Physical Therapy Management of Two Patients with Stage D Heart Failure in the Cardiac Medical Intensive Care Unit

Heart failure (HF) is a major cause of morbidity and mortality all over the world. In developed countries because of aging population and increased prevalence of coronary artery disease, heart failure has attained epidemic proportions, whereas, in developing countries like Nepal, rheumatic heart dissease is still the commonest cause of HF admission in medical intensive care unit (MICU). A retrospective study analysing registered data of HF admissions in MICU of Shahid Gangalal National Heart Centre (SGNHC) from August 2002 to OCtober 2008. Among these, 1771 patients were admitted for management of HF and were included in this study. Mean age was 45.07 Å} 35.09 (ranges from 11 years to 95 years). 836 (47%) were male and 935 (53%) were female. Rheumatic heart disease causing valvular cardiac lesion leading to HF was found in 791 (45%) patients. Dilated cardiomyopathy in 424 (24%), Ischemic heart disease in 378 (1%), hypertensive heart failure in 101 (6%) and HG due to congenital heart disease was found in 43 (2%) patients, Though, HF due to COPD / Cor-pulmonale is usually discouraged to be admitted in this heart centre, still 34(2%) patients were admitted for the management of HF due to COPD/cor-pulmonale. Rheumatic heart disease causing valvular cardiac lesion leading to HF admission was still the commonest cause of HF admission in MICU in our heart centre. Despite ACC/AHA guideline suggesting use of beta-blocking agent in patients with heart failure, only 22% of our patients received that agent. Thus, many patients were not being managed fully in accordance with international evidence based guidelines.

Download Full-text

Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea

Journal of Critical Care ◽

10.1016/j.jcrc.2015.04.012 ◽

2015 ◽

Vol 30 (4) ◽

pp. 673-677 ◽

Cited By ~ 18

Author(s):

Hyun Lee ◽

Young Jun Ko ◽

Gee Young Suh ◽

Jeong Hoon Yang ◽

Chi-Min Park ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Physical Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Safety Profile ◽

Medical Intensive Care Unit ◽

Medical Intensive Care ◽

Early Physical Therapy

Download Full-text

Release of mitochondrial DNA is associated with mortality in severe acute heart failure

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618823405 ◽

2019 ◽

Vol 9 (5) ◽

pp. 419-428 ◽

Cited By ~ 2

Author(s):

Konstantin A Krychtiuk ◽

Raphael Wurm ◽

Sarah Ruhittel ◽

Max Lenz ◽

Kurt Huber ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Mitochondrial Dna ◽

Intensive Care ◽

Chronic Heart Failure ◽

Brain Natriuretic Peptide ◽

Acute Heart Failure ◽

Medical Intensive Care Unit ◽

Health Evaluation ◽

Medical Intensive Care

Background: Inflammation is regarded as an important trigger for disease progression in heart failure. Particularly in severe acute heart failure, tissue hypoxia may lead to cellular damage and the release of intracellular mitochondrial DNA, which acts as an activator of the immune system due to its resemblance to bacterial DNA. It may therefore serve as a mediator of disease progression. The aim of this study was to determine circulating levels of mitochondrial DNA and its association with mortality in patients with heart failure in different presentations. Methods: Plasma levels of circulating mitochondrial DNA were measured in 90 consecutive patients with severe acute heart failure admitted to our medical intensive care unit as well as 109 consecutive chronic heart failure patients. Results: In patients admitted to our medical intensive care unit (median age 64 (49–74) years, median NT-pro-brain natriuretic peptide 4986 (1525–23,842) pg/mL, 30-day survival 64.4%), mitochondrial DNA levels were significantly higher in patients who died within 30 days after intensive care unit admission, and patients with plasma levels of mitochondrial DNA in the highest quartile had a 3.4-fold increased risk ( P=0.002) of dying independent of renal function, vasopressor use and NT-pro-brain natriuretic peptide, troponin T, lactate levels or CardShock and acute physiology and chronic health evaluation II score. However, mitochondrial DNA did not provide incremental prognostic accuracy on top of the current gold standard acute physiology and chronic health evaluation II. Patients with severe acute heart failure showed significantly higher mitochondrial DNA levels ( P<0.005) as compared to patients with chronic heart failure. In these patients, mitochondrial DNA levels were associated with the New York Heart Association functional class but were not associated with outcome. Conclusions: The release of mitochondrial DNA into the circulation is associated with mortality in patients with severe acute heart failure but not in patients with chronic heart failure. The release of mitochondrial DNA may therefore play a role within the pathophysiology of acute heart failure, which warrants further research. However, the use of mitochondrial DNA as a biomarker for risk stratification in these patients is of limited utility.

Download Full-text