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betablockers in shock

Martin Balik, Vojtech Matousek, Michal Maly, Tomas Brozek
The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents...
2017: Anaesthesiology Intensive Therapy
Petr Kala, Tomas Novotny, Irena Andrsova, Klara Benesova, Maria Holicka, Jiri Jarkovsky, Katerina Hnatkova, Lumir Koc, Monika Mikolaskova, Tereza Novakova, Tomas Ondrus, Lenka Privarova, Jindrich Spinar, Marek Malik
OBJECTIVE: The introduction of primary percutaneous coronary intervention (PPCI) has modified the profile of ST elevation myocardial infarction (STEMI) patients. Occurrence and prognostic significance of hypotension episodes are not known in PPCI treated STEMI patients. It is also not known whether and/or how the hypotension episodes correlate with the degree of myocardial damage and whether there are any sex differences. METHODS: Data of 293 consecutive STEMI patients (189 males) treated by PPCI and without cardiogenic shock were analyzed...
2017: PloS One
Luiz Carlos Passos, Márcio Galvão Oliveira, Andre Rodrigues Duraes, Thiago Moreira Trindade, Andréa Cristina Costa Barbosa
Background Beta-blockers have been recommended for patients with heart failure and reduced ejection fraction for their long-term benefits. However, the tolerance to betablockers in patients hospitalized with acute heart failure should be evaluated. Objective To estimate the proportion of patients hospitalized with acute heart failure who can tolerate these agents in clinical practice and compare the clinical outcomes of patients who can and cannot tolerate treatment with beta-blockers. Setting Two reference hospitals in cardiology...
August 2016: International Journal of Clinical Pharmacy
Francesco Santoro, Riccardo Ieva, Armando Ferraretti, Mario Fanelli, Francesco Musaico, Nicola Tarantino, Luigi Di Martino, Luisa De Gennaro, Pasquale Caldarola, Matteo Di Biase, Natale Daniele Brunetti
BACKGROUND: Left ventricular outflow tract obstruction (LVOTO) may complicate an episode of Takotsubo cardiomyopathy (TTC), potentially leading to cardiogenic shock. Beta-blockers are considered the most suitable treatment for such complication. AIM OF THE STUDY: The objective of this study was to evaluate the hemodynamic effects, safety, and feasibility of a selective beta-blocker (β1) with a short half-life, esmolol, in subjects with a TTC episode. METHODS: Ninety-six consecutive patients with TTC were enrolled in a multicenter registry...
June 2016: Cardiovascular Therapeutics
N C Roche, L Raynaud, F Bompaire, J-J Lucas, Y Auxéméry
INTRODUCTION: Electroconvulsive therapy (ECT) is most frequently indicated for episodes of melancholic depression, but is also useful in the treatment of maniac syndrome and some schizophrenia subtypes. ECT is part of the treatment of movement disorders, neuroleptic malignant syndrome and even in the treatment of severe conversions. Although the therapeutic results are excellent when used appropriately, the mortality rate is estimated between 2 and 4 for 100,000 shocks. Despite this mortality rate, the benefit-risk ratio remains very positive and serious complications are extremely rare...
February 2016: L'Encéphale
Faber, Zehender
In patients with severe chronic heart failure, many deaths are sudden due to life-threatening ventricular arrhythmias. Supraventricular arrhythmias such as paroxysmal or chronic atrial fibrillation may also cause serious complications in those patients due to acute loss of atrial contraction, pump failure during rapid ventricular response and embolic events. Two therapeutic strategies are currently available for therapy and prevention of malignant ventricular arrhythmias and subsequent sudden arrhythmic death: antiarrhythmic drug therapy and implantable defibrillators...
May 1, 2000: Therapeutische Umschau. Revue Thérapeutique
Martin Balik, Jan Rulisek, Pavel Leden, Michal Zakharchenko, Michal Otahal, Hana Bartakova, Josef Korinek
BACKGROUND: Betablockade has been shown to have cardioprotective effects in patients under perioperative stress. Besides animal model of septic shock and a small cohort of septic patients, these benefits have not been studied in septic shock patients who require norepinephrine administration. METHODS: After correction of preload, an esmolol bolus (0.2-0.5 mg/kg) followed by continuous 24 h infusion was administered in septic patients with sinus or supraventricular tachycardia (HR > 120/min)...
August 2012: Wiener Klinische Wochenschrift
A Link, J Pöss, M Böhm
In acute decompensated heart failure rapid diagnosis and causal therapy are necessary to avoid cardiogenic shock. Treatment goals are to decrease congestion, afterload, and neurohormonal activation in order to improve hemodynamics and symptoms and, perhaps, reduce in-hospital events, re-hospitalizations, and mortality. A combined medical therapy of diuretics and / or vasodilators should be favoured in order to protect organs and to avoid toxicities of therapy such as hypotension, arrhythmias and renal dysfunction...
May 2012: Deutsche Medizinische Wochenschrift
Evelyn Fischer, Felix Beuschlein, Martin Bidlingmaier, Martin Reincke
The Endocrine Society guidelines suggest to screen patients with primary aldosteronism (PA) free of hypertensive medications or alternatively to switch to drugs known to have minimal influence on the aldosterone to renin ratio (ARR). We retrospectively investigated the impact of such strategy on clinical outcome. 25 patients with PA and 25 with essential hypertension (EH) were studied. Initially all subjects were evaluated biochemically and received if possible an adjustment of their medication following the guidlines...
March 2011: Reviews in Endocrine & Metabolic Disorders
Paulo M Pêgo-Fernandes, Luiz Felipe P Moreira, Germano Emílio C Souza, Fernando Bacal, Edimar Alcides Bocchi, Noedir Antônio G Stolf, Fábio Biscegli Jatene
BACKGROUND: The level of sympathetic nervous activity is a major determinant of prognosis in patients with heart failure. OBJECTIVE: The purpose of this investigation was to perform a proof-of-principle trial of therapeutic endoscopic left thoracic sympathetic blockade in heart failure patients to assess safety and immediate effects. METHODS: Fifteen patients with dilated cardiomyopathy and left ventricular ejection fraction (LVEF) < 40%, New York Heart Association functional class II or III, and heart rate > 65 bpm, despite either adequate betablocker use or intolerant to it, were enrolled...
December 2010: Arquivos Brasileiros de Cardiologia
Jacquemin L, Bourrelly N, Roth O, Wiedemann J-Y, Le Bouar R, Levy J, Monassier J-P
AIMS OF THE STUDY: The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12 hours after symptom onset treated by coronary angioplasty. PATIENTS AND METHOD: This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December 2003 to February 2008. RESULTS: We included 93 patients aged 42,8+/-5,2 years old with smoking estimated at 27,7+/-12,7 pack-years...
June 2010: Annales de Cardiologie et D'angéiologie
K Heer
The field of Emergency Care Medicine is a very dynamic part of the Medical Science. That is why there is a huge amount of publications on this topic every year. This article is my personal selection of recently published scientific work on pulmonary embolism, classification of circulatory shock, betablockers in acute decompensated heart failure, advanced cardiac life support, subarachnoid hemorrhage, inhalation therapy with ipratropium-bromide, community acquired pneumonia, diverticulosis, gout and pancreatitis...
October 21, 2009: Praxis
Jochen Schuler, Birga Maier, Steffen Behrens, Walter Thimme
AIMS: Guidelines issued by European and German cardiology societies clearly define procedures for treatment of acute myocardial infarction (AMI). These guidelines, however, are based on clinical studies in which older patients are underrepresented. Older patients, on the other hand, represent a large and growing portion of the infarction population. It was our goal in the present paper to analyse the present treatment of AMI patients over 75 years of age in the city of Berlin, Germany, with data gained from the Berlin Myocardial Infarction Registry (BHIR)...
July 2006: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
C Stöllberger, J Finsterer, B Schneider
Tako-tsubo-like left ventricular dysfunction phenomenon (TTP) has primarily been described in Japan and is characterized by transient left ventricular apical ballooning in the absence of coronary artery disease, associated with chest symptoms, electrocardiographic changes and minimal cardiac enzymes release. Aim of the present review is to summarize the current knowledge about TTP. TTP has been described predominantly in females. TTP occurs also outside Japan. Clinical symptoms comprise anginal chest pain, dyspnea and syncope...
April 2005: Minerva Cardioangiologica
A Vacheron
Prescriptions in cardiology have progressed from the often empirical and approximate approach used in the past to more rational approach based on the results of large clinical trials. For high blood pressure, bi- or even tri-therapy is often necessary. For coronary heart disease, betablockers, aspirin, calcium inhibitors, statins and converting enzyme inhibitors constitute the mainstay drugs. For myocardial infarction, the crucial point is to restore muyocardial perfusion as quickly as possible by thrombolysis or angioplasty...
March 2005: Annales Pharmaceutiques Françaises
F Philippe, F Larrazet, A Dibie, K Bouabdallah, D Carbognani, T Folliguet, D Czitrom, A Lagier, F Laborde, A Cohen, G Montalescot
UNLABELLED: The GRACE registry provides the opportunity to analyse management of acute coronary syndromes in the real word and the impact of hospital characteristics. In this setting, we compare the activity of a new coronary intensive care unit with regional data. METHODS: From January 2000 to December 2003, 376 eligible patients were involved (22% of regional inclusion). GRACE standard diagnosis were the following, for our centrer (for the cluster): ST elevation myocardial infarction 28% (37%), non-ST elevation myocardial infarction 32% (31%), unstable angina 33% (24%)...
March 2005: Annales de Cardiologie et D'angéiologie
J C Deharo, F Mouliom, A Salamand, P Djiane
There is a logical basis for the prescription of antiarrhythmic therapy (AAT) in patients with an implanted automatic defibrillator (IAD): the prevention of supraventricular and ventricular arrhythmias, slowing the rate of a ventricular arrhythmia to improve the haemodynamic tolerance and better efficacy of anti-tachycardia stimulation. Adjuvant therapy of this kind is used in 49 to 69% of cases. Forty six per cent of patients in the MADIT I trial had AAT at the last follow-up. In the AVID trial, despite recommendations to avoid the association of AAT and [AD, 18% of patients had this combination because of the large number of shocks in 64% of cases; AAT was associated with both a reduction in the number of shocks (p < 0...
February 2005: Archives des Maladies du Coeur et des Vaisseaux
Gerian C Grönefeld, Yi-Gang Li, Stefan H Hohnloser
BACKGROUND: Despite the increasing availability of nonpharmacological treatment options for atrial fibrillation, drug therapy targeted at restoration and maintenance of sinus rhythm, or aimed at symptomatic ventricular rate control remains the mainstay of therapy for the majority of patients. METHOD: Available data suggest that these two treatment approaches yield similar responder rates with regard to symptomatic improvement. RESULTS: Detailed results from major prospective studies investigating the prognostic effects of different atrial fibrillation treatment modalities are expected to become available soon...
June 2002: Herz
T S Faber, M Zehender
In patients with severe chronic heart failure, many deaths are sudden due to life-threatening ventricular arrhythmias. Supraventricular arrhythmias such as paroxysmal or chronic atrial fibrillation may also cause serious complications in those patients due to acute loss of atrial contraction, pump failure during rapid ventricular response and embolic events. Two therapeutic strategies are currently available for therapy and prevention of malignant ventricular arrhythmias and subsequent sudden arrhythmic death: antiarrhythmic drug therapy and implantable defibrillators...
May 2000: Therapeutische Umschau. Revue Thérapeutique
S Wagner, S Schneider, R Schiele, F Fischer, H Dehn, R Grube, G Becker, B Baumgärtel, E Altmann, J Senges
The "Myocardial Infarction Registry" in Germany (MIR) is a multicenter and prospective registry of consecutively included, unselected patients with acute myocardial infarction. The purpose of MIR is to document the actual praxis of decision making and prescribing of an optimized infarction therapy in AMI patients. Optimized infarction therapy is defined as the combination of reperfusion therapy and ASS, betablocker, and ACE inhibitor.14,598 patients with acute myocardial infarction were included between 12/96 and 5/98 in 217 hospitals throughout Germany...
October 1999: Zeitschrift Für Kardiologie
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