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https://www.readbyqxmd.com/read/28615774/hypokalemia-with-trifluoperazine-at-therapeutic-dose
#1
Sajjadur Rehman, Dhruba Jyoti Chetia
This case report outlines a rare presentation of hypokalemia with therapeutic doses of trifluoperazine in a patient with schizophrenia. Although there was comorbid diabetes mellitus in the patient, its effect was ruled out subsequently. On recovery, rechallenge with trifluoperazine resulted in the same effect at a milder level. No cardiac abnormalities were detected with the presentation. Naranjo adverse drug reaction probability scale reported definite relation with the drug.
May 2017: Indian Journal of Psychological Medicine
https://www.readbyqxmd.com/read/28611935/gastrointestinal-amyloidosis-review-of-the-literature
#2
REVIEW
Kyle Rowe, Jon Pankow, Fredy Nehme, William Salyers
Gastrointestinal amyloidosis (GIA), a protein deposition disorder, represents a complex common pathway that encompasses multiple etiologies and presentations. It represents a significant diagnostic and treatment challenge. The disease results from the deposition of insoluble extracellular protein fragments that have been rendered resistant to digestion. GIA can be acquired or genetic, and most commonly results from chronic inflammatory disorders (AA amyloidosis), hematologic malignancy (AL amyloidosis), and end-stage renal disease (Beta-2 amyloidosis)...
May 8, 2017: Curēus
https://www.readbyqxmd.com/read/28611898/utility-of-the-history-and-physical-examination-in-the-detection-of-acute-coronary-syndromes-in-emergency-department-patients
#3
REVIEW
Zachary Dw Dezman, Amal Mattu, Richard Body
Chest pain accounts for approximately 6% of all emergency department (ED) visits and is the most common reason for emergency hospital admission. One of the most serious diagnoses emergency physicians must consider is acute coronary syndrome (ACS). This is both common and serious, as ischemic heart disease remains the single biggest cause of death in the western world. The history and physical examination are cornerstones of our diagnostic approach in this patient group. Their importance is emphasized in guidelines, but there is little evidence to support their supposed association...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28610438/pneumorachis-associated-with-persistent-tachycardia-after-blunt-thoracic-trauma
#4
Paris-Dimitrios Kalogerakos, George Lazopoulos, Stefanos Palioudakis, Ioannis Drositis, Kiriaki Chionidou, George Chalkiadakis
Pneumorachis, or intraspinal air, can be a rare result of blunt thoracic trauma. We report the case of a 40-year-old man with multiple injuries and pneumorachis associated with persistent tachycardia. As factors that increase heart rate were gradually ruled out, intraspinal air was considered the potential culprit. Computed tomography revealed intraspinal air at the thoracic level, which possibly promoted cardiac arrhythmogenesis. Air may transiently compress the preganglionic cardiac sympathetic nerves and increase sympathetic output to the heart...
January 1, 2017: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/28603595/cough-induced-syncope-a-hint-to-cardiac-tamponade-diagnosis
#5
Roberto Ramirez, Glenmore Lasam
We report a case of a 75-year-old male with history of lung adenocarcinoma who presented with shortness of breath and frequent episodes of cough-induced syncope. A large pericardial effusion was found on echocardiogram suggestive of cardiac tamponade. Pericardiocentesis was done which improved the dyspnea and eventually resolved the syncope. There are only two other cases reported in the literature with cough-induced syncope in the setting of pericardial effusion or cardiac tamponade. Our clinical vignette also highlights the importance of pulsus paradoxus identification in patients with cough induced syncope to rule out cardiac tamponade since this is the most sensitive physical finding for its diagnosis...
May 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28603565/current-concepts-congenital-scoliosis
#6
Agnivesh Tikoo, Manish K Kothari, Kunal Shah, Abhay Nene
BACKGROUND: Congenital scoliosis is one of the 'difficult to treat' scenarios which a spine surgeon has to face. Multiple factors including the age of child at presentation, no definite pattern of deformity and associated anomalies hinder the execution of the ideal treatment plan. All patients of congenital scoliosis need to be investigated in detail. X rays and MRI of spine is usually ordered first. Screening investigations to rule out VACTERL (Visceral, Anorectal, Cardiac, Tracheo-esophageal fistula, Renal and Lung) abnormalities are required...
2017: Open Orthopaedics Journal
https://www.readbyqxmd.com/read/28601817/the-organisational-value-of-diagnostic-strategies-using-high-sensitivity-troponin-for-patients-with-possible-acute-coronary-syndromes-a-trial-based-cost-effectiveness-analysis
#7
Paul Jülicher, Jaimi H Greenslade, William A Parsonage, Louise Cullen
OBJECTIVES: To evaluate hospital-specific health economic implications of different protocols using high-sensitivity troponin I for the assessment of patients with chest pain. DESIGN: A cost prediction model and an economic microsimulation were developed using a cohort from a single centre recruited as part of the (ADAPT) trial, a prospective observational trial conducted from 2008 to 2011. The model was populated with 40 000 bootstrapped samples in five high-sensitivity troponin I-enabled algorithms versus standard care...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28596204/malignant-hypertension-as-a-rare-cause-of-thrombotic-microangiopathy
#8
Guramrinder Thind, Karthik Kailasam
Malignant hypertension can occasionally be associated with microangiopathic haemolytic anaemia. A 38-year-old male presented with nausea, vomiting, loss of appetite and oliguria for 2 weeks. He was diagnosed with hypertensive emergency with cardiac and renal dysfunction. Interestingly, further workup was diagnostic for the presence of thrombotic microangiopathy (TMA): haemoglobin =12.7 g/dL, indirect bilirubin =2.0 mg/dL, haptoglobin ≤6 mg/dL, platelet count =121 000/μL and schistocytes on peripheral smear...
June 8, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28593800/use-of-copeptin-for-rapid-rule-out-of-acute-myocardial-infarction
#9
Christian Mueller, Martin Möckel, Evangelos Giannitsis, Kurt Huber, Johannes Mair, Mario Plebani, Kristian Thygesen, Allan S Jaffe, Bertil Lindahl
Copeptin is currently understood as a quantitative marker of endogenous stress. It rises rapidly in multiple acute disorders including acute myocardial infarction. As a single variable, it has only modest diagnostic accuracy for acute myocardial infarction. However, the use of copeptin within a dual-marker strategy together with conventional cardiac troponin increases the diagnostic accuracy and particularly the negative predictive value of cardiac troponin alone for acute myocardial infarction. The rapid rule-out of acute myocardial infarction is the only application in acute cardiac care mature enough to merit consideration for routine clinical care...
June 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28572743/design-and-rationale-of-the-high-sensitivity-troponin-t-rules-out-acute-cardiac-insufficiency-trial
#10
Benton R Hunter, Sean P Collins, Gregory J Fermann, Phillip D Levy, Changyu Shen, Syed Imran Ayaz, Mette L Cole, Karen F Miller, Adam A Soliman, Peter S Pang
BACKGROUND: Acute heart failure (AHF) is a common presentation in the Emergency Department (ED), and most patients are admitted to the hospital. Identification of patients with AHF who have a low risk of adverse events and are suitable for discharge from the ED is difficult, and an objective tool would be useful. METHODS: The highly sensitive Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) will enroll ED patients being treated for AHF. Patients will undergo standard ED evaluation and treatment...
2017: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/28571224/waldmann-s-disease-primary-intestinal-lymphangiectasia-with-atrial-septal-defect
#11
Shrikiran Aroor, Suneel Mundkur, Shravan Kanaparthi, Sandeep Kumar
Waldmann's disease or Primary Intestinal Lymphangiectasia (PIL) is a rare disorder of gastrointestinal tract characterized by dilated lymphatics and widened villi causing leakage of lymph into intestinal lumen. Loss of lymph leads to hypoalbuminemia, hyogammaglobulinemia and lymphopenia. Secondary lymphangiectasia occurs secondary to an elevated lymphatic pressure as in lymphoma, systemic lupus erythematosus, constrictive pericarditis, cardiac surgeries (Fontan's procedure), inflammatory bowel disease and malignancies...
April 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28567710/the-preoperative-cardiology-consultation-indications-and-risk-modification
#12
M W Groot, A Spronk, S E Hoeks, R J Stolker, F van Lier
BACKGROUND: The cardiologist is regularly consulted preoperatively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear. METHODS: This is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for elective non-cardiac surgery, which resulted in 273 (1%) referrals to the cardiologist for further preoperative evaluation. Medical charts were reviewed for patient characteristics, main reason for referring, requested diagnostic tests, interventions, adjustment in medical therapy, 30-day mortality and major adverse cardiac events...
May 31, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28544100/undetectable-concentrations-of-an-fda-approved-high-sensitivity-cardiac-troponin-t-assay-to-rule-out-acute-myocardial-infarction-at-emergency-department-arrival
#13
Andrew D McRae, Grant Innes, Michelle Graham, Eddy Lang, James E Andruchow, Yunqi Ji, Shabnam Vatanpour, Tasnima Abedin, Hong Yang, Danielle A Southern, Dongmei Wang, Isolde Seiden-Long, Lawrence DeKoning, Peter Kavsak
BACKGROUND: The objective of this study was to quantify the sensitivity of very low concentrations of high-sensitivity cardiac troponin T (hsTnT) at ED arrival for acute myocardial infarction (AMI) in a large cohort of chest pain patients evaluated in real-world clinical practice. METHODS: This retrospective study included consecutive ED patients with suspected cardiac chest pain evaluated in four urban EDs were, excluding those with ST-elevation AMI, cardiac arrest or abnormal kidney function...
May 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28540216/impact-of-plaque-characteristics-on-the-degree-of-functional-stenosis
#14
REVIEW
Pedro de Araújo Gonçalves, Alexandre Hideo-Kajita, Hector Manuel Garcia-Garcia
Coronary CT angiography (CCTA) is mainly regarded as a gatekeeper for invasive coronary angiography, in face of its widely recognized value to noninvasively rule out significant coronary stenosis. Nevertheless, it is also increasingly recognized that this noninvasive modality can depict several atherosclerotic plaque features and quantify total coronary plaque burden. This opens a new field for cardiac CT, since these atherosclerotic features beyond stenosis severity have been correlated with the degree of functional significance, and are the focus of the present manuscript...
April 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28537984/postoperative-high-sensitivity-troponin-and-its-association-with-30-day-and-12-month-all-cause-mortality-in-patients-undergoing-on-pump-cardiac-surgery
#15
Eckhard Mauermann, Daniel Bolliger, Jens Fassl, Martin Grapow, Esther E Seeberger, Manfred D Seeberger, Miodrag Filipovic, Giovanna A L Lurati Buse
BACKGROUND: Troponin T is a predictor of cardiac morbidity and mortality after cardiac surgery with most data examining fourth generational troponin T assays. We hypothesize that postoperative high-sensitivity troponin T (hsTnT) measured in increments of the upper limit of the norm independently predicts 30-day all-cause mortality. METHODS: We included consecutive patients undergoing on-pump cardiac surgery from February 2010 to March 2012 in a prospective cohort that measured hsTnT at 0600 of the first and second postoperative day...
May 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28534694/the-heart-score-for-early-rule-out-of-acute-coronary-syndromes-in-the-emergency-department-a-systematic-review-and-meta-analysis
#16
Patricia Van Den Berg, Richard Body
AIMS: The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. METHODS AND RESULTS: Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome...
May 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#17
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
May 17, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28513401/brain-natriuretic-peptide-what-the-nurse-needs-to-know
#18
Christopher Nicholson
Rationale and key points Brain natriuretic peptide is a chemical secreted when the heart is under strain. It is sampled by a blood test. This article informs nurses about how brain natriuretic peptide can be used as a diagnostic and prognostic marker for patients with cardiac conditions. » A brain natriuretic peptide level within the normal range in a patient who is not receiving treatment, almost certainly rules out a significant cardiac condition. » An elevated brain natriuretic peptide level suggests an active cardiac condition and further investigations are indicated, usually an electrocardiogram and echocardiogram...
May 17, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28511924/evaluation-of-the-effectiveness-of-a-phone-based-care-coordination-pilot-on-hospital-utilisation-and-costs-for-patients-with-chest-pain
#19
Peita Price, Ruth Vincent, Mark Tacey, Jane Gilchrist, Danny Liew, Leeanne Grigg, Lucio Naccarella
BACKGROUND: A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the Emergency Department (ED) after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain...
April 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28509783/the-evaluation-of-adolescent-chest-pain-a-screening-ecg-or-psc-17
#20
Patricia E Acra, María T Pérez
PURPOSE OF REVIEW: The present review offers an update on entities presenting as chest pain in the adolescent population. It discusses recently proposed tools and shared mental models used in primary and urgent care settings to evaluate chest pain, and their focus on identifying life-threatening processes. We consider whether the current practice may be improved by accounting for the increasingly recognized non-life-threatening causes of adolescent chest pain. RECENT FINDINGS: The present experiences and behaviors of adolescents have added new causes of chest pain to the work-up of this disquieting chief complaint...
May 13, 2017: Current Opinion in Pediatrics
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