scholarly journals December 2020 Pulmonary Case of the Month: Resurrection or Medical Last Rites?

2020 ◽  
Vol 21 (6) ◽  
pp. 128-135
Author(s):  
Lewis Wesselius ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Chronic Atrial Fibrillation ◽  
Community Acquired Pneumonia ◽  
Bypass Grafting ◽  
The Past ◽  
History Of ◽  
Artery Disease

No abstract available. Article truncated after the first page. History of Present Illness An 88-year-old man who has been short of breath and febrile up to 101.5° F for the past day presented on October 20, 2020. He has no known sick contacts or exposure to COVID-19. PMH, SH, and FH • No reported pulmonary history although he had a Xopenex MDI which he rarely used. • Coronary artery disease with prior coronary artery bypass grafting (1978); multiple subsequent stents; chronic atrial fibrillation; pacemaker (Micra) • Stage 3-4 CKD (creatinine 1.95) • Chronically on warfarin Physical Examination • Temp 37.3, Sat 92% on RA, 95% on 2 lpm, • Lungs: Few crackles in right upper chest • CV: regular, no murmur • Ext: 1 to 2+ edema (chronic, uses TED hose) Which of the following is/are the most likely diagnosis? 1. Community-acquired pneumonia 2. Congestive heart failure 3. COVID-19 4. 1 and 3 5. Any of the above …

scholarly journals Predictive potential assessment of preoperative risk factors for atrial fibrillation in patients with coronary artery disease after coronary artery bypass grafting

2020 ◽  
Vol 35 (4) ◽  
pp. 128-136
Author(s):  
K. I. Shakhgeldyan ◽  
V. Y. Rublev ◽  
B. I. Geltser ◽  
B. O. Shcheglov ◽  
V. G. Shirobokov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Preoperative Risk ◽  
Preoperative Risk Factors ◽  
Artery Disease

Introduction. Postoperative atrial fibrillation (POAF) is one of the most common complications of coronary artery bypass grafting (CABG) and occurs in 25–65% of patients.Aim. The study aimed to assess the predictive potential of preoperative risk factors for POAF in patients with coronary artery disease (CAD) after CABG based on machine learning (ML) methods.Material and Methods. An observational retrospective study was carried out based on data from 866 electronic case histories of CAD patients with a median age of 63 years and a 95% confidence interval [63; 64], who underwent isolated CABG on cardiopulmonary bypass. Patients were assigned to two groups: group 1 comprised 147 (18%) patients with newly registered atrial fibrillation (AF) paroxysms; group 2 included 648 (81.3%) patients without cardiac arrhythmia. The preoperative clinical and functional status was assessed using 100 factors. We used statistical analysis methods (Chi-square, Fisher, Mann – Whitney, and univariate logistic regression (LR) tests) and ML tests (multivariate LR and stochastic gradient boosting (SGB)) for data processing and analysis. The models’ accuracy was assessed by three quality metrics: area under the ROC-curve (AUC), sensitivity, and specificity. The cross-validation procedure was performed at least 1000 times on randomly selected data.Results. The processing and analysis of preoperative patient status indicators using ML methods allowed to identify 10 predictors that were linearly and nonlinearly related to the development of POAF. The most significant predictors were the anteroposterior dimension of the left atrium, tricuspid valve insufficiency, ejection fraction <40%, duration of the P–R interval, and chronic heart failure of functional class III–IV. The accuracy of the best predictive multifactorial model of LR was 0.61 in AUC, 0.49 in specificity, and 0.72 in sensitivity. The values of similar quality metrics for the best model based on SGB were 0.64, 0.6, and 0.68, respectively.Conclusion. The use of SGB made it possible to verify the nonlinearly related predictors of POAF. The prospects for further research on this problem require the use of modern medical care methods that allow taking into account the individual characteristics of patients when developing predictive models.

scholarly journals Real-Life Incident Atrial Fibrillation in Outpatients with Coronary Artery Disease

2020 ◽  
Vol 9 (8) ◽  
pp. 2367 ◽  
Author(s):  
Sandro Ninni ◽  
Gilles Lemesle ◽  
Thibaud Meurice ◽  
Olivier Tricot ◽  
Nicolas Lamblin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Real Life ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Outpatient Visits ◽  
History Of ◽  
Artery Disease

Background: The risk, correlates, and consequences of incident atrial fibrillation (AF) in patients with chronic coronary artery disease (CAD) are largely unknown. Methods and results: We analyzed incident AF during a 3-year follow-up in 5031 CAD outpatients included in the prospective multicenter CARDIONOR registry and with no history of AF at baseline. Incident AF occurred in 266 patients (3-year cumulative incidence: 4.7% (95% confidence interval (CI): 4.1 to 5.3)). Incident AF was diagnosed during cardiology outpatient visits in 177 (66.5%) patients, 87 of whom were asymptomatic. Of note, 46 (17.3%) patients were diagnosed at time of hospitalization for heart failure, and a few patients (n = 5) at the time of ischemic stroke. Five variables were independently associated with incident AF: older age (p < 0.0001), heart failure (p = 0.003), lower left ventricle ejection fraction (p = 0.008), history of hypertension (p = 0.010), and diabetes mellitus (p = 0.033). Anticoagulant therapy was used in 245 (92%) patients and was associated with an antiplatelet drug in half (n = 122). Incident AF was a powerful predictor of all-cause (adjusted hazard ratio: 2.04; 95% CI: 1.47 to 2.83; p < 0.0001) and cardiovascular mortality (adjusted hazard ratio: 2.88; 95% CI: 1.88 to 4.43; p < 0.0001). Conclusions: In CAD outpatients, real-life incident AF occurs at a stable rate of 1.6% annually and is frequently diagnosed in asymptomatic patients during cardiology outpatient visits. Anticoagulation is used in most cases, often combined with antiplatelet therapy. Incident AF is associated with increased mortality.

Analysis of Risk Factors for Myocardial Infarction and Cardiac Mortality after Major Vascular Surgery

2000 ◽  
Vol 93 (1) ◽  
pp. 129-140 ◽  
Author(s):  
Juraj Sprung ◽  
Basem Abdelmalak ◽  
Alexandru Gottlieb ◽  
Catharine Mayhew ◽  
Jeffrey Hammel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Vascular Surgery ◽  
Coronary Artery Bypass ◽  
Cardiac Death ◽  
Artery Bypass ◽  
History Of ◽  
Artery Disease

Background Patients undergoing vascular surgical procedures are at high risk for perioperative myocardial infarction (PMI). This study was undertaken to identify predictors of PMI and in-hospital death in major vascular surgical patients. Methods From the Vascular Surgery Registry (6,948 operations from January 1989 through June 1997) the authors identified 107 patients in whom PMI developed during the same hospital stay. Case-control patients (patients without PMI) were matched at a 1x:x1 ratio with index cases according to the type of surgery, gender, patient age, and year of surgery. The authors analyzed data regarding preoperative cardiac disease and surgical and anesthetic factors to study association with PMI and cardiac death. Results By using univariable analysis the authors identified the following predictors of PMI: valvular disease (P = 0.007), previous congestive heart failure (P = 0.04), emergency surgery (P = 0.02), general anesthesia (P = 0.03), preoperative history of coronary artery disease (P = 0.001), preoperative treatment with beta-blockers (P = 0.003), lower preoperative (P = 0.03) and postoperative (P = 0.002) hemoglobin concentrations, increased bleeding rate (as assessed from increased cell salvage; P = 0.025), and lower ejection fraction (P = 0.02). Of the 107 patients with PMI, 20.6% died of cardiac cause during the same hospital stay. The following factors increased the odds ratios for cardiac death: age (P = 0.001), recent congestive heart failure (P = 0.01), type of surgery (P = 0.04), emergency surgery (P = 0.02), lower intraoperative diastolic blood pressure (P = 0.001), new intraoperative ST-T changes (P = 0.01), and increased intraoperative use of blood (P = 0.005). Patients who underwent coronary artery bypass grafting, even more than 12 months before index surgery, had a 79% reduction in risk of death if they had PMI (P = 0.01). Multivariable analysis revealed preoperative definitive diagnosis of coronary artery disease (P = 0.001) and significant valvular disease (P = 0.03) were associated with increased risk of PMI. Congestive heart failure less than 1 yr before index vascular surgery (P = 0. 0002) and increased intraoperative use of blood (P = 0.007) were associated with cardiac death. The history of coronary artery bypass grafting reduced the risk of cardiac death (P = 0.04) in patients with PMI. Conclusions The in-hospital cardiac mortality rate is high for patients who undergo vascular surgery and experience clinically significant PMI. Stress of surgery (increased intraoperative bleeding and aortic, peripheral vascular, and emergency surgery), poor preoperative cardiac functional status (congestive heart failure, lower ejection fraction, diagnosis of coronary artery disease), and preoperative history of coronary artery bypass grafting are the factors that determine perioperative cardiac morbidity and mortality rates.

scholarly journals ISCHEMIC STROKE

2018 ◽  
Vol 25 (01) ◽  
pp. 84-89
Author(s):  
Muhammad Naveed Alam ◽  
Tahir Habib Rizvi ◽  
Memoona Alam ◽  
Muhammad Tahir
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Ischemic Stroke ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Contributing Factors ◽  
Cross Sectional ◽  
History Of

Objectives: To determine the frequency and contributing factors of atrialfibrillation in patients with first ischemic stroke. Methodology: This study included 150 patientswith first acute ischemic stroke. All the patients had electrocardiography to detect the presenceof atrial fibrillation. The patients were also labeled for risk factors like hypertension, congestiveheart failure, smoking, and hyperthyroidism, etc. Setting: Mayo Hospital Lahore. Duration ofStudy: 1st January 2013 to 30th June 2013. Type: Descriptive Cross Sectional. Results: Atrialfibrillation was present among 22 (14.6%) patients. Among patients with atrial fibrillation,smoking, congestive heart failure and hypertension were the most frequent risk factors whichwere present in 11 (50%), 6 (27%), and 5 (22.7%) patients, respectively. Conclusion: Frequencyof atrial fibrillation among patients with first ischemic stroke was high. Smoking, congestiveheart failure and history of coronary artery bypass grafting are frequent risk factors.

Colchicine-induced rhabdomyolysis: a review of 83 cases

2021 ◽  
Vol 14 (7) ◽  
pp. e241977
Author(s):  
Mohammad Abudalou ◽  
Ahmed S Mohamed ◽  
Eduardo A Vega ◽  
Ali Al Sbihi
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Recurrent Pericarditis ◽  
Patient Reports ◽  
Rehabilitation Facility ◽  
Elevated Creatinine ◽  
Artery Disease

A 74-year-old man with medical history significant for atrial fibrillation, hyperlipidaemia and coronary artery disease on atorvastatin presented to the emergency department with profound weakness. The patient reports he first noticed his weakness 4 weeks after starting colchicine, prescribed for recurrent pericarditis with pericardial effusion, a complication following recent coronary artery bypass grafting. The patient was also on prednisone therapy for presumed post-pericardiotomy syndrome. The weakness involved all four limbs but was more notable in the lower extremities, with preserved sensation and tenderness to palpation. Labs showed an elevated creatinine phosphokinase and serum creatinine consistent with rhabdomyolysis. Discontinuation of the offending medications, including colchicine and atorvastatin, as well as intravenous fluid resuscitation with physical rehabilitation, led to improvement in the patient’s symptoms. He was eventually discharged to a rehabilitation facility to continue physical therapy.

scholarly journals Clinical and functional features of patients with acute coronary syndrome and history of coronary artery bypass grafting

2020 ◽  
Vol 27 (4) ◽  
pp. 18-24
Author(s):  
V. V. Matiy ◽  
M. V. Rishko ◽  
O. O. Kutsin
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Coronary Syndrome ◽  
History Of

The aim – to investigate the clinical and functional parameters features in acute coronary syndrome and coronary artery bypass grafting history patients.Materials and methods. 68 patients with acute coronary syndrome (ACS) were examined according to the current protocols, in 30 of them there was a history of coronary artery bypass grafting (ACS and CABG group) and 38 patients who didn’t undergo CABG (ACS without CABG group). Physical and laboratory-instrumental methods of investigation, including ECG, echocardiography, coronary ventriculography, coronary artery bypass graft angiography and methods of variation statistics were used in the work.Results and discussion. Among patients with ACS and CABG, a history of a higher incidence and duration of stable angina pectoris, arterial hypertension, diabetes mellitus, and multiple concomitant pathology had been found in comparison with the ACS without CABG group. History of ACS and CABG patients comprised a higher incidence of ACS without ST segment elevation in comparison with ACS without CABG group, repeated ACS, heart failure progression and those patients needed significantly longer stay in ICU than ACS without CABG group. Electrocardiograms of patients with ACS and CABG vs ACS without CABG group were characterized by a significantly higher incidence of pathological Q, atrial and ventricular fibrillation, as well as a combined disturbances of rhythm and conduction. Echocardiography revealed a significantly lower ejection fraction, increase in left atrium size and an E/A ratio in the ACS and CABG group, indicating worse heart failure compensation as well as systolic and diastolic dysfunction with dysfunctional of left ventricular than in ACS without CABG patients.Conclusions. Acute coronary syndrome with coronary artery bypass grafting history patients are characterized by a complicated history and clinical course with more significant electrocardiogram and echocardiography changes in comparison to the group of acute coronary syndrome patients without prior coronary artery bypass grafting history.

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