Severe Amlodipine Toxicity: A Case Rescued with Extracorporeal Membrane Oxygenation.

Amlodipine is a widely prescribed drugs for the management of hypertension. Its toxicity is associated with severe myocardial depression and refractory hypotension. We present a case of a 28-year-old female known case of seizure disorder and depression who got admitted to our hospital with a history of consumption of 80 tablets of 5 mg amlodipine (total 400 mg). Patient presented to our hospital after 23 hours following consumption of the drug. Patient was managed in the intensive care unit (ICU) with mechanical ventilation support and intravenous infusion of noradrenalin, adrenalin, insulin-dextrose, and calcium gluconate. Due to refractory hypotension, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated on the same day. Patient was successfully managed and discharged home on the 8th day. This report highlights a rare case of a massive amlodipine overdose (400 mg) and ECMO as a rescue therapy. HOW TO CITE THIS ARTICLE: Sutar A, Venkategowda PM, Murthy A, Chikkaswamy SB. Severe Amlodipine Toxicity: A Case Rescued with Extracorporeal Membrane Oxygenation. Indian J Crit Care Med 2020;24(5):365-366.

Intracardiac mass in chronic myeloid leukemia.

Chronic myeloid leukaemia (CML) is a neoplastic disorder of myeloid cell lines and is a less aggressive disease compared to acute myeloid leukemia (AML). Although cardiovascular complications are not uncommon, intracardiac thrombosis in CML is rarely reported. Herein, we report a case of CML presenting with an intracardiac thrombus attached to the posterior mitral leaflet, and subsequently resulting in peripheral embolization.

Angiographic profile and endovascular interventions in Takayasu's arteritis.

BACKGROUND: Takayasu's arteritis (TA) is a rare inflammatory, granulomatous vasculitis primarily involving the aorta and its major branches. Clinical and angiographic manifestations of the disease differ in various parts of the world. OBJECTIVES: To analyze the clinical features, angiographic profile, and endovascular interventions in TA patients (pts). METHODS: From January 2009 to March 2013, a total of 62 consecutive pts who were diagnosed with Takayasu's arteritis at our institute based on American College of Rheumatology Criteria were included in the study. Thirty-four pts underwent conventional angiography, while 28 were evaluated using computed tomographic angiography. Endovascular interventions were attempted for 24 lesions in 23 pts who were symptomatic and had significant stenotic lesions. RESULTS: The mean age of presentation was 28.4 ± 9.7 years, with 69.4% female. Limb claudication (52%) was the most common presenting symptom, followed by vertigo (35%) and constitutional symptoms. The most common angiography class was type V (37.1%), followed by type I (32.2%), type IV (17.7%), type IIa (8.1%), type III (3.2%), and type IIb (1.6%). The most common artery involved was the subclavian (64.5%), with the left subclavian more commonly involved than the right, followed by the abdominal aorta (51.6%) and renal artery (32.2%). Stenotic lesions were present in 59 pts (95%), while aneurysmal involvement was seen in 17 (27.4%), with isolated aneurysmal involvement in 3 of these. CONCLUSIONS: Our cohort of TA pts had more severe and widespread involvement. Despite a more advanced presentation, percutaneous balloon angioplasty with stent implantation is feasible, with good immediate results but slightly higher complication rates.

Preventing a central nervous system catastrophe in a case of Takayasu's arteritis presenting with critical stenosis of all three arch vessels.

Multifocal and bilateral involvement of the arch vessels is a common presentation of Takayasu's arteritis. Endovascular stenting of multiple supra aortic lesions in Takayasu's arteritis has been described scarcely in literature. We describe the management of a case of Takayasu's arteritis who presented with recurrent vertebro-basilar symptoms and a single surviving arch vessel. Whether routine revascularization of all three vessels is superior to symptom driven revascularization of individual lesions remains uncertain. The abundant collateral blood flow; the problems with stenting during the acute phase of the disease; the risk of restenosis that is considerably higher than atherosclerotic lesions; and the chances of progression of the disease have to be taken into account during endovascular revascularization of multiple supra aortic arch vessels.

Novel transcatheter closure of internal iliac arteriovenous malformation.

Arteriovenous malformations arising from iliac arteries are rare anomalies. Percutaneous embolization of such malformations is an established therapeutic option. In this paper, we will describe a case, wherein the internal iliac artery feeding a giant arteriovenous fistula was closed using a patent ductus arteriosus (PDA) duct occluder percutaneously. The PDA duct occluder is a versatile device that can be used as an alternative to vascular plugs.