Patric W Gibbons, Peter R Chai, Timothy B Erickson
We present a unique case of a massive calcium channel antagonist overdose in a patient with a permanent pacemaker. Upon presentation after the acute overdose, the patient's cardiac device was found to be pacing to an adequate rate (75 beats per minute) and she was admitted to the cardiac intensive care unit. Approximately 24 hours after her ingestion, she acutely decompensated and became hypotensive. The patient was started on infusions of norepinephrine, epinephrine, phenylephrine, and vasopressin. Her mean arterial pressure was unresponsive to multi-vasopressor therapy. She was then given a bolus of methylene blue and high-dose insulin euglycemic therapy. Despite these treatments, the patient remained hypotensive Therefore, intralipid emulsion therapy and IV epinephrine pushes were also administered. As a result of her shock and hemodynamic instability, her course was further complicated by hypoxemic respiratory failure for which she required ventilatory support and developed oliguric renal failure for which she was initiated on continuous veno-venous hemofiltration. This case emphasizes the challenges in managing complex physiology associated with nodal agent toxicity and is the first, to our knowledge, to describe management in a patient who already had a pacemaker, though it was ultimately ineffective in avoiding the patient's profound decompensation.
{"title":"Complex Management of AV Nodal Agent Toxicity in Patients with Cardiac Devices: Massive Calcium Channel Antagonist Overdose in a Patient with a Permanent Pacemaker.","authors":"Patric W Gibbons, Peter R Chai, Timothy B Erickson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present a unique case of a massive calcium channel antagonist overdose in a patient with a permanent pacemaker. Upon presentation after the acute overdose, the patient's cardiac device was found to be pacing to an adequate rate (75 beats per minute) and she was admitted to the cardiac intensive care unit. Approximately 24 hours after her ingestion, she acutely decompensated and became hypotensive. The patient was started on infusions of norepinephrine, epinephrine, phenylephrine, and vasopressin. Her mean arterial pressure was unresponsive to multi-vasopressor therapy. She was then given a bolus of methylene blue and high-dose insulin euglycemic therapy. Despite these treatments, the patient remained hypotensive Therefore, intralipid emulsion therapy and IV epinephrine pushes were also administered. As a result of her shock and hemodynamic instability, her course was further complicated by hypoxemic respiratory failure for which she required ventilatory support and developed oliguric renal failure for which she was initiated on continuous veno-venous hemofiltration. This case emphasizes the challenges in managing complex physiology associated with nodal agent toxicity and is the first, to our knowledge, to describe management in a patient who already had a pacemaker, though it was ultimately ineffective in avoiding the patient's profound decompensation.</p>","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9316685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mostafa Mahmoud Fahmy, Sangeetha Palanivelu, Qamar Al tinawi, Mostafa Reda Mostafa, Yomna Elbandrawy, Q. Radaideh, A. Smer
{"title":"Penetrating Aortic Ulcer, Intramural Hematoma, and Aortic Dissection - All in One","authors":"Mostafa Mahmoud Fahmy, Sangeetha Palanivelu, Qamar Al tinawi, Mostafa Reda Mostafa, Yomna Elbandrawy, Q. Radaideh, A. Smer","doi":"10.15761/jccr.1000179","DOIUrl":"https://doi.org/10.15761/jccr.1000179","url":null,"abstract":"","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67483453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Contained Rupture of a Left Coronary Sinus of Valsalva Aneurysm: A Case Report","authors":"Kipson Charles, Arroj Ali, Ann T. Tong","doi":"10.15761/jccr.1000178","DOIUrl":"https://doi.org/10.15761/jccr.1000178","url":null,"abstract":"","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67483450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Novo García Enrique, Castillo Sandoval Alicia, Jurado López Juan Carlos, Jiménez Martínez Maria Eulalia, Benitez Peyrat Jaime, Angulo Llanos Rocio, Seidelberger Bernhard, García Magallón Belen, Torán Martínez Claudio, Balaguer Recena Javier
{"title":"Correlation of Angiographic and Anatomic Findings with the Study of Intracoronary Pressure Wire in Patients with Intramyocardial Bridges Presenting Different Clinical Profiles","authors":"Novo García Enrique, Castillo Sandoval Alicia, Jurado López Juan Carlos, Jiménez Martínez Maria Eulalia, Benitez Peyrat Jaime, Angulo Llanos Rocio, Seidelberger Bernhard, García Magallón Belen, Torán Martínez Claudio, Balaguer Recena Javier","doi":"10.15761/jccr.1000177","DOIUrl":"https://doi.org/10.15761/jccr.1000177","url":null,"abstract":"","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67483444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fatima S. Alwan, Zachary R. Bergman, Jillian K. Wothe, Jason A. Bartos, R. Bakken, Melissa E. Brunsvold
{"title":"Successful Use of Extracorporeal Cardiopulmonary Resuscitation in a COVID-19 Patient","authors":"Fatima S. Alwan, Zachary R. Bergman, Jillian K. Wothe, Jason A. Bartos, R. Bakken, Melissa E. Brunsvold","doi":"10.15761/jccr.1000176","DOIUrl":"https://doi.org/10.15761/jccr.1000176","url":null,"abstract":"","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67483437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Demetrio Sharp Dimitri, Priya V Parikh, Sneha Sharma, Sven Wang, Ahmed Souka, Mohamed Effat
This case highlights the importance of having constrictive pericarditis (CP) as a differential diagnosis in unexplained sign and symptoms of right-sided heart failure. This case portrays challenges in diagnosing CP caused by certain rheumatologic diseases despite advances in diagnostic modalities, clinical suspicion remains the most important tool for this diagnosis.
{"title":"An Unusual Sticky Situation of New-Onset Right Sided Heart Failure.","authors":"Demetrio Sharp Dimitri, Priya V Parikh, Sneha Sharma, Sven Wang, Ahmed Souka, Mohamed Effat","doi":"10.15761/jccr.1000168","DOIUrl":"https://doi.org/10.15761/jccr.1000168","url":null,"abstract":"<p><p>This case highlights the importance of having constrictive pericarditis (CP) as a differential diagnosis in unexplained sign and symptoms of right-sided heart failure. This case portrays challenges in diagnosing CP caused by certain rheumatologic diseases despite advances in diagnostic modalities, clinical suspicion remains the most important tool for this diagnosis.</p>","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"4 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Yadav, R. Gajurel, C. Poudel, Manju Sharma, S. Adhikari
Left ventricular pseudoaneurysm is a rare mechanical complication of acute myocardial infarction. The study aims at early detection of a rare complication of myocardial infarction which carries a grave prognosis and whose mainstay of management is surgical. We describe a 60 year old male who presented with typical ischemic type of chest pain with low blood pressure and heart rate. A 12 lead electrocardiogram showed atrioventricular (AV) dissocation with ST segment elevation in the inferior leads. The initial echocardiography depicted moderate pericardial effusion without tamponade. The possibilities of both, acute mechanical complications of myocardial infarction, and acute aortic dissection were sought of. The echocardiography on the following day revealed a free wall rupture of the infero-posterior wall of left ventricle with formation of a pseudoaneurysm. This was further proved by the computed tomography (CT) of chest with contrast, which in addition, ruled out acute aortic dissection. The patient was planned for an early surgery. Pre-operative coronary angiogram revealed complete occlusion of distal left circumflex artery and 70-80% discrete stenosis of mid left anterior descending artery.
{"title":"Left ventricular pseudoaneurysm complicating acute inferoposterior myocardial infarction","authors":"V. Yadav, R. Gajurel, C. Poudel, Manju Sharma, S. Adhikari","doi":"10.15761/JCCR.1000155","DOIUrl":"https://doi.org/10.15761/JCCR.1000155","url":null,"abstract":"Left ventricular pseudoaneurysm is a rare mechanical complication of acute myocardial infarction. The study aims at early detection of a rare complication of myocardial infarction which carries a grave prognosis and whose mainstay of management is surgical. We describe a 60 year old male who presented with typical ischemic type of chest pain with low blood pressure and heart rate. A 12 lead electrocardiogram showed atrioventricular (AV) dissocation with ST segment elevation in the inferior leads. The initial echocardiography depicted moderate pericardial effusion without tamponade. The possibilities of both, acute mechanical complications of myocardial infarction, and acute aortic dissection were sought of. The echocardiography on the following day revealed a free wall rupture of the infero-posterior wall of left ventricle with formation of a pseudoaneurysm. This was further proved by the computed tomography (CT) of chest with contrast, which in addition, ruled out acute aortic dissection. The patient was planned for an early surgery. Pre-operative coronary angiogram revealed complete occlusion of distal left circumflex artery and 70-80% discrete stenosis of mid left anterior descending artery.","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48082272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Las urgencias dermatológicas son eventos poco frecuentes que puedenser causados por alteraciones agudas de la salud, con o sin afectaciónsistémica, o por enfermedades crónicas cuando se presentan cuadros de agudización.
{"title":"Pitiriasis rosada, una reacción exantemática","authors":"Michel Faizal-Geagea","doi":"10.15446/cr.v7n2.95527","DOIUrl":"https://doi.org/10.15446/cr.v7n2.95527","url":null,"abstract":"Las urgencias dermatológicas son eventos poco frecuentes que puedenser causados por alteraciones agudas de la salud, con o sin afectaciónsistémica, o por enfermedades crónicas cuando se presentan cuadros de agudización.","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79486811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Gutiérrez-Zúñiga, H. Martín, Oscar Messa-Botero, Jerónimo Sotomayor, F. Linares
Introducción. El condrosarcoma de células claras es un subtipo de tumor poco frecuente del grupo de los condrosarcomas de bajo grado. A diferencia de los condrosarcomas convencionales, estos tumores se presentan principalmente en epífisis de huesos largos. Dadas sus características líticas de aspecto quístico, pueden confundirse con quistes óseos, por lo que su diagnóstico debe hacerse por histopatología e inmunohistoquímica mediante biopsia. Igualmente, la negatividad para citoqueratinas y anticuerpos antiendomisio es una herramienta para descartar el diagnóstico diferencial de metástasis. Su tratamiento es quirúrgico, bien sea con manejo intralesional o resección completa con márgenes libres. Presentación del caso. Mujer de 46 años quien consultó al servicio de ortopedia oncológica de una institución de IV nivel de atención por un cuadro clínico de 8 meses de evolución consistente en dolor en la cara medial de la rodilla izquierda a nivel de la tibia proximaluna. Se practicaron imágenes diagnósticas que mostraron una lesión quística en el platillo tibial lateral; se ordenó biopsia de la lesión, y mediante histopatología e inmunohistoquímica se diagnosticó condrosarcoma de células claras. Se realizó un manejo quirúrgico con resección de la lesión con márgenes libres y una reconstrucción del defecto óseo con un aloinjerto estructural de tibia proximal, con lo cual se obtuvo una evolución satisfactoria. Conclusiones. Se presenta el caso de una paciente con un subtipo de condrosarcoma de bajo grado infrecuente en su presentación y localización, quien fue diagnosticada mediante inmunohistoquímica y tratada quirúrgicamente para lograr un salvamento exitoso de su extremidad.
{"title":"Condrosarcoma de células claras en tibia proximal. Reporte de caso","authors":"D. Gutiérrez-Zúñiga, H. Martín, Oscar Messa-Botero, Jerónimo Sotomayor, F. Linares","doi":"10.15446/cr.v7n2.89300","DOIUrl":"https://doi.org/10.15446/cr.v7n2.89300","url":null,"abstract":"Introducción. El condrosarcoma de células claras es un subtipo de tumor poco frecuente del grupo de los condrosarcomas de bajo grado. A diferencia de los condrosarcomas convencionales, estos tumores se presentan principalmente en epífisis de huesos largos. Dadas sus características líticas de aspecto quístico, pueden confundirse con quistes óseos, por lo que su diagnóstico debe hacerse por histopatología e inmunohistoquímica mediante biopsia. Igualmente, la negatividad para citoqueratinas y anticuerpos antiendomisio es una herramienta para descartar el diagnóstico diferencial de metástasis. Su tratamiento es quirúrgico, bien sea con manejo intralesional o resección completa con márgenes libres.\u0000Presentación del caso. Mujer de 46 años quien consultó al servicio de ortopedia oncológica de una institución de IV nivel de atención por un cuadro clínico de 8 meses de evolución consistente en dolor en la cara medial de la rodilla izquierda a nivel de la tibia proximaluna. Se practicaron imágenes diagnósticas que mostraron una lesión quística en el platillo tibial lateral; se ordenó biopsia de la lesión, y mediante histopatología e inmunohistoquímica se diagnosticó condrosarcoma de células claras. Se realizó un manejo quirúrgico con resección de la lesión con márgenes libres y una reconstrucción del defecto óseo con un aloinjerto estructural de tibia proximal, con lo cual se obtuvo una evolución satisfactoria.\u0000Conclusiones. Se presenta el caso de una paciente con un subtipo de condrosarcoma de bajo grado infrecuente en su presentación y localización, quien fue diagnosticada mediante inmunohistoquímica y tratada quirúrgicamente para lograr un salvamento exitoso de su extremidad.","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80587921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. García-Prada, Tomás Rodríguez-Yánez, Carlos Alberto Ferrer-Santos
Introduction: Rosai-Dorfman disease (RDD), also known as sinus histiocytosis, is a rare disorder characterized by histiocyte proliferation. Case presentation: A 33-year-old man consulted the emergency department of a tertiary care institution in Cartagena de Indias, Colombia, due to a 6-month history of progressive deformity in the frontal right side of the face, associated with pain of slow progression, without any other symptoms or dermatological involvement. There were no other major findings on physical examination and laboratory tests performed were negative. Imaging scans obtained showed extensive inflammatory involvement of the frontal bone, which led to suspect osteomyelitis as the first diagnostic possibility. A biopsy of the lesion was performed with negative cultures for bacteria, which allowed establishing a diagnosis of extranodal Rosai-Dorfman disease with isolated bone involvement. Treatment with systemic corticosteroids was indicated with poor response, so methotrexate was added, achieving an evident improvement after 2 months. Conclusions: Little is known about the manifestations of Rosai-Dorfman disease and its treatment in the adult population. The present case report contributes to expanding the literature on this topic, which can present with rare symptoms that may pose challenges for its diagnosis.
Rosai-Dorfman病(RDD)，又称窦性组织细胞增多症，是一种罕见的以组织细胞增生为特征的疾病。病例介绍:一名33岁男子就诊于哥伦比亚Cartagena de Indias一家三级保健机构的急诊科，因6个月的面部右侧额部进行性畸形史，伴有缓慢进展的疼痛，无任何其他症状或皮肤病变。身体检查没有其他重大发现，实验室检查也呈阴性。成像扫描显示额骨广泛的炎症累及，这导致怀疑骨髓炎作为第一诊断可能性。对病变进行活检，细菌培养阴性，从而确定结外Rosai-Dorfman病伴孤立骨累及的诊断。全身性糖皮质激素治疗效果不佳，因此加用甲氨蝶呤，2个月后明显改善。结论:成人Rosai-Dorfman病的临床表现及治疗方法尚不清楚。本病例报告有助于扩大关于该主题的文献，该主题可以呈现罕见的症状，可能对其诊断构成挑战。
{"title":"Rosai-Dorfman disease: a rare presentation of extranodal involvement of isolated bone. Case report","authors":"C. García-Prada, Tomás Rodríguez-Yánez, Carlos Alberto Ferrer-Santos","doi":"10.15446/cr.v7n2.88306","DOIUrl":"https://doi.org/10.15446/cr.v7n2.88306","url":null,"abstract":"Introduction: Rosai-Dorfman disease (RDD), also known as sinus histiocytosis, is a rare disorder characterized by histiocyte proliferation. Case presentation: A 33-year-old man consulted the emergency department of a tertiary care institution in Cartagena de Indias, Colombia, due to a 6-month history of progressive deformity in the frontal right side of the face, associated with pain of slow progression, without any other symptoms or dermatological involvement. There were no other major findings on physical examination and laboratory tests performed were negative. Imaging scans obtained showed extensive inflammatory involvement of the frontal bone, which led to suspect osteomyelitis as the first diagnostic possibility. A biopsy of the lesion was performed with negative cultures for bacteria, which allowed establishing a diagnosis of extranodal Rosai-Dorfman disease with isolated bone involvement. Treatment with systemic corticosteroids was indicated with poor response, so methotrexate was added, achieving an evident improvement after 2 months. Conclusions: Little is known about the manifestations of Rosai-Dorfman disease and its treatment in the adult population. The present case report contributes to expanding the literature on this topic, which can present with rare symptoms that may pose challenges for its diagnosis.","PeriodicalId":73637,"journal":{"name":"Journal of cardiology case reports","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80802882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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