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Yao Lu, Han Zhang, Fang Teng, Wen-Jun Xia, Gui-Xiang Sun, Ai-Qing Wen
INTRODUCTION: The Surviving Sepsis Campaign guidelines recommend early goal-directed therapy (EGDT) for the resuscitation of patients with sepsis; however, the recent evidences quickly evolve and convey conflicting results. We performed a meta-analysis to evaluate the effect of EGDT on mortality in adults with severe sepsis and septic shock. METHODS: We searched electronic databases to identify randomized controlled trials that compared EGDT with usual care or lactate-guided therapy in adults with severe sepsis and septic shock...
October 18, 2016: Journal of Intensive Care Medicine
Hae-Young Lee, Chan-Soon Park, Sang-Hoon Na, Kyung-Jin Kim, Chan Joo Lee, Sungha Park
A 47-year-old woman was admitted via emergency department due to dyspnea NYHA Fc II-III aggravated for 2 months after upper respiratory infection. Her height and body weight were 161 cm / 67 kg. Initial vital signs were 110/70 mmHg - 112 BPM - 24/min - 36.5°C. Chest PA showed cardiomegaly and pulmonary congestion (Figure 1). B-natriuretic peptide level was markedly increased (2002 pg/mL, normal range ≤ 100 pg/mL). The echocardiographic examination showed severely dilated LV cavity (61/72 mm) and severe LV systolic dysfunction (EF 28%) with normal left ventricular wall thickness (9/11 mm) (Figure 2)...
September 2016: Journal of Hypertension
Maude St-Onge, Kurt Anseeuw, Frank Lee Cantrell, Ian C Gilchrist, Philippe Hantson, Benoit Bailey, Valéry Lavergne, Sophie Gosselin, William Kerns, Martin Laliberté, Eric J Lavonas, David N Juurlink, John Muscedere, Chen-Chang Yang, Tasnim Sinuff, Michael Rieder, Bruno Mégarbane
OBJECTIVE: To provide a management approach for adults with calcium channel blocker poisoning. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Following the Appraisal of Guidelines for Research & Evaluation II instrument, initial voting statements were constructed based on summaries outlining the evidence, risks, and benefits. DATA SYNTHESIS: We recommend 1) for asymptomatic patients, observation and consideration of decontamination following a potentially toxic calcium channel blocker ingestion (1D); 2) as first-line therapies (prioritized based on desired effect), IV calcium (1D), high-dose insulin therapy (1D-2D), and norepinephrine and/or epinephrine (1D)...
October 3, 2016: Critical Care Medicine
Mohammad Khassawneh, Nedaa Al-Ghazo
A 35-year-old woman with a 9-year history of Grave's disease delivered a male infant weighing 2,210 g at 32 weeks of gestation by caesarean section. The neonate developed thyrotoxicosis and, at the age of 24 h, was treated with oral carbimazole (500 µg every 8 h) and propranolol (2 mg/kg/day in two divided doses). He subsequently developed hypertension on day 4, which required therapy with amlodipine (0.1 mg once daily). Severe hypotension developed within 24 h and required discontinuation of amlodipine, with initiation of intravenous inotropic support with dopamine and dobutamine (at a rate of 20 µg/kg/min)...
December 2015: Drug Saf Case Rep
Jack H Boyd, Vedant S Pargaonkar, David H Scoville, Ian S Rogers, Takumi Kimura, Shigemitsu Tanaka, Ryotaro Yamada, Michael P Fischbein, Jennifer A Tremmel, Robert Scott Mitchell, Ingela Schnittger
BACKGROUND: Left anterior descending artery myocardial bridges (MBs) range from clinically insignificant incidental angiographic findings to a potential cause of sudden cardiac death. Within this spectrum, a group of patients with isolated, symptomatic, and hemodynamically significant MBs despite maximally tolerated medical therapy exist for whom the optimal treatment is controversial. We evaluated supraarterial myotomy, or surgical unroofing, of the left anterior descending MBs as an isolated procedure in these patients...
October 1, 2016: Annals of Thoracic Surgery
Satoshi Masutani, Seiko Kuwata, Clara Kurishima, Yoichi Iwamoto, Hirofumi Saiki, Masaya Sugimoto, Hirotaka Ishido, Hideaki Senzaki
OBJECTIVE: The details of the ventricular-vascular dynamics of heart failure with preserved ejection fraction (HFpEF) in children remain poorly understood. We tested the hypothesis that pediatric HFpEF patients have ventricular systolic, diastolic, and arterial stiffening at rest as well as impaired reserve function associated with coronary supply/demand imbalance. METHODS: We studied the ventricular pressure-area relationship in 22 pediatric HFpEF patients and 22 control subjects before and after dobutamine infusion and during abdominal compression...
September 30, 2016: International Journal of Cardiology
Janus Adler Hyldebrandt, Nicolaj Brejnholt Støttrup, Christian Alcaraz Frederiksen, Johan Heiberg, Rune Isak Dupont Birkler, Mogens Johannsen, Michael Rahbek Schmidt, Hanne Berg Ravn
OBJECTIVES: Myocardial infarction and chronic heart failure induce specific metabolic changes in the neonatal myocardium that are closely correlated to outcome. The aim of this study was to examine the metabolic responses to noninfarct heart failure and inotropic treatments in the newborn heart, which so far are undetermined. DESIGN: A total of 28 newborn pigs were instrumented with a microdialysis catheter in the right ventricle, and intercellular citric acid cycle intermediates and adenosine metabolite concentrations were determined at 20-minute intervals...
October 12, 2016: Pediatric Critical Care Medicine
Gualter Lisboa Ramalho, Matheus Fachini Vane, Luciana Cavalcanti Lima, Lucas Fachini Vane, Rosa Beatriz Amorim, Maria Aparecida Domingues, José Mariano Soares de Moraes, Lídia Raquel de Carvalho, Pedro Paulo Tanaka, Luiz Antonio Vane
PURPOSE: To evaluate the effects of dobutamine (DB), noradrenaline (NA), and their combination (NADB), on volume retention in rabbits submitted to hemorrhage. METHODS: Thirty six rabbits were randomly divided into 6 groups: SHAM, Control, Saline, DB, NA, DB+NA. All the animals, except for SHAM, were subjected to hemorrhage of 25% of the calculated blood volume. Control animals were replaced with their own blood. The other groups received NSS 3 times the volume withdrawn...
September 2016: Acta Cirúrgica Brasileira
Ankush Sachdeva, Biswajit Paul
Dobutamine stress echocardiography (DSE) has come a long way as establishing itself as a feasible, safe, effective, relatively cheaper non-invasive technique to detect population suffering from coronary artery disease (CAD) and following up patients post revascuralization. Besides these DSE is commonly used to diagnose low gradient, low flow true severe aortic stenosis (AS); differentiating it from pseudo- AS and to follow up patients with dilated cardiomyopathy (DCMP). Various non-invasive techniques have different sensitivity and specificity to accurately judge a viable myocardium and to accurately detect the improvement in regional wall motion abnormality (RWMA) post-revascularization, leading to an overall increase in left ventricular ejection fraction (LVEF)...
February 2016: Journal of the Association of Physicians of India
Chaofan Wang, Shuguang Han, Tongda Xu, Fengli Wang, Xiaoping Wang, Jing Chen, Chunfeng Hu, Dongye Li
The aim of this study was to explore the significance of delayed enhancement magnetic resonance imaging (DE-MRI) combined with two-dimensional speckle tracking echocardiography (STE) and low dose dobutamine stress echocardiography (LDDSE) to assess viable myocardium (VM) in the patients with old myocardial infarction (OMI) associated with congestive heart failure (CHF). Thirty five hospitalized OMI patients with regional wall motion abnormalities and left ventricular ejection fraction (LVEF) < 50% were recruited based on routine echocardiography...
2016: American Journal of Translational Research
Zhongheng Zhang, Kun Chen
The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine...
September 2016: Annals of Translational Medicine
Srdjan Aleksandric, Ana Djordjevic-Dikic, Branko Beleslin, Biljana Parapid, Gordana Teofilovski-Parapid, Jelena Stepanovic, Dragan Simic, Ivana Nedeljkovic, Milan Petrovic, Milan Dobric, Miloje Tomasevic, Marko Banovic, Milan Nedeljkovic, Miodrag Ostojic
BACKGROUND: To consider hemodynamic assessment of myocardial bridging (MB) adequate, it is believed that inotropic stimulation with dobutamine should be estimated because its dynamic nature depends on the degree of extravascular coronary compression. This study evaluated comparative assessment of hemodynamic relevance of MB using coronary flow velocity reserve (CFVR) measurements by transthoracic Doppler echocardiography (TTDE) with vasodilatative and inotropic challenges. METHODS: This prospective study included forty-four patients with angiographic evidence of isolated MB of the left anterior descending coronary artery (LAD) and systolic compression of ≥50% diameter stenosis...
September 28, 2016: International Journal of Cardiology
Aude Belliard, Gaurav K Gulati, Qiming Duan, Rosana Alves, Shannon Brewer, Namrata Madan, Yoann Sottejeau, Xiaoliang Wang, Jennifer Kalisz, Sandrine V Pierre
Cardiac glycosides (CG) are traditionally known as positive cardiac inotropes that inhibit Na(+)/K(+)-ATPase-dependent ion transport. CG also trigger-specific signaling pathways through the cardiac Na(+)/K(+)-ATPase, with beneficial effects in ischemia/reperfusion (I/R) injury (e.g., ouabain preconditioning, known as OPC) and hypertrophy. Our current understanding of hypersensitivity to CG and subsequent toxicity in the ischemic heart is mostly based on specific I/R-induced alterations of the Na(+)/K(+)-ATPase enzymatic function and has remained incomplete...
October 2016: Physiological Reports
F Aboukhoudir, I Aboukhoudir, S Rekik
Although generally regarded as a safe stress modality, dobutamine stress echocardiography (DSE) has been associated with several well described complications. However, to our knowledge, acute constitution of thrombi during the stress test has never been described. In this report, we present the case of a 64 year-old man with a history of ischemic heart disease who underwent a preoperative DSE; during the test, we witnessed a striking acute constitution of an intense prethrombotic state with almost a formation of a highly mobile massive thrombus adjacent to the infero-apical segment spontaneously resolving few minutes after the end of the test...
September 28, 2016: Annales de Cardiologie et D'angéiologie
Ursula Reiter, Gert Reiter, Martin Manninger, Gabriel Adelsmayr, Julia Schipke, Alessio Alogna, Alexandra Rajces, Aurelien F Stalder, Andreas Greiser, Christian Mühlfeld, Daniel Scherr, Heiner Post, Burkert Pieske, Michael Fuchsjäger
BACKGROUND: The hypertensive deoxy-corticosterone acetate (DOCA)-salt-treated pig (hereafter, DOCA pig) was recently introduced as large animal model for early-stage heart failure with preserved ejection fraction (HFpEF). The aim of the present study was to evaluate cardiovascular magnetic resonance (CMR) of DOCA pigs and weight-matched control pigs to characterize ventricular, atrial and myocardial structure and function of this phenotype model. METHODS: Five anesthetized DOCA and seven control pigs underwent 3 T CMR at rest and during dobutamine stress...
September 30, 2016: Journal of Cardiovascular Magnetic Resonance
R Q Zhu, C Z Liu, J H Lu, Y P Su, S C Wen, G J Nie, Y Z Hu, L E Zuo
Objective: To observe the clinical efficacy and factors associated with outcome of extracorporeal membrane oxygenation (ECMO) in refractory cardiogenic shock patients. Methods: Patients with refractory cardiogenic shock received ECMO treatment in our hospital from May 2013 to November 2015 were retrospectively analyzed. The clinical status before ECMO support, ECMO timing, complications and outcome were observed and analyzed.The hemodynamic data and the amount of vasoactive drugs at 2 hours before ECMO support and at 2, 6, 24 and 48 hours after ECMO support were collected and compared...
September 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
Alessandro Belletti, Umberto Benedetto, Giuseppe Biondi-Zoccai, Carlo Leggieri, Paolo Silvani, Gianni D Angelini, Alberto Zangrillo, Giovanni Landoni
PURPOSE: Inotropes and vasopressors are cornerstone of therapy in septic shock, but search for the best agent is ongoing. We aimed to determine which vasoactive drug is associated with the best survival. MATERIALS AND METHODS: PubMed, BioMedCentral, Embase, and the Cochrane Central Register were searched. Randomized trials performed in septic patients with at least 1 group allocated to an inotrope/vasopressor were included. Network meta-analysis with a frequentist approach was performed...
August 13, 2016: Journal of Critical Care
J Li, F Wang, N Zhang, Q He, Y-J Sun, H-Y Wang, D-M Yin
OBJECTIVE: The aim of the study is to investigate the cardiac compensatory function change in senior people with Coronary Artery Disease (CAD) by Quantitive Dobutamine Stress Echocardiography (DSE) and Tissue Doppler Imaging (TDI). PATIENTS AND METHODS: All of the 98 senior people (age >60) who were suspected to have CAD received the examination of DSE and TDI. The mean systolic peak velocity (Sa), early diastolic peak velocity (Ea) and late diastolic peak velocity (Aa) of mitral annulus were measured in a different dose of dobutamine stress...
September 2016: European Review for Medical and Pharmacological Sciences
Hae-Young Lee, Chan-Soon Park, Sang-Hoon Na, Kyung-Jin Kim, Chan Joo Lee, Sungha Park
A 47-year-old woman was admitted via emergency department due to dyspnea NYHA Fc II-III aggravated for 2 months after upper respiratory infection. Her height and body weight were 161 cm / 67 kg. Initial vital signs were 110/70 mmHg - 112 BPM - 24/min - 36.5°C. Chest PA showed cardiomegaly and pulmonary congestion (Figure 1). B-natriuretic peptide level was markedly increased (2002 pg/mL, normal range ≤ 100 pg/mL). The echocardiographic examination showed severely dilated LV cavity (61/72 mm) and severe LV systolic dysfunction (EF 28%) with normal left ventricular wall thickness (9/11 mm) (Figure 2)...
September 2016: Journal of Hypertension
E Montaudon, L Dubreil, V Lalanne, B Jagu, G Toumaniantz, C Thorin, D Henrion, J-C Desfontis, L Martignat, M Y Mallem
OBJECTIVE: To evaluate whether active immunization producing β1- or β3-antibodies (β1-ABs and β3-ABs) detected in sera of patients with dilated cardiomyopathies has deleterious effects on vascular reactivity in Lewis rats thoracic aorta (TA) and small mesenteric arteries (SMA). DESIGN AND METHOD: Lewis rats were immunized for 6months with peptidic sequences corresponding to the second extracellular loop of β1- and β3-adrenoceptors (ARs). During the immunization, systolic blood pressure (SBP) was monitored using the tail cuff method...
September 9, 2016: Vascular Pharmacology
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