RESUMO
A 35-year-old male presented with weakness in all four extremities rendering him unable to ambulate. The patient stated the symptoms began after consuming an unknown, large amount of Oreo cookies; thus, a high carbohydrate load likely caused him to exceed the recommended dietary allowance (RDA) of 225-325 grams of carbohydrates per day, depending on one's daily caloric intake. Lab workup revealed a potassium level of 2.1 mmol/L. Upon potassium replacement, the patient's symptoms improved to baseline, and he was discharged home with follow-up instructions that included a referral for genetic testing. Hypokalemic periodic paralysis (HPP) is a rare condition that, despite having a relatively simple solution for treatment, can lead to an extensive and expensive workup if not considered early on the list of differential diagnoses. Herein, we will discuss the pathophysiology, clinical signs/symptoms, and management of HPP.
RESUMO
Cardiovascular complications such as arrhythmias, hypoxemic cardiomyopathy, pericarditis, myocardial infarction, heart failure, and myocarditis are rare but seen in COVID-19 patients. These cardiac injuries could be the result of direct SARS-CoV-2 effects. The most prominent mediator of this hypothesis is angiotensin-converting enzyme-2 (ACE2) receptors, which are highly expressed in heart and lung tissues. These ACE2 receptors are found to be the functional receptors for the Coronavirus. Another hypothesis for cardiac complications in COVID-19 patients is macrophage-induced inflammation. The SARS-CoV-2 infection leads to invasion of epithelial cells by binding with ACE-2 receptors, localized inflammation, endothelial and macrophage activation, tissue damage, and dysregulated cytokine release. Current data have shown that mRNA COVID-19 vaccines are efficacious and safe for indicated patients. However, these vaccines can cause mild adverse reactions similar to those of traditional vaccines, and more severe side effects can also be seen infrequently. The exact pathogenesis of COVID-19 vaccine-induced pericarditis remains unknown, but there are several hypotheses regarding the pathophysiology of pericarditis after COVID-19 vaccine administrations. There has been speculation that mRNA vaccines can produce a large number of antibodies in a small subgroup of people, especially young individuals, and this elicits an inflammatory response similar to the multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Another proposed mechanism is the cross-reaction between produced antibodies and the pericardium, leading to myocardial and pericardial inflammation induction. This report describes a 69-year-old female who presented with three days of chest pain that started one day after a booster shot of the Moderna COVID-19 vaccine. The patient was diagnosed with pericarditis, and she was effectively treated with colchicine and later steroids.
RESUMO
Coronary artery plaque rupture, erosion, thrombosis, and dissection account for nearly all acute myocardial infarction (AMI). However, coronary artery embolism remains a significant cause of AMI that is essentially unaccounted for. In this report, we present two cases of acute coronary syndrome caused by coronary embolism. Both cases illustrate that patients with atrial fibrillation are at an increased risk of thromboembolic events of the coronary circulation. We highlight the clinical characteristics of atrial fibrillation associated with coronary embolism and present the therapeutic interventions based on our experience and a review of the literature. Given that AMI is a significant cause of morbidity and mortality among adults worldwide, it is imperative that practicing clinicians be aware of coronary embolism as a cause of AMI, particularly in high-risk populations such as those with atrial fibrillation.