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Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction

Firdaus MAM, Rahim NSA, Rusdi N, Idris NS, Mohd Said MR, Abidin IZ

Case Rep Cardiol, 2020;2020:8836627.
PMID: 32774930 DOI: 10.1155/2020/8836627

Ventricular wall rupture possesses a high mortality rate in patients with acute myocardial infarction. We presented a case of a ninety-year-old gentleman who presented with acute inferolateral myocardial infarction in cardiogenic shock and right ventricular free wall rupture. He was treated conservatively and survived.

Matched MeSH terms: Shock, Cardiogenic
Pulmonary edema of an unexpected cause

Abdullah HN, Khairina WW

South. Med. J., 2008 Oct;101(10):1035-7.
PMID: 18791521 DOI: 10.1097/SMJ.0b013e31817fbeb8

Atrial myxoma is rarely seen in practice. We report a 67-year-old female who presented with acute cardiac insufficiency and pulmonary edema. Cardiac murmur was not detected on precordial examination. Urgent echocardiography, however, revealed atrial myxoma causing mitral valve obstruction. We point out that a normal cardiac examination does not exclude atrial myxoma. The diagnosis may be delayed until significant myocardial dysfunction occurs, as reported here. The clinical presentation of cardiac myxoma is discussed, along with appropriate investigations and treatment.

Matched MeSH terms: Shock, Cardiogenic/etiology
Fulltext In-hospital mortality of cardiogenic shock complicating ST-elevation myocardial infarction in Malaysia: a retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry

Venkatason P, Zubairi YZ, Wan Ahmad WA, Hafidz MI, Ismail MD, Hadi MF, et al.

BMJ Open, 2019 05 05;9(5):e025734.
PMID: 31061031 DOI: 10.1136/bmjopen-2018-025734

OBJECTIVES: Cardiogenic shock (CS) complicating ST-elevation myocardial infarction (STEMI) carries an extremely high mortality. The clinical pattern of this life threatening complication has never been described in Malaysian setting. This study is to investigate the incidence, clinical characteristics and outcome of STEMI patients with CS in our population.
DESIGN: A retrospective analysis of STEMI patients from 18 hospitals across Malaysia contributing to the Malaysian National Cardiovascular Database-acute coronary syndrome) registry (NCVD-ACS) year 2006-2013.
PARTICIPANTS: 16 517 patients diagnosed of STEMI from 18 hospitals in Malaysia from the year 2006 to 2013.
PRIMARY OUTCOME MEASURES: In-hospital and 30 day post-discharge mortality.
RESULTS: CS complicates 10.6% of all STEMIs in this study. They had unfavourable premorbid conditions and poor outcomes. The in-hospital mortality rate was 34.1% which translates into a 7.14 times mortality risk increment compared with STEMI without CS. Intravenous thrombolysis remained as the main urgent reperfusion modality. Percutaneous coronary interventions (PCI) in CS conferred a 40% risk reduction over non-invasive therapy but were only done in 33.6% of cases. Age over 65, diabetes mellitus, hypertension, chronic lung and kidney disease conferred higher risk of mortality.
CONCLUSION: Mortality rates of CS complicating STEMI in Malaysia are high. In-hospital PCI confers a 40% mortality risk reduction but the rate of PCI among our patients with CS complicating STEMI is still low. Efforts are being made to increase access to invasive therapy for these patients.

Matched MeSH terms: Shock, Cardiogenic/complications*; Shock, Cardiogenic/mortality*; Shock, Cardiogenic/therapy
Postoperative death in a patient with unrecognized arrhythmogenic right ventricular dysplasia syndrome

Toh KW, Nadesan K, Sie MY, Vijeyasingam R, Tan PS

Anesth Analg, 2004 Aug;99(2):350-2, table of contents.
PMID: 15271703

Arrhythmogenic right ventricular dysplasia is an inherited disease causing fatty replacement of heart tissue. This disease often presents as T-wave inversion in the anterior leads of the electrocardiogram (ECG) with life-threatening ventricular arrhythmias. In older patients, progressive right and left ventricular failure can develop. This is a case report of postoperative death occurring in a 59-yr-old woman with undiagnosed arrhythmogenic right ventricular dysplasia after hepatic cystectomy. The patient had T-wave inversion in the inferior ECG leads and no history of arrhythmias. During general anesthesia, cardiovascular collapse occurred in the absence of arrhythmias that was unresponsive to resuscitation.

Matched MeSH terms: Shock, Cardiogenic/etiology
Fulltext Management of Takotsubo Syndrome: A Comprehensive Review

Sattar Y, Siew KSW, Connerney M, Ullah W, Alraies MC

Cureus, 2020 Jan 03;12(1):e6556.
PMID: 32042529 DOI: 10.7759/cureus.6556

Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy, is a transient left ventricular wall dysfunction that is often triggered by physical or emotional stressors. Although TTS is a rare disease with a prevalence of only 0.5% to 0.9% in the general population, it is often misdiagnosed as acute coronary syndrome. A diagnosis of TTS can be made using Mayo diagnostic criteria. The initial management of TTS includes dual antiplatelet therapy, anticoagulants, beta-blockers, angiotensin-converting enzyme inhibitors or aldosterone receptor blockers, and statins. Treatment is usually provided for up to three months and has a good safety profile. For TTS with complications such as cardiogenic shock, management depends on left ventricular outflow tract obstruction (LVOTO). In patients without LVOTO, inotropic agents can be used to maintain pressure, while inotropic agents are contraindicated in patients with LVOTO. In TTS with thromboembolism, heparin should be started, and patients should be bridged to warfarin for up to three months to prevent systemic emboli. Our comprehensive review discussed the management in detail, derived from the most recent literature from observational studies, systematic review, and meta-analyses.

Matched MeSH terms: Shock, Cardiogenic