Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Critical congenital heart disease (cCHD) is the most common reason for acute cardiac failure in the neonatal period. cCHD, defined by systemic low cardiac output (LCO) and requiring surgery or catheter-based intervention in the first year of life, has an incidence of approximately 15% of CHD and is responsible for up to 25% fatalities of newborn infants. Clinical deterioration develops in most cases due to rapid closure of the ductus arteriosus (DA). Early diagnosis and immediate treatment determinate beneficial outcome. Critical CHD can be classified in duct-dependent systemic flow, duct-dependent pulmonary flow and transposition of the great arteries. The latter two manifest themselves in oxygen resistant cyanosis, whereas CHD with duct-dependent systemic flow may present itself with cardiogenic shock, which can be difficult to differentiate from other causes of shock such as sepsis. Besides prostaglandin therapy for reopening the arterial duct, a balanced parallel pulmonary and systemic circulation should be a therapeutic goal. In CHD with duct-dependent systemic flow a decrease of pulmonary resistance should be avoided; therefore inadequate oxygen therapy, hyperventilation and alkalosis due to excessive treatment of acidosis, should be averted. Volume therapy should be performed carefully. In CHD with duct-dependent pulmonary flow, pulmonary resistance can be decreased, in case of poor pulmonary flow systemic resistance should be increased, mild alkalosis is recommended. Intense volume therapy is in most cases necessary, except if a restrictive atrial communication is present. In addition to intensive care measures, an arsenal of catheter- and surgery-based procedures need to be hold available as back-up for emergency procedures. Transcatheter interventions are nowadays decisive. Atrial-septostomy was the first and still the most utilized high-urgency procedure; DA-stenting is used in prostaglandin-refractory duct stenosis. In the presence of critical aortic valve stenosis, palliation consists of balloon valvuloplasty. In critical aortic coarctation with myocardial failure and no response to prostaglandin, palliative balloon angioplasty may be the method of choice as bridging for corrective surgery.
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PMID:Acute therapy of newborns with critical congenital heart disease. 3116 Oct 78

Takotsubo cardiomyopathy is characterized by the acute onset of a reversible left ventricular wall motion abnormality that extends beyond a single coronary artery's distribution, following a period of emotional or physical stress. We present a 4 yr 11 mo old boy who was admitted to the pediatric intensive care unit a few days following tonsillectomy and adenoidectomy. The patient presented with mild cyanosis, shortness of breath and decreased levels of consciousness. Initial investigations revealed significant hypokinesia and dilatation of the mid and apical segments of the left ventricle along with preserved function of the basal segment. The patient was given inotropes and diuretics for hemodynamic management. The patient made a complete recovery with normalization of cardiac function within 3-4 wk. Upon follow up, the patient had normal sinus rhythm, improved ejection fraction and no ventricular wall motion abnormalities. The authors believe the myocarditis, rhabdomyolysis, and sepsis following tonsillectomy and adenoidectomy to be the stressors in this case. The rarity of cases that phenotypically mimic classical Takotsubo cardiomyopathy in children makes this case of special interest to pediatricians and cardiologists.
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PMID:Takotsubo cardiomyopathy-like phenotype in a boy. 3121 42


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