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Troponin leak

Caitlin E O'Brien, John D Coulson, Priya Sekar, Jon R Resar, Kristen Nelson McMillan
An adolescent male with a recent history of streptococcal pharyngitis presented with severe substernal chest pain, troponin leak, and ST-segment elevation, which are suggestive of acute inferolateral myocardial infarction. The coronary angiogram was normal. The patient was subsequently diagnosed with non-rheumatic streptococcal myocarditis. He was treated with amoxicillin and had excellent recovery. Non-rheumatic streptococcal myocarditis is an important mimic of acute myocardial infarction in young adults.
March 2018: Cardiology in the Young
Asiel Yair Adan Sanchez, Jessica J Foster, Carla M Plymen, Sukhi Shergill
BACKGROUND: There is currently limited experience in the initiation and maintenance of clozapine for treatment-resistant psychosis in adults with established structural heart disease. These complex patients require close supervision and liaison between colleagues. Here we present the successful experience of treating one such patient within our service and describe a monitoring plan to ensure that these treatments can be provided both safely and effectively. CASE PRESENTATION: A 36-year-old man with treatment-resistant schizophrenia and known hypertrophic cardiomyopathy (HCM) was admitted to a specialist unit for a trial of clozapine...
November 2016: BJPsych Open
L McLean House, Khensani N Marolen, Paul J St Jacques, Matthew D McEvoy, Jesse M Ehrenfeld
STUDY OBJECTIVE: To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery. DESIGN: Single-center retrospective cohort study of surgical patients from 2007 to 2012. SETTING: Postanesthesia care unit, intensive care unit, and medical-surgical ward at an academic tertiary medical center. PATIENTS: A total of 46,799 adult noncardiac, nonthoracic surgery patients, for which 2290 peak cardiac troponin (cTn) levels were available...
November 2016: Journal of Clinical Anesthesia
Leili Pourafkari, Arezou Tajlil, Samad Ghaffari, Mohammadreza Chavoshi, Kasra Kolahdouzan, Rezayat Parvizi, Raziyeh Parizad, Nader D Nader
BACKGROUND: Electrocardiography (ECG) offers some information that may be used to prognosticate acute type A aortic dissection (AAOD) for short- and long-term mortality. METHODS: We retrospectively analyzed the electrocardiograms of patients with AAOD admitted from March 2004 to March 2015. The frequency of ECG findings and their prognostic value on hospital and follow-up mortality were investigated. Findings pertaining to coronary involvement and troponin level were also examined...
August 2016: American Journal of Emergency Medicine
Florian J Fintelmann, Kemal Tuncali, Stefan Puchner, Debra A Gervais, Ashraf Thabet, Paul B Shyn, Ronald S Arellano, Servet Tatli, Peter R Mueller, Stuart G Silverman, Raul N Uppot
PURPOSE: To identify retrospectively predictors of catecholamine surge during image-guided ablation of metastases to the adrenal gland. MATERIALS AND METHODS: Between 2001 and 2014, 57 patients (39 men, 18 women; mean age, 65 y ± 10; age range, 41-81 y) at two academic medical centers underwent ablation of 64 metastatic adrenal tumors from renal cell carcinoma (n = 27), lung cancer (n = 23), melanoma (n = 4), colorectal cancer (n = 3), and other tumors (n = 7)...
March 2016: Journal of Vascular and Interventional Radiology: JVIR
Y Moodley, B M Biccard
BACKGROUND: Acute β-blockade has been associated with poor perioperative outcomes in non-cardiac surgery patients, probably as a result of P-blocker-induced haemodynamic instability during the perioperative period, which has been shown to be more severe in hypertensive patients. OBJECTIVE: To determine the impact of acute preoperative β-blockade on the incidence of perioperative cardiovascular morbidity and all-cause mortality in hypertensive South African (SA) patients who underwent vascular surgery at a tertiary hospital...
June 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Justyna Rybicka, Piotr Dobrowolski, Magdalena Lipczyńska, Ewa Kowalik, Anna Klisiewicz, Piotr Hoffman, Piotr Szymański
BACKGROUND: High sensitivity troponin T (hsTnT) assays enable us to detect chronic heart failure (CHF). Adult congenital heart disease (ACHD) patients are classified as being in at least stage B of CHF. The purpose of the study was to assess hsTnT levels in ACHD patients and determine its clinical significance. METHODS: This is a prospective cross-sectional study. We assessed hsTnT in 131 ACHD patients and in 30 healthy controls. All ACHD patients underwent routine clinical and echocardiographic evaluation and had hsTnT and N-terminal brain natriuretic peptide (NT-pro-BNP) level measurements...
September 15, 2015: International Journal of Cardiology
Michael A Mancano
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers. Write to Dr. Mancano at ISMP, 200 Lakeside Drive, Suite 200, Horsham, PA 19044 (phone: 215-707-4936; e-mail: Your report will be published anonymously unless otherwise requested...
January 2015: Hospital Pharmacy
Parijat S Joy, Creticus P Marak, Anna M Ponea, Achuta K Guddati
Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak...
October 2014: Journal of Clinical and Diagnostic Research: JCDR
Michael Behringer, Johannes Montag, Alexander Franz, Molly L McCourt, Joachim Mester, Kazunori Ken Nosaka
In sports medicine, muscle enzymes in the blood are frequently used as an indicator of muscle damage. It is commonly assumed that mechanical stress disrupts plasma membrane to an extent that allows large molecules, such as enzymes, to leak into the extracellular space. However, this does not appear to fully explain changes in muscle enzyme activity in the blood after exercise. Apart from this mechanically induced membrane damage, we hypothesize that, under critical metabolic conditions, ATP consuming enzymes like creatine kinase (CK) are "volitionally" expulsed by muscle cells in order to prevent cell death...
December 2014: Medical Hypotheses
Fahad Ali, Pavan Tenneti, Hari Prasad
SESSION TITLE: Cardiovascular Student/Resident Case Report Posters IISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Energy drinks (ED) are beverages purported to increase physical and mental performance. A recent surge is seen in the number of patients presenting with the energy drink associated adverse events (EDAV).CASE PRESENTATION: 21 year old male with past history of otitis media admitted to hospital after he had 2 episodes of left sided chest pain...
October 1, 2014: Chest
Alex Torborg, Lisa Ryan, Gary Kantor, Bruce M Biccard
BACKGROUND: A postoperative troponin leak that was previously considered clinically insignificant has been independently associated with 30-day mortality in unselected surgical patients ≥45 years of age following non-cardiac surgery. OBJECTIVES: To determine whether routine troponin surveillance following non-cardiac surgery and initiation of aspirin and statin therapy in troponin-positive patients is cost-effective. METHODS: Pharmacoeconomic analysis to determine the cost-effectiveness of routine postoperative surveillance for patients aged ≥45 years undergoing non-cardiac surgery...
July 22, 2014: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Ion A Hobai, Jessica Edgecomb, Kara LaBarge, Wilson S Colucci
Sepsis-induced cardiomyopathy (SIC) develops as the result of myocardial calcium (Ca) dysregulation. Here we reviewed all published studies that quantified the dysfunction of intracellular Ca transporters and the myofilaments in animal models of SIC. Cardiomyocytes isolated from septic animals showed, invariably, a decreased twitch amplitude, which is frequently caused by a decrease in the amplitude of cellular Ca transients (ΔCai) and sarcoplasmic reticulum (SR) Ca load (CaSR). Underlying these deficits, the L-type Ca channel is downregulated, through mechanisms that may involve adrenomedullin-mediated redox signaling...
January 2015: Shock
Ayesha Amjad, Amjad Ali, Ahmed Bashir, Muhammed Ali, Muhammad Najeeb Azam
A 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak...
March 31, 2014: BMJ Case Reports
Robert D Cannon, Michael Wagner, Jeanne L Jacoby
Drug-induced methemoglobinemia is a well-described entity but has not been previously associated with elevated troponins in the absence of cardiac symptoms. We report a case of a patient presenting to the emergency department (ED) with complaints related to an exacerbation of her long-standing cystitis. A low pulse oximetry reading prompted an evaluation, revealing a troponin leak, which peaked at 10 hours. Her methemoglobin level was found to be elevated at 11.4%, but a preexisting anemia apparently prevented the clinical recognition of cyanosis...
October 2014: American Journal of Emergency Medicine
L A Redman, P Naidoo, B M Biccard
Risk factors for peri-operative cardiac morbidity are poorly described in HIV-positive patients. This prospective observational study describes cardiovascular risk factors in a cohort of vascular surgical patients of known HIV status. We recruited 225 patients with 73 (32%) being HIV-positive. When compared with HIV-negative patients, the HIV-positive patients were younger (mean (SD) 56.4 (13.3) vs 40.5 (10.4) years, respectively, p < 0.01). They had fewer Revised Cardiac Risk Index cardiovascular risk factors (median (range [IQR]) 1 (0-5 [0-2]) vs 0 (0-2 [0-0]), respectively, p < 0...
March 2014: Anaesthesia
Frank Courmier, Juan Sanchez
SESSION TYPE: ILD Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Acute and rapidly progressing pulmonary fibrosis associated with spontaneous pneumomediastinum in a young woman is an unusual presentation for interstitial lung disease.CASE PRESENTATION: A 23 YO healthy Caucasian woman presented with retrosternal and back pain preceeded by a viral prodrome consisting of fevers, myalgias, nasal congestion and sore throat. The rest of the review of systems, medications, and social history was noncontributory...
October 1, 2012: Chest
Nasir Hussain
Elevation of cardiac troponins and creatinine kinase is frequently observed in setting of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock. Underlying pathophysiologic mechanism for such troponin leak, its clinical significance, and what different could be done in such settings remain elusive. In this paper we have briefly overviewed the proposed pathogenic mechanisms for SIRS, sepsis, or septic shock-related troponin elevation (SRTE) and have provided brief overview on its clinical significance...
2013: ISRN Cardiology
Shinichi Okuda, Masafumi Yano
Alterations in Excitation-Contraction coupling have recently been shown to play a crucial role in the pathogenesis of heart failure (HF). In failing hearts, abnormalities of neurohormonal mechanisms, which were included chronic activation of the sympathetic nervous system or of the renin-angiotensin system result in structural and functional changes in the calcium (Ca(2 +) ) regulatory proteins. These changes include the decreased sarcoplasmic reticulum (SR) load, which could be caused by reduced SR Ca(2 +) -ATPase (SERCA2A) function and increased SR Ca(2 +) leak via cardiac ryanodine receptor (RyR2) , a functional defect in L-type Ca(2 +) channel and activation of the reversal mode of Na (+) /Ca(2 +) exchanger...
April 2013: Clinical Calcium
Peter M Kekenes-Huskey, Yuhui Cheng, Johan E Hake, Frank B Sachse, John H Bridge, Michael J Holst, J Andrew McCammon, Andrew D McCulloch, Anushka P Michailova
The transverse tubular system of rabbit ventricular myocytes consists of cell membrane invaginations (t-tubules) that are essential for efficient cardiac excitation-contraction coupling. In this study, we investigate how t-tubule micro-anatomy, L-type Ca(2+) channel (LCC) clustering, and allosteric activation of Na(+)/Ca(2+) exchanger by L-type Ca(2+) current affects intracellular Ca(2+) dynamics. Our model includes a realistic 3D geometry of a single t-tubule and its surrounding half-sarcomeres for rabbit ventricular myocytes...
2012: Frontiers in Physiology
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