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https://www.readbyqxmd.com/read/28800806/toxicologic-emergencies-in-patients-with-mental-illness-when-medications-are-no-longer-your-friends
#1
REVIEW
Spencer Greene, Erin AufderHeide, Lindsay French-Rosas
Patients with psychiatric disorders are at risk for toxicologic emergencies. Psychotropic medications have numerous effects on the neurologic, cardiac, and other organ systems and interact with other medications, potentially leading to further side effects. It is important to become familiar with accepted psychiatric practice guidelines, common toxidromes, medical sequelae associated with prescribed medications, and the specific workup and treatment of overdoses of frequently prescribed psychotropics.
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28797399/a-54-year-old-man-with-anasarca-dyspnea-and-recurrent-bilateral-pleural-effusions
#2
Pradnya D Patil, Yvette M Cua, Carol Farver, Rafael L Perez, Atul C Mehta, Tanmay S Panchabhai
A 54-year-old African-American man presented with 2 years of progressively worsening dyspnea and anasarca. Over the past 6 months he gained 30 lbs with worsening lower extremity, abdominal wall, and scrotal edema. A recent workup for cardiac, renal, and liver disease, including two-dimensional echocardiogram, liver and renal function tests, and abdominal ultrasound, was unremarkable. He reported a 15-pack year history of smoking and quit 3 years ago. Chest radiograph at that time revealed bilateral pleural effusions that were both reportedly milky in appearance when drained by thoracenteses...
August 2017: Chest
https://www.readbyqxmd.com/read/28780621/an-international-consensus-on-the-appropriate-evaluation-and-treatment-for-adults-with-spinal-deformity
#3
Sigurd H Berven, Steven J Kamper, Niccole M Germscheid, Benny Dahl, Christopher I Shaffrey, Lawrence G Lenke, Stephen J Lewis, Kenneth M Cheung, Ahmet Alanay, Manabu Ito, David W Polly, Yong Qiu, Marinus de Kleuver
PURPOSE: Evaluation and surgical management for adult spinal deformity (ASD) patients varies between health care providers. The purpose of this study is to identify appropriateness of specific approaches and management strategies for the treatment of ASD. METHODS: From January to July 2015, the AOSpine Knowledge Deformity Forum performed a modified Delphi survey where 53 experienced deformity surgeons from 24 countries, rated the appropriateness of management strategies for multiple ASD clinical scenarios...
August 5, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28768449/recurrent-fuo-due-to-intermittent-enterobacter-cloacae-bacteremias-from-an-infected-pacemaker-lead-diagnosed-by-gallium-scan
#4
Burke A Cunha, Ismail Jimada
Fever of unknown origin (FUO) refers to fevers of ≥101° F that persist for ≥3 weeks and remain undiagnosed after a focused inpatient or outpatient workup. FUO may be due to infectious, malignant/neoplastic, rheumatic/inflammatory, or miscellaneous disorders. Recurrent FUOs are due to the same causes of classical FUOs. Recurrent FUOs may have continuous or intermittent fevers and are particularly difficult to diagnose. With intermittent fever, recurrent FUO diagnostic tests are best obtained during fever episodes...
August 2, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28767580/metastatic-cardiac-tumor-presenting-as-atrial-fibrillation-in-a-previously-healthy-woman-a-case-report
#5
Chi-Wen Cheng, Ning-I Yang, Koon-Kwan Ng, Wen-Jin Cherng
RATIONALE: Metastatic cardiac tumor (MCT) is rare in clinical practice. MCT presenting initially as atrial fibrillation (AF) is even rarer. PATIENT CONCERNS: We report a 47-year-old woman with no previous medical history presented with intermittent palpitation for 3 days. DIAGNOSES: The electrocardiography showed AF with rapid ventricular rate. The transthoracic echocardiography showed a 4 × 4 cm mass occupying the left atrium (LA)...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28758563/papillary-fibroelastoma-found-with-transesophageal-echocardiography-after-a-normal-transthoracic-echocardiography
#6
Andrew G Cook, Omar Viswanath, Jayanand D'Mello
We present the case of a patient with transient ischemic attacks who was being investigated for multiple embolic strokes. Initial workup, including brain computed tomography, computed tomography angiography, and transthoracic echocardiography (TTE) were negative for a source until transesophageal echocardiography (TEE) found a mass in the left atrium. The TEE differentiated the mass as a rare cardiac papillary fibroelastoma on the left atrial free wall confirmed by postsurgical pathology. This case highlights the importance of TEE as a diagnostic tool for its ability to more accurately differentiate and characterize the tumor compared with TTE...
September 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28752729/cardiac-imaging-in-patients-with-cardiac-syncope
#7
Stefania A DI Fusco, Furio Colivicchi, Federico Nardi
Syncope is a common symptom with a possibly unfavourable prognosis, especially when the cause is a cardiac disease. Often diagnostic workup requires multiple and challenging investigations to determine whether the patient has a structural heart disease. Cardiac imaging tests should be used when baseline clinical findings raise the suspicion of a cardiac syncope. Transthoracic echocardiography is the first line imaging examination as it helps establish the cause of syncope and supplies useful information for prognostic stratification by evaluating systolic ventricle function...
July 27, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/28743311/hypercapnic-respiratory-failure-during-pregnancy-due-to-polymyositis-related-respiratory-muscle-weakness-a-case-report
#8
Husain Shabbir Ali, Ibrahim Fawzy Hassan, Saibu George, Abdalrazig Elsadig Fadlelmula
BACKGROUND: Polymyositis is a rare medical disorder complicating pregnancy. Ventilatory muscle weakness leading to respiratory failure is an uncommon manifestation of this autoimmune disease. We report a case of life-threatening hypercapnic respiratory failure due to polymyositis-related respiratory muscle weakness in a pregnant woman. CASE PRESENTATION: A 31-year-old, African woman in her second trimester of pregnancy presented to the emergency department with fever, shortness of breath and muscle weakness...
July 26, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28721322/etiology-and-age-distribution-of-syncope-in-a-predominantly-african-american-population
#9
Ahmad Awan, Hasan Iftikhar, Fasil Tiruneh, Shahabuddin Soherwardi, Daniel Larbi
BACKGROUND: Syncope, the sudden transient loss of consciousness due to multiple etiologies, usually has worse outcomes in African Americans compared with other races because of other comorbidities. This study aims to identify a correlation between the etiologies of syncope and age in a predominantly African-American sample population to facilitate future investigations with potentially improved specificity to address this condition. METHODS: We reviewed the medical records of 155 patients who presented with syncope concerns to the emergency department at our university hospital...
June 14, 2017: Curēus
https://www.readbyqxmd.com/read/28706112/workup-for-perinatal-stroke-does-not-predict-recurrence
#10
Laura L Lehman, Jeanette Beaute, Kush Kapur, Amy R Danehy, Miya E Bernson-Leung, Hayley Malkin, Michael J Rivkin, Cameron C Trenor
BACKGROUND AND PURPOSE: Perinatal stroke, including neonatal and presumed perinatal presentation, represents the age in childhood in which stroke occurs most frequently. The roles of thrombophilia, arteriopathy, and cardiac anomalies in perinatal ischemic stroke are currently unclear. We took a uniform approach to perinatal ischemic stroke evaluation to study these risk factors and their association with recurrent stroke. METHODS: We reviewed records of perinatal stroke patients evaluated from August 2008 to February 2016 at a single referral center...
July 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28705229/brugada-syndrome-in-a-patient-with-amyotrophic-lateral-sclerosis-a-case-report
#11
Anusha Battineni, Rohit Gummi, Naresh Mullaguri, Raghav Govindarajan
BACKGROUND: Amyotrophic lateral sclerosis is a fatal neuromuscular disorder characterized by progressive death of the upper and lower motor neurons in the central nervous system. Patients with this disease die mostly as a result of respiratory failure; however, owing to prolonged survival through assisted ventilation, cardiovascular causes are increasingly responsible for mortality. We report what is to the best of our knowledge the first case of type 2 Brugada syndrome causing ventricular tachyarrhythmia and cardiac arrest in a patient with upper limb onset amyotrophic lateral sclerosis...
July 14, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28701599/interesting-images-multiple-coronary-artery-aneurysms
#12
Jonathon M Howard, Omar Viswanath, Alfredo Armas, Orlando Santana, Gerald P Rosen
We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28683456/can-noncardiac-syncope-occur-during-exercise
#13
Georgios A Christou, Konstantinos A Christou, Evangelos A Christou, Dimitrios N Kiortsis
We describe the case of a 25-year-old athlete experiencing syncope during a 5-km running race. A thorough diagnostic workup reasonably excluded a cardiac disorder as the cause of syncope. The characterization of this episode of syncope as noncardiac appears to contradict the common belief that syncope during exercise has always a cardiac origin. Following a detailed history taking, it was revealed that the symptoms of the athlete started after a 180° turn of the route. This situation represents a setting relevant to a runner who stops suddenly after reaching the finish line and soon after experiences noncardiac syncope due to the abrupt cessation of muscle pump function of the lower limbs...
July 6, 2017: Cardiology
https://www.readbyqxmd.com/read/28677313/a-case-of-disseminated-mycobacterium-bovis-2-years-post-intravesicular-bacillus-calmette-gu%C3%A3-rin-therapy-for-superficial-urinary-bladder-cancer
#14
Alexander R L Robinson, Rajeswari Radhakrishnan, Robert Horvath, Sushil Pandey
Disseminated Mycobacterium bovis is an uncommon side-effect of intravesical Bacillus Calmette-Guérin (BCG) therapy that may be mediated through Mycobacteraemia. This case report, of a 77-year-old man with a history of intravesical BCG therapy and recent cardiac surgery, highlights the need for patients with similar features on history, presenting with generalised symptoms, to have mycobacterial cultures included in their workup.
July 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28676385/syncope-workup-greater-yield-in-select-trauma-population
#15
Melike Harfouche, Michael Cline, Michael Mazzei, Thomas Santora
BACKGROUND: There is great variation in practice regarding the assessment of trauma patients who present with syncope. The purpose of this study was to determine the yield of screening studies (electrocardiogram, echocardiogram, and carotid duplex) and define characteristics to identify groups that may benefit from these investigations. METHODS: We conducted a retrospective cohort study of all trauma patients from 2003 to 2015 who received a carotid duplex as part of a syncope evaluation at our urban Level 1 Trauma Center...
July 1, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28668146/a-rare-case-of-cardiac-melanoma-mimicking-hypertrophic-cardiomyopathy
#16
Imke Friedel, Wolfgang Burchert, Dieter Horstkotte, Lothar Faber
A 40-year-old female patient with a remote history of a malignant melanoma treated with curative intent presented with the diagnosis of hypertrophic cardiomyopathy (HCM) made at another hospital. Further diagnostic workup included positron emission tomography/computed tomography, which revealed that the HCM phenotype was produced by cardiac involvement of metastatic melanoma. For this reason, the primary diagnosis of HCM had to be retracted and melanoma-specific antineoplastic treatment was initiated.
July 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28652676/utility-of-cardiac-magnetic-resonance-in-recurrent-myocarditis
#17
Abdullah M Alotaibi, Ahmed Aljizeeri, Mouaz Al-Mallah, Ahmed Alsaileek
We report a 26-year-old man who presented to the emergency department four times within a 4-year period with recurrent myocarditis. His presentations were characterized by chest pain, elevated troponin I, and normal coronary angiography. Endomyocardial biopsy showed nonspecific inflammatory process. Laboratory workup including viral screening and autoimmune markers were negative. Cardiac magnetic resonance imaging showed evidence of recurrent myocarditis with progressive appearance of new areas of myocardial delayed enhancement seen in each admission...
July 2017: Journal of the Saudi Heart Association
https://www.readbyqxmd.com/read/28651919/st2-predicts-survival-in-patients-undergoing-transcatheter-aortic-valve-implantation
#18
Johannes Schmid, Tatjana Stojakovic, David Zweiker, Hubert Scharnagl, Ralph D Maderthaner, Daniel Scherr, Robert Maier, Albrecht Schmidt, Winfried März, Josepha S Binder, Peter P Rainer
OBJECTIVE: To assess soluble suppression of tumorigenicity 2 (sST2) serum concentrations and predict mortality in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS: We prospectively enrolled 74 patients with severe aortic stenosis (AS) who underwent TAVI and matched them to patients without aortic valve disease (n=74). AS patients underwent comprehensive echocardiographic and cardiac magnetic resonance imaging and laboratory examinations...
June 19, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28639774/-discovery-of-left-ventricular-hypertrophy-during-adult-echocardiography
#19
Nicolas B Dayal, Hajo Müller
Left ventricular hypertrophy is a common finding during echocardiography. A precise evaluation of the left ventricular wall thickness, ventricular mass and distribution of hypertrophy is crucial both for diagnostic workup, follow-up and for prognostic evaluation. The differential diagnosis of left ventricular hypertrophy includes hypertrophic cardiomyopathies, hypertrophy secondary to abnormal left ventricular filling conditions, hypertrophy linked to intense physical training and the isolated basal septal hypertrophy of the elderly...
May 24, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28638298/uncertainty-of-myocardial-perfusion-imaging-in-chest-pain-risk-stratification
#20
Htoo Kyaw, Sivacharan Buddhavarapu, Joseph Abboud, Deepika Misra
BACKGROUND: Chest pain is a common presenting symptom in the emergency department (ED). Although the diagnostic workup for chest pain is well established, the best time to perform invasive cardiac catheterization in patients with low to moderate risk of coronary artery disease is still unclear, particularly if noninvasive tests such as the electrocardiogram (ECG) and nuclear myocardial perfusion scan show nonsignificant findings. CASE REPORT: We present the case of a 52-year-old female who presented to the ED with acute-onset chest pain that had started early in the morning while she was sleeping...
2017: Ochsner Journal
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