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Arquivos Brasileiros de Cardiologia Feb 2009
Review
Topics: Humans; Myocardial Infarction; Ventricular Dysfunction; Ventricular Remodeling
PubMed: 19360249
DOI: 10.1590/s0066-782x2009000200013 -
International Journal of Molecular... Jan 2021Trauma remains a leading global cause of mortality, particularly in the young population. In the United States, approximately 30,000 patients with blunt cardiac trauma... (Review)
Review
Trauma remains a leading global cause of mortality, particularly in the young population. In the United States, approximately 30,000 patients with blunt cardiac trauma were recorded annually. Cardiac damage is a predictor for poor outcome after multiple trauma, with a poor prognosis and prolonged in-hospitalization. Systemic elevation of cardiac troponins was correlated with survival, injury severity score, and catecholamine consumption of patients after multiple trauma. The clinical features of the so-called "commotio cordis" are dysrhythmias, including ventricular fibrillation and sudden cardiac arrest as well as wall motion disorders. In trauma patients with inappropriate hypotension and inadequate response to fluid resuscitation, cardiac injury should be considered. Therefore, a combination of echocardiography (ECG) measurements, echocardiography, and systemic appearance of cardiomyocyte damage markers such as troponin appears to be an appropriate diagnostic approach to detect cardiac dysfunction after trauma. However, the mechanisms of post-traumatic cardiac dysfunction are still actively being investigated. This review aims to discuss cardiac damage following trauma, focusing on mechanisms of post-traumatic cardiac dysfunction associated with inflammation and complement activation. Herein, a causal relationship of cardiac dysfunction to traumatic brain injury, blunt chest trauma, multiple trauma, burn injury, psychosocial stress, fracture, and hemorrhagic shock are illustrated and therapeutic options are discussed.
Topics: Animals; Biomarkers; Complement Activation; Disease Management; Disease Susceptibility; Energy Metabolism; Heart Diseases; Heart Function Tests; Humans; Severity of Illness Index; Ventricular Dysfunction; Wounds and Injuries
PubMed: 33450984
DOI: 10.3390/ijms22020737 -
JACC. Cardiovascular Imaging Oct 2017
Topics: Cardiac Imaging Techniques; Humans; Phenotype; Predictive Value of Tests; Prognosis; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 29025580
DOI: 10.1016/j.jcmg.2017.09.001 -
The Journal of Thoracic and... Jul 2001Right heart failure after cardiopulmonary bypass can result in severe hemodynamic compromise with high mortality, but the underlying mechanisms remain poorly understood....
BACKGROUND
Right heart failure after cardiopulmonary bypass can result in severe hemodynamic compromise with high mortality, but the underlying mechanisms remain poorly understood. After ischemia-induced right ventricular failure, alterations in the interventricular septal position decrease left ventricular compliance and limit filling but may also distort left ventricular geometry and compromise contractility and relaxation. This study investigated the effect of acute isolated right ventricular ischemia on biventricular performance and interaction and the response of subsequent right ventricular unloading by use of a modified Glenn shunt.
METHODS
In 8 pigs isolated right ventricular ischemic failure was induced by means of selective coronary ligation. A modified Glenn circuit was then established by a superior vena cava-pulmonary artery connection. Ventricular performance was determined by conductance catheter-derived right ventricular pressure-volume loops and left ventricular pressure-segment length loops. Hemodynamic data at baseline, after right ventricular ischemia, and after institution of the Glenn circuit were obtained during inflow occlusion, and the load-independent contractile indices were derived.
RESULTS
Right ventricular free-wall ischemia resulted in acute right ventricular dilation (118 +/- 81 mL vs 169 +/- 70 mL, P =.0008) and impairment of left ventricular contractility indicated by the reduced end-systolic pressure-volume relation slope (50.0 +/- 19 mm Hg/mm vs 18.9 +/- 8 mm Hg/mm, P =.002) and preload recruitable stroke work index slope (69.6 +/- 26 erg x cm(-3) x 10(3) vs 39.7 +/- 13 erg x cm(-3) x 10(3), P =.003). In addition, left ventricular relaxation (tau) was significantly prolonged (33.3 +/- 10 ms vs 53.0 +/- 16 ms, P =.012). Right ventricular unloading with the Glenn shunt reduced right ventricular dilation and significantly improved left ventricular contraction, end-systolic pressure-volume relation slope (18.9 +/- 8 mm Hg/mm vs 35.8 +/- 18 mm Hg/mm, P =.002), preload recruitable stroke work index slope (39.7 +/- 26 erg x cm(-3) x 10(3) vs 63.0 +/- 22 erg x cm(-3) x 10(3), P =.003), and diastolic performance (tau 53.0 +/- 16 ms vs 43.5 +/- 13 ms, P =.001).
CONCLUSIONS
Right ventricular ischemia-induced dilation resulted in acute impairment of left ventricular contractility and relaxation. A modified Glenn shunt attenuated the left ventricular dysfunction by limiting right ventricular dilation and restoring left ventricular cavity geometry.
Topics: Animals; Diastole; Dilatation, Pathologic; Disease Models, Animal; Female; Heart Bypass, Right; Heart Ventricles; Hemodynamics; Male; Myocardial Ischemia; Swine; Systole; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 11436040
DOI: 10.1067/mtc.2001.114632 -
Circulation Journal : Official Journal... 2014Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome and stress-induced cardiomyopathy, is typically characterized by transient systolic... (Review)
Review
Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome and stress-induced cardiomyopathy, is typically characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle, in the absence of obstructive coronary artery lesions. Patients may present with symptoms and signs of acute coronary syndrome, and the provider is challenged to differentiate between these conditions. In this review, we guide the reader through the diagnostic pathway, focusing on differential diagnoses and diagnostic criteria for takotsubo cardiomyopathy.
Topics: Diagnosis, Differential; Female; Heart Ventricles; Humans; Male; Stress, Physiological; Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left
PubMed: 25131525
DOI: 10.1253/circj.cj-14-0859 -
Current Cardiology Reports May 2005Studies have demonstrated that diastolic dysfunction is frequently present in asymptomatic community-based individuals, especially in the elderly with hypertension,... (Review)
Review
Studies have demonstrated that diastolic dysfunction is frequently present in asymptomatic community-based individuals, especially in the elderly with hypertension, coronary artery disease, and diabetes. The presence of diastolic dysfunction is a predictor for the development of heart failure (HF) and confers a higher risk of mortality. These findings have raised the question of whether treating preclinical diastolic dysfunction will be helpful in preventing or delaying the onset of clinical HF and mortality, as has been proven with treatment of asymptomatic left ventricular systolic dysfunction. In addition, in some individuals, diastolic dysfunction in the presence of a normal ejection fraction is associated with exercise intolerance as well as symptomatic clinical HF, referred to as diastolic HF. Patients with diastolic HF, who are more often elderly women, have a significant mortality and morbidity burden compared with age-matched controls. Studies that further our understanding of mechanisms underlying diastolic dysfunction and diastolic HF will provide potential new targets for development of effective therapies for these conditions.
Topics: Age Factors; Diastole; Exercise; Heart Failure; Humans; Prevalence; Prognosis; Sex Factors; Ventricular Dysfunction
PubMed: 15865857
DOI: 10.1007/s11886-005-0074-7 -
Critical Care Nursing Quarterly May 1995Even with multiple medical advancements, heart failure patients still have a dismal prognosis. Technologic improvements in coronary artery bypass graft (CABG) surgery... (Review)
Review
Even with multiple medical advancements, heart failure patients still have a dismal prognosis. Technologic improvements in coronary artery bypass graft (CABG) surgery have led to the use of high-risk myocardial revascularization for the treatment of patients with heart failure and severe ventricular dysfunction. This article describes advances in cardiac surgery and their impact on the treatment of heart failure. Postoperative management of the heart failure patient is also discussed. Because patient selection is important in achieving positive surgical outcomes, the role of prospective severity risk score is also addressed.
Topics: Heart Failure; Humans; Myocardial Revascularization; Patient Selection; Prognosis; Ventricular Dysfunction
PubMed: 7719947
DOI: 10.1097/00002727-199505000-00006 -
Circulation. Heart Failure Feb 2017
Topics: Echocardiography; Extracorporeal Membrane Oxygenation; Female; Heart Failure; Humans; Male; Middle Aged; Oxygen; Thrombosis; Treatment Outcome; Ventricular Dysfunction
PubMed: 28188269
DOI: 10.1161/CIRCHEARTFAILURE.116.003757 -
PloS One 2019Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and...
BACKGROUND
Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients.
METHODS AND FINDINGS
A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24%) had normal LV filling pattern, 20 patients (49%) had grade 1, and 11 patients (27%) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to ≥15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20%) with mild and 7 patients (63%) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001).
CONCLUSIONS
Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.
Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Diastole; Female; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Oxygen Consumption; Stroke Volume; Ventricular Dysfunction; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Left
PubMed: 31361748
DOI: 10.1371/journal.pone.0215364 -
Journal of the Neurological Sciences Feb 2019Takotsubo syndrome(TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate... (Review)
Review
Takotsubo syndrome(TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate and delayed detection of seizure-induced TTS differ. We screened the literature and compared clinical and electrocardiographic (ECG) findings. In 48 cases with seizure-associated TTS, the time between seizure and TTS-detection was reported. Troponin levels were elevated in 37/40. ECG abnormalities were negative T-waves(40%), ST-elevations(33%) and ventricular fibrillation/flutter(10%). Immediate detection was reported in 23 patients, in the remaining 25 patients, TTS was detected 5-288 h postictally. Patients did not differ in gender, age or symptoms. Negative T-waves were more frequent in patients with delayed detection(64 vs. 13%, p = .0009), whereas ECG-abnormalities suggesting acute myocardial infarction tended to be more prevalent in patients with immediate detection. Due to lack of typical symptoms, seizure-induced TTS can be overlooked. Postictally, an ECG should be recorded and troponin levels measured. New T-wave inversions might indicate seizure-induced TTS.
Topics: Electrocardiography; Humans; Seizures; Takotsubo Cardiomyopathy; Time Factors; Ventricular Dysfunction, Left
PubMed: 30583237
DOI: 10.1016/j.jns.2018.12.005