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sepsis, stroke, coronary syndromes,

Faheem W Guirgis, John P Donnelly, Sunita Dodani, George Howard, Monika M Safford, Emily B Levitan, Henry E Wang
BACKGROUND: Dyslipidemia is a risk factor for cardiovascular disease, with elevated low-density lipoprotein cholesterol (LDL-C) and decreased high-density lipoprotein cholesterol (HDL-C) recognized as risk factors for acute coronary events. Studies suggest an association between low cholesterol levels and poor outcomes in acute sepsis. We sought to determine the relationship between baseline cholesterol levels and long-term rates of sepsis. METHODS: We used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, a population-based cohort of 30,239 community-dwelling adults...
December 23, 2016: Critical Care: the Official Journal of the Critical Care Forum
Jean-Pierre Bassand, Gabriele Accetta, Alan John Camm, Frank Cools, David A Fitzmaurice, Keith A A Fox, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Werner Hacke, Gloria Kayani, Lorenzo G Mantovani, Frank Misselwitz, Hugo Ten Cate, Alexander G G Turpie, Freek W A Verheugt, Ajay K Kakkar
AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy...
October 7, 2016: European Heart Journal
Kevin D Rooney, Ulf Martin Schilling
Emergency departments (EDs) face several challenges in maintaining consistent quality care in the face of steadily increasing public demand. Improvements in the survival rate of critically ill patients in the ED are directly related to the advancement of early recognition and treatment. Frequent episodes of overcrowding and prolonged waiting times force EDs to operate beyond their capacity and threaten to impact upon patient care. The objectives of this review are as follows: (a) to establish overcrowding as a threat to patient outcomes, person-centered care, and public safety in the ED; (b) to describe scenarios in which point-of-care testing (POCT) has been found to ameliorate factors thought to contribute to overcrowding; and (c) to discuss how POCT can be used directly, and indirectly, to expedite patient care and improve outcomes...
December 8, 2014: Critical Care: the Official Journal of the Critical Care Forum
Ronald G Pearl
Based on its pleiotropic effects, erythropoietin can decrease inflammation, oxidative stress, and apoptosis. Erythropoietin provides organ protection for the heart, brain, and kidney in diverse preclinical animal studies, especially models that include ischemia-reperfusion injury and/or inflammation. However, large clinical studies in coronary reperfusion, heart failure, stroke, acute kidney injury, and chronic renal disease have failed to demonstrate improved outcomes. A study in a previous issue of Critical Care examining the ability of erythropoietin to prevent or ameliorate acute kidney injury in patients undergoing complex valvular heart surgery is similarly negative...
September 11, 2014: Critical Care: the Official Journal of the Critical Care Forum
Roberta Capp, Cheryl Lynn Horton, Sukhjit S Takhar, Adit A Ginde, David A Peak, Richard Zane, Keith A Marill
OBJECTIVES: Approximately one in every four patients who present to the emergency department with sepsis progresses to septic shock within 72 hours of arrival. In this study, we describe key patient characteristics present within 4 hours of emergency department arrival that are associated with developing septic shock between 4 and 48 hours of emergency department arrival. DESIGN AND SETTING: This study was a retrospective chart review study of all patients hospitalized from the emergency department with two or more systemic inflammatory response syndrome criteria present within 4 hours of emergency department arrival from September 2010 to February 2011 at two large academic institutions...
May 2015: Critical Care Medicine
Shunsuke Miyahara, Yutaka Okita
Our experiences of secondary aortic root replacement after proximal aortic operation and their technical details are presented. Between November 1999 and February 2013, 50 patients underwent reoperative aortic root replacement(34 male, mean age 59.6±13.1 years). The mode of previous operation was ascending and arch replacement in 21, aortic valve replacement (AVR) in 19, and aortic root replacement in 10. Indications for reoperation included root dilation( n=13), aortic root abscess( n=13), residual proximal dissection (n=12), formation of pseudoaneurysm (n=5)and graft infection (n=3), and non-structural valve dysfunction (n=4)...
July 2013: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Allan J Walkey, Melissa A Greiner, Susan R Heckbert, Paul N Jensen, Jonathan P Piccini, Moritz F Sinner, Lesley H Curtis, Emelia J Benjamin
BACKGROUND: Newly diagnosed atrial fibrillation (AF) during severe sepsis is associated with increased risks of in-hospital stroke and mortality. However, the prevalence, incidence, and risk factors associated with AF during the sepsis syndromes are unclear. METHODS: We identified patients with preexisting, newly diagnosed, or no AF in a nationally representative 5% sample of Medicare beneficiaries hospitalized with sepsis between 2004 and 2007. We identified multivariable-adjusted demographic and clinical characteristics associated with development of newly diagnosed AF during a sepsis hospitalization...
June 2013: American Heart Journal
Vasundhara Muthu, Hani Kozman, Kan Liu, Harold Smulyan, Daniel Villarreal
Cardiac troponins are the preferred biomarkers for the determination of acute myocardial necrosis. The high sensitivity of the available assays has significantly increased the detection of microscopic amounts of myocardial damage. Although compelling evidence indicates that elevated cardiac troponins are markers of poor prognosis and increased mortality, irrespective of the clinical scenario, small elevations can be seen in protean conditions and may confound the diagnosis of acute coronary syndromes. Emerging evidence suggests multiple different cellular mechanisms leading to cardiac troponin release, which challenge long held paradigms such as equivalency between troponin release into the circulation and irreversible cell death...
April 2014: American Journal of the Medical Sciences
Michael D Jain, Rosa Cabrerizo-Sanchez, Keyvan Karkouti, Terrence Yau, Jacob M Pendergrast, Christine M Cserti-Gazdewich
Cardiopulmonary bypass (CPB) during cardiac surgery can involve deliberate hypothermia of the systemic (22-36 °C) and coronary circulations (as low as 8-12 °C). Adverse sequelae of cold-active antibodies have been feared and reported under such conditions, and some centers thus elect to screen for cold agglutinins before CPB. We reviewed the literature on cold agglutinins in cardiac surgery and described the yields and effects of cold agglutinin screening (CAS) in 14,900 cardiac surgery patients undergoing CPB over 8 years at a single institution...
April 2013: Transfusion Medicine Reviews
Henry E Wang, Nathan I Shapiro, Russell Griffin, Monika M Safford, Suzanne Judd, George Howard
BACKGROUND: We sought to determine the associations between baseline chronic medical conditions and future risk of sepsis. METHODS: Longitudinal cohort study using the 30,239 community-dwelling participants of the REGARDS cohort. We determined associations between baseline chronic medical conditions and incident sepsis episodes, defined as hospitalization for an infection with the presence of infection plus two or more systemic inflammatory response syndrome criteria...
2012: PloS One
Christian Richard
Stress-related cardiomyopathies can be observed in the four following situations: Takotsubo cardiomyopathy or apical ballooning syndrome; acute left ventricular dysfunction associated with subarachnoid hemorrhage; acute left ventricular dysfunction associated with pheochromocytoma and exogenous catecholamine administration; acute left ventricular dysfunction in the critically ill. Cardiac toxicity was mediated more by catecholamines released directly into the heart via neural connection than by those reaching the heart via the bloodstream...
2011: Annals of Intensive Care
Vincenzo Toschi, Maddalena Lettino
Cardiovascular diseases are still the most important cause of morbidity and mortality in western countries and antithrombotic treatment is nowadays widely used. Drugs able to reduce coagulation activation are the treatment of choice for a number of arterial and/or venous thromboembolic conditions. Some of the drugs currently used for this purpose, such as heparins (UFH or LMWH) and VKA, have limitations consisting of a narrow therapeutic window and an unpredictable response with the need of laboratory monitoring in order to assess their efficacy and safety...
October 2011: British Journal of Clinical Pharmacology
Douglas L Mann
Recent studies suggest that the heart possesses an innate immune system that is intended to delimit tissue injury, as well as orchestrate homoeostatic responses, within the heart. The extant literature suggests that this intrinsic stress response system is mediated, at least in part, by a family of pattern recognition receptors, most notably the Toll-like receptors. Although the innate immune system provides a short-term adaptive response to tissue injury, the beneficial effects of this phylogenetically ancient system may be lost if innate immune signaling becomes sustained and/or excessive; in which case, the salutary effects of activation of these pathways are contravened by the known deleterious effects of inflammatory signaling...
April 29, 2011: Circulation Research
Peter A McCullough, Aftab Ahmad
Cardiorenal syndromes (CRS) have been subclassified as five defined entities which represent clinical circumstances in which both the heart and the kidney are involved in a bidirectional injury and dysfunction via a final common pathway of cell-to-cell death and accelerated apoptosis mediated by oxidative stress. Types 1 and 2 involve acute and chronic cardiovascular disease (CVD) scenarios leading to acute kidney injury or accelerated chronic kidney disease. Types 2 and 3 describe acute and chronic kidney disease leading primarily to heart failure, although it is possible that acute coronary syndromes, stroke, and arrhythmias could be CVD outcomes in these forms of CRS...
January 26, 2011: World Journal of Cardiology
S Agewall, E Giannitsis, T Jernberg, H Katus
Acute myocardial infarction is defined as myocardial cell death due to prolonged myocardial ischaemia. Cardiac troponins (cTn) are the most sensitive and specific biochemical markers of myocardial injury and with the new high-sensitivity troponin methods very minor damages on the heart muscle can be detected. However, elevated cTn levels indicate cardiac injury, but do not define the cause of the injury. Thus, cTn elevations are common in many disease states and do not necessarily indicate the presence of a thrombotic acute coronary syndrome (ACS)...
February 2011: European Heart Journal
Peter A McCullough
There is a strong association between both acute and chronic dysfunction of the heart and kidneys with respect to morbidity and mortality. The complex interrelationships of longitudinal changes in both organ systems have been difficult to describe and fully understand due to a lack of categorization of the common clinical scenarios where these phenomena are encountered. Thus, cardiorenal syndromes (CRSs) have been subdivided into five syndromes which represent clinical vignettes in which both the heart and the kidney are involved in bidirectional injury and dysfunction via a final common pathway of cell-to-cell death and accelerated apoptosis mediated by oxidative stress...
2011: International Journal of Nephrology
J A Páramo
Prothrombin fragment 1+2 (F1+2), which comes from in vivo cleavage of prothrombin by factor Xa, is considered to be useful for diagnosis of thrombosis. Recognition of the central role of thrombosis in the pathogenesis ofcardiovascular disease has prompted growing interest in the association o F1+2 with cardiovascular clinical syndromes. Increased F1+2 levels have reported in venous thromboembolism, inflammation, cancer, sepsis, acute coronary syndromes, stroke, peripheral arterial disease, atrial fibrillation and during the postoperative period...
2010: Advances in Clinical Chemistry
Xavier Jiménez Fábrega, J L Espila
"Time-dependent" pathologies, understood as those in which diagnostic or therapeutic delay negatively influences the evolution and prognosis of a case, are considered to be critical in emergencies, as their morbidity and mortality is directly related to delay in starting treatment. Examples of this type of pathology can be found in normal clinical practice, i.e. cardiac arrest, stroke, trauma, acute coronary syndrome or sepsis. The creation of systems of coordination between care levels involving different levels of complexity has made possible the implementation and, finally, the consolidation of certain procedures agreed upon amongst all health professionals involved in the care process...
2010: Anales del Sistema Sanitario de Navarra
Shaikh Samiullah, Mona Humaira, Ghani Hanif, Aslam Aziz Ghouri, Khalid Shaikh
OBJECTIVE: To observe frequency of various causes of stroke in patients of young (15-35 years) age. METHODS: This Descriptive case series study was conducted in all Medical Units of Liaquat University Hospital (LUH) Jamshoro, Hyderabad, from August 2006 to February 2008 and included 50 patients of stroke aged 15-35 years, irrespective of sex and community. Data of these patients was collected through a pre-designed proforma by completing a comprehensive history, detailed examination and carrying out basic and relevant investigations...
March 2010: JPMA. the Journal of the Pakistan Medical Association
W Robson, T Nutbeam, R Daniels
Prehospital staff have made a significant contribution in recent years to improving care for patients with acute coronary syndrome, multiple trauma and stroke. There is, however, another group of patients that is not currently being targeted, with a similar time-critical condition. This group of patients is those with severe sepsis and septic shock and they could also benefit greatly from timely prehospital care. This article will consider how prehospital staff can improve the outcome of patients with severe sepsis, and in particular how they can aid emergency departments in identifying and initiating treatment in patients with severe sepsis...
July 2009: Emergency Medicine Journal: EMJ
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