Atrial Flutter Associated with Carboplatin Administration

2011 ◽  
Vol 45 (11) ◽  
pp. 1451-1451 ◽  
Author(s):  
Sammy Zakaria ◽  
Kit Yu Lu ◽  
Veronique Nussenblatt ◽  
Ilene Browner
Keyword(s):  
Atrial Flutter ◽  
Causal Link ◽  
Cardiac Monitoring ◽  
Cardiac Complications ◽  
Medication Regimen ◽  
Cardiac Events ◽  
Drug Induced ◽  
Arrhythmogenic Effect ◽  
Adverse Cardiac Events ◽  
Effect Of Treatment

Objective: To report a novel case of atrial flutter associated with carboplatin administration and review chemotherapy-related cardiac toxicities, focusing on platinum-containing compounds. Case Report: A 69-year-old man with extensive small cell lung cancer and asymptomatic cardiovascular and cerebrovascular disease was inconsistently adherent to his medication regimen. While undergoing carboplatin infusion, he developed atrial flutter. He had no other immediate arrhythmogenic causes of atrial flutter and the arrhythmia spontaneously reverted to sinus rhythm after 24 hours. His condition remained stable until he died 8 days later. The cause of death was unknown and the family declined postmortem examination. Discussion: Although this patient's cardiac history and nonadherence to his medications may have increased his susceptibility to develop atrial arrhythmias, the Naranjo probability scale reveals a possible relationship between atrial flutter and Infusion of carboplatin. A literature search revealed other adverse cardiac events due to platinum compounds; however, to our knowledge, this case is the first to describe an association with atrial flutter. A definitive causal link cannot be determined, but this may have been the result of a direct arrhythmogenic effect of treatment or to a novel hypersensitivity reaction. Given the potential deleterious impact of drug-induced arrhythmias, we have reported this case to the Food and Drug Administration as a new adverse effect of carboplatin. Conclusions: Providers should consider cardiac monitoring during carboplatin infusion in patients with known cardiac disease or at high risk of cardiac complications.

scholarly journals Potential New Approaches in Predicting Adverse Cardiac Events One Month after Major Vascular Surgery

2018 ◽  
Vol 28 (1) ◽  
pp. 63-69
Author(s):  
Mladjan Golubovic ◽  
Velimir Peric ◽  
Dragana Stanojevic ◽  
Milan Lazarevic ◽  
Nenad  Jovanovic ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Vascular Surgery ◽  
Troponin I ◽  
Risk Index ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Preoperative Risk ◽  
Adverse Cardiac Events ◽  
Creatine Kinase Mb ◽  
Major Vascular Surgery

Objective: The aim of our study was to find the best model with sufficient power to improve the risk stratification in major vascular surgery patients during the first 30 days after this procedure. The discriminatory power of 4 biomarkers (troponin I [TnI], N-terminal prohormone of brain natriuretic peptide [NT-proBNP], creatine kinase-MB isoenzyme [CK-MB], high-sensitivity C-reactive protein [hs-CRP]) was tested as well as 2 risk assessment models and 13 different combinations of them. Subjects and Methods: The study included 122 patients (77% men, 23% women) with an average age of 67.03 ± 4.5 years. An aortobifemoral bypass was performed in 6.56% of the patients, a femoropopliteal bypass in 18.85%, and 49.18% received open surgical reconstruction of the carotid arteries. A total of 25.41% of the patients were given an aortobi-iliac bypass. Results: During the first 30 days, 13 patients (10.7%) had 17 cardiac complications. The most common complication was the new onset of atrial fibrillation (35.3%). During the first 10 days, 10 patients had 1 complication and 2 patients had 2 cardiac events, while 1 patient had 3 complications. By comparing combinations of scores and markers, it was shown that revised cardiac risk index (RCRI) + Vascular Portsmouth Physiological and Operative Severity Score (V-POSSUM) + hsTnI and RCRI + V-POSSUM + hsTnI + NT-proBNP with 100% sensitivity, > 80% specificity had the best discriminatory ability (AUC 0.924 and 0.933, respectively; p < 0.001 for both models) for cardiac complications during the 30 days after surgery. Conclusion: Combinations of traditional preoperative risk factors and scores can enhance the assessment of major adverse cardiac events (MACE) in patients preparing for large vascular surgery. Using only one risk score in these patients seems to be underperforming in preoperative risk assessment.

scholarly journals Spontaneous recovery from sunitinib-induced disruption of sarcomere in human iPSC-cardiomyocytes and possible involvement of the Hippo pathway

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Toshikatsu Matsui ◽  
Tadahiro Shinozawa
Keyword(s):  
Nuclear Localization ◽  
Spontaneous Recovery ◽  
Hippo Pathway ◽  
Clinical Settings ◽  
Hippo Signaling ◽  
Cardiac Events ◽  
Drug Induced ◽  
Adverse Cardiac Events ◽  
The Hippo Pathway

Abstract Background Sunitinib is known to cause cardiotoxicity in clinical settings. However, among sunitinib-treated patients experiencing adverse cardiac events, decreased cardiac function was reportedly reversible in > 50% of the patients. We previously showed that anti-cancer drugs such as sunitinib cause marked sarcomere disruption in human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs), and the extent of sarcomere disruption can be used to predict drug-induced cardiotoxicity in humans. The aim of this study is to investigate whether the reversibility of sunitinib-induced cardiac events in clinical settings can be mimicked in vitro, and to examine the molecular mechanism responsible for sunitinib-induced cardiotoxicity focusing on the Hippo pathway. Methods iPSC-CMs were stimulated with sunitinib for 72 h and the morphology of sarcomere structures were analyzed by high-content analysis before and after sunitinib washout. To examine the involvement of the Hippo pathway in the sunitinib-induced sarcomere disruption, the extent of nuclear localization of YAP1 (yes-associated protein 1, a Hippo signaling target) was determined. iPSC-CMs were also stimulated with sunitinib and a small molecule inhibitor of the Hippo pathway, XMU-MP-1 and sarcomere structures were analyzed. Results We observed a spontaneous recovery in cardiac sarcomeres in iPSC-CMs that were significantly disrupted by sunitinib treatment after a 72 h or 144 h washout of sunitinib. The extent of nuclear localization of YAP1 was significantly reduced after sunitinib stimulation and tended to return to normal levels after drug washout. Simultaneous stimulation of iPSC-CM with sunitinib and XMU-MP-1 suppressed the sunitinib-induced disruption of sarcomeres. Conclusions These results indicate that iPSC-CMs have the ability to recover from sunitinib-induced sarcomere disruption, and the Hippo pathway plays a role in the process of sunitinib-induced disruption of sarcomere and its recovery. Inhibition of the Hippo pathway may help to develop a co-medication strategy for mitigating the risk of sunitinib-induced adverse cardiac events.

Cardiac risk assessment with the Revised Cardiac Risk Index index before elective non-cardiac surgery: A retrospective audit from an Australian tertiary hospital

2021 ◽  
pp. 0310057X2110246
Author(s):  
Yao Yao ◽  
Ashok Dharmalingam ◽  
Cyril Tang ◽  
Harrison Bell ◽  
Andrew DJ McKeown ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Risk Index ◽  
Cardiac Risk ◽  
Tertiary Hospital ◽  
Major Adverse Cardiac Events ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Prognostic Accuracy ◽  
Cardiac Risk Index ◽  
Adverse Cardiac Events

Clinicians assessing cardiac risk as part of a comprehensive consultation before surgery can use an expanding set of tools, including predictive risk calculators, cardiac stress tests and measuring serum natriuretic peptides. The optimal assessment strategy is unclear, with conflicting international guidelines. We investigated the prognostic accuracy of the Revised Cardiac Risk Index for risk stratification and cardiac outcomes in patients undergoing elective non-cardiac surgery in a contemporary Australian cohort. We audited the records for 1465 consecutive patients 45 years and older presenting to the perioperative clinic for elective non-cardiac surgery in our tertiary hospital. We calculated individual Revised Cardiac Risk Index scores and documented any use of preoperative cardiac tests. The primary outcome was any major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death. Myocardial perfusion imaging was the most common preoperative stress test (4.2%, 61/1465). There was no routine investigation of natriuretic peptide levels for cardiac risk assessment before surgery. Major adverse cardiac events occurred in 1.3% (18/1366) of patients who had surgery. The Revised Cardiac Risk Index score had modest prognostic accuracy for major cardiac complications, area under receiver operator curve 0.73, 95% confidence interval 0.60 to 0.86. Stratifying major adverse cardiac events by the Revised Cardiac Risk Index scores 0, 1, 2 and 3 or greater corresponded to event rates of 0.6% (4/683), 0.8% (4/488), 4.1% (6/145) and 8.0% (4/50), respectively. The Revised Cardiac Risk Index had only modest predictive value in our single-centre experience. Patients with a revised cardiac risk index score of 2 or more had an elevated risk of early cardiac complications after elective non-cardiac surgery.

Distinct factors correlating with adverse cardiac events after major vascular surgery

VASA ◽  
2005 ◽  
Vol 34 (1) ◽  
pp. 46-49 ◽  
Author(s):  
Wunderlich ◽  
Gossrau ◽  
Wunderlich ◽  
Altmann
Keyword(s):  
Vascular Surgery ◽  
Univariate Analysis ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Infrarenal Aortic Aneurysm ◽  
Beneficial Effects ◽  
Adverse Cardiac Events ◽  
Major Vascular Surgery ◽  
Intraoperative Hypertension

Introduction: Cardiovascular complications remain the principal cause of both morbidity and mortality after major vascular surgery. The well-known coincidence between vascular disease and coronary artery disease provided the rationale for a detailed analysis of major perioperative cardiovascular complications in their relation to preoperative and intraoperative parameter. Methods and Patients: 90 patients scheduled to undergo either femoral-popliteal bypass (n = 74) or repair of an infrarenal aortic aneurysm (n = 16) were prospectively included in the study. All patients had no signs of unstable cardiac disease and required no cardiac testing. Both preoperative and intraoperative parameter were correlated to adverse cardiac events (cardiac death and myocardial infarction -MI). Results: Univariate analysis identified the following parameter to be significantly related to cardiac complications: prior MI and intraoperative hypertension (systolic blood pressure above 200 mmHg). In contrast perioperative betablocker therapy was revealed to be protective. In multivariate analysis the history of MI and intraoperative hypertension correlated with poor cardiac outcome. Conclusions: Our results underline the importance of the individual history in predicting perioperative risk and corroborate the beneficial effects of long-standing beta-blocker therapy. Additionally the significance of stable intraoperative hemodynamic parameter is demonstrated.

scholarly journals Re-Print- COVID-19 Cardiac Complications: Is an Easy, Safe treatment Strategy Right under Our Noses?

2020 ◽  
Vol 3 (13) ◽  
pp. 01-16
Author(s):  
Gary L Murray
Keyword(s):  
Chronic Conditions ◽  
Ventricular Arrhythmias ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Premature Ventricular Contractions ◽  
Off Label ◽  
Acute Infections ◽  
Adverse Cardiac Events ◽  
Coronary Syndromes ◽  
Control Study

Background: Many chronic conditions, as Diabetes Mellitus (DM) and cardiovascular Diseases, suffer Major Adverse Cardiac Events (MACE): congestive heart failure (CHF), Ventricular Tachycardia (VT), Ventricular Fibrillation (VF), Acute Coronary Syndromes [ACSs], and Sudden Cardiac Death (SCD). Acute infections, like COVID-19, also involve oxidative stress, leading to increased Sympathetic tone (S) and decreased Parasympathetic tone (P), increasing Sympathovagal Balance (SB) and MACE. The antioxidant (r) Alpha Lipoic Acid (ALA) improves SB. The antianginal Ranolazine (RAN), also an antioxidant, is an antiarrhythmic. Our studies of their effects on MACE, in DM, and non-DM patients with CHF, ventricular arrhythmias and SCD are reviewed herein, as our findings may apply to acute diseases, such as COVID-19. Methods: (1) In a case-control study, 109 CHF patients, 54 were given adjunctive off-label RAN added to ACC/AHA Guideline therapy (RANCHF). MACE and SB were compared with 55 NORANCHF patients; mean f/u 23.7 mo. (2) 59 adults with triggered premature ventricular contractions (PVCs), bigeminy, and VT were given off-label RAN. Pre- and post-RAN Holters were compared; mean f/u 3.1 mo. (3) 133 DM II with cardiac diabetic autonomic neuropathy were offered (r) ALA; 83 accepted; 50 refused. P&S were followed a mean of 6.31 years, and SCDs recorded. Results: (1) 70% of RANCHF patients increased LVEF 11.3 EFUs (p ≤ 0.003), SCD reduced 56%; VT/VF therapies decreased 53%. (2) 95% of patients responded: VT decreased 91% (p<0.001). (3) SCD was reduced 43% in DM II patients taking (r) ALA (p=0.0076). Conclusion: RAN, (r) ALA treat CHF, VT, and prevent SCD. Trials in COVID-19 are needed.

P5525Impact of clinical presentation at admission on long-term clinical outcomes in patients undergoing percutaneous coronary interventions - a contemporary registry data

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Piatek ◽  
L Zandecki ◽  
J Kurzawski ◽  
A Janion-Sadowska ◽  
M Zabojszcz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Stable Angina ◽  
Clinical Presentation ◽  
P Value ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary

Abstract Background Both unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) are still classified together in non-ST-elevation acute coronary syndromes despite the fact they substantially differ in both clinical profile and prognosis. Purpose The aim of the present study was to evaluate contemporary clinical characteristics and outcomes of UA patients after percutaneous coronary intervention (PCI) in comparison with stable angina (SCAD) and myocardial infarction (NSTEMI as well as STEMI) in Swietokrzyskie District of Poland in years 2014–2017. Methods A total of 7'187 patients after PCI from ORPKI Registry (38% with diagnosis of UA) were included into the analysis. Impact of clinical presentation (UA, SCAD, NSTEMI, STEMI) on 3-year outcomes were determined. Results UA patients were older that SCAD but younger than NSTEMI individuals. Diabetes and hypertension were more often encountered into UA group than in NSTEMI but less often than in SCAD cases. In UA group the percentage of previous myocardial infarction (MI), PCI or coronary artery bypass grafting (CABG) was the highest among all analyzed groups. In 3-year observation the risk of death as well as myocardial infarction (MI) and major adverse cardiac events (MACE) in unstable angina after PCI was higher than in stable angina but considerably lower than in NSTEMI group. Multivariate analysis confirmed that prognosis in NSTEMI was substantially worse in comparison with UA (RR 1.365, 95% CI: 1.126–1.655, p=0.0015). On the contrary there were no difference in mortality risk between UA and SCAD patients (RR 1.189, 95% CI: 0.932–1.518, p=0.1620). Parallel results were observed in respect of MI and MACE. Independ predictors of death were: age, kidney disease, hypertension, diabetes, previous stroke or previous PCI. Multivariate logistic regression analyse Clinical presentation Death Myocardial infarction MACE RR 95% CI p-value RR 95% CI p-value RR 95% CI p-value NSTEMI/UA 1.365 1.126–1.655 0.0015 1.822 1.076–3.055 0.0260 1.514 1.267–1.807 <0.0001 NSTEMI/SCAD 1.624 1.251–2.109 0.0003 1.882 0.982–3.789 0.0568 1.604 1.275–2.094 <0.0001 UA/SCAD 1.189 0.932–1.518 0.1620 1.033 0.557–2.034 0.9219 1.060 0.855–1.323 0.6023 MACE, major adverse cardiac events; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina; SCAD, stable angina. Conclusion Unstable angina accounted for 38% of all cases and was the most common diagnosis in patients that underwent PCI in that time. 3-year prognosis in UA was considerable better in comparison with NSTEMI. On contrary there was no difference in outcomes (death, MI, MACE) between UA and SCAD patients.

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