BACKGROUND Takotsubo cardiomyopathy(TTC)can be diagnosed in patients presenting with clinical features of acute coronary syndrome(ACS)by using Mayo clinic criteria.Multiple precipitators have been attributed to causin...BACKGROUND Takotsubo cardiomyopathy(TTC)can be diagnosed in patients presenting with clinical features of acute coronary syndrome(ACS)by using Mayo clinic criteria.Multiple precipitators have been attributed to causing TTC.Rarely it has been reported to occur following an acute envenomation.AIM This review describes the various patterns,mechanisms,and outcomes of envenomation induced TTC.METHODS In this review,we included all studies on“TTC”and“envenomation”published in the various databases before June 2022.To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation RESULTS A total of 20 patients with envenomation induced TTC were identified.Most episodes of envenomation induced TTC were reported following a bee sting,scorpion sting,and snake envenomation.Fear and anxiety related to the sting,direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients.95%of these patients presented with a clinical picture of ACS.Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC.Echocardiographic evidence of Apical TTC was noted in 72%of patients.94%of these patients had clinical improvement following optimal management and 35%of these patients were treated with guideline directed medications for heart failure.CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC.Most reported envenomation related TTC has been due to bee stings and scorpion bites.Common mechanisms causing TTC were fear,anxiety,and stress of envenomation.Most of these patients present with clinical presentation of ACS,ST elevation,and elevated troponin.The most common type of TTC in these patients is Apical,which improved following medical management.展开更多
BACKGROUND Around 1 million cases of medical termination of pregnancy(MTP)take place yearly in the United States of America with around 2 percent of this population developing complications.The cardiovascular(CVD)comp...BACKGROUND Around 1 million cases of medical termination of pregnancy(MTP)take place yearly in the United States of America with around 2 percent of this population developing complications.The cardiovascular(CVD)complications occurring post MTP or after stillbirth is not very well described.AIM To help the reader better understand,prepare,and manage these complications by reviewing various cardiac comorbidities seen after MTP.METHODS We performed a literature search in PubMed,Medline,RCA,and google scholar,using the search terms“abortions”or“medical/legal termination of pregnancy”and“cardiac complications”or“cardiovascular complications”.RESULTS The most common complications described in the literature following MTP were infective endocarditis(IE)(n=16),takotsubo cardiomyopathy(TTC)(n=7),arrhythmias(n=5),and sudden coronary artery dissection(SCAD)(n=4).The most common valve involved in IE was the tricuspid valve in 69%(n=10).The most observed causative organism was group B Streptococcus in 81%(n=12).The most common type of TTC was apical type in 57%(n=4).Out of five patients de veloping arrhythmia,bradycardia was the most common and was seen in 60%(3/5)of the patients.All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery.Mortality was only reported following IE in 6.25%.Clinical recovery was reported consistently after optimal medical management following all these complications.CONCLUSION In conclusion,the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature.In this review,the most common CVD complication following MTP was noted to be IE and TTC.展开更多
Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to s...Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to study the interaction between COVID-19 and HF from a critical care perspective.We performed a systematic search for studies that reported HF and critical carerelated outcomes in COVID-19 patients in the PubMed and Medline databases.From a total of 1050 papers,we identified 26 that satisfied the eligibility criteria for our review.Data such as patient demographics,HF,intensive care unit(ICU)admission,management,and outcome were extracted from these studies and analyzed.We reported outcomes in heart-transplant patients with COVID-19 separately.In hospitalized patients with COVID-19,the prevalence of HF varied between 4%and 21%.The requirement for ICU admission was between 8%and 33%.HF patients with COVID-19 had an overall mortality rate between 20%and 40%.We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients,and patients with HF were more likely to require ventilation,ICU admission and develop complications.Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction,and HF with preserved ejection fraction.COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.展开更多
文摘BACKGROUND Takotsubo cardiomyopathy(TTC)can be diagnosed in patients presenting with clinical features of acute coronary syndrome(ACS)by using Mayo clinic criteria.Multiple precipitators have been attributed to causing TTC.Rarely it has been reported to occur following an acute envenomation.AIM This review describes the various patterns,mechanisms,and outcomes of envenomation induced TTC.METHODS In this review,we included all studies on“TTC”and“envenomation”published in the various databases before June 2022.To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation RESULTS A total of 20 patients with envenomation induced TTC were identified.Most episodes of envenomation induced TTC were reported following a bee sting,scorpion sting,and snake envenomation.Fear and anxiety related to the sting,direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients.95%of these patients presented with a clinical picture of ACS.Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC.Echocardiographic evidence of Apical TTC was noted in 72%of patients.94%of these patients had clinical improvement following optimal management and 35%of these patients were treated with guideline directed medications for heart failure.CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC.Most reported envenomation related TTC has been due to bee stings and scorpion bites.Common mechanisms causing TTC were fear,anxiety,and stress of envenomation.Most of these patients present with clinical presentation of ACS,ST elevation,and elevated troponin.The most common type of TTC in these patients is Apical,which improved following medical management.
文摘BACKGROUND Around 1 million cases of medical termination of pregnancy(MTP)take place yearly in the United States of America with around 2 percent of this population developing complications.The cardiovascular(CVD)complications occurring post MTP or after stillbirth is not very well described.AIM To help the reader better understand,prepare,and manage these complications by reviewing various cardiac comorbidities seen after MTP.METHODS We performed a literature search in PubMed,Medline,RCA,and google scholar,using the search terms“abortions”or“medical/legal termination of pregnancy”and“cardiac complications”or“cardiovascular complications”.RESULTS The most common complications described in the literature following MTP were infective endocarditis(IE)(n=16),takotsubo cardiomyopathy(TTC)(n=7),arrhythmias(n=5),and sudden coronary artery dissection(SCAD)(n=4).The most common valve involved in IE was the tricuspid valve in 69%(n=10).The most observed causative organism was group B Streptococcus in 81%(n=12).The most common type of TTC was apical type in 57%(n=4).Out of five patients de veloping arrhythmia,bradycardia was the most common and was seen in 60%(3/5)of the patients.All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery.Mortality was only reported following IE in 6.25%.Clinical recovery was reported consistently after optimal medical management following all these complications.CONCLUSION In conclusion,the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature.In this review,the most common CVD complication following MTP was noted to be IE and TTC.
文摘Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to study the interaction between COVID-19 and HF from a critical care perspective.We performed a systematic search for studies that reported HF and critical carerelated outcomes in COVID-19 patients in the PubMed and Medline databases.From a total of 1050 papers,we identified 26 that satisfied the eligibility criteria for our review.Data such as patient demographics,HF,intensive care unit(ICU)admission,management,and outcome were extracted from these studies and analyzed.We reported outcomes in heart-transplant patients with COVID-19 separately.In hospitalized patients with COVID-19,the prevalence of HF varied between 4%and 21%.The requirement for ICU admission was between 8%and 33%.HF patients with COVID-19 had an overall mortality rate between 20%and 40%.We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients,and patients with HF were more likely to require ventilation,ICU admission and develop complications.Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction,and HF with preserved ejection fraction.COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.
