Document Detail


Reversible myocardial dysfunction, a possible complication in critically ill patients without heart disease.
MedLine Citation:
PMID:  14691898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Reversible myocardial dysfunction or myocardial stunning is frequently described in patients with episodes of acute coronary syndrome and has recently been reported in critically ill patients without ischaemic heart disease. This article presents a study and description of the possible existence of myocardial dysfunction in critically ill patients in our setting who present no acute episode or history of cardiovascular disease. DESIGN: Prospective, descriptive study. SETTING: The intensive care unit of a district hospital. PATIENTS AND PARTICIPANTS: The study included all patients admitted to the intensive care unit between March 1998 and March 2001 for noncardiac causes and with no history of heart disease, and who underwent echocardiographic examination for electrocardiographic changes, signs of cardiac insufficiency, persistent arrhythmias, or any other indication. Patients with sepsis or other critical illness known to be associated with myocardial dysfunction were excluded from the study. The study was carried out on those selected patients who developed myocardial dysfunction. MEASUREMENTS AND RESULTS: Transthoracic and transoesophageal echocardiography were carried out to assess the left ventricular ejection fraction and any segmental contractility disturbances. These investigations were carried out within 24 hours of admission, during the first week, during the second or third week, after one month and after three to 6 months. The electrocardiogram was assessed on admission and the changes over time were studied. Thirty-three patients were included in the study after detecting myocardial dysfunction; the median age of these patients was 63 years [range, 23-82 years]. Seven patients died. The median initial left ventricular ejection fraction was 0.34 [range, 0.16-0.48] and improved with time. Segmental contractility disturbances were detected initially in all patients and also normalized with time. All patients presented electrocardiogram changes that normalised in line with the echocardiographic changes. CONCLUSIONS: Reversible myocardial dysfunction can be develop in critically ill patients without primary heart disease. This syndrome is associated with systolic dysfunction, segmental contractility disturbances and electrocardiographic changes.
Authors:
Manuel Ruiz Bailén; Eduardo Aguayo de Hoyos; Asunción López Martnez; Miguel Angel Daz Castellanos; Silvia Ruiz Navarro; Luis Javier Fierro Rosón; Francisco Javier Gómez Jiménez; Ziad Issa-Masad Khozouz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of critical care     Volume:  18     ISSN:  0883-9441     ISO Abbreviation:  J Crit Care     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-23     Completed Date:  2004-07-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  245-52     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, Critical Care and Emergencies Department, Hospital de Poniente, El Ejido, Almería, Spain. ruizbailen@terra.es
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Aged
Aged, 80 and over
Critical Illness*
Electrocardiography
Female
Humans
Intensive Care Units
Male
Middle Aged
Myocardial Stunning / etiology*,  ultrasonography
Prospective Studies
Risk Factors
Ventricular Dysfunction, Left / etiology*,  ultrasonography

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