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Transplante cardíaco pediátrico em vigência de choque cardiogênico refratário: análise crítica da viabilidade, aplicabilidade e resultados; Pediatric heart transplantation in refractory cardiogenic shock: a critical analysis of feasibility, applicability and results

JATENE, Marcelo Biscegli; MIANA, Leonardo Augusto; PESSOA, Alexander John; RISO, Arlindo; AZEKA, Estela; TANAMATI, Carla; GIMENEZ, Solange; LOPES, Antonio Augusto; MARCIAL, Miguel Barbero; STOLF, Noedir Antonio Groppo
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
56.82%
FUNDAMENTO: Considerando crianças com miocardiopatia dilatada, na lista de espera de transplante de coração, podemos avaliar a gravidade do quadro hemodinâmico desses pacientes. Alguns apresentam choque cardiogênico e um elevado índice de mortalidade. Mesmo com suporte inotrópico e respiratório, o transplante de coração é considerado uma condição de extrema gravidade. OBJETIVO: Apresentar nossa experiência com crianças na circunstância de transplante cardíaco em vigência de choque cardiogênico refratário, procurando analisar a viabilidade, a aplicabilidade e os resultados desses transplantes. MÉTODOS: De março de 2001 a fevereiro de 2004, 22 crianças com miocardiopatia dilatada, previamente registradas na lista de transplante, apresentaram choque cardiogênico, necessitando transferência para unidade de terapia intensiva (UTI) pediátrica, intubação e suporte inotrópico. As idades variaram de 11 meses a 11 anos (média = 4,3 idade), com 55% do sexo masculino; 14 poderiam ser listados como prioridade clínica e os outros 8 foram excluídos da lista de espera em razão de condição clínica desfavorável. RESULTADOS: Oito transplantes de coração foram executados, 6 crianças faleceram na fila de espera (42...

Impacto hemodinâmico de manobra de recrutamento alveolar em pacientes evoluindo com choque cardiogênico no pós-operatório imediato de revascularização do miocárdio; Hemodynamic impact of alveolar recruitment maneuver in patients evolving with cardiogenic shock in the immediate postoperative period of myocardial revascularization; Impacto hemodinámico de maniobra de reclutamiento alveolar en pacientes evolucionando con choque cardiogénico en el postoperatorio inmediato de revascularización del miocardio

MALBOUISSON, Luiz Marcelo Sá; BRITO, Marcelo; CARMONA, Maria José Carvalho; AULER JR, José Otávio Costa
Fonte: Sociedade Brasileira de Anestesiologia Publicador: Sociedade Brasileira de Anestesiologia
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
46.82%
JUSTIFICATIVA E OBJETIVOS: Manobras de recrutamento alveolar (MRA) utilizando pressões de 40 cmH2O nas vias aéreas são efetivas em reverter as atelectasias após revascularização cirúrgica do miocárdio (RM), contudo não existem estudos avaliando o impacto hemodinâmico dessa manobra em pacientes que evoluíram com choque cardiogênico. O objetivo foi testar a tolerância hemodinâmica à MRA em pacientes evoluindo com choque cardiogênico após RM. MÉTODO: Após admissão na UTI e estabilização hemodinâmica, foram estudados dez pacientes hipoxêmicos e em choque cardiogênico após RM. Os ajustes ventilatórios foram volume corrente de 8 mL.kg-1, PEEP 5 cmH2O, FR de 12 ipm e FiO2 de 0,6. Pressão contínua de 40 cmH2O foi aplicada nas vias aéreas por 40 segundos em três ciclos. Entre os ciclos, os pacientes foram ventilados por 30 segundos e após o último ciclo a PEEP foi ajustada em 10 cmH2O. Foram obtidas medidas hemodinâmicas após 1, 10, 30 e 60 minutos da MRA e colhidas amostras sangüíneas arteriais e venosas para mensuração de lactato e gases sangüíneos 10 e 60 minutos após. Dados analisados por meio de ANOVA e teste de Friedman. Valor de p fixado em 0,05. RESULTADOS: A MRA aumentou a relação PaO2/FiO2 de 87 para 129...

Is persistent hypotension after transient cardiogenic shock associated with an inflammatory response?

Park,M.; A.T.,Maciel; Noritomi,D.T.; Brunialti,M.K.; Salomão,R.; Schettino,G.P.P.; Azevedo,L.C.P.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2008 Português
Relevância na Pesquisa
66.77%
We evaluated the recovery of cardiovascular function after transient cardiogenic shock. Cardiac tamponade was performed for 1 h and post-shock data were collected in 5 domestic large white female pigs (43 ± 5 kg) for 6 h. The control group (N = 5) was observed for 6 h after 1 h of resting. During 1 h of cardiac tamponade, experimental animals evolved a low perfusion status with a higher lactate level (8.0 ± 2.2 vs 1.9 ± 0.9 mEq/L), lower standard base excess (-7.3 ± 3.3 vs 2.0 ± 0.9 mEq/L), lower urinary output (0.9 ± 0.9 vs 3.0 ± 1.4 mL·kg-1·h-1), lower mixed venous saturation, higher ileum partial pressure of CO2-end tidal CO2 (EtCO2) gap and a lower cardiac index than the control group. Throughout the 6-h recovery phase after cardiac tamponade, tamponade animals developed significant tachycardia with preserved cardiac index, resulting in a lower left ventricular stroke work, suggesting possible myocardial dysfunction. Vascular dysfunction was present with persistent systemic hypotension as well as persistent pulmonary hypertension. In contrast, oliguria, hyperlactatemia and metabolic acidosis were corrected by the 6th hour. The inflammatory characteristics were an elevated core temperature and increased plasma levels of interleukin-6 in the tamponade group compared to the control group. We conclude that cardiovascular recovery after a transient and severe low flow systemic state was incomplete. Vascular dysfunction persisted up to 6 h after release of tamponade. These inflammatory characteristics may also indicate that inflammatory activation is a possible pathway involved in the pathogenesis of cardiogenic shock.

Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

Dallan,Luís Alberto Oliveira; Milanez,Adriano; Lisboa,Luiz Augusto F.; Jatene,Fabio B.
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2013 Português
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56.61%
Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

Plasma adrenaline and noradrenaline concentrations and dopamine-beta-hydroxylase activity in myocardial infarction with and without cardiogenic shock.

Benedict, C R; Grahame-Smith, D G
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1979 Português
Relevância na Pesquisa
46.74%
In patients with myocardial infarction, with or without cardiogenic shock, plasma noradrenaline and adrenaline concentrations are increased. However, plasma noradrenaline concentrations are considerably higher in patients with cardiogenic shock when compared with those with uncomplicated myocardial infarction. Plasma noradrenaline and adrenaline concentrations showed a sustained increase until death in patients with cardiogenic shock whereas those concentrations were back to normal levels by the end of the third day in patients with uncomplicated myocardial infarction. Plasma dopamine-beta-hydroxylase activities in both the groups were within normal range and did not show any significant variation throughout the period of study.

Coronary artery disease in patients dying from cardiogenic shock or congestive heart failure in the setting of acute myocardial infarction.

Wackers, F J; Lie, K I; Becker, A E; Durrer, D; Wellens, H J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1976 Português
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46.82%
Pathological findings in the heart and particularly in the coronary arteries are reported from 70 patients dying from pump failure after acute myocardial infarction. Fifty of the patients had died in cardiogenic shock, the remainder from refractory congestive heart failure. Three-vessel disease (greater than or equal to 75% occlusion) was present in 68 per cent of the group with cardiogenic shock but in only 35 per cent of those with fatal congestive heart failure (P less than 0-02). In both groups there was an almost equal incidence (84% for cardiogenic shock and 80% for congestive heart failure) of severe disease (greater than or equal to 75% occlusion) over a long segment of the left anterior descending artery. However, there were differences between the two groups regarding the involvement of the other coronary arteries. Whereas patients with cardiogenic shock generally showed severe disease over a long segment in all coronary arteries, in 60 per cent of those with congestive heart failure there was only local severe narrowing of the right coronary artery with little or no narrowing of the peripheral part. Similarly, 60 per cent of those with congestive heart failure had less than 75 per cent narrowing in the left circumflex artery. These anatomical findings may be of relevance with regard to desirability of acute coronary bypass surgery in patients with pump failure after acute myocardial infarction.

Intra-aortic balloon assistance in cardiogenic shock after myocardial infarction or cardiac surgery.

Jackson, G; Cullum, P; Pastellopoulos, A; Macarthur, A; Jewitt, D
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1977 Português
Relevância na Pesquisa
46.82%
Sixty-eight patients were referred for consideration of intra-aortic balloon assistance, 55 of whom were accepted. Thirty-one patients were in cardiogenic shock after myocardial infarction and the remaining 24 were cardiac surgical patients. Twenty-three of the myocardial infarct group were established on IABA and all 24 of the cardiac surgical patients. Of the 23 patients with cardiogenic shock after myocardial infarction, 19 showed initial haemodynamic improvement on intra-aortic balloon assistance and 5 (22%) survived to leave hospital. Of the 24 cardiac surgical patients, 15 could not be withdrawn from total cardiopulmonary bypass. With intra-aortic balloon assistance, 11 (73%) could be withdrawn from cardiopulmonary bypass and 5 (33%) were hospital and long-term survivors. The remaining 9 surgical patients were in cardiogenic shock in the early postoperative phase, though 5 showed initial haemodynamic improvement there was only one hospital survivor in this group. Intra-aortic balloon assistance was, therefore, of most value in patients dependent on cardiopulmonary bypass. The survival in patients with cardiogenic shock after myocardial infarction was marginally improved.

Measurement of cardiac reserve in cardiogenic shock: implications for prognosis and management.

Tan, L B; Littler, W A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1990 Português
Relevância na Pesquisa
46.74%
The hypothesis that the prognosis of cardiogenic shock patients is primarily dependent on cardiac pumping reserve was tested in a prospective study of 28 consecutive patients clinically diagnosed to be in cardiogenic shock and treated medically. Haemodynamic function was assessed by thermodilution Swan-Ganz catheters and arterial cannulas. The cardiac pumping reserve was evaluated by the response of the failing heart to graded incremental dobutamine infusion (2.5 to 40 micrograms/kg/min) after optimalising the left ventricular preload. Eleven of the patients survived for more than the one year of follow up and the rest died. Haemodynamic evaluation during the basal resting state was only able to identify unambiguously non-survivors whose cardiac function was most severely compromised. Survivors and non-survivors with higher values were indistinguishable by basal haemodynamic criteria. The response to dobutamine stimulation clearly separated the cardiac pump function of survivors and those who died. All patients with peak cardiac power output of less than 1.0 W or peak left ventricular stroke work index of less than 0.25 J/m2 died whereas all those with higher values lived for more than a year. Thus this study showed that haemodynamic evaluation of cardiac reserve can provide objective criteria for predicting outcome in individual patients with cardiogenic shock. The availability of such a prognostic indicator will be invaluable in formulating management plans for these patients.

The fundamental hemodynamic mechanism underlying gastric "stress ulceration" in cardiogenic shock.

Bailey, R W; Bulkley, G B; Hamilton, S R; Morris, J B; Haglund, U H; Meilahn, J E
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1987 Português
Relevância na Pesquisa
46.79%
Acute hemorrhagic ulceration of the gastric mucosa is seen frequently in patients with hypovolemic or cardiogenic shock. Although such lesions clearly are related to regional gastric ischemia, little attention has been directed at the underlying mechanism(s) mediating the ischemia itself. To this end, anesthetized pigs were subjected to sustained cardiogenic shock (mild hemorrhage and pericardial tamponade) such that cardiac output was reduced to 38 +/- 1% of the baseline level for 4 hours, followed by release of the tamponade, reinfusion of the shed blood, and resuscitation for 2 hours. During the period of shock, there was profound regional gastric ischemia, resulting from severe and disproportionate gastric vasoconstriction. "Blinded" gross and microscopic evaluation of the stomachs removed after the experiment revealed severe mucosal ischemic necrosis, hemorrhage, and ulceration, whereas sham-operated pigs showed no lesions. The characteristics of this model therefore mimic the essential features of the gastric "stress ulceration" syndrome. Prior confirmed total alpha-adrenergic blockade with phenoxybenzamine failed to alter these features significantly. In contrast, prior ablation of the renin-angiotensin axis, whether by angiotensin-converting enzyme inhibition with teprotide or by bilateral nephrectomy...

Management and outcome of cardiogenic shock complicating acute myocardial infarction in hospitals with and without on-site catheterisation facilities

Barbash, I; Behar, S; Battler, A; Hasdai, D; Boyko, V; Gottlieb, S; Leor, J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/2001 Português
Relevância na Pesquisa
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OBJECTIVE—To determine whether the availability of on-site catheterisation and revascularisation facilities influenced hospital management and outcome of patients with acute myocardial infarction complicated by cardiogenic shock.
METHODS—Patients with acute myocardial infarction were enrolled prospectively in four nationwide surveys during 1992, 1994, 1996, and 1998. The characteristics, management, and outcome of patients with cardiogenic shock were compared between hospitals with on-site catheterisation facilities (group 1; 18 hospitals) and without such facilities (group 2; 8 hospitals).
RESULTS—Of 5351 patients with acute myocardial infarction, 254 (4.7%) developed cardiogenic shock. Group 1 patients (n = 186 of 3854; 4.6%) were younger (mean (SD) age, 69.6 (12) v 73.7 (10) years, p = 0.006) and had a lower proportion of women (36% v 52%, p = 0.03) than group 2 (n = 68 of 1243; 5.2%). There was no difference in other characteristics including the use of thrombolysis. Group 1 patients more often underwent coronary angiography (26% v 4%, p < 0.001), angioplasty (21% v 4%, p = 0.002), and intra-aortic balloon counterpulsation (28% v 4%, p < 0.001). Seven day mortality was lower among group 1 than among group 2 patients (61% v 77%...

Percutaneous Hemodynamic Support (Impella) in Patients with Advanced Heart Failure and/or Cardiogenic Shock Not Eligible to PROTECT II Trial

Liu, Wei; Mukku, Venkata Kishore; Gilani, Syed; Fujise, Ken; Barbagelata, Alejandro
Fonte: Thieme Medical Publishers Publicador: Thieme Medical Publishers
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
46.82%
PROTECT I and II trials have tested the efficacy of Impella in patents with high-risk percutaneous coronary intervention (PCI). However, patients with severe hemodynamic instability such as cardiac arrest, ST-segment elevated myocardial infarction (STEMI), or cardiogenic shock were excluded. The objective was to investigate the efficacy of Impella in sicker patient population who were not included in PROTECT trials. These patients merit high-risk PCI who had cardiogenic shock and unstable or decompensated heart failure (HF). From December 2010 to March 2012, 10 consecutive patients with extremely high surgical risk and hemodynamic instability underwent urgent PCI with Impella 2.5 support (Abiomed Inc., Danvers, MA). These patients were presented with advance HF and/or cardiogenic shock. Among the 10 included patients, 3 patients were with cardiac arrest and 1 patient was with acute myocardial infarction. All patients had successful Impella implantation and remained hemodynamically stable during high-risk PCI. Among the 10 patients 2 patients (20%) died within 1 month and 1 patient developed limb ischemia. In high-risk population nonrandomizable to PROTECT trials with advance HF/cardiogenic shock, Impella could be an important tool for hemodynamic support to PCI or could be a bridge to left ventricle assist device to achieve good recovery. Larger studies need to be conducted on this high-risk population.

Evaluation of Cardiac Function Index as Measured by Transpulmonary Thermodilution as an Indicator of Left Ventricular Ejection Fraction in Cardiogenic Shock

Perny, Jessica; Kimmoun, Antoine; Perez, Pierre; Levy, Bruno
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
46.77%
Introduction. The PiCCO transpulmonary thermodilution technique provides two indices of cardiac systolic function, the cardiac function index (CFI) and the global ejection fraction (GEF). Both appear to be correlated with left ventricular ejection fraction (LVEF) measured by echocardiography in patients with circulatory failure, especially in septic shock. The aim of the present study was to test the reliability of CFI as an indicator of LVEF in patients with cardiogenic shock. Methods. In thirty-five patients with cardiogenic shock, we performed (i) simultaneous measurements of echocardiography LVEF and cardiac function index assessed by transpulmonary thermodilution (n = 72) and (ii) transpulmonary thermodilution before/after increasing inotropic agents (n = 18). Results. Mean LVEF was 31% (+/−11.7), CFI 3/min (+/−1), and GEF 14.2% (+/−6). CFI and GEF were both positively correlated with LVEF (P < 0.0001, r2 = 0.27). CFI and GEF were significantly increased with inotropic infusion (resp., P = 0.005, P = 0.007). A cardiac function index <3.47/min predicted a left ventricular ejection fraction ≤35% (sensitivity 81.1% and specificity 63%). In patients with right ventricular dysfunction, CFI was not correlated with LVEF. Conclusion. CFI is correlated with LVEF provided that patient does not present severe right ventricular dysfunction. Thus...

The Acute Phase of Experimental Cardiogenic Shock Is Counteracted by Microcirculatory and Mitochondrial Adaptations

Stenberg, Thor Allan; Kildal, Anders Benjamin; Sanden, Espen; How, Ole-Jakob; Hagve, Martin; Ytrehus, Kirsti; Larsen, Terje S.; Myrmel, Truls
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 04/09/2014 Português
Relevância na Pesquisa
46.94%
The mechanisms contributing to multiorgan dysfunction during cardiogenic shock are poorly understood. Our goal was to characterize the microcirculatory and mitochondrial responses following ≥10 hours of severe left ventricular failure and cardiogenic shock. We employed a closed-chest porcine model of cardiogenic shock induced by left coronary microembolization (n = 12) and a time-matched control group (n = 6). Hemodynamics and metabolism were measured hourly by intravascular pressure catheters, thermodilution, arterial and organ specific blood gases. Echocardiography and assessment of the sublingual microcirculation by sidestream darkfield imaging were performed at baseline, 2±1 and 13±3 (mean±SD) hours after coronary microembolization. Upon hemodynamic decompensation, cardiac, renal and hepatic mitochondria were isolated and evaluated by high-resolution respirometry. Low cardiac output, hypotension, oliguria and severe reductions in mixed-venous and hepatic O2 saturations were evident in cardiogenic shock. The sublingual total and perfused vessel densities were fully preserved throughout the experiments. Cardiac mitochondrial respiration was unaltered, whereas state 2, 3 and 4 respiration of renal and hepatic mitochondria were increased in cardiogenic shock. Mitochondrial viability (RCR; state 3/state 4) and efficiency (ADP/O ratio) were unaffected. Our study demonstrates that the microcirculation is preserved in a porcine model of untreated cardiogenic shock despite vital organ hypoperfusion. Renal and hepatic mitochondrial respiration is upregulated...

Experts’ recommendations for the management of adult patients with cardiogenic shock

Levy, Bruno; Bastien, Olivier; Benjelid, Karim; Cariou, Alain; Chouihed, Tahar; Combes, Alain; Mebazaa, Alexandre; Megarbane, Bruno; Plaisance, Patrick; Ouattara, Alexandre; Splaulding, Christian; Teboul, Jean-Louis; Vanhuyse, Fabrice; Boulain, Thierry; K
Fonte: Springer Paris Publicador: Springer Paris
Tipo: Artigo de Revista Científica
Publicado em 01/07/2015 Português
Relevância na Pesquisa
46.79%
Unlike for septic shock, there are no specific international recommendations regarding the management of cardiogenic shock (CS) in critically ill patients. We present herein recommendations for the management of cardiogenic shock in adults, developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF)), with the participation the French Society of Anesthesia and Intensive Care (SFAR), the French Cardiology Society (SFC), the French Emergency Medicine Society (SFMU), and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV). The recommendations cover 15 fields of application such as: epidemiology, myocardial infarction, monitoring, vasoactive drugs, prehospital care, cardiac arrest, mechanical assistance, general treatments, cardiac surgery, poisoning, cardiogenic shock complicating end-stage cardiac failure, post-shock treatment, various etiologies, and medical care pathway. The experts highlight the fact that CS is a rare disease, the management of which requires a multidisciplinary technical platform as well as specialized and experienced medical teams. In particular...

Survival of Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Complicated by Cardiogenic Shock

Lim, H.; Farouque, O.; Andrianopolous, N.; Yan, B.; Lim, C.; Brennan, A.; Reid, C.; Freeman, M.; Charter, K.; Black, A.; New, G.; Ajani, A.; Duffy, S.; Clark, D.
Fonte: Elsevier Inc. Publicador: Elsevier Inc.
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
Relevância na Pesquisa
66.84%
Objectives We sought to assess clinical outcomes of elderly patients (age ≥75 years) undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated by cardiogenic shock (CS) in a contemporary multicenter PCI registry. Background Although benefits of early PCI have been shown in younger groups, few studies have reported on clinical outcomes in elderly shock patients using current PCI techniques. Methods We analyzed baseline characteristics and procedural and clinical outcomes in 143 consecutive patients presenting with MI and CS who underwent PCI from the Melbourne Interventional Group registry between 2004 and 2007. Results Of the 143 patients, 31.5% (n = 45) were elderly and 68.5% were younger (age <75 years). Elderly patients were more likely to be female (46.7% vs. 22.4%, p < 0.01) and have hypertension (77.8% vs. 46.4%, p < 0.01), previous MI (31.1% vs. 15.5%, p = 0.03), renal failure (24.4% vs. 11.3%, p < 0.05) and multivessel coronary artery disease (93.1% vs. 68.3%, p < 0.01). Stent (86.7% vs. 94.8%, p = 0.09), glycoprotein IIb/IIIa inhibitor (68.9% vs. 65.3%, p = 0.67), and intra-aortic balloon pump (57.8% vs. 58.2%, p = 0.97) use were similar in both groups. In-hospital, 30-day, and 1-year mortality in the elderly group versus the younger group were 42.2% vs. 33.7% (p = 0.32)...

Miocardiopatia de Takotsubo: Na Origem do Choque Cardiogénico; Takotsubo Cardiomyopathy: Cause of a Cardiogenic Shock

Fevereiro, Maria do Carmo; Unidade Funcional de Medicina 1.4. Hospital de São José. Centro Hospitalar de Lisboa Central. Lisboa. Portugal.; Simões, Maria Inês; Unidade Funcional de Medicina 1.4. Hospital de São José. Centro Hospitalar de Lisboa Cent
Fonte: Ordem dos Médicos Publicador: Ordem dos Médicos
Tipo: info:eu-repo/semantics/article; other; info:eu-repo/semantics/publishedVersion Formato: application/pdf
Publicado em 30/10/2015 Português
Relevância na Pesquisa
56.61%
A miocardiopatia de Takotsubo, de etiologia desconhecida, caracteriza-se pela disfunção sistólica súbita e transitória dos segmentos médio-apicais do ventrículo esquerdo, sem doença coronária significativa, com total normalização das alterações segmentares. É mais frequente em mulheres de meia-idade, implicando diagnóstico diferencial com a sindrome coronária aguda. Apresentamos o caso de uma mulher de 59 anos que recorreu ao Serviço de Urgência por dispneia súbita e dor torácica. À admissão apresentava-se em edema pulmonar agudo hipotensivo com necessidade de suporte aminérgico e ventilação invasiva. A avaliação analítica demonstrava elevaçãodos marcadores cardíacos. Electrocardiogramas seriados em ritmo sinusal com inversão progressiva da onda T nas derivações precordiais (v2 - v6). Ecocardiogramas de controlo revelando acinésia apical com diminuição da função sistólica global, e reversão total das alterações em duas semanas. Admitido choque cardiogénico de etiologia não esclarecida foi excluída doença coronária, sustentando o diagnóstico de miocardiopatia de Takotsubo.; Takotsubo cardiomyopathy, of unknown etiology, is characterized by sudden and transient systolic dysfunction of the mid-apical segments of the left ventricle without significant coronary disease...

Transapical transcatheter aortic valve replacement in patients with cardiogenic shock

D'Ancona, Giuseppe; Pasic, Miralem; Buz, Semih; Drews, Thorsten; Dreysse, Stephan; Kukucka, Marian; Hetzer, Roland; Unbehaun, Axel
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
47.12%
Transcatheter aortic valve implantation (TAVI) has been introduced to treat patients at high risk for conventional surgery; however, cardiogenic shock is considered a contraindication for TAVI. The aim of the present study was to evaluate early and intermediate mortality of patients in cardiogenic shock undergoing TAVI as a rescue procedure. Patients in cardiogenic shock underwent transapical TAVI with Edwards SAPIEN (Edwards Lifesciences, Irvine, CA, USA) prosthetic valves. Preoperative, perioperative and 1-year follow-up data were analysed. Analysis included 358 patients. Preoperative cardiogenic shock was present in 21 (5.9%) patients. EuroSCORE (cardiogenic shock 73.1 ± 18.9% vs. non-cardiogenic shock 36.0 ± 18.7%; P < 0.0001) and Society of Thoracic Surgeons score (cardiogenic shock 50.8 ± 28.1% vs. non-cardiogenic shock 16.7 ± 12.2%; P < 0.0001) were significantly higher in the cardiogenic shock group, and left ventricular ejection fraction (cardiogenic shock 26.0 ± 13.1% vs. no-cardiogenic shock 51.4 ± 13.0%; P < 0.0001) was significantly lower. Thirty-day mortality was significantly higher in the cardiogenic shock group (cardiogenic shock 19% vs. non-cardiogenic shock 5%; P = 0.02) and 1-year survival significantly lower (cardiogenic shock 46% vs. no-cardiogenic shock 83%; P < 0.0001). At Cox regression...

Effect of Cardiogenic Shock Hospital Volume on Mortality in Patients With Cardiogenic Shock

Shaefi, Shahzad; O'Gara, Brian; Kociol, Robb D.; Joynt, Karen; Mueller, Ariel; Nizamuddin, Junaid; Mahmood, Eitezaz; Talmor, Daniel; Shahul, Sajid
Fonte: Blackwell Publishing Ltd Publicador: Blackwell Publishing Ltd
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
66.74%
Background: Cardiogenic shock (CS) is associated with significant morbidity, and mortality rates approach 40% to 60%. Treatment for CS requires an aggressive, sophisticated, complex, goal‐oriented, therapeutic regimen focused on early revascularization and adjunctive supportive therapies, suggesting that hospitals with greater CS volume may provide better care. The association between CS hospital volume and inpatient mortality for CS is unclear. Methods and Results: We used the Nationwide Inpatient Sample to examine 533 179 weighted patient discharges from 2675 hospitals with CS from 2004 to 2011 and divided them into quartiles of mean annual hospital CS case volume. The primary outcome was in‐hospital mortality. Multivariate adjustments were performed to account for severity of illness, relevant comorbidities, hospital characteristics, and differences in treatment. Compared with the highest volume quartile, the adjusted odds ratio for inpatient mortality for persons admitted to hospitals in the lowest‐volume quartile (≤27 weighted cases per year) was 1.27 (95% CI 1.15 to 1.40), whereas for admission to hospitals in the low‐volume and medium‐volume quartiles, the odds ratios were 1.20 (95% CI 1.08 to 1.32) and 1.12 (95% CI 1.01 to 1.24)...

Puente al trasplante de 4 semanas utilizando el sistema de asistencia ventricular Levitronix Centrimag® en el shock cardiogénico post-infarto al miocardio: Caso clínico

VILLAVICENCIO,AURICIO; LARREA,RICARDO; LARRAÍN,ERNESTO; TURNER,FEDERICO; RIVERA,JUAN; PERALTA,JUAN PABLO; REYES,ALEX; MUÑOZ,PATRICIA
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2010 Português
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Cardiogenic shock after myocardial infarction has a high mortality even if early revascularization is achieved. Biventricular assist devices have not been used in Chile in this critical setting. We report a case of a 55 year-old diabetic man who suffered an acute chest pain and ventricular fibrillation. Prompt outside hospital defibrillation/ reanimation restored pulse and allowed emergency room transfer on mechanical ventilation. Electrocardiogram showed an anterior myocardial infarction and early revascularization was achieved by anterior descending artery angioplasty. However, severe cardiogenic shock continued in spite of inotropic and intra aortic balloon pump support. Levitronix Centrimag® biventricular mechanical circulatory support was inserted during reanimation for recurrent ventricular fibrillation and the patient listed for urgent cardiac transplantation upon stabilization. Heart transplantation was performed successfully 28 days later and the patient was discharged after a 21-day recovery period. Twelve months after transplant the patient is in NYHA functional class I with normal biventricular function. Levitronix Centrimag® biventricular mechanical circulatory support could be used successfully as a bridge-to-transplant for myocardial infarction cardiogenic shock.

Asistencia ventricular mecánica como puente al trasplante en pacientes en shock cardiogénico: Experiencia preliminar en Chile con ABIOMED BVS 5000®

Castro G,Pablo; Baraona R,Fernando; Baeza P,Cristian; Mc-Nab M,Paul; Berlin R,Alejandro; Zalaquett S,Ricardo; Morán V,Sergio; Becker R,Pedro; Irarrázabal Ll,Manuel; Garayar P,Bernardita; Carvajal T,Mario; Cisternas Y,Sergio
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2006 Português
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Hospitalization and death due to heart failure and cardiogenic shock is frequent and currently is increasing among the adult population. Although cardiac transplantation is the most effective treatment in patients with end-stage heart failure, its availability is limited. While waiting for transplantation, some patients become refractory to treatment and deteriorate progressively. Secondary multi-organ damage could highly compromise the transplant success and also could contraindicate it. Mechanical ventricular assist devices allow reestablishing normal cardiac output and they have been used as a bridge to recovery and transplantation. We report four patients that underwent mechanical ventricular support using the ABIOMED BVS 5000® system as a bridge for transplantation. Two patients were connected to biventricular assistance; a third patient was connected to a left ventricular support and the fourth to a right ventricular support. Three were successfully transplanted and one died of refractory non-cardiogenic shock. There were no complications related to the support system, such as infection, hemorrhage or stroke. In our experience, the ABIOMED BVS 5000® was an effective strategy as a bridge to heart transplant in patients in cardiogenic shock (Rev Méd Chile 2006; 134: 1019-23).