Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Aug 2020
Survival and Right Ventricular Function After Surgical Management of Acute Pulmonary Embolism.
Acute pulmonary embolism (PE) is associated with high morbidity and mortality because of right ventricular (RV) failure. There is evidence suggesting surgical therapy (surgical embolectomy or venoarterial extracorporeal membrane oxygenation [ECMO]) is safe and effective. ⋯ Surgical management of patients with MPE and high-risk SMPE is safe and highly effective at achieving RV recovery.
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J. Am. Coll. Cardiol. · Aug 2020
Randomized Controlled TrialOptimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest.
In patients with shock after acute myocardial infarction (AMI), the optimal level of pharmacologic support is unknown. Whereas higher doses may increase myocardial oxygen consumption and induce arrhythmias, diastolic hypotension may reduce coronary perfusion and increase infarct size. ⋯ In post-cardiac arrest patients with shock after AMI, targeting MAP between 80/85 and 100 mm Hg with additional use of inotropes and vasopressors was associated with smaller myocardial injury.
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J. Am. Coll. Cardiol. · Aug 2020
ReviewFocused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week.
Focused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. ⋯ In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity. This review discusses the rationale, supporting evidence, opportunities, and challenges, and proposes a research agenda for the use of focused TEE in cardiac arrest with the goal to improve resuscitation outcomes.
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J. Am. Coll. Cardiol. · Aug 2020
Loop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure.
Heart failure (HF) is a major source of morbidity and mortality. Fluid retention and shortness of breath are its cardinal manifestations for which loop diuretics are used. Although their usefulness is well accepted, less is known about their role in improving clinical outcomes. ⋯ Hospitalized older patients not taking diuretics prior to hospitalization for HF decompensation who received a discharge prescription for loop diuretics had significantly better 30-day clinical outcomes than those not discharged on loop diuretics. These findings provide new information about short-term clinical benefits associated with loop diuretic use in HF.