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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Septic shock may be defined as hypotension caused by bacteremia and accompanied by decreased peripheral blood flow, evidenced by oliguria. Clinically, a shaking chill is the warning signal. The immediate cause of hypotension is pooling of blood in the periphery, leading to decreased venous return: later, peripheral resistance falls and cardiac failure may occur. Irreversible shock is comparable to massive reactive hyperemia. Reticuloendothelial failure, histamine release, and toxic hypersensitivity may be factors in the pathogenesis of septic shock. Adrenal failure does not usually occur, but large doses of corticosteroid are employed therapeutically to counteract the effect of histamine release or hypersensitivity to endotoxin. The keys to successful therapy are time, antibiotics, vasopressors, cortisone and correction of acidosis.
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PMID:SEPTIC SHOCK. 1406 36

Cardiovascular infections due to Salmonella enterica are infrequently reported, so their clinical features, prognosis, and optimal treatment are not completely known. Mortality associated with aortitis and endocarditis caused by nontyphoidal Salmonella remains exceedingly high. In this review of cases of cardiovascular infections due to Salmonella enterica studied in 2 hospitals in Madrid, we tried to assess the clinical manifestations and the procedures leading to diagnosis in addition to treatment and outcome. To complete the spectrum of infections related to cardiovascular surgery, cases of postoperative mediastinitis, pericarditis, and infections associated with cardiac devices were also included.Twenty-three patients were reviewed: 11 had mycotic aneurysms; 7 had endocarditis; 2 had device-related infections; and 3 had pericarditis, mediastinitis, and infection of an arteriovenous fistula, respectively. The risk of endovascular infection in patients older than 60 years with bacteremia due to nontyphoidal Salmonella was 23%. Most patients with aortitis had risk factors for atherosclerosis, and 6 had preexisting atherosclerotic aortic aneurysms. All except 1 patient with endocarditis had underlying cardiac disorders. Acquired immunodeficiency disease (AIDS) was a major risk factor for salmonella bacteremia in 1 patient with aortitis and 1 with endocarditis. Fever, unremitting sepsis, "breakthrough" and relapsing bacteremia were the most common clinical findings. In addition, abdominal or thoracic pain and cardiac failure and pericarditis were common features in patients with aortitis and endocarditis respectively. Computed tomography (CT) scan, arteriography, and echocardiography were the main diagnostic tools. Mortality associated with mycotic aneurysms and endocarditis due to S. enterica was 45% and 28%, respectively. Thoracic aneurysms, rupture, and shock at the time of diagnosis were associated with increased mortality in patients with aortitis. In situ bypass grafting was successfully performed in most cases. After surgery, antimicrobial therapy was continued for 4-9 weeks. No relapses were observed after a mean follow-up of 64 months. Antimicrobial therapy alone or combined with valve replacement or excision of a ventricular aneurysm was successful treatment for most patients with salmonella endocarditis. Combined medical and surgical treatment was required for patients with mediastinitis and pericarditis, and patients with device-related infections needed removal of the complete device. Diagnosis of aortitis due to nontyphoidal Salmonella should be established as early as possible to reduce mortality. Patients older than 60 years who have positive blood cultures for Salmonella along with fever and back, abdominal, or chest pain should have an extensive workup for infective aortitis. Immediate bactericidal antimicrobial therapy should be started and a CT scan should be performed on an emergency basis. If a mycotic aneurysm is found, surgical resection should follow as soon as possible. Resection of the aneurysm with in situ bypass grafting is the procedure of choice. Postoperative antimicrobial therapy for 6-8 weeks seems enough to avoid relapses. Optimal treatment of patients with endocarditis occurring on ventricular aneurysms must include resection of the aneurysmal sac. Salmonella endocarditis can be successfully treated with antimicrobials alone. Valve replacement should be reserved for patients with cardiac failure or persisting sepsis, and for those who relapse after discontinuation of antimicrobial therapy.
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PMID:The spectrum of cardiovascular infections due to Salmonella enterica: a review of clinical features and factors determining outcome. 1502 66

Patients with infective endocarditis (IE) were studied to assess incidence, clinical features and mortality in a population with either persistent (PF) or recurrent fever (RF) during treatment. A sample of 81 patients was evaluated. Of these, 46 patients (56.8%) had fever during treatment: 35 had PF and 16 had RF (Group 1). This group was compared with 35 patients with IE without fever (Group 2). Age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. The aortic and tricuspid valve compromise, and Staphylococcus aureus as etiologic agent were more frequent in Group 1 (although not significantly). However, the development of complications (95.6 vs. 65.7%), renal dysfunction (58.6 vs. 31.4%), major vessel embolization (60.8 vs. 34%), microvascular phenomena (43.4 vs. 17.1%), infections with MRSA (22.2 vs. 4%) and valvular surgery (34.7 vs. 11.4%) were significantly higher in Group 1 (p<0.05). The most common causes of PF were microvascular phenomena (14/32 patients), systemic and pulmonary embolization (10), valvular abscesses (5), persistent bacteremia (4) and mycotic aneurysm (2). On the other hand, phlebitis (6/16), drug hypersensitivity (3) and nosocomial infections (3) were related with RF. The overall mortality was 39.5%, distributed as follows: 52.2% of Group 1 and in 22.9% of Group 2 (p=0.007). The presence of comorbidities, major vessel embolization, heart failure, MRSA infection and inappropriate initial antibiotic therapy were significantly associated with the increased mortality in Group 1 (p<0.05). We propose an evaluation method during the treatment of patients affected by this type of fever.
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PMID:[Clinical significance of persistent or recurrent fever during the treatment of infective endocarditis]. 1523 31

Postpartum cardiomyopathy is rare form of cardiac failure, with the potential for cardiac function to recover to normal. When medical therapy fails to control symptoms or haemodynamic stability, circulatory support with a ventricular assist device may be considered as a bridge to cardiac transplantation. We describe 2 patients with severe postpartum cardiomyopathy, in whom cardiac function recovered sufficiently during mechanical circulatory assistance to enable device explantation. Bacteremia during device support was treated with chronic suppressive antibiotics, yet after cannula explantation and ventricular repair, residual infection led to destruction of the primary repair, with formation of a left ventricular pseudoaneurysm. This is a complication of device support not previously reported. Surgery was necessary to repair the infected ventricular cannula site. Both patients recovered; however one patient developed recurrent cardiomyopathy 4 months later.
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PMID:Left ventricular apical infection and rupture complicating left ventricular assist device explantation in 2 women with postpartum cardiomyopathy. 1573 66

A search of the computerized database at the National Taiwan University Hospital was made for cefotaxime-resistant and cefmetazole-susceptible isolates of Escherichia coli and Klebsiella pneumoniae (which may be extended-spectrum beta-lactamase-producing strains) in pediatric wards and intensive care units between 1999 and 2001. Fourteen infectious episodes attributed only to study bacteria were identified, including 7 episodes of bacteremia. Nine patients (64.3%) had underlying medical conditions: 3 were premature babies, 3 were immunodeficient, 2 had malignancy, and 2 had a congenital heart disease with active heart failure even after surgery. Among the 7 patients with bacteremias, 5 may be catheter-related; 6 were treated with carbapenems and 1 was treated with cefmetazole successfully, with or without the removal of the catheter. Before the acquisition of the infection, a history of stay in an intensive care unit within 4 weeks was noted in 10 cases (71.4%); a history of use of extended-spectrum cephalosporins within 4 weeks was also noted in 6 cases (42.9%). Cefmetazole, with or without an aminoglycoside, was clinically effective in 6 cases (42.8%). Except for 1 episode of pneumonia that ended in mortality, all of the infectious episodes were successfully treated. The mortality rate was 7.1%.
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PMID:Infections of cefotaxime-resistant and cefmetazole-susceptible Escherichia coli and Klebsiella pneumoniae in children. 1584 55

A diabetic patient with chronic heart failure developed necrotizing fasciitis and bacteremia caused by Chryseobacterium meningosepticum, which rapidly evolved into death, even with fasciotomy and intensive care. A review of the English literature found 10 cases of soft tissue infection caused by C. meningosepticum, which is rarely acquired in the community.
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PMID:Fatal case of community-acquired bacteremia and necrotizing fasciitis caused by Chryseobacterium meningosepticum: case report and review of the literature. 1651 26

Central venous accesses have become an integral component of vascular access procedures for hemodialysis. Although the DOQI guidelines recommend that less than 10% of chronic hemodialysis patients should be maintained on catheters, in some countries higher prevalences are reported, as in the United States and the United Kingdom (18% and 24%, respectively, according to the DOPPS). The native arteriovenous fistulas are still the best suited accesses for hemodialysis. However, this option is impractical in many situations, so that several justifiable reasons exist for protracted dialysis catheter use; these include the catheter as a bridge angioaccess device, while the patient is awaiting living-related kidney donor transplantation or maturation of an autologous fistula or graft or, increasingly, as the permanent vascular access for patients with unsuitable vascular anatomy who have exhausted all other options. Moreover, the surgical creation of an AVF is felt to be impossible or at least seems to entail significant risks in situations of high output cardiac failure, myocardial ischaemic events and steal syndrome. In these cases, the dialysis access catheter brings considerable advantages, but it also carries tremendous drawbacks. In addition to the increased risk of luminal thrombosis, infection, unreliable blood flows, central venous stenosis, shorter use life and patient cosmetic concern, tunneled catheters are associated with an increased risk of death. Tunnellization, exit site protection, antibiotic-coated or antiseptic-impregnated hemodialysis catheters, antibiotic lock solutions could be helpful in preventing and treating catheter-related bacteremias. Moreover, the development of a subcutaneous port, that is durable, offers a high blood flow and is fully implantable subcutaneously, may become an alternative for chronic use. In our 10-year experience we implanted in our center over 450 central venous catheters with a satisfactory survival (86% at 1 year and 79% at 2 years for the subcutaneous port). In a matched comparison between Tesio twin catheters and Dialock ports (37 vs. 35, respectively), followed for a 2 year period, no significant differences emerged as regards bacteremia incidence, 0.58/1,000 catheter-days in the Tesio catheter group vs. 0.9/1000 catheter-days in the subcutaneous port group, p=0.12; thrombolytic agents needed, 4.5% vs 4.3% of dialysis sessions; or access failure with removal of the device, 8.1% vs 14.2%, p=0.4. The longer duration of antibiotic therapy in the Tesio group (24.6 vs 14.3 days, p=0.006) was due to the higher incidence of cutaneous infectious episodes (3.8 vs 0.16/1,000 catheter-days). In conclusion, although central venous catheter is the vascular access of last choice, in particular cases it can be a useful alternative, provided that strict protocols for nursing care and proper catheter management are implemented in every center.
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PMID:Do central venous catheters have advantages over arteriovenous fistulas or grafts? 1687 85

Patients with infective endocarditis usually developed persistent fever and heart failure, especially when the valve structures are invaded and destroyed. Persistent bacteremia often leads to severe sepsis or overwhelming septic shock. Septic emboli from the vegetation will possibly result in systemic thromboembolism with multiple organ infarction. Patients with infective endocarditis have been reported to present with either ruptured sinus of Valsalva or complete atrioventricular block. However, both of these serious complications occurring in a single patient is rare. In this case report, we present a 54-year-old man with a previous history of alcoholic cirrhosis and chronic renal failure who suffered from a fulminant course of infective endocarditis. Simultaneously, ruptured sinus of Valsalva and complete atrioventricular block further complicated the preexisting septic shock and multiple organ failure.
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PMID:Ruptured sinus of valsalva and complete atrioventricular block complicating fulminant course of infective endocarditis: a case report and literature review. 1691 22

We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period June 2004-October 2005 at Henry Dunant Hospital, Athens, Greece. C-reactive protein (CRP) and procalcitonin were assayed from 222 patients preoperatively, and 1-3 days following OPCABG. Variables independently associated with infection were identified by a multivariable logistic regression model. Eighteen of 360 (5%) patients developed postoperative infections; 1.7% developed superficial wound infection, 1.4% pneumonia, 1.1% bacteremia, 0.3% mediastinitis, and 0.3% intra-aortic balloon pump related infection. The mean increase of CRP and procalcitonin levels in the first two or three days, respectively, after surgery was significantly higher (P<0.05) in patients with infection. Independent risk factors of infection (P<0.05) were history of major nervous system disorder, left ventricular heart failure preoperatively, emergent operation, transfusions of red blood cells during ICU stay, and duration of central venous catheter placement. The identification of risk factors for infection in combination with the appropriate evaluation of the increased CRP and procalcitonin values may help clinicians for the early diagnosis of infection after OPCABG.
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PMID:Nosocomial infections after off-pump coronary artery bypass surgery: frequency, characteristics, and risk factors. 1790 81

Enterococci are the third leading cause of infectious endocarditis, and despite advances in diagnosis and treatment, the mortality of enterococcal endocarditis has not changed in recent decades. Although variables such as advanced age, cardiac failure, and brain emboli have been recognized as risk factors for mortality, cooperative multi-institutional studies have not assessed the role of other variables, such as nosocomial acquisition of infection, the presence of comorbidities, or the changing antimicrobial susceptibility of enterococci, as factors determining prognosis.We conducted the current study to determine the risk factors for mortality in patients with enterococcal endocarditis in a single institution. We reviewed 47 consecutive episodes of enterococcal endocarditis in 44 patients diagnosed according to the modified Duke criteria from a retrospective cohort study of cases of infectious endocarditis. The main outcome measure was inhospital mortality. We applied stepwise logistic regression analysis to identify risk factors for mortality.Predisposing heart conditions were observed in 86.3% of patients, and 17 had prosthetic valve endocarditis. A portal of entry was suspected or determined in 38.2%; the genitourinary tract was the most common source of the infection (29.7%). Comorbidities were present in 52.2% of cases. Twelve episodes (25.5%) were acquired during hospitalization. Only 3 isolates of Enterococcus faecalis were highly resistant to gentamicin. Eighteen patients (40.9%) needed valve replacement due to cardiac failure or relapse. Comparing cases of native valve and prosthetic valve endocarditis, we found no differences regarding complications, the need for surgical treatment, or mortality. Eight of 44 (18%) episodes were fatal. Age over 70 years (p = 0.05), heart failure (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.15-2.25; p = 0.001), presence of 1 or more comorbidities (OR, 3.2; 95% CI, 1.11-9.39; p = 0.02), and nosocomial acquisition (OR, 8.05; 95% CI, 1.50-43.2; p = 0.01) were associated with mortality. In the multivariate analysis, only nosocomial acquisition increased the risk of mortality. In patients with enterococcal endocarditis, nosocomial acquisition of infection is an important factor determining outcome. As the incidence of bacteremia and the population of elderly people at risk continue to grow, the hazard of acquiring nosocomial enterococcal endocarditis may increase; hence, major emphasis must be put on prevention.
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PMID:Enterococcal endocarditis on native and prosthetic valves: a review of clinical and prognostic factors with emphasis on hospital-acquired infections as a major determinant of outcome. 1800 81


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