ABSTRACT
Electrical impedance tomography (EIT) is an emerging imaging modality that can be used to diagnose ventilatory and intrathoracic perfusion mismatches in unstable patients at the bedside. We present a case of a postoperative hypoxic patient in the intensive care unit (ICU) who was too unstable for transport for computed tomography (CT) imaging but was diagnosed and treated for a pulmonary embolism using EIT at the bedside. After the patient clinically improved, CT imaging confirmed the pulmonary embolism diagnosis. EIT is a promising diagnostic tool that may have great utility in ICUs, where it can be safely applied at the bedside.
Subject(s)
Pulmonary Embolism , Tomography , Electric Impedance , Humans , Intensive Care Units , Pulmonary Embolism/diagnostic imaging , Tomography/methods , Tomography, X-Ray Computed/methodsSubject(s)
Blood Preservation , Blood Transfusion , Hyperammonemia/diagnosis , Hyperammonemia/etiology , Humans , Male , Middle AgedSubject(s)
Abdominal Pain/etiology , Coronary Thrombosis/drug therapy , Dyspnea/etiology , Hyperglycemia/drug therapy , Pericarditis/etiology , ST Elevation Myocardial Infarction/complications , Tachycardia, Sinus/etiology , Abscess/complications , Abscess/etiology , Abscess/therapy , Adult , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cardiac Catheterization , Coronary Thrombosis/diagnosis , Drug-Eluting Stents , Electrocardiography , Fatal Outcome , Female , Heart/microbiology , Humans , Hyperglycemia/diagnosis , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Pericardiocentesis , Pericarditis/complications , Pericarditis/therapy , Platelet Activating Factor/therapeutic use , ST Elevation Myocardial Infarction/drug therapy , ST Elevation Myocardial Infarction/pathology , Tachycardia, Sinus/diagnosis , Tachycardia, Sinus/drug therapy , Urinary Tract Infections/drug therapyABSTRACT
The "lipotoxic footprint" of cardiac maladaptation in diet-induced obesity is poorly defined. We investigated how manipulation of dietary lipid and carbohydrate influenced potential lipotoxic species in the failing heart. In Wistar rats, contractile dysfunction develops at 48 weeks on a high-fat/high-carbohydrate "Western" diet, but not on low-fat/high-carbohydrate or high-fat diets. Cardiac content of the lipotoxic candidates--diacylglycerol, ceramide, lipid peroxide, and long-chain acyl-CoA species--was measured at different time points by high-performance liquid chromatography and biochemical assays, as was lipogenic capacity in the heart and liver by qRT-PCR and radiometric assays. Changes in membranes fluidity were also monitored using fluorescence polarization. We report that Western feeding induced a 40% decrease in myocardial palmitoleoyl-CoA content and a similar decrease in the unsaturated-to-saturated fatty acid ratio. These changes were associated with impaired cardiac mitochondrial membrane fluidity. At the same time, hepatic lipogenic capacity was increased in animals fed Western diet (+270% fatty acid elongase activity compared with high-fat diet), while fatty acid desaturase activity decreased over time. Our findings suggest that dysregulation of lipogenesis is a significant component of heart failure in diet-induced obesity.
