1/25. Treatment of advanced atrioventricular block with beta-adrenergic blockade therapy.A 26-year old woman, who experienced syncope associated with advanced AV block, was referred for further evaluation. Electrophysiological study showed normal SA and AV node physiology. syncope associated with advanced AV block on the electrocardiogram was induced by head-up tilt test. Oral propranolol therapy completely prevented the AV block and syncope induced by head-up tilt. The physician should be aware of advanced AV block associated with neurocardiogenic syncope, especially before permanent - pacemaker therapy is considered. The head-up tilt test is a useful diagnostic tool for an etiology of paroxysmal AV block.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/25. Ventricular tachycardia in an adolescent with arrhythmogenic right ventricular dysplasia.We report the case of an adolescent boy with exertional syncope and ventricular tachycardia caused by arrhythmogenic right ventricular dysplasia. diagnosis was determined by transthoracic echocardiography and definitive management with an automatic internal cardiac defibrillator. Emergency physicians must be aware of this serious but treatable cause of adolescent exertional syncope.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/25. Case report of an aviator with a single episode of altered consciousness due to hymenoptera hypersensitivity.This case is presented to: a) emphasize the importance of a careful history, including interviewing witnesses and considering a complete differential diagnosis when evaluating aviators with a history of an episode of altered consciousness; and b) demonstrate an appropriate use of literature review, subspecialty consultations, and U.S. air Force Aeromedical Guidelines to arrive at an aeromedical disposition for an unusual case. A military aviator experienced an episode of syncope/near syncope, initially felt to be caused by a primary seizure or an arrhythmia. Subsequent thorough evaluation included careful history taking, extensive interviewing of witnesses, subspecialty consultations, review of appropriate literature and deliberation by a board of experienced military aeromedical physicians. Cardiac and neurologic diagnoses were considered but careful history and witness interviews revealed that the aviator had sustained an insect sting just minutes before the episode. Evaluation by allergy specialists, including skin testing, identified him as being hypersensitive to hymenoptera stings. A diagnosis of hypersensitivity reaction to a hymenoptera sting was determined to be the cause of the altered consciousness episode. review of the literature revealed that immunotherapy for hymenoptera sensitivity reduces the risk of future anaphylaxis to only 1-2% after maintenance dose is achieved. Consideration of the risk of future events and the success of rush immunotherapy resulted in a recommendation for a waiver to return the aviator to unrestricted flying duties. The importance of diligent history taking must never be forgotten. In this aviator it led to the correct diagnosis and definitive therapy. In addition, appropriate consideration of the literature and knowledge of outcome rates allowed a return to unrestricted flying for this aviator. If the original diagnosis of seizure or arrhythmia had been accepted, this aviator would have been disqualified without waiver and a valuable flying asset would have been lost.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/25. syncope caused by nonsteroidal anti-inflammatory drugs and angiotensin-converting enzyme inhibitors.A 85-year-old woman with diabetes mellitus and prior myocardial infarction was transferred to the emergency room with loss of consciousness due to marked bradycardia caused by hyperkalemia. The T wave during right ventricular pacing was tall and tent-shaped while the concentration of serum potassium was high, and its amplitude during pacing was decreased after correction of the serum potassium level. Simultaneously with the correction, normal sinus rhythm was restored. The cause of hyperkalemia was considered to be several doses of loxoprofen, a nonsteroidal anti-inflammatory drug (NSAID), prescribed for her lumbago by an orthopedic specialist, in addition to the long-term intake of imidapril, an angiotensin-converting enzyme inhibitor (ACEI), prescribed for her hypertension by a cardiologist. This case warns physicians that the combination of NSAID and ACEI can produce serious side effects in aged patients who frequently suffer from hypertension, diabetes mellitus, ischemic heart disease, and degenerative joint disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/25. arrhythmogenic right ventricular dysplasia. An illustrated review highlighting developments in the diagnosis and management of this potentially fatal condition.arrhythmogenic right ventricular dysplasia is an inherited, progressive condition. Characterised by fatty infiltration of the right ventricle, it frequently results in life threatening cardiac arrhythmias, and is one of the important causes of sudden cardiac death in the young. There are characteristic electrocardiographic and echocardiographic features that all physicians need to be aware of if we are to reduce these occurrences of premature death. diagnosis with magnetic resonance imaging is discussed along with current treatment options.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/25. brugada syndrome as the cause of syncope in a 49-year-old man.We report the case of a 49-year-old man in whom a diagnosis of brugada syndrome was made after he presented to the emergency department for evaluation of a syncopal episode. The diagnosis was made by ECG changes, after the characteristic findings of peculiar downsloping ST-segment elevation in leads V(1) and V(2) and QRS morphology resembling a right bundle branch block were identified. Emergency physician recognition of this syndrome and its ECG findings is essential, because without treatment the incidence of sudden cardiac death in these patients is high.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/25. giant cell arteritis. Episodes of syncope add complexity to an unusual presentation.GCA presents in various forms, creating a diagnostic conundrum for the treating physician. Evaluation requires extensive medical examination, testing, and imaging to rule out other conditions. Compared with the process of diagnosing GCA, treating it is relatively straightforward. Most patients show significant improvement with corticosteroid therapy. Our patient presented with syncope, which also has numerous causes. Detailed testing confirmed a positional trigger for her syncope in the absence of hemodynamic disturbances. She responded promptly to corticosteroid therapy. We speculate that flow-limiting stenosis in the vertebrobasilar system may have caused her symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/25. brugada syndrome: an unusual cause of convulsive syncope.A patient who presented with a new apparent seizure was found to have abnormal electrocardiographic findings, with classic features of the brugada syndrome. He had spontaneous episodes of nonsustained ventricular tachycardia, easily inducible ventricular fibrillation at electrophysiological study in the absence of structural heart disease, and a negative neurological evaluation. These findings suggested that sustained ventricular arrhythmias known to be associated with the brugada syndrome and resultant cerebral hypoperfusion, rather than a primary seizure disorder, were responsible for the event. patients with the brugada syndrome often present with sudden death or with syncope resulting from ventricular arrhythmias. In consideration of its variability in presentation sometimes mimicking other disorders, primary care physicians and internists should be aware of its often transient electrocardiographic features.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/25. Adverse reaction characterized by chest pain, shortness of breath, and syncope associated with verteporfin (visudyne).PURPOSE: To report a serious adverse reaction associated with verteporfin infusion. DESIGN: Observational case report. methods: Case report of a single individual undergoing photodynamic therapy (PDT) with verteporfin. RESULTS: A 77-year-old man with long-standing asymptomatic atrial fibrillation, but no known coronary artery disease experienced severe chest and neck pain, shortness of breath, and syncope while undergoing a fourth photodynamic therapy (PDT) treatment with verteporfin. This infusion had been preceded by three prior infusions; the first two were uneventful, and the third was associated with milder, but similar symptoms. Evaluation demonstrated that the chest pain was noncardiac in origin. CONCLUSION: As verteporfin continues to be used around the world, physicians must be alert to the possibility of serious adverse side effects associated with its use.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/25. The brugada syndrome.brugada syndrome describes the syndrome of sudden cardiac death in the setting of the following electrocardiographic findings: right bundle branch block pattern with ST-segment elevation in the right precordial leads. The right bundle branch block may be incomplete while the ST segment elevation is minimal. The electrocardiographic findings are not constant. patients suspected of having brugada syndrome should be promptly referred for electrophysiological testing and treatment. Rapid referral and placement of an implantable cardioverter defibrillator (ICD) is associated with an excellent prognosis, whereas failure to diagnose this condition is associated with a high risk for sudden death. Therefore, it is imperative that all emergency physicians be familiar with the typical ECG manifestations of brugada syndrome. Three illustrative cases are presented with a review of the syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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