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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Previously thought as exclusive in Japanese patients, cases of transient left ventricular apical ballooning from other countries have also been reported. The cause remains unknown. From January 1997 to December 2005, 25 patients presenting with signs and symptoms of acute myocardial infarction with normal coronary arteries were analyzed. In all, 10 patients fulfilled all the criteria for transient left ventricular apical ballooning. In all, 6 patients had chest pain and diaphoresis, 5 patients had ST segment elevation, 7 had T wave inversions, and 5 had QT prolongation; 6 patients had normal coronary arteries and 4 had insignificant stenosis. In all, 2 patients died of sepsis, whereas the rest recovered. This is the first series in Taiwanese patients. Our series showed male preponderance, and most patients recovered with supportive treatment. Without any delineating preangiographic feature differentiating it from acute myocardial infarction, any patient should be treated as a case of myocardial infarction until proven otherwise.
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PMID:Transient left ventricular apical ballooning syndrome: the first series in Taiwanese patients. 1840 60

An early diagnosis of sepsis prior to the onset of clinical decline is of particular interest to health practitioners because this information increases the possibilities for early and specific treatment of this life threatening condition. In comparison to acute myocardial infarction or ischemic stroke, the time to initiate therapy is thought to be crucial and the major determining factor for surviving sepsis. The treatment of severe sepsis and septic shock consists of source control, early antimicrobial therapy, and supportive and adjunctive therapies. For supportive therapy, an adequate volume loading is the most important step in the treatment of patients with sepsis. This step is performed in order to restore and maintain oxygen transport and tissue oxygenation. Therefore, the supportive treatment should focus on adequate volume resuscitation and appropriate use of inotropes and vasopressors. Within the first 24 h after the initial sepsis-induced organ failure, adjunctive therapies can help to decrease mortality in patients suffering from severe sepsis and septic shock. Ongoing research continues to provide new information on the management of sepsis. However, implementing new medical advances in the management of sepsis into daily clinical intensive care remains a major hurdle. High quality management tools are necessary to bring evidence-based therapy to the bedside. With respect to recently published studies, the importance of the time taken to improve the outcome of sepsis can not be overemphasized.
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PMID:Management of sepsis. 1841 61

We report a case of an 81-year-old man with bacterial myocarditis presenting with elevated troponins and sepsis, who succumbed due to a ruptured ventricle. The infecting organism was found to be methicillin-resistant Staphylococcus aureus. Bacterial myocarditis is a rare occurrence when independent of infective endocarditis. Generally, this is a complication of bacteremia that is discovered post-mortem. Rarely, as in our patient, it causes significant necrosis of the myocardium leading to rupture of a ventricle. As with viral myocarditis, this disease can present with signs and symptoms of acute myocardial infarction, complicating the diagnosis. Much of the available data on bacterial myocarditis was collected before the development of many modern diagnostic tests and before antibiotics. Accordingly, the appropriate workup, diagnosis and treatment remain unclear. Our patient represents the first reported case of ventricular rupture due to methicillin-resistant S. aureus-associated bacterial myocarditis.
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PMID:MRSA-associated bacterial myocarditis causing ruptured ventricle and tamponade. 1843 23

This case report relating the association between a septic pseudo-aneurysm of the left trunk and myocardial infarction underscores the importance of early non-invasive imaging when acute myocardial infarction is associated with frank clinical or biological signs of systemic sepsis.
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PMID:Septic pseudo-aneurysm of the left main trunk in a dialysis patient. 1849 Mar 31

A 65-year-old woman was transferred from another hospital with a diagnosis of acute myocardial infarction associated with shock. An initial electrocardiogram (ECG) showed ST-segment elevation in leads V1-V6. A transoesophageal echocardiogram showed akinesis of the distal anterior septum and apical regions and hyperkinesis of the basal segments, with an ejection fraction of 20%- 25%. The coronary angiogram showed trivial coronary disease. By Day 6 of admission, the ECG showed normal left ventricle size and systolic function, with an ejection fraction of 65% and no regional abnormalities of wall motion. Sputum examination subsequently revealed typical Streptococcus pneumoniae. Our case demonstrates for the first time an association between sepsis and takotsubo cardiomyopathy. We analyse the possible role of sepsis and the systemic inflammatory response syndrome caused by severe infection as the initial causative mechanism of this syndrome.
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PMID:Takotsubo cardiomyopathy associated with sepsis due to Streptococcus pneumoniae pneumonia. 1879 22

Despite several decades of research and phenomenal advances in technology and therapeutics, sepsis remains a catastrophic enigma. As a frequent cause of death, sepsis now rivals acute myocardial infarction. The longstanding therapeutic principles of early antibiotics use and supportive care have been difficult to improve upon. The authors conducted a concise review of pertinent literature on the pathophysiologic mechanisms of sepsis and the pharmacologic effects of statins. They conclude that, though statins possess anti-inflammatory and lipid-lowering properties, these effects may not be advantageous throughout the changing immunoresponse that can occur in sepsis syndrome. Based on the available information, statin therapy seems advantageous before the onset of sepsis and during sepsis resolution--but not during the compensatory anti-inflammatory response that may occur. Thus, the authors recommend that, until the status of a patient's changing immune response can be clearly determined, the uninterrupted use of statin therapy throughout the full spectrum of sepsis should be avoided.
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PMID:Statins and sepsis: good bullet, disappearing target. 1880 77

Key links in the chain of survival for the management of severe sepsis and septic shock are early identification and comprehensive resuscitation of high-risk patients. Multiple studies have shown that the first 6 hours of early sepsis management are especially important from a diagnostic, pathogenic, and therapeutic perspective, and that steps taken during this period can have a significant impact on outcome. The recognition of this critical time period and the robust outcome benefit realized in previous studies provides the rationale for adopting early resuscitation as a distinct intervention. Sepsis joins trauma, stroke, and acute myocardial infarction in having "golden hours," representing a critical opportunity early on in the course of disease for actions that offer the most benefit.
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PMID:Management of sepsis: early resuscitation. 1895 3

The TandemHeart percutaneous ventricular assist device (pVAD), which provides temporary circulatory support of the left ventricle, can be used in high-risk and hemodynamically unstable patients. The easily inserted TandemHeart provides cardiac support superior to that from the use of intra-aortic balloon pumps. Herein, we discuss TandemHeart implantation via end-to-side femoral arterial grafting in a cardiac patient whose sepsis and multiorgan failure were complicated by coagulopathy and thromboembolism. A 47-year-old woman, on intra-aortic balloon and intravenous inotropic support after an acute myocardial infarction and emergency coronary artery bypass grafting, was transferred to our institution via helicopter. She developed sepsis and multiorgan failure. Her condition was further complicated by coagulopathy and a left-lower-extremity thromboembolism. After 6 weeks of aggressive pharmacologic and intermittent intra-aortic balloon treatment, the patient developed cardiogenic shock and received a TandemHeart pVAD for short-term circulatory support. A GORE-TEX access graft, sewn end-to-side to the femoral artery because of the patient's leg ischemia and very small vessels, served as a conduit for the TandemHeart's femoral arterial inflow cannula. Her difficult circulatory, anatomic, and coagulopathic status stabilized after 2 weeks of TandemHeart support, and she was bridged to the long-term MicroMed DeBakey VAD Child in anticipation of heart transplantation. The case of our patient shows that high-risk patients who have experienced cardiogenic shock with multiorgan failure and coagulopathy can benefit from the TandemHeart pVAD as a bridge to other therapeutic options, even when creative approaches to treatment and to TandemHeart insertion are required.
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PMID:TandemHeart insertion via a femoral arterial GORE-TEX graft conduit in a high-risk patient. 1915 43

Little attention has been paid to the function of lipoproteins as part of a nonspecific immune defense system that binds and inactivates microbes and their toxins effectively by complex formation. Because of high extra-capillary tissue pressure, aggregates of such complexes may be trapped in vasa vasorum of the major arteries. This complex formation and aggregation may be enhanced by hyperhomocysteinemia, because homocysteine thiolactone reacts with the free amino groups of apo-B to form homocysteinylated low-density lipoprotein (LDL), which is subject to spontaneous precipitation in vitro. Obstruction of the circulation in vasa vasorum, caused by the aggregated complexes, may result in local ischemia in the arterial wall, intramural cell death, bursting of the capillary, and escape of microorganisms into the intima, all of which lead to inflammation and creation of vulnerable plaques. The presence of homocysteinylated LDL and oxidized LDL stimulates production of LDL autoantibodies, which may start a vicious circle by increasing the complex formation and aggregation of lipoproteins. The content of necrotic debris and leukocytes and the higher temperature than its surroundings give the vulnerable plaque some characteristics of a micro-abscess that by rupturing may initiate an occluding thrombosis. This suggested chain of events explains why many of the clinical symptoms and laboratory findings in acute myocardial infarction are similar to those seen in infectious diseases. It explains the presence of microorganisms in atherosclerotic plaques and why bacteriemia and sepsis are often seen in myocardial infarction complicated with cardiogenic shock. It explains the many associations between infections and cardiovascular disease. And it explains why cholesterol accumulates in the arterial wall. Some risk factors may not cause vascular disease directly, but they may impair the immune system, promote microbial growth, or cause hyperhomocysteinemia, leading to vulnerable plaques.
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PMID:Review and Hypothesis: Vulnerable plaque formation from obstruction of Vasa vasorum by homocysteinylated and oxidized lipoprotein aggregates complexed with microbial remnants and LDL autoantibodies. 1920 35

A 77-year-old man presented with Evans syndrome (ES), hard palate thickening, gastrointestinal (GI) hemorrhage, acute myocardial infarction (AMI) and pleural and pericardial effusions. The patient responded well to emergent ES treatment with high-dose steroids and intravenous immunoglobulin. Investigation revealed lymphoplasmacytic lymphoma (LPL) as well as amyloidosis in the hard palate, lymph nodes, and pericardium. Considering his age, non-myelosuppressive agents were administered, with the exception of dose-reduced cyclophosphamide. The patient developed neutropenic fever, atrial fibrillation and subsequently died. This report describes the first LPL patient with ES. LPL is generally an indolent disease. However, as in our patient, it can be life threatening because of its complications. ES contributed to his GI hemorrhage, severe anemia, and thus AMI at the time of presentation. Probable cardiac amyloidosis played a role in the latter phase (i.e. cardiac arrhythmia and hypotension during sepsis). Although rare, the presence of ES and amyloidosis should be investigated diligently in elderly LPL patients. Instead of aggressive myelosuppressive chemotherapy agents, targeted therapies might be considered in these fragile patients.
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PMID:Amyloidosis, Evans syndrome and management options of lymphoplasmacytic lymphoma. 1929 14


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