Epworth Collection:http://hdl.handle.net/11434/192024-03-28T10:29:24Z2024-03-28T10:29:24ZTako-tsubo cardiomyopathy: how stress can mimic acute coronary occlusion.Padayachee, Lavenhttp://hdl.handle.net/11434/22102023-09-04T03:52:42Z2008-03-01T00:00:00ZTitle: Tako-tsubo cardiomyopathy: how stress can mimic acute coronary occlusion.
Epworth Authors: Padayachee, Laven
Abstract: To the Editor: Abdulla and Ward's excellent article on tako-tsubo cardiomyopathy (TTC)1 raises two important issues.
The first issue is the diagnostic dilemma faced by emergency physicians and cardiologists in differentiating TTC from ST-elevation myocardial infarction (STEMI) in centres that lack coronary angiogram capabilities.
In patients presenting with chest pain and ST elevation on electrocardiography, the diagnosis of TTC might be suspected on recognition of risk factors and the common psychological, physical and emotional stressors that precipitate TTC.1 Supporting evidence can be obtained by demonstration of basal hyperkinesis and apical or midventricular hypokinesis on transthoracic echocardiography. This modality is now available in many centres without coronary angiography.
However, if the diagnosis is incorrectly made as STEMI rather than TTC, the patient runs the risk of unnecessary thrombolysis. Alternatively, after risk–benefit analysis, the clinicians may transfer the patient to a facility with coronary angiography to confirm TTC.
The second issue is the therapeutic dilemma facing intensivists treating TTC-related shock with adrenergic inotropes. Although cardiogenic shock in TTC is uncommon, it can still occur (4.2%).2 As increased endogenous catecholamines are thought to be central to the pathophysiology of TTC,3 treating shock with inotropes puts the clinician in a quandary.
Agents such as adrenaline, dobutamine, dopamine, milrinone and noradrenaline increase cyclic AMP within the myocardial cell, and are commonly used to restore blood pressure and cardiac output. However, in TTC, inotropes may theoretically delay resolution of the apical ballooning. A recent echocardiographic study showed no improvement in apical and midventricular akinesis with the use of low-dose dobutamine.4
Levosimendan is a calcium sensitiser that has been used successfully to stabilise shock secondary to TTC (with and without use of an intra-aortic balloon pump).5 Levosimendan is non-adrenergic and allows earlier introduction of β-blockers than would be possible with adrenergic inotropes.
I agree that prospective trials are needed to guide management in this intriguing condition.2008-03-01T00:00:00ZHepatic portal venous gas in a patient with intestinal necrosis.Siswojo, AndyIhle, Bennohttp://hdl.handle.net/11434/21972023-08-11T02:04:15Z2010-04-01T00:00:00ZTitle: Hepatic portal venous gas in a patient with intestinal necrosis.
Epworth Authors: Siswojo, Andy; Ihle, Benno
Abstract: This report describes a case of hepatic portal venous gas (HPVG) in a patient with intestinal ischaemia and necrosis resulting from an obstructing lesion in the sigmoid colon. CT images demonstrating a large amount of HPVG are presented.2010-04-01T00:00:00ZCompetency assessment in focused cardiac ultrasound - can the use of sequential testing help tailor training requirements?Walker, HumphreyMcKenzie, DeanBrooks, Kylehttp://hdl.handle.net/11434/21212022-07-28T01:34:38Z2022-05-01T00:00:00ZTitle: Competency assessment in focused cardiac ultrasound - can the use of sequential testing help tailor training requirements?
Epworth Authors: Walker, Humphrey; McKenzie, Dean; Brooks, Kyle
Abstract: Varying numbers of scans are required by different professional bodies before focused cardiac ultrasound (FCU) competence is assumed. It has been suggested that innovation in the assessment of FCU competence is needed and that competency assessment needs to be more individualized. We report our experience of how the use of sequential testing may help personalize the assessment of FCU competence.
Design: This was a planned exploratory reanalysis of previously prospectively collected data. FCU was performed sequentially by an intensive care trainee and expert on the same patient. Assessment of left ventricular (LV) function by the trainee and expert was compared. Sequential testing methods were used in the analysis of this data to see if they could be used to help in the assessment of competence. Each trainee had completed a 38-hour teaching program and a logbook of 30 scans prior to enrollment.
Setting: Tertiary Australian not for profit private academic hospital.
Measurements and main results: Two hundred seventy paired echocardiograms were completed by seven trainees. For trainees to achieve greater than 90% accuracy in correctly assessing LV function when compared with an expert, a variable number of scans were required. This ranged from 13 to 25 (95% CI, 13-25) scans. Over the study period, the ability to correctly identify LV function was maintained, and it appeared there was no degradation in skill.
Conclusions: Using the Sequential Probability Ratio Test demonstrates a variable number of scans were required to show greater than 90% accuracy in the assessment of LV function. As such, the use of sequential testing could help individualize competency assessments in FCU. Additionally, our data suggests that over a 6-month period, echocardiographic skill is maintained without any formal teaching or feedback. Further work assessing the utility of this method based on larger samples is required.2022-05-01T00:00:00ZFurther exploration of MARS*.Warrillow, Stephenhttp://hdl.handle.net/11434/21182022-07-27T23:57:02Z2022-02-01T00:00:00ZTitle: Further exploration of MARS*.
Epworth Authors: Warrillow, Stephen
Abstract: Discussion regarding a study on the use of Molecular Absorbent Recurculating System (MARS), for Acute Liver Failure and criteria for future studies.2022-02-01T00:00:00Z