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Carcinoid crisis is a life-threatening manifestation of carcinoid syndrome characterized by profound autonomic instability in the setting of catecholamine release from stress, tumor manipulation, or anesthesia. Here, we present an unusual case of carcinoid crisis leading to acute systolic heart failure requiring mechanical circulatory support. (Level of Difficulty: Intermediate.), Graphical abstract

Giant cell myocarditis is a rare form of autoimmune myocarditis with high morbidity and mortality that affects mainly middle‐aged adults. We report a case study of a 70‐year‐old man on chronic immunosuppression who presented with sustained ventricular tachycardia and symptoms of acute systolic heart failure, both with poor response to standard measures. A decision to pursue endomyocardial biopsy established the diagnosis of GCM and lead to initiation of immunosuppressive therapy and a favourable outcome. Our case illustrates that a low threshold for endomyocardial biopsy in new onset heart failure can lead to actionable information even in patients of advanced age.

Background/Introduction Current guidelines recommend targeting overall decongestion in management of patients with decompensated heart failure. With lower extremity edema among the most prevalent symptoms in patients admitted with decompensation, this often serves as a clinical target. Lower extremity compression wraps (LECW) are seldom used in the acute setting, with little data on efficacy in heart failure, despite serving as a cornerstone of chronic lymphedema management. Purpose Evaluate the efficacy of LECW as adjuvant therapy in management of HF with reduced ejection fraction (EF). Methods Open-label, randomized, parallel group controlled trial, with 2:1 randomization of adult patients with a history of HF and reduced EF less than 40% admitted to telemetry unit for intravenous (IV) diuretic therapy. Results A total of 32 patients were enrolled, with 29 patients completing the study; 19 (66%) in the control arm, and 10 (34%) in the intervention arm. There were no significant differences in baseline characteristics of the two groups. Patients in the intervention arm required less escalation of diuretic therapy (0 vs 5 patients, p=0.079), and less frequent use of continuous infusion therapy (0 vs 7 patients, p=0.027). Total days of IV diuresis was not significantly different between the two groups. Greater net reduction of edema was seen in the intervention group (1.5+ [1–2] vs 1+ [1–2], p=0.072), with fewer cases of acute kidney injury (1 vs 13, p=0.005). The intervention group scored significantly better on MLWHF (55.5 vs 65, p=0.021), including both the physical (17.5 vs 23, p Conclusion In this open-label parallel group RCT, use of LECW resulted in less IV diuretic continuous infusion therapy, greater net reduction in lower extremity edema, reduced patient assessed HF burden, and shorter hospital LOS, with fewer rates of AKI. Trends toward fewer total days of IV diuresis, less escalation of diuresis, and greater reduction in edema were also observed. Larger scale clinical trials are needed to further establish LECW as efficacious adjuvant therapy in the management of acute heart failure. Funding Acknowledgement Type of funding sources: None.

Ecstasy or 3,4-methylenedioxymethamphetamine (MDMA) is an illicit recreational drug. Effects include euphoria, increased sensory awareness, and central stimulation. Although various arrhythmias, as well as dilated cardiomyopathy, have been previously noted to occur with chronic use, cardiac toxicities are seldom reported in an acute setting. Herein, we present a 28-year-old female patient with no prior medical condition that presented to the Emergency Department with chest pain following intake of MDMA. Electrocardiographic findings, as well as laboratories, were suggestive of possible Acute Non-ST elevation myocardial infarction. Upon admission, cardiac catheterization revealed patent coronary arteries. Stark regional wall motion abnormalities were observed along with reduced ejection fraction. Acute systolic heart failure was treated with standard medical management. Subsequent reassessment of ventricular function with Echocardiography revealed marked improvement. This article describes a case of MDMA induced heart failure, including details of evaluation, management, and monitoring of patient progress. It brings further attention to potential acute harmful effects of MDMA on cardiac function and viability.

Introduction The characteristics and outcomes of patients hospitalized with acute systolic heart failure (HF) and normal admission B-type natriuretic peptide (BNP) has not been previously explored. Methods Using the ESCAPE trial data, we compared patients with acute HF and left ventricular ejection fraction (LVEF) ≤30% who have either normal or elevated BNP on the day of hospitalization. The study endpoints were 30-day and 6-month mortality, all-cause rehospitalization and rehospitalization for HF. Results Among 347 patients with acute systolic HF, 43 had normal (mean 50.6pg/mL) and 304 had elevated admission BNP (mean 1144pg/mL). Compared with patients with elevated BNP, those with normal admission BNP were younger (51.5 vs. 56.8years, P =0.01), with higher body mass index (33.6 vs. 28.7kg/m 2 , P P P =0.005) and creatinine (1.34 vs. 1.52mg/dL, P =0.038) levels, higher LVEF (25.5% vs. 19.1%, P =0.018), higher cardiac index (2.34 vs. 1.96, P =0.013), and better diastolic function evident by lower E/A ratio (1.73 vs. 2.67, P =0.001) and longer deceleration of E velocity (166 vs. 141ms, P =0.028). There was no difference between patients with normal or elevated admission BNP with regards to the degree of congestion. There were no differences between both groups in post-discharge hard endpoints such as 30-day ( P =0.101) and 6-month ( P =0.143) mortality, rehospitalization for any cause ( P =0.992) or for HF ( P =0.763). Conclusion Patients hospitalized with acute systolic HF and normal admission BNP had no significant differences in the degree of congestion and post-discharge outcomes compared with those with elevated BNP. A normal BNP in this instance was not valuable for diagnostic or prognostic purposes.

Utilization of a left ventricular assist device as a bridge to myocardial recovery is an established therapy for acute systolic heart failure. However, device removal can present a technical challenge, with no clear consensus on preferred method. In this case report, we describe a complex patient who underwent successful explantation of a left ventricular assist device using an intraoperatively constructed apical plug. This method utilizes inexpensive and easily accessible materials, minimizes ventricular distortion during device removal, and preserves the ventricular sewing ring for future reimplantation.

Introduction The pulmonary artery pulsatility index (PAPI) is a newer hemodynamic index used for assessment of right ventricular performance. We hypothesized that PAPI predicts morbidity and mortality in acute systolic heart failure (HF). Methods The ESCAPE trial was utilized to identify the prognostic value of PAPI at different time points in patients hospitalized with acute systolic HF who received care assisted with central hemodynamic monitoring. Results Among 167 patients (age 57 years, 71% men), PAPI significantly increased from admission to optimum hemodynamic day (from 2.88 to 4.09, P Conclusions Discharge PAPI ≤2 is a marker of intermediate-term morbidity and mortality in acute systolic HF.

Background We aimed to evaluate the influence of age on clinical and economic outcomes in patients ≥75 years of age hospitalized for acute systolic heart failure (AHF). Methods From July 2017 to July 2017, among older adults ≥75 years of age, AHF visits were identified by the ICD-10 systolic heart failure code as any primary or secondary diagnosis in the Premier Healthcare Database, stratified by Results Of 420,642 visits for AHF, 151,045 (36%) were for patients ≥75 years of age. Of these, 88,138 (58%) were male, 14,846 (10%) were Black, and 9,048 (6%) were Hispanic. The overall inpatient death rate was higher in older than younger patients (Death: 5.49% vs. 3.44%, p Conclusion In the U.S., in-hospital mortality attributed to AHF is highest among older male patients and accounts for significant societal healthcare cost. Methods to risk-stratify older patients presenting with AHF are needed to optimize healthcare delivery and utilization.

Circulating cardiodepressant factors were found to mediate cardiac dysfunction in patients with sepsis and acute systolic heart failure. To investigate the presence of circulating cardiodepressant factors in patients with Takotsubo Cardiomyopathy (TC), plasma samples were collected from 4 patients with TC, 3 with septic shock, 5 with acute systolic heart failure and 4 healthy controls and injected intraperitoneally in mice. The cardiodepressant effects are measured with transthoracic echocardiography. Plasma injection from control and TC subjects had no effects on left ventricle ejection fraction (LVEF) whereas plasma from the other two groups induced a significant reduction in LVEF. At difference than sepsis and acute heart failure, TC is not characterized by the presence of soluble cardiodepressant factors. Myocardial dysfunction in TC may be mediated by a neurocardiogenic mechanism.

Pheochromocytoma is a rare tumor in adults, with an estimated annual incidence of 0.8 per 100,000 persons. Cardiomyopathy is an uncommon presentation of such a rare disease. Serious cardiovascular complications of these tumors are related to potent effects of secreted catecholamines. The mechanism of pheochromocytoma-related cardiomyopathy is not well understood but it is likely due to the effect of excess catecholamines and their oxidation products which have been found to have a direct toxic effect on the myocardium. We describe below a case of a 70-year old female with uncontrolled hypertension and new onset acute systolic heart failure, who on further evaluation was noted to have pheochromocytoma-related cardiomyopathy. Pheochromocytoma should be strongly considered in the differential diagnosis of non-ischemic cardiomyopathy for a patient with elevated blood pressures relative to severity of cardiac dysfunction.

Chronic anthracycline induced cardiotoxicity (AIC) is a type 1 chemotherapeutic cardiotoxicity characterized by irreversible myocyte destruction and necrosis. Although rare, acute AIC is characterized by a transient decline in left ventricular ejection fraction (LVEF) and does not appear to be dose

Patients with newly diagnosed cardiomyopathy require careful assessment of cause and initiation of treatment before the decision is made to implant an internal cardiac defibrillator. In patients with medicine-refractory atrial fibrillation and cardiomyopathy, atrioventricular node ablation and implantation of a biventricular pacemaker is the therapy of choice when tachycardia-induced cardiomyopathy is suspected and curative therapy is not possible.

Myocarditis, an inflammatory disease of the heart, frequently results from viral infections, postviral immune-mediated responses, or both. It is a common cause of acute-onset systolic heart failure in children. Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of myocarditis. However, EMB is not performed for most myocarditis cases involving children in the United States. Clinical scenarios in which EMB results added unique prognostic data and guidance to therapy have been defined recently. This review outlines the role of EMB in the diagnosis and management of myocarditis for children presenting with acute-onset systolic heart failure.

Obesity is a major risk factor for cardiovascular disease. The obesity paradox concept suggesting improved prognosis in patients with obesity presenting with acute coronary syndromes has been reported by several investigators. We examined the impact of obesity on in-hospital mortality in patients

Eosinophilic myocarditis is a major cause of morbidity and mortality among patients with hypereosinophilic syndromes (HES), which are marked by overproduction of eosinophils (≥1,500/uL), causing damage to multiple organs. It is rare, with estimated prevalence of 0.36-6.3 per 100,000. 52-year-old

s S105 Eur J Echocardiography Abstracts Supplement, December 2006 Conclusions: Levosimendan caused a greater reduction of E/E’ ratio, a noninvasive indicator of LV pressure in acute systolic heart failure compared to dobutamine. This may explain the more favorable effects of levosimendan when compared to conventional positive inotropics.