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

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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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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Cardiogenic Shock due to Kounis Syndrome following Cobra Bite

Case Reports in Critical Care ◽

10.1155/2019/5185716 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

W. D. D. Priyankara ◽

E. M. Manoj ◽

A. Gunapala ◽

A. G. R. M. A. Ranaweera ◽

K. S. Vithanage ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiogenic Shock ◽

Cell Activation ◽

Left Ventricular ◽

Clinical Syndrome ◽

Mast Cell Activation ◽

Left Ventricular Ejection ◽

Kounis Syndrome ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome

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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Myocardial infarction with cardiogenic shock---the experience of a primary PCI centre from North-East Romania

10.22514/sv.2021.070 ◽

2021 ◽

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

Cardiogenic Shock ◽

Right Ventricular ◽

Severe Form ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Risk Of Death ◽

Vessel Disease

Objectives: To evaluate the severity of acute myocardial infarction (AMI) complicated with cardiogenic shock (CS), by comparison with inferior and right ventricular AMI, which is also considered a severe form of myocardial infarction. Methods: In an observational study, from 774 patients with STEMI hospitalized in our Cardiology Institute, over one year and a half, only 120 patients met the inclusion and exclusion criteria (60 patients with CS and 60 patients with right ventricular AMI). Data collected included age, sex, vital signs, oxygen saturation, respiratory rate, left ventricular ejection fraction, right ventricular dysfunction, complications during hospitalization and coronarography results. Results: Patients with CS had a more severe systolic dysfunction (median ejection fraction 22.72 ± 12.30% vs. 41.93 ± 10.50%, P < 0.0001). Single-vessel disease was the most common in both groups, left anterior descending artery being the culprit artery in most patients with cardiogenic shock, 25% of them having residual lesions with a severity >75%. Using a multivariate analysis, we observed that for patients with CS, delayed coronary angiography evaluation, as well as the presence of severe triple-vessel disease, were associated with a higher risk of death. In-hospital mortality (53.33% vs. 8.33%, P < 0.0001) and ventricular arrhythmia were significantly higher in patients with CS (48.3% vs. 11.3%, P < 0.0001). Conclusions: Our study suggests that patients with AMI and CS can be considered the most severe form of myocardial infarction and should, therefore, benefit of prompt and appropriate treatment, to improve the outcome.

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Better in-hospital outcome among hypertensive subjects developing acute myocardial infarction-study in a tertiary cardiac care center in Bangladesh

Bangladesh Heart Journal ◽

10.3329/bhj.v31i1.30615 ◽

2016 ◽

Vol 31 (1) ◽

pp. 10-17

Author(s):

Prabir Kumar Das ◽

Sayed Md Hasan ◽

Salehuddin Siddique ◽

Munzur Murshed ◽

AKM Fazlur Rahman

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Inhospital Mortality ◽

Ventricular Ejection Fraction ◽

Female Ratio ◽

Hypertensive Patients

Background:In-hospital complications and mortality in hypertensives developing acute myocardial infarction(AMI) may be different from those of normotensive counterpart.The aim of the current study was to analyze in-hospital complication and outcome of AMI in hypertensive patients and compare it with age and sex matched normotensive AMI patients.Methods: In-hospital complications of 112 hypertensive patients with AMI admitted over a period of 1 year (April 2014 to March 2015) were compared with the control group. Location and types of AMI were determined by ECG. Patients were considered to be hypertensive if they were taking antihypertensive treatment or were found to have a systolic blood pressure (SBP) e140 mmHg and/or a diastolic blood pressure (DBP) e90 mmHg on repeated measurements. Both groups were studied prospectively. The results were analyzed by SPSS software.Results:Out of total 112 patients 69 were male and 43 were female in each group. Male: female ratio was 1.6:1. Mean age of the study population was 67.3±10.2 yrs (range 41 to 83 yrs). Mean blood pressure values were 145.7±11.5/88.3±8.9 mmHg in the hypertensive and 127.3±9.7/75.8±5.6 mmHg in normotensive group respectively. A significantly higher prevalence of diabetes, dyslipidemia, chronic kidney disease, stroke and peripheral vascular disease were found in the hypertensive compared with the normotensive subjects. Hypertensive AMI patients had higher left ventricular ejection fraction compared with the normotensives(0.51±0.13 vs 0.47±0.15). A higher frequency of paroxysmal atrial fibrillation(AF) (10.7% vs 7.1%, P<0.05) and a lower frequency of atrioventricular block (5.4 % vs 8.0%), ventricular fibrillation (2.7% vs 4.5%), cardiogenic shock (4.5% vs 9.8%, P<0.01) and a lower inhospital mortality(6.2% vs 10.7%, P<0.01) were found among the hypertensives compared with the normotensives.Conclusion: Hypertensive AMI patients had a significantly higher incidence of AF, lower incidence of cardiogenic shock and an overall better inhospital outcome compared with the normotensives, probably owing to a better preserved left ventricular function, prior use of cardioprotective drugs and yet undefined mechanism.Bangladesh Heart Journal 2016; 31(1) : 10-17

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