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1.
J Ark Med Soc ; 113(12): 294-296, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29649357

RESUMEN

Amiodarone is a widely used antiarrhythmic agent for supraventricular and ventricular tachyarrhythmias. It is known to cause pulmonary toxicity, which can manifest in a variety of presentations, ranging from asymptomatic to fatal. We present a case of chronic interstitial pneumonia with organizing pneumonia induced by amiodarone that was successfully treated with drug cessation and use of corticosteroids. The patient experienced complete resolution of symptoms and full recovery of lung function after the course of steroids.


Asunto(s)
Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Enfermedades Pulmonares Intersticiales/inducido químicamente , Neumonía/inducido químicamente , Glucocorticoides/uso terapéutico , Humanos , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Neumonía/tratamiento farmacológico , Prednisona/uso terapéutico
2.
ASAIO J ; 70(1): 31-37, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-37797341

RESUMEN

Primary graft dysfunction (PGD) after cardiac transplantation is a devastating complication with increasing frequency lately in the setting of donation after circulatory death (DCD). Severe PGD is commonly treated with extracorporeal membrane oxygenation (ECMO) using central or peripheral cannulation. We retrospectively reviewed the outcomes of PGD after cardiac transplantation requiring ECMO support at our center from 2015 to 2020, focused on our now preferential approach using peripheral cannulation without a priori venting. During the study period, 255 patients underwent heart transplantation at our center and 26 (10.2%) of them required ECMO for PGD. Of 24 patients cannulated peripherally 19 (79%) were alive at 30 days and 17 (71%) 1 year after transplant; two additional patients underwent central ECMO cannulation due to unfavorable size of femoral vessels and concern for limb ischemia. Successful decannulation with full graft function recovery occurred in 22 of 24 (92%) patients cannulated peripherally. Six of them had an indwelling intra-aortic balloon pump placed before the transplantation. None of the other 18 patients received a ventricular vent. In conclusion, the use of an a priori peripheral and ventless ECMO approach in patients with PGD after heart transplant is an effective strategy associated with high rates of graft recovery and survival.


Asunto(s)
Oxigenación por Membrana Extracorpórea , Trasplante de Corazón , Disfunción Primaria del Injerto , Humanos , Oxigenación por Membrana Extracorpórea/efectos adversos , Estudios Retrospectivos , Disfunción Primaria del Injerto/etiología , Disfunción Primaria del Injerto/terapia , Trasplante de Corazón/efectos adversos , Contrapulsador Intraaórtico/efectos adversos
3.
JACC Case Rep ; 3(3): 443-446, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34317554

RESUMEN

Cardiac sympathetic denervation has been shown to reduce sustained ventricular arrhythmias and implantable cardioverter-defibrillator shocks by inhibiting sympathetic outflow to the heart. We describe the first case to our knowledge of cardiac sympathetic denervation in the left ventricular assist device population. (Level of Difficulty: Advanced.).

4.
BMJ Case Rep ; 20172017 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-28512099

RESUMEN

Oesophageal ultrasound with bronchoscope (EUS-B) is designed to evaluate mediastinal structures. We describe a case of a 78-year-old woman who presented with altered mental status for 2 weeks. CT head revealed a subacute infarct in the right middle cerebral artery distribution. She was also found to have a lung mass on chest imaging. EUS-B-guided fine needle aspiration demonstrated the presence of adenocarcinoma in station 7 lymph node and in the mass. Immunohistochemistry confirmed it to be a lung primary as the Thyroid Transcription Factor-1 (TTF-1) was strongly positive. During the procedure, the cardiac valves were evaluated, and a mitral valve vegetation was noted. Formal echocardiography confirmed the presence of the vegetation. During hospital stay, the patient developed fever. Her blood cultures grew oxacillin-resistant Staphylococcus aureus. She was subsequently treated for infective endocarditis. We suggest that the use of EUS-B to routinely scan adjacent structures during a procedure may help obtain additional clinical information that may be critical to patient management.


Asunto(s)
Broncoscopía/métodos , Confusión/diagnóstico por imagen , Endocarditis Bacteriana/tratamiento farmacológico , Esófago/diagnóstico por imagen , Arteria Cerebral Media/patología , Válvula Mitral/diagnóstico por imagen , Ultrasonografía/métodos , Adenocarcinoma/inmunología , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Administración Intravenosa , Anciano , Antibacterianos/uso terapéutico , Biopsia con Aguja Fina/métodos , Confusión/etiología , Diagnóstico Diferencial , Ecocardiografía , Endocarditis Bacteriana/microbiología , Femenino , Humanos , Neoplasias Pulmonares/inmunología , Neoplasias Pulmonares/patología , Ganglios Linfáticos/patología , Arteria Cerebral Media/diagnóstico por imagen , Válvula Mitral/patología , Staphylococcus aureus/crecimiento & desarrollo , Staphylococcus aureus/aislamiento & purificación , Factor Nuclear Tiroideo 1/metabolismo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Vancomicina/administración & dosificación , Vancomicina/uso terapéutico
5.
Cardiol Res Pract ; 2016: 8956020, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26966608

RESUMEN

Atrial fibrillation (AF) is a common arrhythmia in adults associated with thromboembolic complications. External electrical cardioversion (DCCV) is a safe procedure used to convert AF to normal sinus rhythm. We sought to study factors that affect utilization of DCCV in hospitalized patients with AF. The study sample was drawn from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project in the United States. Patients with a primary discharge diagnosis of AF that received DCCV during hospitalization in the years 2000-2010 were included. An estimated 2,810,530 patients with a primary diagnosis of AF were hospitalized between 2001 and 2010, of which 1,19,840 (4.26%) received DCCV. The likelihood of receiving DCCV was higher in patients who were males, whites, privately insured, and aged < 40 years and those with fewer comorbid conditions. Higher CHADS2 score was found to have an inverse association with DCCV use. In-hospital stroke, in-hospital mortality, length of stay, and cost for hospitalization were significantly lower for patients undergoing DCCV during AF related hospitalization. Further research is required to study the contribution of other disease and patient related factors affecting the use of this procedure as well as postprocedure outcomes.

6.
BMJ Case Rep ; 20152015 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-25953584

RESUMEN

We describe a diagnostic dilemma in a middle-aged man presenting with dyspnoea and bilateral pedal oedema who had been diagnosed with right heart failure based on clinical evidence. The evaluation for aetiology eventually led to discovery of an unusual extrathoracic cause, a left-to-right communication in the renal vasculature. Renal arteriovenous fistulae are rare and can be congenital, acquired or idiopathic. A left-to-right shunt typically presents with high-output cardiac failure involving the left and right sides of the heart. An atypical feature of this case was the finding of overt right heart failure in the setting of a normal left heart. Such a presentation has only been described in a few isolated case reports. Diagnostic approaches include CT angiography and cardiac catheterisation for haemodynamic measurements. The primary treatment options for arteriovenous fistulae are medical management, arterial embolisation and surgical repair.


Asunto(s)
Angiografía/métodos , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico , Insuficiencia Cardíaca/etiología , Riñón/irrigación sanguínea , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/patología , Cateterismo Cardíaco , Disnea/etiología , Edema/etiología , Pie/patología , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Riñón/diagnóstico por imagen , Riñón/patología , Masculino , Persona de Mediana Edad , Esfuerzo Físico , Tomografía Computarizada por Rayos X
7.
BMJ Case Rep ; 20142014 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-24744075

RESUMEN

Myasthenia gravis (MG) is a neuromuscular disorder that typically affects the ocular, bulbar, neck, proximal limbs and respiratory muscles. Dysphagia can occasionally be the only presenting symptom leading to extensive but ultimately futile gastrointestinal workup. Delay in diagnosis and use of certain pharmacological agents in the interim can lead to a myasthenic crisis, which though diagnostic is life threatening. We document a case of dysphagia as the only symptom of myasthenia, diagnosed after a magnesium infusion precipitated myasthenic crisis. A 70-year-old Caucasian woman who had had progressive dysphagia for 2 years, for which multiple oesophageal dilations were performed. During a hosptalisation for further gastrointestinal workup, she went into myasthenic crisis (respiratory failure) after receiving magnesium replacement. She required ventilatory support and received five plasma exchange (PLEX) treatments after myasthenia was confirmed by the detection of high antiacetylcholine receptor antibody. Though her symptoms improved, she had a prolonged hospital stay (25 days) and required 18 days of mechanical ventilation. This underscores the morbidity associated with a delay in diagnosis of this condition. This case report suggests that neuromuscular causes should be considered early in elderly patients presenting with dysphagia. Timely diagnosis, initiation of management and avoidance of drugs that affect neuromuscular transmission may help reduce the morbidity and mortality associated with myasthenic crisis.


Asunto(s)
Trastornos de Deglución/diagnóstico , Magnesio/administración & dosificación , Miastenia Gravis/diagnóstico , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Infusiones Intravenosas , Magnesio/efectos adversos , Miastenia Gravis/inducido químicamente
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