Journal of cardiovascular medicine
-
J Cardiovasc Med (Hagerstown) · Jul 2010
Comparative StudyCerebral oximetry during carotid clamping: is blood pressure raising necessary?
Carotid endarterectomy is subject to a significant risk of intraoperative stroke. Anesthetic management of patients must provide optimal monitoring of cerebral blood perfusion to establish whether intraluminal carotid shunting is necessary. Cerebral oximetry (regional cerebral oxygen saturation, rSO2) measurement can ascertain whether brain perfusion is adequate. During carotid cross-clamping, a rise of blood pressure may be required to guarantee a collateral blood supply throughout the circle of Willis. We retrospectively evaluated the relationship between blood pressure and rSO2 in our experience. ⋯ During carotid cross-clamping, an excessive rise of blood pressure is not necessary to guarantee safe values of rSO2. On the contrary, hypertension could expose the patient to risk of cardiac accident. So we have modified our intraoperative strategy avoiding controlled hypertension for normotensive management during carotid clamping.
-
J Cardiovasc Med (Hagerstown) · Jul 2010
Case ReportsStress cardiomyopathy and arrhythmic storm in a 14-year-old boy.
Stress cardiomyopathy is a newly described reversible cardiomyopathy, characterized by transient cardiac dysfunction usually precipitated by intense emotional or physical stress. Apart from the classical apical ballooning syndrome (Takotsubo), it is now increasingly recognized that the spectrum of stress cardiomyopathies is quite wide, with significant individual variations in clinical and morphological pattern. Very recently, it has been suggested that, in young boys in stressful situations, atypical forms of stress cardiomyopathy could be associated with malignant arrhythmias. We describe the case of a 14-year-old boy, in whom stress cardiomyopathy with mid-ventricular ballooning started with an arrhythmic storm.
-
J Cardiovasc Med (Hagerstown) · Jul 2010
Case ReportsOsborn waves in severe accidental hypothermia secondary to prolonged immobilization and malnutrition.
We report the case of a 77-year-old man, in whom accidental hypothermia was secondary to prolonged immobilization and malnutrition. The electrocardiogram showed typical Osborn waves, which disappeared with the rewarming of the patient. The diagnosis of hypothermia is easy in patients with a history of prolonged exposure to a cold environment but accidental hypothermia may also occur as a consequence of prolonged immobilization and malnutrition. ECG analysis is very important for a correct and fast diagnosis.
-
J Cardiovasc Med (Hagerstown) · Jul 2010
Case ReportsCardiogenic shock with basal transient left ventricular ballooning (Takotsubo-like cardiomyopathy) as first presentation of pheochromocytoma.
Pheochromocytoma is a rare tumor that produces a distant effect by secretion of catecholamines. This tumor usually presents with hypertension and palpitations but it may also cause cardiogenic shock because of catecholamine-induced myocardial dysfunction. We describe a rare case of Takotsubo-like cardiomyopathy as first manifestation of pheochromocytoma with an unusual onset characterized by severe hypotension and transient basal left ventricular ballooning ('inverted' Takotsubo-like cardiomyopathy).