High-Goal ‘Lytes: Repletion Gone Awry?

2019 ◽  
Vol 14 (12) ◽  
pp. 785-786
Author(s):  
Ramzi Dudum ◽  
Steven J Lahti ◽  
Michael J Blaha
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Ventricular Ectopy ◽  
Serum Electrolytes ◽  
Per Se

Electrolyte imbalances, per se, predispose to ventricular ectopy and, in extreme cases, sudden cardiac death.1 As these outcomes are more common in the presence of intrinsic heart disease, serum electrolytes—particularly potassium and magnesium—are routinely monitored and made replete in patients with myocardial infarction (MI) or acute decompensated heart failure (ADHF).

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

scholarly journals Dealing with Sudden Cardiac Death: Who Deserves Device Implantation

2019 ◽  
Vol 5 (1 (P)) ◽  
pp. 12
Author(s):  
Dicky Armein Hanafy
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Arrhythmias ◽  
Cardiac Death ◽  
Cardiac Insufficiency ◽  
Resynchronization Therapy ◽  
Icd Implantation ◽  
Life Threatening

Sudden cardiac death is one of the leading causes of death in the western industrial nations. Most people are affected by coronary heart disease (coronary heart disease, CHD) or heart muscle (cardiomyopathy). These can lead to life-threatening cardiac arrhythmias. If the heartbeat is too slow due to impulse or conduction disturbances, cardiac pacemakers will be implanted. High-frequency and life-threatening arrhythmias of the ventricles (ventricular tachycardia, flutter or fibrillation) cannot be treated with a pacemaker. In such cases, an implantable cardioverter-defibrillator (ICD) is used, which additionally also provides all functions of a pacemaker. The implantation of a defibrillator is appropriate if a high risk of malignant arrhythmias has been established (primary prevention). If these life-threatening cardiac arrhythmias have occurred before and are not caused by a treatable (reversible) cause, ICD implantation will be used for secondary prevention. The device can stop these life-threatening cardiac arrhythmias by delivering a shock or rapid impulse delivery (antitachycardic pacing) to prevent sudden cardiac death. Another area of application for ICD therapy is advanced heart failure (heart failure), in which both main chambers and / or different wall sections of the left ventricle no longer work synchronously. This form of cardiac insufficiency can be treated by electrical stimulation (cardiac resynchronization therapy, CRT). Since the affected patients are also at increased risk for sudden cardiac death, combination devices are usually implanted, which combine heart failure treatment by resynchronization therapy and the prevention of sudden cardiac death by life-threatening arrhythmia of the heart chambers (CRT-D device). An ICD is implanted subcutaneously or under the pectoral muscle in the area of the left collarbone. Like pacemaker implantation, ICD implantation is a routine, low-complication procedure today.

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

Secondary prevention of sudden cardiac death in ischaemic cardiomyopathy

ESC CardioMed ◽  
2018 ◽  
pp. 2337-2341
Author(s):  
Jens Cosedis Nielsen ◽  
Jens Kristensen
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Death ◽  
Cardioverter Defibrillator ◽  
Ischaemic Cardiomyopathy ◽  
Life Threatening

The most common reason for sudden cardiac death is ischaemic heart disease. Patients who survive cardiac arrest are at particularly high risk of recurrent ventricular arrhythmia and sudden cardiac death, and are candidates for secondary prevention defined as ‘therapies to reduce the risk of sudden cardiac death in patients who have already experienced an aborted cardiac arrest or life-threatening arrhythmias’. The mainstay therapy for secondary prevention of sudden cardiac death is implantation of an implantable cardioverter defibrillator. Furthermore, revascularization and optimal medical therapy for heart failure and concurrent cardiovascular diseases should be ensured.

P836Glasgow Prognostic Score predicts the readmission caused by acute decompensated heart failure after myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Namiuchi ◽  
S Sunamura ◽  
R Ushigome ◽  
K Noda ◽  
T Takii
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Decompensated Heart Failure ◽  
Albumin Concentration ◽  
Reactive Protein ◽  
Hazard Ratios ◽  
The Glasgow Prognostic Score

Abstract Purpose The Glasgow Prognostic Score (GPS), combination of C-reactive protein (CRP) and serum albumin concentration, provides predictions of prognosis in patients with heart failure. We evaluated the GPS of patients with acute myocardial infarction (MI). Methods We investigated the prognosis of 1182 patients with acute MI in our institution. These patients were classified into three groups by GPS at admission. GPS was defined as follows: patients with both elevated CRP (>1.0mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a score of 2, patients with only one of these biochemical abnormalities were allocated a score of 1, and patients with neither of these abnormalities were allocated a score of 0. Results Of the patients, 70.3% (n=831), 19.2% (n=227), and 10.5% (n=124) had GPS of 0, 1, and 2, respectively. In-hospital mortality of GPS 0, GPS 1, and GPS 2 were 4.7%, 18.1%, and 31.5%, respectively (p<0.0001). Relative to a GPS of 0, the hazard ratios for the readmission caused by acute decompensated heart failure (ADHF) were 3.27 (95% CI: 2.04–5.18) for a GPS of 1 and 3.62 (95% CI: 1.93–6.42) for a GPS of 2 in the age- and sex- adjusted Cox proportional hazard model. After propensity score matching, baseline characteristics were balanced, and 250 paired patients constituted GPS 0 group and GPS 1–2 group. Patients with GPS1 or 2 had a higher risk of the development of ADHF compared with patients with GPS 0 (Hazard ratio: 1.96, 95% confidence interval: 1.13–3.47, p=0.017). Conclusions The GPS, which is based on systemic inflammation, is useful for predicting the development of acute decompensated heart failure after myocardial infarction.

Daytime peak incidence of death due to the ischemic heart disease

2014 ◽  
Vol 2 (4) ◽  
pp. 213-227
Author(s):  
Janet H. Wilenky ◽  
Hsin Chang
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Early Morning ◽  
Morning Peak ◽  
Circadian Time ◽  
Ventricular Dysrhythmias ◽  
Relationship Of

Myocardial infarction, myocardial ischemia, ventricular dysrhythmias, and sudden cardiac death occur most frequently in the morning, especially in the first few hours after awakening. Among individual patients, however, this pattern may vary widely. Up to 80% of individuals who suffer sudden cardiac death have coronary heart disease; the epidemiology of sudden cardiac death to a great extent parallels that of coronary heart disease. This review describes circadian patterns in cardiovascular disease processes and analyses the findings of recent studies by searched, from PubMed, ISI Web of Science, Google Scholar and Scopus databases in a time period between late 1970s through July 2013. The circadian pattern of numerous cardiovascular events (myocardial infarction, sudden cardiac death, stroke) reveals a peak in the early hours of the morning, which occurs in more than 20% of patients with arterial hypertension, and can be regularly detected in combined 24-h-ABPM/EKG examinations. The awareness of an increased incidence of myocardial infarction and sudden cardiac death in the early morning hours, shortly after waking, has stimulated an interest in the relationship of these events and the occurrence of both silent and symptomatic myocardial ischaemia. A number of studies have been reported that examine both the physiological triggers and the underlying causes of these events. Beta-adrenergic blockers have been shown to abolish the early morning peak of myocardial infarction and blunt the morning peak in sudden cardiac death. Newer calcium antagonists, such as amlodipine, have been demonstrated to control angina throughout a 24-hour period. Aspirin is effective in preventing morning infarction. Approaching the pathophysiology of circadian time-dependent sudden cardiac death has implication for future prevention and treatment.

scholarly journals An Incidentally Detected Right Ventricular Pseudoaneurysm

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Vamsi C. Gaddipati ◽  
Angel I. Martin ◽  
Mauricio O. Valenzuela ◽  
Asef Mahmud ◽  
Aarti A. Patel
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Right Ventricular ◽  
Chest Trauma ◽  
Clinical Presentation ◽  
Acute Decompensated Heart Failure ◽  
Imaging Techniques ◽  
Decompensated Heart Failure ◽  
Advanced Imaging ◽  
Fatal Complication

Ventricular pseudoaneurysm is an uncommon, potentially fatal complication that has been associated with myocardial infarction, cardiac surgery, chest trauma, and infectious processes. Diagnosis can be challenging, as cases are rare and slowly progressing and typically lack identifiable features on clinical presentation. As a result, advanced imaging techniques have become the hallmark of identification. Ahead, we describe a patient who presents with acute decompensated heart failure and was incidentally discovered to have a large right ventricular pseudoaneurysm that developed following previous traumatic anterior rib fracture.

scholarly journals Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): Observational and Retrospective Study (Preprint)

2018 ◽  
Author(s):  
Behnam Tehrani ◽  
Alexander Truesdell ◽  
Ramesh Singh ◽  
Charles Murphy ◽  
Patricia Saulino
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Survival Rates ◽  
Decompensated Heart Failure ◽  
Circulatory Support

BACKGROUND The development and implementation of a Cardiogenic Shock initiative focused on increased disease awareness, early multidisciplinary team activation, rapid initiation of mechanical circulatory support, and hemodynamic-guided management and improvement of outcomes in cardiogenic shock. OBJECTIVE The objectives of this study are (1) to collect retrospective clinical outcomes for acute decompensated heart failure cardiogenic shock and acute myocardial infarction cardiogenic shock, and compare current versus historical survival rates and clinical outcomes; (2) to evaluate Inova Heart and Vascular Institute site specific outcomes before and after initiation of the Cardiogenic Shock team on January 1, 2017; (3) to compare outcomes related to early implementation of mechanical circulatory support and hemodynamic-guided management versus historical controls; (4) to assess survival to discharge rate in patients receiving intervention from the designated shock team and (5) create a clinical archive of Cardiogenic Shock patient characteristics for future analysis and the support of translational research studies. METHODS This is an observational, retrospective, single center study. Retrospective and prospective data will be collected in patients treated at the Inova Heart and Vascular Institute with documented cardiogenic shock as a result of acute decompensated heart failure or acute myocardial infarction. This registry will include data from patients prior to and after the initiation of the multidisciplinary Cardiogenic Shock team on January 1, 2017. Clinical outcomes associated with early multidisciplinary team intervention will be analyzed. In the study group, all patients evaluated for documented cardiogenic shock (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) treated at the Inova Heart and Vascular Institute by the Cardiogenic Shock team will be included. An additional historical Inova Heart and Vascular Institute control group will be analyzed as a comparator. Means with standard deviations will be reported for outcomes. For categorical variables, frequencies and percentages will be presented. For continuous variables, the number of subjects, mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum will be reported. Reported differences will include standard errors and 95% CI. RESULTS Preliminary data analysis for the year 2017 has been completed. Compared to a baseline 2016 survival rate of 47.0%, from 2017 to 2018, CS survival rates were increased to 57.9% (58/110) and 81.3% (81/140), respectively (P=.01 for both). Study data will continue to be collected until December 31, 2018. CONCLUSIONS The preliminary results of this study demonstrate that the INOVA SHOCK team approach to the treatment of Cardiogenic Shock with early team activation, rapid initiation of mechanical circulatory support, hemodynamic-guided management, and strict protocol adherence is associated with superior clinical outcomes: survival to discharge and overall survival when compared to 2015 and 2016 outcomes prior to Shock team initiation. What may limit the generalization of these results of this study to other populations are site specific; expertise of the team, strict algorithm adherence based on the INOVA SHOCK protocol, and staff commitment to timely team activation. Retrospective clinical outcomes (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) demonstrated an increase in current survival rates when compared to pre-Cardiogenic Shock team initiation, rapid team activation and diagnosis and timely utilization of mechanical circulatory support. CLINICALTRIAL ClinicalTrials.gov NCT03378739; https://clinicaltrials.gov/ct2/show/NCT03378739 (Archived by WebCite at http://www.webcitation.org/701vstDGd)

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