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Pulmonary arterial hypertension (PAH) was first associated with stimulants use in the 1960s during an outbreak of amphetamine-like appetite suppressants (anorexigens). To date, various drugs and toxins have been correlated with PAH. Diagnosing PAH in nephrotic syndrome has always remained a challenge due to the overlap of signs and symptoms in clinical presentation between the two entities. Case presentation: In this report, the authors present an interesting case of a 43-year-old male, diagnosed with nephrotic syndrome secondary to minimal change disease, as well as currently presenting with PAH secondary to amphetamine. Clinical discussion and conclusion: Patients with nephrotic syndrome and end-stage renal disease should be regularly followed up and evaluated for comorbidities, complications, as well as adverse events from pharmacological intervention. In patients with end-stage renal disease hypertension control is key, stimulant use can precipitate poor blood pressure control especially in pulmonary arteries resulting in PAH. PAH can result in right ventricular dysfunction and heart failure that can further exacerbate renal dysfunction and vice-versa in a vicious cycle, deteriorating patient condition and quality of life.
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ST-segment elevation in post-return of spontaneous circulation after cardiac arrest is a major concern for underlying acute coronary syndrome. This case report presents a rare case of vasopressor-induced coronary vasospasm as an underlying cause for this ST-segment elevation with complete reversal of EKG changes after reducing the vasopressor dose. (Level of Difficulty: Beginner.).
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INTRODUCTION: The principle behind the generation of the Korotkoff sounds is the turbulence of blood flowing through a partially occluded area in the artery. With increasing age, the vascular wall compliance is expected to decrease, which is due to the thickening of the vessel wall, due to which the amplitude of the transmitted Korotkoff sounds is decreased. There is also an accompanying rise in the systolic B.P. and pulse pressure. AIM: To record and compare the amplitudes of the intermediate Korotkoff sounds and the blood pressures in individuals of the two age groups, and calculate the pulse pressure and determine whether they vary in relation to the amplitude of the intermediate Korotkoff sounds recorded. MATERIALS AND METHODS: The cross-sectional study was conducted on 50 young subjects (15-25 years) and 50 older subjects (50-70 years). The mid arm circumference was measured using a tape. A phonoarteriogram was placed over the left brachial artery and the sphygmomanometer cuff was tied 2cm above the cubital fossa of the left arm. The blood pressure was recorded using the Lab Tutor software. The Korotkoff sounds picked up and transmitted by the phonoarteriogram are represented as distinct lines on the graphical recording. STATISTICAL ANALYSIS: Independent samples t-test to look for significant mean amplitude differences and for correlating mean amplitude and pulse pressure. Null hypothesis rejected at p<0.05. Data analysed using the SPSS software version 20.0 (SPSS Inc.). RESULTS: There was a significant difference in the mean amplitudes of Korotkoff sounds among the different age groups (p=0.001) and subject categories (p=0.043 among males, p=0.037 among females). A significant difference in pulse pressures was also seen among different age groups and subject categories. The decrease in the amplitudes of Korotkoff sounds in the older age group accompanies the increase in pulse pressures seen in this group and the same was seen among the different age groups within each sex (r=-0.574, p=0.001 among males) and (r=-0.449, p=0.002 among females). CONCLUSION: Measuring the amplitude of Korotkoff sounds can give us an idea of the nature of the arterial wall as shown by a decrease in amplitude in older individuals when compared to the younger individuals and of the volume of blood flowing through the artery as shown by the higher amplitudes observed in males when compared to females.