RESUMEN
An 86-year-old woman with history of hypertension, diabetes, hyperlipidemia, and coronary artery disease was admitted with new-onset congestive heart failure and pneumonia. She underwent coronary angiography after suffering a non-ST elevation myocardial infarction. There was severe coronary artery disease in addition to coronary artery-pulmonary fistulas involving proximal right coronary artery and a branch of left main coronary artery. Coronary artery fistula (CAF) is an abnormal communication between one or more coronary arteries and great vessels or a cardiac chamber. We reviewed 15 cases of CAFs published in PubMed and studied the clinical features of CAFs.
RESUMEN
Takotsubo cardiomyopathy, or transient left ventricular apical ballooning or broken heart syndrome, is characterized by excessive sympathetic stimulation induced acute coronary vasospasm. A 46-year-old female presented with polyuria and polydypsia and was diagnosed with new-onset diabetes mellitus, treated with insulin and intravenous fluids. During the hospital stay, she complained of an episode of left-sided chest pain and had mildly elevated cardiac enzymes. EKG showed new ST-segment elevation in V2, V3 leads without reciprocal changes. Her coronary angiogram showed no significant coronary artery stenosis, but severe systolic dysfunction and akinesis of the mid-anterior, anteroapical, mid-inferior and inferoapical segments. Further workup was negative except for plasma metanephrine being elevated. MRI of the abdomen showed a right adrenal mass consistent with pheochromocytoma. Surgical resection of the adrenal mass showed evidence of pheochromocytoma and the patient's symptoms were resolved.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Feocromocitoma/complicaciones , Cardiomiopatía de Takotsubo/etiología , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/metabolismo , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Biomarcadores/sangre , Angiografía Coronaria , Electrocardiografía , Femenino , Humanos , Imagen por Resonancia Magnética , Metanefrina/sangre , Persona de Mediana Edad , Feocromocitoma/diagnóstico , Feocromocitoma/metabolismo , Feocromocitoma/cirugía , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/metabolismo , Resultado del Tratamiento , Regulación hacia ArribaRESUMEN
Gross and microscopic findings consistent with acute and healed myocardial injury without coronary artery disease have been described in autopsy studies of patients with sickle cell crisis. The present study was designed to determine whether serum levels of cardiac troponin I are elevated in sickle cell crisis. Cardiac troponin I levels were measured in 32 patients age>18 years with the admission diagnosis of sickle cell crisis. All patients had cardiac troponin I level drawn >24 h after the onset of symptoms. The clinical profile and electrocardiograms were analyzed. Out of 32 patients, 2 patients had serum cardiac troponin I elevated, both had presented with acute chest syndrome. Serum cardiac troponin I may be elevated during sickle cell crisis, possibly by myocardial ischemia resulting from microvascular coronary obstruction during sickle cell crisis.
Asunto(s)
Anemia de Células Falciformes/sangre , Biomarcadores/sangre , Isquemia Miocárdica/sangre , Troponina I/sangre , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/etiologíaRESUMEN
Hyperkalemia is a life threatening metabolic condition. The common risk factors for hyperkalemia include renal insufficiency, use of angiotensin converting enzyme inhibitors, potassium supplementation and excessive consumption of potassium containing diet. A mild to moderate increase in serum potassium causes an increase in myocardial excitability, but further increase leads to impaired myocardial responsiveness, including that to pacing stimulation. Hyperkalemia has been reported to cause failure of atrial capture due to pacemaker exit block. We report a case where hyperkalemia resulted in failure of both the atrial and the ventricular pacemaker capture.
Asunto(s)
Atrios Cardíacos/fisiopatología , Frecuencia Cardíaca/fisiología , Ventrículos Cardíacos/fisiopatología , Hiperpotasemia/etiología , Fallo Renal Crónico/complicaciones , Marcapaso Artificial , Síndrome del Seno Enfermo/terapia , Electrocardiografía , Falla de Equipo , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Síndrome del Seno Enfermo/complicaciones , Síndrome del Seno Enfermo/fisiopatologíaRESUMEN
We report a case of a 26-year-old female who after septic abortion developed tricuspid valve endocarditis with large vegetations, which subsequently resulted in embolism to right main pulmonary artery. Patient was treated with intravenous antibiotics and had a good recovery.
Asunto(s)
Aborto Terapéutico/efectos adversos , Endocarditis Bacteriana/complicaciones , Endometritis/complicaciones , Embolia Pulmonar/etiología , Sepsis/complicaciones , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Femenino , Estudios de Seguimiento , Humanos , Embarazo , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/microbiología , Sepsis/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiologíaRESUMEN
Diphenhydramine overdose in one of the frequent reported causes of acute poisoning. Patients with diphenhydramine overdose can present with central nervous system manifestations, anticholinergic manifestations and cardiovascular symptoms. The cardiovascular symptoms of diphenhydramine overdose include myocardial depression and refractory hypotension. Massive ingestions have been reported to cause myocardial depressant effect with widening of QRS complex and prolonged QT interval on electrocardiogram. We report an adolescent male with moderate diphenhydramine ingestion, who was found unresponsive with seizure like activity. Electrocardiogram on presentation showed wide complex tachycardia with right bundle branch block pattern and QT interval prolongation. These changes reverted to normal with treatment. Diphenhydramine overdose may occasionally result in prolongation of QT interval.