RESUMEN
Prosthetic valve endocarditis is a serious complication following valve replacement surgery, with the development of aortic root abscess being a catastrophic manifestation. We present a case of a 71-year-old female with a bioprosthetic aortic valve who presented with shortness of breath. Echocardiographic findings revealed vegetation on the prosthetic aortic valve with a periaortic, annular abscess. Given the patient's comorbidities and high surgical risk, conservative management with antibiotics was chosen. The patient responded well to antibiotic therapy and was discharged with long-term antibiotic treatment. Prosthetic valve endocarditis, particularly with periaortic abscess formation, is associated with significant morbidity and mortality. Early diagnosis and appropriate management are crucial for improving outcomes.
RESUMEN
Immune thrombocytopenia (ITP) is a bleeding disorder characterized by a decreased number of platelets. It is an immune system-mediated condition, with formation of antibodies against a structural platelet antigen. Although the pathogenesis remains elusive, primary disease is idiopathic and comprises 80% of cases. However, quite a few secondary causes have been established including Helicobacter pylori, varicella-zoster virus and cytomegalovirus. A few cases with an incidental association with herbal medications have been reported, but this causality has not been studied in detail. Here we present the case of 38-year-old African-American woman who presented with symptomatic thrombocytopenia, with a platelet count of 5 K/µl 1 week after she had consumed herbal tea containing Rumex crispus (yellow dock) and Arctium lappa (burdock). The association between unstudied herbs and ITP needs further research, given the widespread use of these substances and ongoing public uncertainty about their benefits. LEARNING POINTS: Over-the-counter herbal products marketed as having beneficial effects are not always harmless and can have clinically significant side effects.When investigating the causes of thrombocytopenia, physicians should be aware of and search for this rare cause.Treatment for herbal tea-induced thrombocytopenia is the same as for immune thrombocytopenia (i.e., steroids and platelet transfusion if there is actively bleeding).
RESUMEN
Cocaine is considered a leading non-opioid cause of drug overdose in the US. It acts as a sympathomimetic and increases the amount of catecholamines, thereby increasing the risk of ventricular irritability and resultant arrhythmias. Its sodium (Na) channel blockage is the principal mechanism behind the Brugada pattern on an electrocardiogram (ECG), which is often transient but is indistinguishable from that of Brugada syndrome, the autosomal dominant channelopathy. We are presenting a case of a 32-year-old male with a history of cocaine and nicotine abuse, who sought medical attention for sudden-onset palpitations and pressure-like chest pain after having snorted an impressive amount of cocaine. His ECG depicted a classical Brugada pattern with ST-elevation with T inversion in V1; however, previous ECGs were normal without ST changes, signifying the Brugada pattern unmasked by cocaine use. Other investigations including stress tests and nuclear imaging were equivocal. His symptoms as well as the ECG pattern reverted to baseline signifying the presence of Brugada phenotype in the absence of channelopathy. Hence, as a sodium channel blocker, cocaine may unmask latent Brugada syndrome in asymptomatic patients without a family history. Recognizing Brugada syndrome on ECG is vital to avoid misdiagnosis and mistreatment of the patient with and without a genetic predisposition.
RESUMEN
BACKGROUND: Non-adherence to dietary recommendations, exercise and prescribed drug regimens, in coronary heart disease (CHD) patients following coronary artery bypass grafting (CABG), is a major health care issue worldwide. AIMS AND OBJECTIVES: The primary objective of this study was to investigate the frequency and predictors of non-adherence to lifestyle changes and medication among CHD patients after undergoing CABG surgery. METHOD: The sample of this cross sectional descriptive study was 265 patients who underwent isolated primary CABG. Participants who met the eligibility criteria were provided with a pre-coded questionnaire 4 weeks or more after surgery. Adherence was assessed on the basis of patient's self-report. Significance of results was analyzed using Chi square test. RESULTS: Roughly half of the patients were non-adherent to dietary recommendations (n=120, 45.3%) and exercise (n=109, 41.1%) while about one third (n=69, 26%) were non-adherent to prescribed medications. Unwillingness to adopt a new lifestyle and more than one social gathering per week, were found to be statistically significant predictors of non-adherence to diet (p-values<0.001). Reluctance to follow exercise regimen, busy schedule, and fear that exercise will aggravate heart issues were commonly reported as reasons for non-compliance to exercise. As for non-adherence to medication, forgetfulness, affordability of drugs and too many medications to take were important predictors. CONCLUSION: Non-adherence to lifestyle modifications and medication is an emerging problem worldwide. It is essential for medical health professionals to discuss these predictors and address them individually. Our findings highlight the need for a healthy physician and patient relationship.