scholarly journals 398 Right ventricular cardiogenic shock induced by propafenone intoxication: a case report

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Matteo Maurina ◽  
Letizia Bertoldi ◽  
Martina Briani ◽  
Mauro Chiarito ◽  
Bernhard Reimers ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Coronary Plaque ◽  
Hemodynamic Instability ◽  
Clinical Findings ◽  
Circulatory Support ◽  
Emergency Setting ◽  
Conduction Disturbances ◽  
Function Recovery ◽  
Ecg Abnormalities

Abstract Aims Propafenone is a Class 1C antiarrhythmic drug recommended in the treatment of supraventricular or ventricular tachycardia and paroxysmal atrial fibrillation (AF). Most common cardiological features associated with propafenone intoxication include heart failure and conduction disturbances while other clinical findings range from nausea and vomiting to seizures and coma. Methods We report a case of atypical presentation of propafenone intoxication occurred in 88-year-old woman who presented at Emergency Department with severe ECG abnormalities and prevalent acute right ventricular with massive tricuspidalic regurgitation and cardiogenic shock. The patient underwent urgent coronary angiography that revealed a stable 90% coronary plaque that was treated with a single stent and then brought to Intensive Care Unit where she was successfully treated with inotropic and mechanical circulatory support (intra-aortic balloon pump, IABP). Results The patient progressively achieved hemodynamic stability with complete ECG normalization and biventricular function recovery. Conclusions Our case further expands the vast spectrum of presentations of Class 1c antiarrhythmic drugs overdose. In an emergency setting it is difficult to rule out other causes of cardiogenic shock but propafenone toxicity needs to be suspected in every case of hemodynamic instability in patients in chronical treatment. Patients in chronical treatment with propafenone who have kidney or liver dysfunction might be at higher risk of drug accumulation: in such cases, the real utility of propafenone must be evaluated before therapy initiation.

scholarly journals Right ventricular function is associated with 28-day mortality in myocardial infarction complicated by cardiogenic shock: A retrospective observational study

2021 ◽  
pp. 175114372110379
Author(s):  
Hazem Lashin ◽  
Olusegun Olusanya ◽  
Sanjeev Bhattacharyya
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Sensitivity And Specificity ◽  
Peak Systolic Velocity ◽  
Circulatory Support ◽  
Male Mortality ◽  
Cardiac Centre ◽  
Rv Function

Background Right ventricular (RV) function is increasingly being recognised as an important factor influencing outcomes in ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). In this study, we investigated RV echocardiographic parameters’ association with 28-day mortality in patients admitted to intensive care with STEMI complicated by CS with reduced left ventricle ejection fraction (LVEF). Method We performed a retrospective analysis of patients admitted to intensive care unit (ICU) in a single tertiary cardiac centre over a 34-month period with STEMI complicated by CS and LVEF < 40%. Clinical and echocardiographic data were collected and correlated with 28-day mortality. Results One-hundred patients were included with a mean age of 62.6 ±12.7 years and 78% were male. Mortality at 28 days was 37%. Respectively, 85%, 40% and 25% of patients required mechanical ventilation, mechanical circulatory support and renal replacement therapy. Tricuspid annulus peak systolic velocity (RV S’) was significantly higher in survivors (12 ± 3.3 v 10 ± 3.5 cm/s, p = 0.03) and was an independent predictor of mortality (odds ratio 1.2, 95% confidence interval 1.1–1.4, p = 0.04). RV S’ of 10.5 cm/s exhibited best sensitivity and specificity (64% and 65%, respectively; p = 0.02) for mortality. The Kaplan–Meier curve demonstrated 85% risk of 28-day mortality for RV S’ < 10.5 cm/s v 53% for RV S’ > 10.5 cm/s ( p = 0.02). Conclusion RV function is associated 28-day mortality in patients admitted to ICU with STEMI complicated by CS with reduced LVEF. RV S’ predicted mortality with good sensitivity and specificity.

scholarly journals Cardiogenic Shock Due to ST Elevation Myocardial Infarction: How Far Are We?

2021 ◽  
Vol 01 (01) ◽  
pp. 003-0010
Author(s):  
Rohit Mody
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Hemodynamic Instability ◽  
St Elevation Myocardial Infarction ◽  
Treatment Modalities ◽  
Circulatory Support ◽  
Low Cardiac Output ◽  
Body Tissues ◽  
Early Revascularization ◽  
St Elevation

Cardiogenic shock (CS) due to acute ST-elevation myocardial infarction is a complex state of low cardiac output and hemodynamic instability that transmutes to hypoperfusion of various body tissues leading to multi-organ dysfunction and death. Mortality rates due to CS remain high despite many recent advances in treatment. In the management of CS, early revascularization is the mainstay of the treatment. The patient can be stabilized using fl uids, vasopressors or inotropes, mechanical circulatory support, and general intensive care techniques. Due to only few randomized trials on CS patients, there is lack of concrete evidence supporting various treatment modalities, except for revascularization. Thus, CS and its management is a topic with more controversies than conclusions regarding optimal treatment and management.

scholarly journals Acute Right Ventricular Failure in a Patient with Non-ischemic Cardiogenic Shock on Left-Sided Mechanical Circulatory Support

2021 ◽  
Author(s):  
Shuvodra Routh ◽  
Carly Fabrizio ◽  
Christopher Sciortino ◽  
Arman Kilic ◽  
Catalin Toma ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Heart Transplantation ◽  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Right Ventricular Failure ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Ventricular Failure ◽  
Acute Right Ventricular Failure ◽  
Learning Points

We report a case of acute right ventricular failure in a patient with cardiogenic shock on left-sided mechanical circulatory support with Impella 5.0. The patient was successfully bridged to heart transplantation using additional right-sided support with ProtekDuo. Key learning points of the case include prompt recognition of right ventricular failure in patients on left-sided support, early consideration of right-ventricular mechanical support platforms, and timely deployment of right-sided mechanical support.

Abstract 14314: Men Admitted With Takotsubo Syndrome (TTS) Have Increased In-Hospital Morbidity and Mortality: Perspectives From the National Inpatient Sample Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Louis T Vincent ◽  
Jelani Grant ◽  
Bertrand Ebner ◽  
Jennifer Maning ◽  
Paul Montana ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Skilled Nursing Facility ◽  
Hemodynamic Instability ◽  
Primary Diagnosis ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Takotsubo Syndrome ◽  
National Inpatient Sample ◽  
Increased Risk ◽  
All Cause Mortality

Introduction: Takotsubo Syndrome (TTS), also known as Stress Induced Cardiomyopathy, is characterized by reversible left ventricular dysfunction without obstructive coronary disease, and largely affects post-menopausal women. However, limited data suggest increased mortality risk in men. We sought to compare national in-hospital outcomes between men and women admitted with TTS. Methods: All patients above 18 years who were admitted with primary diagnosis of TTS between 2012-2017 were identified by International Classification of Diseases (ICD)-9 and ICD-10 diagnostic codes in the National Inpatient Sample (NIS) Database. The primary endpoint was in-hospital all-cause mortality. Secondary endpoints included in-hospital complications, total cost, and duration of hospitalization. Results: A total of 8732 patients (90.8% female) were admitted with primary diagnosis of TTS. Women with TTS were older compared to men (66.9±12.4 vs. 63.1±15.7 years, p<0.001). However, men had increased tobacco use (48.8% vs 37.2%), alcohol use (11.6% vs 3.1%), and coronary artery disease (47.0% vs 39.7%, p<0.001 for all). Prevalence of diabetes, hypertension, atrial fibrillation, anemia, and heart failure was similar between groups. Men more frequently developed cardiogenic shock (7.1% vs 4.4%, p<0.001) requiring mechanical circulatory support (2.9% vs 1.7%, p=0.01), and had greater all-cause mortality compared to women (2.5% vs 1.4%, p=0.01). Using a multivariate regression model to adjust for age, race, substance use, and comorbidities, male gender (OR 2.12, 95% CI [1.69-2.68], p<0.001) and cardiogenic shock (OR 15.1, 95% CI [12.6-18.0], p<0.001) were associated with increased all-cause mortality. Lastly, men experienced greater length and cost of stay (4.0±4.2 vs. 3.6±3.6 days, and $56,428 vs. $46,908), fewer routine discharges (74.3% vs. 77.6%), and greater need for skilled nursing facility (11.6% vs. 9.2%, p<0.001 for all). Conclusion: TTS occurs predominantly in women but carries increased risk of in-hospital mortality in men, especially when complicated by cardiogenic shock. Perhaps improved risk stratification and early identification of patients with signs of shock or hemodynamic instability may help to improve outcomes.

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