1/7. Spontaneous pneumomediastinum and myocarditis following Ecstasy use: a case report.Ecstasy is a very popular and widely used party drug with known complications such as agitation, hyperpyrexia, rhabdomyolysis or renal failure. A 16-year-old boy was admitted to our Emergency Department with a spontaneous pneumomediastinum (SPM) after Ecstasy ingestion, complicated by myocarditis. To our knowledge this is the first case described with the combination of Ecstasy ingestion, SPM and myocarditis. Although SPM is well known in inhalation drug users who try to enhance alveolar resorption with repeated valsalva manoeuvres, it is rather rare after the ingestion of party drugs. The probable causative event is the prolonged and excessive dancing in this party drug culture. The course is usually benign, with spontaneous resorption. Emergency physicians should be aware of the risk, especially if a drug user presents with neck emphysema, difficulty in swallowing, and precordial crepitations or thoracic pain. Ecstasy, similarly to cocaine, can induce cardiac symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. The wheezer that wasn't.The expression of cardiac dysfunction in pediatric patients with myocarditis may not be conspicuous. While older children with myocarditis may abruptly present with pleuritic or angina-like pain, infants and toddlers with fulminant disease are unable to verbalize such complaints. Cardiac compromise in preverbal children may only be inferred from variable examination findings that include gallop rhythm, tachycardia, malignant dysrhythmias, murmur, rub, and signs of congestive heart failure. The emergency physician is likely to overlook a cardiac origin for wheezing in a child with a past medical history of asthma. Therapeutic modalities chosen for reactive airway disease may adversely influence the outcome of a patient with myocarditis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Two unusual presentations of acute rheumatic fever.patients with acute rheumatic fever sometimes present with atypical signs and symptoms. In these circumstances, the Jones criterions may not be sufficient to make a clinical diagnosis. We describe here two patients with unusual presentations, highlighting that, both in regions where the disease is endemic, or where it is seen only sporadically, physicians should be more alert and careful in making the diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Lethal enterovirus-induced myocarditis and pancreatitis in a 4-month-old boy.After inconspicuous pregnancy and birth, a 16-year-old mother presented her male baby 5 days later with severe diarrhoea and vomiting. During the following weeks, the child temporarily showed hypotension, hypothermia and increased body temperature, bradyarrythmia with apnoea, continuing diarrhoea, sometimes vomiting and developed signs of pancreatic insufficiency. Due to increasing loss of weight and obviously severe dystrophia, parenteral nutrition had to be initiated. All clinical investigations revealed no underlying disease. Numerous biopsies, mainly from the gastrointestinal tract were taken, but no relevant pathological findings were disclosed. The baby was found lifeless by his mother, 4 months after birth. According to the death certificate, the physicians regarded the lethal outcome as a case of sudden infant death syndrome (SIDS). Histological and immunohistochemical investigations of organ samples revealed signs of myocarditis, pancreatitis and focal pneumonia. Molecularpathological techniques were used to detect enterovirus rna from tissue samples from the myocardium, liver and pancreas. Enteroviral myocarditis with concomitant pancreatitis was determined as cause of death.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. myocarditis presenting as gastritis in children.vomiting and abdominal pain are common pediatric complaints encountered by emergency physicians. The differential diagnosis of abdominal pain is extensive. Herein, we report 2 cases with fatal myocarditis who initially presented with abdominal pain and vomiting. Both cases were presented with abdominal pain, vomiting, and loose stools. On arrival at our emergency department, hypotension, tachycardia, and cyanotic extremities were found. Their serum troponin-I levels were elevated. The echocardiogram demonstrated poor left ventricular performance and a decreased ejection fraction. In both cases, an arrhythmia and a coma developed within hours and were shortly followed by death. The clinical presentations of acute myocarditis are variable, ranging from an initial mild discomfort to acute progressive heart failure, and at times, even death. abdominal pain may be a manifestation of systemic disease, an extra-abdominal lesion, or myocarditis. Although myocarditis associated with abdominal pain or vomiting remains a diagnostic challenge to physicians, it should be considered in the differential diagnosis of children with gastritis and hypotension or who are refractory to rehydration therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/7. A case of carbamazepine overdose with focal myocarditis.An autopsy case of carbamazepine overdose with focal myocarditis is reported. The decedent was a 33-year-old female with a history of schizophrenia and bipolar disorder, who reportedly took 5-day dose of prescribed medications at around midnight. Although she stayed home following the direction of the physician, she was pronounced dead 8h after the intake. At autopsy she was obese, and her face was slightly swollen. The 420 g heart was free of coronary atherosclerosis, and the myocardium had no obvious scars. Both the left and right lungs were markedly congested and edematous. Strong congestion was also noted in the brain and visceral organs. Microscopic examination disclosed focal infiltration of inflammatory cells, most of which were lymphocytes, into the myocardium. In the toxicological analyses, carbamazepine concentration in the blood was 9.9 microg/ml, and other medications were below the toxic levels. It was considered that under the compromised cardiac function due to myocarditis presumably induced by some prescribed medications, and obesity, the carbamazepine overdose deteriorated her condition by triggering critical arrhythmia or congestive heart failure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Acute congestive heart failure in a 55-year-old man. Rheumatic carditis diagnosed by endomyocardial biopsy.We describe a 55-year-old man who presented with acute left ventricular dysfunction and congestive heart failure caused by rheumatic carditis. The diagnosis of rheumatic carditis was established by percutaneous endomyocardial biopsy. Since many physicians may not be familiar with some of the clinical and histopathologic features of rheumatic carditis, we submit this report as a reminder that the disease has not disappeared, should be considered in the differential diagnosis of acute heart failure, and can be diagnosed by endomyocardial biopsy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |