RESUMEN
Coronary subclavian steal syndrome (CSSS) is a rare complication of the internal mammary artery (IMA) grafting in coronary artery bypass surgery. The technical definition is myocardial ischemia due to the reduced flow of blood, or flow reversal in the IMA graft. This in most cases results from hemodynamically significant proximal subclavian artery stenosis. The clinical presentation is variable and ranges from unstable angina to myocardial infarction, and in some cases, sudden cardiac arrest. CSSS is an entity that is hard to diagnose if one is not actively looking for it. The clinical diagnosis is often complicated, and the prevalence of the disorder is frequently underestimated. In this case presentation, we report a case of myocardial infarction that resulted from significant proximal subclavian artery stenosis.
Asunto(s)
Síndrome de Robo Coronario-Subclavio , Arterias Mamarias , Infarto del Miocardio , Síndrome del Robo de la Subclavia , Puente de Arteria Coronaria , Síndrome de Robo Coronario-Subclavio/complicaciones , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Humanos , Síndrome del Robo de la Subclavia/complicaciones , Síndrome del Robo de la Subclavia/diagnóstico por imagenRESUMEN
Sirolimus is an immunosuppressant frequently prescribed to prevent graft-vs-host disease in renal transplant patients. Pericardial effusion is recognized as a rare and potentially lethal side effect of this medication. Hemopericardium, specifically, is an even rarer complication that has yet to be reported in the literature. We report the first case of sirolimus-induced hemopericardium in a renal transplant patient.
Asunto(s)
Aneurisma/complicaciones , Aneurisma/diagnóstico por imagen , Puente de Arteria Coronaria , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Vena Safena/trasplante , Anciano , Angiografía Coronaria , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Although most intracardiac defects are congenital, a small fraction may be acquired during life. The Gerbode defect is an abnormal anatomical connection between the left ventricle and the right atrium. We describe herein a patient who initially underwent repair of tetralogy of Fallot (TOF). Years after TOF repair, he developed severe dyspnea. Extensive evaluation revealed that he had developed a Gerbode defect. Very few cases of acquired Gerbode defect have been previously reported. Management options are predominantly surgical interventions.
Asunto(s)
Defectos del Tabique Interventricular/etiología , Complicaciones Posoperatorias/terapia , Tetralogía de Fallot/cirugía , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ecocardiografía , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Gordonia is a catalase-positive, aerobic, nocardioform, Gram-positive staining actinomycete that also shows weak acid-fast staining. Several Gordonia species are commonly found in the soil. The bacterium has been isolated from the saliva of domesticated/wild dogs as well. In hospitalized patients, most commonly it is found in the setting of intravascular catheter-related infections. However, recent reports show that it is being increasingly isolated from sternal wounds, skin/neoplastic specimens and from pleural effusions. Gordonia shares many common characteristics with Rhodococcus and Nocardia. Ergo, it is commonly misrecognized as Nocardia or Rhodococcus. Since this pathogen requires comprehensive morphological and biochemical testing, it is often difficult and cumbersome to isolate the species. Broad-range Polymerase Chain Reaction (PCR) and sequencing with genes like 16S rRNA or hsp65 are used to correctly identify the species. Identification is essential for choosing and narrowing the right antimicrobial agent. Herein, we report our experience with a patient who presented with sternal osteomyelitis after infection with this elusive bug.
Asunto(s)
Actinobacteria/aislamiento & purificación , Infecciones por Actinomycetales/diagnóstico , Procedimientos Quirúrgicos Cardíacos , Osteomielitis/microbiología , Complicaciones Posoperatorias/microbiología , Esternón/microbiología , Infecciones por Actinomycetales/terapia , Anciano , Humanos , Inmunocompetencia , Masculino , Osteomielitis/diagnóstico , Osteomielitis/terapia , Complicaciones Posoperatorias/terapiaRESUMEN
Pulmonary embolism (PE) may be potentially fatal if not diagnosed and treated in time. Although specific electrocardiogram (ECG) findings often suggest the diagnosis of PE, occasionally, the ECG may mimic that of an acute coronary syndrome (ACS). We report an interesting case of a 45-year-old female presenting with sudden onset chest pain and shortness of breath with widespread ST depression in anterior precordial leads. Although initially treated and referred as a case of ACS, careful analysis of the ECG and subsequent echocardiography and computed tomography imaging confirmed the diagnosis of PE. Intensivists and cardiologists need to be aware that diagnostic dilemma between PE and ACS is not uncommon due to such "ischemic-looking" ECG as well as elevated troponin levels in both conditions. The use of multimodality imaging techniques is helpful in arriving at the correct diagnosis.
Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Electrocardiografía , Embolia Pulmonar/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada EspiralRESUMEN
PURPOSE OF REVIEW: This review aims to summarize the epidemiology, current pathophysiologic understanding, and state-of-the-art treatment of venous thromboembolism (VTE) in cancer patients. RECENT FINDINGS: The risk of VTE varies among cancer patients. Recently introduced prediction models better identify those at high risk of VTE. New mechanisms underlying hypercoagulability in cancer have been uncovered. Initial data on the efficacy of direct oral anticoagulants (DOACs) compared with low-molecular weight heparin to treat VTE in patients with cancer are promising. However, they may be associated with higher risk of gastrointestinal bleeding. VTE causes significant morbidity and mortality in cancer patients. Our understanding of the mechanisms of VTE, including those associated with cancer treatments, has significantly grown. The assessment of the benefit/risk balance of VTE treatment remains challenging in many patients with cancer. The introduction of DOACs has expanded treatment options, but knowledge on their efficacy and safety is incomplete.
Asunto(s)
Anticoagulantes/administración & dosificación , Neoplasias/complicaciones , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Administración Oral , Anticoagulantes/efectos adversos , Coagulación Sanguínea , Hemorragia/inducido químicamente , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Neoplasias/mortalidad , Recurrencia , Medición de Riesgo , Factores de RiesgoRESUMEN
It is vital to recognize correctly, chest pain of cardiac etiology. Most commonly, it is because of blood supply-demand inequity in the myocardium. However, the phenomenon of myocardial bridging as a cause of cardiac chest pain has come to attention reasonably recently. Herein, a coronary artery with a normal epicardial orientation develops a transient myocardial course. If the cardiac muscle burden is substantial, the respective artery gets compressed during each cycle of systole, thereby impeding blood flow in the artery. Hence, myocardial bridging has been attributed to as a rare cause of angina. In this case report, the authors discuss a patient in whom myocardial bridging turned out to be an elusive cause of angina. We wish to underscore the importance of being clinically mindful of myocardial bridging when assessing a patient with angina.
RESUMEN
Jet lag is one of those common medical problems, to which most people don't give a serious thought. However, it is intricately intertwined with our normal circadian rhythm. It is classified as a sleep disorder. There is also a dearth of good scientific literature, not to mention clinical trials on the subject. Slowly but steadily, the scientific community is realizing the various deleterious health effects of jet lag and is devising innovative methods to counter them. This narrative review touches upon the etiopathogenesis, clinical manifestations and therapeutic strategies effective against the nagging problem of jet lag.
RESUMEN
We have presented a case of 41-year-old male who presented to the hospital with worsening shortness of breath, fatigue and flu-like symptoms. On admission to hospital, the patient was in severe cardiogenic shock secondary to acute perimyocarditis. He was admitted to the cardiac intensive care unit for close monitoring and aggressive hemodynamic support. Influenza B antigen was detected in nasopharyngeal aspirate and the patient was started on oseltamivir. The patient's cardiac function improved significantly in few days and he was discharged home in stable condition with normal ejection fraction.
RESUMEN
Strongyloides stercoralis (S. stercoralis) is an intestinal nematode endemic to tropical regions. An accelerated infection, known as a hyperinfection, occurs in immunocompromised patients, most commonly those treated chronically with glucocorticoids or those who have human T cell leukemia virus-1 (HTLV-1) infection. We describe a 67-year-old Hispanic female who presented with complaints of decreased oral intake and fatigue since three months. Hyponatremia on initial presentation was attributed to syndrome of inappropriate antidiuretic hormone (SIADH) secretion and managed with fluid restriction. Computed tomography (CT) of the chest revealed multiple pulmonary nodules suggestive of miliary tuberculosis, however, sputum acid-fast bacilli (AFB) smears were negative. Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) was performed and specimens sent for AFB testing. A concurrent endoscopy with biopsy was done to evaluate dysphagia. Both respiratory and gastrointestinal (GI) specimens were positive for Strongyloides stercoralis. Treatment with ivermectin and prophylactic antibiotics was started. The patient developed septic shock and had multiple episodes of gastrointestinal bleeding. Despite aggressive management, she expired. Subsequently, cultures for Mycobacterium tuberculosis (MTB) were positive and the autopsy demonstrated evidence of MTB infection in the lungs, liver, and lymph nodes. This case illustrates the importance of considering co-infection with Strongyloides stercoralis in patients with MTB, both associated with depressed cellular immunity.
RESUMEN
New daily persistent headache (NDPH) is characterized by an abrupt onset of headache that becomes a daily entity, is unremitting and continuous from the onset, and lasts for more than 3 months. Dr Walter Vanast first described NDPH in the year 1986. Originally, it was proposed as a chronic daily headache but it was placed under "other primary headaches" in the International Classification of Headache Disorder Second Edition (ICHD 2nd edition). However, with evolving literature and better understanding of its clinical characteristics, it was classified as a "chronic daily headache" in the ICHD 3rd edition beta. There are still many knowledge-gaps regarding the underlying cause, pathophysiology, natural history and treatment of NDPH. This review tries to revisit the entity and discusses the current status of understanding regarding NDPH.
Asunto(s)
Trastornos de Cefalalgia , HumanosAsunto(s)
Antineoplásicos Fitogénicos/efectos adversos , Neumonía en Organización Criptogénica/inducido químicamente , Hemoptisis/inducido químicamente , Paclitaxel/efectos adversos , Anciano , Antineoplásicos Fitogénicos/uso terapéutico , Neumonía en Organización Criptogénica/complicaciones , Neumonía en Organización Criptogénica/diagnóstico , Diagnóstico Diferencial , Hemoptisis/complicaciones , Humanos , Masculino , Obesidad/complicaciones , Paclitaxel/uso terapéutico , Neoplasias Urológicas/tratamiento farmacológico , Neoplasias Urológicas/radioterapiaAsunto(s)
Aleteo Atrial/complicaciones , Bronquiectasia/complicaciones , Dextrocardia/diagnóstico , Fracturas del Cuello Femoral/complicaciones , Anciano de 80 o más Años , Dextrocardia/complicaciones , Dextrocardia/diagnóstico por imagen , Dextrocardia/fisiopatología , Electrocardiografía , Femenino , Humanos , Radiografía TorácicaRESUMEN
A 29-year-old female with adult-onset Still's disease (AOSD) presented with progressive shortness of breath both on rest and on exertion, increased abdominal girth, and swelling in both legs. She was on oral prednisone and was recently started on canakinumab (interleukin-1 antagonist) for joint pain and rash of AOSD. Echocardiogram showed severely dilated right ventricle, dilated pulmonary artery, moderately reduced right ventricular systolic function, but with normal left ventricular systolic function. Computed tomography with contrast ruled out pulmonary embolism. Blood tests ruled out other rheumatologic diseases. The patient was diagnosed with right-sided heart failure likely secondary to AOSD. Right heart catheterization was needed but could not be performed because of severely dilated pulmonary artery. The patient was transferred to a higher center for further management and possible cardiopulmonary transplant.
Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Capecitabina/efectos adversos , Cardiotoxicidad/etiología , Insuficiencia Cardíaca/inducido químicamente , Anciano , Antimetabolitos Antineoplásicos/administración & dosificación , Capecitabina/administración & dosificación , Cardiotoxicidad/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Humanos , MasculinoRESUMEN
BACKGROUND: Trimetazidine (TMZ) is a metabolic modulator that shifts substrate utilization from fatty acid to carbohydrates, thereby, increasing myocardial glucose oxidation and improving myocardial ischemia. We evaluated whether TMZ is effective in reducing myocardial injury after percutaneous coronary intervention (PCI). METHODS: Patients with stable angina undergoing elective PCI were divided into two groups, one who received oral TMZ (35 mg BD) started 7 days before PCI (n = 48) and second who did not receive any TMZ (in addition to the standard therapy (n = 52)). Troponin-I (cTnI) and creatine kinase-MB (CK-MB) were measured before, 8, and 24 h after PCI. The primary end point was a difference in post-PCI cTnI and CK-MB levels (vs baseline). Frequency of cTnI release in the two groups, total amount of cTnI release, and difference in TIMI flow grade before and after the procedure were also assessed. RESULTS: Baseline demographics in the groups were comparable. Despite similar baseline levels, post-procedural cTnI was lower at 8 h (0.13 vs 0.56 ng/ml, p = 0.03) and 24 h (0.2 vs 1.13 ng/ml, p = 0.004) in the TMZ group. Decline or no change in cTnI was significantly more common in the TMZ group (26% vs 2%, p < 0.01). Total cTnI released after PCI, as assessed by area under curve was significantly lower in the TMZ group (15.84 vs 3.32 ng h/ml, p = 0.005). Although CK-MB levels were also lower in the TMZ group, the difference was not statistically significant. Incidence of post-PCI TIMI 1 or 2 flow was significantly lesser in the TMZ group. CONCLUSIONS: Oral TMZ started 7 days before PCI was effective in limiting PCI-induced myocardial injury with lower cTnI levels and higher prevalence of TIMI-3 flow.