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Emergency Medicine in Cardiovascular Diseases
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Emergency Medicine in Cardiovascular Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: 22 October 2024 | Viewed by 4366

Special Issue Editors

Dr. Vincenzo G. Menditto

E-Mail Website
Guest Editor
Emergency Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
Interests: emergency medicine; sepsis; cardiopulmonary resuscitation; emergency management; emergency treatment
Dr. Federico Guerra

E-Mail Website
Guest Editor
Cardiology and Arrhythmology Clinic, University Hospital “Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60123 Ancona, Italy
Interests: clinical cardiology; statistics; cardiovascular medicine; atrial fibrillation; blood pressure; echocardiography; heart failure; hypertension; myocardial infarction; electrophysiology
Dr. Marco Marini

E-Mail Website
Guest Editor
Head ICCU, Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
Interests: acute heart failure; acute coronary syndrome; chronic heart failure; clinical registries; RCTs
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The way to provide the right care for the right patient at the right time in contemporary overcrowded Emergency Departments is a major topic. This is particularly true in the management of the acute phase of cardiovascular diseases. An increasing number of accurate strategies have been designed in order to optimize the determination of acute coronary syndrome or pulmonary embolism in case of chest pain. The role of the Emergency Department Observation Unit and structural protocols has been studied to better manage patients with acute heart failure or pericarditis. Moreover, the acute aortic syndrome remains a challenge for Emergency physicians. In this Special Issue, we welcome authors to submit papers on the management of arrhythmias, acute coronary syndrome, pulmonary embolism, acute heart failure, pericarditis and acute aortic syndrome in the Emergency Department in terms of both diagnosis and treatment.

Dr. Vincenzo G. Menditto
Dr. Federico Guerra
Dr. Marco Marini
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • arrhythmias
  • atrial fibrillation
  • acute coronary syndrome
  • myocardial infarction
  • sudden cardiac death
  • cardiogenic shock
  • pulmonary embolism
  • heart failure
  • pericarditis
  • acute aortic syndrome
  • aortic dissection
  • emergency department
  • observation unit
  • biomarkers
  • echocardiography

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Published Papers (4 papers)

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Research

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13 pages, 1676 KiB  
Article
Centhaquine Increases Stroke Volume and Cardiac Output in Patients with Hypovolemic Shock
by Aman Khanna, Krish Vaidya, Dharmesh Shah, Amaresh K. Ranjan and Anil Gulati
J. Clin. Med. 2024, 13(13), 3765; https://doi.org/10.3390/jcm13133765 - 27 Jun 2024
Viewed by 608
Abstract
Introduction: Centhaquine is a resuscitative agent that acts on α2B adrenergic receptors. Its effect on cardiac output in hypovolemic shock patients has not been reported. Methods: This pilot study was conducted in 12 hypovolemic shock patients treated with centhaquine who participated in an [...] Read more.
Introduction: Centhaquine is a resuscitative agent that acts on α2B adrenergic receptors. Its effect on cardiac output in hypovolemic shock patients has not been reported. Methods: This pilot study was conducted in 12 hypovolemic shock patients treated with centhaquine who participated in an open-label phase IV study (NCT05956418). Echocardiography was utilized to measure stroke volume (SV), cardiac output (CO), left ventricular outflow tract velocity time integral (LVOT-VTI) and diameter (LVOTd), heart rate (HR), left ventricular ejection fraction (LVEF) and fractional shortening (LVFS), and inferior vena cava (IVC) diameter before (0 min) and 60, 120, and 300 min after centhaquine (0.01 mg/kg) iv infusion for 60 min. Results: SV was significantly increased after 60, 120, and 300 min. CO increased significantly after 120 and 300 min despite a decrease in HR. IVC diameter and LVOT-VTI at these time points significantly increased, indicating the increased venous return. LVEF and LVFS did not change, while the mean arterial pressure (MAP, mmHg) increased after 120 and 300 min. Positive correlations between IVC diameter and SV (R2 = 0.9556) and between IVC diameter and MAP (R2 = 0.8928) were observed, which indicated the effects of an increase in venous return on SV, CO, and MAP. Conclusions: Centhaquine-mediated increase in venous return is critical in enhancing SV, CO, and MAP in patients with hypovolemic shock; these changes could be pivotal for reducing shock-mediated circulatory failure, promoting tissue perfusion, and improving patient outcomes. Trial Registration: CTRI/2021/01/030263 and NCT05956418. Full article
(This article belongs to the Special Issue Emergency Medicine in Cardiovascular Diseases)
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13 pages, 850 KiB  
Article
Evolution of Cardiogenic Shock Management and Development of a Multidisciplinary Team-Based Approach: Ten Years Experience of a Single Center
by Leonardo Belfioretti, Matteo Francioni, Ilaria Battistoni, Luca Angelini, Maria Vittoria Matassini, Giulia Pongetti, Matilda Shkoza, Luca Piangerelli, Tommaso Piva, Elisa Nicolini, Alessandro Maolo, Andi Muçaj, Paolo Compagnucci, Christopher Munch, Antonio Dello Russo, Marco Di Eusanio and Marco Marini
J. Clin. Med. 2024, 13(7), 2101; https://doi.org/10.3390/jcm13072101 - 3 Apr 2024
Cited by 2 | Viewed by 1002
Abstract
Background: The management of cardiogenic shock (CS) after ACS has evolved over time, and the development of a multidisciplinary team-based approach has been shown to improve outcomes, although mortality remains high. Methods: All consecutive patients with ACS-CS admitted at our CICU from March [...] Read more.
Background: The management of cardiogenic shock (CS) after ACS has evolved over time, and the development of a multidisciplinary team-based approach has been shown to improve outcomes, although mortality remains high. Methods: All consecutive patients with ACS-CS admitted at our CICU from March 2012 to July 2021 were included in this single-center retrospective study. In 2019, we established a “shock team” consisting of a cardiac intensivist, an interventional cardiologist, an anesthetist, and a cardiac surgeon. The primary outcome was in-hospital mortality. Results: We included 167 patients [males 67%; age 71 (61–80) years] with ischemic CS. The proportion of SCAI shock stages from A to E were 3.6%, 6.6%, 69.4%, 9.6%, and 10.8%, respectively, with a mean baseline serum lactate of 5.2 (3.1–8.8) mmol/L. Sixty-six percent of patients had severe LV dysfunction, and 76.1% needed ≥ 1 inotropic drug. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021, we observed a significative temporal trend in mortality reduction from 57% to 29% (OR = 0.90, p = 0.0015). Over time, CS management has changed, with a significant increase in Impella catheter use (p = 0.0005) and a greater use of dobutamine and levosimendan (p = 0.015 and p = 0.0001) as inotropic support. In-hospital mortality varied across SCAI shock stages, and the SCAI E profile was associated with a poor prognosis regardless of patient age (OR 28.50, p = 0.039). Conclusions: The temporal trend mortality reduction in CS patients is multifactorial, and it could be explained by the multidisciplinary care developed over the years. Full article
(This article belongs to the Special Issue Emergency Medicine in Cardiovascular Diseases)
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Review

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22 pages, 310 KiB  
Review
Transcatheter Structural Heart Interventions in the Acute Setting: An Emerging Indication
by Nikolaos Pyrpyris, Kyriakos Dimitriadis, Panagiotis Theofilis, Panagiotis Iliakis, Eirini Beneki, Daphne Pitsiori, Panagiotis Tsioufis, Mony Shuvy, Konstantinos Aznaouridis and Konstantinos Tsioufis
J. Clin. Med. 2024, 13(12), 3528; https://doi.org/10.3390/jcm13123528 - 16 Jun 2024
Viewed by 1111
Abstract
Structural heart disease is increasingly prevalent in the general population, especially in patients of increased age. Recent advances in transcatheter structural heart interventions have gained a significant following and are now considered a mainstay option for managing stable valvular disease. However, the concept [...] Read more.
Structural heart disease is increasingly prevalent in the general population, especially in patients of increased age. Recent advances in transcatheter structural heart interventions have gained a significant following and are now considered a mainstay option for managing stable valvular disease. However, the concept of transcatheter interventions has also been tested in acute settings by several investigators, especially in cases where valvular disease comes as a result of acute ischemia or in the context of acute decompensated heart failure. Tested interventions include both the mitral and aortic valve, mostly evaluating mitral transcatheter edge-to-edge repair and transcatheter aortic valve implantation, respectively. This review is going to focus on the use of acute structural heart interventions in the emergent setting, and it will delineate the available data and provide a meaningful discussion on the optimal patient phenotype and future directions of the field. Full article
(This article belongs to the Special Issue Emergency Medicine in Cardiovascular Diseases)
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12 pages, 755 KiB  
Review
The Use of Thrombectomy during Primary Percutaneous Coronary Intervention: Resurrecting an Old Concept in Contemporary Practice
by Zahir Satti, Muntaser Omari, Bilal Bawamia, Timothy Cartlidge, Mohaned Egred, Mohamed Farag and Mohammad Alkhalil
J. Clin. Med. 2024, 13(8), 2291; https://doi.org/10.3390/jcm13082291 - 15 Apr 2024
Viewed by 1058
Abstract
Optimal myocardial reperfusion during primary percutaneous coronary intervention (pPCI) is increasingly recognized to be beyond restoring epicardial coronary flow. Both invasive and non-invasive tools have highlighted the limitation of using this metric, and more efforts are focused towards achieving optimal reperfusion at the [...] Read more.
Optimal myocardial reperfusion during primary percutaneous coronary intervention (pPCI) is increasingly recognized to be beyond restoring epicardial coronary flow. Both invasive and non-invasive tools have highlighted the limitation of using this metric, and more efforts are focused towards achieving optimal reperfusion at the level of the microcirculation. Recent data highlighted the close relationship between thrombus burden and impaired microcirculation in patients presenting with ST-segment elevation myocardial infarction (STEMI). Moreover, distal embolization was an independent predictor of mortality in patients with STEMI. Likewise, the development of no-reflow phenomenon has been directly linked with worse clinical outcomes. Adjunctive thrombus aspiration during pPCI is intuitively intended to remove atherothrombotic material to mitigate the risk of distal embolization and the no-reflow phenomenon (NRP). However, prior trials on the use of thrombectomy during pPCI did not support its routine use, with comparable clinical endpoints to patients who underwent PCI alone. This article aims to review the existing literature highlighting the limitation on the use of thrombectomy and provide future insights into trials investigating the role of thrombectomy in contemporary pPCI. Full article
(This article belongs to the Special Issue Emergency Medicine in Cardiovascular Diseases)
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