Background. The term “ATAK” complex has been coined by the association of adrenaline, takotsubo, anaphylaxis and Kounis syndrome. We present an uncommon case of an “ATAK” complex with biphasic onset ...and a midventricular takotsubo pattern. Case Summary. A 50-year-old male was brought to the emergency department in anaphylactic shock. He had progressive exertional dyspnea and angina for the past 2 days. The intravenous administration of adrenaline for anaphylactic shock resulted in chest pain and concerning ECG repolarization findings. The patient was immediately transferred to the catheterization laboratory. Coronary angiography showed a midventricular ballooning pattern without significant coronary stenosis, with subsequent recovery during hospitalization, suggestive of takotsubo syndrome. The allergy tests remained inconclusive for the trigger. Discussion. Adrenaline-mediated stress is the link between these two entities, in which Kounis syndrome itself or anaphylactic shock treatment (adrenaline) are potential triggers for takotsubo syndrome.
ABSTRACT Percutaneous coronary intervention (PCI) plays a key role in the management of patients with obstructive coronary artery disease. Besides, depending on the patients’ clinical presentation, ...characteristics, comorbidities, and coronary anatomy, an increasing number of patients will undergo a high-risk PCI. Left ventricular assist devices, as the intra-aortic balloon pump, TandemHeart, Impella, HeartMate PHP, and extracorporeal membrane oxygenation are useful tools to provide circulatory support for high-risk PCIs. Some studies and trials have assessed its impact on this clinical scenario with controversial results. This review provides an overview on the scientific evidence available on the use of left ventricular assist devices and their potential role in high-risk PCI.
Abstract
Background
Ex vivo lung perfusion (EVLP) constitutes a tool with great research potential due to its advantages over in vivo and in vitro models. Despite its important contribution to lung ...reconditioning, this technique has the disadvantage of incurring high costs and can induce pulmonary endothelial injury through perfusion and ventilation. The pulmonary endothelium is made up of endothelial glycocalyx (EG), a coating of proteoglycans (PG) on the luminal surface. PGs are glycoproteins linked to terminal sialic acids (Sia) that can affect homeostasis with responses leading to edema formation. This study evaluated the effect of two ex vivo perfusion solutions on lung function and endothelial injury.
Methods
We divided ten landrace swine into two groups and subjected them to EVLP for 120 min: Group I (n = 5) was perfused with Steen® solution, and Group II (n = 5) was perfused with low-potassium dextran-albumin solution. Ventilatory mechanics, histology, gravimetry, and sialic acid concentrations were evaluated.
Results
Both groups showed changes in pulmonary vascular resistance and ventilatory mechanics (p < 0.05, Student’s t-test). In addition, the lung injury severity score was better in Group I than in Group II (p < 0.05, Mann–Whitney U); and both groups exhibited a significant increase in Sia concentrations in the perfusate (p < 0.05 t-Student) and Sia immunohistochemical expression.
Conclusions
Sia, as a product of EG disruption during EVLP, was found in all samples obtained in the system; however, the changes in its concentration showed no apparent correlation with lung function.
RESUMEN La intervención coronaria percutánea (ICP) desempeña un papel fundamental en el tratamiento de los pacientes con enfermedad coronaria obstructiva. De ellos, un porcentaje significativo se ...someterán a un procedimiento de alto riesgo, en función de la presentación clínica, las características del paciente y su anatomía coronaria. Los dispositivos de asistencia ventricular izquierda, como el balón intraaórtico de contrapulsación, el dispositivo TandemHeart, el Impella, los dispositivos HeartMate PHP y las técnicas de oxigenación veno-arterial con oxigenador extracorpóreo de membrana (ECMO), son herramientas empleadas para proporcionar soporte circulatorio en la ICP de alto riesgo, con un impacto creciente en la práctica clínica. Existen numerosos trabajos en la literatura científica sobre su empleo en este escenario, con resultados controvertidos. Esta revisión proporciona una visión general de la evidencia disponible sobre el empleo de los distintos tipos de dispositivos, así como de su potencial papel en la ICP de alto riesgo.
The multivariate analysis, adjusted by age and number of ECGs interpreted a week, showed that using a correct automated interpretation, in comparison of not using it, had an odds ratio of a better ...diagnostic success of 2.09 (95% confidence interval, 1.52-2.87; P<.001). 1-Common atrial flutter 74.6 76.8 .464 2-Complete atrioventricular block 46.3 82.1 <.001 3-Pacemaker malfunction 0 1.8 .307 4-Anterior myocardial infarction 74.6 83.9 .001 5-Left ventricular hypertrophy 59.7 55.4 .771 6-Inferior myocardial infarction 73.1 76.8 .083 ECGs incorrectly diagnosed by the machine (%)
The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased ...series with COVID-19, comparing specifically between unexpected and expected deaths.
In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods.
In total, 324 deceased patients were included. Median age was 82 years (IQR 76-87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0-8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence.
This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.
The diagnostic yield of invasive coronary angiography (ICA) to identify obstructive coronary artery disease in the context of chronic coronary syndromes (CCS) is very low. Furthermore, myocardial ...ischemia may have a non-obstructive origin, which cannot be detected by ICA.
AID-ANGIO is an observational, prospective, single-cohort, multicenter study, intended to evaluate the diagnostic yield of adopting a hierarchical strategy to assess obstructive and non-obstructive causes of myocardial ischemia in an all-comers population of patients with CCS at the time of ICA. The primary endpoint will investigate the additional diagnostic value of such strategy over angiography alone regarding the identification of ischemia-generating mechanisms.
An estimated sample of consecutive 260 patients with CCS referred by their clinicians to ICA, will be enrolled. In a stepwise manner, a conventional ICA will be performed as the initial diagnostic tool. Those patients with severe-grade stenosis will not undergo further assessment and an obstructive origin for myocardial ischemia will be assumed. Subsequently, the remainder with intermediate-grade stenosis will be assessed with pressure guidewires. Those with a negative result from physiological evaluation and those without epicardial coronary stenosis will be further studied for ischemia of non-obstructive origin, including microvascular dysfunction and vasomotor disorders. The study will be conducted in two steps. Firstly, ICA images will be displayed to patient's referring clinicians, who will be asked to identify the existent epicardial stenosis, their angiographic severity and probable physiological relevance, together with a tentative therapeutic approach. Then, the diagnostic algorithm will continue to be applied and, considering the whole gathered information, a definite therapeutic plan will be consensually established by the interventional cardiologist and patient's referring clinicians.
The AID-ANGIO study will assess the additional diagnostic yield of a hierarchical strategy over ICA alone to identify ischemia-generating mechanisms in patients with CCS and its impact on therapeutic approach. Positive results of the study might support a streamlined invasive diagnostic process for patients with CCS.
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