Achenbach Syndrome: A Case Report

Introduction: Achenbach syndrome is a rare, benign condition characterized by painful discoloration ofa finger. Recognition of this syndrome prevents unnecessary costly workup and risky interventions. Case Report: A healthy, 54-year-old female was transferred to our emergency department (ED) from acommunity ED for vascular evaluation of discoloration and numbness to her finger. After extensiveworkup, medical intervention, and consultation with multiple specialists, she was diagnosed withAchenbach syndrome. Conclusion: Emergency physicians may practice good healthcare stewardship and limit invasive,potentially harmful, and expensive workup by reassuring patients of the benign nature of this condition

Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation

<p>Abstract</p> <p>Background</p> <p>The treatment of patients with aortic regurgitation (AR) or mitral regurgitation (MR) relies on the accurate assessment of the severity of the regurgitation as well as its effect on left ventricular (LV) size and function. Cardiovascular Magnetic Resonance (CMR) is an excellent tool for quantifying regurgitant volumes as well as LV size and function. The 2008 AHA/ACC management guidelines for the therapy of patients with AR or MR only describe LV size in terms of linear dimensions (i.e. end-diastolic and end-systolic dimension). LV volumes that correspond to these linear dimensions have not been published in the peer-reviewed literature. The purpose of this study is to determine the effect of regurgitant volume on LV volumes and chamber dimensions in patients with isolated AR or MR and preserved LV function.</p> <p>Methods</p> <p>Regurgitant volume, LV volume, mass, linear dimensions, and ejection fraction, were determined in 34 consecutive patients with isolated AR and 23 consecutive patients with MR and no other known cardiac disease.</p> <p>Results</p> <p>There is a strong, linear relationship between regurgitant volume and LV end-diastolic volume index (aortic regurgitation r²= 0.8, mitral regurgitation r²= 0.8). Bland-Altman analysis of regurgitant volume shows little interobserver variation (AR: 0.6 ± 4 ml; MR 4 ± 6 ml). The correlation is much poorer between regurgitant volume and commonly used clinical linear measures such as end-systolic dimension (mitral regurgitation r²= 0.3, aortic regurgitation r²= 0.5). For a given regurgitant volume, AR causes greater LV enlargement and hypertrophy than MR.</p> <p>Conclusion</p> <p>CMR is an accurate and robust technique for quantifying regurgitant volume in patients with AR or MR. Ventricular volumes show a stronger correlation with regurgitant volume than linear dimensions, suggesting LV volumes better reflect ventricular remodeling in patients with isolated mitral or aortic regurgitation. Ventricular volumes that correspond to published recommended linear dimensions are determined to guide the timing of surgical intervention.</p

Abstract 16718: The Impact of Prior Revascularization in Acute Myocardial Infarction Patients With Cardiogenic Shock: Prior Bypass Surgery a Marker of Worse Outcome?

Background: Cardiogenic shock (CS) in patients with acute myocardial infarction (AMI) is a marker of worse prognosis with extremely high mortality rates. We assessed the impact of previous surgical revascularization by CABG or percutaneous coronary intervention (PCI) on in-hospital outcomes of AMI patients with CS undergoing primary PCI. Methods: Between 1/2010 and 5/2019, a total of 1,170 patients were diagnosed with AMI and CS, defined by New York State Percutaneous Coronary Interventions Reporting System (PCIRS) as acute and persistent systolic blood pressure &lt;80 mmHg on mechanical or pharmacological support. Baseline clinical, angiographic and procedural characteristics, as well as in-hospital outcomes were prospectively collected among all patients undergoing primary PCI as part of the New York State PCIRS data collection. Results: There were no significant baseline differences between the two groups. Patients with a prior CABG were older and had a history of congestive heart failure. All other risk factors were similar (Table). There was a trend towards higher mortality rates in post CABG patients but longer length of stay in post PCI patients. The combined endpoint of death, reinfarction, acute kidney failure requiring dialysis or stroke (MARCCE) was numerically higher in post CABG patients but did not reach statistical significance. Conclusions: The results of this study show that in patients with AMI and CS undergoing PCI: 1) Patients with a prior history of CABG are usually older at presentation and had a prior history of heart failure; 2) there was a trend to higher in-hospital mortality rates in post CABG patient but MARCCE rates were similar in both groups. </jats:p