemoral Coronary Intervention for AMI
When cardiogenic shock occurs after AMI, which access point is safer for PCI? The Journal of Invasive Cardiology (Source: Medscape Today Headlines)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Use of a single circuit to provide temporary mechanical respiratory and circulatory support in patients with LV apical thrombus and cardiogenic shock.
CONCLUSION: We demonstrated the use of MCS as a bridge to decision in patients with LV thrombi, utilizing biatrial cannulation with a 'Y' connection to drain both right- and left-sided circulation through a single circuit and pump. PMID: 24916009 [PubMed - as supplied by publisher] (Source: Perfusion)


Acute kidney injury in adults receiving extracorporeal membrane oxygenation.
Authors: Chen YC, Tsai FC, Fang JT, Yang CW Abstract Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as patients with postcardiotomy cardiogenic shock or life-threatening respiratory failure. Acute kidney injury (AKI) that develops during ECMO is associated with a very poor outcome, possibly because of accumulated extravascular water causing interstitial overload, impaired oxygen transport through tissues, and increased extravascular lung water volume with impaired O2 transport. Increased water is associated with subsequent organ dysfunction, particularly of the heart, lungs, and brain. Based on single-center studies, the incidence of AKI is 70-85% in ECMO patients. Therefore, renal replacement therapy is required in approximately 50% o...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers
Abstract: The presented work relates to the procedure followed for the automation of a portable extracorporeal circulatory support system. Such a device may help increase the chances of survival after suffering from cardiogenic shock outside the hospital, additionally a controller can provide of optimal organ perfusion, while reducing the workload of the operator.Animal experiments were carried out for the acquisition of haemodynamic behaviour of the body under extracorporeal circulation. A mathematical model was constructed based on the experimental data, including a cardiovascular model, gas exchange and the administration of medication. As the base of the controller fuzzy logic was used allowing the easy integration of knowledge from trained perfusionists, an adaptive mechanism was incl...


Abstract 29: Temporal Trends in Incidence and Outcomes of Peripartum Cardiomyopathy in the United States: A Nationwide Population-Based Study [Session Title: Concurrent III Session A: Oral Abstracts on Outcomes Issues]
Conclusion: From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, need for mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted. (Source: Circulation: Cardiovascular Quality and Outcomes)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Abstract 350: The 'Frequent Flyer' Hypothesis and Increased Risk of Thirty Day Readmission after Percutaneous Coronary Intervention [Session Title: Poster Session III]
Conclusion: A prior history of frequent admissions and anxiety or depression diagnoses contribute significantly and independently towards 30DR post PCI, even after adjusting for traditional risk factors of readmissions. As such, they should be considered as important risk factors for post PCI readmission. Patients with diagnoses of anxiety or depression were not at increased risk of 30DR for cardiovascular events such as PCI, CABG or acute CHF. Future studies are needed to evaluate the role of treating anxiety and depression in patients at risk for frequent readmissions. (Source: Circulation: Cardiovascular Quality and Outcomes)


Case images: Cardiogenic shock caused by huge para-aortic hematoma and pseudoaneurysm after Bentall operation.
Authors: Sunman H, Erat M, Doğan M, Yeter E PMID: 24899493 [PubMed - as supplied by publisher] (Source: Turk Kardiyoloji Dernegi arsivi)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers
The presented work relates to the procedure followed for the automation of a portable extracorporeal circulatory support system. Such a device may help increase the chances of survival after suffering from cardiogenic shock outside the hospital, additionally a controller can provide of optimal organ perfusion, while reducing the workload of the operator.Animal experiments were carried out for the acquisition of haemodynamic behaviour of the body under extracorporeal circulation. A mathematical model was constructed based on the experimental data, including a cardiovascular model, gas exchange and the administration of medication. (Source: Medical Engineering and Physics)


Takotsubo syndrome with refractory cardiogenic shock after trauma: successful treatment with an intra‐aortic balloon pump
(Source: ANZ Journal of Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


[Emergency coronary artery bypass grafting for acute coronary syndrome: mid-term follow-up results].
CONCLUSION: Despite a slight increase of the in-hospital mortality, ECABG can improve the mid-term survival, freedom from cardiac event, and cardiac function when the indications and timing for surgery are well controlled with optimal perioperative management. PMID: 24849435 [PubMed - in process] (Source: Journal of Southern Medical University)


Inotropes
have been fundamental to resuscitation of acute cardiogenic shock for decades. Heart failure and cardiogenic shock, in severe cases, are syndromes characterized in many patients by a reduction in myocardial contractile force. While inotropes successfully increase cardiac output, their use has been plagued by excessive mortality due to increased tachycardia and myocardial oxygen consumption leading to arrhythmia and myocardial ischemia. There is a pressing need for new inotropic agents that avoid these harmful effects. This review describes the mechanism of action and the clinical utility of some of the older inotropic agents, which are still commonly used, and provides an update for physicians on the development of newer inotropic drugs. The field is rapidly changing, and it is likely tha...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Efficacy and safety of a routine early invasive strategy after fibrinolysis stratified by glycoprotein IIb/IIIa inhibitor use during percutaneous coronary intervention: a pre-specified subgroup analysis of the TRANSFER-AMI randomised controlled trial
Conclusions The apparent difference in the efficacy of an early invasive strategy between GPIIb/IIIa inhibitor strata likely reflects an association between GPIIb/IIIa inhibitor use and baseline risk. GPIIb/IIIa inhibitor use during PCI at the discretion of the treating physician does not appear to modulate the efficacy of an early invasive strategy post-fibrinolysis. Clinical Trial Registration: http://www.clinicaltrials.gov/ct2/show/NCT00164190, NCT00164190. (Source: Heart)


Cardiogenic Shock and Pulmonary Embolism.
Authors: Romero Gómez C, Aguilar García JA, Martín Escalante MD PMID: 24816126 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Effect of early and intensive continuous venovenous hemofiltration on patients with cardiogenic shock and acute kidney injury after cardiac surgery
(Source: The Journal of Thoracic and Cardiovascular Surgery)


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


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


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


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


Short-term and long-term adverse cardiovascular events across the glycaemic spectrum in patients with acute coronary syndrome: the Gulf Registry of Acute Coronary Events-2
BackgroundLimited data exist on the prognostic impacts of diabetes mellitus (DM) and new-onset hyperglycaemia (NOH) on cardiovascular outcomes in Middle Eastern patients with acute coronary syndrome (ACS). Here, we explored this relationship in a large contemporary Middle Eastern ACS registry: the second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Patients and methodsOur analysis included 6362 consecutive ACS patients enrolled from October 2008 to June 2009, with or without a known DM diagnosis, and with an available fasting blood sugar measurement from the index hospitalization. Baseline demographics, risk factors for atherosclerosis, medical history, investigations and therapies were registered. Adverse hospital outcomes, as well as short-term and long-term mortalities were com...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


[ST segment elevation myocardial infarction: What is the best timing for revascularization of non-culprit lesions?]
This article is a review over timing of secondary revascularization in STEMI patients with multi-vessels disease. PMID: 24834992 [PubMed - as supplied by publisher] (Source: Annales de Cardiologie et d'Angeiologie)


Towards a proactive therapy utilizing the modern spectrum of extracorporeal life support: a single-centre experience.
CONCLUSIONS: Our results exemplify the benefits of ELS as a bridge to initial stabilization of critically ill patients. Potentially, the early application of ELS technology can lower mortality and morbidity in patients with a regressive pathology. PMID: 24759930 [PubMed - as supplied by publisher] (Source: Perfusion)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment-Myocardial Infarction: A Prospective, Randomized, Open-Labeled Trial [Myocardial Infarction]
Conclusions&mdash; Treatment with NAC or NaHCO3 did not reduce the rate of acute CIN significantly. Combined treatment with NAC and NaHCO3 may reduce the risk of renal dysfunction after 30 days. Clinical Trial Registration&mdash; URL: http://www.clinicaltrials.gov. Unique identifier: NCT01160627. (Source: Circulation: Cardiovascular Interventions)


Emergency coronary artery bypass grafting for cardiogenic shock due to left main coronary artery obstruction caused by Kawasaki disease in a 4‐year‐old boy
We describe the case of a 4‐year‐old boy whose clinical course after Kawasaki disease resulted in coronary artery bypass grafting (CABG) due to acute myocardial infarction (AMI) causing cardiogenic shock. He had developed an ischemic cardiomyopathy due to severe localized stenosis of the left main coronary artery (LCA) and went into cardiogenic shock due to AMI on the day before a scheduled operation. He underwent successful emergency CABG within 4 h of MI. Postoperatively his neurological status was intact. This is the first report of a successful emergency CABG in a small child with cardiogenic shock due to LCA occlusion. CABG should be undertaken in small patients when appropriate indications exist, if bodyweight is &gt;10 kg. (Source: Pediatrics International)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Short-term continuous-flow ventricular assist devices
Purpose of reviewTo provide a comprehensive update on the current state of short-term, continuous-flow ventricular assist devices (CF-VADs) in the treatment of refractory cardiogenic shock in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 patients. Recent findingsThe mortality rate associated with refractory cardiogenic shock remains markedly elevated, with INTERMACS 1 profile repeatedly demonstrating the worst outcomes. Recent innovations in continuous-flow pump technology have not only contributed to improved outcomes with long-term left ventricular assist device technology, but have also led to the development of various short-term, percutaneous, and surgical CF-VADs. Short-term CF-VADs have several favorable features, but, most notably, they allow the ...


The role of extracorporeal membrane oxygenation circulatory support in the ‘crash and burn’ patient: from implantation to weaning
Purpose of reviewIn advanced cardiogenic shock, early mechanical circulatory support may prevent multiorgan failure and death. In this article, we are describing our experience with extracorporeal membrane oxygenation (ECMO) application. Recent findingsVenoarterial ECMO has been used successfully as a therapeutic option for patients with advanced cardiogenic shock and cardiac arrest. SummaryIn this review, based on the daily routine of the Hershey group using ECMO for therapy of advanced cardiogenic shock, the application of ECMO is described. The aim is to share our hands-on experience during emergent implantation and to contribute to the knowledge within the field of mechanical circulatory support. (Source: Current Opinion in Cardiology)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Editorial: Hypoglycaemia, Hypotriglyceridaemia and Starvation Associated with Cardiogenic Shock
(Source: Nutrition)


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


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


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


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


A new face of endocannabinoids in pharmacotherapy. Part I: Protective role of endocannabinoids in hypertension and myocardial infarction.
Authors: Zubrzycki M, Liebold A, Janecka A, Zubrzycka M Abstract Cannabinoids are compounds which were first isolated from the Cannabis sativa plant. For thousands of years they have been used for treatment of numerous diseases. Currently, synthetic cannabinoids and endocannabinoids are also known. Cannabinoid receptors, endocannabinoids and the enzymes that catalyze their synthesis and degradation constitute the endocannabinoid system which plays an important role in functioning of the cardiovascular system. The results obtained to date suggest the involvement of endocannabinoids in the pathology of many cardiovascular diseases, including myocardial infarction, hypertension and hypotension associated with hemorrhagic, endotoxic, and cardiogenic shock. Cardioprotective effect and d...<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


[Successful surgery for lateral left ventricular wall rupture with severe mitral insufficiency resulting in cardiogenic shock].
Authors: Michalski B, Lipiec P, Bochenek A, Kasprzak JD PMID: 24677044 [PubMed - in process] (Source: Polish Heart Journal)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Case 1/2014 - Syncope Due to Cardiogenic Shock in a 25-year-old Male Patient
Os avanços nas técnicas de cirurgia cardíaca e o diagnóstico precoce têm possibilitado maior sobrevida de indivíduos com cardiopatias congênitas. A investigação da qualidade de vida em crianças e adolescentes com cardiopatias congênitas fornece informações complementares aos dados clínicos que podem auxiliar na tomada de decisão dos profissionais de saúde. Embora muitos estudos tenham sido realizados para investigar a qualidade de vida de crianças e adolescentes com cardiopatias congênitas, os resultados mostram-se contraditórios. Enquanto alguns estudos revelam que as cardiopatias podem impactar a qualidade de vida, outros descrevem melhor percepção da qualidade de vida entre crianças e adolescentes cardiopatas quando comparados com controles saudáveis. O objetivo d...


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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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...


Cardiogenic shock following fulminant myocarditis: a pluri-complicated case report
(Source: The American Journal of Emergency Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Trends in Door‐to‐Balloon Time and Outcomes Following Primary Percutaneous Coronary Intervention for ST‐elevation Myocardial Infarction – An Australian Perspective
ConclusionsThere has been a decline in median DTBT in the MIG registry over five years. DTBT of ≤90 minutes is associated with improved clinical outcomes at 12 months. (Source: Internal Medicine Journal)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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)


Outcomes among patients requiring unplanned intra-aortic balloon pump reinsertion in cardiogenic shock
Conclusion: Among patients with CS undergoing IABP removal, hemodynamic deterioration requiring IABP reinsertion is associated with extremely poor outcomes and, in appropriate patients, should prompt consideration of more advanced cardiac support. (Source: Cardiovascular Revascularization Medicine)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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)


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


Percutaneous Mechanical Assist for Severe Cardiogenic Shock Due to Acute Right Ventricular Failure
Abstract Acute right ventricular failure can lead to severe cardiogenic shock and death. Recovery may be achieved with early supportive measures. In many patients, intravenous fluid and inotropic resuscitation is inadequate to improve cardiac output. In these cases, percutaneous mechanical assist may provide a non‐surgical bridge to recovery. Herein, we describe a case series of patients with severe, refractory cardiogenic shock due to acute right ventricular failure who received a continuous flow percutaneous ventricular device primarily utilizing the right internal jugular vein for out flow cannula placement. © 2014 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Choosing wisely - when to mend a broken heart with ECMO?
Refractory cardiac shock in the cardiac surgical intensive care unit confers significant morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) has become a common intervention for refractory cardiogenic shock when other therapies have failed. However, it is difficult to predict who will benefit from this costly, resource-intensive, but potentially life-saving technology. Here, we discuss the utility of a novel biomarker, serum butylcholinesterase, in determining survival in patients supported with ECMO following cardiac surgery. (Source: Critical Care)


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)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


Refractory hypoglycemia and subsequent cardiogenic shock in starvation and refeeding: Report of three cases
(Source: Nutrition)


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


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


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


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


HeartWare left ventricular assist device thrombosis including outflow graft
A 42-year-old man referred with refractory acute cardiogenic shock and ventricular arrhythmias after extensive anterior myocardial infarction underwent rescue implantation of a CentriMag (Levitronix LLC, Waltham, Mass) biventricular assist device. Because we were not able to match him with a suitable donor, he was implanted with a HeartWare left ventricular assist device (HeartWare International, Inc, Framingham, Mass). At 3 months after discharge, he was urgently readmitted with high pump flow, suggestive of pump thrombosis, for which he underwent thrombolysis. (Source: The Journal of Thoracic and Cardiovascular Surgery)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


Early 'in-lab' use of levosimendan in patients with cardiogenic shock unsuitable for intra-aortic balloon pump counterpulsation
We report the results of four patients with ST elevation myocardial infarction, complicated by cardiogenic shock unsuitable for intra-aortic balloon pump counterpulsation treated with early levosimendan infusion during primary percutaneous coronary intervention. (Source: Therapeutic Advances in Cardiovascular Disease)<div id="medworm"><p><b><i>MedWorm Sponsor Message:</i></b> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


A unique access for the ablation catheter to treat electrical storm in a patient with extracorporeal life support
Conclusion Ablation of ventricular arrhythmias using a Y-connector to insert the ablation catheter into the arterial cannula is feasible in patients with a V-A ECMO system avoiding additional arterial puncture with potentially major vascular complications in critically ill patients. Manipulation of the catheter is not as easy as using a standard sheath but can well be performed after a short habituation. (Source: Europace)


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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</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> Directory of the best <a href="http://www.thejanuarysales.com/">January Sales</a> in the UK. Find the best <a href="http://www.thejanuarysales.com/">Christmas presents</a> too.</p></div>


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


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


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


New generation drug‐eluting stents for ST‐Elevation myocardial infarction: A new paradigm for safety
Conclusions: New generation DES in STEMI patients have less ST compared to BMS and trends for less ST compared to early generation DES. These data suggest a new safety paradigm and should encourage the use of new generation DES in most STEMI patients treated with primary PCI. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)