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Loperamide-Induced Cardiac Events: Case Reports And Review., Vivek Modi, Matthew Krinock, Ravi V. Desai Md, Steven Stevens, Sudip Nanda

Cardiology Division

Reports of cardiac arrhythmia secondary to loperamide toxicity have become increasingly common in the literature. We present two patients in their mid-20s, each having overdosed on loperamide and subsequently manifesting life-threatening cardiac arrhythmias not otherwise explained by known pathology. An analysis of the limited research available indicates that loperamide's capacity to block ion channels may be responsible for these events. A better mechanistic understanding of loperamide's effects can help inform clinical management of patients with these life-threatening symptoms as at this time no set guidelines for management have yet been established.

Management And Outcomes Of Cardiogenic Shock In Cardiac Icus With Versus Without Shock Teams., Alexander I Papolos, Benjamin B Kenigsberg, David D Berg, Carlos L Alviar, Erin Bohula, James A Burke Md, Anthony P Carnicelli, Sunit-Preet Chaudhry, Stavros Drakos, Daniel A Gerber, Jianping Guo, James M Horowitz, Jason N Katz, Ellen C Keeley, Thomas S Metkus, Jose Nativi-Nicolau, Jeffrey R Snell, Shashank S Sinha, Wayne J Tymchak, Sean Van Diepen, David A Morrow, Christopher F Barnett

Cardiology Division

BACKGROUND: Single-center studies suggest that implementation of multidisciplinary cardiogenic shock (CS) teams is associated with improved CS survival.

OBJECTIVES: The aim was to characterize practice patterns and outcomes in the management of CS across multiple centers with versus without shock teams.

METHODS: The Critical Care Cardiology Trials Network is a multicenter network of cardiac intensive care units (CICUs) in North America. All consecutive medical admissions to each CICU (n = 24) were captured during annual 2-month collection periods (2017-2019; n = 6,872). Shock management and CICU mortality among centers with versus without shock teams were compared using inverse probability weighting. …

Risk Stratification Among Survivors Of Cardiac Arrest Considered For Coronary Angiography., Ahmed A Harhash, Teresa L May, Chiu-Hsieh Hsu, Sachin Agarwal, David B Seder, Michael R Mooney, Nainesh C. Patel Md, John Mcpherson, Paul Mcmullan, Richard Riker, Eldar Soreide, Karen G Hirsch, Pascal Stammet, Alison Dupont, Sten Rubertsson, Hans Friberg, Niklas Nielsen, Tanveer Rab, Karl B Kern

Cardiology Division

BACKGROUND: The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival.

OBJECTIVES: This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis.

METHODS: Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed "unfavorable feature" on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes.

RESULTS: Seven unfavorable features (of …

Ventricular Septal Aneurysm Mimicking Right Ventricular Outflow Tract Mass In A Patient With Ventricular Septal Defect., Nikhil A. Mehta Md, Syed Rafay Ali Sabzwari, Sara Godil Md, Ghulam Akbar Md, Raman Dusaj Md, Neeraj Shah

Cardiology Division

A 50-year-old man presented with an episode of chest pain. Cardiac magnetic resonance revealed the presence of a large ventricular septal aneurysm partially closing a perimembranous ventricular septal defect, prolapsing into the right ventricular outflow tract, and mimicking a mass. We illustrate the diagnostic approach and management of such ventricular septal aneurysms. (

2015 Scai/Acc/Hfsa/Sts Clinical Expert Consensus Statement On The Use Of Percutaneous Mechanical Circulatory Support Devices In Cardiovascular Care: Endorsed By The American Heart Assocation, The Cardiological Society Of India, And Sociedad Latino Americana De Cardiologia Intervencion; Affirmation Of Value By The Canadian Association Of Interventional Cardiology-Association Canadienne De Cardiologie D'Intervention., Charanjit S Rihal, Srihari S Naidu, Michael M Givertz, Wilson Y Szeto, James A. Burke Md, Phd, Navin K Kapur, Morton Kern, Kirk N Garratt, James A Goldstein, Vivian Dimas, Thomas Tu

Cardiology Division

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those …