Intractable cardiac arrest due to lidocaine toxicity successfully resuscitated with lipid emulsion.

Objective: Demonstrate a case report involving successful use of lipid emulsion therapy for intractable cardiac arrest due to lidocaine toxicity.

Data Source: Lipid emulsion therapy has been shown to be effective in treating the cardiotoxic effects of such drugs as bupivacaine, verapamil, propranolol, and clomipramine as mentioned in a 2009 editorial in Critical Care Medicine by Jeffrey Bent. The mechanism of action of lipid emulsion therapy is not well defined and has been postulated to work by both a "lipid sink," decreasing circulating amounts of drugs to the periphery, or through a direct "energy source" to the myocardium.

Ventricular assist devices the challenges of outpatient management.

The need for mechanical assistance of the failing heart, whether acute after a myocardial infarction or permanent in patients with end-stage heart failure, has increased with improvements in medical therapy and a growing aged population. Over the past few decades, much progress has been made in the development and refinement of ventricular assist devices (VADs), medical devices capable of maintaining circulatory output of the diseased ventricle. Initially designed as a temporary support to allow ventricular recovery or as a bridge for patients to cardiac transplantation, these devices are now being used as a permanent form of "destination" therapy.

Management of end-stage heart failure: a perspective on the Arab Gulf states.

The ever expanding epidemic of end-stage heart failure represents one of the greatest challenges of modern cardiovascular medicine. With medical treatments hampered by significant limitations, physicians caring for patients with advanced heart disease have turned to cardiac transplantation and durable mechanical circulatory assist devices as definitive therapies. These advanced therapeutic modalities are not widely available outside the United States and Europe, but nevertheless offer enormous potential for patients in the Arab Gulf suffering from end-stage heart failure.

Thresholds of physical activity and life expectancy for patients considering destination ventricular assist devices.

Background: Current implantable left ventricular assist devices (LVAD) improve survival and function for patients with very late stage heart failure (HF) but may also offer benefit before inotrope dependence. Debate continues about selection of HF patients for LVAD therapy. We sought to determine what level of personal risk and disability HF patients thought would warrant LVAD therapy.

The physiologic basis for the management of ventricular assist devices.

Mechanical ventricular assist devices are now approved as destination therapy for terminal heart failure. It is the purpose of this review to discuss the physiology of this technology that is considered in outpatient care. The currently available pulsatile devices are solely dependent of preload volume and, when placed in the automatic mode, can maintain physiologic cardiac outputs with exercise.

BK viral reactivation in cardiac transplant patients: evidence for a double-hit hypothesis.

Background: BK nephropathy is a significant cause of renal dysfunction in renal allograft recipients. The question of whether BK viral infection plays a role in renal dysfunction in cardiac transplantation patients remains to be answered.

Methods: We prospectively examined the prevalence of BK viral reactivation in the setting of cardiac transplantation and performed a cross-sectional analysis of 111 cardiac transplantation patients.

The management of mechanical hearts.

Mechanical ventricular assist devices are now approved as destination therapy for terminal heart failure. It is the purpose of this review to discuss the physiology of this technology that is considered in outpatient care. The currently available pulsatile devices are solely dependent of preload volume, and when placed in the automatic mode, can maintain physiologic cardiac outputs with exercise.

Characteristics of patients who die with heart failure and a low ejection fraction in the new millennium.

Background: Therapies for heart failure (HF) with a low ejection fraction (EF) have delayed disease progression and prolonged survival, but the implications of these therapies on the end stages of HF have not been examined.

Methods And Results: Patients seen by the Brigham and Women's cardiomyopathy service with an EF < or =35%, at least 1 outpatient visit or at least 30 days of follow-up who died between January 1, 2000, and October 20, 2003, were evaluated retrospectively. Of the 160 patients who died since 2000, 80 (50%) were outpatients.

Intensity and focus of heart failure disease management after hospital discharge.

Background: Although features of heart failure disease management programs are broadly outlined, little is known about which interventions are actually used in the outpatient setting or which patients are most likely to require interventions.

Methods And Results: Between September 2001 and June 2002, we enrolled 32 patients admitted to the Brigham and Women's Hospital Heart Failure Services, Boston, Mass, with decompensated heart failure. The intensity of care and outcomes of these patients were prospectively tracked for more than 90 days.

Severity of intraoperative tricuspid regurgitation predicts poor late survival following cardiac transplantation.

Background: This study evaluates the significance of tricuspid regurgitation (TR) on long-term survival as detected by intraoperative transesophageal echocardiography at the time of orthotopic heart transplantation. Although significant (2+ to 4+) TR after orthotopic heart transplantation is rare, its influence on long-term survival is unknown, warranting further investigation.

Methods: Between January 1992 and July 2001, 181 consecutive patients underwent orthotopic heart transplantation.

Risk factors and outcomes for 'vasoplegia syndrome' following cardiac transplantation.

Objective: Vasoplegia syndrome after orthotopic heart transplantation (OHT) is a rare but highly lethal syndrome of unknown etiology, characterized by severe refractory hypotension, metabolic acidosis, and decreased systemic vascular resistance (SVR). The objective of this retrospective study was to identify the risk factors contributing to the development of vasoplegia syndrome after OHT in order to provide potential algorithms for its management.

Methods: Between October 1992 and July 2001, 187 consecutive patients underwent OHT.

Frequency and impact of delayed decisions regarding heart transplantation on long-term outcomes in patients with advanced heart failure.

Objectives: We sought to characterize decisions regarding listing of heart transplant candidates and to determine the impact of delayed listing for a transplant on survival.

Background: Evaluation and listing for heart transplantation have evolved over the past decade, with the complex decision process often extending beyond the time of initial review. Little is known about the current impact of decisions and timing of listing on outcomes.

Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality.

Objectives: This study examined the hypothesis that patients who develop angiotensin-converting enzyme inhibitor intolerance attributable to circulatory-renal limitations (CRLimit) have more severe underlying disease and worse outcome.

Background: Although the renin-angiotensin system contributes to the progression of heart failure (HF), it also supports the failing circulation. Patients with the most severe disease may not tolerate inhibition of this system.

Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure.

Objectives: This study was designed to determine the relevance of a proposed classification for advanced heart failure (HF). Profiles based on clinical assessment of congestion and perfusion at the time of hospitalization were compared with subsequent outcomes.

Background: Optimal design of therapy and trials for advanced HF remains limited by the lack of simple clinical profiles to characterize patients.

Effect of vitamins C and E on progression of transplant-associated arteriosclerosis: a randomised trial.

Background: Cardiac transplantation is associated with oxidant stress, which may contribute to the development of accelerated coronary arteriosclerosis. We postulated that treatment with antioxidant vitamins C and E would retard the progression of transplant-associated arteriosclerosis.

Methods: In a double-blind prospective study, 40 patients (0-2 years after cardiac transplantation) were randomly assigned vitamin C 500 mg plus vitamin E 400 IU, each twice daily (n=19), or placebo (n=21) for 1 year.