Search

Poisoning by ingestion of ‘Jamaican Stone’, a kind of cardioactive steroid, is extremely rare. However, mortality is very high. For this reason, when it occurs, an early and accurate diagnosis represents a critical challenge for clinicians. We present an unusual case of electrical storm caused by this substance. Resumo: O envenenamento por ingestão de «pedra jamaicana», um tipo de esteroide cardioativo, é extremamente raro. Contudo, dado esta situação se associar a uma mortalidade muito elevada, o diagnóstico precoce e rigoroso desta situação pode ser clinicamente crucial. É retratado um caso pouco comum de tempestade arrítmica causada por esta substância. Keywords: Jamaican Stone, Cardenolides, Bufadienolides, Cardioactive steroids, Palavras-chave: Pedra jamaicana, Cardenolídeos, Bufadienolídeos, Esteroides cardioativos

Abstract Aims This study aimed to assess, in patients with cardiogenic shock secondary to unprotected left main coronary artery‐related myocardial infarction (ULMCA‐related AMICS), the incidence and predictors of no recovery of left ventricular function during the admission. Methods and results This was an observational study conducted at two tertiary care centres (2012–20). The main outcome measured was death or requirement for heart transplantation (HT) or left ventricular assist devices (LVAD) during the admission. A total of 70 patients were included. Percutaneous coronary intervention (PCI) was successful in 53/70 patients (75.7%). The combined endpoint of death or requirement of HT or LVAD during the admission occurred in 41/70 patients (58.6%). The highest incidence of the primary endpoint was observed among patients with profound shock and occluded left main coronary artery (LMCA) (20/23, 87%, P

Background: The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is currently unpredictable. We hypothesized that the presence of uni- or bi-ventricular failure before implantation and the cannulation strategy may influence this interaction. We sought to assess the RV performance during VA-ECMO support and identify RV-related predictors of successful weaning. Methods: Changes in RV size and function during VA-ECMO support by echocardiography were retrospectively analyzed in 87 consecutive adult patients between February 2008 and June 2017. Predictors of successful weaning due to myocardial recovery were evaluated by multivariable logistic regression. Results: RV echocardiographic parameters did not vary significantly during VA-ECMO support and neither after stratification by the type of cannulation or the presence of isolated or biventricular failure. Successful weaning was conditioned by the absence of RV dysfunction before implantation (OR, 14.7; 95% CI, 13.3-140.3; p = 0.025) or in the last day of support (OR, 9.5; 95% CI, 1.6-54; p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR, 6.2; 95%CI, 1.7-22.4; p = 0.005). RV improvement was more often observed in patients with acute RV failure and longer support, while VA-ECMO configuration, additional mechanical support, or pharmacological therapy had no effect. Conclusions: Preservation or improvement of RV function during VA-ECMO is essential for successful weaning. RV echocardiographic performance does not change significantly during VA-ECMO support and is not influenced by cannulation type or the presence of uni- or bi-ventricular failure before implantation.

Abstract Aims To evaluate echocardiographic and biomarker changes during chemotherapy, assess their ability to early detect and predict cardiotoxicity and to define the best time for their evaluation. Methods and results Seventy‐two women with breast cancer (52 ± 9.8 years) treated with anthracyclines (26 also with trastuzumab), were evaluated for 14 months (6 echocardiograms/12 laboratory tests). We analysed: high‐sensitivity cardiac troponin T, NT‐proBNP, global longitudinal strain (GLS), left ventricle end‐systolic volume (LVESV), left ventricle end‐diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF). Cardiotoxicity was defined as a reduction in LVEF>10% compared with baseline with LVEF

Sr. Editor: El inicio de la pandemia de la COVID-19 tuvo una enorme repercusión en la atención del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en todo el mundo1,2. En España se produjo una disminución generalizada en el número de pacientes tratados con angioplastia primaria y un incremento en el tiempo de isquemia desde el inicio de los síntomas hasta la reperfusión3. La fase inicial de la pandemia dio paso a un periodo con rebrotes sucesivos en el que la atención al IAMCEST parece haber mejorado gracias a una menor saturación del sistema sanitario y a los protocolos de actuación implementados4. No obstante, hay pocos datos sobre las posibles secuelas en el funcionamiento de los sistemas de asistencia en red del IAMCEST una vez pasada la primera fase de la pandemia. En el área de Madrid, nuestro hospital es uno de los centros con mayor volumen de angioplastias primarias, abarcando aproximadamente el 20% de todas las activaciones de la región5. Presentamos nuestra experiencia con el Código Infarto en los meses posteriores al final de la desescalada en junio de 2020, cuando terminó la fase inicial de la pandemia en España. Se analizaron los tiempos de las activaciones del Código...

To the Editor, The outbreak of the COVID-19 pandemic had enormous repercussions for the management of ST-segment elevation myocardial infarction (STEMI) worldwide.1,2 Overall, the number of patients treated with primary angioplasty in Spain dropped while ischemia time increased from symptom onset until reperfusion.3 The early phase of the pandemic gave rise to a period of consecutive outbreaks during which the management of STEMI seems to have improved thanks to a less saturated healthcare system and the implementation of proper healthcare protocols.4 However, data on the possible side effects associated with the functioning of the healthcare systems in the STEMI Care Network after the first phase of the pandemic are scarce. In the Madrid area, our hospital is one of the highest-volume centers regarding primary angioplasty as it takes over nearly 20% of all activations in the region.5 We present our experience with the STEMI Care Network in the months that followed the de-escalation of June 2020 when the early phase of the COVID-19 pandemic ended in Spain. Our center STEMI Care Network activation times were analyzed during the first phase of the pandemic (March 14 through June 21, 2020), as well as in the previous and following 12 months. Also, consistent with...