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Background: Targeted temperature management (TTM) is used to treat patients after sudden out‑of‑hospital cardiac arrest (OHCA)., Aims: The aim of the study was to compare the results of TTM between intensive general and cardiac care units (ICCUs)., Methods: The Polish Registry of Therapeutic Hypothermia obtained data on 377 patients with OHCA from 26 centers (257 and 120 patients treated at the ICCU and intensive care unit [ICU], respectively). Eligibility for TTM was based on the current inclusion criteria for therapy. Medical history as well as data on TTM and additional treatment were analyzed. The main outcomes included in‑hospital survival and complications as well as neurologic assessment using the Glasgow Coma Scale (GCS) and Rankin scale., Results: Both ICU and ICCU patients were mostly male (mean age, 60 years). There were no significant differences regarding the medical history, mechanism of arrhythmia responsible for OHCA, GCS score on admission, time of cardiopulmonary resuscitation activities, and the time to target temperature (33°C). Coronary angiography and the use of dual antiplatelet therapy, intra‑aortic balloon pump, intravascular hypothermia, dopamine, and dobutamine were more common in ICCU patients, while ICU patients more often received norepinephrine. Pneumonia and acute renal failure were more frequent in the ICCU group. Death occurred in 17% and 20% of ICU and ICCU patients, respectively (P = 0.57). The Rankin class after 48 hours since discontinuation of sedation and at discharge was comparable between groups., Conclusions: The ICCU has become a considerable alternative to the ICU to treat OHCA patients with TTM.

Background: Acute kidney injury (AKI) is a serious complication of heart failure (HF). Continuous venovenous haemodiafiltration (CVVHDF) is a widely accepted method for treating this complication. However, the optimal time of its initiation has not been established., Aim: To compare the outcome of patients with HF treated with CVVHDF which was implemented late (the first two years of our experience) or early (the next two years of our experience)., Methods: Thirty seven patients, mean age 65 years, were hospitalised between April 2006 and January 2010 with the diagnosis of HF complicated by AKI. The primary cardiovascular diseases were: valvular heart disease (30%), acute coronary syndrome (27%), dilated cardiomyopathy (16%), exacerbation of chronic HF (11%), and others (16%). The inclusion criteria for CVVHDF therapy were: symptoms of HF including cardiogenic shock with high levels of creatinine (≥ 300 μmol/L) and/or oliguria and/or symptoms of septic shock. The exclusion criteria were: serious coagulation disturbances or inability of placing a catheter in a central vein. Group A consisted of 12 patients treated from April 2006 to the end of 2007. In group B, there were 25 patients treated from the beginning of 2008 to January 2010. Before treatment, mean ejection fraction, left ventricular diastolic diameter and mean blood pressure in both groups were comparable. Renal replacement therapy in group B was started earlier than in group A (mean 2.0 ± 2.0 days vs 4.0 ± 4.3 days from the onset of symptoms of AKI; NS)., Results: The day after the beginning of CVVHDF, renal failure parameters improved in both groups, but the improvement was much more significant in group B. In group A, 11 (92%) patients died. The mean CVVHDF duration was six days and all patients required mechanical ventilation. In group B, 17 (68%) patients died (NS). The mean CVVHDF duration was shortened to four days. Seventeen (68%) patients were ventilated mechanically and this parameter was significantly different between the groups (p = 0.03), Conclusions: An early introduction of CVVHDF significantly diminished the need to use mechanical ventilation and indicated a positive trend in the reduction of in-hospital mortality in patients with HF complicated by AKI.

We describe a case of a 59-year-old male with permanent VT in the course of an acute coronary syndrome. Coronary angiography revealed acute occlusion of the right coronary artery. Although the underlying condition was treated by implantation of 4 stents with excellent haemodynamic effect (TIMI 3), the tachycardia continued, being refractory to drugs (amiodarone). The attempts to restore sinus rhythm by DC electrical cardioversion or transvenous pacing were unsuccessful. The patient was referred to the EP lab. A critical isthmus localised at the paraseptal region of the LV and parallel to the mitral annulus was identified. The isthmus was closed by linear RF application, resulting in VT termination. Due to impaired LV ejection fraction (<30%) the patient was scheduled for ICD implantation. During 6-week follow-up the patient remained free of arrhythmia.

Background: Mortality in acute myocardial infarction (MI) complicated by cardiogenic shock approaches 90%, regardless of the type of pharmacological treatment., Aim: To assess in-hospital and mid-term results of invasive treatment of patients with acute MI with ST segment elevation (STEMI) complicated by cardiogenic shock., Methods: From a prospective registry of all patients admitted to our institution for urgent coronary angiography due to acute coronary syndrome between February 2001 and June 2002, patients with STEMI, symptom duration up to 12 hours and cardiogenic shock diagnosed on admission were identified. The in-hospital and mid-term outcome of 37 patients (mean age 65 years, range 54-77, 68% of males) treated with primary percutaneous coronary intervention (PCI) was analysed., Results: Of the 41 patients with STEMI and cardiogenic shock, total occlusion or critical stenosis of a coronary artery were found in 38 patients. One patient with the occlusion of three main coronary arteries underwent urgent surgical revascularisation and remains alive after an 18-month follow-up. In the remaining 37 patients primary PCI of an infarct-related artery was performed (stent implantation in 70%, abciximab administration in 54%) which restored normal blood flow (TIMI grade 3 flow) in 54% of subjects. In patients with TIMI grade 3 flow the in-hospital mortality was 25%. Of the whole PCI-treated group, 18 (48.6%) patients died during stay in our institution, an additional two - after transfer to another hospital, and one - during a 19-month follow-up period. The remaining 16 patients remain alive (median follow-up of 8 months)., Conclusions: Invasive treatment of patients with STEMI complicated by cardiogenic shock significantly reduces mortality in this high-risk population. The mid-term results in patients discharged from hospital are good. Invasive treatment of acute MI should be accessible for all patients with extensive acute MI.

Background: Short-acting calcium channel blockers (Ca-blockers) have been shown in some studies to increase the risk of myocardial infarction (MI) and post-MI complications. Data from large, international, randomised studies such as the INJECT trial may bring new important information on the effects of medication used before MI, on the course of MI and post-MI complications., Aim: To assess the effects of beta-blocker and Ca-blocker therapy administered prior to MI on the early and late outcome after MI., Methods: The study group consisted of 6001 patients with acute MI treated according to the INJECT protocol. The patients were divided into four groups according to the type of treatment before the index MI: Group I (n=580) - patients treated with beta-blockers; Group II (n=831) - patients treated with Ca-blockers; Group III (n=277) - patients treated with both beta-blockers and Ca-blockers; and Group IV (n=4313) - no beta-blocker or Ca-blocker treatment. The analysed end-points were 35- and 180-day mortality as well as angina recurrences, occurrence of heart failure, atrial fibrillation/flutter and asystole., Results: During hospital stay, supraventricular arrhythmias, asystole, recurrent ischaemia and heart failure occurred more frequently in patients from groups II and III than in other groups. Early mortality was significantly higher in group II (p<0.001) and group III (p<0.002) than in group IV. Late mortality was the lowest in group IV, followed by group I. Cox proportional hazards multivariable analysis revealed that hypotension, Killip class IV (p<0.001), previous Ca-blocker (p<0.01) or Ca- and beta-blocker treatment (p<0.01) as well as previous MI (p<0.05) were the independent predictors of death., Conclusions: Compared with beta-blocker therapy or no treatment, previous use of Ca-blockers increases both early and long-term complication rates in patients with MI.

There was presented the case of a bronchial asthma attack in 29 years old patient with congestive heart failure and a history of atopic bronchial asthma in 30th minute after 12.5 mg of captopril administration.