RESUMO
We discuss a 72-year-old woman admitted with acute shortness of breath and severe sharp chest pain several hours after receiving acupuncture therapy. She was subsequently diagnosed as having an iatrogenic pneumothorax secondary to acupuncture. We discuss the complications of acupuncture and why patients should be informed of the risks of such procedures.
Assuntos
Analgesia por Acupuntura/efeitos adversos , Pneumotórax/etiologia , Idoso , Dor no Peito/etiologia , Dispneia/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Pneumotórax/diagnóstico , Pneumotórax/diagnóstico por imagem , RadiografiaAssuntos
Vasos Coronários , Infarto do Miocárdio , Dor no Peito , Eletrocardiografia , Humanos , MasculinoRESUMO
Tension pneumocephalus is an uncommon but important complication of neurosurgery, often requiring urgent surgical intervention. It should be considered in any patient presenting with neurological symptoms after recent craniotomy, particularly if they also have clinical features consistent with cerebrospinal fluid (CSF) leak. We describe a patient who presented four weeks post-craniotomy with fluctuating neurological signs and CSF rhinorrhoea, who made a full recovery following repair of a frontal sinus defect and dural tear.
RESUMO
QRS electrical alternans is characterised by alternating amplitude of the QRS complexes, and is well-documented in cardiac conditions such as pericardial effusion. We describe a case of QRS alternans in a patient with gastric volvulus.
Assuntos
Volvo Gástrico , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Eletrocardiografia , Feminino , Hérnia Hiatal/complicações , Humanos , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico , Volvo Gástrico/fisiopatologia , Taquicardia/complicações , Tórax/diagnóstico por imagemRESUMO
Brugada syndrome (BrS) is a genetic condition that accentuates the risk of potentially lethal ventricular arrhythmias and sudden cardiac death (SCD) in a structurally normal heart. The Brugada electrocardiographic pattern may manifest separately from the syndrome-this clinical scenario has been described as Brugada phenocopy (BrP). Many etiologies of BrP have been reported, but it has not yet been reported as a result of coronary slow flow (CSF) phenomenon. This case report highlights a suspected coronary slow flow-associated Brugada type 1 electrocardiographic pattern, which subsequently normalized following the institution of guideline-directed medical therapy for acute coronary syndrome.
Assuntos
Abdome Agudo/etiologia , Arteriopatias Oclusivas/diagnóstico por imagem , Artéria Celíaca/diagnóstico por imagem , Enfisema/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Idoso , Arteriopatias Oclusivas/complicações , Enfisema/etiologia , Evolução Fatal , Feminino , Humanos , Gastropatias/etiologia , Tomografia Computadorizada por Raios XRESUMO
The metabolic syndrome-otherwise called syndrome X, insulin resistance syndrome, Reaven syndrome, and "the deadly quartet"-is the name given to the aggregate of clinical conditions comprising central and abdominal obesity, systemic hypertension, insulin resistance (or type 2 diabetes mellitus), and atherogenic dyslipidemia. It is a prothrombotic and proinflammatory state characterized by increased inflammatory cytokine activity. In addition to inflammatory dermatoses such as psoriasis, lichen planus, and hidradenitis suppurativa, metabolic syndrome is also commonly associated with accelerated atherosclerotic cardiovascular disease, hyperuricemia/gout, chronic kidney disease, and obstructive sleep apnea. Current therapeutic options for metabolic syndrome are limited to individual treatments for hypertension, hyperglycemia, and hypertriglyceridemia, as well as dietary control measures and regular exercise.
Assuntos
Inflamação/metabolismo , Resistência à Insulina , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Citocinas/metabolismo , Humanos , Inflamação/complicações , Síndrome Metabólica/etiologia , Obesidade Abdominal/complicações , Estresse OxidativoRESUMO
Brugada phenocopies (BrPs) are clinical entities that differ in etiology from true congenital Brugada syndrome but have identical electrocardiographic (ECG) patterns. Hyperkalemia is known to be one of the causes of BrP. The aim of this study was to determine the clinical characteristics and evolution of hyperkalemia-induced BrP. Data from 27 cases of hyperkalemia-induced BrP were collected from the International Registry at www.brugadaphenocopy.com. Data were extracted from publications. Of the 27 patients included in the analysis, 18 (67%) were male; mean age was 53 ± 15 years (range 31 to 89). Mean serum potassium concentration was 7.45 ± 0.89 mmol/L. Type-1 Brugada ECG pattern was observed in 21 cases (78%), whereas 6 cases (22%) showed a type-2 Brugada ECG pattern. The Brugada ECG pattern resolved once the hyperkalemia was corrected, with no arrhythmic events. Estimated time to resolution was 7 ± 3 hours. In 4 cases (16%), a concurrent metabolic abnormality was detected: 3 (11%) presented with acidosis, 2 (7%) with hyponatremia, 1 (4%) with hypocalcaemia, 1 (4%) with hyperphosphatemia, and 1 (4%) with hyperglycemia. In 7 cases (26%), provocative testing using sodium channel blockers was performed, and all failed to reproduce a BrS ECG pattern (BrP class A). Additionally, no sudden cardiac death or malignant ventricular arrhythmias were detected. Hyperkalemia was found a common cause of BrP in our International Registry. The Brugada ECG pattern appears to occur at high serum potassium concentrations (>6.5 mmol/L). The ECG normalizes within hours of correcting the electrolyte imbalance. Importantly, hyperkalemia-induced BrP has not been associated with sudden cardiac death or ventricular arrhythmia.