Hypertension has been shown to have long-term cardiovascular effects if left untreated. Hypertension also has been shown to affect women during pregnancy, which can be detrimental not only to the patient but also to the fetus. Early identification and treatment are paramount to prevent adverse outcomes. This article details the epidemiology, clinical presentation, diagnosis, and treatment of essential hypertension in women, gestational hypertension, preeclampsia, and eclampsia.
Hypertension, Pregnancy-Induced , Hypertension , Pre-Eclampsia , Pregnancy , Female , Humans , Pre-Eclampsia/diagnosis , Pre-Eclampsia/epidemiology , Pre-Eclampsia/therapy , Hypertension, Pregnancy-Induced/diagnosis , Hypertension, Pregnancy-Induced/epidemiology , Hypertension, Pregnancy-Induced/therapy
Falsely elevated troponin has been reported in the literature. The authors present a case of a 51-year-old man who was admitted with nausea, vomiting, and chest discomfort. He was found to have elevated troponin with no electrocardiographic changes. He has normal coronaries on angiogram and normal echocardiogram. A diagnostic time-out and second look at the laboratory values captured abnormalities that triggered a workup that ruled in a multiple myeloma diagnosis. We suspected falsely elevated troponin levels secondary to macrotroponin, a complex of elevated immunoglobulin levels and troponin, which has been rarely reported to cause elevated troponin levels in patients with multiple myeloma.
Most neurosurgical emergencies involve management of intracranial pressure, decompression of brain parenchyma, or diversion of cerebrospinal fluid. These interventions aim to prevent progression and reverse damage to neural structures. The pathologies that require emergent treatment either develop acutely or may progress over days until they reach a critical point causing decompensation. The risk of any intervention need to be weighed against potential benefits and should involve discussions with the family. Interventions have shown to be effective and facilitate patients' return to improved functionality. However, while neurosurgical interventions are lifesaving, surviving patients may have a severe residual disability. This article presents an overview of commonly seen nontraumatic neurosurgical emergencies. Each section presents key facets of presentation, initial workup, management, and role of surgical intervention.
Emergencies , Neurosurgical Procedures , Humans
Chronic obstructive pulmonary disease is a highly symptomatic disease that may lead to significant morbidity. Even with optimal therapy, the patient's quality of life can be severely affected. These symptoms include dyspnea, anxiety, depression, and malnourishment. Palliative care is a branch of medicine that specializes in the care of patients with a terminal illness no matter what stage of the disease they are in. It implements a family-centered approach to help patients deal with their symptoms. It also helps with shared decision-making and advanced care planning.
Palliative Care , Pulmonary Disease, Chronic Obstructive , Terminal Care , Anxiety , Dyspnea , Humans , Quality of Life
Extracorporeal membrane oxygenation (ECMO) has become a key tool in the management of cardiac and/or respiratory failure refractory to conventional management. Although ECMO has multiple indications, it has been widely studied for the management of acute respiratory distress syndrome in adults. ECMO provides rest and support while the damaged lungs heal. It is an invasive modality with risks of serious complications; therefore, clinicians should be vigilant during patient selection. Furthermore, users should be familiar with different components of the ECMO machinery and the management of different organ systems while patients are on the circuit. ECMO is a relatively new modality that has shown good results when used in certain circumstance, and its use is becoming more popular across the United States.
Extracorporeal Membrane Oxygenation , Guidelines as Topic/standards , Respiratory Distress Syndrome/therapy , Adult , Extracorporeal Membrane Oxygenation/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Middle Aged
Venous thromboembolism (VTE) can present in a variety of different clinical settings and in a diverse, comorbid patient population, both of which will guide the clinician toward the appropriate therapeutic response. Patients who present with pulmonary embolism are at risk for hemodynamic instability, recurrence of VTE, cardiac comorbidities, and increased risk of overall mortality. Prognostication models have been clinically validated for risk stratification and prediction of mortality. Similar to pulmonary embolism, patients with deep vein thrombosis carry a higher risk of VTE recurrence and cardiac comorbidities. Consequently, VTE can be treated by a variety of methods such as anticoagulants or inferior vena cava filters, which bear their own risks and benefits. It is imperative that clinicians monitor patients for complications from VTE and the chosen therapy.
Comorbidity , Pulmonary Embolism/diagnosis , Venous Thromboembolism/epidemiology , Anticoagulants/therapeutic use , Humans , Prognosis , Pulmonary Embolism/drug therapy , Recurrence , Risk Factors , Vena Cava Filters/statistics & numerical data , Venous Thromboembolism/drug therapy , Venous Thromboembolism/mortality
Catheter induced cardiac arrhythmia is a well-known complication encountered during pulmonary artery or cardiac catheterization. Injury to the cardiac conducting system often involves the right bundle branch which in a patient with preexisting left bundle branch block can lead to fatal arrhythmia including asystole. Such a complication during central venous cannulation is rare as it usually does not enter the heart. The guide wire or the cannula itself can cause such an injury during central venous cannulation. The length of the guide wire, its rigidity, and lack of set guidelines for its insertion make it theoretically more prone to cause such an injury. We report a case of LBBB that went into transient complete heart block following guide wire insertion during a central venous cannulation procedure.
