scholarly journals Principles of using esmolol in the practice of anesthesiologists and intensive care physicians

2021 ◽  
Vol 4 (1) ◽  
pp. 22-28
Author(s):  
Volodymyr Chernii
Keyword(s):  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Surgical Stress ◽  
Perioperative Period ◽  
Cardiac Risk ◽  
Sympathoadrenal System ◽  
Hemodynamic Changes ◽  
Coronary Syndrome ◽  
System A ◽  
Excessive Activation

Prevention and reduction of cardiac risk remains an important issue in anesthesiology and intensive care. There is a successful clinical experience in the use of esmolol for the correction of hemodynamic and ischemic disorders in acute coronary syndrome, in the perioperative period with excessive activation of the sympathoadrenal system. A large number of works are devoted to the use of esmolol as a drug that prevents hemodynamic changes due to tracheal intubation. The aim of the study was to evaluate the use of esmolol and dexmedetomidine as intravenous adjuvants in general analgesia during thyroidectomy in patients with thyrotoxicosis. The use of esmolol (Biblock) and dexmedetomidine in anesthesia for thyroidectomy, suppresses the hemodynamic response caused by surgical stress. Both adjuvants stabilize oxygen consumption and maintain a stable metabolism. Both drugs are quite effective as intravenous adjuvants in general analgesia for thyroidectomy in patients with thyrotoxicosis. They are the drugs of choice and can be recommended in practical anesthesiology.

Spontaneous coronary artery dissection in association with cabergoline therapy

2021 ◽  
Vol 14 (2) ◽  
pp. e240022
Author(s):  
Zia Saleh ◽  
Susan Koshy ◽  
Vaninder Sidhu ◽  
Andrea Opgenorth ◽  
Janek Senaratne
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Ergot Derivative

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline—an ergot derivative and dopamine agonist that may induce vasospasm—has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.

scholarly journals Acute Myocardial Infarction In Systemic Mastocytosis: Case Report With Literature Review Of The Role Of Inflammatory Process In Acute Coronary Syndrome

2020 ◽  
Vol 16 ◽  
Author(s):  
Ayman Battisha ◽  
Khalid Sawalha ◽  
Bader Madoukh ◽  
Omar Sheikh ◽  
Karim Doughem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Plasma Lipids ◽  
Plaque Rupture ◽  
Systemic Mastocytosis ◽  
Cardiac Risk ◽  
Control Group ◽  
Coronary Syndrome

: Systemic Mastocytosis (SM) is a disorder of excessive mast cell infiltration in multiple organ tissues. Atherosclerosis is a major risk factor for developing acute coronary syndrome [1]. In addition to lipid accumulation in the arterial wall, inflammation plays an important role in the pathogenesis of plaque rupture and activating the thrombosis cascade [2]. The Mast cells contribution to plaque destabilization has been well established in multiple animal and human studies [3]. In a recent study, SM has been proven to be associated with a higher incidence of acute coronary syndrome even with lower plasma lipids level [4]. The study showed that 20% of patients with SM had cardiovascular events compared to only 6% in the control group with adjustment to all cardiac risk factors. Here, we present a case of acute myocardial infarction in a patient with SM with limited risk factors other than age.

Prognostic Value of Troponin I with Echocardiography Assessment in Septic Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Farouk Ibrahim ◽  
Ashraf Elsayed Elagmy ◽  
Abdelrhman Gamal Abdelsabour
Keyword(s):  
Septic Shock ◽  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Coronary Syndrome ◽  
Sepsis And Septic Shock

Abstract Background Sepsis is heterogenous with regard to factors such as causal microorganism, patient predisposition, co-morbidity and response to therapy, a key element and unifying feature is the manifestation of cardiovascular dysfunction. Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with severe sepsis and septic shock even in the absence of an acute coronary syndrome (ACS). Objective To evaluate the prognostic value of (cTnI) with echocardiography assessment in septic patients. Patients and Methods This study was conducted at the intensive care units of Ain Shams university hospitals. 20 patients of both sexes with age ranging from 18 to 70 years diagnosed with sepsis admitted to Intensive care unit were included in prospective observational study. Results Baseline cTnI had a significant positive correlation with follow up troponine (p = 0.0016). Baseline EF had a significant negative correlation with follow up troponine (p = 0.036). Using ROC-curve analysis, troponin level at a cutoff point (>1.9) predicted patients with mortality, with good (87%) accuracy, sensitivity= 90% and specificity= 90% (p < 0.01). Conclusion Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with sepsis and septic shock even in the absence of an acute coronary syndrome.

scholarly journals Lowered anti-beta1 adrenergic receptor antibody concentrations may have prognostic significance in acute coronary syndrome

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Diana Ernst ◽  
Johan Westerbergh ◽  
Georgios Sogkas ◽  
Alexandra Jablonka ◽  
Gerrit Ahrenstorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Myocardial Infarct ◽  
Prognostic Significance ◽  
Cardiac Risk ◽  
Cardiovascular Death ◽  
Antibody Concentration ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Prognostic Implications

Abstract Although several risk factors exist for acute coronary syndrome (ACS) no biomarkers for survival or risk of re-infarction have been validated. Previously, reduced serum concentrations of anti-ß1AR Ab have been implicated in poorer ACS outcomes. This study further evaluates the prognostic implications of anti-ß1AR-Ab levels at the time of ACS onset. Serum anti-ß1AR Ab concentrations were measured in randomly selected patients from within the PLATO cohort. Stratification was performed according to ACS event: ST-elevation myocardial infarct (STEMI) vs. non-ST elevation myocardial infarct (NSTEMI). Antibody concentrations at ACS presentation were compared to 12-month all-cause and cardiovascular mortality, as well as 12-month re-infarction. Sub-analysis, stratifying for age and the correlation between antibody concentration and conventional cardiac risk-factors was subsequently performed. Serum anti-ß1AR Ab concentrations were measured in 400/799 (50%) STEMI patients and 399 NSTEMI patients. Increasing anti-ß1AR Ab concentrations were associated with STEMI (p = 0.001). Across all ACS patients, no associations between anti-ß1AR Ab concentration and either all-cause cardiovascular death or myocardial re-infarction (p = 0.14) were evident. However among STEMI patients ≤60 years with anti-ß1AR Ab concentration <median higher rates of re-infarction were observed, compared to those with anti-ß1AR Ab concentrations > median (14/198 (7.1%) vs. 2/190 (1.1%)); p = 0.01). Similarly, the same sub-group demonstrated greater risk of cardiovascular death in year 1, including re-infarction and stroke (22/198 (11.1%) vs. 10/190 (5.3%); p = 0.017). ACS Patients ≤60 years, exhibiting lower concentrations of ß1AR Ab carry a greater risk for early re-infarction and cardiovascular death. Large, prospective studies quantitatively assessing the prognostic relevance of Anti-ß1AR Ab levels should be considered.

scholarly journals Prognostic Value of Initial Elevation in Cardiac Troponin I Level in Critically Ill Patients Without Acute Coronary Syndrome

2015 ◽  
Vol 35 (2) ◽  
pp. e1-e10 ◽  
Author(s):  
Michael Liu ◽  
Merita Shehu ◽  
Edmund Herrold ◽  
Henry Cohen
Keyword(s):  
Intensive Care Unit ◽  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Troponin Level ◽  
Coronary Syndrome

BackgroundCardiac troponin I levels are often obtained to help rule out acute coronary syndrome.ObjectiveTo determine if elevation of troponin level within 24 hours for patients without acute coronary syndrome admitted to the intensive care unit provides important prognostic information. METHODS Patients without acute coronary syndrome admitted to the intensive care unit were prospectively divided into 2 groups according to highest serum level of cardiac troponin I within 24 hours of admission (elevated &gt; 0.049 ng/mL; control ≤ 0.049 ng/mL). Hospital mortality, incidence of intubation, and other parameters were compared between the 2 groups.ResultsPatients with elevated troponin level (n = 40) had higher mortality than did control patients (n = 50) (35% vs 12%; P = .01). Compared with control patients, patients with elevated levels were more likely to be intubated (41% vs 17%; P = .02).ConclusionCritically ill patients without acute coronary syndrome with elevated levels of cardiac troponin I at admission had higher mortality and more intubations than did control patients.

scholarly journals Cardiogenic shock associated with acute coronary syndrome: the current state of the problem of diagnostics and intensive care. Article

2020 ◽  
pp. 73-85
Author(s):  
E. V Grigoryev ◽  
A. E Bautin ◽  
M. Yu Kirov ◽  
D. L Shukevich ◽  
R. A Kornelyuk
Keyword(s):  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Cardiogenic Shock ◽  
Contractile Activity ◽  
Circulatory Support ◽  
Necessary Condition ◽  
Coronary Syndrome ◽  
Current State ◽  
Myocardial Contractile ◽  
Postcardiotomy Cardiogenic Shock

Cardiogenic shock is a syndrome of critical hypoperfusion associated with a fatal decrease in myocardial contractile activity. Phenotypically cardiogenic shock is most frequently based on acute coronary syndrome, less often - on postcardiotomy cardiogenic shock and shock due to sepsis. Despite successes in the development of intensive care methods, cardiogenic shock is still accompanied by high mortality. Updating the data on the diagnosis and intensive care of this condition is a necessary condition for improving the quality of medical care. The present work describes modern definitions and ideas about the pathogenesis of cardiogenic shock, as well as the phase concept of intensive care, the role of endovascular revascularization and methods of mechanical circulatory support. The review is emphasized on cardiogenic shock in acute coronary syndrome.

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