1/10. ED echocardiography for peripartum cardiomyopathy.Although peripartum cardiomyopathy is uncommon, emergency physicians should be knowledgeable of it because of its high morbidity and mortality. Emergency physicians should be alert to the fact that the clinical presentation of peripartum cardiomyopathy is nonspecific. Its clinical manifestations are found in other medical conditions that can present in the late prepartum or postpartum patient. We present a case of peripartum cardiomyopathy that illustrates how its nonspecific respiratory signs and symptoms led to an initial diagnosis of pulmonary embolism. The case also highlights the need for echocardiography in the evaluation of peripartum cardiomyopathy. We discuss the clinical presentation, diagnosis, and treatment of peripartum cardiomyopathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. A case study of Jerry: emphasizing team communication through use of the Discipline.After the chaplain is well acquainted with The Discipline and has begun to implement it in daily pastoral practice, half of the work is done. The further work concerns how and what to communicate to the care team regarding the chaplain's observations. This article begins by offering a pastoral reflection on the chaplain's identity and pastoral practice within a multi-disciplinary care team. The pastoral reflection highlights key theological assertions used by The Discipline. The author then identifies the particular problems facing care teams and their communication that the chaplain can anticipate when using The Discipline. Thirdly, the author suggests workable, theologically based tools for the resolution of these problems. Lastly, through the case study of "Jerry," the author illustrates both the "how" and "what" components of care team communication using the working elements of The Discipline. The "how" component describes the informal and formal relational processes that have contributed to a working partnership. The case study also illustrates the "what" part of care team communication--the structure and delivery of observable and discernible content to physicians and nurses. These materials can ease the transition towards effective pastoral presence on the interdisciplinary care team regarding patient and family/support partner care.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/10. Detection of covert myocardial sarcoidosis by scalene node biopsy.The antemortem diagnosis of myocardial sarcoidosis is rare in patients without overt signs of the disease. Two patients are presented to alert physicians to the value of early scalene node biopsy when sarcoidosis could be the cause of marked disturbances in cardiac conduction. The first patient, aged 29 years, had first, second, and third degree atrioventricular block and intermittent left and right bundle-branch block; the second, aged 59 years, had second degree atrioventricular block and complete right bundle-branch block. Both had diagnoses of sarcoidosis based on scalene node biopsy. The cardiac conductive disturbance improved, and the symptoms disappeared with steroid therapy.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/10. Sudden cardiac death due to physical exercise in male competitive athletes. A report of six cases.In the period of 30 years, i.e. from 1973 to 2002, we noticed in croatia 6 sudden and unexpected cardiac deaths in male athletes during or after training. Two were soccer players, 2 athletic runners, one was a rugby player and one was a basketball player. All of them were without cardiovascular symptoms. At the forensic autopsy, the first athlete, aged 29, had chronic myocarditis and thickened left ventricular wall of 15 mm. The second, aged 21, had an acute myocardial infarction of the posterior wall with normal coronaries and thickened left ventricular wall of 15 mm. The third aged 17, had hypoplastic right coronary artery and narrowed ascending aorta, suppurant tonsillitis and subacute myocarditis. Two athletes, aged 29 and 15, had hypertrophic cardiomyopathy and normal coronaries, and one dilated aorta. The sixth, aged 24, had arrhythmogenic cardiomyopathy of the right ventricle. All the 6 athletes died suddenly, obviously because of malignant ventricular arrhythmias. In croatia the death rate among athletes reached 0.15/100 000, in others who practice exercise reached 0.74/100,000 and the difference is highly significant (c2=14.487, Poisson rates=3.81, P=0.00014) and in physicians-specialists reached 33.6/100,000. Preventive medical examinations are essential, especially in athletes before physical exercise, as are other investigations in every case suspicious of heart disease, including electrocardiogram (ECG), stress ECG, echocardiography and stress-echocardiography and other findings if indicated. Physical exercise is contraindicated in acute respiratory infection: in 2 of those cases had been a cause of death as a trigger.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/10. Transient left ventricular apical ballooning: a review of the literature.Transient left ventricular apical ballooning is a newly defined syndrome characterized by sudden onset of chest symptoms, electrocardiographic changes characteristic of myocardial ischemia, transient left ventricular dysfunction-particularly in the apical region, low-grade troponin elevation, and no significant coronary stenosis by angiogram. This syndrome is also referred to as takotsubo cardiomyopathy, "Ampulla" cardiomyopathy, Human Stress cardiomyopathy, and Broken Heart Syndrome. Emergency physicians, family physicians, general internists, and cardiologists may all encounter this syndrome at the point of contact. The similarity to acute coronary syndrome requires all clinicians who may potentially care for these patients to familiarize themselves with this newly recognized disease. We provide a recent case and review the current literature surrounding this syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Death due to chronic syrup of ipecac use in a patient with bulimia.A 17-year-old girl presented with malaise, weakness, palpitations, dysphagia, myalgias, and weight loss of 1 month's duration. Within 24 hours of admission to the hospital, she had hypotension unresponsive to medical management, intractable congestive heart failure, and arrhythmias; she died. Several empty bottles of syrup of ipecac were later found among her belongings. Syrup of ipecac is commonly used to induce emesis in patients who had ingested toxic substances. The chief pharmacologic property of this agent is due to its alkaloid component, emetine. There have been many previous reports of death due to emetine poisoning in patients receiving ipecac fluid extract and in those treated for amoebic dysentery. However, the literature cites only three case reports of fatalities secondary to chronic ipecac use as a means of losing weight. This is the first report of a death due to chronic ipecac use in an adolescent patient with bulimia. emetine persists in the body for long periods, and in patients who have ingested it chronically, emetine is extremely toxic, specifically to cardiac smooth and skeletal muscles. With an increased awareness of the importance of weight control in the adolescent age group, the physician must carefully evaluate these patients for the use of emetics.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/10. Prediction of the development of sigmoid ischemia on the day of aortic operations. Indirect measurements of intramural pH in the colon.A deviation in an indirect measurement of intramural pH below the limits of normality (6.86) was used as a diagnostic test for sigmoid ischemia in 25 high-risk patients undergoing abdominal aortic operations. The clinical diagnosis of ischemic colitis was made by the attending physicians in only two of the 25, on the day after operation in one and three months after operation in another. In neither was the ischemic colitis considered to have been a causative factor in their subsequent deaths. In contrast, six patients developed pH evidence of ischemia on the day of operation. All six subsequently developed a transient episode of guaiac-positive diarrhea, four developed physical signs consistent with ischemic colitis, and four died. Of 19 who did not develop pH evidence of ischemia, none developed guaiac-positive diarrhea, none developed any signs of ischemic colitis, and none died. Stepwise logistic regression showed the duration of pH evidence of ischemia on the day of operation to be the best predictor for the symptoms and signs of ischemic colitis and for death after operation.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/10. Hypomagnesemia-induced cardiomyopathy.Magnesium is the fourth most abundant cation in the body and the second most plentiful intracellularly. Magnesium is crucial to mitochondrial integrity, oxidative phosphorylation, protein synthesis, nucleic acid stability, membrane permeability, and neuro-muscular excitability. In addition, magnesium deficiency induces other electrolyte disturbances including hypocalcemia, hypokalemia, and hypophosphatemia. Because it is not routinely measured, many physicians fail to remember the significance of this element. Reported here is a patient with bulimia who presented with a magnesium deficiency which resulted in her refractory and eventually fatal cardiomyopathy. The cardiac pathophysiology of hypomagnesemia, hypokalemia, hypocalcemia and hypophosphatemia is reviewed and correlated with the clinical and pathological findings.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/10. Serial histopathologic myocardial findings in a patient with ectopic atrial tachycardia-induced cardiomyopathy.A 17-year-old woman was found to have ectopic atrial tachycardia by her physician. echocardiography and cardiac catheterization revealed findings resembling dilated cardiomyopathy at the time of initial presentation. The tachycardia was controlled with atenolol only at a dose of 50 mg/day. However, at the age of 22, the presence of ectopic atrial tachycardia was once again confirmed. We successfully performed catheter ablation for persistent ectopic atrial tachycardia. Serial echocardiographic findings showed the left ventricular dimension and function appeared to return to normal 1 year postablation. However, despite pharmacologic control and catheter ablation therapy, histopathology revealed myocardial fibrosis presumably representing permanent damage of the heart secondary to tachycardia 1 year postablation.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/10. Bioimpedance cardiac output measurements in patients with presumed congestive heart failure.OBJECTIVE: To describe preliminary ED experience with thoracic electrical bioimpedance (TEB) for evaluation of patients with complaints suggestive of congestive heart failure (CHF). methods: A 6-month, prospective, observational study was performed using a convenience sample of patients with signs and symptoms consistent with CHF. patients were excluded if they had received medication prior to arrival in the ED, if they were obese, and if they had unstable vital signs. They also were excluded if they were combative, refused to sign consent, or had invasive lines that did not allow for TEB lead placement. patients also were excluded if the study could not be completed because the patient was taken from the department for a diagnostic test, or if there were no good follow-up records available 6-12 months after the patient's visit. The patient's physician was blinded to the output of the TEB monitor. cardiac output (CO), stroke volume (SV), end-diastolic volume (EDV), thoracic fluid index (TFI), and acceleration index (ACI) were recorded at 5-minute intervals. Results were evaluated for the time intervals 0-5 minutes, 30-35 minutes, and 60-65 minutes. RESULTS: Seven patients were included in the study. The echocardiographic diagnoses were hypertrophic cardiomyopathy (2 cases), dilated cardiomyopathy (2 cases), ischemic cardiomyopathy (1 case), right ventricular hypertrophy (1 case), and pericardial effusion (1 case). Significant changes were seen in all cardiac parameters, with variance from individual to individual. CONCLUSIONS: Significant differences in TEB variables exist between patients who appear similar on initial examination in the ED. Changes noted on TEB may help to further elucidate physiologic differences. The clinical use of TEB-based hemodynamic measurements to guide presumed CHF patient management remains speculative.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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