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Parness S, Tasoudis P, Agala CB, Merlo AE. Management of Myocardial Infarction and the Role of Cardiothoracic Surgery. J Clin Med 2024; 13:5484. [PMID: 39336971 PMCID: PMC11432415 DOI: 10.3390/jcm13185484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/09/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Myocardial infarction (MI) is a leading cause of mortality globally and is predominantly attributed to coronary artery disease (CAD). MI is categorized as ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI), each with distinct etiologies and treatment pathways. The goal in treatment for both is restoring blood flow back to the myocardium. STEMI, characterized by complete occlusion of a coronary artery, is managed urgently with reperfusion therapy, typically percutaneous coronary intervention (PCI). In contrast, NSTEMI involves a partial occlusion of a coronary artery and is treated with medical management, PCI, or coronary artery bypass grafting (CABG) depending on risk scores and clinical judgment. The Heart Team approach can assist in deciding which reperfusion technique would provide the greatest benefit to the patient and is especially useful in complicated cases. Despite advances in treatment, complications such as cardiogenic shock (CS) and ischemic heart failure (HF) remain significant. While percutaneous coronary intervention (PCI) is considered the primary treatment for MI, it is important to recognize the significance of cardiac surgery in treatment, especially when there is complex disease or MI-related complications. This comprehensive review analyzes the role of cardiac surgery in MI management, recognizing when it is useful, or not.
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Affiliation(s)
- Shannon Parness
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Chris B Agala
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Aurelie E Merlo
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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2
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Chen DL, Lin YK, Li CI, Wang GJ, Chang KC. Impact of mechanical circulatory support on out-of-hospital cardiac arrest outcomes stratified by vasoactive-inotropic score: A retrospective cohort study. Resusc Plus 2024; 19:100743. [PMID: 39219812 PMCID: PMC11363560 DOI: 10.1016/j.resplu.2024.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/10/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024] Open
Abstract
Aims To assess whether mechanical circulatory support (MCS), including intra-aortic balloon pump (IABP) or veno-arterial extracorporeal membrane oxygenation (ECMO), can help improve neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA). Methods This is a retrospective observational cohort study performed in China Medical University Hospital, Taichung, Taiwan. Adult patients with OHCA admitted between January 2015 and June 2023. Quantitative score of vasoactive-inotropic agents and qualitative interventions of MCS, including IABP and ECMO after OHCA. Multivariate regression evaluated the efficacy of each MCS approach in patients stratified by the vasoactive-inotropic score (VIS). Results A total of 334 patients were included and analyzed, 122 (36.5%) had favorable neurological outcomes and 215 (64.4%) survived ≥90 days. These patients were stratified by VIS: 0-25, 26-100, 101-250, and >250. In patients with a VIS > 100, ECMO with or without IABP ensured favorable neurological outcomes and survival after OHCA compared to non-MCS interventions (p < 0.001). For patients with a VIS ≤ 100, IABP alone was beneficial, with no significant outcome difference from non-MCS interventions (p > 0.05). Conclusions ECMO with or without IABP therapy may improve post-OHCA neurological outcomes and survival in patients with an expected VIS-24 h > 100 (e.g., epinephrine dose reaches 3 mg during CPR).
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Affiliation(s)
- Da-Long Chen
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Kai Lin
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Guei-Jane Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Pharmacy Department, Wizcare Medical Corporation Aggregate, Taichung, Taiwan
- School of Medicine, Weifang University of Science and Technology, Weifang, Shandong, China
| | - Kuan-Cheng Chang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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3
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Estévez-Loureiro R, Lorusso R, Taramasso M, Torregrossa G, Kini A, Moreno PR. Management of Severe Mitral Regurgitation in Patients With Acute Myocardial Infarction: JACC Focus Seminar 2/5. J Am Coll Cardiol 2024; 83:1799-1817. [PMID: 38692830 DOI: 10.1016/j.jacc.2023.09.840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 05/03/2024]
Abstract
Severe acute mitral regurgitation after myocardial infarction includes partial and complete papillary muscle rupture or functional mitral regurgitation. Although its incidence is <1%, mitral regurgitation after acute myocardial infarction frequently causes hemodynamic instability, pulmonary edema, and cardiogenic shock. Medical management has the worst prognosis, and mortality has not changed in decades. Surgery represents the gold standard, but it is associated with high rates of morbidity and mortality. Recently, transcatheter interventions have opened a new door for management that may improve survival. Mechanical circulatory support restores vital organ perfusion and offers the opportunity for a steadier surgical repair. This review focuses on the diagnosis and the interventional management, both surgical and transcatheter, with a glance on future perspectives to enhance patient management and eventually decrease mortality.
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Affiliation(s)
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | | | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Annapoorna Kini
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pedro R Moreno
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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4
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Boyle C, Nguyen K, Steiner J, Macon CJ, Marbach JA. Mitral Regurgitation Complicated by Cardiogenic Shock: Reassessing Risk Stratification and Therapeutic Strategies. Interv Cardiol Clin 2024; 13:191-205. [PMID: 38432762 DOI: 10.1016/j.iccl.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Mitral regurgitation complicated by cardiogenic shock creates a unique and devastating risk profile for patients and poses significant difficulties for physicians who lack a comprehensive range of effective management strategies. Supportive measures such as intravenous vasodilators, intra-aortic balloon pumps, and percutaneous ventricular assist devices are often necessary to stabilize patients prior to definitive treatment with surgical mitral valve replacement or trans-catheter edge-to-edge repair. This review evaluates the evidence for the available supportive and definitive management strategies in patients with mitral regurgitation complicated by cardiogenic shock and presents a framework to aid clinicians in navigating the complex clinical decision-making process. Additionally, the authors review emerging transcatheter mitral valve replacement technologies that hold promise for expanding the therapeutic armamentarium and improving patient outcomes.
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Affiliation(s)
- Carla Boyle
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Khoa Nguyen
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Johannes Steiner
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Conrad J Macon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA.
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5
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Alsagaff MY, Revianto O, Sembiring YE, Ilman MI, Intan RE. Intra-aortic balloon pump still has a role in late-onset myocardial infarction complicated by ventricular septal rupture with intractable heart failure: a case report. J Med Case Rep 2024; 18:8. [PMID: 38184640 PMCID: PMC10771645 DOI: 10.1186/s13256-023-04284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/24/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR). CASE PRESENTATION A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support. CONCLUSION We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60286, Indonesia.
| | - Oky Revianto
- Department of Cardiovascular Thoracic Surgery, Faculty of Medicine, Airlangga University-RSUD Dr. Soetomo General Hospital Surabaya, Surabaya, East Java, 60286, Indonesia
| | - Yan Efrata Sembiring
- Department of Cardiovascular Thoracic Surgery, Faculty of Medicine, Airlangga University-RSUD Dr. Soetomo General Hospital Surabaya, Surabaya, East Java, 60286, Indonesia
| | - Muhammad Insani Ilman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ryan Enast Intan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60286, Indonesia
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6
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Arsh H, Pahwani R, Arif Rasool Chaudhry W, Khan R, Khenhrani RR, Devi S, Malik J. Delayed Ventricular Septal Rupture Repair After Myocardial Infarction: An Updated Review. Curr Probl Cardiol 2023; 48:101887. [PMID: 37336311 DOI: 10.1016/j.cpcardiol.2023.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but serious complication that can occur after myocardial infarction (MI) and is associated with significant morbidity and mortality. The optimal management approach for VSR remains a topic of debate, with considerations including early versus delayed surgery, risk stratification, pharmacological interventions, minimally invasive techniques, and tissue engineering. The pathophysiology of VSR involves myocardial necrosis, inflammatory response, and enzymatic degradation of the extracellular matrix (ECM), particularly mediated by matrix metalloproteinases (MMPs). These processes lead to structural weakening and subsequent rupture of the ventricular septum. Hemodynamically, VSR results in left-to-right shunting, increased pulmonary blood flow, and potentially hemodynamic instability. The early surgical repair offers the advantages of immediate closure of the defect, prevention of complications, and potentially improved outcomes. However, it is associated with higher surgical risk and limited myocardial recovery potential during the waiting period. In contrast, delayed surgery allows for a period of myocardial recovery, risk stratification, and optimization of surgical outcomes. However, it carries the risk of ongoing complications and progression of ventricular remodeling. Risk stratification plays a crucial role in determining the optimal timing for surgery and tailoring treatment plans. Various clinical factors, imaging assessments, scoring systems, biomarkers, and hemodynamic parameters aid in risk assessment and guide decision-making. Pharmacological interventions, including vasopressors, diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, antiplatelet agents, and antiarrhythmic drugs, are employed to stabilize hemodynamics, prevent complications, promote myocardial healing, and improve outcomes in VSR patients. Advancements in minimally invasive techniques, such as percutaneous device closure, and tissue engineering hold promise for less invasive interventions and better outcomes. These approaches aim to minimize surgical morbidity, optimize healing, and enhance patient recovery. In conclusion, the management of VSR after MI requires a multidimensional approach that considers various aspects, including risk stratification, surgical timing, pharmacological interventions, minimally invasive techniques, and tissue engineering.
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Affiliation(s)
- Hina Arsh
- Department of Medicine, THQ Hospital, Pasrur, Pakistan
| | - Ritesh Pahwani
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Rubaiqa Khan
- Department of Neurosurgery, Sherwan Rural Health Center, Sherwan, Pakistan
| | - Raja Ram Khenhrani
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Sapna Devi
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Research, Cardiovascular Analytics Group, Islamabad, Pakistan.
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7
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Duncan CF, Bowcock E, Pathan F, Orde SR. Mitral regurgitation in the critically ill: the devil is in the detail. Ann Intensive Care 2023; 13:67. [PMID: 37530859 PMCID: PMC10397171 DOI: 10.1186/s13613-023-01163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Mitral regurgitation (MR) is common in the critically unwell and encompasses a heterogenous group of conditions with diverging therapeutic strategies. MR may present acutely with haemodynamic instability or more insidiously with failure to wean from mechanical ventilation. Critical illness is associated with marked physiological stress and haemodynamic changes that dynamically influence the severity and implication of MR. The expanding role of critical care echocardiography uniquely positions the intensivist to apply advanced bedside valvular assessment to recognise haemodynanically significant MR, manipulate and optimise cardiopulmonary physiology and identify patients requiring urgent cardiology and surgical referral. This review will consider common clinical scenarios, therapeutic strategies and the pearls and pitfalls of echocardiographic assessment and quantification in the critically unwell.
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Affiliation(s)
- Chris F Duncan
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia.
| | - Emma Bowcock
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia
| | - Faraz Pathan
- Department of Cardiology, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia
- Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Sydney, NSW, 2747, Australia
| | - Sam R Orde
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia
- University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
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8
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Accorsi TAD, Paixão MR, Souza Júnior JLD, Gaz MVB, Cardoso RG, Köhler KF, Lima KDA, Tarasoutchi F. Valvular Heart Disease Emergencies: A Comprehensive Review Focusing on the Initial Approach in the Emergency Department. Arq Bras Cardiol 2023; 120:e20220707. [PMID: 37341248 DOI: 10.36660/abc.20220707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/05/2023] [Indexed: 06/22/2023] Open
Abstract
Valvular heart disease (VHD) is an increasing health problem worldwide. Patients with VHD may experience several cardiovascular-related emergencies. The management of these patients is a challenge in the emergency department, especially when the previous heart condition is unknown. Specific recommendations for the initial management are currently poor. This integrative review proposes an evidence-based three-step approach from bedside VHD suspicion to the initial treatment of the emergencies. The first step is the suspicion of underlying valvular condition based on signs and symptoms. The second step comprises the attempt to confirm the diagnosis and assessment of VHD severity with complementary tests. Finally, the third step addresses the diagnosis and treatment options for heart failure, atrial fibrillation, valvular thrombosis, acute rheumatic fever, and infective endocarditis. In addition, several images of complementary tests and summary tables are provided for physician support.
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Affiliation(s)
- Tarso Augusto Duenhas Accorsi
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
- Instituto do Coração (InCor), Faculdade de Medicina , USP , São Paulo , SP - Brasil
| | - Milena Ribeiro Paixão
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
- Instituto do Coração (InCor), Faculdade de Medicina , USP , São Paulo , SP - Brasil
| | | | | | - Ricardo Galesso Cardoso
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Karen Francine Köhler
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Karine De Amicis Lima
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (InCor), Faculdade de Medicina , USP , São Paulo , SP - Brasil
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9
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Estévez-Loureiro R, Tavares Da Silva M, Baz-Alonso JA, Caneiro-Queija B, Barreiro-Pérez M, Calvo-Iglesias F, González-Ferreiro R, Puga L, Piñón M, Íñiguez-Romo A. Percutaneous mitral valve repair in patients developing severe mitral regurgitation early after an acute myocardial infarction: A review. Front Cardiovasc Med 2022; 9:987122. [PMID: 36211549 PMCID: PMC9537753 DOI: 10.3389/fcvm.2022.987122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Acute mitral regurgitation (MR) may develop in the setting of an acute myocardial infarction (AMI) because of papillary muscle dysfunction or rupture. Severe acute MR in this scenario is a life-threatening complication associated with hemodynamic instability and pulmonary edema, and has been linked to a worse prognosis even after reperfusion. Patients treated solely with medical therapy have the highest mortality rates. Surgery has been the only treatment strategy until recently, but the results of the technique are hindered by high rates of morbidity and mortality. Therefore, the development of less invasive interventions for correcting MR would be ideal. We aimed to review the current role of transcatheter interventions in this clinical setting.
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Affiliation(s)
- Rodrigo Estévez-Loureiro
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
- *Correspondence: Rodrigo Estévez-Loureiro ;
| | - Marta Tavares Da Silva
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - José Antonio Baz-Alonso
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Berenice Caneiro-Queija
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Manuel Barreiro-Pérez
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Francisco Calvo-Iglesias
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Rocio González-Ferreiro
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Luis Puga
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Miguel Piñón
- Department of Cardiovascular Surgery, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Andrés Íñiguez-Romo
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
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10
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Acute Ischaemic Mitral Valve Regurgitation. J Clin Med 2022; 11:jcm11195526. [PMID: 36233410 PMCID: PMC9571705 DOI: 10.3390/jcm11195526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Acute ischaemic mitral regurgitation (IMR) is an increasingly rare and challenging complication following acute myocardial infarction. Despite recent technical advances in both surgical and percutaneous interventions, a poor prognosis is often associated with this challenging patient cohort. In this review, we revisit the diagnosis and typical echocardiographic features, and evaluate current surgical and percutaneous treatment options for patients with acute IMR.
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11
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Hayek A, Azar L, Pozzi M, Grinberg D, Abou-Saleh I, Simion H, Tomasevic D, Prieur C, Kochly F, Scheppler B, Rioufol G, Derimay F, Farhat F, Obadia JF, Mewton N, Bonnefoy-Cudraz E, Bochaton T. Ventricular septal rupture: insights into an old disease. Heart Vessels 2022; 37:1305-1315. [PMID: 35133497 DOI: 10.1007/s00380-022-02031-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
Abstract
Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0 years IQR [66-78] and 188 patients (70.9%) were operated on. IABP was used more routinely (p < 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8 days HR 2.7 IC95% [1.9-3.8] p < 0.0001, a Killip class > 2 HR 2.5 IC [1.9-3.4] p < 0.0001 and Euroscore 2 > 20 HR 2.4 IC [1.8-3.2] p < 0.0001. A "time from MI to surgery" of 8 days offers the best ability to discriminate between patients with or without mortality. The ability of "Euroscore 2 and Killip" to detect the patients most likely to wait 8 days for surgery was at 0.81 [0.73-0.89] p < 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8 days since MI before being referred to surgery.
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Affiliation(s)
- Ahmad Hayek
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France. .,Claude Bernard University Lyon 1, Villeurbanne, France. .,INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France.
| | - Léa Azar
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Daniel Grinberg
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Iyad Abou-Saleh
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Héléna Simion
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Danka Tomasevic
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Cyril Prieur
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Flora Kochly
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Bertrand Scheppler
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Gilles Rioufol
- Claude Bernard University Lyon 1, Villeurbanne, France.,Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - François Derimay
- Claude Bernard University Lyon 1, Villeurbanne, France.,Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Fadi Farhat
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Nathan Mewton
- Claude Bernard University Lyon 1, Villeurbanne, France.,Centre d'investigation Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Eric Bonnefoy-Cudraz
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France.,INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
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12
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 596] [Impact Index Per Article: 298.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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13
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 160] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Pahuja M, Ranka S, Chauhan K, Patel A, Chehab O, Elmoghrabi A, Mony S, Ando T, Mishra T, Singh M, Abubaker H, Yassin A, Glazier JJ, Afonso L, Kapur NK, Burkhoff D. Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action. ASAIO J 2021; 67:907-916. [PMID: 33093383 DOI: 10.1097/mat.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Papillary muscle rupture (PMR) or chordae tendinae rupture (CTR) is a rare but lethal complication after ST elevation myocardial infarction (STEMI). Due to the rarity of this condition, there are limited studies defining its epidemiology and outcomes. This is a retrospective study from Nationwide Inpatient Sample database from 2002 to 2014 of patients with STEMI and PMR/CTR. Outcomes of interest were incidence of in-hospital mortality, cardiogenic shock (CS), utilization of mechanical circulatory support (MCS) devices and mitral valve procedures (MVPs) among patients with and without rupture. We also performed simulation using the cardiovascular model to better understand the hemodynamics of severe mitral regurgitation and effects of different medications and device therapy. We identified 1,888 patients with STEMI complicated with PMR/CTR. Most of the patients were >65 years of age (65.3%), male (63.6%), and white (82.3%). They had significantly higher incidence of CS, cardiac arrest, and utilization of MCS devices. In-hospital mortality was higher in patients with rupture (41% vs. 7.40%, p < 0.001) which remained unchanged over the study period. Hospitalization cost and length of stay was also higher in them. MVP and revascularization led to better survival rates (27.9% vs. 60.6%, adjusted OR: 0.14; 95% CI: 0.10-0.19; p < 0.001). Despite significant advancement in the revascularization strategy, PMR/CTR after STEMI continues to portend poor prognosis with high inpatient mortality. Cardiogenic shock is a common presentation and is associated with significantly inpatient mortality. Future studies are needed determine the best strategies to improve outcomes in patients with STEMI with PMR/CTR and CS.
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Affiliation(s)
- Mohit Pahuja
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Sagar Ranka
- Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Kinsuk Chauhan
- Internal Medicine Department, Wayne State University, Detroit, Michigan
| | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Omar Chehab
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Adel Elmoghrabi
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Shruti Mony
- Department of Gastroenterology, Johns Hopkins University school of Medicine, Baltimore, Maryland
| | - Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York
| | - Tushar Mishra
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Manmohan Singh
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Hossam Abubaker
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Los Angeles, California
| | - Ahmed Yassin
- Internal Medicine Department, Wayne State University, Detroit, Michigan
| | - James J Glazier
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Luis Afonso
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Navin K Kapur
- Division of Cardiology, Department of Internal Medicine, Tufts University Medical Center, Boston, Massachusetts
| | - Daniel Burkhoff
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York
- Cardiovascular Research Foundation, New York
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15
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Surgical Repair of Postinfarction Ventricular Septal Rupture: Systematic Review and Meta-Analysis. Ann Thorac Surg 2021; 112:326-337. [DOI: 10.1016/j.athoracsur.2020.08.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
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16
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Kimman JR, Van Mieghem NM, Endeman H, Brugts JJ, Constantinescu AA, Manintveld OC, Dubois EA, den Uil CA. Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation? Curr Heart Fail Rep 2021; 17:247-260. [PMID: 32870448 PMCID: PMC7496039 DOI: 10.1007/s11897-020-00480-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose of Review We aim to summarize recent insights and provide an up-to-date overview on the role of intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS). Recent Findings In the largest randomized controlled trial (RCT) of patients with CS after acute myocardial infarction (AMICS), IABP did not lower mortality. However, recent data suggest a role for IABP in patients who have persistent ischemia after revascularization. Moreover, in the growing population of CS not caused by acute coronary syndrome (ACS), multiple retrospective studies and one small RCT report on significant hemodynamic improvement following (early) initiation of IABP support, which allowed bridging of most patients to recovery or definitive therapies like heart transplant or a left ventricular assist device (LVAD). Summary Routine use of IABP in patients with AMICS is not recommended, but many patients with CS either from ischemic or non-ischemic cause may benefit from IABP at least for hemodynamic improvement in the short term. There is a need for a larger RCT regarding the role of IABP in selected patients with ACS, as well as in patients with non-ACS CS.
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Affiliation(s)
- Jesse R Kimman
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Henrik Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Eric A Dubois
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Corstiaan A den Uil
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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17
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Omer MA, Exaire JE, Jentzer JC, Sandoval YB, Singh M, Cagin CR, Elgendy IY, Tak T. Management of ST-Elevation Myocardial Infarction in High-Risk Settings. Int J Angiol 2021; 30:53-66. [PMID: 34025096 PMCID: PMC8128492 DOI: 10.1055/s-0041-1723941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Despite the widespread adoption of primary percutaneous intervention and modern antithrombotic therapy, ST-segment elevation myocardial infarction (STEMI) remains the leading cause of death in the United States and remains one of the most important causes of morbidity and mortality worldwide. Certain high-risk patients present a challenge for diagnosis and treatment. The widespread adoption of primary percutaneous intervention in addition to modern antithrombotic therapy has resulted in substantial improvement in the short- and long-term prognosis following STEMI. In this review, we aim to provide a brief analysis of the state-of-the-art treatment for patients presenting with STEMI, focusing on cardiogenic shock, current treatment and controversies, cardiac arrest, and diagnosis and treatment of mechanical complications, as well as multivessel and left main-related STEMI.
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Affiliation(s)
- Mohamed A. Omer
- Cardiovascular Services, Mayo Clinic Health System, La Crosse, Wisconsin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jose E. Exaire
- Cardiovascular Services, Mayo Clinic Health System, La Crosse, Wisconsin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Charles R. Cagin
- Cardiovascular Services, Mayo Clinic Health System, La Crosse, Wisconsin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Islam Y. Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Tahir Tak
- Cardiovascular Services, Mayo Clinic Health System, La Crosse, Wisconsin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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18
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Fujino T, Imamura T, Kinugawa K. Future Perspectives of Intra-Aortic Balloon Pumping for Cardiogenic Shock. Int Heart J 2020; 61:424-428. [DOI: 10.1536/ihj.20-004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takeo Fujino
- Department of Medicine, Section of Cardiology, University of Chicago Medicine
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19
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Abstract
Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Bradley Ternus
- Division of Cardiovascular Medicine, 5228University of Wisconsin, Madison, WI, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
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20
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Leurent G, Auffret V, Pichard C, Laine M, Bonello L. Is there still a role for the intra-aortic balloon pump in the management of cardiogenic shock following acute coronary syndrome? Arch Cardiovasc Dis 2019; 112:792-798. [DOI: 10.1016/j.acvd.2019.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
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21
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22
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Ueno D, Nomura T, Ono K, Sakaue Y, Hori Y, Yoshioka K, Kikai M, Keira N, Tatsumi T. Fatal Right Ventricular Free Wall Rupture During Percutaneous Coronary Intervention for Inferior Acute Myocardial Infarction. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1155-1158. [PMID: 31387984 PMCID: PMC6693362 DOI: 10.12659/ajcr.917217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient: Female, 76 Final Diagnosis: Right ventricular free wall rupture Symptoms: Chest pain Medication: — Clinical Procedure: Echocardiography Specialty: Cardiology
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Affiliation(s)
- Daisuke Ueno
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Tetsuya Nomura
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Kenshi Ono
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Yu Sakaue
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Yusuke Hori
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Kenichi Yoshioka
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Masakazu Kikai
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Natsuya Keira
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
| | - Tetsuya Tatsumi
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Kyoto, Japan
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23
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Hardin CC, Malhotra R, Petranović M, Klassen S, Mihatov N, Oakley DH. Case 23-2019: A 52-Year-Old Man with Fever, Cough, and Hypoxemia. N Engl J Med 2019; 381:359-369. [PMID: 31340098 DOI: 10.1056/nejmcpc1900598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Charles C Hardin
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Rajeev Malhotra
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Milena Petranović
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Sheila Klassen
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Nino Mihatov
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Derek H Oakley
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
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24
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Montrief T, Davis WT, Koyfman A, Long B. Mechanical, inflammatory, and embolic complications of myocardial infarction: An emergency medicine review. Am J Emerg Med 2019; 37:1175-1183. [DOI: 10.1016/j.ajem.2019.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022] Open
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25
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Davis WT, Montrief T, Koyfman A, Long B. Dysrhythmias and heart failure complicating acute myocardial infarction: An emergency medicine review. Am J Emerg Med 2019; 37:1554-1561. [PMID: 31060863 DOI: 10.1016/j.ajem.2019.04.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality. OBJECTIVE This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions. DISCUSSION Limited evidence exists for ED management of dysrhythmias in AMI due to relatively low prevalence and frequent exclusion of patients with active cardiac ischemia from clinical studies. Management decisions for bradycardia in the setting of AMI are determined by location of infarction, timing of the dysrhythmia, rhythm assessment, and hemodynamic status of the patient. Atrial fibrillation is common in the setting of AMI, and caution is warranted in acute rate control for rapid ventricular rate given the possibility of compensation for decreased ventricular function. Regular wide complex tachycardia in the setting of AMI should be managed as ventricular tachycardia with electrocardioversion in the majority of cases. Management directed towards HF from left ventricular dysfunction in AMI consists of noninvasive positive pressure ventilation, nitroglycerin therapy, and early cardiac catheterization. Norepinephrine is the first line vasopressor for patients with cardiogenic shock and hypoperfusion on clinical examination. Early involvement of a multi-disciplinary team is recommended when caring for patients in cardiogenic shock. CONCLUSIONS This review discusses considerations of ED management of dysrhythmias and HF associated with AMI.
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Affiliation(s)
- William T Davis
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Tim Montrief
- University of Miami, Jackson Memorial Hospital/Miller School of Medicine, Department of Emergency Medicine, 1611 N.W. 12th Avenue, Miami, FL 33136, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
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26
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Imamura T, Juricek C, Song T, Ota T, Onsager D, Sarswat N, Kim G, Raikhelkar J, Kalantari S, Sayer G, Burkhoff D, Jeevanandam V, Uriel N. Improvement in Biventricular Cardiac Function After Ambulatory Counterpulsation. J Card Fail 2019; 25:20-26. [DOI: 10.1016/j.cardfail.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
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27
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Lee JH, Kim MS, Yoo BS, Park SJ, Park JJ, Shin MS, Youn JC, Lee SE, Jang SY, Choi S, Cho HJ, Kang SM, Choi DJ. KSHF Guidelines for the Management of Acute Heart Failure: Part II. Treatment of Acute Heart Failure. Korean Circ J 2019; 49:22-45. [PMID: 30637994 PMCID: PMC6331324 DOI: 10.4070/kcj.2018.0349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/14/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic HF were introduced in March 2016. However, chronic and acute HF represent distinct disease entities. Here, we introduce the Korean guidelines for the management of acute HF with reduced or preserved ejection fraction. Part II of this guideline covers the treatment of acute HF.
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Affiliation(s)
- Ju Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Min Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Sung Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seok Min Kang
- Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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28
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Goldsweig AM, Wang Y, Forrest JK, Cleman MW, Minges KE, Mangi AA, Aronow HD, Krumholz HM, Curtis JP. Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcomes among medicare beneficiaries 1999-2014. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27576] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Andrew M. Goldsweig
- Division of Cardiovascular Medicine, Department of Internal Medicine; University of Nebraska Medical Center; Omaha Nebraska
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Department of Biostatistics, Harvard School of Public Health; Boston Massachusetts
| | - John K. Forrest
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
| | - Michael W. Cleman
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
| | - Karl E. Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
| | - Abeel A. Mangi
- Section of Cardiac Surgery, Yale University School of Medicine; New Haven Connecticut
| | - Herbert D. Aronow
- Division of Cardiovascular Medicine; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health; New Haven Connecticut
- Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital; Center for Outcomes Research and Evaluation; New Haven Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine; New Haven Connecticut
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Durko AP, Budde RPJ, Geleijnse ML, Kappetein AP. Recognition, assessment and management of the mechanical complications of acute myocardial infarction. Heart 2017; 104:1216-1223. [DOI: 10.1136/heartjnl-2017-311473] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Morales-Camacho WJ, Chilatra-Fonseca JM, Plata-Ortiz JE, Gómez-Mancilla YP, Villabona-Suárez AN, Villabona-Rosales SA. Ruptura del septum ventricular como complicación de un evento coronario agudo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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MacDonald RD, Allendes F. Intra-aortic Balloon Pump-Dependent Patient Transports by Critical Care Paramedics. Air Med J 2016; 35:231-4. [PMID: 27393759 DOI: 10.1016/j.amj.2015.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/21/2015] [Accepted: 12/30/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Transport of intra-aortic balloon pump (IABP)-dependent patients between hospitals is increasingly common. The transports are typically time-sensitive and require personnel familiar with IABP operation and management of a potentially unstable patient. This study examined transports performed by specially trained critical care paramedics in a large air medical and land critical care transport service. METHODS This retrospective, descriptive review prospectively collected data for IABP-dependent patient transports in Ontario, Canada in a 10-year interval beginning September 2003. Call records and patient care reports were reviewed to capture demographic, patient care, adverse events, and transport-related data. Adverse events, including resuscitation medication, procedure, and patient instability, were independently reviewed by 2 investigators. RESULTS There were 162 IABP-dependent patients transported. Seventy-one were performed by land critical care transport vehicles, 60 by helicopter, and 31 by fixed wing aircraft. The mean patient age was 63.7 ± 13.8 years; the majority (72.2%) were men. Fifty-nine patients (36.4%) were inotrope or vasopressor dependent, and 46 (28.4%) were intubated and mechanically ventilated. The most common indications for IABP insertion were acute myocardial infarction requiring prompt surgical intervention (n = 70), bridge to definitive care (n = 41), and cardiogenic shock (n = 37). The mean transport time was 92.7 ± 79.4 minutes. There were 48 adverse events in 35 patients, most commonly hypotension (systolic blood pressure < 90 mm Hg, n = 18) and tachyarrhythmia requiring therapy (n = 12). There were 3 IABP-related events and 3 cases in which the transport vehicle was inoperable resulting in a transport delay. One patient with cardiogenic shock died before departing the sending hospital. Paramedics managed all events without assistance from other health care personnel. CONCLUSION Specially trained critical care flight paramedics can safely transport potentially unstable IABP-dependent patients to definitive cardiac surgical care.
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Affiliation(s)
- Russell D MacDonald
- Ornge Transport Medicine, Mississauga, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Felipe Allendes
- Department of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Güvenç RÇ, Güvenç TS. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kapelios CJ, Terrovitis JV, Nanas JN. Current and future applications of the intra-aortic balloon pump. Curr Opin Cardiol 2014; 29:258-65. [PMID: 24686399 DOI: 10.1097/hco.0000000000000059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The intra-aortic balloon pump (IABP) has been used for more than 40 years. Although recommended in a wide variety of clinical settings, most of these indications are not evidence-based. This review focuses on studies challenging these traditional indications and evaluates potentially new applications of intra-aortic counterpulsation. RECENT FINDINGS Recent studies have failed to confirm an improvement in clinical outcomes conferred by the IABP in patients developing cardiogenic shock after acute myocardial infarction. This issue is in need of further investigations. While conflicting results of several retrospective studies and meta-analyses have been published regarding the performance of the IABP in high-risk percutaneous coronary interventions, it has recently been found to improve the long-term clinical outcomes of patients in whom it was implanted before the procedure. Small, single-center studies have reported the use of the IABP as a bridge to transplantation or candidacy for left-ventricular assist device implantation. The recently reported feasibility and safety of its insertion via the subclavian or axillary arteries will facilitate these applications. SUMMARY The revisiting of available data and the performance of new, thoughtfully designed trials should clarify the proper indications for the IABP.
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Affiliation(s)
- Chris J Kapelios
- The 3rd Department of Cardiology, University of Athens School of Medicine, Athens, Greece
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Webb CAJ, Weyker PD, Flynn BC. Management of Intra-Aortic Balloon Pumps. Semin Cardiothorac Vasc Anesth 2014; 19:106-21. [DOI: 10.1177/1089253214555026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The role for temporary and durable mechanical circulatory support is rapidly expanding. As the use of these technologies continues to grow, the emergency physician has an increasing opportunity to participate in the advancement of these potentially life-saving technologies. This review discusses the current role of the intra-aortic balloon pump in cardiogenic shock, describes the complications and management strategies for the critically ill patient with a left ventricular assist device, and explores the emerging role of ECMO in the emergency department for patients presenting in refractory cardiogenic shock and cardiac arrest.
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Affiliation(s)
- John C Greenwood
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA.
| | - Daniel L Herr
- Critical Care Service, Cardiac Surgery ICU, Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
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