A passionate endurance cyclist ultimately survives sudden death in right ventricular giant cell myocarditis

Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence

Cardiac arrest (CA) is a common and potentially avoidable cause of death, while constituting a substantial public health burden. Although survival rates for out-of-hospital cardiac arrest (OHCA) have improved in recent decades, the prognosis for refractory OHCA remains poor. The use of veno-arterial extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being considered to support rescue measures when conventional cardiopulmonary resuscitation (CPR) fails. ECPR enables immediate haemodynamic and respiratory stabilisation of patients with CA who are refractory to conventional CPR and thereby reduces the low-flow time, promoting favourable neurological outcomes. In the case of refractory OHCA, multiple studies have shown beneficial effects in specific patient categories. However, ECPR might be more effective if it is implemented in the pre-hospital setting to reduce the low-flow time, thereby limiting permanent brain damage. The ongoing ON-SCENE trial might provide a definitive answer regarding the effectiveness of ECPR. The aim of this narrative review is to present the most recent literature available on ECPR and its current developments.

The impact of a 21-day ultra-endurance ride on the heart in young, adult and older adult recreational cyclists

BACKGROUND

This study assessed the acute effect of 21 days of challenging exercise on heart structure and function in recreationally active people across a range of age categories.

METHODS

15 recreationally active people completed a 21-day fundraising cycling ride (MADRIDE) over a distance of 3515 km. Twenty-four hour Holter electrocardiography and blood biochemistry analyses were performed before and after the MADRIDE.

RESULTS

Incidence of cardiac arrhythmia was higher after MADRIDE (OR: 5.93; 95% CI: 5.68-6.19), with increases in both ventricular arrhythmias (OR: 9.90; 95% CI: 9.27-10.57) and supraventricular arrhythmias (OR: 3.09; 95% CI: 2.91-3.29). Adults (OR: 11.45; 95% CI: 7.41-17.69) and older adults (OR: 10.42 95% CI 9.83-11.05) were approximately 10 times more likely to experience arrhythmias after the MADRIDE. Whereas, young participants experienced 18% less cardiac arrhythmias after MADRIDE (OR: 0.82; 95% CI: 0.75-0.90). Aortic valve max velocity was reduced (MD: -0.12 m/s; 95% CI: -0.19-0.05 m/s) and mitral valve deceleration time was slower (MD: -28.91 m/s; 95% CI: -50.97-6.84 m/s) after MADRIDE. Other structural and functional characteristics along with heart rate variability were not different after MADRIDE.

CONCLUSIONS

Multi-day challenging exercise increased the incidence of both supraventricular and ventricular arrhythmias in active adults and older adults. Increases in arrhythmia rates after MADRIDE occurred without changes in cardiac structure and autonomic control. Further exploration is necessary to identify the causes of exercise-induced cardiac arrhythmia in adult and older adults.

Giant cell myocarditis presenting with acute heart failure

Idiopathic giant cell myocarditis (GCM) is a rare and rapidly progressing form of myocarditis predominantly affecting younger people. We report a case of a 23-year-old athletic patient who presented with features of acute heart failure due to GCM and discuss his management that included a left ventricular assist device as a bridge to transplant. He died immediately following the transplant.We also review the literature on this rare disease, highlighting the advances in the management of the disease including immunosuppressive therapy, ventricular assist devices and heart transplantation.