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Broken-heart syndrome (BHS) is an acute reversible myocardial injury of left or right ventricular myocardium in the absence of coronary occlusion. We, herein, discuss a case of a postmenopausal female presenting with angina equivalent with surface electrocardiogram (ECG) and echocardiography consistent for acute coronary syndrome. The patient was subsequently diagnosed and treated as BHS.
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Objective:To investigate the indication, effectiveness, tolerance, and safety of levosimendan in patients with acute heart failure (AHF) in 20 hospitals in Beijing, China.Methods:This prospective, observational, and multicenter study consecutively enrolled AHF patients who were treated with levosimendan at 20 hospitals in Beijing from April 2020 to March 2022. Baseline demographics, laboratory parameters, clinical presentation, concomitant diseases and medications were collected. After initiation of levosimendan, levosimendan administration, laboratory parameter pre- and post-administration, symptoms improvement, and adverse events were also collected.Results:Totally 800 AHF patients were included, 67% of whom were male, aged (65 ±17) years, 50% of whom had ischemic heart disease, and the left ventricular ejection fraction (LVEF) was (36±11)%. The dose of levosimendan was (11.84 ±2.11) mg and the mean infusion time was (1 450±307) min. Dyspnea was improved in 83.4% of AHF patients at 24 h after treatment. The level of B-type natriuretic peptide (BNP) significantly decreased from 689 (406-1509) pg/mL to 410 (156-697) pg/mL in all patients at 24-72 h after treatment ( P<0.001), and the level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) decreased from 6910 (3 715-13 914) pg/mL to 2 851 (1 288-6 191) pg/mL ( P<0.001). Meanwhile, LVEF level also improved significantly [(40±11)% vs. (36±11)%, P<0.001]. During levosimendan administration, adverse events occurred in 74 (9.3%) patients, including hypotension (5.9%), arrhythmia (1.9%), and other symptoms (1.1%). Among them, 7 patients ( 2 patients with hypotension and 5 patients with ventricular tachycardia) interrupted levosimendan administration. Conclusions:The use of levosimendan is safe, and can improve symptoms reduce BNP or NT-pro BNP levels and increase LVEF level in AHF patients.
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OBJECTIVE To explore the role of clinical pharmacists in the treatment of critical patients with acute heart failure after percutaneous coronary intervention （PCI）， and to provide reference for drug treatment and monitoring of such patients. METHODS Clinical pharmacists participated in the treatment of a critical patient with acute heart failure after PCI， and assisted physicians to jointly develop individualized medication plans based on domestic and foreign literature： it was suggested to give imipenem and cilastatin for anti-infective therapy， adjust drug dose according to renal function， and timely descend step therapy； Levetiracetam tablets were selected to prevent epilepsy； the differential diagnosis and treatment of rhabdomyolysis possibly caused by Atorvastatin calcium tablets were performed； the whole process of pharmaceutical care was conducted. RESULTS Physicians adopted the suggestions of clinical pharmacists. The acute heart failure of the patient was controlled， the pulmonary infection was improved， the adverse reaction symptoms were relieved， and the patient was successfully transferred out of the ICU. CONCLUSIONS For severe patients， when giving imipenem and cilastatin for anti-infection treatment，the clinical pharmacist should adjust the dose according to the patient’s renal function and be alert to the possible neurotoxicity. During the treatment with Atorvastatin calcium tablets，the clinical pharmacist should comprehensively analyze the risk of rhabdomyolysis. For the adverse reactions that have occurred， clinical pharmacist should promptly address symptomatic issues to ensure the safety and effectiveness of medication for patients.
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Objective:To analyze the effects of different plasma B-type natriuretic peptide (BNP) changes on worsening renal function (WRF) on 1-year all-cause mortality in patients with acute heart failure (AHF).Methods:The clinical data of 399 patients with AHF admitted to our hospital from January 2015 to December 2019 were retrospectively analyzed. According to the severity of WRF, the patients were divided into non-severe worsening renal function (nsWRF) group, severe worsening renal function (sWRF) group and non-WRF group. Plasma BNP decrease was defined as a reduction of B-type natriuretic peptide (BNP) at the time of discharge by ≥30% compared with the time of admission.Demographic characteristics and medical history, clinical data at admission, during hospitalization and at discharge, and survival status 1 year after discharge were collected. The measurement data presented in the form of normal distribution are as follows: single factor analysis of variance is used for comparison between groups, and LSD- t test is used for comparison between pairs; The Kruskal Wallis rank sum test was used for the multi group comparison of non normal distribution measurement data, and Wilcoxon rank sum test was used for the pairwise comparison. The comparison of counting data between groups was conducted using χ 2 test. Survival analysis was conducted using the Kaplan Meier method and Log rank test, and the Cox proportional risk regression model was used to analyze the influencing factors of 1-year all-cause mortality in patients. Results:399 cases of AHF were divided into nsWRF group with 68 cases, sWRF group with 82 cases, and nWRF group with 249 cases. 86 cases (21.5%) died within 1 year after discharge. The one-year mortality rate of the sWRF group was higher than that of the nWRF group and nsWRF group [42.7% (35/82) vs 16.1% (40/249), 16.2% (11/68)], and the differences were statistically significant (The χ 2 values were 24.94 and 12.28 respectively, both P<0.001), while there was no statistically significant difference between the nWRF group and the nsWRF group (χ 2=0.00、 P=0.982). The 1-year mortality rate of the nWRF group and sWRF group with decreased BNP during hospitalization was lower than that of the non decreased BNP group [29.1% (6/55) vs 70.4% (19/27), 10.5% (17/162) vs 26.4% (23/87), The χ 2 values are 12.61 and 10.67 respectively, and the P values are <0.001 and 0.001, respectively. The occurrence of nsWRF during hospitalization did not increase the one-year all-cause mortality risk of AHF patients ( P=0.754), but the occurrence of sWRF increased the all-cause mortality risk of AHF patients (odds ratio=2.33, 95% confidence interval: 1.31-4.13, P=0.004). The decrease in BNP during hospitalization reduced the one-year all-cause mortality risk of AHF patients (odds ratio=0.36, 95% confidence interval: 0.23-0.55, P<0.001). Conclusions:NsWRF does not increase the one-year all-cause mortality risk of AHF patients, while sWRF increases the one-year all-cause mortality risk, and a decrease in BNP during hospitalization reduces the one-year all-cause mortality risk.
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Abstract Objective: The objective of the study is to validate the use of the Killip-Kimball classification (KC) as a predictor of outcomes in an octogenarian cohort with acute coronary syndrome. Methods: A retrospective analysis of patients who underwent a catheterization procedure for acute coronary syndrome (ACS) was performed. ACS was defined as per the American Heart Association guidelines, and included ST-elevation myocardial infarction (STEMI), non-STEMI and Unstable Angina. We determined factors associated with the KC upon admission to the emergency room. Likewise, we compared in-hospital mortality, length of stay, and other outcomes dividing the patients by KC. Results: A total of 133 patients with a mean age of 83 years were analyzed and assigned a KC from 1 to 4 according to clinical presentation. Each group included 86, 9, 23, and 15 patients, respectively. In-hospital mortality was 12%, 5% in KC-I, 11% in KC-II, 22% in KC-III, and 40% in KC-IV with a significant difference between classes (p = 0.002). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p < 0.01). Conclusion: Despite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher KC have a high mortality rate, as described in younger cohorts. KC remains a reliable prognostic tool, with applicability in octogenarian patients.
Resumen Objetivo: Validar el uso de la clasificación de Killip- Kimball como predictor de desenlaces en una cohorte de pacientes octogenarios con síndrome coronario agudo. Métodos: Se realizó un análisis retrospectivo de pacientes sometidos a cateterismo por síndrome coronario agudo (ACS). Se incluyeron infarto al miocardio con y sin elevación del segment ST, así como angina inestable, utilizando las definiciones de la American Heart Association (AHA). Se determinaron los factores que influyeron en la clasificación de Killip-Kimball (KC) al momento de ingreso al hospital. Se comparó la mortalidad, la estancia intrahospitalaria y otros desenlaces, dividiendo a los pacientes por su KC. Resultados: Un total de 133 pacientes se incluyeron en el análisis y se clasificaron dependiendo de su KC (I-IV). Cada grupo incluyó 86, 9, 23 y 15 pacientes, respectivamente. La edad media fue de 83 años. La mortalidad intrahospitalaria fue de 5, 11, 22 y 40%, respectivamente para cada KC, y 12% global. Hubo una diferencia significativa en la mortalidad por clase (p = 0.002). Adicionalmente, se encontró que a mayor KC, mayor riesgo de lesión renal aguda durante la hospitalización (p < 0.01). Conclusión: A pesar de una reducción en la mortalidad de adultos mayores con ACS en décadas recients, pacientes con ACS y mayor KC tienen riesgo aumentado de morir, igual que pacientes en grupos de edad menores. La KC continñua siendo una herramienta confiable para la clasificación y con utilidad pronóstica, con aplicabilidad en pacientes mayores de 80 años.
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Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.
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Objective: Nitroglycerin is a first-line treatment for hypertensive acute heart failure syndrome (AHFS). However, nicardipine is frequently used to treat hypertensive emergencies, including AHFS. In this study, we compared the effectiveness of nicardipine and nitroglycerin in patients with hypertensive AHFS.Patients and Methods: This single-center, retrospective, observational study was conducted at the intensive care unit of a Japanese hospital. Patients diagnosed with AHFS and systolic blood pressure 140 mmHg on arrival between April 2013 and March 2021 were included. The outcomes were the time to optimal blood pressure control, duration of continuous infusion of antihypertensive agents, duration of positive pressure ventilation, need for additional antihypertensive agents, length of hospital stay, and body weight changes. Outcomes were compared between the nicardipine and nitroglycerin groups. We also compared these outcomes between the groups after excluding patients who received renal replacement therapy.Results: Fifty-eight patients were enrolled (26 and 32 patients were treated with nitroglycerin and nicardipine, respectively). The nicardipine group had a shorter time to optimal blood pressure control (2.0 [interquartile range, 2.0–8.5] h vs. 1.0 [0.5–2.0] h), shorter duration of continuous anti-hypertensive agent infusion (3.0 [2.0–5.0] days vs. 2.0 [1.0–2.0] days), less frequent need for additional anti-hypertensive agents (1 patients [3.1%] vs. 11 patients [42.3%]), and shorter length of hospital stay (17.5 [10.0–33.0] days vs. 9.0 [5.0–15.0] days) than the nitroglycerin group. The duration of positive pressure ventilation and body weight changes were similar between the groups. The outcomes were similar after excluding patients who received renal replacement therapy.Conclusion: Nicardipine may be more effective than nitroglycerin for treating hypertensive AHFS.
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Takotsubo syndrome (TTS) is an acute and mostly reversible cardiomyopathy that mimics an acute coronary syndrome with systolic dysfunction of left ventricular.Although supraphysiological epinephrine levels have been associated with TTS, the detailed pathophysiology is incompletely understood.According to the distribution of left ventricular wall motion abnormalities, various morphological subtypes have been identified.The ultimate diagnosis depends on cardiac imaging with left ventricular angiography during acute heart catheterization, as well as echocardiography and cardiac magnetic resonance.Management is based on observational data, while randomized multicenter studies are still lacking.Mechanical circulatory support is an emerging strategy for patients with TTS and shock, in order to avoid catecholamines and inotropes in particular.This review provides a general overview of TTS.However, the demographic characteristics, diagnosis, treatment and prognosis of TTS have not been well studied in children.
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Objective:To investigate the effects of intervention mapping on cardiopulmonary function for patients with acute heart failure in compensatory period, so as to provide references for their early rehabilitation activities.Methods:A total of 90 patients with acute heart failure admitted to Fuwai Central China Cardiovascular Hospital from October 2018 to October 2019 were enrolled in the present study. They were divided into experimental group and control group according to draw-lots-method, with 45 cases in each group. The control group received the routine care and activity plan, while the experimental group implemented intervention mapping-based stage early rehabilitation program. The indicators included 6MWT, forced expiratory volume in one second (FEV 1), brain natriuretic peptide (BNP) as well as Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the intervention effects were compared between the two groups. Results:There were no significant differences in FEV 1, 6MWT, BNP and MLHFQ scores between the two groups at admission ( P>0.05). On discharge, FEV 1, 6MWT were (2.17±0.44) L, (273.09±55.80) m in the experimental group, significantly higher than (1.94 ± 0.39) L and (236.44 ± 50.99) m in the control group; the plasma BNP were (676.79 ± 78.75) ng/L in the experimental group, significantly lower than (736.05 ± 78.77) ng/L in the control group; in addition, the physical demention, emotional dimenson, other demension scores and total scores of MLHFQ in the experimental group were (65.39 ± 5.02), (67.56 ± 4.99), (66.05 ± 4.16) and (66.33 ± 2.63) points, significantly higher than (59.79 ± 5.94), (64.33 ± 5.93), (62.76 ± 4.47), (62.36 ± 2.98) points in the control group, the differences were statistically significant ( t values were 2.56-6.51, all P<0.05). Conclusions:Designing and implementing stage early rehabilitation program using intervention mapping can promote cardiopulmonary function and quality of life of patients with acute heart failure in compensatory period.
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Introducción: Las teorías físicas y matemáticas han permitido el desarrollo de nuevas metodologías diagnósticas de la dinámica cardiaca. Entre estas se encuentra la evaluación de las proporciones de la entropía proporcional para diferenciar la normalidad de la enfermedad cardiaca, aunque su capacidad diagnóstica debe comprobarse en escenarios clínicos críticos específicos, como en la falla cardiaca y el infarto agudo de miocardio. Objetivo: Describir evaluaciones diagnósticas de la dinámica cardiaca en pacientes con infarto agudo de miocardio o falla cardiaca aguda. Métodos: En un estudio a doble ciegos con 20 Holter, 5 normales, 8 con falla cardiaca aguda y 7 con infarto agudo de miocardio, se aplicó un método fundamentado en las proporciones de la entropía tomando los valores máximos y mínimos de la frecuencia cardiaca y el número total de latidos por hora, en un mínimo de 18 horas, generando un atractor numérico. Se evaluó cada dinámica con base en la entropía y sus proporciones. Finalmente, se comparó la precisión diagnóstica del método matemático con respecto al diagnóstico clínico convencional. Resultados: Se diferenciaron matemáticamente los casos normales y patológicos mediante la evaluación en 18 horas con el método descrito, encontrando valores de sensibilidad y especificidad del 100 por ciento y un coeficiente Kappa de uno, indicando una concordancia diagnóstica perfecta del método matemático con respecto al diagnóstico clínico. Conclusiones: Las proporciones de la entropía permiten establecer diagnósticos objetivos de la dinámica cardiaca, diferenciando matemáticamente dinámicas normales de aquellas que presentan infarto agudo de miocardio y falla cardiaca aguda(CU)
Introduction: Physical and mathematical theories have allowed the development of new diagnostic methodologies of cardiac dynamics, as one based on the evaluation of entropy proportions to differentiate normality from cardiac disease, although its diagnostic capacity must be yet determined in specific critical scenarios as acute heart failure and acute myocardial infarction Objective: To describe diagnostic evaluations of cardiac dynamics in patients diagnosed with acute myocardial infarction or acute heart failure. Methods: A blind study was developed with 20 Holter registries; 5 normal, 8 with acute cardiac failure and 7 with acute myocardial infarction. Then, a method based on the proportions of the entropy of the numerical attractors was applied. The maximum and minimum values of the heart rate and the total number of beats per hour were taken for at least 18 hours, with which numerical attractors were generated, which measure the probability of consecutive heart rate pairs. An evaluation of all dynamics was made based on the entropy and its proportions. Finally, a comparison between the diagnostic precision of the mathematical method with respect to the conventional clinical diagnosis was performed. Results: Normal cases were mathematically differentiated from the pathological ones through the evaluation of Holter registries for 18 hours, achieving values of sensitivity and specificity of 100 percent as well as a Kappa coefficient of 1, indicating a perfect diagnostic concordance between the mathematical method to diagnose the cardiac dynamics with respect to the clinical diagnosis. Conclusions: The proportions of entropy allow to establish objective diagnoses of cardiac dynamics, mathematically differentiating normal dynamics from those with acute myocardial infarction and with acute cardiac failure(AU)
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Humans , Entropy , Heart Failure/diagnosis , Myocardial Infarction/diagnosis , Mathematics/methodsABSTRACT
Resumen La insuficiencia cardíaca aguda descompensada (ICAD) es una causa común de hospitalización, con repercusiones significativas en los sistemas de salud. El manejo agudo se basa en la reducción de la volemia con diuréticos de asa, sin embargo, un porcentaje de pacientes presenta resistencia o no logra la respuesta clínica esperada con este tratamiento. Una de las medidas que ha comprobado ser efectiva en este contexto, es el uso de solución salina hipertónica (SSH) en conjunto con dosis altas de diuréticos de asa, como medida terapéutica temida por sus posibles repercusiones sobre la función renal y posible sobrecarga de sodio. Objetivos: Determinar si el uso de solución salina hipertónica en pacientes con falla cardiaca aguda e hipervolemia genera un deterioro de la función renal. Determinar la respuesta del Pro-BNP ante el uso de la solución salina hipertónica en pacientes con falla cardiaca aguda como marcador de respuesta terapéutica. Determinar si el uso de solución salina hipertónica aumenta la diuresis sin generar cambios importantes en el sodio. Se muestran datos de pacientes con insuficiencia cardiaca aguda descompensada, que tras no presentar mejoría con altas dosis de diurético de asa en bolo, se les aplicó la solución hipertónica como adyuvante a este tratamiento. Se toma un total de 26 pacientes analizando datos generales clínicos y de laboratorio, se valoran curvas con la respuesta diurética y por parámetros de laboratorio a las 48 y 72 horas. El uso de solución salina hipertónica consigue un aumento de más de un 200% de la diuresis en 24 horas, con un descenso del Pro BNP de más de un 60% a las 48 horas, sin mostrar un cambio importante en los niveles de creatinina, nitrógeno ureico y sodio. Se requirió reposición de potasio en la totalidad de los pacientes. Se concluye que la infusión de furosemida más solución hipertónica es efectiva tanto en disminuir niveles de NT Pro-BNP en los pacientes, como en generar un aumento en el volumen de diuresis. La principal complicación fue la hipokalemia, sin cambios considerables en el valor de sodio, creatinina y nitrógeno ureico séricos.
Abstract Uso de Solución Hipertónica en pacientes con insuficiencia cardiaca aguda como terapia adyuvante a altas dosis de diuréticos Acute decompensated heart failure (AHF) is a common cause of hospitalization, with significant repercussions on health systems. Acute management is based on the reduction of blood volume with loop diuretics; however, a percentage of patients show resistance or do not achieve the expected clinical response with this treatment. One of the measures that has proven to be effective in this context is the use of hypertonic saline (HSS) in conjunction with high doses of loop diuretics, as a therapeutic measure feared due to its possible repercussions on kidney function and possible sodium overload. Objetives: To determine if the use of hypertonic saline in patients with acute heart failure and hypervolemia leads to a deterioration in renal function. To determine the response of Pro-BNP to the use of hypertonic saline in patients with acute heart failure as a marker of therapeutic response. Determine if the use of hypertonic saline increases urine output without causing significant changes in sodium. Data are shown from patients with acute decompensated heart failure, who after not presenting improvement with high doses of bolus loop diuretic, the hypertonic solution was applied as an adjunct to this treatment. A total of 26 patients are taken analyzing general clinical and laboratory data, curves with the diuretic response and by laboratory parameters are evaluated at 48 and 72 hours. The use of hypertonic saline solution achieves an increase of more than 200% in diuresis in 24 hours, with a decrease in Pro BNP of more than 60% at 48 hours, without showing a significant change in creatinine levels, urea nitrogen and sodium. Potassium replacement was required in all patients. It is concluded that the infusion of furosemide plus hypertonic solution is effective both in reducing levels of NT Pro-BNP in patients, and in generating an increase in the volume of diuresis. The main complication was hypokalemia, without significant changes in serum sodium, creatinine, and urea nitrogen.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Diuretics/therapeutic use , Heart Failure/drug therapy , Hypertonic Solutions/therapeutic use , Costa RicaABSTRACT
Resumen Objetivo: Identificar la epidemiología clínica y los procesos diagnósticos y terapéuticos de las mujeres con miocardiopatía periparto en un centro de referencia cardiovascular. Método: Se realizó un estudio observacional descriptivo retrospectivo con pacientes de sexo femenino de entre 15 y 50 años con diagnóstico de cardiopatía periparto durante los últimos 10 años en una institución especializada de la ciudad de Medellín. Resultados: Hubo 17 mujeres con diagnóstico de cardiopatía periparto, con una edad media de 31 años (± 6.7). El número promedio de embarazos fue de 1.0, con un 52.9%. Las condiciones más frecuentes durante la gestación fueron obesidad y preeclampsia, con un 23.5% para ambas; se halló diabetes gestacional en una paciente (5.9%) y dos presentaron hemorragia del primer trimestre (11.8%). El 41.2% de las mujeres tuvieron parto vértice espontáneo. Ninguna mujer tuvo antecedentes cardiovasculares. Los síntomas presentados al momento del diagnóstico fueron deterioro de la clase funcional (100%), edema en miembros inferiores (52.9%), ortopnea (76.4%) y disnea paroxística nocturna (88.2%). La terapia farmacológica iniciada incluyó diuréticos (58.8%), inhibidores de la enzima convertidora de angiotensina (IECA) (64.7%), betabloqueadores (82.4%), bromocriptina (5.8%), ivabradina (23.5%) y antagonistas de la aldosterona (64.7%). Conclusiones: Este registro señala la similitud en nuestro medio de esta enfermedad, respecto a la epidemiología, la presentación y el manejo, con el resto del mundo. Muestra que el tratamiento farmacológico para falla cardiaca con la combinación de betabloqueadores, IECA y diuréticos sigue siendo el pilar fundamental en el tratamiento; además, destaca que la miocardiopatía periparto aún es una afección grave, con alta morbilidad y que permanece en insuficiencia cardiaca después del diagnóstico y con un riesgo importante de mortalidad.
Abstract Objective: To identify the epidemiology and the diagnostic and therapeutic processes of women with peripartum cardiomyopathy on a cardiovascular reference center. Method: A retrospective descriptive observational study was conducted with female patients between 15 and 50 years of age with a diagnosis of peripartum cardiomyopathy during the last 10 years. Results: 17 women with a diagnosis of peripartum cardiomyopathy where included, with a mean age of 31 (± 6,7) years at the time of diagnosis. The average number of previous pregnancies was 1.0 in 52.9% of the population. Obesity and preeclampsia were present in 23.5% and 18.8%, respectively. Diabetes was found in one patient (5.9%) and two had hemorrhage of the first trimester (11.8%). 41.2% of the women had a spontaneous vertex delivery. The symptoms presented at the time of diagnosis were deterioration of their functional class in 100.0%, edema in the lower limbs in 52.9%, orthopnea in 76.4% and paroxysmal nocturnal dyspnea in 88.2%. Conclusions: Our data show that peripartum cardiomyopathy occurs with a mode of presentation similar to the rest of the world, pharmacological treatment for heart failure with the combination of beta blockers, ACE inhibitors/ARBs, and diuretics continue to be the fundamental pillar in the treatment of peripartum cardiomyopathy; It is also important to note that peripartum cardiomyopathy remains a serious condition with a high rate of critically ill patients who remain in heart failure after diagnosis with a significant risk of mortality.
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Humans , Female , Adult , Cardiomyopathies , Pregnancy , Biomarkers , Heart FailureABSTRACT
Acute heart failure (AHF) is a common critical illness in pediatrics.At present, there is a lack of evidence-based diagnosis and drugs for children with AHF.Besides, there is a paucity of reliable evidence on the effectiveness and safety of technologies and drugs for the management of AHF in children.Moreover, the innovation is absent from the treatment theory.Furthermore, the consensus or guidelines on the management of children with AHF are out of date.Therefore, there are huge challenges in the clinical management of children with AHF.In recent years, new drugs and technologies have been applied in the diagnosis and treatment of children with AHF.For example, calcium sensitizers have gradually attracted attention in the treatment of children with AHF, blood purification and extracorporeal membrane oxygenation can significantly improve the prognosis of some children with AHF.Therefore, a multi-center, large sample high-quality and randomized control study is still required to guide the clinical management of children with AHF.
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Objective:To investigate the clinical diagnostic value of soluble leukocyte differentiation antigen 14 subtype (sCD14-ST, presepsin) in elderly patients with acute left heart failure (AHF) complicated with bacterial pneumonia.Methods:The data of 111 elderly patients with acute left heart failure complicated with bacterial pneumonia or acute left heart failure (the control group) who were admitted into emergency department from August 2017 to August 2018 were retrospectively analyzed. Chemilluminescence immunoassay was performed to detect presepsin in all patients. And meanwhile, fever or not, presepsin, procalcitonin (PCT), C-reaction protein (CRP) and other clinical data were compared between the two groups. Univariate and multivariate logistic regression analysis were adopted to screen the risk factor influencing the diagnosis. The receiver operating characteristic (ROC) curve was used to analyze the clinical value of presepsin on diagnosing acute left heart failure complicated with bacterial pneumonia in elderly patients.Results:Presepsin of the group complicated with bacterial pneumonia was significantly higher than that of the control group [(500.9±283.5) ng/L vs. (167.7±102.3) ng/L, t=-7.902, P=0.000]. The logistic regression analysis, showed that fever, presepsin and procalcitonin were independent risk factors for AHF combined with bacterial pneumonia diagnosis. The area under ROC curve (AUC) of presepsin, PCT and WBC was 0.887 (95% CI: 0.825-0.949, P<0.001), 0.794(95% CI: 0.704-0.885, P<0.001), and 0.566 (95% CI: 0.455-0.678, P=0.231), respectively. The optimal threshold value of presepsin was 227 ng/L, the sensitivity was 82.0%, specificity was 83.6%, the positive likelihood ratio was 5, the negative likelihood ratio was 0.22, the positive predictive value) was 80.4%, and the negative predictive value was 85%. Conclusions:Presepsin has an important diagnostic value for the identification of AHF combined with bacterial pneumonia in elderly patients.
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Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.
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Resumen Paciente masculino de 41 años vecino de Jicaral de Puntarenas. Sin antecedentes personales patológicos de importancia quien es referido al Servicio de Emergencias del Hospital Víctor Manuel Sanabria Martínez por consumo de aproximadamente 20 mililitros de Paraquat el día anterior con propósitos autolíticos. El paciente es ingresado en el Servicio de Medicina Interna y al momento de la valoración presenta únicamente lesiones ulceradas a nivel de la lengua. Durante su internamiento presenta deterioro en la función renal y alteraciones electrolíticas y al décimo día presenta cuadro de dolor torácico tipo opresivo acompañado de datos de insuficiencia cardiaca aguda. Los biomarcadores de laboratorio presentan incremento de la Troponina I y del Péptico Natriurético Cerebral. La radiografía de tórax mostró una cardiomegalia grado II con signos de falla cardiaca. Se le realiza un ecocardiograma que documentó trastornos en la contractilidad de manera difusa con deterioro en la función ventricular y dilatación de las cámaras cardiacas. Se le realiza una arteriografía coronaria que documenta arterias coronarias epicárdicas sin lesiones significativas. Se confirma el diagnóstico de miocarditis aguda por Paraquat y se da tratamiento para la insuficiencia cardiaca presentando una evolución satisfactoria y recuperación de la función cardiaca evidenciada por ecocardiograma control a los 9 meses posterior a el episodio inicial.
Summary Acute paraquat myocarditis. Case report and literature review A 41-year-old male patient from Jicaral of Puntarenas. Without significant pathological personals backgroun of importance who is referred to the Emergency Service of the Victor Manuel Sanabria Martínez Hospital for consumption of approximately 20 milliliters of Paraquat the previous day for autolytic purposes. The patient is admitted to the Internal Medicine Service and at the time of the evaluation presents only ulcerated lesions at the level of the tongue. During hospitalization, there is deterioration in renal function and electrolyte disturbances and on the tenth day, he presents a episode of oppressive chest pain accompanied by data on acute heart failure. Laboratory biomarkers show an increase in Troponin I and Brain Natriuretic Peptic. Chest radiography showed grade II cardiomegaly with signs of heart failure. An echocardiogram was performed which documented diffuse contractility disorders with deterioration in ventricular function and dilation of the cardiac chambers. A coronary arteriography is performed that documents epicardial coronary arteries without significant injuries. The diagnosis of acute Paraquat myocarditis is confirmed and treatment for heart failure is presented, the patient presenting a satisfactory evolution and recovery of heart function evidenced by a control echocardiogram at 9 months after the initial episode.
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Humans , Male , Adult , Paraquat/adverse effects , Myocarditis/diagnostic imaging , Costa RicaABSTRACT
Congestive cardiac failure (CCF) is a worldwide phenomenon and affects millions of people years and is accompanied with high mortality. The present review is undertaken to evaluate the usefulness of Lung Ultrasound Scan in diagnosis and to identify its role as a marker of clinical outcome in patients with Acute LVF. A review of literature was done to find the role of lung ultrasound and clinical congestion score in acute left ventricular failure from search engines such as PubMed, google scholar. Major exclusion criteria were the studies that included patients with Right Ventricular Failure, renal insufficiency, other respiratory causes of breathlessness like pneumonia, pulmonary embolism, pneumothorax and pleural effusion. This review concluded that lung ultrasonography is as a rapid, non-invasive, bedside tool for the diagnosis and risk assessment of pulmonary congestion in Acute LVF.
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Background: Acute heart failure (AHF) is a common and growing medical problem associated with major morbidity and mortality. It is the leading reason for hospital admission among patients over age 65 years. Not much of data is available from India, there are a lot of differences between the western data and available Indian data. Prompt diagnosis, identification of reversible causes and supportive management in ICU is of paramount importance.Methods: This study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka after the institutional ethics committee approval. Those patients who were diagnosed to have AHF, were evaluated and treated as per the institution protocols in ICU and standard medical care which includes diuretics, inotropes and vasopressors. All the patients were prospectively studied; investigated for the etiology of AHF.Results: Majority of patients presenting as Acute Heart Failure are of 60 years mean age, with 63% males. Ischemic heart disease is the leading cause of Acute Heart Failure. Shortness of breath was the commonest presentation followed by crackles. Abdominal pain was the most common (28%) non cardiac symptom. There is no significant correlation between the presence of anemia and mortality. Hyponatremia had relation with mortality. 22% had HFpEF, rest had HFrEF. The mean hospital stay was 8.3 days. The study mortality was 9 % and the 30-day mortality was 13 % in our study.Conclusions: Current available data from Indian studies and registries has a lot of difference from the western data with regards to causes, response to treatment, and more such data is needed to frame regional guidelines for better understanding of presentation of heart failure ,treatment and risk factors for mortality.
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Resumen Introducción: la estimación temprana del riesgo en falla cardiaca aguda puede ayudar en la toma de decisiones clínicas. Objetivo: identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con falla cardiaca aguda. Métodos: análisis de una cohorte retrospectiva de pacientes mayores de 18 años ingresados a hospitalización por falla cardiaca aguda en un hospital de tercer nivel, entre los años 2012 y 2016. Resultados: se incluyeron 247 pacientes, con edad promedio de 62,8 años; predominó el sexo masculino con un 60%. El 84% de los pacientes tenía falla cardiaca con fracción de expulsión disminuida (mediana de 25%). La mortalidad intrahospitalaria fue de 9,3% y la acumulada a 30 días y 6 meses posterior al egreso hospitalario fue de 10,9 y 14,1%, respectivamente. Los dos predictores asociados a muerte intrahospitalaria fueron el nitrógeno ureico en sangre (BUN)> 37 mg/dl (OR: 10,8; 95% IC: 4,10-28,8) y la presión arterial sistólica (PAS) ≤ 125 mm Hg (OR: 3,42; 95% IC:1,15-10,0). El modelo de árbol de regresión y clasificación (CART) identificó como el mejor predictor de mortalidad los niveles elevados de BUN (≥ 32,5 mg/dl), seguido por la presión sistólica disminuida (< 97 mm Hg) y finalmente por los niveles elevados de creatinina (≥ 1,75 mg/dl). Conclusión: el análisis mediante el CART permite clasificar en forma temprana la probabilidad de muerte por un árbol de riesgo que incluye el BUN ≥ 32,5 mg/dl, la presión sistólica < 97 mm Hg y los niveles de creatinina ≥ 1,75 mg/dl.
Abstract Introduction: The early estimation of risk in acute heart failure may help in the taking of clinical decisions. Objective: To identify the risk factors associated with in-hospital mortality in patients with acute heart failure. Methods: An analysis was performed on a retrospective cohort of patients greater than 18 years admitted to a tertiary hospital due acute heart failure between the years 2010 and 2016. Results: A total of 247 patients were included, with a mean age of 62.8 years, and of which 60% were male. The large majority (84%) of the patients had heart failure with a reduced ejection fraction (median 25%). The in-hospital mortality was 9.3%, and the accumulated rate at 30 days and 6 months after hospital discharge was 10.9% and 14.1%, respectively. The two predictors associated with in-hospital death was a blood urea nitrogen (BUN) > 37 mg/dL (OR: 10.8; 95% CI: 4.10-28.8) and a systolic blood pressure (SBP) ≤ 125 mmHg (OR: 3.42; 95% CI: 1.15-10.0). The classification and regression tree (CART) model identified elevated levels of as the best predictor of mortality, followed by a decreased systolic pressure (< 97 mmHg), and finally due to elevated creatinine levels (≥ 1,75 mg/dL). Conclusion: The analysis using the classification and regression tree (CART) model can provide an early classification of the probability of death by a risk tree that includes BUN ≥ 32.5 mg/dL, systolic pressure <97 mm Hg, and creatinine levels ≥ 1.75 mg/dL.
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Humans , Male , Female , Middle Aged , Risk Factors , Hospital Mortality , Heart Failure , Trees , Blood Urea Nitrogen , Clinical Decision-MakingABSTRACT
ObjectiveThe assessment of volume load status in patients with acute heart failure is of great significance for preventing volume overload. The aim of this study was to explore the predictive value of NT-proBNP level and IVC-CI on volume load and prognosis in patients with acute heart failure. MethodsFrom January 2017 to April 2019, the clinical characteristics of 98 patients with acute heart failure diagnosed and treated in the Peking University People's Hospital were retrospectively reviewed in this study. All of them were treated with routine anti-heart failure treatment. According to the level of relative volume balance, they were divided into volume overload group (65 cases) and non-volume overload group (33 cases). All the patients were followed up for 30 days after discharge. The patients with death and cardiogenic rehospitalization were included in the event group (30 cases), and the rest were in the non-event group (68 cases). NT-proBNP and IVC-CI in different volume load groups and different prognosis groups were compared. The volume index levels (serum albumin, hemoglobin, hematocrit, PCWP, CVP) of patients in different volume load groups were compared. The effects of NT-proBNP and IVC-CI on volume load and prognosis of patients were analyzed.ResultsThe levels of NT-proBNP [（1306.39±313.98）pg/mL], PCWP [（19.63±1.95）mmHg] and CVP [（14.65±1.03）cmHg] in the volume overload group were higher than those in the non-volume overload group, while the IVC-CI [（38.26±8.14）%], albumin [（16.23±2.12）g/L], hemoglobin and hematocrit [（36.26±2.78）%] in the volume overload group were lower than those in the non-volume overload group (P0.05). On discharge, the AUC of NT-proBNP, IVC-CI in predicting patients with acute heart failure was respectively 0.806 and 0.847. Although the prediction accuracy was relatively high, the AUC of combined prediction was 0.982, which was significantly higher than that of NT-proBNP and IVC-CI (Z=3.589, 3.274, both P<0.05).Conclusion There is a correlation between NT-proBNP, IVC-CI and volume indexes. The combined detection of NT-proBNP and IVC-CI can help to assess the volume load status of patients with acute heart failure and improve the predictive value of short-term prognosis of patients.