ABSTRACT
A 46-year-old man with a personal history of a repaired aortic dissection was admitted because of hemolytic anemia. The transesophageal echocardiogram displayed an accelerated flow and a residual intimal flap in the proximal descending aorta. A total arch replacement was performed, the flap was removed, and his hemolytic anemia was resolved. (Level of Difficulty: Advanced.).
ABSTRACT
INTRODUCTION AND OBJECTIVES: Mortality remains high in cardiogenic shock (CS), especially in refractory CS involving the use of mechanical circulatory support (MCS) devices. The aim of this study was to analyze the results of a care program for patients in CS after the creation of a multidisciplinary team in our center and a regional network of hospitals in our area. METHODS: Observational and retrospective study of patients attended in this program from September 2014 to January 2019. We included patients in refractory CS who required MCS and those who, because of their age and absence of comorbidities, were candidates for advanced therapies. The primary endpoint was survival to discharge. RESULTS: A total of 130 patients were included (69 local and 61 transferred patients). The mean age was 52±15 years (72% men). The most frequent causes of CS were acute decompensated heart failure (29%), acute myocardial infarction (26%), and postcardiotomy CS (25%). MCS was used in 105 patients (81%), mostly extracorporeal membrane oxygenation (58%). Survival to discharge was 57% (74 of 130 patients). The most frequent destinations were myocardial recovery and heart transplant. Independent predictors of in-hospital mortality were SAPS II score, lactate level, acute myocardial infarction etiology, and vasoactive-inotropic score. CONCLUSIONS: The creation of multidisciplinary teams for patients with mainly refractory CS and a regional network is feasible and allows survival to discharge in more than a half of attended patients with CS.
Subject(s)
Shock, Cardiogenic , Adult , Aged , Female , Heart-Assist Devices , Humans , Male , Middle Aged , Retrospective Studies , Shock, Cardiogenic/epidemiology , Shock, Cardiogenic/therapy , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: Anxiety is often present among patients with atrial fibrillation (AF). This condition has been associated with greater symptom severity and worse quality of life in these patients. However, the influence of anxiety on the risk of AF recurrence is not well known. We aimed to define the level of anxiety in patients with persistent AF undergoing elective cardioversion (EC) and determine whether there is an association between anxiety and the risk of early AF recurrence after EC. METHODS: Anxiety was measured before EC using the State-Trait Anxiety Inventory. Early AF recurrence was assessed with a control electrocardiogram at 30-day follow-up. RESULTS: We included 107 patients undergoing effective EC. Early AF recurrence was diagnosed in 40 patients (37.4%). Compared with those who remained in sinus rhythm, individuals with early AF recurrence had significantly higher levels of trait anxiety (23.1 [10.4] versus 17.9 [9.5]; p = .013) and larger left atrial volume index (45.8 [12.3] versus 37.9 [13.3] ml/m; p = .004). Both variables remained independently associated with early AF recurrence after multivariate analysis. A predictive model including trait anxiety score >20 and left atrial volume index >41 ml/m showed acceptable accuracy for the diagnosis of early AF recurrence (area under the curve = 0.733; 95% confidence interval = 0.634-0.832; p < .001). CONCLUSIONS: Our study shows that trait anxiety is an independent risk factor for early AF recurrence after EC. Further studies are warranted to assess the beneficial role of anxiety-reducing strategies on the outcomes of patients with AF.
Subject(s)
Atrial Fibrillation , Anxiety , Electric Countershock , Humans , Quality of Life , Recurrence , Treatment OutcomeSubject(s)
Coronary Vessels/diagnostic imaging , Embolism/complications , Endocarditis, Bacterial/complications , Myocardial Infarction/etiology , Coronary Angiography , Embolism/diagnostic imaging , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Enterococcus faecalis , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/diagnosis , Humans , Male , Middle AgedSubject(s)
Acute Coronary Syndrome/mortality , Dehydration/blood , Acute Coronary Syndrome/blood , Acute Coronary Syndrome/complications , Aged , Dehydration/etiology , Female , Follow-Up Studies , Humans , Male , Osmolar Concentration , Prognosis , Retrospective Studies , Spain/epidemiology , Survival Rate/trendsSubject(s)
Cardiology , Cardiology/trends , Heart Diseases/therapy , Humans , Physician's Role , SpainABSTRACT
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