The aim of this review is to analyze in detail some possible pathophysiological mechanisms linking obesity and cardiac endocrine function, in order to try to explain the negative association previously observed between BMI and BNP values in both healthy subjects and patients with cardiovascular diseases. In particular, we discuss the ...

Cardiac resynchronization therapy (CRT) has traditionally been reserved for patients with left ventricular (LV) dysfunction in the setting of advanced heart failure. Early clinical trials clearly demonstrated reverse ventricular remodeling and clinical benefits following CRT in this population. More recently, with the publication of the REVERSE, MADIT-CRT, and RAFT trials, ...

Aim: The Rose questionnaire was developed in epidemiological studies to obtain a reproducible diagnosis of angina pectoris. We studied the prognostic value of this questionnaire with respect to the occurrence of future coronary events. Methods and results: We studied 7916 consecutive patients (mean age 56 years; 67% men) with clinically ...

Our work on atrophic remodelling of the heart has led us to appreciate the simple principles in biology: (i) the dynamic nature of intracellular protein turnover, (ii) the return to the foetal gene programme when the heart remodels, and (iii) the adaptive changes of cardiac metabolism. Although the molecular mechanisms ...

The indications for percutaneous coronary intervention (PCI) have expanded, especially after the approval of drug-eluting stents, for both complex lesions and those with intermediate stenosis. Because recent randomized trials have demonstrated the non-inferiority of optimal medical treatment for stable angina compared with coronary revascularization, and the benefits of PCI guided ...

We have demonstrated that a return of spontaneous circulation in the first 3 mins of resuscitation in swine is predicted by ventricular fibrillation waveform (amplitude spectral area or slope) when untreated ventricular fibrillation duration or presence of acute myocardial infarction is unknown. We hypothesized that in prolonged resuscitation efforts that ...

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Can intracoronary stem cell injection permanently improve cardiac function after myocardial infarction?'. Altogether 314 papers were found using the reported search, of which five represented the best evidence to answer the clinical ...

Right ventricular infarction is a not uncommon cause of cardiogenic shock, whose frecuency is variable and could be underestimated. Although left ventricular myocardial management is well defined in the right ventricular infarction are few studies with low level of evidence, to establish definitive guidelines. It is assumed that the treatment ...

Cardiac dysfunction is a well-recognized complication of severe sepsis and septic shock. Cardiac dysfunction in sepsis is characterized by ventricular dilatation, reduction in ejection fraction and reduced contractility. Initially, cardiac dysfunction was considered to occur only during the "hypodynamic" phase of shock. But we now know that it occurs very ...

Left ventricular outflow tract obstruction is not a rare problem in the intensive care units and can precipitate hemodynamic shock unresponsive to catecholamine therapy. The use of echocardiographic examination is extremely important in recognizing this phenomenon and its underlying conditions, finally identifying the most appropriate therapeutic strategy. The simple correction ...

Surgical revascularization for postinfarction cardiogenic shock carries 20-50% mortality. Beating-heart techniques have been favoured, but their impact on the avoidance of additional myocardial injury is unknown. Ten consecutive patients with postinfarction cardiogenic shock, unsuitable anatomy for percutaneous coronary intervention (Syntax score 34.0±7.5; triple-vessel disease, 10/10; left main stenosis, 5/10), and ...

Information about the clinical course of patients with acute myocardial infarction requiring mechanical ventilation is scarce. We sought to evaluate the clinical outcome of a large cohort of such patients in clinical practice. The German BEAT registry prospectively enrolled consecutive patients requiring mechanical ventilation who were admitted to an internal ...

Procalcitonin (PCT) levels are below the detection level in healthy subjects, while pre-procalcitonin mRNA is over expressed in human medullar thyroid carcinoma, in small cell lung tumor, and occasionally in other rare neuroendocrine tumors such as phaeochromocytoma. PCT is known as a sensitive and specific biomarker for bacterial sepsis, being ...

BACKGROUND: In cardiac acute patients, data on procalcitonin (PCT) are controversial and the clinical interpretation of absolute PCT values represents a major challenge since they may be influenced by several factors. No data are so far available on the dynamics of PCT levels in patients with cardiogenic shock. AIMS: to ...

Early revascularization (ERV) is beneficial in the management of cardiogenic shock (CS) complicating myocardial infarction. The severity of CS varies widely, and identification of independent risk factors for outcome is needed. The effect of ERV on mortality in different risk strata is also unknown. We created a severity scoring system ...

This study tested the hypothesis that early extracorporeal membrane oxygenator offered additional benefits in improving 30-day outcomes in patients with acute ST-segment elevation myocardial infarction complicated with profound cardiogenic shock undergoing primary percutaneous coronary intervention. Between May 1993 and July 2002, 920 patients with acute ST-segment elevation myocardial infarction underwent ...

Patients with cardiogenic shock (CS) are currently treated with acute coronary revascularization, mechanical support (i.e., IABP), and in addition with vasopressor and inotropic support. Among medical treatment dobutamine and norepinephrine are drugs of first choice. Nowadays, intravenous levosimendan, a new calcium sensitizer and K-ATP channel opener, has emerged as an ...

BACKGROUND: The increasing survival rates after out-of-hospital cardiac arrests (OHCA) are due mainly to improvements in the first 3 steps of the chain of survival. The aim of this study was to describe the temporal trends of OHCA incidence and outcomes with shock-resistant ventricular fibrillation (VF) requiring advanced life support ...

Despite therapeutic improvements, cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction (AMI). In addition to percutaneous coronary intervention, inotropes, fluids, adjunctive medication, intra-aortic balloon counterpulsation, and also assist devices are widely used for treatment. However, currently, there is only limited evidence for ...

OBJECTIVES: In this study, 30-day mortality from cardiogenic shock caused by left anterior descending artery (LAD) occlusion was compared with that caused by left circumflex (LCX) or right coronary artery (RCA) occlusion after primary percutaneous coronary intervention (PCI). METHODS: Between May 2001 and December 2009, 212 consecutive patients with anterior-wall ...

Pheochromocytoma is a rare tumor that produces a distant effect by secretion of catecholamines. This tumor usually presents with hypertension and palpitations but it may also cause cardiogenic shock because of catecholamine-induced myocardial dysfunction. We describe a rare case of Takotsubo-like cardiomyopathy as first manifestation of pheochromocytoma with an unusual ...

OBJECTIVE: To document the incidence, mortality rate, and risk factors for sepsis and septic shock compared with pulmonary embolism and myocardial infarction in the general-surgery population. DESIGN: Retrospective review. SETTING: American College of Surgeons National Surgical Quality Improvement Program institutions. PATIENTS: General-surgery patients in the 2005-2007 National Surgical Quality Improvement ...

The mortality of heart failure patients with renal insufficiency is high, and these patients tend to develop diuretic resistance. Under these conditions, continuous hemodiafiltration (CHDF) is a possible alternative volume reduction therapy to diuretics. However, its efficacy and safety are not clear. Between April 2005 and March 2008, 248 patients ...

Acute coronary syndromes range in severity from unstable angina to evolving myocardial infarction with persistent ST-segment elevation, with or without cardiogenic shock. Despite major improvements in medical and percutaneous therapy, acute coronary syndromes still represent a major cause of morbidity and mortality. The aggressive approaches to myocardial revascularization and mechanical ...

BACKGROUND: The increasing survival rates after out-of-hospital cardiac arrests (OHCA) are due mainly to improvements in the first 3 steps of the chain of survival. The aim of this study was to describe the temporal trends of OHCA incidence and outcomes with shock-resistant ventricular fibrillation (VF) requiring advanced life support ...

ABSTRACT: INTRODUCTION: Severe sepsis during pregnancy or in the post partum period is a rare clinical event. In non-obstetric surviving patients, the cardiovascular changes seen in sepsis and septic shock are fully reversible in 5 to10 days after their onset. We report a case of septic myocardial dysfunction lasting longer ...

A 60-year-old man was admitted to our department with non ST-segment elevation myocardial infarction complicated by cardiogenic shock. Total revascularization, using percutaneous coronary intervention facilitated by extracorporeal membrane oxygenation support, was performed, with a favorable outcome.

This article presents the case of a 71-year-old man who developed septic shock complicated by acute renal failure. Because of clinical suspicion of myocardial infarction, 24 hours before passing away, the patient had a coronary cineangiography. Limited incidences and views have been used to avoid contrast-induced nephropathy and no significant ...

Hypotension and shock are important issues confronting the intensivist. Volume overload can have dire consequences such as decreased gas exchange and increased myocardial dysfunction. This article explores dynamic means of determining preload responsiveness.

Echocardiography is a rapid, noninvasive, comprehensive cardiac assessment option for patients presenting with hemodynamic instability. In patients with septic shock, echocardiography can be used to guide fluid therapy by measuring collapsibility of the inferior vena cava. Sepsis-induced myocardial dysfunction can be diagnosed, and responses to therapy can be monitored with ...

After near-defibrillation threshold (DFT) shocks from an implantable cardioverter-defibrillator (ICD), the first postshock activation that leads to defibrillation failure arises focally after an isoelectric window (IW). The mechanisms underlying the IW remain incompletely understood. The goal of this study was to provide mechanistic insight into the origins of postshock activations ...

Cardiogenic shock following acute myocardial infarction affects 5% to 10% of patients and carries a grave prognosis. The dismal prognosis associated with post-MI cardiogenic shock, allied with surgical and technological advancements, has shifted the treatment paradigm toward wider use of mechanical circulatory support devices (MCSD). Current experience demonstrates that better ...

We investigated the risk factors for appropriate and inappropriate implantable cardioverter-defibrillator (ICD) shocks and mortality in 549 patients (mean age 74 years) with heart failure and ICDs. During a mean follow-up of 1,243 + or - 655 days, of the 549 patients, 163 (30%) had appropriate ICD shocks, 71 (13%) ...

Dynamic left ventricular outflow tract obstruction is a rare cause of cardiogenic shock after an acute myocardial infarction. A case is presented where inotropic support and an intra-aortic balloon pump aggravated the cardiac hemodynamics by this mechanism. The circulatory support provided by Impella 2.5 heart pump, in addition to discontinuation ...

Despite early revascularization, mortality remains high in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. It has been shown that the effect of multivessel disease (MVD) on mortality in patients with STEMI treated with primary percutaneous coronary intervention is mainly caused by the presence of chronic total ...

Studies have documented the beneficial roles of δ opioid receptor (OR) agonist for hemorrhagic shock. However, the myocardial protection roles and the mechanisms of hemodynamic stability during resuscitation of δ-OR agonist have not been explored. This study was designed to investigate myocardial protective effects and the mechanisms of high selective ...

Septic shock, the most severe complication of sepsis, accounts for approximately 10% of all admissions to intensive care. Our understanding of its complex pathophysiology remains incomplete but clearly involves stimulation of the immune system with subsequent inflammation and microvascular dysfunction. Cardiovascular dysfunction is pronounced and characterized by elements of hypovolaemic, ...

The aim of this study was to evaluate the effect of levosimendan on mortality in cardiogenic shock (CS) after ST elevation myocardial infarction (STEMI). Data were obtained prospectively from the SCAAR (Swedish Coronary Angiography and Angioplasty Register) and the RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care ...

Tachycardia-induced cardiomyopathy refers to an impairment in left-ventricular function due to chronic or prolonged tachycardia. We describe a heart transplant patient who developed cardiogenic shock due to tachycardia-induced cardiomyopathy. Low-output failure was further aggravated by administration of a short-acting beta-blocker during invasive hemodynamic monitoring. In contrast, heart rate control by ...

A newly discovered, early nineteenth-century lithograph by John Lewis Marks (b. ca. 1795-1796, d. ca. 1857-1861), entitled A Left Handed Compliment, is described. In this humorous print a young boy is using his left hand to draw the face of an elderly woman who is his grandmother, and she is ...

OBJECTIVES: Cardiogenic shock (CS) still remains one of the most important factors affecting the mortality rate of patients with ST segment elevation myocardial infarction (STEMI). However, the data with follow-up longer than 1 year are limited. The aim of this study was to evaluate the early and long-term treatment results ...

The effect of hypothyroidism on the cardiovascular system has been well documented. Cardiac dysfunction due to hypothyroidism manifests as both systolic and diastolic dysfunction of the heart leading to cardiac arrhythmia and congestive heart failure. Its presentation in the form of refractory hypotension is rare. We describe a 52 year ...

Acute myocardial infarction is one of the 10 leading reasons for admission to adult critical care units. In-hospital mortality for this condition has remained static in recent years, and this is related primarily to the development of cardiogenic shock. Recent advances in reperfusion therapies have had little impact on the ...

To present the design of a multicenter, randomized trial testing the effects of stress reduction treatment (SRT) on the prevalence of shock-treated ventricular arrhythmias among patients with an implantable cardioverter defibrillator (ICD). Significant adjustment problems secondary to ICD shock can increase the likelihood of arrhythmias requiring shock for termination. Whether ...

BACKGROUND: Implantable cardioverter-defibrillator (ICD) shocks have been associated with an increased risk of death. It is unknown whether this is due to the ventricular arrhythmia (VA) or shocks and whether antitachycardia pacing (ATP) termination can reduce this risk. OBJECTIVE: The purpose of this study was to determine whether mortality in ...

BACKGROUND: Left ventricular compromise in the neonate may be caused by birth asphyxia, metabolic disease, congenital heart disease, and systemic bacterial or viral infections. In rare cases, enterovirus infection may cause severe disease including cardiac, cerebral, hepatic and multi organ failure. PATIENTS AND METHODS: Case report. RESULTS: A 3-week-old neonate ...

OBJECTIVES: Levosimendan improves left ventricular hemodynamic function in patients with cardiogenic shock. However, its impact on right ventricular performance has not been determined. We compared the hemodynamic effects of levosimendan on left and right ventricular function in patients with intractable cardiogenic shock following myocardial infarction. DESIGN: Observational hemodynamic study. SETTING: ...

Right ventricular dysfunction during acute pulmonary embolism (PE) predisposes to hemodynamic instability and cardiogenic shock. Aim of this case-control study was to determine the clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with acute PE involving the main or segmental pulmonary arteries (central PE) and without ...

Heart failure is a well-recognized manifestation of organ failure in sepsis and septic shock. The pathophysiology of septic heart failure is complex and currently believed to involve several mechanisms. So far, the contributory role of high plasma catecholamine levels has not been investigated. In this manuscript, we present a hypothesis ...

It is well known that electric shock can both initiate and terminate ventricular fibrillation. Refractory ventricular fibrillation (RVF) may often be an iatrogenic paradoxical result of early, frequent, excessive salvos of DC current countershocks and inappropriate off-label drug use, particularly aggressive epinephrine administration. Evidence suggests that the current advanced cardiac ...