Acute cardiac care is no longer limited to simply providing life-saving therapy to patients with acute myocardial infarction (AMI). The modern concept of an acute cardiac care unit (ACCU) integrates advanced monitoring systems for cardiovascular emergencies, most frequent in the immediate post-PCI period for patients with myocardial infarction, with cutting edge facilities for treating multi-organ failure resulting from systemic complications of acute cardiovascular conditions. Data from the BLITZ-3 registry, published by Casella et al. in 2017, encountering the pathologies admitted in the intensive cardiac care units, showed that acute coronary syndromes represent indeed the core business of ACCUs, with 52% of the cases admitted in acute cardiac facilities being represented by AMI (21% STEMI and 31% NSTEMI), while a significant proportion of 34% of patients were admitted for other cardiovascular emergencies such as acute heart failure, arrhythmia, aortic dissection, cardiac tamponade, pulmonary embolism etc.1 However, a study published by Sinha et al. in 2017 revealed that an important proportion of patients admitted in ACCUs presented significant non-cardiac comorbidities such as neurologic, hematologic/oncologic, musculoskeletal, infections, gastrointestinal or respiratory diseases.2 Another study by Holland et al., on the impact of non-cardiovascular illnesses on ACCU mortality, showed that in a model of 100 patients admitted in the ACCU, from 50 patients without acute kidney injury, acute respiratory failure, or sepsis only 1 will die, while from 50 patients with acute kidney injury, acute respiratory failure, or sepsis 11 will die, revealing the impact of coexisting morbidity on cardiovascular mortality in acute settings.3 These observations led to a paradigm shift in the concept of ACCUs, which was directly reflected in the guidelines. While the 2005 recommendations of the European Society of Cardiology considered ACCUs as facilities caring for patients in the immediate period of thrombolysis and AMI complications, the position paper published by the European Association of Acute Cardiovascular Care in 2017 defined 3 levels of complexity of ACCUs, level 3 being designed for the most complex cases, usually with associated comorbidities or in critical conditions.4,5 At the same time, there is an important interaction between cardiovascular conditions and other comorbidities which require special cardiac attention. This underlines the strong interdisciplinary approach required for providing highly specialized care for complex cardiovascular patients. For instance, preexisting chronic kidney disease, HIV infection, lung diseases, diabetes, inflammatory diseases, or oncological illnesses may lead to a more severe evolution of acute coronary syndromes, as inflammatory reactions play a pivotal role in the pathophysiology of ACS, and systemic inflammation may be exacerbated by these coexisting conditions.6–11 The history of stem cell transplantati
{"title":"Acute Cardiac Care – an Interdisciplinary Approach","authors":"T. Benedek","doi":"10.2478/jce-2020-0021","DOIUrl":"https://doi.org/10.2478/jce-2020-0021","url":null,"abstract":"Acute cardiac care is no longer limited to simply providing life-saving therapy to patients with acute myocardial infarction (AMI). The modern concept of an acute cardiac care unit (ACCU) integrates advanced monitoring systems for cardiovascular emergencies, most frequent in the immediate post-PCI period for patients with myocardial infarction, with cutting edge facilities for treating multi-organ failure resulting from systemic complications of acute cardiovascular conditions. Data from the BLITZ-3 registry, published by Casella et al. in 2017, encountering the pathologies admitted in the intensive cardiac care units, showed that acute coronary syndromes represent indeed the core business of ACCUs, with 52% of the cases admitted in acute cardiac facilities being represented by AMI (21% STEMI and 31% NSTEMI), while a significant proportion of 34% of patients were admitted for other cardiovascular emergencies such as acute heart failure, arrhythmia, aortic dissection, cardiac tamponade, pulmonary embolism etc.1 However, a study published by Sinha et al. in 2017 revealed that an important proportion of patients admitted in ACCUs presented significant non-cardiac comorbidities such as neurologic, hematologic/oncologic, musculoskeletal, infections, gastrointestinal or respiratory diseases.2 Another study by Holland et al., on the impact of non-cardiovascular illnesses on ACCU mortality, showed that in a model of 100 patients admitted in the ACCU, from 50 patients without acute kidney injury, acute respiratory failure, or sepsis only 1 will die, while from 50 patients with acute kidney injury, acute respiratory failure, or sepsis 11 will die, revealing the impact of coexisting morbidity on cardiovascular mortality in acute settings.3 These observations led to a paradigm shift in the concept of ACCUs, which was directly reflected in the guidelines. While the 2005 recommendations of the European Society of Cardiology considered ACCUs as facilities caring for patients in the immediate period of thrombolysis and AMI complications, the position paper published by the European Association of Acute Cardiovascular Care in 2017 defined 3 levels of complexity of ACCUs, level 3 being designed for the most complex cases, usually with associated comorbidities or in critical conditions.4,5 At the same time, there is an important interaction between cardiovascular conditions and other comorbidities which require special cardiac attention. This underlines the strong interdisciplinary approach required for providing highly specialized care for complex cardiovascular patients. For instance, preexisting chronic kidney disease, HIV infection, lung diseases, diabetes, inflammatory diseases, or oncological illnesses may lead to a more severe evolution of acute coronary syndromes, as inflammatory reactions play a pivotal role in the pathophysiology of ACS, and systemic inflammation may be exacerbated by these coexisting conditions.6–11 The history of stem cell transplantati","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"7 1","pages":"72 - 74"},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87013280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Onur Seker, I. Cerik, Metin Çoksevim, M. Yenerçağ, K. Soylu
Abstract Background: ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome with high mortality. The main purpose of STEMI treatment is to achieve optimal revascularization for tissue perfusion. Besides the innovations in revascularization strategies, developments in antithrombotic therapy resulted in a significant reduction in STEMI-related mortality. Reperfusion can be demonstrated by resolution of ST-segment elevation (STR), TIMI frame count (TFC), and myocardial blush grade (MBG). Aim of the study: In our study, we investigated the effects of P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor on reperfusion parameters such as TFC, MBG, and STR, after primary percutaneous coronary intervention (pPCI) in STEMI. Material and Methods: The study was a retrospective analysis of STEMI patients who underwent successful pPCI. A total of 120 patients were included in the study as 3 equal groups according to the type of P2Y12 inhibitor administered in loading dose in the acute phase, and reperfusion parameters were compared between the groups. Results: There was no statistically significant difference between the groups in terms of baseline demographic, clinical, and angiographic parameters. Evaluation of reperfusion parameters indicated that STR, MBG, angina relief after pPCI and corrected TFC (cTFC) were significantly different between the groups (p <0.05). In post-hoc analysis, the percentage of change in STR, MBG, angina relief after pPCI, and cTFC was significantly higher in the prasugrel group (p <0.017). Conclusion: In STEMI patients undergoing pPCI, the analysis of tissue level reperfusion parameters indicates a superior effect of prasugrel compared with other P2Y12 inhibitors used to achieve reperfusion.
{"title":"Effectiveness of Different P2Y12 Inhibitors on Coronary Flow in Patients with ST-Elevation Myocardial Infarction","authors":"Onur Seker, I. Cerik, Metin Çoksevim, M. Yenerçağ, K. Soylu","doi":"10.2478/jce-2020-0018","DOIUrl":"https://doi.org/10.2478/jce-2020-0018","url":null,"abstract":"Abstract Background: ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome with high mortality. The main purpose of STEMI treatment is to achieve optimal revascularization for tissue perfusion. Besides the innovations in revascularization strategies, developments in antithrombotic therapy resulted in a significant reduction in STEMI-related mortality. Reperfusion can be demonstrated by resolution of ST-segment elevation (STR), TIMI frame count (TFC), and myocardial blush grade (MBG). Aim of the study: In our study, we investigated the effects of P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor on reperfusion parameters such as TFC, MBG, and STR, after primary percutaneous coronary intervention (pPCI) in STEMI. Material and Methods: The study was a retrospective analysis of STEMI patients who underwent successful pPCI. A total of 120 patients were included in the study as 3 equal groups according to the type of P2Y12 inhibitor administered in loading dose in the acute phase, and reperfusion parameters were compared between the groups. Results: There was no statistically significant difference between the groups in terms of baseline demographic, clinical, and angiographic parameters. Evaluation of reperfusion parameters indicated that STR, MBG, angina relief after pPCI and corrected TFC (cTFC) were significantly different between the groups (p <0.05). In post-hoc analysis, the percentage of change in STR, MBG, angina relief after pPCI, and cTFC was significantly higher in the prasugrel group (p <0.017). Conclusion: In STEMI patients undergoing pPCI, the analysis of tissue level reperfusion parameters indicates a superior effect of prasugrel compared with other P2Y12 inhibitors used to achieve reperfusion.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"23 1","pages":"91 - 97"},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79584654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-08DOI: 10.22541/au.160217171.12408562/v1
C. Șuteu, Cristina Blesneac, M. Pop, Amalia Făgărășan, L. Gozar, R. Togănel
Abstract Scimitar syndrome is a rare congenital cardiovascular malformation that includes a partially anomalous drainage of the pulmonary veins in the inferior vena cava, right pulmonary hypoplasia, and systemic-pulmonary collaterals originating from various segments of the aorta. We present a case of Scimitar syndrome with associated intracardiac lesions and a large arterial conduct supplying the right lung, originating from the abdominal aorta and draining in the inferior vena cava.
{"title":"A Particular Infantile Scimitar Syndrome Variant with Anomalous Systemic Arterial Supply-Inferior Vena Cava Fistula","authors":"C. Șuteu, Cristina Blesneac, M. Pop, Amalia Făgărășan, L. Gozar, R. Togănel","doi":"10.22541/au.160217171.12408562/v1","DOIUrl":"https://doi.org/10.22541/au.160217171.12408562/v1","url":null,"abstract":"Abstract Scimitar syndrome is a rare congenital cardiovascular malformation that includes a partially anomalous drainage of the pulmonary veins in the inferior vena cava, right pulmonary hypoplasia, and systemic-pulmonary collaterals originating from various segments of the aorta. We present a case of Scimitar syndrome with associated intracardiac lesions and a large arterial conduct supplying the right lung, originating from the abdominal aorta and draining in the inferior vena cava.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"141 1","pages":"17 - 21"},"PeriodicalIF":0.4,"publicationDate":"2020-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78524438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Răzvan-Andrei Licu, E. Blîndu, I. Benedek, T. Benedek
Abstract The new coronavirus (COVID-19) outbreak was declared a pandemic by the World Health Organization on March 11, 2020. Since then, important changes have been observed in the medical world, both in terms of patient management and patient presentations to the hospital. A dramatic decrease in the number of cardiovascular emergencies presenting to the emergency rooms has been reported in every country affected by the COVID-19 pandemic. This resulted mainly from the fear of patients to present at the hospital due to the risk of infection with the new coronavirus. Moreover, a significant increase in the time spent for investigations and specialized treatment has been reported for patients suffering from acute cardiovascular diseases. This adds to the longer times reported from symptom onset to presentation, and also to the longer period spent for triage in the emergency room. The aim of this paper is to highlight the dramatic reduction in the number of cardiovascular emergencies during the COVID-19 period and its possible explanations.
{"title":"Decrease of Cardiovascular Emergencies During the COVID-19 Pandemic","authors":"Răzvan-Andrei Licu, E. Blîndu, I. Benedek, T. Benedek","doi":"10.2478/jce-2020-0011","DOIUrl":"https://doi.org/10.2478/jce-2020-0011","url":null,"abstract":"Abstract The new coronavirus (COVID-19) outbreak was declared a pandemic by the World Health Organization on March 11, 2020. Since then, important changes have been observed in the medical world, both in terms of patient management and patient presentations to the hospital. A dramatic decrease in the number of cardiovascular emergencies presenting to the emergency rooms has been reported in every country affected by the COVID-19 pandemic. This resulted mainly from the fear of patients to present at the hospital due to the risk of infection with the new coronavirus. Moreover, a significant increase in the time spent for investigations and specialized treatment has been reported for patients suffering from acute cardiovascular diseases. This adds to the longer times reported from symptom onset to presentation, and also to the longer period spent for triage in the emergency room. The aim of this paper is to highlight the dramatic reduction in the number of cardiovascular emergencies during the COVID-19 period and its possible explanations.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"5 1","pages":"59 - 62"},"PeriodicalIF":0.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89482115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute myocardial infarction continues to represent a devastating disease. In spite of many significant advances in the therapy of ischemic heart diseases, an effective method to recover damaged myocardium has not been validated so far. More than ten years ago, transplantation of bone marrow stem cells into the infarcted area was proposed in the hope that angiogenic properties of the stem cells can lead to regeneration of myocardial tissue and may trigger the development of new, viable myocardial cells that will replace the scar tissue. This challenging hypothesis has been tested in an impressive number of clinical trials, all of them showing promising results.1 However, none of these trials led to a real revolution in the therapy of acute myocardial infarction, as expected, mainly because they did not succeed to demonstrate a significant impact on survival. In 2007, in Târgu Mureș, an interdisciplinary team led by Prof. István Benedek and myself, performed the first stem cell transplantation in a patient suffering from myocardial infarction. Prof. István Benedek was the Head of the Clinic of Hematology and was the champion who performed the first stem cell transplantation in an adult with a hematological disorder in Romania. Working together, we performed a series of stem cell transplantations in patients with acute myocardial infarction or with critical limb ischemia with very good results, demonstrating that an effective collaboration between the two disciplines can lead to a significant progress for both and can expand the horizons of medicine. In a follow-up study published after 6 years, using CT imaging performed at 4 years after the transplantation, we demonstrated that the infusion of stem cells in the infarcted coronary artery can also play a protective role, preventing atherosclerosis progression.2 At 4 years after the stem cell infusion, plaque volume (PV) and coronary calcium (CC) accumulation were significantly lower in the group who received stem cells compared to the control group, at the level of the entire coronary tree (PV 702 mm3 vs. 1,465 mm3, p = 0.0006; CC score 295 vs. 796, p <0.0001) and at the level of the coronary segment as well (coronary PV 112.12 ± 16.82 mm3 for the treated arteries vs. 189.56 ± 20.98 mm3 for the untreated arteries, p <0.0001, and mean CC score 53.12 ± 16.4 vs. 106.43 ± 10.86, p <0.0001). At the same time, in our experience, patients with critical limb ischemia who received stem cell infusion in the ischemic limb and in the affected peripheral artery, reported a significant relief in symptoms, which was persistent after 4 years. Our work shows that an interdisciplinary approach that facilitates a revolutionary treatment may save lives and may improve the quality of life. This is, after all, the goal of our activity in the medical field. Unfortunately, this did not work for Prof. István Benedek. He died on September1, 2020, at the age of 71, after contacting COVID-19 while he was working in the front l
急性心肌梗塞仍然是一种毁灭性的疾病。尽管缺血性心脏病的治疗取得了许多重大进展，但迄今为止还没有一种有效的方法来恢复受损的心肌。十多年前，有人提出将骨髓干细胞移植到梗死区域，希望干细胞的血管生成特性可以导致心肌组织再生，并可能引发新的、有活力的心肌细胞的发育，以取代疤痕组织。这个具有挑战性的假设已经在大量的临床试验中得到了验证，所有这些试验都显示出令人鼓舞的结果然而，这些试验都没有像预期的那样导致急性心肌梗死治疗的真正革命，主要是因为它们没有成功地证明对生存有重大影响。2007年，由István Benedek教授和我本人领导的跨学科研究小组在 rgu mureau进行了首例心肌梗死患者的干细胞移植手术。István Benedek教授是血液学诊所的负责人，他是罗马尼亚第一个对患有血液学疾病的成人进行干细胞移植的冠军。我们合作进行了一系列急性心肌梗死或肢体缺血患者的干细胞移植，并取得了非常好的结果，这表明两个学科之间的有效合作可以带来双方的重大进步，并可以扩大医学的视野。在6年后发表的一项随访研究中，通过移植后4年的CT成像，我们证明了在梗死冠状动脉中输注干细胞也可以发挥保护作用，防止动脉粥样硬化进展干细胞输注4年后，在整个冠状树的水平上，接受干细胞治疗的组斑块体积(PV)和冠状动脉钙(CC)积累明显低于对照组(PV = 702 mm3 vs. 1,465 mm3, p = 0.0006;CC评分295比796,p <0.0001)，在冠状动脉段水平也是如此(治疗动脉的冠状动脉PV为112.12±16.82 mm3，未治疗动脉为189.56±20.98 mm3, p <0.0001，平均CC评分53.12±16.4比106.43±10.86,p <0.0001)。同时，根据我们的经验，严重肢体缺血患者在缺血肢体和受影响的外周动脉中接受干细胞输注后，症状明显缓解，并持续4年。我们的工作表明，一个跨学科的方法，促进革命性的治疗可能挽救生命，并可能提高生活质量。毕竟，这是我们在医学领域活动的目标。不幸的是，这对István Benedek教授不起作用。他于2020年9月1日去世，享年71岁，他在自己创建的血液学诊所的一线工作期间接触了COVID-19。
{"title":"For the Good Times","authors":"I. Benedek","doi":"10.2478/jce-2020-0015","DOIUrl":"https://doi.org/10.2478/jce-2020-0015","url":null,"abstract":"Acute myocardial infarction continues to represent a devastating disease. In spite of many significant advances in the therapy of ischemic heart diseases, an effective method to recover damaged myocardium has not been validated so far. More than ten years ago, transplantation of bone marrow stem cells into the infarcted area was proposed in the hope that angiogenic properties of the stem cells can lead to regeneration of myocardial tissue and may trigger the development of new, viable myocardial cells that will replace the scar tissue. This challenging hypothesis has been tested in an impressive number of clinical trials, all of them showing promising results.1 However, none of these trials led to a real revolution in the therapy of acute myocardial infarction, as expected, mainly because they did not succeed to demonstrate a significant impact on survival. In 2007, in Târgu Mureș, an interdisciplinary team led by Prof. István Benedek and myself, performed the first stem cell transplantation in a patient suffering from myocardial infarction. Prof. István Benedek was the Head of the Clinic of Hematology and was the champion who performed the first stem cell transplantation in an adult with a hematological disorder in Romania. Working together, we performed a series of stem cell transplantations in patients with acute myocardial infarction or with critical limb ischemia with very good results, demonstrating that an effective collaboration between the two disciplines can lead to a significant progress for both and can expand the horizons of medicine. In a follow-up study published after 6 years, using CT imaging performed at 4 years after the transplantation, we demonstrated that the infusion of stem cells in the infarcted coronary artery can also play a protective role, preventing atherosclerosis progression.2 At 4 years after the stem cell infusion, plaque volume (PV) and coronary calcium (CC) accumulation were significantly lower in the group who received stem cells compared to the control group, at the level of the entire coronary tree (PV 702 mm3 vs. 1,465 mm3, p = 0.0006; CC score 295 vs. 796, p <0.0001) and at the level of the coronary segment as well (coronary PV 112.12 ± 16.82 mm3 for the treated arteries vs. 189.56 ± 20.98 mm3 for the untreated arteries, p <0.0001, and mean CC score 53.12 ± 16.4 vs. 106.43 ± 10.86, p <0.0001). At the same time, in our experience, patients with critical limb ischemia who received stem cell infusion in the ischemic limb and in the affected peripheral artery, reported a significant relief in symptoms, which was persistent after 4 years. Our work shows that an interdisciplinary approach that facilitates a revolutionary treatment may save lives and may improve the quality of life. This is, after all, the goal of our activity in the medical field. Unfortunately, this did not work for Prof. István Benedek. He died on September1, 2020, at the age of 71, after contacting COVID-19 while he was working in the front l","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"24 1","pages":"48 - 49"},"PeriodicalIF":0.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90250641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Gerculy, Camelia Libenciuc, N. Raț, I. Kovács, M. Chițu, I. Benedek, T. Benedek
Abstract Environmental factors may have an important role in the development of coronary heart disease. However, it is not clearly understood yet how the genetic factors interplay with the environmental ones in the onset of acute myocardial infarction. The early onset of coronary artery disease in cases with a positive family history suggests a certain role of genetic predisposition, but the open question remains: could environmental differences contribute to this predisposition? This case report describes similar coronary angiographic findings of two brothers who developed acute myocardial infarction in their early 40s, after being exposed to different environmental risk factors.
{"title":"Identical STEMI Pattern in Two Siblings with Different Risk Factors","authors":"R. Gerculy, Camelia Libenciuc, N. Raț, I. Kovács, M. Chițu, I. Benedek, T. Benedek","doi":"10.2478/jce-2020-0012","DOIUrl":"https://doi.org/10.2478/jce-2020-0012","url":null,"abstract":"Abstract Environmental factors may have an important role in the development of coronary heart disease. However, it is not clearly understood yet how the genetic factors interplay with the environmental ones in the onset of acute myocardial infarction. The early onset of coronary artery disease in cases with a positive family history suggests a certain role of genetic predisposition, but the open question remains: could environmental differences contribute to this predisposition? This case report describes similar coronary angiographic findings of two brothers who developed acute myocardial infarction in their early 40s, after being exposed to different environmental risk factors.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"1 1","pages":"63 - 66"},"PeriodicalIF":0.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90166929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.
{"title":"Left Ventricular Assist Device-Related Complications","authors":"A. Clément, L. Anghel, R. Sascău, C. Stătescu","doi":"10.2478/jce-2020-0014","DOIUrl":"https://doi.org/10.2478/jce-2020-0014","url":null,"abstract":"Abstract Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"10 1","pages":"50 - 58"},"PeriodicalIF":0.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84688431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andreea Paler Cerghit, Amalia Făgărășan, I. Muntean, Sorina Pasc, Dorottya Miklósi, L. Gozar, R. Togănel
Abstract Introduction: The incidence of cardiac arrhythmia is approximately 1% in the neonatal period and 1–3% in late pregnancy. Atrial flutter (AF), a rhythm disorder based on the mechanism of reentry, represents approximately 32% of all neonatal cardiac arrhythmias. In the majority of cases, the flutter is converted to sinus rhythm using antiarrhythmic drugs, transesophageal overdrive pacing, or synchronized electrical cardioversion. Case presentation: We present a case of a born on term, female infant who was noted to be tachycardic on the fetal monitor. Clinical examination revealed tachypnea and tachycardia with dysrhythmia, at a heart rate of 250 bpm. Electrocardiography showed AF with 2–3 : 1 atrioventricular conduction (atrial and ventricular rates were 350 bpm and 250–275 bpm, respectively). Echocardiography revealed no relevant structural disease. Therapy with amiodarone and prophylactic anticoagulant was initiated. As no control of ventricular rate was obtained and a succession of three ventricular extrasystoles was noted on the surface ECG, propranolol therapy was initiated, without success. Therefore, synchronized electrical cardioversion was applied, with conversion to sinus rhythm at a heart rate of 136 bpm. The neonate was discharged in good condition. Conclusions: AF is one of the most common high ventricular rate arrhythmias during fetal age. Uncontrolled AF may precipitate heart failure, and prompt restoration to sinus rhythm may require electrical cardioversion in cases refractory to anti-arrhythmic drugs, in order to prevent possible complications.
{"title":"Atrial Flutter in a Newborn: a Case Report","authors":"Andreea Paler Cerghit, Amalia Făgărășan, I. Muntean, Sorina Pasc, Dorottya Miklósi, L. Gozar, R. Togănel","doi":"10.2478/jce-2020-0010","DOIUrl":"https://doi.org/10.2478/jce-2020-0010","url":null,"abstract":"Abstract Introduction: The incidence of cardiac arrhythmia is approximately 1% in the neonatal period and 1–3% in late pregnancy. Atrial flutter (AF), a rhythm disorder based on the mechanism of reentry, represents approximately 32% of all neonatal cardiac arrhythmias. In the majority of cases, the flutter is converted to sinus rhythm using antiarrhythmic drugs, transesophageal overdrive pacing, or synchronized electrical cardioversion. Case presentation: We present a case of a born on term, female infant who was noted to be tachycardic on the fetal monitor. Clinical examination revealed tachypnea and tachycardia with dysrhythmia, at a heart rate of 250 bpm. Electrocardiography showed AF with 2–3 : 1 atrioventricular conduction (atrial and ventricular rates were 350 bpm and 250–275 bpm, respectively). Echocardiography revealed no relevant structural disease. Therapy with amiodarone and prophylactic anticoagulant was initiated. As no control of ventricular rate was obtained and a succession of three ventricular extrasystoles was noted on the surface ECG, propranolol therapy was initiated, without success. Therefore, synchronized electrical cardioversion was applied, with conversion to sinus rhythm at a heart rate of 136 bpm. The neonate was discharged in good condition. Conclusions: AF is one of the most common high ventricular rate arrhythmias during fetal age. Uncontrolled AF may precipitate heart failure, and prompt restoration to sinus rhythm may require electrical cardioversion in cases refractory to anti-arrhythmic drugs, in order to prevent possible complications.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"50 10 1","pages":"67 - 71"},"PeriodicalIF":0.4,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85940217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Răzvan-Andrei Licu, E. Blîndu, D. Opincariu, T. Benedek
Abstract Background: All plaques that trigger acute coronary syndromes (ACS) present various characteristics of vulnerability. However, not all vulnerable plaques (VP) lead to an ACS. This raises the question as to which of the established CT vulnerability features hold the highest probability of developing ACS. Aim: To identify the distinct phenotype of VP that exposes the unstable atheromatous plaque to a higher risk of rupture. Material and Methods: In total, 20 patients in whom cardiac computed tomographic angiography (CCTA) identified the presence of a vulnerable plaque and who developed an ACS within 6 months after CCTA examination were enrolled in the study, and compared to 20 age- and gender-matched subjects with VPs who did not develop an ACS. All included patients presented VPs at baseline, defined as the presence of minimum 50% degree of stenosis and at least one CT marker of vulnerability (low attenuation plaques [LAP], napkin-ring sign [NRS], positive remodeling [PR], spotty calcifications [SCs]). Results: The two groups were not different in regards to age, gender, cardiovascular risk factors, and comorbidities. Patients who developed an ACS at six months presented higher volumes of lipid-rich (p = 0.01) and calcified plaques (p = 0.01), while subjects in the control group presented plaques with a larger fibrotic content (p = 0.0005). The most frequent vulnerability markers within VPs that had triggered ACS were LAPs (p <0.0001) and PR (p <0.0001). Multivariate analysis identified LAP as the strongest independent predictor of ACS at 6 months in our study population (OR 8.18 [1.23-95.08], p = 0.04). Conclusions: VPs producing an ACS exhibit a different phenotype compared to VPs that remain silent. The CCTA profile of VPs producing an ACS includes the presence of low attenuation, positive remodeling, and lipid-rich atheroma. The presence of these features in VPs identifies very high-risk patients, who can benefit from adapted therapeutic strategies in order to prevent an ACS.
{"title":"Vulnerable Plaques Producing an Acute Coronary Syndrome Exhibit a Different CT Phenotype than Those That Remain Silent","authors":"Răzvan-Andrei Licu, E. Blîndu, D. Opincariu, T. Benedek","doi":"10.2478/jce-2020-0008","DOIUrl":"https://doi.org/10.2478/jce-2020-0008","url":null,"abstract":"Abstract Background: All plaques that trigger acute coronary syndromes (ACS) present various characteristics of vulnerability. However, not all vulnerable plaques (VP) lead to an ACS. This raises the question as to which of the established CT vulnerability features hold the highest probability of developing ACS. Aim: To identify the distinct phenotype of VP that exposes the unstable atheromatous plaque to a higher risk of rupture. Material and Methods: In total, 20 patients in whom cardiac computed tomographic angiography (CCTA) identified the presence of a vulnerable plaque and who developed an ACS within 6 months after CCTA examination were enrolled in the study, and compared to 20 age- and gender-matched subjects with VPs who did not develop an ACS. All included patients presented VPs at baseline, defined as the presence of minimum 50% degree of stenosis and at least one CT marker of vulnerability (low attenuation plaques [LAP], napkin-ring sign [NRS], positive remodeling [PR], spotty calcifications [SCs]). Results: The two groups were not different in regards to age, gender, cardiovascular risk factors, and comorbidities. Patients who developed an ACS at six months presented higher volumes of lipid-rich (p = 0.01) and calcified plaques (p = 0.01), while subjects in the control group presented plaques with a larger fibrotic content (p = 0.0005). The most frequent vulnerability markers within VPs that had triggered ACS were LAPs (p <0.0001) and PR (p <0.0001). Multivariate analysis identified LAP as the strongest independent predictor of ACS at 6 months in our study population (OR 8.18 [1.23-95.08], p = 0.04). Conclusions: VPs producing an ACS exhibit a different phenotype compared to VPs that remain silent. The CCTA profile of VPs producing an ACS includes the presence of low attenuation, positive remodeling, and lipid-rich atheroma. The presence of these features in VPs identifies very high-risk patients, who can benefit from adapted therapeutic strategies in order to prevent an ACS.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"27 1","pages":"26 - 34"},"PeriodicalIF":0.4,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72469310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Simon, A. Panajotu, Judit Csőre, M. Pólos, E. Zsarnóczay, B. Merkely, P. Maurovich-Horvat
Abstract Introduction: The diagnosis of coronary artery anomalies (CAAs) can be challenging due to the highly variable manifestations and symptoms. CAAs occur in less than 1% of the population. Multidetector cardiac computed tomography angiography (CTA) provides excellent spatial and temporal resolution for the imaging of CAAs. This case report describes an anomalous origin of the left main coronary artery. Case presentation: A 64-year-old woman with atypical chest pain underwent coronary CTA. The CT demonstrated that the left coronary artery was originating from the right coronary sinus and had an interarterial course with an approximately 50% stenosis at the segment between the great arteries. Invasive coronary angiography confirmed hemodynamically significant stenosis of the interarterial segment. The patient underwent off-pump coronary artery bypass graft surgery. Conclusion: Left coronary artery originating from the right coronary sinus with an interarterial course increases the risk of sudden cardiac death. In these patients, surgical revascularization is recommended. However, timely diagnosis, especially in those with mild symptoms, remains challenging. Coronary CTA is a robust tool to diagnose CAA and provides valuable information to support the clinical decision making in this patient population.
{"title":"Anomalous Left Coronary Artery Originating from the Right Coronary Sinus with an Interarterial Course: a Case Report and Literature Review","authors":"J. Simon, A. Panajotu, Judit Csőre, M. Pólos, E. Zsarnóczay, B. Merkely, P. Maurovich-Horvat","doi":"10.2478/jce-2020-0005","DOIUrl":"https://doi.org/10.2478/jce-2020-0005","url":null,"abstract":"Abstract Introduction: The diagnosis of coronary artery anomalies (CAAs) can be challenging due to the highly variable manifestations and symptoms. CAAs occur in less than 1% of the population. Multidetector cardiac computed tomography angiography (CTA) provides excellent spatial and temporal resolution for the imaging of CAAs. This case report describes an anomalous origin of the left main coronary artery. Case presentation: A 64-year-old woman with atypical chest pain underwent coronary CTA. The CT demonstrated that the left coronary artery was originating from the right coronary sinus and had an interarterial course with an approximately 50% stenosis at the segment between the great arteries. Invasive coronary angiography confirmed hemodynamically significant stenosis of the interarterial segment. The patient underwent off-pump coronary artery bypass graft surgery. Conclusion: Left coronary artery originating from the right coronary sinus with an interarterial course increases the risk of sudden cardiac death. In these patients, surgical revascularization is recommended. However, timely diagnosis, especially in those with mild symptoms, remains challenging. Coronary CTA is a robust tool to diagnose CAA and provides valuable information to support the clinical decision making in this patient population.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"90 1","pages":"35 - 39"},"PeriodicalIF":0.4,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80729057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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