The Canadian journal of cardiology
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Cardiogenic shock is classically defined by systemic hypotension with evidence of hypoperfusion and end organ dysfunction. In modern practice, however, these metrics often incompletely describe cardiogenic shock because patients present with more advanced cardiovascular disease and greater degrees of multiorgan dysfunction. Understanding how perfusion, congestion, and end organ dysfunction contribute to hypoxia at the cellular level are central to the diagnosis and management of cardiogenic shock. ⋯ Organ-specific susceptibility to hypoxia is presented in the context of their functional architecture. We discuss how the concepts of contractile reserve, fluid responsiveness, tissue oxygenation, and cardiopulmonary interactions can help personalize the management of cardiogenic shock. Finally, we highlight the limitations of using lactate for tailoring therapy in cardiogenic shock.
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Multicenter Study
The Risk of Cardiovascular Events on Cannabis' Highest Day.
Knowledge of the acute cardiovascular effects of cannabis consumption remains largely unknown and is important given the changing landscape of legalization of recreational cannabis use. "4/20" is an annual event where many individuals gather to consume cannabis. An increased risk of adverse health events such as motor vehicle accidents has previously been reported to occur on "4/20." In this study, population-based administrative databases in Ontario, Canada, were used to evaluate the association between "4/20" and cardiovascular events. An increased risk of cardiovascular events on a population level was not observed on "4/20." Additional research into the changes in the prevalence of the use of cannabis with recreational legalization and acute and chronic risk with cannabis use is suggested.
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Cardiac rehabilitation (CR) is a guideline-indicated modality for reducing residual cardiovascular risk among patients undergoing coronary artery bypass grafting (CABG) surgery. However, many referred patients do not initiate or complete a CR program; even more patients are never even referred. ⋯ Automated referral in post-CABG patients resulted in modest improvement in CR program completion. Therefore, even when CR referral is automated to include all eligible patients, additional strategies to support CR program enrollment and completion remain necessary to achieve the desired health benefits.
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Adult cardiology residency training programs require residents to become proficient at many procedural skills, including pericardiocentesis. However, in many programs, opportunities to perform this procedure are limited. Expensive mannequins have been developed to assist with teaching this skill, however, the associated cost make them impractical for many programs. ⋯ All cardiology residents agreed or strongly agreed that the model should be incorporated into their formal curriculum. This study shows that a low-cost, high-fidelity model can be constructed and easily implemented into the formal curriculum of adult cardiology residency programs. It allows residents the opportunity to practice pericardiocentesis in a low-risk setting on a high-yield device.
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Observational Study
Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations.
Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI). ⋯ Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population.