Right Ventricular Wall Dissection After a Late-Presenting Inferior Myocardial Infarction.

A 40-year-old male presented with an inferior ST-segment elevation myocardial infarction. Multimodality imaging identified a ventricular septal defect and a right ventricular free wall dissection. He was bridged with a percutaneous microaxial left ventricular assist device to successful surgical repair.

Routine Versus Selective Distal Perfusion Catheter Use in Venoarterial Extracorporeal Membrane Oxygenation.

Although current studies support the use of prophylactic distal perfusion catheters (DPCs) to decrease limb ischemia in patients on venoarterial extracorporeal membrane oxygenation (VA ECMO), methods for monitoring limb ischemia differ between studies. We evaluated the safety of a selective rather than prophylactic DPC strategy at a single center with a well-established protocol for limb ischemia monitoring. Distal perfusion catheters were placed selectively if there was evidence of hypoperfusion at any point until decannulation.

Predictors of Polymorphic Ventricular Tachycardia and Ventricular Fibrillation in Patients With Takotsubo Syndrome.

Polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF) are life-threatening complications of takotsubo syndrome (TTS). Data regarding risk factors for PVT/VF based on the TTS variant are lacking. This study aimed to identify demographic and clinical factors associated with PVT and VF in patients with TTS.

Early vs. delayed mechanical circulatory support in patients with acute myocardial infarction and cardiogenic shock.

Aims: Despite increased temporary mechanical circulatory support (tMCS) utilization for acute myocardial infarction complicated by cardiogenic shock (AMI-CS), data regarding efficacy and optimal timing for tMCS support are limited. This study aimed to describe outcomes based on tMCS timing in AMI-CS and to identify predictors of 30-day mortality and readmission.

Methods And Results: Patients with AMI-CS identified in the National Readmissions Database were grouped according to the use of tMCS and early (<24 h) vs.

Consumer-grade wearable cardiac monitors: What they do well, and what needs work.

Consumer-grade smart devices, including smartwatches and smartphones, are potentially valuable tools in detecting cardiac arrhythmias, particularly atrial fibrillation, and their use is increasing. These devices, which use photoplethys mography, show remarkably high sensitivity and specificity for detection of atrial fibrillation, with implications for stroke prevention and management in at-risk patients. The ability of the devices to detect atrial fibrillation is being compared with single-lead electrocardiography.

A Novel Thrombolytic Regimen for Mechanical Prosthetic Valve Thrombosis in a Patient With Antiphospholipid Syndrome.

Management of mechanical prosthetic valve thrombosis (PVT) includes medical and surgical options. Standard medical treatment involves thrombolytic therapy with repeated slow infusions of low-dose IV tissue plasminogen activator (t-PA). The evidence for managing mechanical PVT that does not respond to the standard t-PA dosing is limited in the setting of an exacerbating hypercoagulable condition.

Managing stage 1 hypertension: Consider the risks, stop the progression.

The 2017 American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines on the treatment of hypertension recommended lifestyle modification and monitoring every 3 to 6 months for patients with stage 1 hypertension. However, the guidelines did not include recommendations for patients whose blood pressure is unresponsive to lifestyle therapy. The authors review the updated AHA position statement, which is meant to help clinicians manage patients with stage 1 hypertension and a low 10-year risk of atherosclerotic cardiovascular disease.

Update on chronic total occlusion percutaneous coronary intervention.

Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be challenging to perform. The main indication for CTO PCI is to improve symptoms. Several contemporary studies have reported high CTO PCI success rates at experienced centers but success rates in all-comer registries remain low.

A Pericardial Pin: Embolization of an Inferior Vena Cava Filter Strut Presenting as Acute Pericarditis.

A 39-year-old man presented with chest pain initially attributed to viral pericarditis. He was found to have an embolized inferior vena cava filter strut that perforated the right ventricle. Inferior vena cava filter fracture and embolization should be considered in patients with chest pain and pericardial effusion.

Identification of an Intracardiac Shunt in a Patient With Recurrent Cryptogenic Strokes: Are Dextrose Solutions More Sensitive?

• There is a higher incidence of strokes in patients with a PFO. • Right-to-left shunting can be diagnosed on TTE by a “bubble study.”.

Protamine-Induced Bradycardic Arrest in a Diabetic Patient.

Protamine sulfate is a common reversal agent of systemic heparinization used during procedures. While the exact epidemiology of adverse events is unknown, prior allergic response to protamine-containing compounds or concomitant use of neutral protamine Hagedorn (NPH) insulin is associated with an increased risk of tachyarrhythmias and bradyarrhythmias. We present a case of a 68-year-old woman with no prior history of protamine sulfate intolerance that suffered bradycardic arrest following protamine infusion.

Systematic review and meta-analysis of short-term outcomes with drug-coated balloons vs. stenting in acute myocardial infarction.

The role of drug-coated balloons (DCBs) in patients with acute myocardial infarction (AMI) remains controversial. We performed a meta-analysis of all published studies comparing the outcomes of DCBs vs. stenting in AMI patients.

Outcomes and Utilization of Therapeutic Hypothermia in Post-Cardiac Arrest Patients in Teaching Versus Non-Teaching Hospitals: Retrospective Study of the Nationwide Inpatient Sample Database (2016).

Background Using therapeutic hypothermia (TH) reduces the core body temperature of survivors of cardiac arrest to minimize the neurological damage caused by severe hypoxia. The TH protocol is initiated following return of spontaneous circulation (ROSC) in non-responsive patients. Clinical trials examining this technique have shown significant improvement in neurological function among survivors of cardiac arrests.

Atropine-Induced Ventricular Asystole During a Dobutamine Stress Test.

Dobutamine stress echocardiography is a safe diagnostic test with low incidence of serious complications. Atropine has been shown to reduce test duration without increasing the rate of complications. We present a case of a 52-year-old man with end stage renal disease who experienced syncope due to ventricular asystole after atropine administration during a dobutamine stress test.