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Liu B, Xie B, Chen X, Zhu K, Wang CM, Guo SH. A successful case of electrical storm rescue after acute myocardial infarction. BMC Cardiovasc Disord 2022; 22:537. [PMID: 36494628 PMCID: PMC9733321 DOI: 10.1186/s12872-022-02982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electrical storm (ES) is a heterogeneous clinical emergency that can present with malignant ventricular arrhythmias such as ventricular fibrillation (VF), ventricular tachycardia (VT), requiring the need for cardiac defibrillation. ES is a life-threatening condition with a high mortality rate. Successfully managing ES in the setting of acute myocardial infarction (MI) is expected to be known by physicians on call to reduce in-hospital mortality. CASE PRESENTATION A 57-year-old man presenting with acute onset chest pain was found to have an infero-posterior ST-segment elevation myocardial infarction (STEMI) complicated by acute right ventricular MI secondary to total occlusion of the proximal right coronary artery (RCA). The patient developed ES in the form of recurrent VF that was managed successfully with electrical defibrillation, antiarrhythmic therapy with amiodarone and esmolol, endotracheal intubation, sedation, electrolyte replacement, volume resuscitation, comfort care, psychological intervention, and percutaneous coronary intervention (PCI) of the occluded epicardial artery. With these interventions used in quick succession and with the aspiration of a massive RCA thrombus, the patient was reversed to hemodynamic stability, did not have further episodes of VF, and survived the index hospitalization. CONCLUSION ES is a rare but fatal complication of acute MI. Residents on night shifts should be better prepared and equipped to deal with this rare condition. We hope our successful experience can benefit physicians on call who take care of acute MI patients that deteriorate with ES.
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Affiliation(s)
- Bin Liu
- grid.501248.aFirst Division, Department of Respiratory and Critical Care Medicine, Zhuzhou Hospital, Affiliated to Xiangya School of Medicine, Central South University/Zhuzhou Central Hospital, Zhuzhou, 412007 Hunan China
| | - Bo Xie
- grid.501248.aMedical Affairs Department, Zhuzhou Hospital, Affiliated to Xiangya School of Medicine, Central South University/Zhuzhou Central Hospital, Zhuzhou, 412007 Hunan China
| | - Xun Chen
- grid.501248.aMedical Affairs Department, Zhuzhou Hospital, Affiliated to Xiangya School of Medicine, Central South University/Zhuzhou Central Hospital, Zhuzhou, 412007 Hunan China
| | - Ke Zhu
- grid.501248.aCardiovascular Medicine Department, Zhuzhou Hospital, Affiliated to Xiangya School of Medicine, Central South University/Zhuzhou Central Hospital, Zhuzhou, 412007 Hunan China
| | - Cheng-Ming Wang
- grid.501248.aCardiovascular Medicine Department, Zhuzhou Hospital, Affiliated to Xiangya School of Medicine, Central South University/Zhuzhou Central Hospital, Zhuzhou, 412007 Hunan China
| | - Shu-Hong Guo
- grid.501248.aCardiovascular Medicine Department, Zhuzhou Hospital, Affiliated to Xiangya School of Medicine, Central South University/Zhuzhou Central Hospital, Zhuzhou, 412007 Hunan China
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Ullah A, Hoang-Trong MT, Lederer WJ, Winslow RL, Jafri MS. Critical Requirements for the Initiation of a Cardiac Arrhythmia in Rat Ventricle: How Many Myocytes? Cells 2022; 11:cells11121878. [PMID: 35741007 PMCID: PMC9221049 DOI: 10.3390/cells11121878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease is the leading cause of death worldwide due in a large part to arrhythmia. In order to understand how calcium dynamics play a role in arrhythmogenesis, normal and dysfunctional Ca2+ signaling in a subcellular, cellular, and tissued level is examined using cardiac ventricular myocytes at a high temporal and spatial resolution using multiscale computational modeling. Ca2+ sparks underlie normal excitation-contraction coupling. However, under pathological conditions, Ca2+ sparks can combine to form Ca2+ waves. These propagating elevations of (Ca2+)i can activate an inward Na+-Ca2+ exchanger current (INCX) that contributes to early after-depolarization (EADs) and delayed after-depolarizations (DADs). However, how cellular currents lead to full depolarization of the myocardium and how they initiate extra systoles is still not fully understood. This study explores how many myocytes must be entrained to initiate arrhythmogenic depolarizations in biophysically detailed computational models. The model presented here suggests that only a small number of myocytes must activate in order to trigger an arrhythmogenic propagating action potential. These conditions were examined in 1-D, 2-D, and 3-D considering heart geometry. The depolarization of only a few hundred ventricular myocytes is required to trigger an ectopic depolarization. The number decreases under disease conditions such as heart failure. Furthermore, in geometrically restricted parts of the heart such as the thin muscle strands found in the trabeculae and papillary muscle, the number of cells needed to trigger a propagating depolarization falls even further to less than ten myocytes.
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Affiliation(s)
- Aman Ullah
- School of Systems Biology, Krasnow Institute for Advanced Study, George Mason University, Fairfax, VA 22030, USA; (A.U.); (M.T.H.-T.)
| | - Minh Tuan Hoang-Trong
- School of Systems Biology, Krasnow Institute for Advanced Study, George Mason University, Fairfax, VA 22030, USA; (A.U.); (M.T.H.-T.)
| | - William Jonathan Lederer
- Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Raimond L. Winslow
- Institute for Computational Medicine and Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 20218, USA;
- The Roux Institute, Northeastern University, Portland, ME 04102, USA
| | - Mohsin Saleet Jafri
- School of Systems Biology, Krasnow Institute for Advanced Study, George Mason University, Fairfax, VA 22030, USA; (A.U.); (M.T.H.-T.)
- Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Institute for Computational Medicine and Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 20218, USA;
- Correspondence: ; Tel.: +1-703-993-8420
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Chen H, Das S, Morgan JM, Maharatna K. Prediction and classification of ventricular arrhythmia based on phase-space reconstruction and fuzzy c-means clustering. Comput Biol Med 2021; 142:105180. [PMID: 35026575 DOI: 10.1016/j.compbiomed.2021.105180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Prediction and classification of Ventricular Arrhythmias (VA) may allow clinicians sufficient time to intervene for stopping its escalation to Sudden Cardiac Death (SCD). This paper proposes a novel method for predicting VA and classifying its type, in particular, the fatal VA even before the event occurs. METHODS A statistical index J based on the combination of phase-space reconstruction (PSR) and box counting has been used to predict VA. The fuzzy c-means (FCM) clustering technique is applied for the classification of impending VA. RESULTS 32 healthy and 32 arrhythmic subjects from two open databases - PTB Diagnostic database (PTBDB) and CU Ventricular Tachyarrhythmia (CUDB) database respectively; were used to validate our proposed method. Our method showed average prediction time of approximately 5 min (4.97 min) for impending VA in the tested dataset while classifying four types of VA (VA without ventricular premature beats (VPBs), ventricular fibrillation (VF), ventricular tachycardia (VT), and VT followed by VF) with an average 4 min (approximately) before the VA onset, i.e., after 1 min of the prediction time point with average accuracy of 98.4%, a sensitivity of 97.5% and specificity of 99.1%. CONCLUSIONS The results obtained can be used in clinical practice after rigorous clinical trial to advance technologies such as implantable cardioverter defibrillator (ICD) that can help to preempt the occurrence of fatal ventricular arrhythmia - a main cause of SCD.
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Affiliation(s)
- Hanjie Chen
- School of Electronics and Computer Science, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Saptarshi Das
- Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Penryn Campus, Penryn, TR10 9FE, UK; Institute for Data Science and Artificial Intelligence, University of Exeter, North Park Road, Exeter, Devon, EX4 4QE, UK.
| | - John M Morgan
- Faculty of Medicine, University of Southampton, Tremona Road, Southampton, SO17 1BJ, UK.
| | - Koushik Maharatna
- School of Electronics and Computer Science, University of Southampton, Southampton, SO17 1BJ, UK.
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Szabó Z, Hornyák L, Miskei M, Székvölgyi L. Two Targets, One Hit: new Anticancer Therapeutics to Prevent Tumorigenesis Without Cardiotoxicity. Front Pharmacol 2021; 11:569955. [PMID: 33643029 PMCID: PMC7902874 DOI: 10.3389/fphar.2020.569955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
A serious adverse effect of cancer therapies is cardiovascular toxicity, which significantly limits the widespread use of antineoplastic agents. The promising new field of cardio-oncology offers the identification of potent anti-cancer therapeutics that effectively inhibit cancer cell proliferation without causing cardiotoxicity. Future introduction of recently identified cardio-safe compounds into clinical practice (including ERK dimerization inhibitors or BAX allosteric inhibitors) is expected to help oncologists avoid unwanted cardiological complications associated with therapeutic interventions.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lilla Hornyák
- MTA-DE Momentum Genome Architecture and Recombination Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Doctoral School of Molecular Cell and Immune Biology, Debrecen, Hungary
| | - Márton Miskei
- MTA-DE Momentum Genome Architecture and Recombination Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Doctoral School of Molecular Cell and Immune Biology, Debrecen, Hungary
| | - Lóránt Székvölgyi
- MTA-DE Momentum Genome Architecture and Recombination Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Doctoral School of Molecular Cell and Immune Biology, Debrecen, Hungary.,Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
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Kharkovskaya EЕ, Osipov GV, Mukhina IV. Ventricular fibrillation induced by 2-aminoethoxydiphenyl borate under conditions of hypoxia/reoxygenation. Minerva Cardioangiol 2020; 68:619-628. [DOI: 10.23736/s0026-4725.20.05376-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Elmahrouk AF, Elghaysha E, Arafat AA, Edrees A, Aluthman U, Jamjoom AA. Bolus potassium in frustrated ventricular fibrillation storm: Evidence are growing! J Card Surg 2020; 35:2117. [PMID: 32652774 DOI: 10.1111/jocs.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Ehab Elghaysha
- Cardiac Surgery Intensive Care Unit (CSICU) Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Intensive Care Unit, Basildon and Thurrock University Hospital, Essex, UK
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Azzahra Edrees
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Uthman Aluthman
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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