Background: Neutropenic fever is a medical emergency, which poses a significant morbidity and mortality risk to cancer patients receiving chemotherapy. National guidelines recommend that patients presenting with suspected neutropenic fever receive appropriate intravenous antibiotics within 60 min of admission.
Aim: We aimed to investigate the management of neutropenic fever in a large private oncology centre.
Transcatheter aortic valve implantation (TAVI) is growing in utilization in the USA, and atrioventricular heart block is a common complication of the procedure. In patients with conduction system changes following TAVI, there are no clear guidelines for permanent pacing, leading to difficult clinical decisions on how long to leave temporary transvenous pacemakers in place. The aim of our study was to determine whether changes in electrocardiogram characteristics could predict the need for permanent pacing.
View Article and Find Full Text PDFWe propose a novel Myocardial Injury Summary Score (MISS) integrating the 4 biomarkers suggested by the 2013 American College of Cardiology/American Heart Association guidelines for management of heart failure. In this case series, we examined 4 heart failure patients who received treatment guided by the biomarker results and 4 patients who received routine clinical management with no information about the biomarkers. Most of the patients receiving biomarker-guided management had medications adjusted based on the biomarker values, while no changes were recommended for patients in the biomarker-blinded category.
View Article and Find Full Text PDFClin J Am Soc Nephrol
November 2016
Warfarin has had a thin margin of benefit over risk for the prevention of stroke and systemic embolism in patients with ESRD because of higher bleeding risks and complications of therapy. The successful use of warfarin has been dependent on the selection of patients with nonvalvular atrial fibrillation at relatively high risk of stroke and systemic embolism and lower risks of bleeding over the course of therapy. Without such selection strategies, broad use of warfarin has not proven to be beneficial to the broad population of patients with ESRD and nonvalvular atrial fibrillation.
View Article and Find Full Text PDFThe interrelationship between diabetes mellitus and cardiovascular disease is well-documented, and, secondary to the latter, is the use of antiplatelet therapy. Although diabetes and the associated vascular manifestations are driving forces behind lower extremity amputations, few data are available on the risks of perioperative antiplatelet therapy with foot and ankle amputations. The goal of the present study was to address the surgical effect of continuing or discontinuing antiplatelet therapy before foot and/or ankle amputation.
View Article and Find Full Text PDFJ Cardiothorac Vasc Anesth
August 2016
Objective: To create a universal checklist of key preparatory steps to aid anesthesiologists in patient separation from cardiopulmonary bypass.
Design: Multistep, iterative survey with statistically guided refinement of survey items using a modified Delphi technique.
Setting: Internet-based surveys.
Background: Vascular closure devices (VCDs) are frequently used for hemostasis with endovascular procedures by employing sutures or plug devices (using collagen or hydrogel) or through the use of a metal clip made of nickel and titanium, such as the StarClose SE device. In comparison to manual compression (MC), VCDs are associated with earlier time to discharge and ambulation, improved patient comfort, and better cost-effectiveness.
Case Report: A 77-year-old man with history of ischemic cardiomyopathy with non-ST segment elevation myocardial infarction (NSTEMI) underwent diagnostic cardiac catheterization with deployment of a StarClose SE vascular closure device for hemostasis.
Proc (Bayl Univ Med Cent)
January 2016
Carcinoid heart disease is classically described as right-sided valvular pathology. Solid cardiac metastases from carcinoid tumors are seldom reported. A multimodality imaging approach is needed to diagnose and localize this disease.
View Article and Find Full Text PDFExercise-induced dyspnea (EID) is a common complaint in young athletes. Exercise-induced bronchospasm (EIB) is the most common cause of EID in healthy athletes, but it is important to recognize more serious pathology. Herein we present the case of an 18-year-old woman with a 1.
View Article and Find Full Text PDFProc (Bayl Univ Med Cent)
April 2015
We report a patient with hypoxia secondary to a right-to-left shunt through a patent foramen ovale, following aortic root, valve, and arch replacement due to an aortic dissection in the setting of the Marfan syndrome. Following the operation, he failed extubation twice due to hypoxia. An extensive workup revealed a right-to-left shunt previously not seen.
View Article and Find Full Text PDFAcute kidney injury (AKI) is a common medical problem, especially in patients undergoing cardiovascular procedures. The risk of kidney damage has multiple determinants and is often related to or exacerbated by intravenous or intra-arterial iodinated contrast. Contrast-induced AKI (CI-AKI) has been associated with an increased risk of subsequent myocardial infarction, stroke, the development of heart failure, rehospitalization, progression of chronic kidney disease, end-stage renal disease, and death.
View Article and Find Full Text PDFObjective: Separation from cardiopulmonary bypass (CPB) requires multiple preparatory steps, during which mistakes, omissions, and human errors may occur. Checklists have been used extensively in aviation to improve performance of complex, multistep tasks. The aim of this study was to (1) develop a checklist using a modified Delphi process to identify essential steps necessary to prepare for separation from CPB, and (2) compare the frequency of completed items with and without the use of a checklist in simulation.
View Article and Find Full Text PDFJ Cardiothorac Vasc Anesth
December 2014
Objective: Because heart rate affects ventricular filling, the aim of the present study was to assess the effects of increasing heart rate and tidal volume on stroke volume variability to determine whether this dynamic index is heart-rate dependent.
Design: Prospective, randomized study.
Setting: Single university hospital.
A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure.
View Article and Find Full Text PDFObjective: To compare the noninvasive estimated continuous cardiac output (esCCO), device-derived cardiac output (CO) to simultaneous pulmonary artery catheter (PAC) thermodilution (TD) CO.
Design: A prospective study comparing pulse wave transit time (estimated continuous cardiac output, esCCO; Nihon Kohden, Tokyo, Japan) to intermittent TD CO.
Setting: One academic hospital.
Background: Von Willebrand disease (vWD) results from quantitative or qualitative deficiency of von Willebrand factor (vWF). The occurrence of myocardial infarction is very rare in patients with vWD. A few case reports of acute coronary syndrome (ACS) in vWD patients are present in the literature, but no definite management recommendations are available for such patients.
View Article and Find Full Text PDFThe "Crush" procedure is a 2-stent technique for the treatment of bifurcation lesions with greater rates of in-stent restenosis than the Culotte technique. In conclusion, we report a possible mechanism for this discrepancy in the case of severe Crush stent fracture with associated focal restenosis identified by postmortem microcomputed tomography and histologic examination.
View Article and Find Full Text PDFBackground: The aim of this study was to summarize our single-center real-world experience with percutaneous coronary intervention (PCI) stenting of unprotected left main coronary artery (ULMCA). PCI-stenting of the ULMCA, while controversial, is emerging as an alternative to coronary artery bypass graft (CABG) surgery in select patients and clinical situations.
Methods: Between January 2005 and December 2008, PCI-stenting was performed on 125 patients with ULMCA lesions at our institution.
Microcomputed tomography is an important tool for preclinical vascular imaging, with micron-level resolution. This nondestructive means of imaging allows for rapid collection of 2D and 3D reconstructions to visualize pathologic specimens. Postmortem analysis of stented arteries has yielded significant insights into the 'natural' history of stented arteries.
View Article and Find Full Text PDFAchieving a door-to-balloon time < 90 min may be challenging in patients with ST-segment elevation acute myocardial infarction with difficult to wire coronary lesions. We report use of the Venture wire control catheter to facilitate wiring in four patients with significant tortuosity proximal to a thrombotic coronary occlusion, after conventional wiring attempts failed. Early use of the Venture catheter may help shorten the door-to-balloon time in patients with challenging to wire lesions.
View Article and Find Full Text PDFJ Heart Lung Transplant
June 2011
Antibody-mediated rejection (AMR) continues to present a challenge for the survival of the cardiac allograft. AMR appears to be on the rise, likely secondary to changing trends in clinical practice, including selection of patients for transplantation on mechanical circulatory support and development of more effective combinations of immunosuppressive drugs against acute cellular rejection. Most current strategies are aimed at treating acute AMR, but the treatment of chronic AMR is still not well defined.
View Article and Find Full Text PDFBackground: The clinical use of miniaturized echocardiograph devices is expanding due to the potential to rapidly assess cardiac function in the critically ill patient. Novice echocardiographers have used the pocket echocardiograph (PE) to estimate ejection fraction in ambulatory patients, but have not evaluated intubated patients. We hypothesize that a novice echocardiographer can use PE to acquire interpretable cardiac images, and provide an accurate tool for estimating ejection fraction.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
October 2010
Unlabelled: Coronary stent fracture has been postulated as an important mechanism for in-stent restenosis and late-stent thrombosis. We have developed a nondestructive microcomputed tomography (micro-CT) technique to image en bloc stented arterial segments.
Case Report: A 43-year-old man died of sepsis 5 months following placement of a paclitaxel-eluting stent (PES) in the left circumflex coronary artery to treat in-stent restenosis of a sirolimus-eluting stent (SES).