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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
One specific drug, Tafamadis, has been assessed and shown to give improved survival, quality of life and slowed disease progression in ATTR amyloidosis. Systemic thromboembolism is common and anticoagulation is often required. A heart transplant may be considered.
The Advanced HEART FAILURE Patient
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Eran Kalmanovich, Philippe Gaudard, François Roubille
Heart transplant remains the standard for surgical intervention in refractory advanced HF, despite the absence of RCTs due to limited donor heart availability.129 With proper patient selection, heart transplant significantly increases survival, exercise capacity, and quality of life compared to medical therapy.42,130 In a recent report from the United States, one-year survival after heart transplant was 90.8% for males and 90.6% for females, and five-year survival was 77.5% for males and 75.6% for females.115 Other registries worldwide have reported similar results on short- and long-term outcomes.131–134 Acute and chronic rejection and autoimmune vasculopathy pose major post-transplantation challenges, followed by the consequences of the complications of immunosuppressive therapy in the long term (i.e., infection, hypertension, renal failure, diabetes, and malignancy).130
Infections in Solid Organ Transplant Recipients Admitted to the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Almudena Burillo, Patricia Muñoz, Emilio Bouza
In HT and LT recipients, the possibility of mediastinitis (2%–9%) should be considered. Heart transplant recipients have a higher risk of postsurgical mediastinitis and sternal osteomyelitis than other heart surgery patients [59]. Mediastinitis may initially appear just as fever or bacteremia of unknown origin. Inflammatory signs in the sternal wound, sternal dehiscence, and purulent drainage may appear later. The most commonly involved microorganisms are staphylococci, but gram-negative rods represented at least a third of our cases. Mycoplasma spp., mycobacteria, and other less common pathogens should be suspected in “culture-negative” SSI [60,61]. Bacteremia of unknown origin during the first month after HT should always suggest the possibility of mediastinitis [62]. Risk factors are prolonged hospitalization before surgery, early chest re-exploration, and low-output syndrome in adults. Aspiration of fluid collections in the mediastinum is critical to guide therapy [63,64]. Treatment consists of surgical debridement and repair, and antimicrobial treatment for 3–6 weeks.
Molecular mechanisms of ferroptosis and their role in inflammation
Published in International Reviews of Immunology, 2023
Feng Wang, Jingya He, Ruxiao Xing, Tong Sha, Bin Sun
Tsurusaki et al. found that ferroptosis inhibitors Trolox and DFP almost completely inhibit necrotic cell death, infiltration of inflammatory cells, and inflammatory cytokine expression [56]. This implies that the initial necrosis of steatohepatitis may be caused by ferroptosis. Non-apoptotic cell death triggers sterile inflammation by releasing damage-related molecular patterns, which are recognized by innate immune receptors. For example, inflammation following a heart transplant can be alleviated by ferroptosis inhibitors, which prevent cardiomyocyte cell death and block neutrophil recruitment following heart transplantation. Li et al. also showed that in inflammation after heart transplantation and myocardial IRI after coronary artery transient occlusion, increased ferroptosis mediates early cell death and promotes the initial stages of inflammation [57].
CPR Induced Inappropriate Shocks from a Subcutaneous Implantable Cardioverter Defibrillator during Out-of-Hospital Cardiac Arrest
Published in Prehospital Emergency Care, 2020
Patrik Cmorej, Eva Smrzova, David Peran, Tana Bulikova
We present the case of a 30-year-old man who in 2006 underwent a heart transplant for terminal heart failure due to dilated cardiomyopathy. Twelve years after transplant the patient was placed on the waiting list for a second heart transplant. Given his high risk of sudden death, he underwent pre-transplant implantation of an S-ICD (EMBLEM MRI S-ICD, Boston Scientific) with a Conditional Shock Zone programed at 200 beats/min and a Shock Zone programed at 230 beats/min. The Shock Zone determines the heart rate threshold, which once reached triggers shock delivery based solely on the heart rate. In the Conditional Shock Zone, the device uses other elements to differentiate whether a shock is truly needed. Apart from the heart rate, these mainly involve the morphology of the QRS complexes (4).
Bedside placement of peritoneal dialysis catheters – a single-center experience from Hungary
Published in Renal Failure, 2019
Ákos Pethő, Réka P. Szabó, Mihály Tapolyai, László Rosivall
Of note, two of our acutely decompensated chronic heart failure patients received successful orthotopic heart transplants. Our series is the first in Hungary to document acute PD treatment in lieu of HD to address diuretic resistant CHF, while also enabling subsequent successful heart transplantation for some of our patients [26]. In our clinical experiment, we were able to treat patients successfully with CAPD in severe chronic heart failure. Our patients on CAPD have been stable and got compensated heart functions. Moreover, our patients with heart failure had improved quality of life till successful orthotopic heart transplantation. Patients with severe diuretics resistant CHF, who require mechanical circulatory support have much higher rates of morbidity and mortality from infections attributable to temporary blood stream access and extracorporeal circulation devices. Accordingly, PD probably should be considered in patients who require renal replacement therapy [27].