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Refractory heart failure

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https://www.readbyqxmd.com/read/29151508/cardiac-sarcoidosis-presenting-as-acute-progressive-heart-failure-with-abdominal-lymphadenopathy
#1
Satoshi Oka, Ken Umetani, Tomoko Harama, Takuya Shimizu, Aritaka Makino, Keita Sano, Masahiko Nakamura
A 77-year-old Japanese woman presented with asymptomatic abdominal lymphadenopathy. Soluble interleukin-2 receptor (sIL2R) and angiotensin-converting enzyme (ACE) levels were elevated, and a pathological examination of lymph-node biopsies revealed non-caseating granulomas, which was consistent with sarcoidosis. Fluorodeoxyglucose-positron emission tomography did not show a clear accumulation in the mediastinal lymph-nodes or heart. Five months later, she presented with acute progressive heart failure that was refractory to conventional treatment...
November 20, 2017: Internal Medicine
https://www.readbyqxmd.com/read/29141964/acute-decompensated-pulmonary-hypertension
#2
Laurent Savale, Jason Weatherald, Xavier Jaïs, Constance Vuillard, Athénaïs Boucly, Mitja Jevnikar, David Montani, Olaf Mercier, Gerald Simonneau, Elie Fadel, Olivier Sitbon, Marc Humbert
Acute right heart failure in chronic precapillary pulmonary hypertension is characterised by a rapidly progressive syndrome with systemic congestion resulting from impaired right ventricular filling and/or reduced right ventricular flow output. This clinical picture results from an imbalance between the afterload imposed on the right ventricle and its adaptation capacity. Acute decompensated pulmonary hypertension is associated with a very poor prognosis in the short term. Despite its major impact on survival, its optimal management remains very challenging for specialised centres, without specific recommendations...
December 31, 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/29124028/inter-facility-transport-on-extracorporeal-life-support-clinical-outcomes-and-comparative-analysis-with-in-house-patients
#3
Tae Hee Hong, Heemoon Lee, Jae Jun Jung, Yang Hyun Cho, Kiick Sung, Ji-Hyuk Yang, Young-Tak Lee, Su Hyun Cho
Background: Extracorporeal life support (ECLS) is widely used in refractory heart or lung failure, and the demand for inter-facility transportation on ECLS is expanding. However, little is known about post-transportation outcomes, the clinical safety of such transportation, or the characteristics of the transported patients. Methods: This was a retrospective review of a 3-year, single-institution experience with inter-facility ECLS transport, as well as a comparative analysis of clinical outcomes with those of in-house patients...
October 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29113751/cardiomyopathy-induced-by-incessant-ventricular-tachycardia-originating-in-the-vicinity-of-the-his-bundle
#4
Sana Ouali, Manel Ben Halima, Selim Boudiche, Anissa Gharbi, Khedher Nadim, Kaouthar Hakim, Fatma Ouarda, Mohamed Sami Mourali
A 04-year-old boy was referred to our institution with severe, progressive heart failure of 4-months duration associated with a persistent wide QRS tachycardia with left bundle branch block and severe left ventricular dysfunction. Because of incessant wide QRS tachycardia refractory to antiarrhythmic drugs, he was referred for electrophysiological study. The ECG was suggestive of VT arising from the right ventricle near the His area. Electrophysiological study revealed that origin of tachycardia was septum of the right ventricle, near His bundle, however the procedure was not successful and an inadvertent complete atrioventricular conduction block occurred...
November 4, 2017: Indian Pacing and Electrophysiology Journal
https://www.readbyqxmd.com/read/29112081/predictors-prevalence-and-outcomes-of-early-crystalloid-responsiveness-among-initially-hypotensive-patients-with-sepsis-and-septic-shock
#5
Daniel E Leisman, Martin E Doerfler, Sandra M Schneider, Kevin D Masick, Jason A D'Amore, John K D'Angelo
OBJECTIVES: The prevalence of responsiveness to initial fluid challenge among hypotensive sepsis patients is unclear. To avoid fluid overload, and unnecessary treatment, it is important to differentiate these phenotypes. We aimed to 1) determine the proportion of hypotensive sepsis patients sustaining favorable hemodynamic response after initial fluid challenge, 2) determine demographic and clinical risk factors that predicted refractory hypotension, and 3) assess the association between timeliness of fluid resuscitation and refractoriness...
November 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29111210/interaction-of-adverse-disease-related-pathways-in-hypertrophic-cardiomyopathy
#6
Ethan J Rowin, Martin S Maron, Raymond H Chan, Anais Hausvater, Wendy Wang, Hassan Rastegar, Barry J Maron
Hypertrophic cardiomyopathy (HC) has been characterized as a generally progressive genetic heart disease, creating an ominous perspective for patients and managing cardiologists. We explored the HC disease burden and interaction of adverse clinical pathways to clarify patient expectations over long time periods in the contemporary therapeutic era. We studied 1,000 consecutive HC patients (52 ± 17 years) at Tufts Medical Center, followed 9.3 ± 8 years from diagnosis, employing a novel disease pathway model: 46% experienced a benign course free of adverse pathways, but 42% of patients progressed along 1 major pathway, most commonly refractory heart failure to New York Heart Association class III or IV requiring surgical myectomy (or alcohol ablation) or heart transplant; repetitive or permanent atrial fibrillation; and least commonly arrhythmic sudden death events...
September 20, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29103620/an-unusual-cause-of-heart-failure-in-a-young-man
#7
Krishna Kumar Mohanan Nair, Narayanan Namboodiri, Arun Gopalakrishnan, Sreevilasam Pushpangadhan Abhilash, Ajitkumar Valaparambil
A 21year old gentleman was admitted with shortness of breath and heart failure. He was noted to have incessant supraventricular tachycardia which was refractory to pharmacological and electrical cardioversion. Electrophysiology study revealed focal atrial tachycardia from an unusual location which was successfully ablated.
October 5, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/29103567/-difficulty-in-diagnosis-of-a-cardiogenic-shock-with-thrombotic-and-sub-occluded-lad-a-train-can-hide-another-one
#8
R Cheaito, A Tritar, H Benamer, M Saighi Bouaouina, A Masri, M A Bouzid, M Younes, H Mansour, P Jessen
The pheochromocytome is a localized tumor at the level of the medullosurrenale in 85% of the cases. The clinical presentation is very variable. Severe Heart failure presentation can be the mode of revelation in 2% of the cases. We present the case of a patient admitted for refractory cardiogenic shock correlated to pheochromocytome tumor. The difficulty of this rare clinical presentation was to confirm rapidly and in emergency this diagnosis in the same time when the patient presents a persistante and severe cardiogenic chock after finding a sub-occluded and thrombotic LAD coronary artery and which was treated by thrombectomy and coronary revascularization...
November 2, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29098712/flap-coverage-for-the-treatment-of-exposed-left-ventricular-assist-device-lvad-hardware-and-intractable-lvad-infections
#9
Adam Jacoby, John T Stranix, Oriana Cohen, Eddie Louie, Leora B Balsam, Jamie P Levine
BACKGROUND: Left ventricular assist devices (LVADs) have become useful adjuncts in the treatment of patients with end-stage heart failure. LVAD implantation is associated with a unique set of problems; one such problem is device infection. We report our experience with flap salvage of infected and/or exposed LVAD hardware. METHODS: Between 2011 and 2016, 49 patients underwent LVAD implantation at our institution. Patients were then categorized by infectious status: systemic infection not directly involving the LVAD device, hardware infection responsive to antibiotics, and exposure of LVAD hardware or device infection refractory to antibiotics requiring debridement and flap coverage...
November 3, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29094471/antifibrillatory-effects-of-renal-denervation-on-ventricular-fibrillation-in-a-canine-model-of-pacing-induced-heart-failure
#10
Qingzhi Luo, Qi Jin, Ning Zhang, Shangwei Huang, Yanxin Han, Changjian Lin, Tianyou Ling, Kang Chen, Wenqi Pan, Liqun Wu
This study investigated the effects of renal denervation (RDN) on vulnerability to ventricular fibrillation (VF) and ventricular electrical properties in a canine model of pacing-induced heart failure (HF). Eighteen beagles were divided into the following three groups: control (n = 6), HF (n = 6) and HF+RDN (n = 6). HF was induced by rapid right ventricular pacing. RDN was performed simultaneously with the pacemaker implantation in the HF+RDN group. A 64-unipolar basket catheter was used to perform global endocardial mapping of the left ventricle...
November 2, 2017: Experimental Physiology
https://www.readbyqxmd.com/read/29070522/left-ventricular-assist-devices-and-the-kidney
#11
REVIEW
Daniel W Ross, Gerin R Stevens, Rimda Wanchoo, David T Majure, Sandeep Jauhar, Harold A Fernandez, Massini Merzkani, Kenar D Jhaveri
Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience...
October 25, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29056460/use-of-a-percutaneous-temporary-circulatory-support-device-as-a-bridge-to-decision-during-acute-decompensation-of-advanced-heart-failure
#12
Shelley A Hall, Nir Uriel, Sandra A Carey, Michelle Edens, Geoffrey Gong, Michele Esposito, Ryan O'Kelly, Shiva Annamalai, Nima Aghili, S Adatya, Navin K Kapur
BACKGROUND: Prognosis is poor for patients with decompensated advanced heart failure (HF) refractory to medical therapy. Evaluating candidacy for durable mechanical circulatory support (MCS), cardiac transplantation, or palliative care is complex, and time is often needed to stabilize the patient hemodynamically. The Impella 5.0 (Abiomed, Danvers, MA) is a minimally invasive axial-flow catheter capable of providing full temporary hemodynamic support. We report a multicenter series on the use of this device for bridge to decision (BTD) in decompensated advanced HF patients...
September 30, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29054204/electroceuticals-in-medicine-the-brave-new-future
#13
Sundeep Mishra
Electroceuticals are a new category of therapeutic agents which act by targeting the neural circuits of organs. The therapy involves mapping the neural circuitry and delivering neural impulses to these specific targets. The impulse is administered via an implantable device. In cardiology besides pacemaker, defibrillation and resynchronization applications it could have usefulness in heart failure, atrial fibrillation, coronary artery disease, myocarditis, resistant hypertension, atrial and ventricular tachyarrhythmias, pulseless electrical activity, and refractory angina...
September 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/29045285/milrinone-dosing-and-a-culture-of-caution-in-clinical-practice
#14
Luke Yong Zheng Chong, Kumar Satya, Bernard Kim, Robert Berkowitz
Milrinone is an invaluable agent in the treatment of end-stage heart failure patients who are refractory to optimal medical therapy. In addition to its use in acute decompensated heart failure, milrinone can also be employed as a home infusion therapy or a bridge to cardiac transplant. Concerns about its adverse effects, such as an increased risk of arrhythmias and hypotension, often limit the doses of milrinone used in clinical practice. In addition, milrinone is infrequently used or avoided entirely in patients with acute renal failure or end-stage renal disease since the drug is primarily cleared by renal excretion...
October 17, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/29035000/use-of-sacubitril-valsartan-in-acute-decompensated-heart-failure-a-case-report
#15
Taison D Bell, Adrien J Mazer, P Elliott Miller, Jeffrey R Strich, Vandana Sachdev, Mary E Wright, Michael A Solomon
Refractory heart failure typically requires costly long-term, continuous intravenous inodilator infusions while patients await mechanical circulatory support or cardiac transplantation. The combined angiotensin receptor blocker-neprilysin inhibitor, sacubitril/valsartan, is a novel therapy that can increase levels of endogenous vasoactive peptides. This therapy has been recommended as an alternative agent in patients with chronic heart failure with reduced ejection fraction and New York Heart Association class II-III symptoms...
October 16, 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/29033442/efficacy-of-oxycodone-for-dyspnea-in-end-stage-heart-failure-with-renal-insufficiency-a-case-report
#16
Masayuki Tanaka, Hirofumi Maeba, Takeshi Senoo, Junji Iwasaka, Aki Ohkita, Haruna Kita, Kazuki Uchitani, Yasuhiko Hirota
A 67-year-old man with dilated cardiomyopathy and renal insufficiency was admitted to our hospital with dyspnea secondary to end-stage heart failure. We introduced oxycodone for medically refractory dyspnea instead of morphine because of the patient's renal insufficiency. After the administration of oxycodone, his dyspnea was alleviated without any adverse opioid effects, such as respiratory depression. After treating his heart failure, he was able to leave the intensive care unit. Oxycodone may therefore be a reliable agent for the treatment of dyspnea in patients with end-stage heart failure and renal insufficiency...
October 16, 2017: Internal Medicine
https://www.readbyqxmd.com/read/29030806/palliative-care-in-the-management-of-patients-with-advanced-heart-failure
#17
Susan E Lowey
Globally, there are 18-million individuals living with heart failure, a disease that is responsible for 12-15 million office visits and 6.5 million inpatient hospitalizations each year. As HF becomes advanced or end-stage, patients often live in a cycle of frequent transitions between care settings, and with unmet needs, including distress from inadequately managed symptoms. Prognostication in patients with heart failure can be challenging due to the unpredictable exacerbating-remitting illness trajectory that is associated with this progressive disease...
October 14, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28982560/surgery-versus-transcatheter-interventions-for-significant-paravalvular%C3%A2-prosthetic-leaks
#18
Xavier Millán, Ismail Bouhout, Anna Nozza, Karla Samman, Louis-Mathieu Stevens, Yoan Lamarche, Antonio Serra, Anita W Asgar, Ismail El-Hamamsy, Raymond Cartier, Michel Pellerin, Stephane Noble, Phillipe Demers, Reda Ibrahim, E Marc Jolicœur, Denis Bouchard
OBJECTIVES: This study sought to assess the relative merit of surgical correction (SC) versus transcatheter reduction on long-term outcomes in patients with significant paravalvular leak (PVL) refractory to medical therapy. BACKGROUND: PVL is the most frequent dysfunction following prosthetic valve replacement. Although repeat surgery is the gold standard, transcatheter reduction (TR) of PVL has been associated with reduced mortality. METHODS: From 1994 to 2014, 231 patients underwent SC (n = 151) or TR (n = 80) PVL correction...
October 9, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28982073/cardiac-specific-inactivation-of-lpp3-in-mice-leads-to-myocardial-dysfunction-and-heart-failure
#19
Mini Chandra, Diana Escalante-Alcalde, Md Shenuarin Bhuiyan, Anthony Wayne Orr, Christopher Kevil, Andrew J Morris, Hyung Nam, Paari Dominic, Kevin J McCarthy, Sumitra Miriyala, Manikandan Panchatcharam
Lipid Phosphate phosphatase 3 (LPP3), encoded by the Plpp3 gene, is an enzyme that dephosphorylates the bioactive lipid mediator lysophosphatidic acid (LPA). To study the role of LPP3 in the myocardium, we generated a cardiac specific Plpp3 deficient mouse strain. Although these mice were viable at birth in contrast to global Plpp3 knockout mice, they showed increased mortality ~ 8 months. LPP3 deficient mice had enlarged hearts with reduced left ventricular performance as seen by echocardiography. Cardiac specific Plpp3 deficient mice had longer ventricular effective refractory periods compared to their Plpp3 littermates...
September 28, 2017: Redox Biology
https://www.readbyqxmd.com/read/28979560/a-case-study-of-likely-wild-type-cardiac-transthyretin-amyloidosis-causing-rapid-deterioration
#20
Thomas Davies, Aarash Saleh, Gerry Coghlan, Carol Whelan, Banwari Agarwal
We present the case of an 88-year-old gentleman who presented to hospital septic with bilateral leg cellulitis, pulmonary oedema and hypotension. He had no history of heart disease but had had bilateral carpal tunnel releases. His condition deteriorated with refractory hypotension in spite of fluid filling, inotropic and vasopressor support. His echocardiogram showed an infiltrative cardiomyopathy with a speckled myocardium, severe concentric left and right ventricular increased wall thickness, diastolic dysfunction, biatrial dilatation and restrictive physiology in keeping with cardiac amyloidosis...
May 2017: J Intensive Care Soc
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