scholarly journals PILOT RESULTS OF STUDYING CARDIAC MICROPOTENTIALS IN PATIENTS WITH MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK

2019 ◽  
Vol 33 (4) ◽  
pp. 103-110 ◽  
Author(s):  
I. V. Maximov ◽  
D. K. Avdeeva ◽  
M. L. Ivanov ◽  
I. A. Zimin ◽  
M. M. Yuzhakov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pilot Study ◽  
High Resolution ◽  
Cardiogenic Shock ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
National Guidelines ◽  
Software Complex ◽  
Heart Rhythm Disorders ◽  
Life Threatening

Aim. To study cardiac micropotentials registered by the hardware and software complex with nanosensors in patients with myocardial infarction for the early detection of life-threatening conditions.Materials and Methods. The pilot study included 29 patients with acute myocardial infarction who had life-threatening complications such as heart rhythm disorders, the development of acute left ventricular failure, or clinical death prehospitally or at admission to the coronary care unit. The diagnosis of myocardial infarction was established and treatment was carried out according to the national guidelines for the management of patients with myocardial infarction, including the methods of myocardial revascularization.Results. During hospitalization, eight patients developed cardiogenic shock and died. 21 patients survived and were included in the comparison group. At admission, all patients underwent high-resolution electrocardiography using the originally developed hardware and software complex with nanosensors. The micropotentials on the ST segment of the electrocardiogram were recorded for 30 s in three leads on-line. The numbers of micropotentials in the studied groups were analyzed. The analysis of the number of micropotentials within certain ranges of amplitude and duration registered on high-resolution electrocardiogram showed a decrease of the micropotential number in group of patients who died from cardiogenic shock compared with the group of survived patients.Conclusions. The results of this pilot study of cardiac micropotentials are preliminary and require further accumulation of data as well as a search for new criteria for diagnostics, prognosis, and evaluation of the treatment efficacy in patients with myocardial infarction.

scholarly journals Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

2019 ◽  
Vol 76 (2) ◽  
pp. 152-160
Author(s):  
Milovan Petrovic ◽  
Milana Jarakovic ◽  
Milenko Cankovic ◽  
Ilija Srdanovic ◽  
Mila Kovacevic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Vessel Disease ◽  
Early Revascularization ◽  
Infarct Related Artery

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The study group consisted of 235 patients treated in the period from August 2007 until October 2016 for STEMI complicated by cardiogenic shock. Three groups were formed. The first group consisted of patients with one vessel disease who underwent revascularization of infarct related artery; the second group of patients had multi-vessel disease and only culprit lesions were revascularized and the third one consisted of patients with multi-vessel disease and the complete myocardial revascularization performed. Additional subgroups were formed in reference to the intra-aortic balloon pump (IABP) implantation. Intra-hospital mortality was analyzed in all groups and subgroups. Results. Revascularization of the culprit lesion alone among patients with multivessel disease was performed in 142 (60.4%) patients while the complete revascularization (revascularization of ?culprit? and other significant lesions) was performed in 28 (11.9%) patients with multi-vessel disease. There were 65 (27.7%) patients with single-vessel disease who underwent revascularization of infarct related artery. The lowest mortality was found in the group of patients with multi-vessel coronary disease who underwent complete myocardial revascularization and had IABP implanted (mortality was 35.7%). The difference in the mean value of the left ventricular ejection fraction (EF) between the surviving and deceased patients was statistically significant (p < 0.005). The average EF of survivors was 44% (35%?50%) while 30% (25%?39.5%) deceased of patients. Based on the obtained data, the mathematically predictive model was tested. The receiver operating characteristic (ROC) curve showed that our model is a good predictor of fatal outcome (p < 0.0005; AUROC = 0.766) with the sensitivity of 80.3%, and the specificity of 67%. Conclusion. STEMI complicated by cardiogenic shock is still associated with a high mortality rate. Complete myocardial revascularization independently as well as in combination with an IABP, significantly reduces mortality in patients with acute STEMI complicated by cardiogenic shock.

scholarly journals Mechanical circulatory support with impella in patients with non-acute myocardial infarction related cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Haurand ◽  
S Bueter ◽  
C Jung ◽  
M Kelm ◽  
R Westenfeld ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Apache Ii Score ◽  
Hemodynamic Parameters ◽  
Clinical Scores ◽  
Lactate Levels

Abstract Background Percutaneous left ventricular assist devices such as the Impella pump, are used to hemodynamically stabilize patients with cardiogenic shock (CS) caused by acute myocardial infarction (AMI) until cardiac function has recovered after revascularization. Whether Impella mechanical circulatory support (MCS) is effective in stabilizing patients with CS not caused by AMI has so far not been thoroughly investigated. Purpose The aim of this study is to analyze whether MCS with Impella is effective to stabilize patients with non-AMI related CS compared to patients with AMI related CS. Method We retrospectively analyzed 106 patients with CS and Impella support in the years from 2011 to 2018. Efficacy to stabilize the patient was assessed by laboratory values such as lactate, hemodynamic parameters and clinical scores. The difference in mortality was calculated with the Log-Rank-Test, comparing Kaplan-Meier curves. Results 36 patients suffered from non-AMI CS and in 70 patients CS was caused by AMI. Regarding the clinical scores and hemodynamic parameters, both groups were severely ill, with no significant difference in APACHE II score, with a mean score of 17.9 in the non-AMI group compared to 20.5 in the AMI-group (p=0.103), the SOFA score (mean score of 6.3 in non-AMI group vs 6.8 in AMI group, p=0.467) and cardiac index (mean CI of 1.9 l/min/m2 in non-AMI group vs 2.2 l/min/m2 in AMI group, p=0.176). There was a comparable mean decrease in lactate levels in both groups 48 hours after initiation of MCS, from initially 4.1 mmol/l to 1.7 mmol/l (p&lt;0.001) in the non-AMI group and from initially 3.6 mmol/l to 2.2 mmol/l (p=0.025) in the AMI group. The non-ACS group exhibited a trend of lower mortality compared to the AMI group, with 47% in the non-AMI group and 57% in the AMI group (p=0.067). In multivariate analysis, age, lactate levels, cardiopulmonary resuscitation, low platelets and higher doses of inotropes and vasopressors were independent predictors for mortality. An upgrade to LVAD was performed for 22% of the non-AMI group and for 6% of the AMI group (p=0.020). Conclusion Impella support is effective to hemodynamically stabilize patients with non-AMI related CS. Therefore, MCS can be used as bridge to recovery or enables further treatment options as upgrade to longterm mechanical support devices. Funding Acknowledgement Type of funding source: None

Extracorporeal membrane oxygenation in pheochromocytoma-induced cardiogenic shock

2017 ◽  
Vol 26 (4) ◽  
pp. 314-316 ◽  
Author(s):  
Nadia Bouabdallaoui ◽  
Denis Bouchard ◽  
E. Marc Jolicoeur ◽  
Alexandra Chronopoulos ◽  
Pierre Y Garneau ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Clinical Value ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Life Saving ◽  
Adrenal Pheochromocytoma ◽  
Life Threatening

Extracorporeal membrane oxygenation has been extensively used for cardiopulmonary support in cardiogenic shock. However, its clinical value in the management of pheochromocytoma crisis remains unclear. We report a rare case of life-threatening cardiogenic shock managed with peripheral venoarterial extracorporeal membrane oxygenation combined with endovascular left ventricular venting, in a 40-year-old female patient, in the setting of unknown adrenal pheochromocytoma. We highlight the life-saving role of extracorporeal membrane oxygenation in undiagnosed endocrine emergencies, allowing cardiac and end-organ recovery, and giving time for accurate diagnosis and specific treatment in such unusual situations.

scholarly journals A life-threatening reverse Takotsubo syndrome in a young breastfeeding woman: a case report

2021 ◽  
Author(s):  
Carla Marques Pires ◽  
Sérgia Rocha ◽  
Nuno Salomé ◽  
Pedro Azevedo
Keyword(s):  
Cardiogenic Shock ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Presumptive Diagnosis ◽  
Lv Dysfunction ◽  
St Segment ◽  
Life Threatening ◽  
Triggering Factor ◽  
Β Blocker

Abstract Background Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and is usually triggered by emotional, physical or combined stress. This syndrome has been increasingly recognized, although it remains a challenging and often misdiagnosed disorder. Case Summary A 36-year-old breastfeeding woman was admitted with sudden dyspnoea and oppressive chest pain. On admission she was lethargic, hypotensive and tachycardic. The electrocardiogram showed rapid atrial fibrillation and diffuse ST-segment depression. The transthoracic echocardiogram (TTE) revealed severe LV systolic dysfunction, with midventricular and basal akinesis, compensatory apical hyperkinesia and without intraventricular gradient. Emergent coronary angiogram showed normal coronary arteries. A presumptive diagnosis of reverse TTS with cardiogenic shock was made. The patient was transferred to the Intensive Care Unit after intubation and inotropic and vasopressor support was initiated. During hospitalization, rapid clinical improvement was observed. In three days, the patient was weaned from hemodynamic support and extubated. Furthermore, β-blocker and angiotensin receptor blocker were initiated and tolerated. Cabergoline was also administered to inhibit lactation. The presumptive diagnosis was further strengthened by cardiac magnetic resonance and all triggering factors were excluded. At hospital discharge she was asymptomatic and the follow-up TTE was normal, which confirmed the diagnosis of reverse TTS. DISCUSSION We present a case of a young woman, eight months after delivery, which developed a life-threatening reverse TTS without triggering factor identified. Reverse TTS is a rare variant of TTS with different clinical features and is more likely to be complicated by pulmonary edema and cardiogenic shock.

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