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Refractory heart failure

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https://www.readbyqxmd.com/read/28930049/experience-with-the-syncardia-total-artificial-heart-in-a-canadian-centre
#1
Anthony Nguyen, Michel Pellerin, Louis P Perrault, Michel White, Anique Ducharme, Normand Racine, Michel Carrier
BACKGROUND: The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. METHODS: We retrospectively analyzed the demographics, clinical characteristics and survival of all patients receiving the TAH. RESULTS: From September 2004 to November 2016, 13 patients (12 men, mean age 45 ± 13 yr) received the TAH for refractory cardiogenic shock secondary to idiopathic (56%) or ischemic (17%) cardiomyopathy and to other various causes (33%)...
October 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28917560/outcomes-of-rescue-cardiopulmonary-support-for-periprocedural-acute-hemodynamic-decompensation-in-patients-undergoing-catheter-ablation-of-electrical-storm
#2
Andres Enriquez, Jackson Liang, Javier Gentile, Robert Schaller, Gregory Supple, David S Frankel, Fermin Garcia, Joyce Wald, Edo Y Birati, J Eduardo Rame, Christian Bermudez, David Callans, Francis Marchlinski, Pasquale Santangeli
BACKGROUND: In patients with ventricular tachycardia/fibrillation (VT/VF) electrical storm (ES) undergoing catheter ablation (CA), hypotension due to refractory VT/VF, use of anesthesia and cardiac stunning due to repeated ICD shocks might precipitate acute hemodynamic decompensation (AHD). OBJECTIVE: We evaluated the outcomes of emergent cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) to rescue AHD in patients undergoing CA of ES. METHODS: Between 2010 and 2016, 21 patients with ES (VT in 11 and PVC-triggered VF in 10) were referred for CA and had periprocedural AHD requiring emergent ECMO support...
September 13, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28916516/an-uncommon-manifestation-of-shock-takotsubo-syndrome
#3
Ying X Gue, Sanjay S Bhandari, Mubarak Ahamed
76 year old female presented following an episode of collapse. She was hypotensive with the paramedics and remained refractory despite fluid resuscitation. Her initial baseline tests revealed an elevated troponin; she subsequently underwent a coronary angiogram which showed mild coronary artery disease. Left ventriculogram was performed which showed abnormal mid-wall ballooning and severely impaired systolic function, characteristic of takotsubo syndrome. Echocardiogram confirmed presence of diagnosis and presence of left ventricular outflow tract obstruction with high gradient...
September 15, 2017: Echo Research and Practice
https://www.readbyqxmd.com/read/28916239/effect-of-body-mass-index-on-clinical-events-after-acute-coronary-syndromes
#4
Pablo Lamelas, Jon-David Schwalm, Ibrahim Quazi, Shamir Mehta, P J Devereaux, Sanjit Jolly, Salim Yusuf
The association between body mass index (BMI) and major clinical events after acute coronary syndrome (ACS) remains controversial. We investigated the impact of BMI on major clinical events after ACS in a large individual patient data meta-analysis. Data on 81,553 patients from 45 different countries with ACS enrolled in 8 large randomized clinical trials were included, followed up for a median of 171 days. The mean age was 63.4 ± 11.7, 70% were male, and the mean BMI was 27.3 ± 4.7 kg/m(2). Compared with upper-normal-weight participants (BMI 21...
July 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28914153/cardiotoxicity-with-carfilzomib-at-doses-greater-than-27%C3%A2-mg-m-2-a-case-series
#5
Gee Youn Kim, Tania Ahuja, John Papadopoulos, Frank Cirrone
Carfilzomib is a second-generation proteasome inhibitor that irreversibly inhibits chymotrypsin-like (CT-L) activities of the proteasome, and is indicated for relapsed or refractory multiple myeloma. Cardiotoxicity is a well-established adverse effect of carfilzomib. The extent of cardiac toxicity in the literature spans anywhere from palpitations to cardiac arrest, with the most commonly reported manifestation being new-onset or worsening heart failure. A pre-clinical study of the pharmacokinetics and pharmacodynamics of carfilzomib given via intravenous bolus or 30-minute infusion in rats showed that carfilzomib can strongly induce apoptosis and potently damage cardiac myocytes at clinically relevant concentrations...
January 1, 2017: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/28890659/loeffler-endocarditis-a-unique-presentation-of-right-sided-heart-failure-due-to-eosinophil-induced-endomyocardial-fibrosis
#6
Amit Alam, Shankar Thampi, Shahryar G Saba, Rita Jermyn
Loeffler endocarditis is a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis. Although an uncommon entity, it is still a disease with significant morbidity and mortality. Often identified only at late stages, treatment options are limited once fibrosis occurs, usually requiring heart failure medications or surgical intervention. We present a unique case of a woman with remote history of hypereosinophilic syndrome, attributed to treatment of rheumatoid arthritis with infliximab, who presented with symptoms of heart failure refractory to medical management and was found to have Loeffler endocarditis...
2017: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/28880699/mobile-ecmo-a-divine-technology-or-bridge-to-nowhere
#7
Julia Merkle, Ilija Djorjevic, Anton Sabashnikov, Elmar W Kuhn, Antje-Christin Deppe, Kaveh Eghbalzadeh, Javid Fattulayev, Christopher Hohmann, Mohamed Zeriouh, Ferdinand Kuhn-Régnier, Yeong-Hoon Choi, Navid Mader, Thorsten Wahlers
Extracorporeal life support emerged as a salvage option in patients with therapy-refractory severe hemodynamic or respiratory failure. However, this promising therapy option has been limited by the use of experienced teams in highly specialized tertiary-care centers. Thus, in order to provide this standard of care in local hospitals and due to increasing evidence on improved outcomes using ECMO devices and setting for patients with heart and lung failure, an increasing number of experienced ECMO centers have launched mobile ECMO retrieval services in recent years...
September 12, 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/28878203/biventricular-cardiac-hypertrophy-in-a-patient-with-primary-aldosteronism-and-atrial-septal-defect
#8
Tjokorda Gde Dalem Pemayun, Ridho M Naibaho, Muhammad Achmad Sungkar
BACKGROUND Primary aldosteronism can be caused by adrenocortical adenoma and is usually associated with left ventricular hypertrophy. Biventricular cardiac hypertrophy and heart failure in the presence of a pre-existing atrial septal defect (ASD) are a rare association of primary aldosteronism. CASE REPORT A 33-year-old woman with resistant hypertension and refractory hypokalemia presented with signs and symptoms of heart failure. She had previously been diagnosed having a right adrenal tumor and ostium secundum type ASD...
September 7, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28876373/minimally-invasive-epicardial-pacemaker-implantation-in-neonates-with-congenital-heart-block
#9
Roberto Costa, Katia Regina da Silva, Martino Martinelli Filho, Roger Carrillo
BACKGROUND: Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). OBJECTIVE: This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. METHODS: Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB...
September 4, 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/28859030/treatment-of-refractory-infantile-hemangiomas-and-pulmonary-hypertension-with-sirolimus-in-a-pediatric-patient
#10
Kelley K Hutchins, Robert D Ross, Daisuke Kobayashi, Alissa Martin, Madhvi Rajpurkar
Infantile hemangioma is a benign vascular neoplasm that spontaneously involutes over time. Management, when needed, consists of medications, laser treatment and surgical excision. We describe a 3-year-old girl who presented shortly after birth with diffuse cutaneous hemangiomas, hepatosplenomegaly with liver lesions, anemia, and acute heart failure. She was diagnosed with hepatic and cutaneous infantile hemangioma based on skin biopsy. She developed progressive pulmonary hypertension with numerous pulmonary nodules suspicious for pulmonary arteriovenous malformations...
August 30, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28846098/the-metabolic-effects-of-gdf15-are-mediated-by-the-orphan-receptor-gfral
#11
Paul J Emmerson, Feng Wang, Yong Du, Qian Liu, Richard T Pickard, Malgorzata D Gonciarz, Tamer Coskun, Matthew J Hamang, Dana K Sindelar, Kimberly K Ballman, Lisa A Foltz, Avinash Muppidi, Jorge Alsina-Fernandez, Gavin C Barnard, Jason X Tang, Xilin Liu, Xudong Mao, Robert Siegel, John H Sloan, Pamela J Mitchell, Bei B Zhang, Ruth E Gimeno, Bei Shan, Xinle Wu
Growth/differentiation factor 15 (GDF15), also known as MIC-1, is a distant member of the transforming growth factor-β (TGF-β) superfamily and has been implicated in various biological functions, including cancer cachexia, renal and heart failure, atherosclerosis and metabolism. A connection between GDF15 and body-weight regulation was initially suggested on the basis of an observation that increasing GDF15 levels in serum correlated with weight loss in individuals with advanced prostate cancer. In animal models, overexpression of GDF15 leads to a lean phenotype, hypophagia and other improvements in metabolic parameters, suggesting that recombinant GDF15 protein could potentially be used in the treatment of obesity and type 2 diabetes...
August 28, 2017: Nature Medicine
https://www.readbyqxmd.com/read/28835586/effects-of-additive-tolvaptan-vs-increased-furosemide-on-heart-failure-with-diuretic-resistance-and-renal-impairment%C3%A3-results-from-the-k-star-study
#12
Takayuki Inomata, Yuki Ikeda, Keisuke Kida, Yugo Shibagaki, Naoki Sato, Yuji Kumagai, Hisahito Shinagawa, Junya Ako, Tohru Izumi
BACKGROUND: Although diuretic resistance leading to residual congestion is a known predictor of a poorer heart failure (HF) prognosis, better therapeutic strategies for effective and safe decongestion have not been established.Methods and Results:In this study, 81 HF patients with fluid retention (despite taking ≥40 mg/day furosemide (FUR)), with an estimated glomerular filtration rate <45 mL/min/1.73 m(2), were randomized into 2 groups and administered either ≤15 mg/day additive tolvaptan (TLV) or ≤40 mg/day increased FUR for 7 days...
August 22, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28832793/quality-of-life-depression-anxiety-and-coping-strategies-after-heart-transplantation
#13
Fulvio Bergamo Trevizan, Maria Cristina de Oliveira Santos Miyazaki, Yasmin Lima Witzel Silva, Christiane Maia Waetman Roque
Introduction: Heart transplantation is the therapeutic procedure indicated to increase the survival of patients with refractory heart failure. Improvement in overall functioning and quality of life are expected factors in the postoperative period. Objective: To identify and evaluate mental disorders and symptoms, such as depression and anxiety, quality of life and coping strategies in the post-surgical situation of heart transplantation. Methods: A cross-sectional, quantitative study with patients who have undergone heart transplantation...
May 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28822659/incidence-and-risk-factors-of-groin-lymphocele-formation-after-venoarterial-extracorporeal-membrane-oxygenation-in-cardiogenic-shock-patients
#14
Michael Salna, Hiroo Takayama, Arthur R Garan, Paul Kurlansky, Maryjane A Farr, Paolo C Colombo, Thomas Imahiyerobo, Nicholas Morrissey, Yoshifumi Naka, Koji Takeda
OBJECTIVE: Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-established therapy for refractory cardiopulmonary failure. Femoral cannulation offers a quick and effective means of providing circulatory support but is not without complication. Inflammation or lymphatic disruption at the site of cannulation can cause the formation of lymphoceles, leading to the patient's discomfort and possibly necessitating intervention. The purpose of this study was to evaluate the incidence of in-hospital lymphocele formation in VA-ECMO patients and to identify predictors for their development...
August 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28822384/clinical-characteristics-of-trauma-patients-requiring-hydrocortisone-treatment-for-refractory-hypotension
#15
Gina Kim, Jeffrey Young
Corticosteroids play an important role in responding to physiologic stress in the human body. However, its application in critical care remains heavily debated. The purpose of this study was to identify patient characteristics associated with receiving stress-dose steroids during the intensive care unit stay after traumatic injury and its effect on in-hospital mortality. Patients admitted to the University of Virginia trauma center between January 1, 2011, and December 31, 2015, were identified using our Trauma Registry...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28819361/unilateral-headache-status-after-intra-aortic-balloon-pump-placement
#16
Garret M Weber, Alan L Gass, Shalvi B Parikh
INTRODUCTION: Intra-aortic balloon pump (IABP) counterpulsation is a catheter-based treatment for coronary artery disease and decompensated heart failure to increase coronary blood flow and improve cardiac output. IABP is generally well tolerated, and complications are usually related to peripheral vasculature or red blood cell and platelet consumption. The usual insertion site via femoral artery renders the patient bedbound. Recently, axillary artery has been used in patients with atherosclerotic peripheral vascular disease and documented small arteries or in those awaiting transplant to ensure ambulation and prevent deconditioning...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/28816096/management-of-severe-pulmonary-hemorrhage-in-a-neonate-on-veno-arterial-ecmo-by-the-temporary-clamping-of-the-endotracheal-tube-a-case-report
#17
Vaclav Vobruba, Tomas Grus, Frantisek Mlejnsky, Jan Belohlavek, Jan Hridel, Lukas Lambert
Severe pulmonary hemorrhage in the newborn is an infrequent, but life-threatening, event. A newborn with persistent pulmonary hypertension and a large persistent ductus arteriosus and open foramen ovale presented with hypoxemia and progressive right heart failure shortly after birth, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) support. Twenty minutes after the initiation of ECMO, the patient developed severe pulmonary hemorrhage refractory to conventional treatment. As a last resort, the endotracheal tube was clamped...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28805198/severe-reversible-hypocalcemic-cardiomyopathy-diagnosed-36-years-after-subtotal-thyroidectomy-a-case-report
#18
Waldemar Elikowski, Małgorzata Małek-Elikowska, Patrycja Lachowska-Kotowska
Chronic hypocalcemia, irrespectively of its etiology, can lead to severe impairment of the left ventricular (LV) contractility manifesting as dilated cardiomyopathy, usually defined as hypocalcemic cardiomyopathy (hypocaCM). This rarely diagnosed type of heart failure (HF), can be completely reversible, when treated properly with calcium and vitamin D supplementation or, in some subjects, with human recombinant parathormone. A CASE REPORT: The authors present a case of a 60-year-old male admitted with advanced pulmonary congestion, recurrent pulmonary edema and pleural effusion...
July 21, 2017: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/28782466/current-status-of-renal-artery-angioplasty-and-stenting-for-resistant-hypertension-a-case-series-and-review-of-the-literature
#19
Antonis S Manolis, Antonis A Manolis, Helen Melita
BACKGROUND: Renal artery stenosis (RAS) has a high prevalence in older patients, especially in the context of general atherosclerosis. It is frequently associated with resistant hypertension and impaired renal function and their attendant consequences. The issue whether revascularization via percutaneous renal angioplasty and stenting (PRA/S) can benefit these patients remains unsettled. OBJECTIVE: To present a case series of patients with refractory hypertension and RAS undergoing PRA/S and also to provide an extensive review of the literature on the current status of PRA/S for resistant hypertension...
August 4, 2017: Current Hypertension Reviews
https://www.readbyqxmd.com/read/28772042/giant-cell-myocarditis-masquerading-as-orbital-myositis-with-a-rapid-fulminant-course-necessitating-mechanical-support-and-heart-transplantation
#20
Vinisha Garg, Weiyi Tan, Reza Ardehali, Janki Shah, Tracy Huynh, Olcay Aksoy
Giant cell myocarditis (GCM), a rapidly progressive inflammation of the myocardium, is associated with fulminant heart failure, refractory ventricular arrhythmias, and conduction system abnormalities. Few case reports have noted orbital myositis as the initial clinical presentation. Our case demonstrates a unique presentation of GCM with only ocular symptoms, which unlike prior studies, rapidly progressed to heart failure, tachyarrhythmias, and conduction disease. Our case necessitated quick recognition and treatment with mechanical support making this the first known case of GCM with successful placement of biventricular assist devices and ultimately with heart transplantation...
August 2017: ESC Heart Failure
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