1/36. New treatment strategies for cardiogenic shock in acute MI. Management options depend on the availability of a cath lab.Aggressive treatment strategies that include early revascularization may significantly improve survival from acute MI complicated by cardiogenic shock. Symptoms of impending cardiogenic shock include tachycardia, cool extremities, pallor, cyanosis, and a normal or low blood pressure. When possible, the right and left sides of the heart are catheterized immediately. For patients who need to be transferred to a hospital with a catheterization laboratory, use temporary support measures--intubation, administration of positive inotropic agents, and placement of an intra-aortic balloon pump. coronary angiography can reveal whether direct PTCA or bypass surgery is appropriate. Thrombolysis is limited to patients for whom transfer is delayed and those in whom cardiogenic shock is ruled out.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/36. bupivacaine-induced myocardial depression and pulmonary edema: a case report.central nervous system and cardiovascular toxicity are well-known side effects of bupivacaine. We report a case of bupivacaine-induced myocardial depression and cardiogenic pulmonary edema. A previously healthy woman developed soon after bupivacaine epidural injection of 5 mL 0.5% (25 mg) cardiogenic shock complicated with pulmonary edema. There were pronounced rales on auscultation with a butterfly sign on chest radiograph. A cardiac ultrasound showed reduced myocardial contractility, diffuse hypokinesia, left ventricular ejection fraction (LVEF) 25%, mitral and pulmonary insufficiency. Right heart catheterization showed increased pulmonary artery wedge pressure (34 mm Hg) and a pulmonary artery pressure of 48 over 33 mm Hg. These findings suggest myocardial depression owing to bupivacaine sodium channel blocking of myocardial nerve and tissue and subsequent reduction of myocardial contractility. The patient completely recovered with normalization of clinical, roentenographic, ultrasound, and hemodynamic findings and discharged 10 days later in good condition.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/36. A survival case of acute mitral regurgitation and cardiogenic shock caused by subtotal occlusion of the first diagonal branch.An 80-year-old woman was admitted with cardiogenic shock; she arrived in a deep coma with systolic blood pressure of 44 mmHg. An electrocardiogram showed ST elevation in I, aVL, V5 and V6, suggesting myocardial infarction in the lateral area of the left ventricle. A chest roentgenogram showed right pulmonary edema without cardiomegaly. Transthoracic and transesophageal echocardiograms revealed severe mitral regurgitation and a flailing anterior mitral valve leaflet, suggesting a ruptured papillary muscle. The patient was initially treated with high-dose dopamine, dobutamine and norepinephrine. Intraaortic balloon pumping was initiated after the patient's condition stabilized. She underwent emergency mitral valve replacement with a prosthetic valve. Complete rupture of the anterior papillary muscle was confirmed. Histological examination revealed necrosis of the anterior papillary muscle with inflammatory changes. She recovered uneventfully. Postoperative coronary angiography demonstrated subtotal occlusion of the first diagonal branch, and left ventriculography demonstrated akinesis of the lateral segment. This was a rare case in which subtotal occlusion of the first diagonal branch caused rupture of an anterior papillary muscle leading to severe mitral regurgitation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/36. Oozing-type of left ventricular rupture treated under percutaneous cardiopulmonary support without surgical repair.A 65-year-old man was admitted to the National Defense Medical College Hospital for acute anterolateral myocardial infarction and cardiogenic shock. Emergency coronary angiography demonstrated occlusion of the proximal left anterior descending artery. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed with the support of intra-aortic balloon pumping (IABP) and medical treatment to stabilize the patient's blood pressure. On the second hospital day, the patient suffered cardiac tamponade. pericardiocentesis showed bloody fluid and revealed that an oozing-type of left ventricular rupture had occurred after the myocardial infarction. Cardiogenic shock persisted after successful removal of the pericardial effusion. Although the heparinization required during percutaneous cardiopulmonary support (PCPS) can increase pericardial effusion, PCPS was initiated to correct the systemic hypoperfusion; a surgical team was on standby in case massive pericardial effusion resulted, but fortunately that did not occur, and cardiac function recovered. The patient was weaned successfully from PCPS and IABP and has remained in a satisfactory condition for over 1 year. PCPS contributed to the patient's recovery from cardiac shock and may have decreased the effusion from the oozing-type rupture by reducing ventricular wall tension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/36. Traumatic cardiogenic shock due to massive air embolism. A possible role for cardiopulmonary bypass.Systemic arterial embolism is a potentially lethal complication of bronchopulmonary venous fistula in trauma patients with blunt chest trauma or isolated penetrating lung injury on positive pressure ventilation. A high index of suspicion, early diagnosis and management in specialized centres are keys to a successful outcome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/36. Effect of vasopressin on sublingual microcirculation in a patient with distributive shock.OBJECTIVE: To assess the sublingual microcirculation in a patient during vasopressin administration for a distributive shock after cardiopulmonary bypass. DESIGN AND SETTING: Case-report in the Department of intensive care of a university hospital. PATIENT: A 53 year-old man developed severe distributive shock after cardiac transplant, requiring massive doses of vasopressor agents. methods: Vasopressin administered twice at a dose of 0.02 U/min increased mean blood pressure and allowed partial weaning of other vasopressor drugs. Microcirculatory alterations were assessed by orthogonal polarization spectral technique: 50% and 60% of capillaries were perfused at baseline, and these proportions did not worsen when vasopressin was administered. CONCLUSIONS: Despite its strong vasopressor effects vasopressin infusion did not worsen microcirculatory alterations in this patient with distributive shock following cardiac surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/36. The enigma of occult mitral regurgitation in a patient with cardiogenic shock.In patients with mitral regurgitation (MR), there is a high pressure gradient between the left ventricle (LV) and left atrium that Doppler echocardiography can easily detect. We present a case where transthoracic echocardiography (TTE) failed to provide an accurate evaluation of a patient who presented in cardiogenic shock. A transesophageal echocardiogram diagnosed MR because of a flail leaflet caused by a ruptured papillary muscle in the setting of normal ventricular function.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/36. Acute left ventricular failure after large volume pericardiocentesis.This paper reports on two cases of large volume pericardiocentesis followed by transient severe acute left ventricular (LV) systolic failure in the absence of any prior history of LV dysfunction. Acute LV volume overload due to interventricular volume mismatch is believed by most authors to be the cause for this phenomenon. Another plausible physiopathologic explanation is the acute increase in "wall stress" (Laplace's law) due to acute distention of the cardiac chambers secondary to a sudden increase in venous return at high filling pressures, combined with a "vacuum" effect of the evacuated pericardial space.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/36. Asymmetric septal hypertrophy presenting with cardiogenic shock, complete heart block, and septal infarction despite normal coronaries.A 37-year-old man, brought in following a syncopal episode, was found to be in cardiogenic shock with a complete infranodal heart block. A temporary transvenous pacemaker and an intra-aortic balloon pump were inserted emergently. cardiac catheterization revealed a high left ventricular end-diastolic pressure but normal coronary vasculature. An echocardiogram demonstrated a hyperdynamic left ventricle, severe hypokinesis of the septum, and asymmetric septal hypertrophy. An endomyocardial biopsy showed myofibril hypertrophy and disarray. The patient required implantation of a permanent pacemaker for full recovery. Although arrhythmias are common in asymmetric septal hypertrophy, complete atrioventricular block is rare but can cause syncope and cardiogenic shock. This is the first case, reported in the literature, of asymmetric septal hypertrophy in which the patient presented with cardiogenic shock and complete heart block secondary to a septal infarction, despite normal coronaries, and in whom a myocardial biopsy was performed. The case report is followed by a review of the literature on hypertrophic cardiomyopathy associated with complete heart block.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/36. Percutaneous bridge to heart transplantation by venoarterial ECMO and transaortic left ventricular venting.We report a case in which life support for cardiogenic shock was achieved by a nonpulsatile venoarterial bypass, and left ventricular decompression was obtained by a catheter placed percutaneously through the aortic valve into the left ventricle. The blood drained from the left ventricle was pumped into the femoral artery. The normalization of left heart filling pressures allowed the resolution of pulmonary edema, and the patient underwent a successful heart transplantation following 7 days of mechanical cardiocirculatory support.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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