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Cardiac emergencies

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https://www.readbyqxmd.com/read/27923115/a-comparison-of-the-universal-tor-guideline-to-the-absence-of-prehospital-rosc-and-duration-of-resuscitation-in-predicting-futility-from-out-of-hospital-cardiac-arrest
#1
Ian R Drennan, Erin Case, P Richard Verbeek, Joshua C Reynolds, Zachary D Goldberger, Jamie Jasti, Mark Charleston, Heather Herren, Ahamed H Idris, Paul R Leslie, Michael A Austin, Yan Xiong, Robert H Schmicker, Laurie J Morrison
INTRODUCTION: The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some Emergency Medical Service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination. OBJECTIVE: To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC...
December 3, 2016: Resuscitation
https://www.readbyqxmd.com/read/27923114/effect-of-bystander-cpr-initiation-prior-to-the-emergency-call-on-rosc-and-30day-survival-an-evaluation-of-548-emergency-calls
#2
Søren Viereck, Thea Palsgaard Møller, Annette Kjær Ersbøll, Fredrik Folke, Freddy Lippert
BACKGROUND: This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPRprior) versus during the emergency call following dispatcher-assisted CPR (CPRduring) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPRprior. METHODS: This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01...
December 3, 2016: Resuscitation
https://www.readbyqxmd.com/read/27923113/characteristics-and-outcomes-of-young-adults-who-suffered-an-out-of-hospital-cardiac-arrest-ohca
#3
Michael Yih-Chong Chia, Qing Shu Lu, Nik Hisamuddin Rahman, Nausheen Edwin Doctor, Tatsuya Nishiuchi, Benjamin Sieu-Hon Leong, Lai Peng Tham, E-Shaun Goh, Ling Tiah, Apichaya Monsomboon, Marcus Eng Hock Ong
BACKGROUND: There is paucity of data examining the incidence and outcomes of young OHCA adults. The aim of this study is to determine the outcomes and characteristics of young adults who suffered an OHCA and identify factors that are associated with favourable neurologic outcomes. METHODS: All EMS-attended OHCA adults between the ages of 16 and 35 years in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry were analysed. The primary outcome was favourable neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge or at 30th day post OHCA if not discharged...
December 3, 2016: Resuscitation
https://www.readbyqxmd.com/read/27922195/the-neuropeptide-cortistatin-attenuates-experimental-autoimmune-myocarditis-via-inhibition-of-cardiomyogenic-t-cell-driven-inflammatory-responses
#4
Virginia Delgado-Maroto, Clara P Falo, Irene Forte-Lago, Norma Adan, Maria Morell, Elena Maganto-Garcia, Gema Robledo, Francisco O'Valle, Andrew H Lichtman, Elena Gonzalez-Rey, Mario Delgado
BACKGROUND AND PURPOSE: Myocarditis is an inflammatory and autoimmune cardiovascular disease that causes dilated myocardiopathy and is responsible of high morbidity and mortality worldwide. Cortistatin is a neuropeptide produced by neurons and cells of immune and vascular systems. Besides its action in locomotor activity and sleep, cortistatin inhibits inflammation in different experimental models of autoimmune diseases. However, its role in inflammatory cardiovascular disorders is unexplored...
December 6, 2016: British Journal of Pharmacology
https://www.readbyqxmd.com/read/27920243/between-the-flags-implementing-a-safety-net-system-at-scale-to-recognise-and-manage-deteriorating-patients-in-the-new-south-wales-public-health-system
#5
Charles Pain, Malcolm Green, Colette Duff, Deborah Hyland, Annette Pantle, Kimberley Fitzpatrick, Cliff Hughes
QUALITY PROBLEM: In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals. INITIAL ASSESSMENT: The challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals. DESIGNING A SOLUTION: The CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies...
December 4, 2016: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/27919929/interleukin-37-and-dendritic-cells-treated-with-interleukin-37-plus-troponin-i-ameliorate-cardiac-remodeling-after-myocardial-infarction
#6
Ruirui Zhu, Haitao Sun, Kunwu Yu, Yucheng Zhong, Huairui Shi, Yuzhen Wei, Xin Su, Wenbin Xu, Quan Luo, Fangyuan Zhang, Zhengfeng Zhu, Kai Meng, Xiaoqi Zhao, Yuzhou Liu, Yi Mao, Peng Cheng, Xiaobo Mao, Qiutang Zeng
BACKGROUND: Excessive immune-mediated inflammatory reactions play a deleterious role in postinfarction ventricular remodeling. Interleukin-37 (IL-37) emerges as an inhibitor of both innate and adaptive immunity. However, the exact role of IL-37 and IL-37 plus troponin I (TnI)-treated dendritic cells (DCs) in ventricular remodeling after myocardial infarction (MI) remains elusive. METHODS AND RESULTS: MI was induced by permanent ligation of the left anterior descending artery...
December 5, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27919865/shared-decision-making-in-patients-with-low-risk-chest-pain-prospective-randomized-pragmatic-trial
#7
Erik P Hess, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, Victor M Montori
OBJECTIVE:  To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN:  Multicenter pragmatic parallel randomized controlled trial. SETTING:  Six emergency departments in the United States. PARTICIPANTS:  898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain...
December 5, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27917693/identification-of-kcnq1-compound-heterozygous-mutations-in-three-chinese-families-with-jervell-and-lange-nielsen-syndrome
#8
Cuicui Wang, Yu Lu, Jing Cheng, Lei Zhang, Wei Liu, Weihua Peng, Di Zhang, Hong Duan, Dongyi Han, Huijun Yuan
CONCLUSION: Besides expanding the spectrum of KCNQ1 mutations causing Jervell and Lange-Nielsen Syndrome (JLNS), the results showed diversity of its phenotypes, and emphasized the importance of molecular genetic analysis in confirming clinical diagnosis and making diagnosis possible before the emergency symptoms for deaf individuals. OBJECTIVES: This study aimed to investigate four patients from three Chinese families with congenital hearing loss clinically and genetically...
December 5, 2016: Acta Oto-laryngologica
https://www.readbyqxmd.com/read/27916210/heart-type-fatty-acid-binding-protein-in-the-assessment-of-acute-pulmonary-embolism
#9
Hai-Yan Qian, Ji Huang, Yue-Jin Yang, Yan-Min Yang, Zhi-Zhong Li, Jing-Mei Zhang
OBJECTIVE: To explore the predictive value of heart-type fatty acid binding protein (H-FABP) in the stratification and prognosis of patients with acute pulmonary embolism (APE). METHODS: According to risk stratification, 69 patients with APE admitted into the emergency department within 24 hours after onset were divided into the following 3 groups: high-risk group, moderate-risk group and low-risk group. H-FABP- and cardiac troponin I (cTNI)-positive rates of all groups were analyzed and compared, and the correlation between major adverse events (death, endotracheal intubation and cardiopulmonary resuscitation) and the cardiac markers (heart rate, arterial partial pressure of oxygen, right ventricular dimension, pulmonary arterial pressure, etc...
December 2016: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/27915239/emergency-cardiac-double-valve-surgery-in-active-infective-endocarditis-due-to-acinetobacter-baumannii-with-aortic-root-abscess-in-a-patient-with-dialysis-dependent-end-stage-renal-failure-a-rare-case-report
#10
Moosa Kunhi, Sachin Sanagar, N Jagadeesh, Bhima Shankar, Abi Abraham
We report an end-stage renal disease (ESRD) patient on regular haemodialysis awaiting renal transplant having native aortic valve endocarditis due to Acinetobacter baumannii complicated with aortic root abscess and severe mitral valve regurgitation with NYHA class IV symptoms. He underwent emergency aortic root abscess debridement, reconstruction with autologous pericardial patch and bioprosthetic aortic valve replacement along with mitral valve repair. This emergency intervention in active infective endocarditis due to A...
December 2, 2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/27911441/sirt1-protects-the-heart-from-er-stress-induced-cell-death-through-eif2%C3%AE-deacetylation
#11
Alexandre Prola, Julie Pires Da Silva, Arnaud Guilbert, Lola Lecru, Jérôme Piquereau, Maxance Ribeiro, Philippe Mateo, Mélanie Gressette, Dominique Fortin, Céline Boursier, Cindy Gallerne, Anaïs Caillard, Jane-Lise Samuel, Hélène François, David A Sinclair, Pierre Eid, Renée Ventura-Clapier, Anne Garnier, Christophe Lemaire
Over the past decade, endoplasmic reticulum (ER) stress has emerged as an important mechanism involved in the pathogenesis of cardiovascular diseases including heart failure. Cardiac therapy based on ER stress modulation is viewed as a promising avenue toward effective therapies for the diseased heart. Here, we tested whether sirtuin-1 (SIRT1), a NAD(+)-dependent deacetylase, participates in modulating ER stress response in the heart. Using cardiomyocytes and adult-inducible SIRT1 knockout mice, we demonstrate that SIRT1 inhibition or deficiency increases ER stress-induced cardiac injury, whereas activation of SIRT1 by the SIRT1-activating compound STAC-3 is protective...
December 2, 2016: Cell Death and Differentiation
https://www.readbyqxmd.com/read/27911381/a-novel-approach-for-the-administration-of-medications-and-fluids-in-emergency-scenarios-and-settings
#12
Akilesh Honasoge, Neal Lyons, Kathleen Hesse, Braden Parker, Robert Mokszycki, Kelly Wesselhoff, Rolla Sweis, Erik B Kulstad
The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption)...
November 9, 2016: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/27910056/cardiac-gene-delivery-using-recirculating-devices
#13
Melissa J Byrne, David M Kaye
Cardiac gene delivery has become an important issue following the emergence of gene therapy for the possible treatment of heart failure. Despite many advances in the management of heart failure (HF), treatment options for many patients with advanced HF remain limited. At a cellular and molecular level, many of the fundamental alterations that contribute to the pathogenesis of HF are becoming better understood and this has resulted in the discovery of new therapeutic targets in animal models of HF, in particular in the area of gene therapy...
2017: Methods in Molecular Biology
https://www.readbyqxmd.com/read/27909276/-closure-of-ascending-aortic-entry-by-debranching-endovascular-management-in-an-elderly-patient-with-acute-stanford-type-a-dissection
#14
Munehiro Saiki, Keiji Yunoki, Naoya Sakoda, Shigeru Hattori, Gaku Uchino, Takuya Kawabata, Yasufumi Fujita, Kunikazu Hisamochi, Hideo Yoshida
An 85-year-old woman was hospitalized by emergency for an acute Stanford type A aortic dissection. Computed tomography showed a primary entry on the ascending aorta and pericardial effusion. Although her hemodynamics was unstable due to cardiac shock, her family wished no open surgery considering her age and frailty. A couple of days later, her condition became stabilized with antihypertensive therapy. Since the dissection was limited within the ascending aorta, closure of the entry with the stentgraft was considered appropriate and much less invasive as compared with an open surgery...
December 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27908913/comfrey-herbal-remedy-causing-second-degree-heart-block-do-not-be-outfoxed-by-digitalis
#15
Mathew Kurian Vithayathil, Matthew Edwards
A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes. She had no previous medical or cardiac history, with the patient stating that she tried a herbal remedy of boiled comfrey leaves for insomnia 18 hours before arrival to the department. Her ECG showed multiple abnormalities, including bradycardia, second-degree atrioventricular node block, Mobitz Type 2, a shortened QT interval, downsloping ST depression and presence of U waves...
December 1, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27908815/regional-variation-in-postoperative-myocardial-infarction-in-patients-undergoing-vascular-surgery-in-the-united-states
#16
Andrea M Steely, Peter W Callas, Daniel Neal, Salvatore T Scali, Philip P Goodney, Andres Schanzer, Jack L Cronenwett, Daniel J Bertges
OBJECTIVE: To assess for regional variation in the incidence of postoperative myocardial infarction (POMI) following non-emergent vascular surgery across the United States in order to identify potential areas for quality improvement initiatives. METHODS: We evaluated POMI rates across 17 regional Vascular Quality Initiative (VQI) groups comprised of 243 centers with 1,343 surgeons who performed 75,057 vascular operations from 2010-2014. Four procedures were included in the analysis: carotid endarterectomy (CEA, n=39,118), endovascular abdominal aortic aneurysm (AAA) repair (EVAR, n=15,106), infra-inguinal bypass (INFRA, n=17,176), and open infra-renal AAA repair (OAAA, n=3,657)...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27908765/long-term-requirement-for-pacemaker-implantation-after-cardiac-valve-replacement-surgery
#17
Francisco Leyva, Tian Qiu, David McNulty, Felicity Evison, Howard Marshall, Maurizio Gasparini
BACKGROUND: The risk of permanent pacemaker implantation (PPI) after cardiac valve replacement surgery is thought be highest in the post-operative period. Long-term risks are uncertain. OBJECTIVE: To determine rates and timing of PPI after valve replacement surgery. METHODS: We compared PPI rates patients undergoing aortic (AVR, n = 111,674), mitral (MVR, n = 18,402) valve replacement, AVR+MVR (n = 5,166) or AVR + MVR and tricuspid valve replacement (TVR, n = 114) or CABG without valve replacement (n=249,742)...
November 28, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27908353/the-risk-continuum-of-atherosclerosis-and%C3%A2-its-implications-for-defining-chd-by%C3%A2-coronary-angiography
#18
REVIEW
Armin Arbab-Zadeh, Valentin Fuster
Patients undergoing coronary angiography for suspected coronary heart disease who are found to have coronary atherosclerotic disease with <50% diameter stenosis may carry a risk of adverse cardiac events similar to that in patients with single-vessel obstructive disease. Yet clinical practice guidelines offer no direction for managing symptomatic patients with nonobstructive coronary atherosclerosis because current diagnostic criteria for coronary heart disease are not met. Accordingly, secondary preventive measures are not endorsed, and their role is not defined in this setting...
December 6, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27908316/-frail-patients-and-surgery
#19
Nadia A Henriksen, Frederik Helgstrand, Ismail Gögenur
It is estimated that 15% of patients above 65 years of age are frail. Frail patients have significantly higher risk of post-operative complications when undergoing both elective and emergency surgery than patients who are not frail. Therefore, it is recommended that all patients above 65 years are frailty scored prior to a surgical procedure. It seems advisable to include the following items in a multimodal frailty score: evaluation of the patient's cognitive ability, functional status, nutritional status and pulmonary and cardiac function...
November 21, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/27907969/neuroprotection-in-critical-care-neurology
#20
Menno R Germans, Hieronymus D Boogaarts, R Loch Macdonald
Ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury-all have in common early brain injury due to brain tissue destruction, reduced cerebral blood flow and oxygen delivery, and overall substantial morbidity and mortality. The pathophysiology of brain tissue damage likely includes common cellular mechanisms. Neuroprotection has seldom, if ever, been shown to reduce early brain injury. Secondary brain injury develops after these conditions due to macroscopic events such as increased intracranial pressure and reduced cerebral blood flow, as well as cellular processes including vascular damage, inflammation, and apoptotic/necrotic cell death...
December 2016: Seminars in Neurology
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