Risk factors for stroke after cardiac surgery: The role of screening carotid ultrasonography

Introduction: Takotsubo syndrome (TTS) may be complicated by left-ventricular (LV) thrombus formation in 1.3–5.3% of patients. Risk factors for thrombi comprise apical TTS, elevated levels of C-reactive protein and troponine, thrombocytosis, persisting ST segment elevation and right-ventricular involvement. Embolic risk appears high, and anticoagulation is recommended. Case Presentation: We present 3 females, aged 60–82 years, with TTS-associated LV thrombi and cerebral embolism despite therapeutic anticoagulation. Two patients showed apical and 1 patient midventricular ballooning. In 2 patients LV thrombi had not been present at the first echocardiographic examination. LV thrombi were multiple and highly mobile in 2 patients; 1 patient had a single immobile thrombus associated with spontaneous echocardiographic contrast (SEC). In each case, 3 of the described risk factors for LV thrombus formation were identified. The embolic stroke occurred 41–120 h after TTS symptom onset and 21–93 h after the initiation of therapeutic anticoagulation. Two patients were discharged with a neurological deficit, and 1 of them eventually died as a consequence of the stroke. LV thrombectomy to prevent embolism, which has been reported in a small number of cases, had not been considered in our patients. Conclusion: At present, the management of patients with TTS-related thrombi is still unclear, and further studies are urgently needed to assess the best methods for imaging and anticoagulation and to determine the role of thrombolysis and cardiac surgery. Until these studies are available, we suggest the following approach: patients with a TTS-related thrombus should be monitored by echocardiography while receiving anticoagulation. In case of highly mobile LV thrombi, the heart team may consider cardiac surgery to prevent systemic embolism. The role of SEC in TTS remains to be determined.

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Low cardiac output state in a postoperative cardiac patient

Challenging Concepts in Paediatric Critical Care ◽

10.1093/med/9780198794592.003.0013 ◽

2020 ◽

pp. 153-166

Author(s):

Arun Ghose ◽

Adrian Plunkett

Keyword(s):

Risk Factors ◽

Cardiac Output ◽

Cardiac Surgery ◽

Measurement Techniques ◽

Surgical Patients ◽

Low Cardiac Output ◽

Output State ◽

Cardiac Lesions ◽

Systolic And Diastolic Function

Chapter 13 covers the low cardiac output state (LCOS) in children following cardiac surgery. It begins by explaining how LCOS is defined, risk factors for its development, and how to assess and investigate a child with LCOS. The role of echocardiography is discussed, and the limitations of other measurement techniques are examined. Modifiable causes of LCOS in postoperative cardiac surgical patients are examined, including residual cardiac lesions and arrhythmias—and their management discussed. Important physiological concepts in the understanding of LCOS are addressed, including preload, afterload, systolic and diastolic function, and fluid responsiveness. Finally, options for managing patients with LCOS are covered, including the role of drugs, surgery, and extracorporeal membrane oxygenation.

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Epidemiology, risk factors and clinical role of TT virus infection in polytransfused patients after cardiac surgery in childhood: Impact of HCV co infection

Journal of Clinical Virology ◽

10.1016/j.jcv.2006.01.007 ◽

2006 ◽

Vol 36 (1) ◽

pp. 82-83

Author(s):

Manfred Vogt ◽

Mustafa Rifai ◽

Siegmund Braun ◽

Raymonde Busch ◽

John Hess ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Virus Infection ◽

Clinical Role ◽

Tt Virus

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Risk Factors for Perioperative Acute Kidney Injury After Adult Cardiac Surgery: Role of Perioperative Management

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2011.09.073 ◽

2012 ◽

Vol 93 (2) ◽

pp. 584-591 ◽

Cited By ~ 140

Author(s):

Alessandro Parolari ◽

Lorenzo L. Pesce ◽

Davide Pacini ◽

Valeria Mazzanti ◽

Stefano Salis ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Perioperative Management ◽

Kidney Injury ◽

Adult Cardiac Surgery

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Risk factors for surgical site infection after cardiac surgery: The role of endogenous flora

Heart & Lung ◽

10.1016/j.hrtlng.2004.02.004 ◽

2005 ◽

Vol 34 (2) ◽

pp. 108-114 ◽

Cited By ~ 29

Author(s):

Janet P. Haas ◽

Ann M. Evans ◽

Karen E. Preston ◽

Elaine L. Larson

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Surgical Site Infection ◽

Site Infection

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Role of acquired and hereditary thrombotic risk factors in patients with ischemic colitis

Gastroenterology ◽

10.1016/s0016-5085(01)81398-6 ◽

2001 ◽

Vol 120 (5) ◽

pp. A282-A282

Author(s):

I KOUTROUBAKIS ◽

A SFIRIDAKI ◽

A THEODOROPOULOU ◽

A LIVADIOTAKI ◽

P DIMOULIOS ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Colitis ◽

Thrombotic Risk

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Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽

10.1027/0227-5910/a000364 ◽

2016 ◽

Vol 37 (2) ◽

pp. 130-139 ◽

Cited By ~ 9

Author(s):

Danica W. Y. Liu ◽

A. Kate Fairweather-Schmidt ◽

Richard Burns ◽

Rachel M. Roberts ◽

Kaarin J. Anstey

Keyword(s):

Risk Factors ◽

Well Being ◽

Current Status ◽

Psychological Resilience ◽

Cross Sectional ◽

Life Project ◽

Resilience Factors ◽

First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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Protective Factors and Suicidality in Members of Arab Kindred

Crisis ◽

10.1027/0227-5910/a000116 ◽

2012 ◽

Vol 33 (2) ◽

pp. 80-86 ◽

Cited By ~ 6

Author(s):

Sami Hamdan ◽

Nadine Melhem ◽

Israel Orbach ◽

Ilana Farbstein ◽

Mohammad El-Haib ◽

...

Keyword(s):

Risk Factors ◽

Protective Factors ◽

Suicidal Behavior ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Suicidal Risk ◽

Arab Population ◽

Psychiatric Interview ◽

History Of

Background: Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors. Aims: To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors. Methods: We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale. Results: Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2 = 11.17, p = .001), an anxiety disorder (87.5% vs. 22.9, χ2 = 21.02, p < .001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher’s, p = .003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31 ± 1.36 vs. 4.96 ± 1.40, t = 4.10, df = 62, p < .001), and they have the view that suicide is somehow unacceptable (1.83 ± .10 vs. 1.89 ± .07, t = 2.76, df = 60, p = .008). Conclusions: Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

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