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Special Issue "Cardiovascular and Neurological Emergency"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (5 April 2019)

Special Issue Editors

Guest Editor
Dr. Giuseppe Ristagno

Laboratory of Cardiopulmonary Pathophysiology, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
Website | E-Mail
Interests: resuscitation science; emergency medicine; neurosurgery; neurological acute disorders; defibrillation; biomarkers
Guest Editor
Dr. Laura Ruggeri

IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
Website | E-Mail
Interests: cardiovascular pathophysiology; extracorporeal circulation; cardiac surgery; emergency; intensive care

Special Issue Information

Dear Colleagues,

Cardiovascular and neurological emergencies represent a vast public health problem, being a leading cause of death in the world (accounting for more than one third of all deaths worldwide each year). In addition, nonfatal events lead to disabilities and disability-adjusted life years, representing a major healthcare concern. The mechanisms responsible for poor outcome are not well understood, although several events (i.e., ischemia/reperfusion syndrome), have been described. Knowledge and understanding of these conditions have led to the development of animal models, successful therapies, and novel tools to characterize these clinical conditions and provide better care to patients.

This Special Issue of the Journal of Clinical Medicine on “Cardiovascular and Neurological Emergency” aims to collect brilliant contributions from worldwide experts in the field. Thus, we invite investigators to contribute with original research articles as well as review articles that will stimulate the continuing efforts to understand mechanisms accounting for cardiovascular and neurological emergencies and outcome, the development of new interventional strategies to improve survival with good functional recovery, new approach for evaluation and prediction of outcome, surgical and medical approaches, and different training methodologies. We are particularly interested in articles directed to promote, share and disseminate new experimental and clinical advances. Specific attention is dedicated to: Evidence from experimental and clinical trials; controversial topics; gold standard and experimental treatments and interventions.

Dr. Giuseppe Ristagno
Dr. Laura Ruggeri
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Cardiovascular emergency and cardiac surgery
  • Neurological emergency and neurosurgery
  • Resuscitation
  • Coronary artery disease
  • Stroke/Ictus
  • Trauma
  • Spine injury/surgery
  • Biomarkers
  • Patient management
  • Translational medicine

Published Papers (16 papers)

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Research

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Open AccessArticle
Transthoracic Impedance Measured with Defibrillator Pads—New Interpretations of Signal Change Induced by Ventilations
J. Clin. Med. 2019, 8(5), 724; https://doi.org/10.3390/jcm8050724
Received: 11 April 2019 / Revised: 14 May 2019 / Accepted: 17 May 2019 / Published: 22 May 2019
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Abstract
Compressions during the insufflation phase of ventilations may cause severe pulmonary injury during cardiopulmonary resuscitation (CPR). Transthoracic impedance (TTI) could be used to evaluate how chest compressions are aligned with ventilations if the insufflation phase could be identified in the TTI waveform without [...] Read more.
Compressions during the insufflation phase of ventilations may cause severe pulmonary injury during cardiopulmonary resuscitation (CPR). Transthoracic impedance (TTI) could be used to evaluate how chest compressions are aligned with ventilations if the insufflation phase could be identified in the TTI waveform without chest compression artifacts. Therefore, the aim of this study was to determine whether and how the insufflation phase could be precisely identified during TTI. We synchronously measured TTI and airway pressure (Paw) in 21 consenting anaesthetised patients, TTI through the defibrillator pads and Paw by connecting the monitor-defibrillator’s pressure-line to the endotracheal tube filter. Volume control mode with seventeen different settings were used (5–10 ventilations/setting): Six volumes (150–800 mL) with 12 min−1 frequency, four frequencies (10, 12, 22 and 30 min−1) with 400 mL volume, and seven inspiratory times (0.5–3.5 s ) with 400 mL/10 min−1 volume/frequency. Median time differences (quartile range) between timing of expiration onset in the Paw-line (PawEO) and the TTI peak and TTI maximum downslope were measured. TTI peak and PawEO time difference was 579 (432–723) m s for 12 min−1, independent of volume, with a negative relation to frequency, and it increased linearly with inspiratory time (slope 0.47, R 2 = 0.72). PawEO and TTI maximum downslope time difference was between −69 and 84 m s for any ventilation setting (time aligned). It was independent ( R 2 < 0.01) of volume, frequency and inspiratory time, with global median values of −47 (−153–65) m s , −40 (−168–68) m s and 20 (−93–128) m s , for varying volume, frequency and inspiratory time, respectively. The TTI peak is not aligned with the start of exhalation, but the TTI maximum downslope is. This knowledge could help with identifying the ideal ventilation pattern during CPR. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Prognostic Value of the Conversion to a Shockable Rhythm in Out-of-Hospital Cardiac Arrest Patients with Initial Non-Shockable Rhythm
J. Clin. Med. 2019, 8(5), 644; https://doi.org/10.3390/jcm8050644
Received: 3 April 2019 / Revised: 4 May 2019 / Accepted: 8 May 2019 / Published: 9 May 2019
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Abstract
In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter “conversion”) during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA [...] Read more.
In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter “conversion”) during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. The primary outcome was good neurologic outcome at hospital discharge. Of 85,602 patients with an initial non-shockable rhythm, 17.9% experienced conversion. Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248–3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167–4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Galectin 3 and Galectin 3 Binding Protein Improve the Risk Stratification after Myocardial Infarction
J. Clin. Med. 2019, 8(5), 570; https://doi.org/10.3390/jcm8050570
Received: 26 March 2019 / Revised: 11 April 2019 / Accepted: 24 April 2019 / Published: 26 April 2019
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Abstract
Background: Acute myocardial infarction (AMI) survivors are at risk of major adverse cardiac events and their risk stratification is a prerequisite to tailored therapeutic approaches. Biomarkers could be of great utility in this setting. Methods: We sought to evaluate the utility of the [...] Read more.
Background: Acute myocardial infarction (AMI) survivors are at risk of major adverse cardiac events and their risk stratification is a prerequisite to tailored therapeutic approaches. Biomarkers could be of great utility in this setting. Methods: We sought to evaluate the utility of the combined assessment of Galectin 3 (Gal-3) and Galectin 3 binding protein (Gal-3bp) for post-AMI risk stratification in a large, consecutive population of AMI patients. The primary outcomes were: Recurrent angina/AMI and all-cause mortality at 12 months after the index event. Results: In total, 469 patients were included. The median Gal-3bp was 9.1 μg/mL (IQR 5.8–13.5 μg/mL), while median Gal-3 was 9.8 ng/mL (IQR 7.8–12.8 ng/mL). During the 12 month follow-up, 34 patients died and 41 had angina pectoris/reinfarction. Gal-3 was associated with all-cause mortality, while Gal-3bp correlated with the risk of angina/myocardial infarction even when corrected for other significant covariates. The final multivariable model for mortality prediction included patients’ age, left ventricular ejection fraction (LVEF), Gal-3, and renal function. The ROC curve estimated for this model has an area under the curve (AUC) of 0.84 (95%CI 0.78–0.9), which was similar to the area under the ROC curve obtained using the GRACE score 1-year mortality. Conclusions: The integrated assessment of Gal-3 and Gal-3bp could be helpful in risk stratification after AMI. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma
J. Clin. Med. 2019, 8(3), 390; https://doi.org/10.3390/jcm8030390
Received: 15 January 2019 / Revised: 8 March 2019 / Accepted: 12 March 2019 / Published: 20 March 2019
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Abstract
Children with abusive head trauma tend to have worse outcomes than children with accidental head trauma. However, current predictors of poor outcomes for children with abusive head trauma are still limited. We aim to use clinical data to identify early predictors of poor [...] Read more.
Children with abusive head trauma tend to have worse outcomes than children with accidental head trauma. However, current predictors of poor outcomes for children with abusive head trauma are still limited. We aim to use clinical data to identify early predictors of poor outcome at discharge in children with abusive head trauma. In the 10-year observational retrospective cohort study, children aged between zero and four years with abusive or accidental head trauma were recruited. Multivariate logistic regression models were applied to evaluate factors associated with poor prognosis in children with abusive head trauma. The primary outcome was mortality or a Glasgow Coma Scale (GCS) motor component score of less than 6 at discharge. A total of 292 head trauma children were included. Among them, 59 children had abusive head trauma. In comparison to children with accidental head trauma, children with abusive head trauma were younger, had more severe head injuries, and experienced a higher frequency of post-traumatic seizures. Their radiologic findings showed common presence of subdural hemorrhage, cerebral edema, and less epidural hemorrhage. They were more in need of neurosurgical intervention. In the multivariate analysis for predictors of poor outcome in children with abusive head trauma, initial GCS ≤ 5 (versus GCS > 5 with the adjusted odds ratio (OR) = 25.7, 95% confidence interval (CI) = 1.5–432.8, p = 0.024) and older age (per year with the adjusted OR = 3.3, 95% CI = 1.2–9.5, p = 0.024) were independently associated with poor outcome. These findings demonstrate the characteristic clinical differences between children with abusive and accidental head trauma. Initial GCS ≤ 5 and older age are predictive of poor outcome at discharge in children with abusive head trauma. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
Open AccessArticle
Effect of Prophylactic Amiodarone Infusion on the Recurrence of Ventricular Arrhythmias in Out-of-Hospital Cardiac Arrest Survivors: A Propensity-Matched Analysis
J. Clin. Med. 2019, 8(2), 244; https://doi.org/10.3390/jcm8020244
Received: 22 January 2019 / Revised: 8 February 2019 / Accepted: 11 February 2019 / Published: 13 February 2019
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Abstract
Amiodarone is recommended for shock-refractory ventricular arrhythmia during resuscitation; however, it is unknown whether amiodarone is effective for preventing ventricular arrhythmia recurrence in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). We investigated the effectiveness of prophylactic amiodarone in preventing [...] Read more.
Amiodarone is recommended for shock-refractory ventricular arrhythmia during resuscitation; however, it is unknown whether amiodarone is effective for preventing ventricular arrhythmia recurrence in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). We investigated the effectiveness of prophylactic amiodarone in preventing ventricular arrhythmia recurrence in OHCA survivors. Data of consecutive adult non-traumatic OHCA survivors treated with TTM between 2010 and 2016 were extracted from prospective cardiac arrest registries of four tertiary care hospitals. The prophylactic amiodarone group was matched in a 1:1 ratio by using propensity scores. The primary outcome was ventricular arrhythmia recurrence requiring defibrillation during TTM. Among 295 patients with an initially shockable rhythm and 149 patients with initially non-shockable-turned-shockable rhythm, 124 patients (27.9%) received prophylactic amiodarone infusion. The incidence of ventricular arrhythmia recurrence was 11.26% (50/444). Multivariate analysis showed prophylactic amiodarone therapy to be the independent factor associated with ventricular arrhythmia recurrence (odds ratio 1.95, 95% CI 1.04–3.65, p = 0.04), however, no such association was observed (odds ratio 1.32, 95% CI 0.57–3.04, p = 0.51) after propensity score matching. In this propensity-score-matched study, prophylactic amiodarone infusion had no effect on preventing ventricular arrhythmia recurrence in OHCA survivors with shockable cardiac arrest. Prophylactic amiodarone administration must be considered carefully. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Endovascular Therapy for Tandem Occlusion in Acute Ischemic Stroke: Intravenous Thrombolysis Improves Outcomes
J. Clin. Med. 2019, 8(2), 228; https://doi.org/10.3390/jcm8020228
Received: 4 January 2019 / Revised: 30 January 2019 / Accepted: 7 February 2019 / Published: 10 February 2019
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Abstract
Ischemic stroke related to tandem internal carotid and middle cerebral artery (TIM) occlusion is a challenging condition where endovascular treatment (EVT) is an emerging revascularization option. The identification of factors influencing clinical outcomes can assist in creating appropriate therapeutic algorithms for such patients. [...] Read more.
Ischemic stroke related to tandem internal carotid and middle cerebral artery (TIM) occlusion is a challenging condition where endovascular treatment (EVT) is an emerging revascularization option. The identification of factors influencing clinical outcomes can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to evaluate prognostic factors in the context of EVT for TIM occlusion. We performed a retrospective study of consecutive patients with TIM occlusion admitted within 6 h from symptom onset to two tertiary stroke centers. We recorded the etiology of stroke, clinical deficits at stroke onset and discharge, details of EVT, final infarct volume (FIV), in-hospital mortality, and outcome at three months. Among 73 patients with TIM occlusion, 53 were treated with EVT. The median age was 75.9 years (interquartile range (IQR) 64.6–82.6), with the most common etiology of cardioembolism (51.9%). Intravenous thrombolysis with tissue-plasminogen activator (t-PA) was performed in the majority (69.8%) of cases. EVT achieved successful recanalization with a thrombolysis in cerebral infarction (TICI) grade of 2b or 3 in 67.9%. A good outcome (modified Rankin score of 0–2 at three months) was observed in 37.7%. After adjustment for age, the National Institutes of Health Stroke Scale (NIHSS) at admission, and success of recanalization, smaller final infarct volume (odds ratio (OR) 0.021 for FIV above 25th percentile (95% CI 0.001–0.332, p = 0.005)) and administration of intravenous t-PA (OR 12.04 (95% CI 1.004–144.392, p = 0.049)) were associated with a good outcome at three months. Our study demonstrates that bridging with t-PA is associated with improved outcomes in the setting of tandem ICA and MCA occlusions treated with EVT and should therefore not be withheld in eligible patients. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
Open AccessArticle
The Correlation between Severity of Neurological Impairment and Left Ventricular Function in Patients after Acute Ischemic Stroke
J. Clin. Med. 2019, 8(2), 190; https://doi.org/10.3390/jcm8020190
Received: 2 January 2019 / Revised: 27 January 2019 / Accepted: 31 January 2019 / Published: 5 February 2019
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Abstract
Despite left ventricular (LV) dysfunction increases the risk of incidental acute ischemic stroke (AIS), the association between LV function and severity of neurological deficits after AIS remains unclear. Between November 2015 and October 1017, a total of 99 AIS patients were prospectively enrolled [...] Read more.
Despite left ventricular (LV) dysfunction increases the risk of incidental acute ischemic stroke (AIS), the association between LV function and severity of neurological deficits after AIS remains unclear. Between November 2015 and October 1017, a total of 99 AIS patients were prospectively enrolled and categorized into two groups based on National Institute of Health Stroke Scale (NIHSS). The AIS patients with NIHSS <6 were allocated into Group 1 (n = 50) and those with NIHSS ≥6 were into Group 2 (n = 49). Echocardiography was performed within 5 days after AIS to assess chamber size, left ventricular ejection fraction (LVEF) and valvular regurgitation. Besides, two inflammatory biomarkers, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were evaluated on admission. The results showed Group 2 had significantly higher value of NLR and PLR (all p-values < 0.01) but lower LVEF (p = 0.001) and frequency of mitral regurgitation (p = 0.021) than Group 1. The NIHSS and modified Rankin scale were significantly negatively correlated with LVEF, whereas both were significantly positively correlated with NLR and PLR (all p-values < 0.02). Multivariate analysis showed LVEF <65%, aging and inflammation were significantly associated with NIHSS ≥6 (all p-values < 0.01). In conclusion, the AIS patients with NIHSS ≥6 had lower LVEF but more clinically dominant mitral regurgitation and higher NLR and PLR compared to those with NIHSS <6. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Perioperative Goal-Directed Therapy during Kidney Transplantation: An Impact Evaluation on the Major Postoperative Complications
J. Clin. Med. 2019, 8(1), 80; https://doi.org/10.3390/jcm8010080
Received: 16 November 2018 / Revised: 3 January 2019 / Accepted: 7 January 2019 / Published: 11 January 2019
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Abstract
Background: Kidney transplantation is considered the first-choice therapy in end-stage renal disease (ESRD) patients. Despite recent improvements in terms of outcomes and graft survival in recipients, postoperative complications still concern the health-care providers involved in the management of those patients. Particularly challenging are [...] Read more.
Background: Kidney transplantation is considered the first-choice therapy in end-stage renal disease (ESRD) patients. Despite recent improvements in terms of outcomes and graft survival in recipients, postoperative complications still concern the health-care providers involved in the management of those patients. Particularly challenging are cardiovascular complications. Perioperative goal-directed fluid-therapy (PGDT) and hemodynamic optimization are widely used in high-risk surgical patients and are associated with a significant reduction in postoperative complication rates and length of stay (LOS). The aim of this work is to compare the effects of perioperative goal-directed therapy (PGDT) with conventional fluid therapy (CFT) and to determine whether there are any differences in major postoperative complications rates and delayed graft function (DGF) outcomes. Methods: Prospective study with historical controls. Two groups, a PGDT and a CFT group, were used: The stroke volume (SV) optimization protocol was applied for the PGDT group throughout the procedure. Conventional fluid therapy with fluids titration at a central venous pressure (CVP) of 8–12 mmHg and mean arterial pressure (MAP) >80 mmHg was applied to the control group. Postoperative data collection including vital signs, weight, urinary output, serum creatinine, blood urea nitrogen, serum potassium, and assessment of volemic status and the signs and symptoms of major postoperative complications occurred at 24 h, 72 h, 7 days, and 30 days after transplantation. Results: Among the 66 patients enrolled (33 for each group) similar physical characteristics were proved. Good functional recovery was evident in 92% of the CFT group, 98% of the PGDT group, and 94% of total patients. The statistical analysis showed a difference in postoperative complications as follows: Significant reduction of cardiovascular complications and DGF episodes (p < 0.05), and surgical complications (p < 0.01). There were no significant differences in pulmonary or other complications. Conclusions: PGDT and SV optimization effectively influenced the rate of major postoperative complications, reducing the overall morbidity and thus the mortality in patients receiving kidney transplantation. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Hospitalization Length after Myocardial Infarction: Risk-Assessment-Based Time of Hospital Discharge vs. Real Life Practice
J. Clin. Med. 2018, 7(12), 564; https://doi.org/10.3390/jcm7120564
Received: 7 December 2018 / Accepted: 15 December 2018 / Published: 18 December 2018
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Abstract
According to guidelines, it is safe for low-risk patients with myocardial infarction (MI) to be discharged within 72 h of hospitalization. However, results coming from registries show that the hospital stay is often much longer in a real-life situation. Data on the length [...] Read more.
According to guidelines, it is safe for low-risk patients with myocardial infarction (MI) to be discharged within 72 h of hospitalization. However, results coming from registries show that the hospital stay is often much longer in a real-life situation. Data on the length of the hospital stay (LOS) of MI patients in Polish centers are lacking. We enrolled 212 consecutive patients with acute MI. Low-risk patients were defined according to PAMI II criteria: age <70 years, left ventricular ejection fraction (LVEF) >45%, no persistent ventricular arrhythmia, and no multi-vessel disease (MVD). The median of the hospitalization length was eight days (Q1: 6; Q3: 9). In low-risk patients (25%), the median of LOS was six days (Q1: 5; Q3: 7) (p < 0.001). In a logistic regression analysis patients age, LVEF, ST-segment-elevation MI and the presence of MVD were independent predictors of longer hospitals stay (≥8 days). During follow up, there were no significant differences in the rates of clinical events between patients with shorter (<8 days) and longer (≥8 days) hospitalization. In a real-life situation, the LOS, even in low-risk patients is much longer than recommended in the guidelines. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Seasonality of the Cardiac Biomarker Troponin in the Eastern Croatian Population
J. Clin. Med. 2018, 7(12), 520; https://doi.org/10.3390/jcm7120520
Received: 28 October 2018 / Revised: 21 November 2018 / Accepted: 3 December 2018 / Published: 6 December 2018
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Abstract
Background: The seasonality of acute myocardial infarction and progressive heart failure has been well established so far. Cardiac troponins (cTns) are organ-specific, not disease-specific, biomarkers. The seasonality of cTns has not been reported before. Methods: Data were collected from the emergency admission unit [...] Read more.
Background: The seasonality of acute myocardial infarction and progressive heart failure has been well established so far. Cardiac troponins (cTns) are organ-specific, not disease-specific, biomarkers. The seasonality of cTns has not been reported before. Methods: Data were collected from the emergency admission unit of a community hospital in eastern Croatia for each month of the year 2014 covering the number of patients whose doctors requested high-sensitivity cTn I (hs-cTn I) testing, the number of positive test results and hospital admissions. Results: The proportion of patients with positive test results was 15.75% (350 patients out of 2221 patients referred to testing), with the males being outnumbered by the females (F: 57.15%, M: 42.85%) (p = 0.069). The month with the highest number of patients with positive test results was December, whereas the month with the lowest number of those patients was January (p < 0.001). The highest numbers of patients referred to testing (30.9%) and of those with positive test results (50.8%) were found in the oldest age group (76+). Conclusion: Tracking the results of cTns testing during patient admissions to emergency departments would be a more effective approach from a public health perspective than tracking the number of patients diagnosed with a particular cardiovascular (CV) disease and could be used as a research approach to guide a search for precipitating factors for CV disease specific to a local community. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Evaluation of Cardiac Complications Following Hemorrhagic Stroke Using 5-Year Centers for Disease Control and Prevention (CDC) Database
J. Clin. Med. 2018, 7(12), 519; https://doi.org/10.3390/jcm7120519
Received: 13 November 2018 / Revised: 28 November 2018 / Accepted: 3 December 2018 / Published: 5 December 2018
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Abstract
Literature regarding cardiac deaths in hemorrhagic stroke patients is few. The aim of this study was to investigate the incidence and risk factors of cardiac death in hemorrhagic stroke patients. We used the multiple causes of death database from the Centers for Disease [...] Read more.
Literature regarding cardiac deaths in hemorrhagic stroke patients is few. The aim of this study was to investigate the incidence and risk factors of cardiac death in hemorrhagic stroke patients. We used the multiple causes of death database from the Centers for Disease Control and Prevention Wide-ranging Online Data of the United States. We identified death certificates from 2006 to 2010 with hemorrhagic stroke (International Classification of Disease, Tenth Revision (ICD-10) code I60-62), or ischemic stroke (ICD-10 code I63), and evaluated the frequency and risk factors of reporting MI (ICD-10 code I20-25) or arrhythmias (ICD-10 code I44-45, I47-49) as the main cause of death in these populations. Over the five-year period, 224,359 death certificates that mentioned hemorrhagic stroke were identified, and the cause of death was MI in 8.95% and arrhythmia in 7.28% patients. With autopsy confirmation, the incidences of MI and arrhythmias in the hemorrhagic stroke group were still lower than the ischemic group. The odds ratio of reporting arrhythmias as a cause of death in hospitalized population was higher. A substantial percentage of hemorrhagic stroke patients had cardiac death. Greater efforts are needed to closely monitor high-risk groups such as females and the elderly. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
Open AccessArticle
Estimation of Arterial Carbon Dioxide Based on End-Tidal Gas Pressure and Oxygen Saturation
J. Clin. Med. 2018, 7(9), 290; https://doi.org/10.3390/jcm7090290
Received: 27 June 2018 / Revised: 12 September 2018 / Accepted: 13 September 2018 / Published: 19 September 2018
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Abstract
Arterial blood gas (ABG) analysis is the traditional method for measuring the partial pressure of carbon dioxide. In mechanically ventilated patients a continuous noninvasive monitoring of carbon dioxide would obviously be attractive. In the current study, we present a novel formula for noninvasive [...] Read more.
Arterial blood gas (ABG) analysis is the traditional method for measuring the partial pressure of carbon dioxide. In mechanically ventilated patients a continuous noninvasive monitoring of carbon dioxide would obviously be attractive. In the current study, we present a novel formula for noninvasive estimation of arterial carbon dioxide. Eighty-one datasets were collected from 19 anesthetized and mechanically ventilated pigs. Eleven animals were mechanically ventilated without interventions. In the remaining eight pigs the partial pressure of carbon dioxide was manipulated. The new formula (Formula 1) is PaCO2 = PETCO2 + k(PETO2 − PaO2) where PaO2 was calculated from the oxygen saturation. We tested the agreements of this novel formula and compared it to a traditional method using the baseline PaCO2 − ETCO2 gap added to subsequently measured, end-tidal carbon dioxide levels (Formula 2). The mean difference between PaCO2 and calculated carbon dioxide (Formula 1) was 0.16 kPa (±SE 1.17). The mean difference between PaCO2 and carbon dioxide with Formula 2 was 0.66 kPa (±SE 0.18). With a mixed linear model excluding cases with cardiorespiratory collapse, there was a significant difference between formulae (p < 0.001), as well as significant interaction between formulae and time (p < 0.001). In this preliminary animal study, this novel formula appears to have a reasonable agreement with PaCO2 values measured with ABG analysis, but needs further validation in human patients. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessArticle
Autoalgometry: An Important Tool for Pressure Pain Threshold Evaluation
J. Clin. Med. 2018, 7(9), 273; https://doi.org/10.3390/jcm7090273
Received: 24 August 2018 / Revised: 7 September 2018 / Accepted: 10 September 2018 / Published: 12 September 2018
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Abstract
The term “pain threshold” refers to the measurement of the intensity of a physical stimulus that evokes pain. To estimate the pain threshold, a mechanical or electrical stimulus with increasing intensity is usually applied until the subject under evaluation refers to a pain [...] Read more.
The term “pain threshold” refers to the measurement of the intensity of a physical stimulus that evokes pain. To estimate the pain threshold, a mechanical or electrical stimulus with increasing intensity is usually applied until the subject under evaluation refers to a pain sensation. This study aims to evaluate the autoalgometric pain threshold as a perfect technique to determine the effects of stimulation rate in relation to both gender and the site of stimulation. In this experimental model, pressure algometry was applied: the subject under evaluation pushed a finger against a small round metal tip, producing and at the same time controlling the intensity of the noxious stimulus. Through autoalgometry, the stimulus intensity was recorded over time, measuring the force change rate applied and studying the subject’s behavior on approaching pain. This test was performed with 50 healthy volunteers on two days, applying a fast or slow rate of stimulation. The results described demonstrate that there is a positive correlation between the pressure increase rate and the pressure threshold evaluation. In light of these findings, autoalgometry can be proposed as an objective measure of pressure pain threshold for clinical and research use. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Review

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Open AccessReview
Advanced Evolution of Pathogenesis Concepts in Cardiomyopathies
J. Clin. Med. 2019, 8(4), 520; https://doi.org/10.3390/jcm8040520
Received: 7 March 2019 / Revised: 12 April 2019 / Accepted: 12 April 2019 / Published: 16 April 2019
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Abstract
Cardiomyopathy is a group of heterogeneous cardiac diseases that impair systolic and diastolic function, and can induce chronic heart failure and sudden cardiac death. Cardiomyopathy is prevalent in the general population, with high morbidity and mortality rates, and contributes to nearly 20% of [...] Read more.
Cardiomyopathy is a group of heterogeneous cardiac diseases that impair systolic and diastolic function, and can induce chronic heart failure and sudden cardiac death. Cardiomyopathy is prevalent in the general population, with high morbidity and mortality rates, and contributes to nearly 20% of sudden cardiac deaths in younger individuals. Genetic mutations associated with cardiomyopathy play a key role in disease formation, especially the mutation of sarcomere encoding genes and ATP kinase genes, such as titin, lamin A/C, myosin heavy chain 7, and troponin T1. Pathogenesis of cardiomyopathy occurs by multiple complex steps involving several pathways, including the Ras-Raf-mitogen-activated protein kinase-extracellular signal-activated kinase pathway, G-protein signaling, mechanotransduction pathway, and protein kinase B/phosphoinositide 3-kinase signaling. Excess biomechanical stress induces apoptosis signaling in cardiomyocytes, leading to cell loss, which can induce myocardial fibrosis and remodeling. The clinical features and pathophysiology of cardiomyopathy are discussed. Although several basic and clinical studies have investigated the mechanism of cardiomyopathy, the detailed pathophysiology remains unclear. This review summarizes current concepts and focuses on the molecular mechanisms of cardiomyopathy, especially in the signaling from mutation to clinical phenotype, with the aim of informing the development of therapeutic interventions. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessReview
Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome—There is Meat on the Bone
J. Clin. Med. 2019, 8(2), 270; https://doi.org/10.3390/jcm8020270
Received: 30 January 2019 / Revised: 18 February 2019 / Accepted: 19 February 2019 / Published: 22 February 2019
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Abstract
Soluble ST2 (sST2) has recently emerged as a promising biomarker in the field of acute cardiovascular diseases. Several clinical studies have demonstrated a significant link between sST2 values and patients’ outcome. Further, it has been found that higher levels of sST2 are associated [...] Read more.
Soluble ST2 (sST2) has recently emerged as a promising biomarker in the field of acute cardiovascular diseases. Several clinical studies have demonstrated a significant link between sST2 values and patients’ outcome. Further, it has been found that higher levels of sST2 are associated with an increased risk of adverse left ventricular remodeling. Therefore, sST2 could represent a useful tool that could help the risk stratification and diagnostic and therapeutic work-up of patients admitted to an emergency department. With this review, based on recent literature, we have built sST2-assisted flowcharts applicable to three very common clinical scenarios of the emergency department: Acute heart failure, type 1, and type 2 acute myocardial infarction. In particular, we combined sST2 levels together with clinical and instrumental evaluation in order to offer a practical tool for emergency medicine physicians. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Open AccessReview
Epilepsy in Children: From Diagnosis to Treatment with Focus on Emergency
J. Clin. Med. 2019, 8(1), 39; https://doi.org/10.3390/jcm8010039
Received: 5 October 2018 / Revised: 9 December 2018 / Accepted: 26 December 2018 / Published: 2 January 2019
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Abstract
Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. An early diagnosis, treatment, and specific medical support must be performed to [...] Read more.
Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. An early diagnosis, treatment, and specific medical support must be performed to prevent Status Epilepticus (SE). Seizure onset, especially in the child population, is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse, and smoking in pregnancy. Early death risk in children without neurological comorbidity is similar to the general population. Diagnosis is generally based on the identification of continuous or recurrent seizures but Electroencephalogram (EEG) evaluation could be useful if SE condition is suspected. The main goal of therapy is to counteract the pathological mechanism which occurs in SE before neural cells are irreversibly damaged. According to the latest International Guidelines and Recommendations of seizure related diseases, a schematic and multi-stage pharmacological and diagnostic approach is proposed especially in the management of SE and its related causes in children. First measures should focus on early and appropriate drugs administration at adequate dosage, airway management, monitoring vital signs, Pediatric Intensive Care Unit (PICU) admission, and management of parent anxiety. Full article
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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