OBJECTIVES: The goal of this study was to describe the core laboratory angiographic findings of "SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK" (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival. BACKGROUND: In the SHOCK trial, emergency revascularization improved one-year survival of patients ...

Sufficiently strong defibrillation shocks will cause temporary or permanent damage to the heart. Weak defibrillation shocks do not cause any damage to the heart but also do not defibrillate. A relevant and practical question is what range of shock energies is most likely to defibrillate while not causing damage to ...

BACKGROUND: Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to protect against in-hospital death, cardiogenic shock, and the combined endpoints in adult but not in elderly patients with acute myocardial infarction. Experimental evidence indicates that caloric restriction may restore ischemic preconditioning in aged animals. OBJECTIVE: The objective was to ...

The Wearable Cardioverter Defibrillator (WCD) automatically detects and treats ventricular tachyarrhythmias without the need for assistance from a bystander, while at the same time allowing the patient to ambulate freely. It represents an alternative to emergency medical services for outpatient populations with a temporary risk of sudden cardiac death. While ...

The increasing prevalence of acute renal failure (ARF) patients with hemodynamic intolerance of intermittent hemodialysis (HD), generally because of septic vasoparesis or severe cardiac dysfunction, has led to the development of several strategies to improve the delivery of renal replacement therapy (RRT) in ARF patients. Intradialytic hypotension (IDH) is caused ...

Cardioversion of atrial fibrillation (AF) using traditional monophasic shock waveform is unsuccessful in up to 20% of cases, and often requires several shocks of up to 360 J. Based on the success with biphasic shock waveform in converting ventricular fibrillation, it was postulated that biphasic shocks would allow cardioversion with ...

OBJECTIVE: To describe the characteristics and mortality rates of 132 cardiogenic shock patients treated with intra-aortic balloon counterpulsation at a university hospital. INTERVENTIONS: All patients underwent intra-aortic balloon counterpulsation. A total of 99 out of 132 patients were revascularized with angioplasty, surgery or were transplanted (intervention group), 33 out of ...

In the setting of acute myocardial infarction (MI) and cardiogenic shock in patients with significant unprotected left main coronary artery (LMCA) disease, treatment options are limited. In this report of a patient presenting in cardiogenic shock secondary to acute MI with critical LMCA stenosis, percutaneous coronary intervention with intra-aortic balloon ...

CONTEXT: Right ventricular involvement in acute myocardial infarction and cardiogenic shock has received little attention by clinicians and researchers, although its pathophysiology, clinical presentation, and natural history are distinctly different from those of left ventricular infarction and associated cardiogenic shock. Right ventricular shock has important therapeutic implications for the management ...

Gastric infarction is rare, owing to the extensive collateral circulation of the stomach. A case of gastric infarction occurring in a patient with septic shock secondary to pneumonia is presented. The aetiology, diagnosis and therapy of gastric infarction are discussed, with consideration of the role of sepsis and vasopressors in ...

STUDY OBJECTIVE: Survival decreases with duration of ventricular fibrillation, and it is possible that failed rescue shocks increase myocardial damage. Structure in the ECG signal during ventricular fibrillation can be quantified by using the scaling exponent, a dimensionless measure that correlates with ventricular fibrillation duration. This study examined whether the ...

Overproduction of nitric oxide (NO) via the induction of NO synthase (NOS) II is implicated in the pathogenesis of the refractory hypotension that characterizes septic shock. However, clinical trials of nonselective NOS inhibitors have failed to afford a mortality benefit in patients with sepsis, and in those with depressed left ...

INTRODUCTION: Biphasic waveforms are routinely used for implantable defibrillators. These waveforms have been less readily adopted for external defibrillation. This study was performed in order to evaluate the efficacy and harms of biphasic waveforms over monophasic waveforms for the transthoracic defibrillation of patients in ventricular fibrillation (VF) or haemodynamically unstable ...

The aim of the study was to evaluate the effect of preshock atrial pacing on the atrial defibrillation threshold (DFT) during internal cardioversion of AF. The implantable atrial defibrillator has been added to the therapeutic options for patients with recurrent episodes of persistent AF. Although the device is efficient in ...

Vasopressin is emerging as a rational therapy for vasodilatory shock states. In part 1 of the review we discussed the structure and function of the various vasopressin receptors. In part 2 we discuss vascular smooth muscle contraction pathways with an emphasis on the effects of vasopressin on ATP-sensitive K+ channels, ...

BACKGROUND: Cardiogenic shock complicating acute coronary syndrome (ACS) implies grim prognosis with conventional management. Previous studies of coronary intervention yielded controversial results and were rarely analyzed chronologically. This study was to determine the impact of percutaneous coronary revascularization on outcome by studying two time periods 5 years apart in which ...

Septic shock decreases cardiac hydraulic work relative to the rate of myocardial oxygen consumption, causing decreased mechanical efficiency (hydraulic work/myocardial oxygen consumption). This study tested whether the mitochondrial uncoupling protein UCP2 was responsible for decreased cardiac mechanical efficiency after polymicrobial septic shock. Sepsis was initiated in ketamine/xylazine-anesthetized rats by cecal ...

BACKGROUND: Biphasic waveform shocks are more effective than monophasic shocks for transchest ventricular defibrillation, atrial cardioversion, and defibrillation with implantable defibrillators but have not been studied for open chest, intraoperative defibrillation. This prospective, blinded, randomized clinical study compares biphasic and monophasic shock effectiveness and establishes intraoperative energy dose-response curves. METHODS: ...

AIMS: The SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) Trial showed no benefit of early revascularization in patients aged >/=75 years with acute myocardial infarction and cardiogenic shock. We examined the effect of age on treatment and outcomes of patients with cardiogenic shock in the SHOCK Trial ...

OBJECTIVES: The purpose of this study was to determine the characteristics and outcomes of patients with acute myocardial infarction (MI) complicated by cardiogenic shock due to predominant right ventricular (RV) infarction. BACKGROUND: Although RV infarction has been shown to have favorable long-term outcomes, the influence of RV infarction on mortality ...

Endocannabinoid production by platelets and macrophages is increased in circulatory shock. This may be protective of the cardiovascular system as blockade of CB(1) cannabinoid receptors exacerbates endothelial dysfunction in haemorrhagic and endotoxin shock and reduces survival. Now evidence suggests that blockade of CB(1) receptors starting 24 h after myocardial infarction ...

The aim of the study was to compare biphasic versus monophasic shocks for open-chest epicardial defibrillation. Transthoracic biphasic waveform shocks require less energy to terminate ventricular fibrillation compared to monophasic waveform shocks. However, if biphasic shocks are effective for open-chest epicardial ("surgical") defibrillation has not been established. Twenty-eight anesthetized adult ...

The objective of the present study was to identify the nature of a filterable cardiodepressant substance (FCS) that contributes to myocardial dysfunction in a canine model of Escherichia coli septic shock. In a previous study, it was found that FCS increased in plasma after 4 h of bacteremia (Am J ...

Acute myocardial infarction is a common disease rarely seen as a complication of bone marrow transplantation in young patients. We report on a 25-year-old patient 3.5 years after bone marrow transplantation who suffered an acute anterior wall myocardial infarction complicated by cardiogenic shock. The patient was treated with thrombolysis and ...

OBJECTIVE: Our objective was to determine if magnesium reduces free radicals generated by direct current countershock and preserves left ventricular contractile function. BACKGROUND: We have previously shown that magnesium reduces free radicals in a coronary occlusion-reperfusion model, and therefore also might reduce free radical generation by direct current shocks. METHODS: ...

AIMS: Cardiogenic shock accounts for the majority of deaths following acute myocardial infarction. The majority of outcome data on this issue are, however, derived from single hospitals, referral centers or selected patients in randomized studies. The purpose of this study was to investigate incidence, outcome and prognostic significance of cardiogenic ...

BACKGROUND: Although echocardiography is used in diagnosis and management of myocardial infarction, it has not been established whether specific features of cardiac structure or function early in the course of cardiogenic shock provide prognostic value. The purposes of this substudy of the SHould we emergently revascularize Occluded Coronaries for cardiogenic ...

A 30-year-old man was admitted to our hospital for left lobar pneumonia with septic shock. Acute left-sided heart failure became evident as sepsis developed. Echocardiography revealed diffuse severe hypokinesis of the left ventricle (LV) and a pulmonary artery catheter showed Forrester subset II hemodynamics. Along with amelioration of sepsis and ...

Several investigations have discovered important physiologic links in the development of contrast-induced nephropathy (CIN). Studies using a canine kidney model showed that contrast media produce a direct cytotoxic effect on the renal structures. Also, there is increasing evidence that apoptosis is involved in CIN as a result of cell injury. ...

Cardiogenic shock is the most common cause of death for patients hospitalized with acute myocardial infarction. The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial randomly assigned 302 patients with predominant left ventricular failure following an acute myocardial infarction to a strategy of emergency revascularization or initial ...

BACKGROUND: Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV) is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. METHODS: Primary ...

The rationale for an arginine vasopressin (argipressin) infusion was put forward after it was discovered that patients in shock states might have an endogenous arginine vasopressin deficiency. Subsequently, several investigations impressively demonstrated that arginine vasopressin can successfully stabilise haemodynamics even in advanced vasodilatory shock. We report on physiological and pharmacological ...

Cardiogenic shock is a serious complication of myocardial infarction (MI) that affects approximately 7% of MI patients, accounting for the majority of all deaths related to acute infarction. Shock is typically the result of a massive amount of damage to the left ventricular myocardium; its defining characteristics are hypotension (systolic ...

BACKGROUND: Little is known about the clinical features and outcome of patients with left circumflex artery (LCX) infarct-related acute myocardial infarction (AMI). This study was conducted to investigate the clinical features and outcome of patients who underwent direct percutaneous coronary intervention (d-PCI) for AMI caused by LCX occlusion, and to ...

The intra-aortic balloon pump (IABP) is a valuable tool in the treatment of cardiogenic shock or instable myocardial ischaemia. We report on our recent experience with interhospital transport of haemodynamically unstable patients using on-site stabilization with IABP. A 75% survival rate encourages us to keep using this technique despite the ...

Blunt thoracic trauma may cause cardiac contusion and cardiogenic shock resistant to inotropic support. The use of intra-aortic balloon counterpulsation (IABCP) as a mechanical means of augmenting cardiac function following cardiac contusion is rare with case reports largely limited to its use in young trauma patients. We describe the case ...

Randomized clinical trials have demonstrated a reduction in mortality with early revascularization of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, and recent single-center studies have particularly suggested further benefit for coronary stenting. The purpose of this study was to examine the use of revascularization and coronary stenting ...

We report the cases of 2 previously healthy young patients with acute carbon monoxide intoxication who deteriorated to cardiogenic shock in the face of apparent metabolic and neurologic recovery. Prolonged exposure to sublethal levels of carbon monoxide (>24 hours, carboxyhemoglobin level of 20.4% and 22.6%) and massive binding of the ...

A case of emergency stent deployment to a critical vein graft lesion in a patient with an acute myocardial infarction and cardiogenic shock is described. An Angioguard vascular protection device was used, retrieving a large amount of atheromatous debris. Use of filter-type protection devices to prevent distal atheroembolism may be ...

The nature of myocardial dysfunction during sepsis and septic shock has been investigated for more than half a century. This review traces the evolution of scientific thought regarding this phenomenon during this period with particular emphasis on the current understanding of both the clinical manifestations and the molecular/cellular basis of ...

BACKGROUND: Observational studies have suggested that psychological stress increases the incidence of sudden cardiac death. Whether emotional or physical stressors can trigger spontaneous ventricular arrhythmias in patients at risk has not been systematically evaluated. METHODS AND RESULTS: Patients with implantable cardioverter-defibrillators (ICDs) were given diaries to record levels of defined ...

The probabilistic nature of the ventricular defibrillation threshold (DFT) remains poorly understood. We hypothesized that shock outcome is a function of the amount of myocardium in its vulnerable period (VP). The endocardial surface of five isolated, perfused swine right ventricles was mapped with 477 bipolar electrodes during ventricular fibrillation (VF). ...

Myocardial dysfunction frequently accompanies severe sepsis and septic shock. Whereas myocardial depression was previously considered a preterminal event, it is now clear that cardiac dysfunction as evidenced by biventricular dilatation and reduced ejection fraction is present in most patients with severe sepsis and septic shock. Myocardial depression exists despite a ...

BACKGROUND: A bolus of 7.5% NaCl-6% Dextran 70 (HSD) is effective in resuscitating hypovolemic shock. Common hemodynamic findings with HSD are restoration of cardiac output, increased blood pressure, and improvement of peripheral circulation. However, the effect of HSD upon cardiac function is still controversial. In our previous study, when HSD ...

INTRODUCTION: The aim of this study was to determine the atrial defibrillation threshold (ADFT) of a first shock across the standard right atrium (RA) to distal coronary sinus (dCS) configuration followed by a second shock along the atrial septum with a standard sequential waveform (the second shock leading edge equaled ...

We hypothesized that electrical shocks that defibrillate hearts successfully also produce myocardial injury, but only in settings in which the myocardium is underperfused. Myocardial function was measured in isolated, conventionally perfused or underperfused rat hearts during sinus rhythm and conventionally perfused or underperfused hearts during ventricular fibrillation (VF) after delivery ...

The mechanisms underlying myocardial dysfunction in sepsis remain poorly understood. The theoretical benefits of nitric oxide synthase (NOS) inhibition in reversing the haemodynamic changes that characterise septic shock have not been supported by clinical trials, some of which have demonstrated detrimental myocardial effects. We have therefore assessed the effects of ...

The present review discusses the hemodynamic effects of hypertonic saline in experimental shock and in patients with sepsis. We comment on the mechanisms of action of hypertonic saline, calling upon data in hemorrhagic and septic shock. Specific actions of hypertonic saline in severe sepsis and septic shock are highlighted. Data ...

A 65-year-old man was admitted to the National Defense Medical College Hospital for acute anterolateral myocardial infarction and cardiogenic shock. Emergency coronary angiography demonstrated occlusion of the proximal left anterior descending artery. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed with the support of intra-aortic balloon pumping (IABP) and ...

OBJECTIVE: Neonatal vein of Galen malformation complicated by severe cardiac failure is a rare disease. The purpose was to assess the outcome of this life-threatening malformation and identify hemodynamic prognostic factors. DESIGN: Retrospective study. PATIENTS: Twenty-four newborns with cardiac failure requiring mechanical ventilation were consecutively admitted from 1986 to 2000. ...