Abstract

The clinical approach to undifferentiated shock in critically ill patients should be revised to use modern, point-of-care tools that are readily available. With the increasing availability of 2-dimensional ultrasonography and advanced Doppler capabilities, a quick, simplified, and integrated stepwise approach to shock using critical care echocardiography is proposed. Evidence supports the feasibility and usefulness of critical care echo-cardiography in enhancing diagnostic accuracy for shock, but there is a lack of systematic application of the technology in patients with undifferentiated shock. The proposed approach begins with the use of noninvasive ultrasonography with pulsed-wave Doppler capability to determine the flow state by measuring the velocity time integral of the left ventricular outflow tract. This narrative review explores the use left ventricular outflow tract velocity time integral, velocity time integral variation, limited visceral organ Doppler, and lung ultrasonography as a systematic approach for patients with undifferentiated shock.

Abstract

Cardiovascular disease is the leading cause of death and disability worldwide. Early detection and treatment of cardiovascular disease are crucial for patient survival and long-term health. Despite advances in cardiovascular disease biomarkers, the prevalence of cardiovascular disease continues to increase worldwide as the global population ages. To address this problem, novel biomarkers that are more sensitive and specific to cardiovascular diseases must be developed and incorporated into clinical practice. Exosomes are promising biomarkers for cardiovascular disease. These small vesicles are produced and released into body fluids by all cells and carry specific information that can be correlated with disease progression. This article reviews the advantages and limitations of existing biomarkers for cardiovascular disease, such as cardiac troponin and cytokines, and discusses recent evidence suggesting the promise of exosomes as cardiovascular disease biomarkers.

Abstract

This report highlights survival and the patient’s perspective after prolonged venovenous extracorporeal membrane oxygenation (ECMO) for COVID-19–related respiratory failure.

A 36-year-old man with COVID-19 presented with fever, anosmia, and hypoxia. After respiratory deterioration necessitating intubation and lung-protective ventilation, he was referred for ECMO. After 3 days of conventional venovenous ECMO, he required multiple creative cannulation configurations. Adequate sedation and recurrent bradycardia were persistent challenges. After 149 consecutive days of ECMO, he recovered native lung function and was weaned from mechanical ventilation.

This represents the longest-duration ECMO support in a survivor of COVID-19 yet reported. Necessary strategies included unconventional cannulation and flexible anticoagulation.

Abbreviations and Acronyms

HFpEF: heart failure with preserved ejection fraction
IL: interleukin
LV: left ventricular
SGLT2: sodium-glucose cotransporter-2

Introduction

Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by elevated left ventricular (LV) stiffness and filling pressures, despite normal or near-normal EFs. It accounts for approximately half of all HF cases and has become increasingly prevalent with an aging population.¹ In contrast to HF with reduced EF, HFpEF is less understood, and options for effective treatment are limited.² Recent evidence suggests that systemic inflammation plays a pivotal role in HFpEF pathophysiology.³

Current

Abbreviations and Acronyms

HF: heart failure
IV: intravenous
LV: left ventricular
MRI: magnetic resonance imaging
MSC: mesenchymal stromal cell

Introduction

Cell therapy is a potentially useful approach to treating heart failure (HF) secondary to chronic ischemic cardiomyopathy (ischemic HF).¹ Despite controversy,² the preclinical data in the field of cell therapy are clear: Although transplanted cells do not regenerate cardiomyocytes, preclinical studies have consistently shown that they improve cardiac performance.^1,2 Bone marrow–derived mesenchymal stromal cells (MSCs) are among the most promising cell types in the preclinical arena¹ and for patients with

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Marco KaldasMD,

Moneal ShahMD,

Diana PashaievaBDS,

Georgios LygourisMD, and

Anita RadhakrishnanMD