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BMJ Case Rep ; 14(10)2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645631


Pacing-induced cardiomyopathy (PICM) consists of heart failure (HF) associated with a drop in the left ventricular ejection fraction (LVEF) in the setting of high-burden right ventricular pacing, with presentation that may range from subclinical to severe. Time to manifestation can go from weeks to years after device implantation. Treatment typically consists in an upgrade to a cardiac resynchronisation therapy (CRT) or His bundle pacing (HisP). Several risk factors for PICM have been described and should be considered before pacemaker (PM) implantation, as thorough patient selection for de novo CRT or HisP, may preclude its manifestation. We present the case of an 82-year-old patient presenting with acute congestive HF and new severely reduced LVEF, 30 days following dual chamber PM implantation for high-grade atrioventricular block. Treatment with HF medication and upgrade to a CRT permitted rapid resolution of the symptoms and normalisation of the LVEF at 1-month follow-up.

Rev Med Suisse ; 17(749): 1515-1519, 2021 Sep 08.
Artigo em Francês | MEDLINE | ID: mdl-34495587


Inhaled medication is the cornerstone of medical treatment of COPD. The efficacy of these treatments depends on the optimal use of inhalation devices. This requires not only an impeccable inhalation technique, but above all the selection of an inhaler adapted to the patient. In this article, we describe the specificities of the different inhalation devices and some of the patient's characteristics to be taken into account when selecting an inhaler, in particular the presence of cognitive disorders, impaired dexterity or insufficient inspiratory force.

Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Aerossóis/uso terapêutico , Desenho de Equipamento , Humanos , Nebulizadores e Vaporizadores , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479878


A 64-year-old man with diabetes mellitus was diagnosed with a non-ST-segment elevation myocardial infarction and was treated with stent implantation. Four days later, he developed an electrical storm (ES) that persisted despite antiarrhythmic drugs and sedation. External defibrillation was performed more than 100 times over 2 hours. After ruling out the common causes of polymorphic ventricular tachycardia, an ES was considered because of brady-dependent R-on-T phenomenon, presumably precipitated by antiarrhythmic drugs. Temporary transvenous atrial overdrive pacing allowed complete suppression of premature ventricular complexes and ventricular fibrillation.

Infarto do Miocárdio , Preparações Farmacêuticas , Complexos Ventriculares Prematuros , Estimulação Cardíaca Artificial , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Fibrilação Ventricular/terapia
BMJ Case Rep ; 14(7)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34326109


Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%-50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

Doença da Artéria Coronariana , Cardiomiopatia de Takotsubo , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Volume Sistólico , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Função Ventricular Esquerda
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641310


Erythema nodosum (EN) is a common dermatological manifestation with many different aetiologies. Often however, the aetiology remains unidentified. We present here a 42-year-old male patient with an EN that is due to an acute COVID-19 infection. Most of the usual aetiologies were excluded by laboratory testing and imaging studies. This case is, to our knowledge, the first report of this cutaneous manifestation in the context of a COVID-19 infection. The EN was successfully treated with the disappearance of the COVID-19 infection and topical corticosteroids.

Analgésicos/administração & dosagem , Infecções por Coronavirus , Eritema Nodoso , Glucocorticoides/administração & dosagem , Pandemias , Pneumonia Viral , Tomografia Computadorizada por Raios X/métodos , Adulto , Betacoronavirus/isolamento & purificação , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diagnóstico Diferencial , Eritema Nodoso/diagnóstico , Eritema Nodoso/etiologia , Eritema Nodoso/terapia , Humanos , Masculino , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Radiografia Torácica/métodos , SARS-CoV-2 , Creme para a Pele/administração & dosagem , Resultado do Tratamento
BJGP Open ; 3(3)2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31581114


BACKGROUND: Seasonal influenza and influenza-like illnesses are widespread, with an impact on GP consultations. GPs apply many preventive and protective measures to prevent seasonal influenza transmission, with no clear evidence of their effectiveness in this setting. AIM: To review the effectiveness of preventive and protective measures to reduce the transmission of seasonal influenza and influenza-like illnesses in GP practices. DESIGN & SETTING: A systematic review was conducted of the literature in Medline, Embase, and the Cochrane Central Register databases published between January 1960 and April 2014, later extended to January 2018. METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used. Controlled trials and experimental studies were included. Study quality was assessed according to the Cochrane risk of bias tool. RESULTS: Out of 5727 articles screened, only two studies were finally retained: one study about the seasonal influenza vaccination of GPs to prevent transmission from patients or staff, and one about surface disinfection. The first study was a controlled trial, which showed limited evidence for seasonal influenza infection reduction among GPs through vaccination. The second, an experimental study, performed a virus screening on toys in the waiting area before and after disinfection. No study on protection measures was found that assessed the impact on influenza transmission in general practices. CONCLUSION: The evidence is scarce on interventions that reduce influenza transmission in GP practices.