Subject(s)
Humans , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Cardiac Output, Low/complications , Cardiovascular Agents/administration & dosage , Myocardial Reperfusion , Heart Transplantation , Coronary Care Units , Hypovolemia/therapy , Electrocardiography/methods , Acute Coronary Syndrome/etiologySubject(s)
Humans , Female , Lupus Erythematosus, Systemic/complications , Myocarditis/diagnosis , Myocarditis/etiology , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Echocardiography , Tomography, X-Ray Computed , Antibodies, Antinuclear/blood , Lupus Erythematosus, Systemic/diagnosisABSTRACT
Abstract Takotsubo Cardiomyopathy mainly occurs in postmenopausal women, with or with- out cardiovascular disease, and is commonly associated with emotional or physical stress. After nearly 27 years of extensive efforts towards a better understanding of this disorder, current knowledge remains limited. Many people suffer post-traumatic stress, and this situation can be associated to stress cardiomyopathy. The case is presented of a female who suffers stress asso- ciated with the earthquake of 19 September 2017 in Mexico City, and arrived in the Emergency Department in cardiogenic shock.
Resumen La miocardiopatía de Takotsubo ocurre principalmente en mujeres posmenopáusicas con o sin enfermedad cardiovascular, y se asocia comúnmente con estrés emocional o físico. Después de casi 27 an˜os de esfuerzos extensos para una mejor comprensión de este trastorno, el conocimiento actual sigue siendo limitado. Muchas personas sufren estrés postraumático y esta situación puede estar asociada a la cardiomiopatía por estrés. Presentamos el caso clínico de una mujer que sufrió estrés relacionado con el pasado terremoto del 19 de septiembre en la Ciudad de México y llegó al servicio de urgencias en choque cardiogénico.
Subject(s)
Humans , Female , Aged , Shock, Cardiogenic/diagnosis , Emergency Service, Hospital , Takotsubo Cardiomyopathy/diagnosis , Earthquakes , Shock, Cardiogenic/etiology , Takotsubo Cardiomyopathy/etiology , MexicoABSTRACT
Rituximab is a plausible alternative first-line treatment of ANCA-associated vasculitis. Adverse effects related to its infusion are common and usually have a benign course. However, there have been reports of refractory cardiogenic shock simulating septic shock. We report an 81-year-old male with the diagnosis of ANCA associated vasculitis. Rituximab 500 mg was administered intravenously for a relapse. The infusion proceeded without incident. However, 24 hours after its administration the patient began with fever, chills, coughing and strong malaise. The patient was transferred to the critical patient unit where a septic shock was suspected and resuscitative measures were started. However, the fast response to moderate doses of vasoactive drugs and complementary tests did not support an infectious etiology for the shock. Antimicrobials were discontinued and systemic corticosteroids were maintained, achieving remission of the symptoms. Shock as an unusual adverse reaction to Rituximab was suspected.
Subject(s)
Humans , Male , Aged, 80 and over , Shock, Cardiogenic/chemically induced , Antirheumatic Agents/adverse effects , Rituximab/adverse effects , Shock, Cardiogenic/diagnosis , Antirheumatic Agents/therapeutic use , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Rituximab/therapeutic useABSTRACT
O choque cardiogênico é uma síndrome clínica caracterizada por hipoperfusão tecidual secundária à disfunção cardíaca, na ausência de hipovolemia. A etiologia principal é o infarto agudo do miocárdio com falência de ventrículo esquerdo, embora existam outras causas relevantes, como complicações mecânicas do infarto, miocardites, evolução de cardiomiopatias, valvopatias agudas não isquêmicas e cardiomiopatia induzida pelo estresse, por exemplo. Apesar dos avanços terapêuticos, persiste como uma afecção de elevada mortalidade e sua incidência não se modificou significativamente nas últimas décadas. A instalação do choque em pacientes com síndromes coronarianasagudas ocorre mais frequentemente após a internação hospitalar, ressaltandoa importância da identificação de preditores e da monitorização de sinais precoces de hipoperfusão tecidual para pronta intervenção. O diagnóstico é essencialmente clínico e alguns exames subsidiários, como eletrocardiograma, marcadores de necrose miocárdica,ecocardiograma e cineangiocoronariografia, que são importantes para a definição da etiologia, estratificação da gravidade e do prognóstico. O manejo adequado dos pacientes requer avaliação dos parâmetros de macro e micro-hemodinâmica. Os principais objetivos terapêuticos incluem a restauração precoce da perfusão tecidual sistêmica ea recuperação da função ventricular. O tratamento inclui medidas gerais para pacientes com choque como ajuste de volemia e adequação da perfusão tecidual com uso de inotrópicos, vasopressores e dispositivos de assistência ventricular, além de medidasespecíficas, direcionadas para a etiologia do choque, como a revascularização precoce nas síndromes coronarianas agudas...
Cardiogenic shock is a clinical syndrome characterized by tissue hypoperfusionsecondary to cardiac dysfunction, in the absence of hypovolemia. Left ventricular failure complicating acute myocardial infarction is the main cause, although other relevant causes include mechanical complications of infarction, myocarditis, progression of cardiomyopathies, acute non-ischemic valvular heart disease, and stress-induced cardiomyopathies, for example. Despite therapeutic advances, it persists as a condition of high mortality, and its incidence has not changed significantly in the last decades.The onset of cardiogenic shock in patients with acute coronary syndromes frequently occurs after hospital admission, reinforcing the importance of identifying predictors and monitoring early signs of tissue hypoperfusion for prompt intervention. The diagnosisis essentially clinical plus some additional tests such as electrocardiogram, myocardial necrosis markers, echocardiogram, and coronary angiography, which are important fordefining the etiology, stratification of severity and prognosis. Proper management of patients requires assessment of macro- and micro-hemodynamic parameters. The maintherapeutic goals include early restoration of tissue perfusion and recovery of ventricular function. Treatment includes general medical care for patients with shock as optimizingvolemia and adjusting of tissue perfusion with inotropic agents, vasopressors and ventricular assist devices, as well as specific interventions focused on the shock etiology, like early revascularization in acute coronary syndromes...
Subject(s)
Humans , Shock, Cardiogenic/complications , Shock, Cardiogenic/diagnosis , Myocardial Infarction/etiology , Myocardial Reperfusion/methods , Acute Coronary Syndrome/etiology , Angioplasty/methods , Pulmonary Artery/surgery , Catheters , Dobutamine/administration & dosage , Echocardiography, Doppler/methods , Risk Factors , Prognosis , Thrombolytic Therapy/methods , Heart VentriclesABSTRACT
A cardiomiopatia de Takotsubo se caracteriza por alterações reversíveis na função sistólica e segmentar do ventrículo esquerdo associada à coronariografia normal. O choque associado a essa cardiomiopatia é causado por disfunção sistólica e/ou obstrução dinâmica do trato de saída do ventrículo esquerdo. A identificação da etiologia do choque tem implicações terapêuticas. Relata-se o caso de paciente feminina, 76 anos, com cardiomiopatia de Takotsubo cuja apresentação mimetizou infarto agudo do miocárdio complicado com choque cardiogênico. O choque foi revertido após administração endovenosa de propranolol.
Takotsubo cardiomyopathy is characterized by reversible changes in the systolic and segmental left ventricular function associated with normal coronariography. The shock associated with this cardiomyopathy is caused by left ventricular systolic dysfunction and/or dynamic left ventricular outflow tract obstruction. Identification of the etiology of the shock has implications for treatment. This case study reports on a 76-year-old women diagnosed with Takotsubo cardiomyopathy whose presentation mimicked an acute myocardial infarction complicated by cardiogenic shock. The shock was reversed after intravenous administration of propanolol.
Subject(s)
Humans , Female , Aged , Adrenergic beta-Antagonists , Takotsubo Cardiomyopathy/etiology , Takotsubo Cardiomyopathy/psychology , Shock, Cardiogenic/complications , Shock, Cardiogenic/diagnosis , Mitral Valve , Echocardiography/instrumentation , Electrocardiography/instrumentationABSTRACT
As doenças cardiovasculares são responsáveis por 34% de todas as causas de morte no Brasil. De acordo com o Ministério da Saúde, foram registrados 500 mil casos de infarto agudo do miocárdio em 1998, com 56 mil óbitos (1). A incidência de choque cardiogênico não sofreu alterações significativas nas últimas três décadas. Ocorre em 5% a 15% dos pacientes com IAM e constitui a principal causa de morte na fase de tratamento hospitalar dos pacientes com infarto agudo do miocárdio
Cardiovascular diseases are responsible for 34% of all causes of deaths in Brazil. According to Department of Health, five hundred thousand of acute myocardial infarction cases in 1998 were registered, resulting in fifty-six thousand deaths related to the disease. The incidence of cardiogenic shock has not meaningful changing in the last three decades. It happens in 5% to 15% with IAM and it's the main cause of deaths with acute myocardial infarction in hospitalar treatment stage
Subject(s)
Humans , Male , Female , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Myocardial Infarction/complications , Hypoxia/etiology , Cardiotonic Agents/administration & dosage , Dobutamine/therapeutic use , Cardiovascular Diseases/mortality , Intubation, Intratracheal , Respiration, Artificial , Vasoconstrictor Agents/therapeutic useABSTRACT
Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
Subject(s)
Aged , Humans , Male , Acute Disease , Coronary Angiography , Diagnosis, Differential , Heart Atria/diagnostic imaging , Heart Failure/diagnosis , Mitral Valve Insufficiency/diagnostic imaging , Myocardial Infarction/complications , Pulmonary Edema/diagnosis , Shock, Cardiogenic/diagnosis , Tomography, X-Ray ComputedSubject(s)
Aged , Humans , Male , Chagas Cardiomyopathy/complications , Coronary Artery Disease/complications , Heart Failure/etiology , Cardiac Tamponade/diagnosis , Diagnosis, Differential , Fatal Outcome , Heart Failure/pathology , Myocardium/pathology , Pulmonary Embolism/diagnosis , Shock, Cardiogenic/diagnosisABSTRACT
O choque cardiogênico é caracterizado como um estado de hipoperfusão sistêmica secundária a disfunção cardíaca grave. Clinicamente é definido como pressão sistólica abaixo de 90mmHg ou queda da pressão arterial média de 30 mmHg em relação ao basal. Em termos hemodinâmicos, é definido como índice cardíaco menor que 1,8 1/min/m2 sem suporte ou entre 2,0 1/min/m2 e 2,2 1/min/m2 com suporte, além de pressão capilar pulmonar elevada em, pelo menos, 15 mmHg. Sua principal etiologia é o infarto agudo do miocárdio com supradesnivelamento de ST. Estudos recentes tem demonstrado que cerca de 20 por cento dos pacientes com choque cardiogênico evoluem com características clínicas e hemodinâmicas de resposta inflamatória sistêmica caracterizada por febre, leucocitose e diminuição da resistência vascular sistêmica. Neste artigo discutiremos esses aspectos e as implicações dessa apresentação.
Subject(s)
Humans , Shock, Cardiogenic/complications , Shock, Cardiogenic/diagnosis , Sepsis/complications , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosisABSTRACT
A intoxicação medicamentosa por dissulfiram é uma situação rara, mas, que pode se apresentar com manifestações cardiovasculares graves e potencialmente fatais, como choque cardiogênico. É apresentado o caso de uma paciente com choque refratário, após intoxicação voluntária por dissulfiram. A avaliação clínica e bioquímica, junto à avaliação ecocardiográfica e à monitorização invasiva, confirmaram tratar-se de um choque cardiogênico associado a esse fármaco. São discutidos os mecanismos de ação conhecidos do dissulfiram e descritos os principais efeitos colaterais, especialmente os cardiovasculares, alertando para a importância da suspeição diagnóstica e da abordagem terapêutica imediata mais adequada nesse contexto.
Drug intoxication with disulfiram is a rare condition that may lead to severe and potentially fatal cardiovascular manifestations such as cardiogenic shock. We report the case of a female patient with refractory shock after deliberate self-poisoning with disulfiram. Clinical, biochemical and echocardiographic assessment, as well as invasive monitoring confirmed cardiogenic shock associated with this drug. The known mechanisms of action of disulfiram are discussed, and the major collateral effects, especially cardiovascular effects, are described. We underscore the importance of suspecting this diagnosis and of adopting prompt and the most adequate therapeutic approach in this context.
La intoxicación medicamentosa por disulfiram es una situación rara, aunque puede presentarse con manifestaciones cardiovasculares graves y potencialmente fatales, como el shock cardiogénico. Este relato presenta el caso de una paciente con shock refractario, tras intoxicación voluntaria por disulfiram. La evaluación clínica y bioquímica, junto a la evaluación ecocardiográfica y el monitoreo invasivo, confirmaron tratarse de un shock cardiogénico asociado a ese fármaco. A lo largo del presente relato se discuten los mecanismos de acción del disulfiram conocidos, así como se describen los principales efectos colaterales, específicamente los cardiovasculares. En este sentido, también se alerta para la importancia de la sospecha diagnóstica y del abordaje terapéutico inmediato más adecuado a este contexto.
Subject(s)
Female , Humans , Middle Aged , Alcohol Deterrents/poisoning , Disulfiram/poisoning , Shock, Cardiogenic/chemically induced , Suicide, Attempted , Shock, Cardiogenic/diagnosisABSTRACT
Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction. The study represents a retrospective analysis in 20 patients presented with cardiogenic shock secondary to left ventricular dysfunction after acute myocardial infarction. Cardiogenic shock was defined according to clinical and hemodynamic criteria. Patients with cardiogenic shock secondary to mechanical complications were excluded. Coronary angiography was done in all patients: 5 patients were not eligible for revascularization, 14 patients had percutanous coronary intervention [PCI], and one patient had coronary artery bypass grafting [CABG]. The total in-hospital mortality was 45%. 100% of patients assigned to conservative treatment died during hospital stay, versus 26.6% mortality in patients who had coronary revascularization [PCI and CABG]. Among patients assigned to PCI, the in-hospital mortality was 28%. Early invasive coronary revascularization improves short term survival in patients with cardiogenic shock complicating acute myocardial infarction
Subject(s)
Humans , Male , Female , Shock, Cardiogenic/diagnosis , Myocardial Revascularization , Coronary Angiography , Electrocardiography , Treatment Outcome , MortalityABSTRACT
The mothers may be infected during pregnancy with infectious agents. Mumps induced myocarditis, especially endocardial fibroelastosis, was previously a common disease of infants but is rare now. A 25 day old male infant admitted to the intensive care of our hospital because of cardiogenic shock. Further studies revealed ischemic electrocardiograms, poor ventricular function, and positive results by polymerase chain reaction [PCR] technique for mumps virus. Regarding this case, although is very rare but mumps myocarditis should be included in the differential diagnosis of left ventricular dysfunction in neonatal period
Subject(s)
Humans , Male , Shock, Cardiogenic/diagnosis , Congenital, Hereditary, and Neonatal Diseases and Abnormalities , Myocarditis/etiology , Mumps/complications , Intensive Care, Neonatal , Electrocardiography , Polymerase Chain Reaction , Ventricular Function , Pregnancy Complications, Infectious , Immunoglobulins, Intravenous , Shock, Cardiogenic/therapyABSTRACT
O choque é um colapso circulatório resultante de inúmeras etiologias. Pode ser classificado em hipovolêmico, cardiogênico, obstrutivo e distributivo. A hemorragia é a causa mais comum de choque hipovolêmico. Infarto agudo do miocárdio deve ser sempre investigado no choque cardiogênico. No choque obstrutivo, drenagem pleural ou pericárdica pode ser suficiente para estabilizar o paciente. Antibioticoterapia é fundamental na terapêutica da sepse, etiologia mais freqüente do choque distributivo. Atualmente novas tecnologias estão à disposição e outras seguem em estudo.
Subject(s)
Humans , Shock , Anti-Bacterial Agents/therapeutic use , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/therapyABSTRACT
El shock es un síndrome multifactorial, siempresecundario a una patología desencadenante que esclaramente evidente en la mayoría de los casos. Elcuadro de shock compromete la vida de los pacientesy se caracteriza por un conjunto de signos y síntomasque dependen de la enfermedad subyacente, más losoriginados por la insuficiencia circulatoria aguda, lahipoperfusión periférica y los trastornos funcionales ymetabólicos de los distintos órganos afectados...
Subject(s)
Humans , Adult , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/physiopathologyABSTRACT
A condição de choque cardiogênico, caracterizada como uma situação de hipoperfusão tecidual devido à incapacidade do miocárdio em fornecer débito adequado às necessidades orgânicas, torna difícil a tarefa de nutrir esses pacientes. O conhecimento da repercussão do choque no trato gastrointestinal e das alterações no metabolismo glicídico e lipídico no miocárdio isquêmico, leva a supor que a meta nos pacientes com choque cardiogênico deva ser a nutrição da célula miocárdica, minimizando as alterações da função muscular causadas pela etiologia isquêmica do processo, e amenizando os efeitos eletéricos do choque no trato gastrointestinal.