Search Results (2,866)

Management of acute coronary syndromes (ACS) in the cardiac intensive care unit (CICU) requires rapid diagnosis, timely reperfusion or invasive assessment, appropriate antithrombotic therapy, and early recognition of haemodynamic, electrical, and mechanical complications. This narrative review examines contemporary evidence across ST-segment elevation and non-ST-segment elevation presentations, with emphasis on decisions during hospitalisation and early secondary prevention. High-sensitivity cardiac troponin algorithms support accelerated assessment of suspected non-ST-segment elevation ACS, whereas next-generation assays require further implementation validation. Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet–anticoagulant treatment are selective strategies. Contemporary care also includes risk-based invasive timing, complete revascularisation in suitable haemodynamically stable patients, culprit-lesion-only initial PCI in cardiogenic shock, and individualised management of frailty and renal impairment. High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care. Full article

Thoracopagus conjoined twins are the most common type of conjoined twinning and are frequently associated with shared cardiac anatomy, the principal determinant of prognosis and postnatal survival. Early prenatal diagnosis is essential for accurate counseling and timely pregnancy management. We report the diagnosis of thoracopagus conjoined twins with a shared cardiac structure in a 35-year-old primigravid woman at 8 weeks and 3 days of gestation. High-resolution transvaginal ultrasound demonstrated persistent thoracic fusion, fixed relative fetal position, a single yolk sac, a single umbilical cord, and absence of an intertwin membrane. Color Doppler confirmed a single sonographically detectable cardiac complex, while three-dimensional ultrasound enhanced spatial visualization and facilitated parental counseling. Differential diagnoses, including monochorionic twins with close apposition, TRAP sequence, body stalk anomaly, and other forms of conjoined twinning, were systematically excluded. Early first-trimester recognition of thoracopagus conjoined twins with shared cardiac anatomy is feasible using dynamic ultrasound and Doppler imaging. Establishing the diagnosis before the end of the first trimester enables accurate prognostic assessment, timely multidisciplinary counseling, and informed parental decision-making for this condition associated with an extremely poor prognosis. Full article

Background/Objectives: Fetal hepatosplenomegaly is an uncommon but clinically significant prenatal finding associated with a wide range of heterogeneous conditions, including congenital infections, fetal anemia, genetic syndromes, metabolic disorders, and other, less common abnormalities. Because of its nonspecific presentation and diverse etiologies, it represents a diagnostic challenge that requires a structured, multidisciplinary approach. This review aims to present a practical, clinically oriented, stepwise approach to the prenatal evaluation of fetal hepatosplenomegaly, integrating current evidence to facilitate differential diagnosis and guide prenatal management. Methods: A comprehensive literature review was performed, focusing on ultrasound diagnosis, differential diagnosis, genetic evaluation, and prenatal management strategies in fetuses with hepatosplenomegaly. Results: The prenatal detection of hepatosplenomegaly should prompt a detailed ultrasound assessment, including the confirmation of organ enlargement, evaluation of associated structural abnormalities, Doppler studies, and screening for signs of fetal anemia, infection, hydrops fetalis, or cardiac dysfunction. The diagnostic workup should begin with targeted maternal and fetal investigations directed toward the most common causes. In unresolved cases, genetic testing—including chromosomal microarray analysis and next-generation sequencing—may help establish the diagnosis. The preservation of biological material obtained during invasive procedures should be considered to allow future molecular analyses if new clinical findings emerge. The management depends on the underlying etiology and may include fetal therapy, maternal treatment, or specific interventions in selected genetic and metabolic conditions. Conclusions: Fetal hepatosplenomegaly requires a systematic diagnostic strategy that integrates ultrasound, laboratory, and genetic assessment. A structured approach may improve diagnostic accuracy, optimize prenatal counseling, and facilitate the timely management of potentially treatable conditions. Full article

Background/Objectives: Cardiac arrest and fluid, electrolyte, and acid–base disorders frequently coexist in critically ill patients and are associated with poor clinical outcomes. However, long-term population-level trends in mortality involving both conditions remain poorly characterized. This study evaluated temporal trends and demographic disparities in mortality involving cardiac arrest and fluid, electrolyte, and acid–base disorders among U.S. adults from 2004 to 2024. Methods: We conducted a retrospective population-based study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database. Adults aged ≥25 years with cardiac arrest (ICD-10: I46) and fluid, electrolyte, and acid–base disorders (ICD-10: E87) listed anywhere on the same death certificate between 2004 and 2024 were included. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC), with analyses stratified by demographic and geographic characteristics. Results: A total of 152,937 deaths involved both cardiac arrest and fluid, electrolyte, and acid–base disorders during the study period. The AAMR nearly doubled, increasing from 2.06 (95% CI, 2.00–2.13) in 2004 to 4.08 (95% CI, 4.00–4.16) in 2024, corresponding to an overall AAPC of 3.42% (95% CI, 2.58–4.26; p < 0.001). Mortality remained consistently higher among males, adults aged ≥65 years, and non-Hispanic Black individuals, with significant increases observed across all demographic groups. The West demonstrated the highest regional mortality burden (AAPC, 3.75%; p < 0.001). Urbanization analyses (2004–2020) showed higher mortality in non-metropolitan than metropolitan areas (AAPCs, 5.36% vs. 4.13%; both p < 0.001). Mortality increased through 2021 before declining modestly during 2021–2024. Conclusions: Mortality involving both cardiac arrest and fluid, electrolyte, and acid–base disorders increased substantially in the United States over the past two decades, with persistent disparities in age, sex, race/ethnicity, and geography. These findings identify populations at increased risk and support targeted public health strategies, equitable healthcare access, and improved recognition and management of metabolic disturbances in patients at risk for cardiac arrest. Full article

Background/Objectives: Persistent atrial fibrillation (AF) is associated with complex structural, electrical, and functional myocardial remodeling that contributes to impaired cardiac performance, symptom burden, and adverse cardiovascular outcomes. Although restoration of sinus rhythm through electrical cardioversion remains a cornerstone of rhythm-control therapy, treatment success is traditionally defined by rhythm maintenance and recurrence rates, while myocardial functional recovery receives substantially less attention. This review aims to summarize current evidence regarding myocardial dysfunction in persistent AF, evaluate available approaches for assessing myocardial recovery after cardioversion, and explore future directions for function-guided rhythm-control strategies. Methods: A narrative review of contemporary literature was performed, focusing on studies published in major cardiovascular journals and current international guidelines. Evidence regarding myocardial remodeling, reverse remodeling after restoration of sinus rhythm, echocardiographic assessment, myocardial strain imaging, biomarker dynamics, and post-cardioversion management strategies was synthesized and critically evaluated. Results: Persistent AF induces multidimensional myocardial dysfunction through tachycardia-mediated injury, structural remodeling, neurohormonal activation, inflammation, and fibrosis. Emerging evidence suggests that restoration of sinus rhythm may initiate a process of reverse remodeling characterized by improvements in left ventricular systolic function, global longitudinal strain, atrial mechanical performance, and biomarker profiles. Advanced echocardiographic techniques and serial biomarker assessment provide valuable opportunities to quantify myocardial recovery beyond conventional rhythm-based endpoints. However, current clinical practice and guideline-directed management remain predominantly focused on rhythm outcomes, while functional recovery is not routinely incorporated into therapeutic decision-making. Based on available evidence, a conceptual framework termed the “Post-Cardioversion Functional Window” is proposed to describe a period of potentially enhanced myocardial recovery during which systematic functional assessment may facilitate individualized management and future risk stratification. Conclusions: Myocardial recovery after restoration of sinus rhythm represents an underrecognized component of contemporary AF management. Integration of echocardiographic, biomarker-based, and clinical functional assessment may improve understanding of post-cardioversion remodeling and support the development of personalized rhythm-control strategies. Future prospective studies are needed to validate myocardial recovery endpoints and determine their role in guiding therapeutic decisions after cardioversion. Full article

Background: Influenza is primarily a respiratory illness, but it is increasingly linked to acute cardiovascular complications, including myocarditis and sudden cardiac death. Evidence on influenza-associated cardiac involvement remains fragmented and largely derived from case-based reports. Methods: This systematic review followed PRISMA guidelines and was registered with PROSPERO (CRD420251249130). PubMed, Web of Science, and Google Scholar were searched for eligible studies. Case reports and case series were included to characterize rare, severe, or atypical cardiac manifestations that are not captured in larger epidemiological studies. Data on demographics, influenza subtype, cardiac manifestations, investigations, management, and outcomes were extracted. Results: Thirty-three studies (32 case reports and one case series) comprising 36 cases were included. Influenza A was reported in 26 cases and influenza B was reported in 9 cases. Myocarditis was the most common manifestation (19 cases, 53%), including fulminant myocarditis in 9 cases (25%). Cardiogenic shock occurred in seven cases (19%), malignant arrhythmias in four(11%), myocardial infarction–like presentations in three (8%), and cardiac arrest or sudden cardiac death in six cases (17%). Cardiac involvement occurred across all age groups, frequently in patients without pre-existing coronary artery disease. Overall mortality was 44% (16/36), with fatalities reported in both influenza A and B infections. These findings predominantly reflect severe and published cases and may not represent the full clinical spectrum of influenza-associated cardiac involvement. Conclusions: This review highlights that influenza infection has been reported in association with a range of acute cardiac manifestations, particularly myocarditis, including severe and fulminant presentations. However, given the reliance on case reports and case series, the findings are subject to significant publication bias and do not permit the estimation of incidence, risk, or causal inference. These observations should therefore be interpreted as hypothesis-generating. Full article

Background/Objectives: Takotsubo cardiomyopathy (TTC), also known as “broken heart syndrome”, is an acute and reversible cardiac condition often triggered by emotional or physical stress. Increasing evidence suggests a strong comorbidity between TTC and psychiatric disorders, particularly anxiety and depression. However, the nature, prevalence, and implications of these associations remain incompletely understood. This scoping review aimed to systematically map the available evidence on the association between Takotsubo cardiomyopathy and anxiety and depressive disorders, characterize the prevalence and nature of these psychiatric comorbidities, evaluate the methods used for their assessment, and identify knowledge gaps to guide future research and clinical practice. Methods: A systematic search of MEDLINE (via PubMed), Embase, Web of Science, and Google Scholar was conducted for peer-reviewed human studies published up to December 2025 in English or French. Eligible studies reported on psychiatric comorbidities in TTC populations, including pre-existing disorders, psychiatric triggers, or psychological sequelae. A standardized extraction grid and the Joanna Briggs Institute appraisal tools were used for data collection and quality assessment. Results: Eighteen studies were included. Depression and anxiety were prevalent among TTC patients, frequently preceding or accompanying cardiac events. Emotional stressors such as bereavement or panic attacks were commonly cited as triggers. Despite this, only a minority of studies used validated psychometric tools, and longitudinal psychiatric follow-up was rare. Most studies were limited by small sample sizes, retrospective designs, and heterogeneity in diagnostic approaches. Conclusions: The findings reveal a consistent association between TTC and affective disorders, underscoring the role of the brain–heart axis. Integrating psychiatric screening and follow-up into TTC management may enhance outcomes. Future interdisciplinary research is needed to clarify causal pathways and inform prevention and treatment strategies. Full article

Blackleg, caused by Clostridium chauvoei, is a severe infectious disease of cattle typically characterized by an acute or peracute course with rapid progression to death within 48 h after the onset of clinical signs. However, well-described reports of chronic or prolonged clinical evolution are rare. This study aimed to describe an outbreak with an atypical, prolonged course and to report the therapeutic management of affected animals. In March 2023, an outbreak occurred in an unvaccinated Nelore herd, with seven cattle showing clinical signs and one dying before veterinary intervention. Due to disease severity, four animals were referred to the Veterinary Hospital (HOVET) of the School of Veterinary Medicine and Animal Science, University of São Paulo (FZEA-USP), while others were managed on-farm. Clinical management included fluid therapy, systemic antimicrobial treatment, surgical debridement of necrotic tissues, drainage, and intensive wound care. Despite treatment, three animals died during hospitalization. One severely affected animal underwent partial amputation of a hind limb and survived, and it was discharged after 116 days of treatment. Diagnosis was confirmed by PCR, clinical examination, and necropsy findings. Overall, the clinical course observed differed from the typical acute presentation, with two animals surviving, suggesting that intensive medical and surgical management may improve outcomes in selected cases. Cardiac lesions were identified in necropsied animals, with exclusive involvement of the left ventricle, a finding that may warrant further investigation. This report highlights atypical manifestations of blackleg and contributes to the limited literature on prolonged cases. Full article

Background/Objectives: Young-onset ischemic stroke shows substantial etiologic heterogeneity. However, the value and diagnostic yield of advanced cardiac and autoimmune evaluations in young adults remain uncertain. Methods: Patients aged 25–55 years admitted with acute ischemic stroke to King Fahd University Hospital in Saudi Arabia between January 2020 and December 2025 were included. Evaluation followed a multidisciplinary young-stroke pathway, incorporating neurovascular imaging, cardiac assessment, and targeted autoimmune and rheumatologic investigations. A Clinically Meaningful Diagnostic Yield (CMDY) was defined as a diagnostic finding that resulted in etiologic reclassification, management modification, or changes to secondary prevention strategy. Results: A total of 480 patients were included (median age, 40 years; 67.7% men). CMDY was observed in 200 (41.7%) patients. Among 79 patients initially classified as having embolic stroke of an undetermined source, 35 (44.3%) were assigned a determined etiologic mechanism following evaluation and follow-up. Patients with undetermined stroke etiology decreased from 16.5% after first-pass evaluation to 9.2% after diagnostic completion. Patent foramen ovale/atrial septal defect-associated stroke mechanisms were identified in 61 patients (12.7%), autoimmune/inflammatory stroke mechanisms in 26 patients (5.4%), and atrial fibrillation-related cardioembolic stroke in 18 patients (3.8%). Clinically relevant mechanisms were identified in 169 patients (35.2%) whose primary etiologic classification remained unchanged. Independent predictors of CMDY were hypertension, prior stroke or transient ischemic attack, multi-territory infarction, and cortical infarction. Conclusions: Etiologic evaluation yielded clinically meaningful findings in over two-fifths of young adults with ischemic stroke and influenced etiologic assessment, treatment, and secondary prevention. Diagnostic yield was greatest among patients with prior cerebrovascular events and cortical or multi-territory infarctions, supporting a selective, phenotype-driven approach that warrants prospective multicenter validation. Full article

Introduction: Bispecific antibodies (BsAbs) are a promising and potent therapeutic intervention for relapsed or refractory (R/R) hematologic malignancies, including acute lymphoblastic leukemia (ALL), multiple myeloma (MM), and B-cell lymphomas. These recombinant molecules are designed to target two distinct antigens or epitopes. While BsAbs have shown significant efficacy in managing hematologic malignancies, toxicities must be carefully monitored and their safety profiles require further investigation. This meta-analysis investigates cardiovascular adverse effects associated with seven BsAbs across multiple clinical trials. Methods: A systematic literature review identified seven BsAbs, blinatumomab, elranatamab, epcoritamab, glofitamab, mosunetuzumab, talquetamab, and teclistamab, analyzing 25 clinical trials (Phase I–III) that included monotherapy regimens. The cardiovascular adverse events studied were arrhythmias, heart failure, blood pressure changes, and myocardial infarctions. A meta-analysis using the R meta package calculated proportions and 95% confidence intervals (CIs) and employed a random-effects model to assess heterogeneity. Results: Among 3215 patients, pooled analysis revealed significant findings with 13.6% cardiac arrhythmia (95% CI 10.1–18.2%, p = 0.05), 13.3% hypotension (95% CI 10–17.3%, p < 0.0001), 10.2% tachycardia (95% CI 7.6–13.5%, p = 0.0003), and 3.4% sudden death (95% CI 0–80%, p = 0.046). Less frequent events were hypertension (8%), acute myocardial infarction (1.5%), heart failure (1.4%), and atrial fibrillation (1.3%). Discussion: As BsAbs see increased use in R/R hematologic malignancies, cardiovascular complications must be closely monitored. This analysis highlights hypotension, cardiac arrhythmias, tachycardia, and sudden death as significant adverse effects. Although study heterogeneity and limited patient-level data may have influenced incidence estimates, these findings support routine cardiovascular monitoring and underscore the need for prospective studies to identify high-risk patients and optimize prevention and management strategies. Oncologists, cardiologists, and pharmacists should establish strategies for early detection and management to optimize patients’ outcomes. Full article

Vasoplegia remains one of the most challenging and incompletely understood complications across the spectrum of mechanical circulatory support (MCS). Initially described following cardiopulmonary bypass, it is increasingly recognized in patients supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and combined unloading strategies such as ECPELLA (ECMO and Impella support) as well as in patients bridged to heart transplantation with temporary or durable mechanical circulatory support (MCS). Despite occurring in different clinical settings, these syndromes share common pathophysiological features, including systemic inflammation, endothelial dysfunction, glycocalyx degradation, dysregulated nitric oxide signaling, neurohormonal imbalance, microcirculatory impairment and severe vasomotor dysregulation. Although vasoplegia is commonly considered a technology-specific complication, growing evidence suggests that CPB-associated vasoplegia, postcardiotomy vasoplegic syndrome, ECMO-related vasodilatory shock and distributive shock during ECPELLA may represent distinct manifestations of a common pathobiological process driven by blood–artificial surface interactions, ischemia–reperfusion injury, hemolysis and immune activation. This narrative review proposes a unified framework of vasoplegia across the continuum of MCS. Key mechanistic pathways and current therapeutic strategies, including catecholamines, vasopressin, angiotensin II, methylene blue and hydroxocobalamin, are discussed. By integrating evidence from cardiac surgery, critical care and mechanical circulatory support, vasoplegia is presented as a unifying syndrome of extracorporeal circulation. This perspective may support earlier recognition, phenotype-based management and the development of more targeted therapeutic strategies in a clinically significant yet underexplored area of cardiovascular critical care. Full article

Diabetic cardiomyopathy (DCM) is a cardiac condition characterized by various structural and functional abnormalities that are associated with diabetes mellitus. Its development involves multiple factors, among which endothelial dysfunction plays a significant role. To fully describe the relationship between DCM and endothelial dysfunction, we conducted a literature search across several databases, including PubMed, Web of Science, and EMBASE. Our review of DCM research focused on understanding its mechanisms, exploring the methods used to diagnose it, and potential treatment options. Although researchers have made significant progress in DCM diagnosis and treatment in recent years, considerable challenges persist as well. Artificial intelligence (AI)-based multimodal approaches may provide new opportunities for cardiovascular risk stratification and early DCM screening, but DCM-specific models still require external validation before clinical implementation. Regarding treatment options, emerging evidence suggests potential benefits of medications that enhance mitochondrial function and antioxidant properties, as well as anti-inflammatory therapies and lifestyle modifications. Future research should focus on combining different relevant data types, such as genetic and molecular information, to improve the AI tools utilized in medical environments. This study aims to identify novel markers for diagnosing DCM and to devise tailored treatment approaches. These advancements have the potential to improve the prognosis of DCM patients and enhance the identification and management of this condition. Full article

Background and Clinical Significance: Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) substantially alters aortic flow dynamics, generating catastrophic false-positive pathology on standard imaging. We report a case of ECMO-induced artifacts mimicking a Stanford type A aortic dissection (TAAD), which led to an unnecessary exploratory sternotomy. Case Presentation: A 67-year-old man underwent extracorporeal cardiopulmonary resuscitation (ECPR) for a shockable out-of-hospital cardiac arrest. Post-resuscitation chest computed tomography angiography (CTA) and preoperative transesophageal echocardiography (TEE) demonstrated a prominent flap-like structure in the ascending aorta, prompting emergency sternotomy. Intraoperative exploration revealed no intimal tear. Subsequent evaluation confirmed an acute anterior myocardial infarction, managed with coronary intervention. Following a dismal neurological prognosis due to hypoxic encephalopathy, VA-ECMO was palliatively withdrawn on day 9, and the patient expired on day 19. The interaction between retrograde ECMO flow and varying levels of intrinsic cardiac function dictates the topology of flow disturbances. Absent native flow creates contrast layering within the aortic root, whereas preserved native flow creates a volatile downstream watershed zone. Based on these distinct phenotypes, we propose a novel conceptual framework for tailor-made imaging strategies titrated to native flow strength—such as temporary ECMO flow reduction for preserved native output, or circuit contrast injections for profound cardiac depression. Conclusions: ECMO-related artifacts present substantial diagnostic pitfalls. Clinicians should adopt a context-aware approach, integrating multi-modality imaging with hemodynamic status to implement individualized, physiologically guided imaging protocols. Full article

Background: Heart failure is a chronic and progressive condition that substantially affects patients’ physical, emotional, social, and spiritual well-being. Although the clinical burden of heart failure is well documented, limited qualitative evidence exists regarding how Saudi adults experience and interpret the condition within their cultural, familial, and religious contexts. This study explored the experiences of Saudi adults living with heart failure and their perceptions of its impact on health-related quality of life. Methods: A qualitative descriptive study informed by an interpretivist perspective was conducted using semi-structured interviews with 25 Saudi adults diagnosed with heart failure. Participants were recruited from specialized heart failure and cardiac outpatient clinics within a tertiary medical city in Riyadh, Saudi Arabia. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s reflexive thematic analysis. Results: Four themes were identified: (1) emotional distress and fear, (2) loss of independence and increased dependency, (3) social role disruption, and (4) coping and adaptation strategies. Participants described significant psychological burden, reduced autonomy, and changes in family and social roles following their diagnosis. Conclusions: Heart failure was experienced as more than a physical illness, affecting participants’ emotional well-being, social identity, family relationships, and spiritual life. The findings underscore the importance of holistic and culturally responsive care that addresses psychological, social, spiritual, and family-related needs alongside symptom management. Full article

Background and Objectives: Out-of-hospital cardiac arrest (OHCA) is one of the most clinically significant conditions and can lead to rapid death if cardiopulmonary resuscitation (CPR) or defibrillator use is not performed. Despite this, in approximately half of cases of witnessed OHCA, bystanders do not initiate resuscitation maneuvers. The factors underlying this phenomenon are varied but not yet fully understood. The aim of our analysis is to identify predictors that may indicate a higher likelihood of not performing resuscitation maneuvers. Materials and Methods: Data from cardiac arrests managed by the emergency medical system of the Lombardy region between 1 July 2024 and 30 June 2025 were analyzed. All missions involving cardiac arrests assisted only by lay bystanders were included in the analysis. Results: A total of 12,066 events were analyzed, of which only 4233 were assisted by laypeople. According to the logistic regression model, cardiac arrests occurring in urban settings (OR 0.60; 95% CI: 0.51–0.71), non-medical events (OR 0.44; 95% CI: 0.37–0.51), female patients (OR 0.80; 95% CI: 0.70–0.91), patients over 80 years old (OR 0.40; 95% CI: 0.35–0.45), and events occurring at home (OR 0.33; 95% CI: 0.28–0.39) were associated with a lower likelihood of performing chest compressions. Conversely, when the emergency service arrived within 15 min (OR 1.31; 95% CI: 1.14–1.51), the probability of receiving chest compressions increased. Conclusions: The presence of such a significant gap related to age and sex is noteworthy, prompting greater attention to the educational material presented during BLS-D courses. Moreover, these factors should be considered by the dispatch center when providing pre-arrival instructions to laypeople for initiating chest compressions. Specific communication training should be developed, and communication in these critical phases should be the subject of further study. Full article