Acute Congestive Cardiac Failure Research Articles

COVID-19 with peripartum cardiomyopathy: a case report

BackgroundThe world has been facing the novel coronavirus SARS-CoV-2 pandemic. The novel coronavirus primarily affects the lungs but also affects multiple organ systems including the cardiovascular system causing myocarditis, cardiomyopathy, and arrhythmias. Cardiomyopathy has been reported in patients with COVID-19; however, prognosis of peripartum cardiomyopathy in a patient with COVID-19 is still unexplored. More knowledge is required to understand the incidence of cardiomyopathy due to novel coronavirus SARS-CoV-2.Case presentationWe report a case of peripartum cardiomyopathy gravida 2 parity 2 COVID-19 confirmed patient who underwent an emergency preterm lower segment caesarean section (LSCS) for severe pre-eclampsia and intra-uterine growth retardation (IUGR) and landed up in acute congestive cardiac failure with pulmonary oedema. A postpartum 32 years female presented to our institute, a dedicated COVID-19 hospital with tachycardia, hypertension, anasarca, tachypnea with desaturation on room air. She had undergone emergency caesarean section for severe preeclampsia with intrauterine growth retardation. On post-operative day 2 (POD2), she complained of shortness of breath. On POD 3 she tested positive RT-PCR for COVID-19 infection. She responded to treatment with steroids. However, on POD6, She developed severe pulmonary oedema with poor ejection fraction necessitating endotracheal intubation and pressure control ventilation. Congestive cardiac failure was managed with diuretics and digoxin. Gradually oxygenation improved. She was electively ventilated for 3 days. Gradually, ejection fraction improved with the resolution of B lines. On the 9th POD, after a successful spontaneous breathing trial, she was extubated and non-invasive ventilation with bi-level positive airway pressure was attached. The patient was gradually tapered off of the non-invasive ventilation over 2 days. On the 11th post-operative day, she was maintaining oxygen saturation on nasal prongs and was sent to the ward.ConclusionsWe recommend early use of bedside lung ultrasonography; echocardiography and close cardiovascular monitoring in severe COVID-19 infected pregnant patients who present with shortness of breath, tachypnea, and hypertensive disorders of pregnancy and previous cardiac abnormalities for expedite management and improved prognosis. An ideal case scenario for extubation may not be present, non-invasive ventilation with bi-level positive airway pressure post-extubation helps in patients with peripartum cardiomyopathy.

A chance encounter with a case of hypertrophic cardiomyopathy.

A chance encounter with a case of hypertrophic cardiomyopathy.

Deciphering an Unexpected Serum Creatinine Result in a Critically Ill Patient.

A 74-year-old man with acute congestive cardiac failure complicated by cardiogenic shock came for emergency care. He required admission to the coronary care unit because of circulatory collapse and was given inotropic support with simultaneous intravenous infusions of dopamine and dobutamine. These medications were administered via a central line. An unexpected change in the patient's serial serum creatinine (SCr) resulted in a >60% change within 24 h (71 μmol/L/0.8 mg/dL from the earlier 186 μmol/L/2.1 mg/dL; reference interval 59–104 μmol/L/0.67–1.17 mg/dL). However, other surrogate markers of renal function (urea and potassium) did not show the same magnitude of variability in their measurements (Fig. 1). Fig. 1. Patient serum creatinine (SCr), urea (Ur), and potassium (K) results over the period of hospitalization in the intensive care unit. All SCr measurements were performed with same enzymatic-based method. Reference intervals for SCr, 59–104 μmol/L/0.67–1.17 mg/dL; Ur, <11.9 mmol/L/<71 mg/dL; and K, 3.5–5.1 mmol/L. The isolated change affecting 1 analyte did not suggest a dilutional effect by sample contamination. Preanalytical errors related to sample misidentification were excluded, and serum indices did not indicate the possibility of hemolysis, icterus, or lipemia interference. Another urgent blood sample was requested, and this was reanalyzed with the same methods used previously for urea, SCr, and potassium. The repeat results yielded values for SCr of 66 μmol/L/0.75 mg/dL, urea of 31 mmol/L/87 mg/dL urea nitrogen (reference interval <11.9 mmol/L/<71 mg/dL), and potassium …

Fgl2deficiency causes neonatal death and cardiac dysfunction during embryonic and postnatal development in mice

We hypothesized that cardiac dysfunction was responsible for the high perinatal lethality that we previously reported in fibrinogen-like protein 2 (Fgl2) knockout (KO) mice. We therefore used ultrasound biomicroscopy to assess left ventricular (LV) cardiac structure and function during development in Fgl2 KO and wild-type (WT) mice. The only deaths observed between embryonic day (E)8.5 (onset of heart beating) and postnatal day (P)28 (weaning) were within 3 days after birth, when 33% of Fgl2 KO pups died. Histopathology and Doppler assessments suggested that death was due to acute congestive cardiac failure without evidence of valvular or other obvious cardiac structural abnormalities. Heart rates in Fgl2 KO embryos were significantly reduced at E8.5 and E17.5, and irregular heart rhythms were significantly more common in Fgl2 KO (21/26) than WT (2/21) embryos at E13.5. Indexes of systolic and/or diastolic cardiac function were also abnormal in KO mice at E13.5 and E17.5, in postnatal mice studied at P1, and in KO mice surviving to P28. M-mode analysis showed no difference in LV diastolic chamber dimension, although posterior wall thickness was thinner at P7 and P28 in Fgl2 KO mice. We conclude that Fgl2 deficiency is not associated with obvious structural cardiac defects but is associated with a high incidence of neonatal death as well as contractile dysfunction and rhythm abnormalities during embryonic and postnatal development in mice.

Reversible Dilated Cardiomyopathy and Neuroblastoma

A previously healthy 11-month-old infant girl presented with a clinical picture of acute congestive cardiac failure. On evaluation, she was persistently hypertensive and had a distinct abdominal mass palpable just below the spleen. Echocardiography demonstrated a structurally normal heart with severely dilated left ventricle and decreased contractility suggestive of dilated cardiomyopathy (Figure 1). She was managed with inotropes, diuretics, and after-load reducing agents. After hypertension was controlled with captopril, clonidine, labetolol, and furosemide, a repeat echocardiogram demonstrated slight improvement in contractile function. Laboratory studies revealed catecholamine excess. Abdominal ultrasonography and magnetic resonance imaging showed a large mass, 8.5 3 7.6 cm, encasing and stretching the left renal artery (Figure 2). De-bulking of the tumor was performed. Pathology was suggestive of a stage III intermediate-risk neuroblastoma, and treatment with carboplatin and etoposide was initiated. Two months later, a repeat echocardiogram demonstrated significant improvement in cardiac dimensions and function. Catecholamine-induced cardiomyopathy is a known clinical entity with pheochromocytoma. However, only four cases of neuroblastoma presenting with cardiomyopathy are reported. 1-4 All patients were <3 years of age, three of them were hypertensive, and one was normotensive. 1 Symptoms of cardiomyopathy improved with anti-hypertensive medication, 2,3

Acute Pulmonary Edema and Trigeminal Nerve Blockade After Retrobulbar Block

Acute Pulmonary Edema and Trigeminal Nerve Blockade After Retrobulbar Block

Tension on coronary bypass conduits: A neglected cause of real or potential obstruction of saphenous vein grafts

Of 41 saphenous vein aorta-coronary bypass grafts from 21 patients, abnormal graft tension was judged to be present at necropsy in 6 grafts (15 per cent) from 5 patients (24 per cent). Five (33 per cent) of 15 grafts placed to the right coronary system and one (3 per cent) of 26 grafts to the left coronary system were under excess tension. The abnormal tension appeared to result from the insertion of grafts too short to accommodate normal or abnormal distention of the right atrium and ventricle (graft to distal right coronary or posterior descending coronary artery) or of the pulmonary trunk (graft to left coronary system) after discontinuation of cardiopulmonary bypass or development of acute congestive cardiac failure.

Idiopathic arterial calcification in infancy.

Two cases of idiopathic generalized arterial calcification in infancy are described. The changes in the vessels consist of calcification in relation to the internal elastic lamina, with secondary subintimal proliferation of fibrous tissue and, occasionally, extension into the media. They are usually most marked in the coronary arteries, with resulting myocardial disease, and acute congestive cardiac failure is the most common presentation and cause of death. The histological picture resembles closely the arterial changes that may occur in severe renal disease, hyperparathyroidism, primary bone disease, hypervitaminosis D, and occasional cases of congenital heart disease.

Simultaneous hypoglycemia and acute congestive heart failure.

Acute congestive cardiac failure and hypoglycemia were observed simultaneously in 27 patients with underlying heart disease. Seventeen of this group had the hypoplastic left heart syndrome, two had transposition of the great vessels, and four had hypoglycemia postoperatively. Liver biopsy in four patients revealed a marked reduction of hepatic glycogen both biochemically and electron microscopically but normal phosphorylase and glucose-6-phosphatase activity. Reduction of their dietary intake and gastrointestinal malabsorption caused by congestive cardiac failure are suggested as possible mechanisms for the observed hepatic glycogen depletion. Constant intravenous infusion of glucose is the method of choice for the treatment of patients with acute congestive cardiac failure and hypoglycemia rather than epinephrine or glucagon. Five patients recovered sufficiently following treatment of hypoglycemia and acute cardiac failure to be discharged from the hospital.