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("Glyceryl Trinitrate" OR "GTN" OR "Nitroglycerin") AND "Emergency"

Daisuke Takeyoshi, Shinsuke Kikuchi, Keisuke Miyake, Takamitsu Tatsukawa, Daita Kobayashi, Daiki Uchida, Yuya Kitani, Hiroyuki Kamiya, Nobuyoshi Azuma
A 79-year-old man with a heavy smoking history presented with threatened lower limbs due to acute exacerbation of peripheral artery disease (PAD). He underwent emergent distal bypass surgery for the right leg and external iliac stenting for the left leg. Fatal coronary artery spasm (CAS) with ST segment changes on electrocardiography was observed 28 h after the procedures, resulting in cardiac arrest. Coronary angiography showed widespread CAS with improvement after intra-arterial nitroglycerin infusion. We should keep in mind that CAS may occur more frequently than expected in PAD patients, especially those who have not stopped smoking prior to revascularization...
September 25, 2018: Annals of Vascular Diseases
Asuka Ueno, Atsuhiko Kawabe, Takushi Sugiyama, Mayuko Ishikawa, Atsuko Uema, Masahiro Shimoyama, Yasuto Horie, Toshiyasu Hoshi, Hiroyuki Sugimura, Takanori Yasu
Coronary spastic angina (CSA) is relatively more common in young people than in elderly people. Here, we present three cases of elderly male patients who experienced out-of-hospital cardiac arrest (OHCA) likely due to coronary spasm-induced ventricular fibrillation (Vf) from 2013 to 2016. After defibrillation, emergency coronary arteriography demonstrated severe coronary vasospasm that resolved following intracoronary infusion of nitroglycerin in the right coronary arteries in all three patients, with no organic obstructive lesion in the coronary arteries after nitroglycerin infusion...
November 2017: Journal of Cardiology Cases
Brit Long, Alex Koyfman, Michael Gottlieb
BACKGROUND: Acute heart failure (AHF) is a common presentation to the emergency department (ED), with the potential to cause significant morbidity and mortality. It is important to tailor treatments to the appropriate type of heart failure. OBJECTIVES: This review provides an evidence-based summary of the current ED management of acute heart failure. DISCUSSION: Heart failure can present along a spectrum, especially in acute exacerbation. Treatment should focus on the underlying disease process, with guidelines focusing primarily on blood pressure and hemodynamic status...
November 2018: Journal of Emergency Medicine
Andrew J Shepherd, Megan E Cloud, Yu-Qing Cao, Durga P Mohapatra
Burrowing, or the removal of material from an enclosed tube, is emerging as a prominent means of testing changes in a voluntary behavior in rodent models of various pain states. Here, we report no significant differences between male and female mice in terms of burrowing performance, in a substantially shorter time frame than previous reports. We found that the color of the burrow tube affects the variability of burrowing performance when tested in a lit room, suggesting that light aversion is at least a partial driver of this behavior...
2018: Frontiers in Behavioral Neuroscience
Hisham A Abbas, Ahmed M Elsherbini
Background: Quorum sensing is a cell-to-cell communication system in bacteria that controls the production of virulence factors. Serratia marcescens is a causative agent of hospital-acquired infections that shows high resistance to antibiotics. This makes the treatment of these infections difficult. Quorum sensing regulates the production of virulence factors of S. marcescens such as prodigiosin, protease, swimming and swarming motilities and formation of biofilms. Inhibition of quorum sensing may be an alternative to antibiotic treatment to avoid emergence of resistance...
March 2018: African Health Sciences
Sebastian J Leathersich, Joshua P Vogel, Thach Son Tran, G Justus Hofmeyr
BACKGROUND: Uterine tachysystole (more than 5 contractions per 10 minutes in 2 consecutive intervals) is common during labour, particularly with use of labour-stimulating agents. Tachysystole may reduce fetal oxygenation by interrupting maternal blood flow to the placenta during contractions. Reducing uterine contractions may improve placental blood flow, improving fetal oxygenation. This review aimed to evaluate the use of tocolytics to reduce or stop uterine contractions for improvement of the condition of the fetus in utero...
July 4, 2018: Cochrane Database of Systematic Reviews
Yi-Ting Hsieh, Tai-Ying Lee, Jui-Shih Kao, Hsin-Lin Hsu, Chee-Fah Chong
Acute pulmonary edema due to sympathetic surge and increased peripheral vascular resistance often present to the emergency department (ED) with markedly elevated blood pressure, severe dyspnea, and desaturation. This condition is known as "SCAPE" (sympathetic crashing acute pulmonary edema). We present three SCAPE patients who were successfully treated with high-dose nitroglycerin (NTG) and bilevel positive airway pressure (BiPAP) ventilation. All three patients presented with respiratory failure on arrival but rapidly improved after treatment and did not require endotracheal intubation or admission to the intensive care unit (ICU)...
March 2018: Turkish Journal of Emergency Medicine
Brit Long, Alex Koyfman, Eric J Chin
INTRODUCTION: Acute heart failure (AHF) accounts for a significant number of emergency department (ED) visits, and the disease may present along a spectrum with a variety of syndromes. OBJECTIVE: This review evaluates several misconceptions concerning heart failure evaluation and management in the ED, followed by several pearls. DISCUSSION: AHF is a heterogeneous syndrome with a variety of presentations. Physicians often rely on natriuretic peptides, but the evidence behind their use is controversial, and these should not be used in isolation...
September 2018: American Journal of Emergency Medicine
Sana Chams, Skye El Sayegh, Mulham Hamdon, Sarwan Kumar, Zain Kulairi
BACKGROUND: Takotsubo cardiomyopathy or stress cardiomyopathy is characterized by transient left ventricular apical ballooning in the absence of coronary occlusion. The underlying pathophysiological mechanism is still unclear but possible causes have been proposed mainly catecholamine cardiotoxicity, followed by metabolic disturbance, coronary microvascular impairment, and multivessel epicardial coronary artery vasospasm. Takotsubo cardiomyopathy accounts for 1-2% of patients presenting with acute coronary syndrome with the majority of patients diagnosed with Takotsubo cardiomyopathy being women > 55 years of age...
June 10, 2018: Journal of Medical Case Reports
Nadarajah Prasanna, Harsha A Dissanayake, Godwin R Constantine
OBJECTIVE: Hypertensive emergencies are potentially life threatening and require prompt blood pressure control with intravenous agents. Preparation of intravenous infusions is time consuming. Usefulness of sublingual nitroglycerin in this setting is not known. We aimed to assess the benefit of sublingual nitroglycerin as a bridge to IV therapy. In a clinical audit in an emergency department, patients presenting with hypertensive emergencies requiring intravenous nitroglycerin were administered single spray of sublingual nitroglycerin awaiting commencement of intravenous infusion...
June 5, 2018: BMC Research Notes
Alfredo Iardino, Orlando Garner, Gabriella Lorusso, Franco Lotta
Ergotism is an ischaemic complication due to vasoconstriction throughout the body due to ingestion of ergotamine. A 34-year-old Hispanic man with HIV infection treated with saquinavir, ritonavir and abacavir/lamivudine presented to the emergency department complaining of left foot pain 1 week prior to admission. The affected extremity was cold with absence of pedal and tibial pulses. Arterial Doppler revealed absent arterial flow from the popliteal artery later confirmed by arteriography. Medication reconciliation revealed a recent prescription for migraine headache containing ergotamine...
June 4, 2018: BMJ Case Reports
Zhen Ren, Li Yu, Mengnv Xie, Yiyi Liang, Fang Zhu, Rui Huang, Zhibang Zhang, Chun Fu
RATIONALE: Brain metastasis of choriocarcinoma is a highly malignant gestational trophoblastic neoplasia (GTN) and has a notoriously poor prognosis. Hemorrhagic choriocarcinoma lesions may lead to life-threatening conditions also. Treatment of brain metastases of choriocarcinoma with hemorrhage in multiple sites is very difficult in clinical practices. A patient has been successfully treated in our hospital, which provides as clinical references for this difficulty in treating brain metastases of choriocarcinoma with hemorrhage in multiple sites...
May 2018: Medicine (Baltimore)
Hugo Silva, Andreia Fernandes, João Rodrigues, Daniel Brandão, Manuela Vieira, Catarina Celestino
INTRODUCTION: Endovascular aortic interventions are suitable alternatives to open surgery, being less invasive and having lower mortality and complications. Accurate positioning of the stent graft is a critical point because of systolic thrush. Techniques used to prevent it include pharmacological (antihypertensive drugs, nitroglycerin, adenosine) and mechanical methods (temporary caval occlusion by balloon). Rapid Right Ventricular Pacing (RRVP) is an emerging alternative with good patient tolerance and low level of complications...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Roberto Sansone, Maximilian Baaken, Patrick Horn, Dominik Schuler, Ralf Westenfeld, Nicolas Amabile, Malte Kelm, Christian Heiss
BACKGROUND AND AIMS: Circulating endothelial microparticles (EMPs) are increased in arterial hypertension. The role of physicomechanical factors that may induce EMP release in vivo is still unknown. We studied the relationship of EMPs and physicomechanical factors in stable arterial hypertension and hypertensive emergencies, and investigated the pattern of EMP release after mechanical endothelial injury. METHODS: In a pilot study, 41 subjects (50% hypertensives) were recruited...
June 2018: Atherosclerosis
Elizabeth Curtis, Ritin Fernandez, Astin Lee
OBJECTIVE: The objective of this review was to identify the effectiveness of topical medications on radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary procedures. INTRODUCTION: Percutaneous coronary procedures were traditionally carried out via the femoral artery; however, over the last 20 years there has been a global increase in the number of proceduralists carrying out percutaneous coronary procedures via the transradial approach...
March 2018: JBI Database of Systematic Reviews and Implementation Reports
Benjamin A Willenbring, Callie K Schnitker, Samuel J Stellpflug
BACKGROUND: Esophageal food impaction is a common illness presenting to emergency departments (ED), and is frequently resistant to pharmacologic therapy. Several medications have been promoted for this indication, but so far have not proven effective. Endoscopic removal is frequently required to resolve the impaction, resulting in risks from anesthesia and the physical procedure, and in prolonged hospital stay for recovery. Oral nitroglycerin solution was recently used in two such cases and may represent a new therapeutic option...
May 2018: Journal of Emergency Medicine
Òscar Miró, Melissa Hazlitt, Xavier Escalada, Pere Llorens, Víctor Gil, Francisco Javier Martín-Sánchez, Pia Harjola, Verónica Rico, Pablo Herrero-Puente, Javier Jacob, David C Cone, Martin Möckel, Michael Christ, Yonathan Freund, Salvatore di Somma, Said Laribi, Alexandre Mebazaa, Veli-Pekka Harjola
OBJECTIVE: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). METHODS: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF...
April 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Håkan Ashina, Lawrence Newman, Sait Ashina
Calcitonin gene-related peptide (CGRP) is a key signaling molecule involved in migraine pathophysiology. Efficacy of CGRP monoclonal antibodies and antagonists in migraine treatment has fueled an increasing interest in the prospect of treating cluster headache (CH) with CGRP antagonism. The exact role of CGRP and its mechanism of action in CH have not been fully clarified. A search for original studies and randomized controlled trials (RCTs) published in English was performed in PubMed and in ClinicalTrials...
December 2017: Neurological Sciences
Brandi M Wynne, Hicham Labazi, Zidonia N Carneiro, Rita C Tostes, R Clinton Webb
Nitroglycerin (Gtn) is a treatment for cardiovascular patients due to its vasodilatory actions, but induces tolerance when given chronically. A proposed mechanism is the superoxide (O2 - )-oxidative stress hypothesis, which suggests that Gtn increases O2 - production. Nitric oxide (NO) exists in three different redox states; the protonated, reduced state, nitroxyl anion (HNO) is an emerging candidate in vascular regulation. HNO is resistant to scavenging and of particular interest in conditions where high levels of reactive oxygen species (ROS) exist...
November 5, 2017: European Journal of Pharmacology
Francesco Formica, Oluwaseun Adebayo Bamodu, Serena Mariani, Giovanni Paolini
Coronary artery spasm (CAS) refers to the spontaneous or stimuli-induced transient, often localized and intense subtotal or total constriction/occlusion of the epicardial coronary artery, usually concomitant with angina pectoris with associated elevation of the ST segment on electrocardiogram (ECG). In this article, we present a literature review on post-valvular surgery CAS and report the clinical case of a 77 year-old man who experienced severe early post-aortic surgery chest pain and hemodynamic instability...
March 2016: IJC Heart & Vasculature
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