Septic cardiomyopathy and mortalityBackground: Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC).Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC.Methods: In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echocardiogram and was defined by a new-onset decline in left ventricular ejection fraction (LVEF) of up to 50% or a decline of at least 10% in LVEF relative to baseline in patients with a history of heart failure with reduced EF. Multivariable logistic regression analysis was performed using the R software program (R Foundation for Statistical Computing). Results: Of the 359 patients in the final analysis, 19 (5.3%) had SIC, and eight (42.1%) of these 19 patients and 60 (17.6%) of the 340 patients in the non-SIC group died. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15-18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23-0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24-55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients.Conclusions: SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.
The spectrum of electrocardiographic changes seen with hyperkalemia is known to progress gradually with increasing serum levels of potassium. Initial changes are limited to peaked T waves and QT shortening, which subsequently progress to prolonged QRS/QT intervals, and finally sinus arrest, sinus bradycardia and asystole. We report a unique case of severe sinus bradycardia with atrial bigeminy and junctional rhythm in the setting of moderate hyperkalemia, a rarely reported electrocardiographic finding.
Aims Loop diuretics have become a mainstay of chronic heart failure management. Furosemide and torsemide are the two most common loop diuretics; nevertheless, there is inconsistent evidence regarding the optimal choice of loop diuretic with respect to clinical outcomes. Methods Medline and Cochrane Databases were systemically reviewed for randomized and observational studies comparing patients with chronic heart failure on oral torsemide versus oral furosemide and their association with intermediate-term outcomes (5–12 months) through May 2018. Odds ratios with corresponding 95% confidence intervals (CIs) were used for outcomes. A random effect model was used to account for heterogeneity among studies. Heterogeneity was assessed with the Higgins I-square statistic. Results A total of 8127 patients were included in the analysis from a total of 14 studies (10 randomized, four observational); 5729 patients were prescribed furosemide and 2398 were given torsemide. There was no significant difference in intermediate-term mortality among heart failure patients on furosemide compared with torsemide [odds ratio (OR) 1.01, CI 0.64–1.59, I 2 = 65.8%]; however, furosemide was associated with an increased risk of heart failure readmissions (OR 2.16, CI 1.28–2.64, I 2 = 0.0%). Heart failure patients taking torsemide were more likely to have an improvement in New York Heart Association class compared with those on furosemide (OR 0.73, CI 0.58–0.93, I 2 = 19.6%). Conclusion Torsemide is associated with a reduction in intermediate-term heart failure readmissions and improvement in New York Heart Association class compared with furosemide but is not associated with a reduced mortality risk. Additional randomized trials are needed to examine the impact of loop diuretics on clinical outcomes in patients with heart failure.
Background: Vascular closure devices have replaced mechanical compression for closure of femoral access sites after endovascular procedures. Case: We present an 87-year old male with symptomatic infrarenal aortic aneurysm measuring 4.8 cm presenting for elective endovascular repair of the aortic aneurysm. A Perclose ProGlide Suture-Mediated Closure was used for closure. The closure was complicated by a separation of the ProGlide device resulting in the migration of the footplate to the descending aorta. Correction required snare retrieval via radial access, and the patient recovered without complications. Discussion: We highlight an important complication of the Perclose ProGlide Suture-Mediated Closure device that is rare but important to know when performing endovascular closures with this device.
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