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Pathophysiology of Heart Failure with Reduced Ejection Fraction
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Jacob Cao, John O'Sullivan, Sean Lal
Trimetazidine is a partial inhibitor of 3-ketoacyl CoA thiolase, a key enzyme involved in fatty acid oxidation. Numerous small-scale trials have been conducted, showing variable changes in cardiac function. A meta-analysis of nearly one thousand patients demonstrated improvements in ventricular hemodynamic and clinical outcomes, including exercise capacity, all-cause mortality, and combined cardiovascular events and hospitalization. Although most studies have been limited to ischemic cardiomyopathy, a more recent trial noted improvements in hemodynamic and functional status in non-ischemic cardiomyopathy patients.28
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
A cardiomyopathy is a primary myocardial disorder. It is different than structural cardiac disorders, including congenital heart disorders, coronary artery disease, or valvular disorders. There are three main types of cardiomyopathies which include dilated, hypertrophic, and restrictive cardiomyopathies. Dilated cardiomyopathy is myocardial dysfunction that results in HF, with ventricular dilation and systolic dysfunction. Hypertrophic cardiomyopathy is a congenital or acquired disorder, with extreme ventricular hypertrophy and diastolic dysfunction, lacking increased afterload – it may be caused by coarctation of the aorta, systemic hypertension, or valvular aortic stenosis. Restrictive cardiomyopathy involves noncompliant ventricular walls, which resist diastolic filling. When one ventricle is affected it is usually the LV. However, both ventricles can be affected. An ischemic cardiomyopathy can occur with severe CAD, with or without infarction. It is not a primary myocardial disorder. Cardiomyopathies are signified by signs and symptoms of HF, based on systolic, diastolic, or combined dysfunction. Diabetic cardiomyopathy is cardiac dysfunction with structural, functional, and metabolic alterations even though coronary artery disease may be absent.
Dopaminergic Prodrugs
Published in M.D. Francesco Amenta, Peripheral Dopamine Pathophysiology, 2019
Cesare Casagrande, Francesco Santangelo
The hemodynamic effects of an infusion of sodium nitroprusside (20 to 30 μg/min) — an increase in CI by 25% and in SWI by 23% — were potentiated by 200 mg of ibopamine administered during the infusion. The total increase in these indices was 55 and 48%, respectively. The patients with idiopathic cardiomyopathy responded to the combined treatment better than patients with ischemic cardiomyopathy.124 In this study, ibopamine further reduced SVR from - 19% on the nitroprusside infusion to a total of -42%, thus showing that it can enact its vasodilating activity even when SVR is lowered by a potent vasodilator such as nitroprusside.
Opportunities and drawbacks of the subcutaneous defibrillator across different clinical settings
Published in Expert Review of Cardiovascular Therapy, 2023
Vincenzo Russo, Michele Ciabatti, Michele Brunacci, Gregory Dendramis, Vincenzo Santobuono, Gianfranco Tola, Giuseppe Picciolo, Lucciola Maria Teresa, Antonello D’Andrea, Martina Nesti
Even if the recommendations for S-ICD implantation are not related to the etiology of the underlying disease, patients with ischemic cardiomyopathy have a reduced probability to receive an S-ICD, mainly due to the fair of sustained VT in need of anti-tachycardia pacing (ATP) or incident bradyarrhythmias in need of pacing [9]. However, it should be noted that only 15–20% of patients experienced a high rate of monomorphic VT during the first year after the implant with a subsequent risk is 1.8%/year; moreover, the proportion of both monomorphic VT and successful ATP was comparable between patients with ischemic and non-ischemic cardiomyopathy. Patients with ischemic cardiomyopathy had significantly less inappropriate therapy compared to patients with non-ischemic cardiomyopathy and appear to be appropriate patients for this type of device [15,16]. Moreover, patients with ischemic heart disease are particularly exposed to the risk of cardiac implanted device complications because of their comorbidities [5].
Cardiopulmonary resuscitation–induced consciousness
Published in Baylor University Medical Center Proceedings, 2021
Raman P. Singh, Soumya Adhikari, David Landsberg, Viren Kaul
A 64-year-old woman with ischemic cardiomyopathy presented with worsening dyspnea and lower-extremity swelling. She responded clinically to diuretics for heart failure but was unexpectedly found to be unresponsive and pulseless. CPR was initiated and rhythm check identified polymorphic ventricular tachycardia. She was defibrillated with administration of 1 mg of epinephrine and 2 g of magnesium sulfate. During the following round of compressions, the patient demonstrated purposeful movements and verbalized a desire to halt CPR. Compressions were discontinued and the patient’s movements and interactions ceased. She developed pulseless ventricular tachycardia and was defibrillated with resumption of compressions and administration of 300 mg of amiodarone. The patient again demonstrated purposeful movements. After 21 minutes of CPR, including four defibrillations, 2 mg of epinephrine, 2 mg of magnesium sulfate, and 300 mg of amiodarone, return of spontaneous circulation was obtained. The patient lost pulses again and her surrogate decision maker decided against further resuscitation.
Vulnerability for ventricular arrhythmias in patients with chronic coronary total occlusion
Published in Expert Review of Cardiovascular Therapy, 2020
Amira Assaf, Roberto Diletti, Mark G. Hoogendijk, Marisa van der Graaf, Felix Zijlstra, Tamas Szili-Torok, Sing-Chien Yap
The last decade, several studies have evaluated the association between CTO and the occurrence of VA in ICD recipients with coronary artery disease [5–8,32] (Table 1). One of the first studies was published in 2012 by Nombela-Franco et al (VACTO Primary Study) [6]. They evaluated in a single-center cohort the impact of unrevascularized CTO on the occurrence of VA in 162 patients with ischemic cardiomyopathy and a primary prevention ICD. The presence of an unrevascularized CTO was an independent predictor of appropriate ICD therapy. In contrast, Raja et al. found that the presence of a CTO (revascularized or not) was not associated with a higher mortality or VA [32]. In this single-center study, 307 patients with ischemic cardiomyopathy and an ICD for primary prevention were included. The study population consisted of 114 patients with unrevascularized CTO, 99 patients with revascularized CTO, and 94 patients without CTO. During a median follow-up of 4.1 years, 17% died and 32% had at least one episode of appropriate ICD therapy. Presence of a CTO (irrespective of revascularization) was not associated with the risk of appropriate ICD therapy or mortality.