RESUMO
The right-to-left shunt (RTLS) through a latent patent foramen ovale (PFO) is a rare complication of right ventricle myocardial infarction (MI). Though a rare complication, the development of refractory hypoxemia after right ventricular MI should always alert clinicians to consider the possibility of shunting across PFO. Right-sided Impella (Impella RP) can be considered in such patients, which helps to decrease the elevated right heart pressure reducing the shunt, thereby providing a bridge to recovery.
RESUMO
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive genetic disorder which commonly affects males. It is due to a defect in the red blood cell enzyme, G6PD. Lack of G6PD makes the RBCs vulnerable to oxidant stress resulting in hemolysis. The severity of hemolytic anemia varies among individuals with G6PD deficiency. Here we present a case of an 80-year-old man admitted with syncope and jaundice. He was treated with phenazopyridine for a UTI 2 weeks ago. Subsequent investigation revealed G6PD deficiency as well as methemoglobinemia. Historically, phenazopyridine has been associated with causing methemoglobinemia and triggering hemolysis in G6PD deficient individuals. However, only a few cases have been reported in the last 60 years, making it a very rare occurrence.
RESUMO
Coronavirus disease 2019 (COVID-19) burden has been identified to cause multiorgan damage. Respiratory compromise is still one of the most common presentations, but cardiac injuries like myocardial injury, ischemia, and conduction abnormalities are also becoming prevalent. We present a case of an 87-year-old male with a history of dementia, type 2 diabetes mellitus, hypertension, chronic kidney disease, and a left kidney transplant hospitalized for respiratory distress and generalized tonic-clonic seizures. He was bradycardic to 27 beats per minute, hypotensive with mean arterial pressure <60 mm Hg. An electrocardiogram (EKG) depicted a high-grade atrioventricular block (AV-block). The transvenous pacemaker was placed via femoral access and tested positive for COVID-19. Work-up was done to rule out possible causes of bradycardia, like hypothyroidism, ischemia, AV nodal blocking agents, and drug-induced bradycardia was negative. His hospital stay got complicated by methicillin-resistant staphylococcus aureus (MRSA) pneumonia leading to empyema and bacteremia. Unfortunately, being critically ill, the family opted for comfort measures, and he passed away. Our clinical vignette signifies cardiovascular complications in COVID-19 patients are associated with poor outcomes if not addressed. The conduction abnormalities in patients with intact cardiac structure and function are becoming more common in the setting of COVID infection. Assessment with serial EKGs and cardiac monitoring might be essential as patients can develop AV blocks at any point of the disease.
