Cardiogenic shock following administration of propofol and fentanyl in a healthy woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used.</p> <p>Case presentation</p> <p>After a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment.</p> <p>Conclusion</p> <p>Although there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.</p

Uncoupling protein-2 expression and effects on mitochondrial membrane potential and oxidant stress in heart tissue

Myocardial uncoupling protein (UCP)-2 is increased with chronic peroxisome proliferator-activated receptor gamma (PPAR gamma) stimulation, but the effect on membrane potential and superoxide is unclear. Wild-type (WI) and UCP-2 knockout (KO) mice were given a 3-week diet of control (C) or the PPAR gamma agonist pioglitazone (PIO; 50 mu g/g-chow per day). In isolated mitochondria, UCP-2 content by Western blots, membrane potential (Delta Psi(m)) by tetraphenylphosphonium (TPP), and relative superoxide levels by dihydroethidium (DHE) were measured. Oxygen respiration was determined at base-line and after 10 min anoxia-reoxygenation. PIO induced a 2-fold increase in UCP-2 and nuclear-bound PGC1 alpha in WT mice with no UCP-2 expression in KO mice. Mitochondria! Delta Psi(m) from WT mice on C and PIO diets was -166 +/- 4 mV and -147 +/- 6 mV, respectively (P < 0.05). These values were lower than in UCP-2 KO mice on C and PIO (-180 +/- 4 mV and -180 +/- 4 mV, respectively; P < 0.05). Maximal complex III inhibitable superoxide from WT mice on C and PIO diets was 22.5 +/- 1.3 and 17.8 +/- 1.1 AU, respectively (P < 0.05), and were lower than UCP-2 KO on C and PIO (32.9 +/- 2.3 and 29.2 +/- 1.9 AU, respectively; P < 0.05). Postanoxia, the respiratory control index (RCI) in mitochondria from wr mice with and without PIO was 2.5 +/- 0.3 and 2.4 +/- 0.2, respectively, and exceeded that of UCP-2 KO mice on C and PIO (1.2 +/- 0.1 and 1.4 +/- 0.1, respectively; P < 0.05). In summary, chronic PPARy stimulation leads to depolarization of the inner membrane and reduced superoxide of isolated heart mitochondria, which was critically dependent on increased expression of UCP-2. Thus, UCP-2 expression affords resistance to brief anoxia-reoxygenation. (Translational Research 2012;159:383-390

Reduced expression of mitochondrial electron transport chain proteins from hibernating hearts relative to ischemic preconditioned hearts in the second window of protection

Although protection against necrosis has been observed in both hibernating (NIB) and ischemic preconditioned hearts in the second window of protection (SWOP), a comparison of the mitochondrial proteome between the two entities has not been previously performed. Anesthetized swine underwent instrumentation with a fixed constrictor around the LAD artery and were followed for 12 weeks (HIB; N = 7). A second group of anesthetized swine underwent ischemic preconditioning by inflating a balloon within the LAD artery 10 times for 2 min, each separated by 2 min reperfusion and were sacrificed 24 h later (SWOP; N = 7). Myocardial blood flow and high-energy nucleotides were obtained in the LAD region and normalized to remote regions. Post-sacrifice, protein content as measured with iTRAQ was compared in isolated mitochondria from the LAD area of a Sham heart. Basal regional blood flow in the LAD region when normalized to the remote region was 0.86 +/- 0.04 in HIB and 1.02 +/- 0.02 in SWOP tissue (P < 0.05). Despite reduced regional blood flows in NIB hearts, ATP content in the LAD region, when normalized to the remote region was similar in NIB versus SWOP (1.06 +/- 0.06 and 1.02 +/- 0.05 respectively; NS) as was the transmural phosphocreatine (PCr) to ATP ratio (2.1 +/- 0.2 and 2.2 +/- 0.2 respectively; NS). Using iTRAQ 64 common proteins were identified in HIB and SWOP hearts. Compared with SWOP, the relative abundance of mitochondrial proteins involved with electron transport chain (ETC) were reduced in HIB including NADH dehydrogenase, Cytochrome c reductase and oxidase, ATP synthase, and nicotinamide nucleotide transhydrogenase. Within chronically HIB heart tissue with reduced blood flow, the relative abundance of mitochondrial ETC proteins is decreased when compared with SWOP tissue. These data support the concept that NIB heart tissue subjected to chronically reduced blood flow is associated with a down-regulation in the expression of key mitochondrial proteins involved in electron transport Published by Elsevier Ltd

Optimization of two-level discount values using queueing tandem model with feedback

The trading company model with two levels of discount is considered in the paper. The problem of choosing the optimal discount values is solved. The mathematical model of the company is formulated in the form of an infinite-server queueing tandem with feedback at the second stage. The analytical form of generating function of multi-dimensional joint probability distribution of the number of purchases is obtained. Analytical expressions are found for the mean and variance of the company’s profit. Optimal discount values are obtained for the case when the probabilities of repeated purchases linearly depend on the value of discounts