Heart failure clinics
-
Heart failure clinics · Jan 2014
ReviewExtracorporeal membrane oxygenation for resuscitation and cardiac arrest management.
This article reviews the potential application of extracorporeal membrane oxygenation (ECMO) technology to cardiopulmonary resuscitation for in and out-of-hospital cardiac arrest and discusses the current evidence on the subject. The possible strategies for organ protection during ECMO and the concept of ECMO networks are also reviewed.
-
The essence of a Fontan circuit is the creation of the Fontan "neoportal system," which allows for oxygenation at near normal levels, but at the cost of a chronic state of systemic venous congestion and decreased cardiac output. The heart, while still the engine of the circuit, cannot compensate for this major flow restriction: the ventricle has lost control of the output and venous congestion. ⋯ The abnormal hemodynamics affects organs outside the heart and may lead to liver cirrhosis/malignancy, protein-losing enteropathy, or plastic bronchitis. The chronic low flow state causes an increase of pulmonary (and systemic) vascular resistance and ventricular filling pressures, causing failure of the Fontan to be progressive with increasing functional impairment.
-
Takotsubo cardiomyopathy is classically stress induced and characterized by regional wall motion abnormalities in the absence of coronary occlusion. It predominantly affects postmenopausal women; emotional and physical stressors can trigger the classic cardiomyopathic findings. ⋯ Underlying mood disorders increase the risk for developing takotsubo cardiomyopathy after a triggering event. Takotsubo cardiomyopathy is one of several brain-heart disorders; its unique pathology can shed light on the complex interactions between the brain, sympathetic nervous system, and the cardiovascular system.
-
Takotsubo cardiomyopathy (TTC) is characterized by transient and reversible left ventricular (LV) systolic dysfunction due to extended myocardial stunning. Despite a good long term prognosis, approximately one-third of patients with TTC experience life-threatening complications during the acute phase. Echocardiography is the first imaging modality for an early evaluation of LV systolic and diastolic function in patients with TTC. Moreover, echocardiography allows the detection of specific findings associated with TTC, such as LV outflow tract obstruction, mitral regurgitation, and right ventricular involvement, providing crucial information for clinical management and therapy and for monitoring myocardial function recovery during the follow-up.
-
Stress cardiomyopathy is a form of reversible systolic dysfunction of the mid and apical left ventricle with pathologic changes of the electrocardiogram in the absence of an obstructive coronary artery disease. The prevalence of stress cardiomyopathy among patients with symptoms suggestive of myocardial infarction is 0.7% to 2.5%, and it is found predominantly in postmenopausal women (90%). No large studies have confirmed the cause of stress cardiomyopathy. Published data suggest that substantially elevated plasma catecholamine levels, due to emotional or physical stress, may be relevant.