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Acute Cardiac Care

Giacomo Veronese, Federico Germini, Stella Ingrassia, Ombretta Cutuli, Valeria Donati, Luca Bonacchini, Maura Marcucci, Andrea Fabbri
BACKGROUND: Electrocardiogram (ECG) interpretation is widely performed by emergency physicians. We aimed to determine the accuracy of interpretation of potential ST-segment elevation myocardial infarction (STEMI) ECGs by emergency physicians. METHODS: Thirty-six ECGs resulted in putative STEMI diagnoses were selected. Participants were asked to focus on whether or not the ECG in question met the diagnostic criteria for an acutely blocked coronary artery causing a STEMI...
October 19, 2016: Acute Cardiac Care
Pedro A Villablanca, David F Briceno, Anand D Jagannath, Martin Cohen, Robert Pyo
Coronary vasospasm is uncommon during pregnancy and the postpartum period. We present a very rare case of an acute coronary vasospasm in a 36-year-old woman who was two weeks postpartum. The coronary arteriograms showed a coronary vasospasm in the distal left anterior descending and circumflex coronary arteries. Electrocardiogram (ECG) presentation was atypical, with T-wave inversions in leads I, aVL, and V2 to V6. To our knowledge, this is the first case with a well-documented coronary artery vasospasm in a postpartum woman without the classic ST elevation on ECG...
October 18, 2016: Acute Cardiac Care
Rohit Bhoil, Shikha Sood, Sabina Bhoil, Anshul Chamail, R G Sood
Left coronary artery compression syndrome is an uncommon entity and characterized by compression of the LMCA in-between the aorta and an enlarged main pulmonary arterial trunk. It is usually associated with a congenital cardiac defect. Cardiac 64-slice MDCT provides a non-invasive and an accurate method for assessing the degree of dynamic LMCA compression throughout the cardiac cycle, its angulation relative to the left sinus of Valsalva and depiction of pulmonary pathology, making it a valuable tool in the workup of patients suspected of left coronary artery compression...
October 18, 2016: Acute Cardiac Care
Jackson J Liang, Eric R Fenstad, Christopher D Janish, Lawrence J Sinak
Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy, which usually presents early in life but may also manifest into adulthood. We present the case of an elderly woman with left ventricular non-compaction cardiomyopathy, which was discovered incidentally following an ST-elevation myocardial infarction.
October 18, 2016: Acute Cardiac Care
Matthew Harris, Grigoris V Karamasis, Shayna Chotai, Kare H Tang, Gerald J Clesham, Paul A Kelly
Intra-aortic balloon pump (IABP) is commonly used as a cardiac assist device in various clinical situations: cardiogenic shock, mechanical complications of acute myocardial infarction, high risk percutaneous coronary interventions, coronary artery bypass graft surgery and refractory unstable angina and ventricular arrhythmias as bridge to therapy. Although current data support its safety, there is limited or no support for its efficacy. We present the case of spinal cord infarction after IABP use in a patient who presented with ST elevation myocardial infarction and cardiac arrest and we discuss the potential mechanism of such a devastating complication...
October 13, 2016: Acute Cardiac Care
Mitsuyasu Terashima, Hideaki Kaneda, Tetsuo Matsubara, Takahiko Suzuki
No abstract text is available yet for this article.
October 13, 2016: Acute Cardiac Care
Stephen O Awuor, Paul M Kitei, Yassir Nawaz, Amy M Ahnert
Baclofen is commonly used to treat spasticity of central etiology. Unfortunately, a potentially lethal withdrawal syndrome can complicate its use. This is especially true when the drug is administered intrathecally. There are very few cases of baclofen withdrawal leading to reversible cardiomyopathy described in the literature. The authors present a patient with a history of chronic intrathecal baclofen use who, in the setting of acute baclofen withdrawal, develops laboratory, electrocardiogram, and echocardiogram abnormalities consistent with cardiomyopathy...
September 28, 2016: Acute Cardiac Care
Carlotta Sorini Dini, Chiara Lazzeri, Marco Chiostri, Gian Franco Gensini, Serafina Valente
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) represents a therapeutic option in patients with refractory cardiogenic shock (RCS). This strategy is limited to a restricted number of centres with capabilities for implanting VA ECMO and management patients on this support. We report on the initial experience of our ECMO referral centre for patients with RCS. METHODS: We retrospectively analysed our ECMO data registry for RCS of 14 patients treated with VA ECMO, consecutively admitted to our intensive cardiac care unit (ICCU), which is an ECMO referral centre...
June 9, 2016: Acute Cardiac Care
Auras R Atreya, Sonali Arora, Gregory Valania
Pulmonary artery catheters have been extensively used for hemodynamic assessment over the past several decades. We present a case that highlights the management of a known, but rare and catastrophic complication of pulmonary artery catheter based therapy. An elderly lady with acute decompensated heart failure, severe pulmonary hypertension, and atrial fibrillation on anticoagulation had a pulmonary artery catheter inserted for hemodynamic monitoring. Subsequently, the patient developed acute hemoptysis and damped pulmonary artery pressure waveforms during inflation of the catheter tip balloon...
June 9, 2016: Acute Cardiac Care
Balakumaran Jeyakumaran, Ajay Raj, Bhagya Narayan Pandit, Tarun Kumar, Surender Deora
Iatrogenic left main coronary artery (LMCA) dissection is a rare complication and may have devastating consequences if not immediately intervened. The management includes urgent revascularization mostly with percutaneous coronary intervention (PCI) with bail-out stenting and rarely requires coronary artery bypass graft (CABG) surgery. In clinically and hemodynamically stable patients, a conservative approach may be preferred. Here, we present a rare case of iatrogenic retrograde LMCA dissection due to pin-hole rupture of angioplasty balloon that was managed conservatively...
June 9, 2016: Acute Cardiac Care
David Snipelisky, Jordan Ray, Gautam Matcha, Archana Roy, Brooke Clark, Adrian Dumitrascu, Veronica Bosworth, Anastasia Whitman, Patricia Lewis, Tyler Vadeboncoeur, Fred Kusumoto, M Caroline Burton
INTRODUCTION: Little data exists evaluating how different risk factors influence outcomes following in-hospital arrests. METHODS: A retrospective review of patients that suffered a cardiopulmonary arrest between 1 May 2008 and 30 June 2014 was performed. Patients were stratified into subsets based on cardiac versus non-cardiac reasons for admission. RESULTS: 199 patients met inclusion criteria, of which 138 (69.3%) had a non-cardiac reason for admission and 61 (30...
December 2015: Acute Cardiac Care
Hadi A R Khafaji, Kadhim Sulaiman, Rajvir Singh, Khalid F Alhabib, Nidal Asaad, Alawi Alsheikh-Ali, Mohammed Al-Jarallah, Bassam Bulbanat, Wael Almahmeed, Mustafa Ridha, Nooshin Bazargani, Haitham Amin, Ahmed Al-Motarreb, Husam Al Faleh, Abdelfatah Elasfar, Prashanth Panduranga, Jassim Al Suwaidi
BACKGROUND: The purpose of this study was to report the prevalence, clinical characteristics, contributing factors, management and outcome of patients with chronic obstructive pulmonary disease (COPD) among patients hospitalized with heart failure (HF). METHODS: Data were derived from Gulf Care (Gulf acute heart failure registry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute heart failure during February to November 2012 in seven Middle Eastern countries...
December 2015: Acute Cardiac Care
Tae-Hun Kim, Hyungseop Kim, In-Cheol Kim
BACKGROUND: The prognosis of acute heart failure (HF) can be determined by cardio-renal function which is assessed by cystatin-C (Cys-C). We evaluated whether Cys-C could be a more useful prognostic indicator in acute HF, compared with uric acid (UA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). METHODS: Two hundred thirty-two HF patients in the emergency room were studied using measurements of Cys-C, UA, and NT-proBNP. During the follow-up, cardiac events, defined as the composites of recurrent HF or cardiac death, were determined...
December 2015: Acute Cardiac Care
Joseph M Krepp, Shrinivas Hebsur, Julio A Panza, Howard A Cooper, Federico M Asch
The need for cardiovascular expertise in the treatment of advanced heart failure (AHF), malignant arrhythmias, and structural heart disease has shifted the role of the CCU to a more diverse and medically complex patient population. This study's purpose was to analyze the temporal trends in the principal diagnosis leading to admission to the CCU in a tertiary referral hospital. Over the last 15 years, the CCU has evolved from a medical unit strictly focusing on the care of patients with ACS to an advanced cardiac intensive care unit...
December 2015: Acute Cardiac Care
Dong Yang, Stefan James, Ulf De Faire, Lars Alfredsson, Tomas Jernberg, Tahereh Moradi
OBJECTIVE: To examine the relationship between country of birth and the utilization of coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) after a first-time myocardial infarction (MI). DESIGN, SETTING AND PATIENTS: 117,494 MI patients of all ages who were admitted to coronary care units between 2001 and 2009 in Sweden were followed-up for three months after admission. MAIN OUTCOME MEASURES: Undergoing coronary angiography, PCI or CABG after first-time MI...
March 2015: Acute Cardiac Care
Elisabetta Palmerini, Stefan Söderberg, Sergio Mondillo, Roberto Favilli, Stefano Lunghetti
BACKGROUND: Levosimendan is a calcium sensitizer and K(+)-ATP channel opener with inotropic and vasodilatatory effects irrespective of myocardial oxygen consumption, used for treatment of heart failure (HF). A loading dose is usually given by infusion for 12 h; however, profound lowering of blood pressure often disrupts or prolongs the infusion. The aim of this study was to assess clinical, biochemical and myocardial differences between different regimes of levosimendan therapy, with or without loading dose, and compared to standard therapy in heart failure...
March 2015: Acute Cardiac Care
Casey J Allen, Laura F Teisch, Kenneth D Stahl
Spontaneous pneumomediastinum is a benign condition that has been reported, however the association with epidural pneumatosis is much less common. A 27-year-old male presented with concomitant air in the epidural space, mediastinum and pericardium after illicit drug use and engagement in sexual activity. The patient was hemodynamically stable. Non-invasive tests ruled out aerodigestive injury. The patient was discharged after a short observation without intervention. Invasive and potentially risky diagnostic tests may be safely avoided in patients who remain asymptomatic with this unique presentation...
March 2015: Acute Cardiac Care
Antonios N Pavlidis, Grigoris V Karamasis, Paul Rees
Radial artery spasm is one of the most commonly encountered problems during transradial interventions with a reported incidence in the range of 6-10%. Balloon-assisted tracking (BAT) of guide catheter has recently been described as a novel technique to overcome difficult radial artery anatomies including tortuosity, loops and spasm. In this report, we describe the successful use of BAT in a patient with radial artery spasm during primary angioplasty.
March 2015: Acute Cardiac Care
Neal W Dickert, Alexandra E Fehr, Alex Llanos, Victoria M Scicluna, Habib Samady
OBJECTIVE: The goal of this study was to improve understanding of patients' perspectives of informed consent for clinical trial enrollment during ST-elevation myocardial infarction (STEMI). BACKGROUND: STEMI research poses challenges regarding informed consent due to time constraints, symptom severity, and potential cognitive impairment. METHODS: An interview study was embedded within a clinical trial of an ischemic post-conditioning procedure for STEMI...
March 2015: Acute Cardiac Care
Shams Y-Hassan
Takotsubo syndrome (TS) is characterized by a unique pattern of transient circumferential left ventricular wall motion abnormality (LVWMA). The LVWMA in TS may be localized to the apical, mid-apical, mid-ventricular, mid-basal or basal regions of the left ventricle. Focal and generialized (global) LVWMA have also been reported. In the acute phase of TS, the hyperkinetic valve-like motion of the basal segments and/or the hyperkinetic slingshot-like motion of the apical segments combined with the firm stunned a-, hypokinetic segments result in a conspicuous left ventricular ballooning during systole...
March 2015: Acute Cardiac Care
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