ABSTRACT
End-stage renal disease (ESRD) carries a significant risk for sudden cardiac arrest (SCA), hospitalization and mortality. We present a case of a vintage hemodialysis patient who had a catastrophic event during his hemodialysis treatment - a sudden cardiac arrest. This case raises several important issues: First, patients with chronic kidney disease (CKD) (and particularly ESRD) are predisposed to an inordinate risk of SCA; second, the factors leading to SCA in CKD are unique; and lastly, it is of paramount importance to have basic life support training, crash carts and defibrillators in dialysis units. It also raises the important discussion regarding the role for automated implantable cardioverter defibrillators and medical therapy for the prevention of SCA in this population.
Subject(s)
Death, Sudden, Cardiac/etiology , Heart Arrest/etiology , Kidney Failure, Chronic/complications , Ventricular Fibrillation/etiology , Aged , Cardiopulmonary Resuscitation , Coronary Angiography , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Electric Countershock/instrumentation , Electrocardiography , Heart Arrest/diagnosis , Heart Arrest/therapy , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Male , Renal Dialysis , Risk Factors , Treatment Outcome , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/therapyABSTRACT
Approximately 1% of adults who undergo cardiac catheterization have coronary anomalies. Patients may present with chest pain, arrhythmias, presyncope, and sometimes sudden cardiac death. Multidetector computed tomography (MDCT) is an excellent tool for identifying coronary artery anomalies and defining their course and relationship to the great vessels and surrounding structures; its value is incremental to conventional angiography. We present a rare case of a coronary anomaly involving three separate ostia at the right sinus of Valsalva for the left and right coronary vessels.
Subject(s)
Coronary Angiography/methods , Coronary Vessel Anomalies/diagnostic imaging , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Female , HumansSubject(s)
Bone Marrow Diseases/diagnosis , Edema/diagnosis , Immunosuppressive Agents/adverse effects , Bone Marrow Diseases/chemically induced , Edema/chemically induced , Female , Foot , Hand , Humans , Kidney Transplantation , Magnetic Resonance Imaging , Middle Aged , Pain/etiology , Postoperative Complications/chemically induced , Postoperative Complications/diagnosisABSTRACT
We report a case of a 66-year-old African-American female who presented with complaints of progressively worsening weakness, shortness of breath on minimal exertion, lethargy for the last few days, and short episodes of aphasia lasting 20-30 seconds. Prior to presentation, she was treated with two courses of moxifloxacin for sinusitis. Laboratory examination was remarkable for anemia and thrombocytopenia with elevated lactate dehydrogenase and no evidence of renal failure. Peripheral smear showed numerous schistocytes and she was diagnosed with thrombotic thrombocytopenic purpura. Moxifloxacin was identified as the offending agent. The patient was treated with prednisone and plasmapheresis. To the best of our knowledge, this is the first reported case of thrombotic thrombocytopenic purpura associated with the use of moxifloxacin. Although rare, physicians should be aware of this serious complication associated with its use.