Cardiogenic Shock due to Kounis Syndrome following Cobra Bite

Kounis syndrome is associated with mast cell activation resulting in acute coronary syndrome secondary to an allergic insult. Various drugs such as antibiotics, analgesics, and environmental exposures such as bee, wasp sting, and poison ivy are known to induce Kounis syndrome. A 68-year-old man admitted with a cobra bite on both hands to emergency care unit and sustained cardiorespiratory arrest. Electrocardiogram, taken 6 hours after the cardiac arrest, showed ST elevations in leads V2 to V5 suggestive of anterior ST elevation myocardial Infarction (STEMI). Serum Troponin was 10 ng/ml (control= <0.5). Serum IgE levels were significantly high (19155IU/ml, baseline 100). 2-Dimensional echocardiogram showed anterior and apical-septal hypokinesia with left ventricular ejection fraction of 30-35%. Coronary angiogram was normal. He remained hypotensive requiring inotropic and vasopressor support during ICU stay. This was a case of Kounis syndrome leading to cardiogenic shock secondary to Cobra (naja naja) bite. This is the only reported case of cobra bite causing Kounis syndrome and cardiogenic shock. Identification of the cause of myocardial infarction in snake envenomation is useful in the management as some of the drugs like adrenaline, morphine, and beta blockers may worsen the clinical syndrome if it is due to Kounis syndrome.

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Acute myocardial infarction and cardiogenic shock in patient with COVID-19

Kardiologiia ◽

10.18087/cardio.2021.11.n1534 ◽

2021 ◽

Vol 61 (11) ◽

pp. 104-107

Author(s):

Yu. A. Schneider ◽

V. G. Tsoi ◽

M. S. Fomenko ◽

P. A. Shilenko ◽

I. I. Dimitrova ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Intensive Care ◽

Cardiogenic Shock ◽

Intensive Therapy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Risk Of Death ◽

Coronary Syndrome

The conditions of the pandemic caused by the novel coronavirus infection (COVID-19) are associated with overloading intensive care units, conversion of hospitals, and changes in routing of patients with acute cardiovascular pathology. At the same time, medical practice is still challenged to provide medical care to patients with acute coronary syndrome (ACS). Patients with COVID-19 and acute myocardial infarction (AMI) are at a higher risk of death while the incidence of this combination of diseases will be growing. This article describes a case of diagnosis and treatment of COVID-19 in a 69-year-old patient who was urgently hospitalized with cardiogenic shock associated with ACS, electrocardiographic signs of complete left bundle branch block, and left ventricular ejection fraction of 19 %. Coronary angiography with stenting was successfully performed in the conditions of extracorporeal membrane oxygenation. The patient received long-term intensive therapy in the intensive care unit followed by symptomatic treatment in the cardiac surgery unit. The patient’s condition gradually improved and he was discharged from the hospital on the 56th day. The strategy of intensive care and active follow-up helped saving life of the patient with COVID-19 and AMI.

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New onset of atrial fibrillation in cardiogenic shock

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.009 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

H Santos ◽

T Vieira ◽

J Fernandes ◽

AR Ferreira ◽

M Rios ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiogenic Shock ◽

Linear Regression Analysis ◽

Clinical Signs ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

The Impact ◽

New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The development of cardiogenic shock (CS) is associated with worse prognosis, and can produce several hemodynamic manifestations. Then, is not surprised the manifestation of new-onset atrial fibrillation (AF) in these patients. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of new-onset of AF in CS. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 40 of them presented new onset of AF. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without AF had a mean age of 61.08 ± 13.77 years old, on the other hand new-onset of AF patients in the setting of CS had a mean age of 67.02 ± 14.21 years old (p = 0.016). Nevertheless, no differences between the two groups was detected regarding the sex cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leukocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. New-onset of AF in CS patient had not impact in mortality rates. Multiple logistic regression reveals that only age was a predictor of new onset of AF in CS patients (odds ratio 1.032, confident interval 1.004-1.060, p = 0.024). Conclusions Age was the best predictor of new-onset AF in CS patients. The presence of this arrhythmia can have a hemodynamic impact, however, seems not influenced the final outcome.

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Is Troponin really a reliable marker in patients with acute ischemic stroke?

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2018-0016 ◽

2018 ◽

Vol 56 (4) ◽

pp. 250-256 ◽

Cited By ~ 1

Author(s):

Zeynep Yildiz ◽

Abdulkadir Koçer ◽

Şahin Avşar ◽

Göksel Cinier

Keyword(s):

Myocardial Infarction ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Troponin I ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Anterior Circulation ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

Reliable Marker

Abstract Background and purpose. Cardiac troponin I (cTnI) is a reliable marker to diagnose acute myocardial infarction, but the pathophysiological explanation for the increase in cTnI levels in patients with acute ischemic stroke (IS) remains unknown. To overcome this question, we aimed to compare serum cTnI levels in acute coronary syndrome (ACS) concomitant with and without stroke. By doing like this, we thought that we could demonstrate the effect of stroke on TrpI level. Methods. Serum cTnI levels of 41 patients having ACS with acute IS during hospitalization were compared with 97 control patients having only ACS. Cranial CT was performed to evaluate the lesions. The severity of IS was evaluated objectively by national institutes of health stroke scale. Results. cTnI levels were found to be similar in both groups. Presence of diabetes mellitus, coronary artery disease and previous myocardial infarction were more frequent in patients with acute IS. The cTnI levels in the patients with the cranial lesion in the anterior circulation was higher (p = 0.039). Presence of acute IS, cTnI level higher than 20 ng/mL and left ventricular ejection fraction < 40% were found to be independent risk factors for mortality (p < 0.05). Conclusions. We found that abnormal troponin levels were more likely to be due to cardiac causes than cerebral ones in this first study evaluating the cTnI levels in patients with ACS concomitant with acute IS. The severity of IS, lesion location in the anterior circulation and higher troponin levels were associated with mortality.

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Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock

Open Heart ◽

10.1136/openhrt-2018-000987 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000987 ◽

Cited By ~ 16

Author(s):

Brunilda Alushi ◽

Andel Douedari ◽

Georg Froehlig ◽

Wulf Knie ◽

Thomas H Wurster ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Primary Outcome ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Left Ventricular Ejection ◽

Bleeding Complications ◽

Ventricular Ejection Fraction ◽

All Cause Mortality

ObjectiveWe investigated the benefit of Impella, a modern percutaneous mechanical support (pMCS) device, versus former standard intra-aortic balloon pump (IABP) in acute myocardial infarction complicated by cardiogenic shock (AMICS).MethodsThis single-centre, retrospective study included patients with AMICS receiving pMCS with either Impella or IABP. Disease severity at baseline was assessed with the IABP-SHOCK II score. The primary outcome was all-cause mortality at 30 days. Secondary outcomes were parameters of shock severity at the early postimplantation phase. Adjusted Cox proportional hazards models identified independent predictors of the primary outcome.ResultsOf 116 included patients, 62 (53%) received Impella and 54 (47%) IABP. Despite similar baseline mortality risk (IABP-SHOCK II high-risk score of 18 % vs 20 %; p = 0.76), Impella significantly reduced the inotropic score (p < 0.001), lactate levels (p < 0.001) and SAPS II (p =0.02) and improved left ventricular ejection fraction (p = 0.01). All-cause mortality at 30 days was similar with Impella and IABP (52 % and 67 %, respectively; p = 0.13), but bleeding complications were more frequent in the Impella group (3 vs 4 units of transfused erythrocytes concentrates due to bleeding complications, p = 0.03). Previous cardiopulmonary resuscitation (HR 3.22, 95% CI 1.76 to 5.89; p < 0.01) and an estimated intermediate (HR 2.77, 95% CI 1.42 to 5.40; p < 0.01) and high (HR 4.32 95% CI 2.03 to 9.24; p = 0.01) IABP-SHOCK II score were independent predictors of all-cause mortality.ConclusionsIn patients with AMICS, haemodynamic support with the Impella device had no significant effect on 30-day mortality as compared with IABP. In these patients, large randomised trials are warranted to ascertain the effect of Impella on the outcome.

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Elevated Plasma IL-37, IL-18, and IL-18BP Concentrations in Patients with Acute Coronary Syndrome

Mediators of Inflammation ◽

10.1155/2014/165742 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 46

Author(s):

Qingwei Ji ◽

Qiutang Zeng ◽

Ying Huang ◽

Ying Shi ◽

Yingzhong Lin ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Angina Pectoris ◽

Unstable Angina ◽

Left Ventricular ◽

Unstable Angina Pectoris ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome

Objective.More recently, evidence showed that the novel anti-inflammatory cytokine interleukin- (IL-) 37 was expressed in the foam-like cells of atherosclerotic coronary and carotid artery plaques, suggesting that IL-37 is involved in atherosclerosis-related diseases. However, the plasma levels of IL-37 in patients with acute coronary syndrome (ACS, including unstable angina pectoris and acute myocardial infarction) have yet to be investigated.Methods.Plasma IL-37, IL-18, and IL-18BP levels were measured in 50 patients with stable angina pectoris (SAP), 75 patients with unstable angina pectoris (UAP), 67 patients with acute myocardial infarction (AMI), and 65 control patients.Results.The plasma IL-37, IL-18, and IL-18BP levels were significantly increased in ACS patients compared to SAP and control patients. A correlation analysis showed that the plasma biomarker levels were positively correlated with each other and with the levels of C-reactive protein (CRP),N-terminal probrain natriuretic peptide (NT-proBNP), and left ventricular end-diastolic dimension (LVEDD) but negatively correlated with left ventricular ejection fraction (LVEF). Furthermore, the plasma IL-37, IL-18, and IL-18BP had no correlation with the severity of the coronary artery stenosis.Conclusions.The results indicate that the plasma IL-37 levels are associated with the onset of ACS.

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Association between admission blood glucose and prognosis in non-diabetic patients with first-ever acute myocardial infarction

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2021-0033 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Ramin Eskandari ◽

Parisa Matini ◽

Sepideh Emami ◽

Yousef Rezaei

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Diabetic Patients ◽

Ventricular Ejection Fraction ◽

Cox Regression Analysis ◽

Coronary Syndrome

Abstract Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome. Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality. Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p <0.05). Based on the Cox regression analysis, the independent predictors of MACCE included age (hazard ratio [HR] 1.068, 95% confidence interval [CI] 1.033 – 1.105, p <0.001), third tertile of ABS >172 mg/dL (HR 21.257, 95% CI 2.832 – 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 – 0.995, p=0.031). Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.

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Arylesterase activity of Paraoxonase 1 - prognostic factor for one-year survival in patients with acute myocardial infarction

Revista Romana de Medicina de Laborator ◽

10.2478/rrlm-2018-0030 ◽

2018 ◽

Vol 26 (3) ◽

pp. 283-292 ◽

Cited By ~ 1

Author(s):

Lorena Ciumărnean ◽

Mihai Greavu ◽

Ştefan C Vesa ◽

Alina I Tanțău ◽

Gabriela B Dogaru ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Prognostic Factor ◽

Coronary Angiography ◽

Left Ventricular ◽

Paraoxonase 1 ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

One Year

Abstract Introduction: Reduced serum levels of paraoxonase 1 (PON1) activities are associated with diseases involving increased oxidative stress, such as acute coronary syndrome. We aimed to determine whether serum PON1 activities are a prognostic factor for one-year survival following ST-elevation myocardial infarction (STEMI). Material and methods: We prospectively followed for one-year 75 patients diagnosed and treated for STEMI. Clinical, laboratory and imagistic data were gathered after coronary angiography. PON1 activities (paraoxonase, arylesterase, and lactonase) were assayed spectophotometrically on samples of heparinized plasma taken from the patients in a timeframe of maximum 20 minutes after coronary angiography. Results: Increased mortality was linked to age (patients over 68 years), permanent atrial fibrillation or left ventricular ejection fraction (LVEF) <40% (associated with global hypokinesia, apical or septal akinesia), trivascular disease atherosclerosis, reduced PON1 activities (paraoxonase <18.4 IU/mL, arylesterase <12.6 IU/mL, lactonase <27.6 IU/mL), and glomerular filtration rate levels <54 mL/min/1.73m2. Multivariate survival analysis showed the independent prognostic role of age (HR 3.92; 95%CI 1.08-14.16; p=0.03), LVEF (HR 9.93; 95%CI 2.20-44.86; p=0.003) and arylesterase (HR 4.25; 95%CI 0.94-19.18; p=0.05) for one-year mortality. Conclusion: Reduced arylesterase activity of PON1 is an independent predictor of one-year survival after acute myocardial infarction.

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Thirty-Five Day Impella 5.0 Support via Right Axillary Side Graft Cannulation for Acute Cardiogenic Shock

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000009 ◽

2013 ◽

Vol 8 (4) ◽

pp. 307-309 ◽

Cited By ~ 10

Author(s):

Mario A Castillo-Sang ◽

Sunil M. Prasad ◽

Jasvindar Singh ◽

Gregory A. Ewald ◽

Scott C. Silvestry

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Cardiogenic Shock ◽

Artery Bypass ◽

Complete Recovery ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Severe Coronary Artery ◽

Artery Disease

We describe the use of an Impella 5.0 for mechanical support in acute cardiogenic shock after an acute myocardial infarction. A 61-year-old man with a history of severe coronary artery disease who underwent coronary artery bypass grafting with ischemic cardiomyopathy presented with cardiogenic shock after an ST-elevation myocardial infarction. An Impella Recover LP 5.0 (Abiomed, Danvers, MA USA) was inserted via a right axillary side graft, using transesophageal echocardiographic and fluoroscopic guidance. The patient remained in the intensive care unit, where he required a tracheostomy to beweaned off the ventilator. He required renal replacement therapy with subsequent complete recovery. His Impella support was weaned, and on postoperative day 35, the device was removed. The patient developed axillary thrombosis the morning after removal, requiring thrombectomy. Discharge echocardiogram showed mild left ventricular enlargement with global hypokinesis and left ventricular ejection fraction of 25%. The Impella 5.0 device can safely and effectively be used in the long-term support of cardiogenic shock.

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In-hospital results of rheolytic catheter thrombectomy in patients with STEMI

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-3-54-61 ◽

2016 ◽

Vol 20 (3) ◽

pp. 54

Author(s):

M V Malkhasyan ◽

V A Kuznetsov ◽

I S Bessonov ◽

P I Pavlov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Contractile Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Old Myocardial Infarction ◽

Mean Time

Aim. The article focuses on the evaluation of short-term efficacy of rheolytic thrombectomy (AngioJet) in patients with STEMI. Methods. 188 patients (85.6% men) with STEMI underwent primary PCI by means of rheolytic catheter thrombectomy (AngioJet). The mean age was 54.1 ± 10.7 years. 32 (17 %) of patients had old myocardial infarction. 104 (55.9 %) patients were diagnosed with ST-elevated inferior myocardial infarction. 22 (12 %) patients were operated under cardiogenic shock. Mean time from the appearance of symptoms to admission was 222.5 [70, 584] min. Anterior interventricular artery (38.3 %) and right coronary artery (43.6 %) were the main infarction-related arteries. Results. Complete thrombotic occlusion of the coronary artery occurred in 144 (77.4%) patients. Mean “door-to-balloon” time amounted to 41.5 [30; 60]. Coronary thrombus was fully removed in 107 (60.8%) of patients. Stents with antiproliferative effect were implanted in 48.8 % of patients. Immediate angiographic success was achieved in 177 (94.1%) cases. Mean time of PCI was 60 [50; 80] min. PCI complications were registered in 3 (1.6%) patients. Intraoperative life-threatening arrhythmias happened in 22 (11.7 %) patients. The phenomenon of "no-reflow" occurred in 6 (3.2%) PCI cases. The rate of in-hospital mortality was 5.9%, including patients with cardiogenic shock (36.4%) and those without it (1.9 %). MACCE (main adverse cardio-cerebral events) were observed in 15 (8%) cases. According to ECG data obtained postoperatively, 26 % of patients demonstrated no regional asynergy, while a decrease in myocardial contractile function occurred in just 26 % of cases, with the average left ventricular ejection fraction running to 57.5±9 %. Mean in-hospital stay was 9.5±0.6 days. Conclusion. The results of this study suggest that rheolytic catheter thrombectomy (AngioJet) is a safe and effective modality. Immediate hospital results show low rate complications and low in-hospital mortality.Received 13 April 2016. Accepted 9 June 2016.Conflict of interest: The authors declare no conflict interests.

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Reduced left ventricular ejection fraction in patients with acute coronary syndrome as a risk factor for mortality

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20215035 ◽

2021 ◽

Vol 10 (1) ◽

pp. 80

Author(s):

Parvaiz Kadloor ◽

Mohammed Hidayathullah ◽

Abhishek Golla

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Reduced Ejection Fraction ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Background: The study aimed to evaluate left ventricular ejection fraction (LVEF) as the risk factor for mortality in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).Methods: This was an observational, single centre study. The patients who were admitted at tertiary care centre in India during the period February 2014 to June 2015 who were diagnosed with ACS were included in the study. The patients were evaluated by dividing into two groups based on LVEF. The patients were followed up to 1 year.Results: Total 100 patients were included in the study. Chest pain was the most prevalent complaint (60%). Seventy patients presented with STEMI (ST-segment elevation myocardial infarction) and 30 with NSTEMI (non-ST-segment elevation myocardial infarction). Seventy five patients had ejection fraction ≥40% and 25 patients had reduced ejection fraction. Reduced LVEF did not show any statistical difference in patients with presentation as STEMI and NSTEMI or need for revascularisation. At year follow up, total 9 patients died. However, reduced LVEF led to statistically higher deaths (p<0.05%).Conclusions: In our study it was observed that patients with ACS complicated by heart failure with reduced ejection fraction have a markedly increased short- and long-term mortality rates compared to ACS patients without heart failure.

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