Acute Myocardial Infarction Complicated by Cardiogenic Shock: Analysis of the Position Statement From the European Society of Cardiology Acute Cardiovascular Care Association, With Perioperative Implications.

Effective management of cardiogenic shock (CS) is hampered by a lack of evidence-based information. This is a high-mortality condition, without clear, evidence-based guidelines for perioperative management, specifically-a lack of target endpoints for treatment (e.g.: mean arterial pressure or oxygenation), utility of regional care systems or the benefits of palliative care. The Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) recently published a position statement that aimed to offer contemporary guidance on the diagnosis and treatment of acute myocardial infarction (AMI) complicated by CS. Herein, we review this complex clinical topic and review the ACCA statement on AMI associated with CS, with a focus on relevance to perioperative management.

Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects.

AIM: To summarize the current evidence on psychological issues in thoracic aortic disease (TAD) and infective endocarditis (IE) setting. METHODS: We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, PubMed and PsycINFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS: We found sixteen studies exploring psychological issues in patients with IE (six studies) and in TAD (ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE (four papers) and in TAD (eight papers). Depression and anxiety were analyzed in TAD only (five papers). Post-traumatic stress disorder was assessed in IE (one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION: Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.

Rationale and design of a multicenter, international and collaborative Coronary Artery Aneurysm Registry (CAAR).

Coronary artery aneurysm is defined as a coronary dilation that exceeds the diameter of adjacent segments or the diameter of the patient's largest normal coronary vessel by 1.5×. It is an uncommon disease that has been diagnosed with increasing frequency since the widespread appearance of coronary angiography. The published incidence varies from 1.5% to 5%, suggesting male dominance and a predilection for the right coronary artery. Although several causes have been described, atherosclerosis accounts for ≥50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture, and vasospasm, causing ischemia, heart failure, or arrhythmias. The natural history and prognosis remain unknown, as definitive data are scarce. Controversies persist regarding the use of medical management (antithrombotic therapy) or interventional/surgical procedures. Only some case reports or small case series are available about this condition. The Coronary Artery Aneurysm Registry (CAAR; http://www.ClinicalTrials.gov NCT02563626) is a multicenter international ambispective registry that aims to provide insights on anatomic, epidemiologic, and clinical aspects of this substantially unknown entity. In addition, the registry will assess management strategies (conservative, interventional, or surgical) and their short- and long-term results in a large cohort of patients. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov. Unique identifier: NCT02563626.

Psychological disorders in adults with inherited cardiomyopathies and Takotsubo syndrome. / Trastornos psicológicos en adultos con miocardiopatías hereditarias y síndrome de Takotsubo.

We performed a narrative review about psychological disorders in adults with Takotsubo syndrome and inherited cardiomyopathies. Through the electronic database PubMed and PsycINFO we searched all relevant related manuscripts published between 2000 and 2015. We found twelve studies that explore psychological disorders in Takotsubo syndrome and eight about inherited cardiomyopathies: five enrolled patients with hypertrophic cardiomyopathy, two dilated cardiomyopathy, and one arrhythmogenic right ventricular cardiomyopathy. All papers reported the presence of psychological disorders. In Takotsubo syndrome, depression fluctuates between 20.5 and 48% and anxiety was present among 26 and 56%. A study reported that anxiety increases the probability of developing Takotsubo syndrome. In dilated cardiomyopathy, anxiety was present in 50% and depression in 22%. In arrhythmogenic right ventricular cardiomyopathy, younger age, poorer functional capacity and having experienced at least one implantable cardioverter defibrillator shock, were significant independent predictors of both device-specific and generalized anxiety. In hypertrophic cardiomyopathy, anxiety and depression were present in 45.2% and 17.9%, respectively. Thirty seven percent met diagnostic criteria for anxiety disorders and 21% for mood disorders. Nearby half hypertrophic cardiomyopathy patients report triggering of chest pain, dyspnea, and dizziness by emotional stress. Due to the small number of studies, conclusions are limited. However, we discuss some results.

Realizamos una revisión narrativa sobre trastornos psicológicos en adultos con diagnóstico de síndrome de Takotsubo y miocardiopatías hereditarias. Utilizando las bases de datos PubMed y PsycINFO buscamos los trabajos relevantes publicados entre 2000 y 2015. Encontramos doce estudios que exploran alteraciones psicológicas en síndrome de Takotsubo y ocho estudios sobre miocardiopatías hereditarias: cinco enrolaron pacientes con miocardiopatía hipertrófica, dos miocardiopatía dilatada, uno miocardiopatía arritmogénica del ventrículo derecho. Todas las publicaciones reportaron la presencia de trastornos psicológicos. En el síndrome de Takotsubo, la depresión oscila entre el 20,5 y el 48% y la ansiedad estuvo presente entre el 26 y el 56%. Un estudio reporta que la ansiedad aumenta la probabilidad de desarrollar el síndrome de Takotsubo. En la miocardiopatía dilatada, la ansiedad estuvo presente en el 50% de los pacientes y la depresión en el 22%. En la miocardiopatía arritmogénica del ventrículo derecho, la edad más joven, peor capacidad funcional y haber experimentado al menos un shock por desfibrilador automático implantable, fueron predictores independientes significativos de ansiedad tanto específica por el dispositivo como generalizada. En la miocardiopatía hipertrófica, la ansiedad y la depresión estaban presentes en 45,2% y 17,9%, respectivamente. Treinta y siete por ciento cumplía con los criterios de diagnóstico para los trastornos de ansiedad y 21% para los trastornos del estado de ánimo. Cerca de la mitad de los pacientes con miocardiopatía hipertrófica informan dolor en el pecho, disnea y mareos desencadenados por estrés emocional. Debido al reducido número de estudios publicados, las conclusiones son limitadas. No obstante, presentamos algunos de los resultados.

Cardiopatía de estrés o síndrome de Tako-Tsubo: conceptos actuales / Stress-Related Cardiomyopathy or Tako-Tsubo Syndrome: Current Concepts

El síndrome de Tako-Tsubo, también conocido como cardiopatía de estrés o apical ballooning, representa una entidad recientemente descripta que mimetiza muchas de las características de un síndrome coronario agudo, clínicas, analíticas, electrocardiográficas y ecocardiográficas. La presencia de arterias coronarias sin obstrucciones significativas y la forma típica en la ventriculografía, junto con la ulterior recuperación total del ventrículo apoyan el diagnóstico. Se observa generalmente en mujeres posmenopáusicas y es frecuente la presencia de una situación estresante, tanto física como emocional. El tratamiento, empíricamente, es similar al del infarto agudo de miocardio, con especial atención en la introducción de betabloqueantes y anticoagulación. Aunque durante el momento agudo es una patología no exenta de complicaciones, predominantemente insuficiencia cardíaca, a largo plazo tiene buen pronóstico y su recurrencia es rara. En la presente revisión se discuten estos aspectos, así como la fisiopatología de este síndrome, cuyo diagnóstico es cada vez más frecuente en nuestro medio.

Tako-Tsubo syndrome, also referred to as stress-related cardiomyopathy or apical ballooning syndrome, is a condition that has been recently described mimicking an acute coronary syndrome in its clinical, analytical, electrocardiographic and echocardiographic characteristics. The diagnosis is made on the basis of coronary arteries with absence of significant obstruction, a typical left ventricular shape and complete recovery of ventricular function. This condition occurs mostly in post-menopausal women under some form of physical or mental stress. Treatment is empirical and similar to that of acute myocardial infarction, with special attention in the administration of beta blockers and anticoagulation therapy. Although associated complications, such as heart failure, may occur in the acute phase, its clinical course is favorable and recurrence is exceptional. These features, as well as the pathophysiology of this syndrome that is becoming more frequent in our environment, are discussed in this review.