RESUMO
After prolonged exposure to cold, an elderly man was found with altered mentation by his family physical examination revealed hypothermia. The electrocardiogram demonstrated characteristic changes. Results of an extensive diagnostic workup revealed only adrenal insufficiency, and the electrocardiographic abnormalities resolved after warming. Hypothermia can result from a variety of endogenous and exogenous causes; the most common of these, however, is accidental exposure. While history and physical exam are the best means for diagnosing hypothermia, several laboratory abnormalities are typical. One finding on electrocardiogram, while not pathognomic, is highly suggestive of hypothermia: the Osborn wave. Other findings on electrocardiogram can assist in diagnosis as well, but the only factors shown to predict outcome are atrial fibrillation and shivering artifact.
Assuntos
Temperatura Baixa/efeitos adversos , Eletrocardiografia , Hipotermia/diagnóstico , Idoso , Diagnóstico Diferencial , Progressão da Doença , Humanos , Hipotermia/fisiopatologia , Hipotermia/terapia , Masculino , Reaquecimento/métodosRESUMO
Remote monitoring has developed out of the need to accommodate the demand of the growing implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) population. After several years of clinical use, remote device interrogation systems have demonstrated ease of use for both patient and provider, reliability compared with in-office interrogations, and the ability to detect asymptomatic but clinically significant events. The effect of remote monitoring on morbidity and mortality is currently unknown, but several trials are underway to assess these outcomes. Many devices also have the capacity to remotely track physiologic parameters that may improve the management of heart failure. Remote monitoring of ICD-CRT populations is a promising technological advancement that likely will become the standard of care for ICD follow-up.