Massive diltiazem and metoprolol overdose rescued with extracorporeal life support.

The management of overdoses of cardioactive medications in the emergency department can be challenging. The reversal of severe toxicity from one or more types of cardioactive medication may fail maximal medical therapies and require extreme invasive measures such as transvenous cardiac pacing and extracorporeal life support. We present a case of massive diltiazem and metoprolol overdose refractory to maximal medical therapy, including intravenous calcium, glucagon, vasopressors, high dose insulin, and lipid emulsion. The patient experienced refractory bradydysrhythmia that responded only to transvenous pacing. Extracorporeal life support was initiated and resulted in successful organ perfusion and complete recovery of the patient. This case highlights the potential utility of extracorporeal life support in cases of severe toxicity due to multiple cardioactive medications.

The impact of preoperative imaging for atypical atrial myxoma locations.

BACKGROUND: Atrial myxomas are the most common primary cardiac neoplasm. The majority (75%-80%) are located in the left atrium at the base of the foramen ovalis. Surgical removal can prevent dangerous obstructive or thromboembolic sequelae. HYPOTHESIS: Atypically located tumors may present technical challenges requiring case-specific surgical adaptations when visualization or surrounding cardiac structures are compromised. METHODS: We describe 3 cases of atypically located atrial myxomas that required preoperative transesophageal echocardiography and computed tomography to afford the optimal surgical approach. CONCLUSIONS: These cases highlight the potential need for multimodality imaging of atypically located atrial myxomas to determine the optimal technical approach for excision.