Relations between bleeding and outcomes in patients with ST-elevation myocardial infarction in the ExTRACT-TIMI 25 trial
Conclusion
Cardiogenic shock, age, and ICH were important independent correlates of 30-day and 1-year mortality in STEMI patients receiving fibrinolytic therapy. In-hospital non-ICH major and minor bleeding were not independently associated with increased mortality at 30 days or 1 year. (Source: European Heart Journal)...
POSTED 09/01/2010 at 02:09 AM --
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Cardiogenic shock due to citomegalovirus myocarditis: successful clinical treatment
CONCLUSION: Potentially curable forms of myocarditis, like M pneumoniae and CMV, for example, can have an initial disproportionate aggression to the myocardium, by the acute inflammatory reaction, that can by itself make worse the damage to the LV function. In our opinion, the blockade of this process by pulsotherapy with steroids can help in the treatment of these patients. We understand that the different scenario of immunosuppressive treatments for the possible auto immunity of the more chronic forms of the presumably post viral cardiomyopathy has been in dispute in the literature, and has stolen the focus from the truly acute cases.OBJETIVO: Doença sistêmica por citomegalovÃrus (CMV) com miocardite em pessoas saudáveis é raramente referida na literatura, apesar de em maior número......
POSTED 08/29/2010 at 04:48 AM --
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Giant Cell Myocarditis Associated With Coxsackievirus Infection
Giant cell myocarditis (GCM) is a rare myocarditis (). The relationship between GCM and Coxsackievirus B (CVB) infection has not been documented yet. A 40-year-old woman was admitted because of palpitations and dizziness for 4 days. Two weeks earlier, she had a mild fever. Mechanical circulatory support was started because of recurrent ventricular tachycardia and progressive cardiogenic shock, and heart transplantation was done at day 10. Biopsy of the left atrium at day 5 showed severe inflammation and myocardial necrosis (A, arrows) with multinucleated giant cells (B, arrows), and enteroviral VP1 protein was detected in immunohistochemistry (C, arrows). By reverse transcriptaseâpolymerase chain reaction, CVB VP1 ribonucleic acid could be detected in all chambers of the explanted heart ......
POSTED 08/27/2010 at 12:23 AM --
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Transapical Aortic Valve Implantation in 175 Consecutive Patients: Excellent Outcome in Very High-Risk Patients
Conclusions: The outcome of transapical aortic valve implantation was very favorable and already reproducible during the learning curve. The method has become de facto our institutional primary choice for treatment of high-risk patients with severe aortic valve stenosis. (Source: Journal of the American College of Cardiology)...
POSTED 08/27/2010 at 12:23 AM --
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Abdominal Compartment Syndrome Due to Extracorporeal Membrane Oxygenation in Adults [CASE REPORTS]
In conclusion, when ECMO dysfunction or hemodynamic impairment occurs, ACS should be considered and a decompressive laparotomy should be performed. (Source: The Annals of Thoracic Surgery)...
POSTED 08/24/2010 at 03:35 PM --
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Use of the AB5000TM Ventricular Assist Device in Cardiogenic Shock After Acute Myocardial Infarction [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions
Results from this nationwide registry suggest that VADs can restore normal hemodynamics and support recovery of native cardiac function in the majority of survivors when conventional therapies fail. However, a longer duration of support than previously recognized may be required. In the absence of clinical guidelines, early aggressive use of VAD support in AMI complicated by cardiogenic shock may improve outcomes, and recovery of native cardiac function should always be the primary goal. (Source: The Annals of Thoracic Surgery)...
POSTED 08/24/2010 at 03:35 PM --
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Off-Pump Bypass Surgery and Postoperative Stroke: California Coronary Bypass Outcomes Reporting Program [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions
The OPCAB was associated with a significantly lower postoperative stroke rate compared with CCB even for older and higher risk patients. However, intraoperative OPCAB to CCB conversion was associated with the highest postoperative stroke rate. (Source: The Annals of Thoracic Surgery)...
POSTED 08/24/2010 at 03:35 PM --
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Abiomed Impella(R) 2.5 patient transport: lessons learned.
Authors: Griffith KE, Jenkins E
The Abiomed Impella((R)) 2.5 is a micro-axial flow, catheter-based left ventricular assist system (LVAS). Designed for percutaneous insertion into the femoral artery and positioned across the aortic valve, the Impella((R)) is capable of pumping 2.5 liters of blood per minute from the patient's left ventricle into the ascending aorta. Since United States Federal Food and Drug Administration clearance in June of 2008, use of the Impella((R) ) 2.5 has grown rapidly. We operate at the center of a "hub-and-spoke" regional referral network that facilitates the transfer of patients in cardiogenic shock to our facility for definitive care. Based on our recent experience of transporting patients supported on the Impella((R)) 2.5 system, we review system operation......
POSTED 08/19/2010 at 06:00 PM --
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Unprotected Left Main Coronary Disease and ST-Segment Elevation Myocardial Infarction: A Contemporary Review and Argument for Percutaneous Coronary Intervention
Acute occlusion involving the unprotected left main coronary artery (ULMCA) is a clinically catastrophic event, often leading to abrupt and severe circulatory failure, lethal arrhythmias, and sudden cardiac death. Although coronary artery bypass grafting (CABG) is the standard of care for ULMCA disease in patients with stable ischemic heart disease, uncertainty surrounds the optimal revascularization strategy for patients with ST-elevation myocardial infarction (MI) and ULMCA occlusion who survive to hospitalization, and treatment guidelines in this setting are vague. Percutaneous coronary intervention (PCI) is technically feasible in most patients, has the advantage of providing more rapid reperfusion compared with CABG with acceptable short- and long-term outcomes, and is associated with......
POSTED 08/16/2010 at 03:01 PM --
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Retroperitoneal Hematoma After Percutaneous Coronary Intervention: Prevalence, Risk Factors, Management, Outcomes, and Predictors of Mortality: A Report From the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) Registry
Conclusions
Retroperitoneal hematoma is an uncommon complication of contemporary percutaneous coronary intervention associated with high morbidity and mortality. The identification of risk factors for the development of RPH could lead to modification of procedure strategies aimed toward reducing its incidence. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)...
POSTED 08/16/2010 at 03:01 PM --
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Prognosis and high-risk complication identification in unselected patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.
Conclusion: Unselected patients with STEMI treated with primary PCI have mortality rates corresponding to those reported in randomized clinical studies including transport of patients. Mortality is strongly related to high-risk complications developed during admission. Thus, patients with high-risk complications should receive special attention. The majority of patients (65%) without high-risk complications have an excellent short- and long-term prognosis following primary PCI.
PMID: 20712452 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)...
POSTED 08/15/2010 at 06:00 PM --
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Flecainide overdose: Cardiogenic shock: case report
(Source: Reactions)...
POSTED 08/13/2010 at 12:47 AM --
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Successful use of intra-aortic counter pulsation therapy for intractable ventricular arrhythmia in patient with severe left ventricular dysfunction and normal coronary arteries.
We report a case in which IABP was used in a patient with dilated cardiomyopathy and normal coronary arteries, who presented with persistent, recurrent and refractory ventricular tachycardia. His ventricular tachycardia settled immediately with the use of IABP therapy. He subsequently had an implantable defibrillator. The use of IABP is associated with favorable changes in the left ventricular wall tension and reduction in afterload, which could reduce the excitability of the myocardium, thus making it less prone to arrhythmias. The use of IABP is relatively safe and should be considered in patients with refractory ventricular arrhythmias, even if it is not associated with ischemia. (Cardiol J 2010; 17, 4: 401-403).
PMID: 20690098 [PubMed - in process] (Source: Cardiology Journal)...
POSTED 08/09/2010 at 05:12 AM --
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Massive mitral regurgitation secondary to acute ischemic papillary muscle rupture: The role of echocardiography.
We report the case of an AMI complicated by the development of an abrupt cardiogenic shock due to the rupture of the head of the postero-medial papillary muscle with echocardiographic demonstration of severe mitral regurgitation due to flail posterior mitral valve leaflet. After initial stabilization with medical therapy and diagnostic coronary angiography, the patient was referred for urgent cardiac surgery and successfully underwent mitral valve replacement with implantation of a bioprosthesis. This case confirms the importance of transthoracic echocardiography in diagnosing mechanical acute complications during an AMI and in the decision making of patients with sudden onset of hemodynamic compromise. Transthoracic echogardiography should be immediately carried out in all patients in who......
POSTED 08/09/2010 at 05:12 AM --
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Intraosseous administration of thrombolysis in out-of-hospital massive pulmonary thromboembolism
Pulmonary thromboembolism has an incidence of more than 69/100 000 population but may be underdiagnosed because of the non-specific character of its symptoms and difficult differential diagnosis. The prognosis is worse if the pulmonary thromboembolism is massive and associated with haemodynamic instability, whereupon mortality rises to over 50%. Cardiogenic shock supervenes and cardiopulmonary arrest is often inevitable. This emergency can only be prevented by aggressive therapy with thrombolytic agents. The case history is described of a 25-year-old woman in cardiogenic shock leading to prehospital cardiac arrest in which intravenous access was impossible. Resuscitation drugs were given by the intraosseous route and, with a suspected diagnosis of massive pulmonary thromboembolism, it was ......
POSTED 08/05/2010 at 09:17 AM --
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Caring of ST-elevation myocardial infarction patients in rural community hospital settings: Determinants of in-hospital mortality
Conclusions: In rural hospital settings, clinical resources and transfer facilities are limited. Therefore, improvement of early transfer and prehospital fibrinolysis capabilities should decrease mortality. (Source: Australian Journal of Rural Health)...
POSTED 08/01/2010 at 06:00 PM --
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Caring of ST-elevation myocardial infarction patients in rural community hospital settings: Determinants of in-hospital mortality.
Conclusions: In rural hospital settings, clinical resources and transfer facilities are limited. Therefore, improvement of early transfer and prehospital fibrinolysis capabilities should decrease mortality.
PMID: 20690914 [PubMed - in process] (Source: The Australian Journal of Rural Health)...
POSTED 07/31/2010 at 06:00 PM --
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Risk factors for death among critically ill elderly patients
OBJETIVO: A população idosa está aumentando em todo o mundo, assim como a necessidade de cuidados intensivos para os idosos. Existem poucos estudos que investiguem os fatores de risco para óbito em pacientes idosos gravemente enfermos. Este estudo teve o objetivo de investigar os fatores associados ao óbito em uma população de pacientes idosos gravemente enfermos admitidos a uma unidade de terapia intensiva no Brasil. MÃTODOS: Estudo retrospectivo de coorte que incluiu todos os pacientes idosos (idade ⥠60 anos) admitidos a uma unidade de terapia intensiva em Fortaleza, Brasil, de janeiro a dezembro de 2007. Foi realizada uma comparação entre os sobreviventes e os não sobreviventes, e os fatores de risco para óbito foram investigados por meio de análise univariada e multivar......
POSTED 07/31/2010 at 02:36 AM --
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Thrombelastometry-guided thrombolytic therapy in massive pulmonary artery embolism
We report a case of a patient who suffered a massive pulmonary embolism with cardiac arrest on post-operative day 4 after a Whipple operation. Despite thrombolytic therapy with the recommended maximal bolus of 50 mg recombinant tissue type plasminogen activator (rt-PA), thrombelastometry showed no signs of fibrinolysis and cardiogenic shock persisted, after only a transient hemodynamic improvement. Not until a repeat bolus of 25 mg rt-PA and an infusion of 50 mg/h did thrombelastometry demonstrate complete fibrinolysis. Although only residual emboli were seen on computed tomography, the patient died secondary to refractory right heart failure. This demonstrates that the standard dosing of thrombolytics may fail in a subgroup of patients, and suggests that thrombelastometry may be useful fo......
POSTED 07/29/2010 at 06:00 PM --
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Management of Prosthetic Valves during Ventricular Assist Device Implantation
Conclusions: The survival rate of 60% is encouraging when compared to overall survival rates. The most common cause of death was MSOF. Patients with prosthetic valves may be safely managed during VAD support.(J Card Surg ****;**:**-**) (Source: Journal of Cardiac Surgery)...
POSTED 07/28/2010 at 06:00 PM --
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