Case Study: Patient with COVID-19 and Cytokine Storm
Admission: Fever, hypertension, and respiratory failure.
Treatment Course: Placed on mechanical ventilation, developed hemodynamic instability, and hypercoagulability.
Innovative Treatment: Immune perfusion for three days.
Outcome: Hemodynamic stabilization, normalization of cytokine levels, decrease in inflammatory parameters, improved pulmonary exchanges leading to extubation.
Additional Improvements: Better miniature pressure, reduced need for neural adrenaline, decreased interleukin-6 concentration, improved monocyte function in phagocytic capacity and antigen presentation.
Further Application: Effectiveness with ECMO in other patients.
Conclusion: Early treatment improves outcomes. Recommendations include cytokine removal, use of ECMO, and specific membranes to remove excess fluid.
Upcoming Events: Promotion of future meetings and a YouTube channel called "Cappuccino with Claudio."
Post-Lecture Discussion
Question on Staging Cardiorenal Syndrome (CRS)
Initial Reluctance: Took ~10 years for cardiologists and nephrologists to accept CRS classification.
Current Need: Consideration of CRS severity levels within specific types.
EVOLUTION: CRS types may evolve, like Type 2 progressing to Type 4 due to unresolved acute kidney injury.
Joint Effort: Importance of cardiologists and nephrologists working together to stratify patients for risk and severity.
Effectiveness of ARNI and SGLT2 Inhibitors
Mid Ejection Fraction Range: Need more studies, especially on patients with chronic kidney disease (CKD).
Precision Medicine: Suggests monitoring for specific treatments even with high-risk patients.
Use in Dialysis: Monitoring is crucial to ensure patients benefit from medications like ARNI even with severe kidney function reduction.
Guideline-Directed Therapy and Chronic Medication Use
Commonly Asked Questions: Use of ARNI and SGLT2 in patients with heart failure and CKD.
Clinical Monitoring: Essential for tailoring medication use to avoid severe complications.
Specific Case Analysis: Patients reviewed at the bedside jointly by cardiologists and nephrologists yield better outcomes.
Case Presentations
Case 1: Worsening Heart Failure with Renal Insufficiency
Patient History: Diabetes, hypertension, past myocardial infarction, previous bypass surgery.
Symptoms: Class III heart failure, hemoglobin at 10.7.
Course of Action:
Medications Prior: Use of diuretics, beta-blockers, RAAS inhibitors.
Readmission: Adjusted therapy with IV diuretics and additional medication modifications.
Outcome and Follow-up: Slight improvement in kidney function, continuous monitoring, iron deficiency correction.
Case 2: Advanced Restrictive Cardiomyopathy and PAH
Diagnostic Findings: Severe MR, severe PAH, right-sided heart strain.
Treatment Attempts: Medication adjustments, repeated hospitalizations, ultrafiltration considered but not initially used, exploratory use of pulmonary vasodilators like Bosentan.
Challenges: Persistent symptoms, fluctuating kidney function, debated use of aggressive therapies like heart transplant.
Final Adjustments: Managing through high-dose diuretics, joint cardiology and nephrology consultations.
Wrap-up and Key Recommendations
Importance of Early Intervention: Start treatments early to avoid severe conditions.
Holistic View: Combine fluid management, regular monitoring of heart and kidney function, and anticipate patient-specific complications.
Collaborative Approach: Consistent interaction between cardiologists, nephrologists, and the patient is key to managing complex cases.
Emerging Treatments: Stay updated on new findings and treatment modalities like SGLT2 inhibitors and ARNI.