Anaesthetic management of a covid 19 positive parturient with newly diagnosed cardiomyopathy presenting with supraventricular tachycardia

Covid 19 has been a globally concerning pandemic affecting more than 20 million population worldwide including pregnant women. Cardiomyopathy is a rare affliction occurring in the last trimester of pregnancy or early postpartum manifesting as acute heart failure/ development of sudden arrhythmias/ thromboembolic complications. Anaesthetic management of such patients for caesarean section can be quite challenging, the main goals being maintenance of preload and afterload while avoiding myocardial depression at the same time whatever be the choice of anaesthetic technique. Here we report the successful management of a Covid-19 positive parturient under regional anaesthesia who was recently diagnosed with cardiomyopathy presenting with supraventricular tachycardia.

Anesthetic Consideration in Case of Large Lymphangioma in Right Atrioventricular Groove: A Case Report

Background Cardiac tumor is a rare disease but it causes various hemodynamic changes depending on location and size. Compression of the right sided heart can lead to impaired venous return and consequent systemic and coronary vascular collapse. Case A 62-year-old male who had cardiac lymphangioma on right atrio-ventricular groove. Upon entering the operating room, he was admitted to the tamponade physiology with tachycardia and hypotension. Opioid based anesthesia was performed to minimize myocardial depression, and myocardial function was continuously monitored through Transesophageal echocardiography and pulmonary artery catheter to safely wean the cardio pulmonary bypass (CPB) machine. Conclusion Anesthesiologists should be able to predict and respond appropriately to physiological hemodynamic changes according to the location and size of cardiac tumor.

Peri-operative fluid management during neurosurgical procedures

The management of fluids and electrolytes in neurosurgical patients aims to reduce the risk of cerebral oedema, reduce ICP and at the same time maintain haemodynamic stability and cerebral perfusion. Neurosurgical patients commonly receive diuretics (mannitol and furosemide), developing complications such as bleeding and diabetes insipidus. These patients may require large volumes of intravenous fluids and even blood transfusions for volume resuscitation, treatment of cerebral vasospasm, correction of preoperative dehydration or maintenance of haemodynamic stability. Goal-oriented therapy is recommended in neurological patients, with the aim of maintaining circulating volume and tolerating the changes induced by anaesthesia (vasodilation and myocardial depression).

Comparative transcriptome analysis of transcripts of uncertain coding potential in septic myocardial depression

Background Septic shock with myocardial depression is very common in intensive care units. However, the exact molecular mechanisms underlying sepsis-induced myocardial depression remain unclear. Whether the profiles of transcripts of uncertain coding potential (TUCPs) differ between patients with and without myocardial depression is also unknown. Our study aimed to find expression differences between groups of TUCPs and determine their potential functions in a preclinical model. Methods We generated rat models of hypodynamic septic shock induced by lipopolysaccharide. A total of 12 rats were established and left ventricular tissue from each was collected. We performed RNA-seq to identify TUCPs in each sample. Transcripts with an corrected P value of < 0.05 were defined as differentially expressed (DE). We also performed GO terms and KEGG analysis to identify the potential functions of DE TUCPs. Results A total of 4,851 TUCPs were identified in heart samples, 85 of which were expressed differently between the sepsis and control groups. Further bioinformatic analyses suggested that TUCPs play important roles in myocardial contraction, energy regulation, and metabolic processes, and are also involved in the regulation of several pathways. Conclusion Our results demonstrate that TUCPs both participate in and mediate the pathological process of myocardial depression. Our study improves the understanding of the basic molecular mechanisms underlying myocardial depression from a novel perspective.

Long non-coding RNA GAS5 aggravates myocardial depression in mice with sepsis via the microRNA-449b/HMGB1 axis and the NF-κB signaling pathway

Sepsis is a common cause of deaths of patients in intensive care unit. The study aims to figure out the role of long non-coding RNA (lncRNA) GAS5 in the myocardial depression in mice with sepsis. Cecal ligation and puncture (CLP) was applied to induce sepsis in mice, and then the heart function, myocardium structure, and the inflammatory response were evaluated. Differentially expressed lncRNAs in mice with sepsis were identified. Then gain- and loss-of-functions of GAS5 were performed in mice to evaluate its role in mouse myocardial depression. The lncRNA-associated microRNA (miRNA)–mRNA network was figured out via an integrative prediction and detection. Myocardial injury was observed by overexpression of high-mobility group box 1 (HMGB1) in septic mice with knockdown of GAS5 expression. Activity of NF-κB signaling was evaluated, and NF-κB inhibition was induced in mice with sepsis and overexpression of GAS5. Collectively, CLP resulted in myocardial depression and injury, and increased inflammation in mice. GAS5 was highly expressed in septic mice. GAS5 inhibition reduced myocardial depression, myocardial injury and inflammation responses in septic mice. GAS5 was identified to bind with miR-449b and to elevate HMGB1 expression, thus activating the NF-κB signaling. HMGB1 overexpression or NF-κB inactivation reduced the GAS5-induced myocardial depression and inflammation in septic mice. Our study suggested that GAS5 might promote sepsis-induced myocardial depression via the miR-449b/HMGB1 axis and the following NF-κB activation.

The Effects of Propofol on Left Ventricular Global Longitudinal Strain

Objectives To determine if hemodynamic changes secondary to propofol administration are a result of direct myocardial depression as measured by global longitudinal strain (GLS). The authors hypothesized that propofol would cause a significant worsening in GLS, indicating direct myocardial depression. Design Prospective, observational. Setting Endoscopy suite at a single academic medical center. Participants Patients undergoing outpatient, elective endoscopic procedures at an outpatient clinic of a single tertiary care academic medical center. Interventions None. Measurements and Main Results Limited transthoracic echocardiograms were performed before and after patients received propofol for endoscopic procedures. Post-processing measurements included GLS, 2D (dimensional) ejection fraction (2D EF), and 3D EF. Using paired sample Student’s t test, no statistically significant change in GLS, 2D EF, or 3D EF was found despite statistically significant hypotension. In fact, there was a trend toward more negative GLS (improved myocardial function) in patients after receiving propofol. Conclusion We found propofol did not cause a reduction in systolic function as measured by GLS, a sensitive measure of myocardial contractility. Therefore, decreases in blood pressure after a propofol bolus in spontaneously breathing patients are likely due to decreased vascular tone and not impaired left ventricular systolic function. These results should be considered in the management of propofol-induced hypotension for spontaneously breathing patients.

Cardiac depression in severe acute pancreatitis: development mechanisms and possible treatment approaches. Review

Cardiac depression, also known as myocardial depression, is one of the typical complications of severe acute pancreatitis. The review describes modern views on the mechanism of development of this phenomenon; the place of the term myocardial depression factor at the current stage of study of the problem was discussed; pathogenetic factors of myocardial depression requiring further study have been identified. An attempt to consider cardiac depression as a phenomenon involving the whole cardiovascular system, rather than the heart along, was made. Each pathophysiological factor is examined in terms of the possibility of clinical use.

Spectrum of cardiovascular diseases in children during high peak COVID-19 period infection in Northern Italy: is there a link?

Background Children with COVID-19 have a milder clinical course than adults. We describe the spectrum of cardiovascular manifestations during a COVID-19 outbreak in Emilia-Romagna, Italy. Methods Cross-sectional multicenter study including all diagnosis of KD, myocarditis and multisystem inflammatory syndrome in children (MIS-C) from February to April,2020. KD patients were compared to those diagnosed before the epidemic. Results KD: 8 patients (6/8 boys, all negative for SARS-CoV-2); complete presentation in 5/8; 7/8 IVIG-responders; 3/8 showed transient coronary lesions (CALs). Myocarditis one 5-year-old girl negative for SARS-CoV-2, positive for Parvovirus B19. She responded to IVIG. MIS-C 4 SARS-CoV-2 positive boys (3 patients with positive swab and serology, 1 patient with negative swab and positive serology). Three presented myocardial dysfunction and pericardial effusion, one developed multicoronary aneurysms and hyperinflammation; all responded to treatment. The fourth boy had mitral and aortic regurgitation that rapidly regressed after steroids. Conclusions KD, myocarditis and MIS-C were distinguishable cardiovascular manifestations. KD did not show a more aggressive form compared to previous years: coronary involvement was frequent, but always transient. MIS-C and myocarditis rapidly responded to treatment without cardiac sequelae despite high markers of myocardial injury at onset suggesting a myocardial depression due to systemic inflammation rather than focal necrosis. Evidence of actual or previous SARS-CoV-2 infection was documented only in patients with MIS-C.