Long-Term Radiotherapy-Induced Cardiac Complications: A Case Report

Patient: Male, 48

Final Diagnosis: Late cardiac complications postradiotherapy

Symptoms: Chest pain • dyspnea • syncope

Medication: —

Clinical Procedure: Diagnostic and therapeutic techniques in cardiology

Specialty: Cardiology

Unusual etiology of acute lung injury in a patient with acute myocardial infarction

BACKGROUND

The known etiology of acute lung injury (ALI) is immensely varied and includes severe burns and trauma. Electrical and multiple defibrillation shocks can cause cutaneous burns and blunt chest trauma. The literature contains no reference to the association between ALI and cutaneous burns or blunt chest trauma secondary to defibrillation.

OBJECTIVE

To report a patient with Acute Myocardial Infarction (AMI) who developed ALI possibly due to multiple defibrillation shocks.

CASE REPORT

A 51 year-old man with AMI presenting with multiple episodes of ventricular fibrillation (VF) treated with defibrillation and subsequently cutaneous burns. He developed soon afterward respiratory failure due to ALI. Cardiac failure or any known etiology of ALI was ruled out. Medical treatment included oxygen therapy, cardiac frequency control with betablockers, in addition to antiplatelet therapy. Clinical and oxymetric evolution was favourable, with resolution of the radiological infiltrates. The patient was discharged alive and in good condition at the 19th day after admission. The authors discuss possible mechanisms of ALI development by multiple defibrillation shocks.

CONCLUSIONS

In the absence of any other known etiology, multiple defibrillation shocks may have played a role in the genesis of ALI in our patient, but this remains speculative.

Cardiogenic shock after primary percutaneous coronary intervention: Effects of levosimendan compared with dobutamine on haemodynamics

BACKGROUND

Levosimendan is a new calcium sensitizer with positive inotropic properties. Cardiac power output (CPO) has been shown to be instrumental in the diagnosis of cardiogenic shock (CS) and is an important determinant of outcomes.

AIMS

To evaluate the haemodynamic effects of levosimendan compared to dobutamine in acute myocardial infarction (AMI) patients revascularised by primary percutaneous coronary intervention (PCI), who developed CS.

METHODS AND RESULTS

Twenty two consecutive AMI patients revascularised by PCI, who developed CS, were randomly assigned to levosimendan (24 microg kg(-1) bolus plus 24-h continuous infusion 0,1 microg kg(-1) min(-1)) or dobutamine (initial dose 5 microg kg(-1) min(-1), with a maximum dose adjustment in order to reach the desired haemodynamic effect). Evaluations were performed from baseline to 30 h. The primary end-point was an increase > or =30% in CPO, after 24 h of therapy. The baseline clinical and haemodynamic characteristics were similar in both groups. Levosimendan had a consistently better effect on CPO than dobutamine, while the decrease in PCWP was similar.

CONCLUSION

The primary objective of our study was achieved better by the end of the 24 h infusion of levosimendan than by dobutamine.

Renal dysfunction is an independent predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty

BACKGROUND

Patients with baseline renal dysfunction (BRD) have an increased cardiovascular risk and a worse prognosis after an acute myocardial infarction (AMI). Besides, the appearance of worsening renal failure (WRF) after an AMI is an independent predictor of worse prognosis too. The aim of the present study was to determine the in-hospital prognostic significance of BRD and WRF in patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful primary angioplasty (PA).

METHODS

Seventy-six consecutive patients with STEMI diagnosis were admitted to our department and treated with PA successfully. Two groups were established in relation to the presence of BRD on admission (defined by a ClCr<60 ml/min/1.73 m2, estimated by the modification of diet in renal disease equation). We compared their baseline characteristics and their in-hospital mortality and developing of WRF.

RESULTS

BRD was associated to a greater in-hospital mortality (11.5% vs. 2.7%, p=0.009) and a higher incidence of WRF (12.2% vs. 2.5%, p<0.001). After adjusting by confounding factors, the multiple logistic regression analysis demonstrated that BRD was an independent predictor of in-hospital mortality (OR 2.5, CI 95% 1.5-3.8, p<0.001). Besides, WRF was associated to a greater in-hospital mortality too, independent of the presence of BRD (OR 1.9, CI 95% 1.3-2.4, p<0.001).

CONCLUSIONS

BRD was an independent predictor of in-hospital mortality in patients with STEMI who underwent successful PA. Likewise, WRF occurring in these patients was an independent predictor of in-hospital mortality too.