1/140. hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient.We report a case of hypotension, bradycardia, and asystole after intravenous administration of high-dose methylprednisolone in a 73-year-old patient who underwent electrocardiographic (ECG) monitoring throughout the episode. There was a history of ischemic cardiac disease 9 years earlier. The patient was admitted with a pulmonary-renal syndrome with hemoptysis, rapidly progressive renal failure, and hypoxemia that required mechanical ventilation in the intensive care unit. After receiving advanced cardiopulmonary resuscitation, the patient recovered cardiac rhythm. The ECG showed a junctional rhythm without ventricular arrhythmia. This study reviews the current proposed mechanisms of sudden death after a high dose of intravenous methylprednisolone (IVMP). These mechanisms are not well understood because, in most cases, the patients were not monitored at the moment of the event. Rapid infusion and underlying cardiac disease were important risk factors in the case reported here, and the authors discount ventricular arrhythmia as the main mechanism.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
2/140. Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock.BACKGROUND: Hypovolemic shock of marked severity and duration may progress to cardiovascular collapse unresponsive to volume replacement and drug intervention. On the basis of clinical observations, we investigated the action of vasopressin in an animal model of this condition. methods AND RESULTS: In 7 dogs, prolonged hemorrhagic shock (mean arterial pressure [MAP] of approximately 40 mm Hg) was induced by exsanguination into a reservoir. After approximately 30 minutes, progressive reinfusion was needed to maintain MAP at approximately 40 mm Hg, and by approximately 1 hour, despite complete restoration of blood volume, the administration of norepinephrine approximately 3 micrograms . kg(-1). min(-1) was required to maintain this pressure. At this moment, administration of vasopressin 1 to 4 mU. kg(-1). min(-1) increased MAP from 39 /-6 to 128 /-9 mm Hg (P<0.001), primarily because of peripheral vasoconstriction. In 3 dogs subjected to similar prolonged hemorrhagic shock, angiotensin ii 180 ng. kg(-1). min(-1) had only a marginal effect on MAP (45 /-12 to 49 /-15 mm Hg). plasma vasopressin was markedly elevated during acute hemorrhage but fell from 319 /-66 to 29 /-9 pg/mL before administration of vasopressin (P<0.01). CONCLUSIONS: Vasopressin is a uniquely effective pressor in the irreversible phase of hemorrhagic shock unresponsive to volume replacement and catecholamine vasopressors. Vasopressin deficiency may contribute to the pathogenesis of this condition.- - - - - - - - - - ranking = 0.0028508669379602keywords = hour (Clic here for more details about this article) |
3/140. Pneumoencephalus and convulsions after ventriculoscopy: a potentially catastrophic complication.A nine-year-old boy with hydrocephalus underwent ventriculoscopy under general anesthesia. After introduction of ventriculoscope the patient had sudden bradycardia, hypotension, and shrinkage of ipsilateral cerebral hemisphere. The ventriculostomy was abandoned. At the end of anesthesia and endotracheal extubation, the patient developed generalized convulsions. Reexploration of wound did not reveal anything significant; however, postoperative CT scan of head showed massive pneumoencephalus. The patients received elective ventilation of lungs for 24 hours and made complete recovery. The authors describe the reasons for these complications and further management.- - - - - - - - - - ranking = 0.0028508669379602keywords = hour (Clic here for more details about this article) |
4/140. Radiofrequency catheter ablation in a haemodynamically compromised premature neonate with hydrops fetalis.A preterm infant was born at 35 weeks gestation after failed antenatal antiarrhythmic therapy. The infant had an incessant supraventricular tachycardia, impaired ventricular function and hypotension and failed to respond to adenosine, cardioversion and intravenous amiodarone. After resuscitation from cardiovascular collapse, a successful radiofrequency catheter ablation (RFA) of a left free wall atrioventricular pathway was performed at 24 h of age without extracorporeal support. The infant is normal on follow up at 12 months of age. Whilst most fetal and neonatal supraventricular tachyarrhythmias respond to antiarrhythmic medications and RFA is not required, this is the earliest RFA to be performed on a premature infant when antiarrhythmics have failed.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
5/140. Hypotensive ischemic optic neuropathy and peritoneal dialysis.PURPOSE: To report anterior ischemic optic neuropathy associated with systemic hypotension in a patient undergoing continuous ambulatory peritoneal dialysis. methods: Case report. A 58-year-old man undergoing continuous ambulatory peritoneal dialysis developed painless blurred vision in both eyes and bilateral optic disk swelling with an altitudinal field defect in the left eye. Twenty-four-hour ambulatory blood pressure monitoring was requested in addition to other routine investigations. RESULTS: Routine blood pressure measurement in the clinic was 130/86 mm Hg, but ambulatory blood pressure monitoring demonstrated pronounced early morning hypotension with individual readings as low as 91/41 mm Hg. CONCLUSIONS: renal dialysis can render patients hypotensive, and this may be associated with anterior ischemic optic neuropathy. The overnight drop in blood pressure may not be appreciated with routine blood pressure measurement. Therefore, 24-hour ambulatory blood pressure monitoring should be considered when investigating patients with suspected anterior ischemic optic neuropathy who are undergoing renal replacement.- - - - - - - - - - ranking = 0.0057017338759204keywords = hour (Clic here for more details about this article) |
6/140. bradycardia, reversible panconduction defect and syncope following self-medication with a homeopathic medicine.Alkaloid extracts from the plant aconitum species have been used in various forms of herbal remedies predominantly as anti-inflammatory and analgesic agents. Many of these alkaloids are extremely potent cardiotoxins and documented cases of various arrhythmias with fatal outcomes have been reported. We report a case of self-medication with 'tincture of aconite' resulting in severe bradycardia, reversible panconduction defect evidenced by sinus inactivity, atrioventricular dissociation with idiojunctional rhythm and left bundle branch block pattern resulting in hypotension and syncope. Complete reversal of ECG findings with marked improvement in symptoms was noted within a few hours. Herbal medicines containing aconite alkaloids may result in severe cardiotoxicity, and strict regulatory measures are warranted to curb unsupervised use for therapeutic purposes.- - - - - - - - - - ranking = 0.50285086693796keywords = rhythm, hour (Clic here for more details about this article) |
7/140. Intravenous valproate associated with significant hypotension in the treatment of status epilepticus.Intravenous valproate has been suggested for the treatment of status epilepticus in part because of its relatively good cardiovascular safety profile. We report a case of severe hypotension associated with intravenous valproate used to treat status epilepticus in an 11-year-old girl. Valproate 960 mg (30 mg/kg) was infused over 1 hour. The patient's blood pressure decreased from a baseline of 130/80 mm Hg to 70/55 mm Hg, 39 minutes into the infusion. Although her seizures stopped, her blood pressure fluctuated between 90/60 mm Hg and 60/30 mm Hg over the next several hours, requiring treatment with intravenous fluids and pressor therapy. Endotracheal intubation eventually was performed. Once her blood pressure stabilized, the patient improved clinically. To our knowledge, this is the first report of significant hypotension associated with intravenous valproate in the treatment of status epilepticus in the pediatric population.- - - - - - - - - - ranking = 0.0057017338759204keywords = hour (Clic here for more details about this article) |
8/140. Abolished nocturnal blood pressure fall in a boy with glucocorticoid-remediable aldosteronism.Glucocorticoid-remediable aldosteronism (GRA) is a rarely recognised cause of arterial hypertension. We report the features of a 13-year-old boy with hypertension (casual blood pressure (BP) 140-180/95-110 mm Hg) discovered during a routine paediatric check. Ambulatory BP monitoring (ABPM) revealed significant hypertension with an abolished nocturnal BP fall (mean daytime BP 155/108 mm Hg, mean night-time BP 156/104 mm Hg, nocturnal BP fall 0/4%) which was indicative of secondary hypertension. Despite triple antihypertensive drug therapy the hypertensive control was unsatisfactory. Laboratory tests revealed hypokalaemia (3.0 mmol/l), suppressed plasma renin activity (0.012 nmol/l/h) and high plasma aldosterone (1.190 nmol/l). The diagnosis of primary hyperaldosteronism was established and GRA was further confirmed by the presence of the chimaeric GRA-gene and dexamethasone therapy was initiated. During the next 2 months of dexamethasone therapy all three antihypertensive drugs were discontinued and BP remained under control with restoration to a normal nocturnal BP fall (mean daytime BP 129/77 mm Hg, mean night-time BP 113/64, nocturnal BP fall 12/17%). A change of therapy from dexamethasone to spironolactone was necessary due to the side effects of corticosteroids after 3 months. spironolactone alone (0.8-2 mg/kg/day) was able to control the BP sufficiently. In conclusion, to our knowledge, this is the first reported case of abolished nocturnal BP fall in a patient with genetically proven GRA. This study indicates that GRA can cause severe hypertension even in children, associated with an abolished nocturnal BP fall. GRA thus should be excluded in all hypertensive patients with circadian BP rhythm disturbances.- - - - - - - - - - ranking = 0.25keywords = rhythm (Clic here for more details about this article) |
9/140. Fatal cardiovascular collapse following acute colchicine ingestion.BACKGROUND: A previously published prognostic rule predicts 100% survival after ingestion of cochicine doses less than 0.5 mg/kg and 100% mortality after ingestion of more than 0.8 mg/kg. This rule inaccurately predicted survival in a recent case. CASE REPORT: We present a case of fatal colchicine poisoning in an adult who ingested a maximum of 39.6 mg of colchicine (0.40 mg/kg). He subsequently developed hypotension which was refractory to fluid resuscitation and infusion of vasopressors. He died of cardiovascular collapse approximately 35 hours after ingestion. DISCUSSION: Fatal outcomes are possible even with colchicine doses less than 0.5 mg/kg. physicians caring for colchicine-poisoned patients must be prepared for the possibility of acute cardiovascular collapse and ventricular dysrhythmias regardless of the reported dose of colchicine.- - - - - - - - - - ranking = 0.25285086693796keywords = rhythm, hour (Clic here for more details about this article) |
10/140. atrial fibrillation and continuous hypotension induced by sildenafil in an intermittent WPW syndrome patient.A 55-year-old Japanese man was hospitalized for palpitations and severe chest oppression one hour after he ingested about 1500 ml of beer and sildenafil (Viagra) 50 mg. At 43 years of age, he had been diagnosed with intermittent WPW syndrome following a paroxysmal supraventricular tachycardia (PSVT) attack. He took a 1 mg tablet of doxazosin daily for mild hypertension. On admission, his blood pressure was 90/54 mmHg and his heart beat was weak and irregular with a rate of about 220/min. Since atrial fibrillation (Af) was diagnosed on an electrocardiogram (minimum RR interval; 0.22 seconds), direct current shock was performed with 100 joules and 150 joules but conversion to sinus rhythm failed. Sinus rhythm returned spontaneously from Af four hours after taking sildenafil. Since blood pressure was 50/17 mmHg despite the return to sinus rhythm, blood pressure was maintained by dopamine for twelve hours after sinus rhythm returned. The patient underwent catheter ablation for curative therapy and thereafter has not had any further episodes of tachycardia.- - - - - - - - - - ranking = 1.0085526008139keywords = rhythm, hour (Clic here for more details about this article) |
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