scholarly journals Postoperative cardiogenic shock secondary to Takotsubo’s syndrome

2019 ◽  
Vol 12 (12) ◽  
pp. e233055
Author(s):  
Tessa Dessain ◽  
Rachel Stewart ◽  
Shashank Patil
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Rapid Recovery ◽  
Impaired Left Ventricular Function ◽  
Atypical Presentations

Takotsubo’s syndrome is a rare acute reversible heart failure, where the pathophysiology is not fully understood. It is being increasingly diagnosed in varied clinical contexts, which can result in atypical presentations in the context of surgical or anaesthetic stress. We discuss the case of a 22-year-old woman who developed cardiogenic shock and impaired left ventricular function after an elective gynaecological procedure. She had a rapid recovery and a follow-up cardiac MRI confirmed Takotsubo’s syndrome.

Abstract 18973: Left Ventricular Function Improvement After Recent MI in Patients Using a Wearable Cardioverter Defibrillator

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chingping Wan ◽  
Steven J Szymkiewicz
Keyword(s):  
Heart Failure ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Clinical Characteristics ◽  
Treated Group ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator

Introduction: The wearable cardioverter defibrillator (WCD) has been used to protect AMI patients with reduced LVEF (≤35%) until ICD evaluation is recommended. The rate of EF improvement (e.g. EF>35%) over the initial 8-12 weeks after AMI has not been reported. METHODS: The manufacturer-maintained registry was searched for AMI patients who received a WCD shock for VT/VF between 05/2008 and 02/2013. The treated group was matched (1: ~4) with event-free WCD patients by ICD-9 code (410.*), gender, age and prescription date. Chart notes were reviewed for clinical characteristics. Follow-up was assessed through the registry and Social Security Death Master File. RESULTS: There were 992 (age=63±12, female=20.2%) AMI patients included in the final analysis, 206 treated by WCD and 786 event-free patients. Median follow-up was 334 days. Mean length of WCD use was 67±506 (median=38) days. Subgroup clinical characteristics are presented in Table 1. In the event-free group, 289 (38.9%) patients showed EF improvement to >35%. Nine (4.5%) in the treated group continued wearing the WCD until EF recovery, while 125 (60.7%) received ICD. Absence of recorded heart failure and/or diabetes were associated with LVEF recovery (p<.0001). CONCLUSION: In our study, almost 40% of AMI patients with initial EF ≤35% had EF improvement in two months. The EF recovery group had lower rates of heart failure and diabetes. WCD allows time for left ventricular function recovery in low EF post MI patients, optimizing ICD implantation decisions.

scholarly journals Adverse Cardiovascular Effects of Ketamine Infusion in Patients with Catecholamine-Dependent Heart Failure

1997 ◽  
Vol 25 (3) ◽  
pp. 255-259 ◽  
Author(s):  
G. Christ ◽  
G. Mundigler ◽  
C. Merhaut ◽  
M. Zehetgruber ◽  
C. Kratochwill ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Cardiovascular Effects ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Impaired Left Ventricular Function ◽  
Midazolam Group ◽  
Group A ◽  
Group B

The longterm effects of ketamine on haemodynamic parameters and exogenous catecholamine requirements were studied in twenty-five critically ill patients with catecholamine-dependent heart failure. Following sedation with midazolam (0.15±0.07 mg.kg–1.h–1) and sufentanil (0.88±0.33 μg.kg–1.h–1), patients with impaired left ventricular function (left ventricular ejection fraction area 30±7%) were randomly assigned to receive ketamine (2.5±0.9 mg.kg–1.h–1) and midazolam (Group A) or remained on sufentanil/midazolam (Group B). Haemodynamic measurements were performed throughout the first 24 hours after randomization. In group A cardiac index decreased by 21% (P=0.01), mean arterial pressure increased by 13% (P=0.01), mean pulmonary artery pressure by 14% (P=0.04), pulmonary capillary wedge pressure by 20% (P=0.03), and systemic vascular resistance index by 38% (P<0.001). No significant cardiovascular effects were observed in Group B. Neither group had significant changes of exogenous catecholamine requirement. In conclusion, ketamine exhibits potential negative cardiovascular effects in patients with catecholamine-dependent heart failure. Therefore, ketamine should not be considered a first line drug for longterm sedation of patients with impaired left ventricular function.

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