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Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
The critical organs damaged in shock are the lungs, heart, kidneys, intestine, liver, and brain. The morphologies are not unique to septic shock, and may be seen in shock from other aetiologies. In the case of the lung, shock lung has a broadly similar morphology whether it follows from sepsis, drug toxicity, or external trauma such as high-pressure ventilation and oxygen toxicity. With regard to the heart, the clinical syndrome of ‘electromechanical dissociation (EMD)’ is a common pre-death observation. The ECG records electrical impulses, but the cardiac output measured both clinically and by echocardiography is slight. This results from overt ischaemic damage to myocytes and probably from direct toxic functional damage by TNF and other cytokines. Finally, as the result of the overactivation of the cytokine and cellular defence systems in the progressive and final stages of septic shock, there is an increased susceptibility to more bacterial infections (e.g. bronchopneumonia).
Cardiogenic Shock
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Many patients die almost instantly with rapid and irreversible electromechanical dissociation. Patients presenting with subacute FWR and hemopericardium appear to have survival rates similar to CS due to LV pump failure.56, 57 Survival requires prompt recognition of tamponade, aggressive stabilization, and prompt surgery.
Questions and answers
Published in Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer, Cardiology and the Cardiovascular System on the move, 2015
Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer
(Pulseless electrical activity) The situation suggests pulseless electrical activity, also known as electromechanical dissociation. There is electrical activity but no blood is being pumped. The history suggests that this may be due to a pulmonary embolism.
The evolution of the CTO-PCI landscape in Belgium and Luxembourg: a four-year appraisal
Published in Acta Cardiologica, 2021
Ward Eertmans, Peter Kayaert, Johan Bennett, Claudiu Ungureanu, Yoann Bataille, Georges Saad, Steven Haine, Patrick Coussement, Bruno Pereira, Pierfrancesco Agostoni, Luc Janssens, Bert Vandeloo, Patrick Maréchal, Kristoff Cornelis, Quentin de Hemptinne, Adel Aminian, Francis Stammen, Stéphane Carlier, Patrick Timmermans, Steven Vercauteren, Jeroen Sonck, Frédéric De Vroey, Benny Drieghe, Keir McCutcheon, Benjamin Scott, Laurent Davin, Chadi Gafari, Jo Dens
In-hospital MACCE occurred in 43 cases (2.3%). Five patients died: one patient due to worsening hypotension culminating in electromechanical dissociation, probably related to diffuse ischaemia, one patient due to coronary perforation with rapid cardiac arrest, one patient due to cardiogenic shock, one patient due to an unknown non-cardiovascular cause and one patient, admitted with an out-of-hospital cardiac arrest where the CTO lesion was successfully treated, died as the result of irreversible hypoxic brain injury. In total, 31 patients suffered an in-hospital MI: non ST-segment elevated MI (n = 24), a STEMI (n = 3) and a not further defined MI (n = 4)). Four patients experienced a stroke. Three patients had target vessel revascularisation during index hospitalisation. A pericardial effusion occurred in 21 patients. In 15 out of these 21 patients, the management was not reported, but of the remaining six patients, one required urgent surgery, three had pericardiocentesis, and two patients did not require any treatment.
Update on shunt closure in neonates and infants
Published in Expert Review of Cardiovascular Therapy, 2021
Karim A. Diab, Younes Boujemline, Ziyad M. Hijazi
We have previously published our experience in closing mVSDs with this device in the largest series of infants less than 1 year of age [67]. Twenty infants underwent attempted closure at a median age of 4.6 months (range, 3 days-12 months) and a median weight of 4.6 kg (range 3.2–8.9 kg). The procedure was successful in 19/20 infants (using the percutaneous approach in 11 and the hybrid approach in 8 infants). Successful closure of the defects (complete closure or trivial residual shunt) was achieved in 84% of patients immediately after the procedure and in 100% of patients at one-year follow-up. That series had zero mortality and major complications occurred in 20% of cases that included wire perforation and hemopericardium, device migration, transient electromechanical dissociation and mediastinitis.
Balloon Aortic Valvuloplasty – Remaining Indications in the Modern TAVR Era
Published in Structural Heart, 2020
Joris F. Ooms, Maarten P. van Wiechen, Francesca Ziviello, Herbert Kroon, Ben Ren, Joost Daemen, Peter de Jaegere, Nicolas M. Van Mieghem
Procedural characteristics and invasive hemodynamic data of the overall population are summarized in Table 2. The mean transaortic gradient dropped by 16.0 ± 10.1 mmHg (p < 0.001), mean proportional gradient reduction was 37.2 ± 17.6%. Peak gradient reduction was 19.5 ± 13.4 mmHg (p < 0.001). The AR index measured pre- and post-BAV did not change. Overall procedural success was achieved in 78.7% of the patients. Reasons for no success were either peri-procedural death or not achieving more than 20% mean transaortic gradient reduction. One patient experienced an increase of aortic regurgitation to >moderate. Two patients in the palliation cohort experienced electromechanical dissociation after BAV and died. One patient, in the BTD group, died of electromechanical dissociation and one died of respiratory failure, both within 24 h after BAV. This resulted in an overall procedural mortality of 8.5%. Procedural success in BTD, BTN, and Palliation group was 85%, 77.8%, and 66.7%, respectively.