1/13. Some hazards of invasive cardiology.Since the introduction of cardiac catheterization by Andre Cournand and Dickinson Richards, the valuable diagnostic and therapeutic device has encouraged many action-minded physicians to use cardiac catheterization to develop a new specialty, invasive cardiology. The data to be presented here derive from a catastrophe that occurred during an invasive treatment of a 54-year-old man who had experienced an ordinary myocardial infarction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. 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) |
3/13. Deaths due to hunger strike: post-mortem findings.hunger strike is described as voluntary refusal of food and/or fluids. Prolonged starvation may produce many adverse events including even death in rare circumstances. Here, we present three fatal cases (all males, 25-38 years) died from hunger strike. In all corpses, obvious muscle wasting with reduced subcutaneous and internal fat deposits, and atrophy in some organs were demonstrated at autopsy. The extraordinary long starvation period before death could presumably be linked to the thiamine uptake in this period, which had been discontinued by all subjects before the death occurred. Prolonged caloric deficiency with subsequent complications such as multiple organ failure, severe sepsis and ventricular fibrillation could account as major causes of death in these subjects. The competence of the physicians working with hunger strikers about the processes and potential problems is of great importance since they have to acknowledge about them to their patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. Prehospital thrombolysis perfomed by a ship's nurse with on-line physician consultation.Prehospital thrombolysis for acute ST-elevation myocardial infarction (STEMI) has been shown to improve recovery from myocardial function. We describe prehospital thrombolytic treatment in two patients suffering from STEMI complicated by ventricular fibrillation (VF) on a passenger ship. The importance of a functioning Emergency Medical Service (EMS) system providing guidance for paramedical personnel is discussed briefly. Both our patients survived and returned back to normal life. It is concluded that EMS physician guided prehospital thrombolytic treatment may offer an important therapeutic option for nurses or paramedics in locations out of reach of ordinary EMS services.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
5/13. Automatic impedance monitoring and patient alert feature in implantable cardioverter defibrillators: being alert for the unexpected!Recent advances in implantable cardioverter defibrillator (ICD) technology have enabled implementation of an automatic monitoring feature in ICDs that provides daily measurements of several technical parameters such as battery status, pacing, and high-voltage impedance. The system alerts the patient with an audible alarm to contact the physician in case the measured parameters are not within normal limits. Early detection of intermittent and potentially serious complications justifies routine use of this feature. This report describes a patient with an ICD who died suddenly due to ventricular fibrillation, which was not appropriately treated by the device. The cause of device malfunction was most likely an intermittent lead fracture that was not detected by the automatic impedance monitoring and alert feature of this device. Based on these data, potential benefits and theoretical pitfalls of automatic impedance monitoring and alert features are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. Pacemaker spikes misleading the diagnosis of ventricular fibrillation.Pacemakers are used more and more in modern cardiology, because of the increasing age of patients and the increasing number of cases of congestive heart failure treated with biventricular stimulation. Twelve lead ECG traces of electro-stimulated patients normally can be interpreted correctly, but in emergency circumstances where only a three lead ECG trace is available (i.e. the usual monitoring setting in the pre-hospital arena or intensive care unit) recognition of the underlying baseline rhythm may be difficult. The case described illustrates how differentiation between true asystole and fine ventricular fibrillation in the presence of some confounding elements (e.g. pacemaker meditated spikes) can be challenging for the physician and life-threatening for the patient. Therefore, after selecting the best diagnostic ECG trace, direct current defibrillation should be used in the presence of a persistent but uncertain cardiac rhythm, even if it may be thought to be asystole or pulse-less electrical activity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. brugada syndrome, manifested by propafenone induced ST segment elevation.We report a case of a 43 year old man who was diagnosed with brugada syndrome after propafenone administration for chemical cardioversion of new onset atrial fibrillation. brugada syndrome has been described in the medical literature and is thought to be responsible for the majority of sudden cardiac deaths in patients without ischaemic heart disease. This syndrome has not yet been extensively discussed in the emergency medicine literature despite its importance. Emergency physicians should consider brugada syndrome in patients who present to the emergency department with right bundle branch block and ST segment elevation in the right precordial leads, which is the classic electrocardiographic pattern of this syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. Short QT syndrome: a case report and review of literature.The short QT syndrome has been recently recognised as a genetic ion channel dysfunction. This new clinical entity is associated with an incidence of sudden cardiac death, syncope, and atrial fibrillation in otherwise healthy individuals. The distinctive ECG pattern consists of an abnormally short QT interval, a short or even absent ST segment and narrow T waves. A 30-year-old resuscitated woman with short QT syndrome is described together with an example of the classic ECG characteristics. A short-coupled variant of torsade de pointes was reveal on Holter recordings. The implantable cardioveter defibrillator seems to be the therapy of choice to prevent from sudden cardiac death. quinidine proved to be efficient in prolonging the QT interval and rendering ventricular tachyarrhythmias non-inducible in patients with a mutation in KCNH2 (HERG). Our preliminary data suggest amiodarone combined with beta-blocker may be helpful in treating episodes of polymorphic ventricular tachycardia for patients with an unknown genotype. Because the short QT syndrome often involves young patients with an apparently normal heart, it is imperative for physicians to recognize the clinical features of the short QT syndrome in making a timely correct diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. Mineral spirits inhalation associated with hemolysis, pulmonary edema, and ventricular fibrillation.A previously healthy 42-year-old woman developed severe dyspnea, chest discomfort, and malaise several hours after prolonged exposure to concentrated vapors from mineral spirits. On the way to the hospital, she sustained a cardiopulmonary arrest; on arrival several minutes later, she was found to be in ventricular fibrillation and was resuscitated. Her hospital course included slowly resolving cardiac abnormalities, amnesia, noncardiogenic pulmonary edema, abrupt hemolytic anemia, sustained rhabdomyolysis, and other metabolic abnormalities. It is highly probable that this syndrome represented acute and near-lethal toxicity caused by the inhalational exposure to the petroleum distillate known as mineral spirits. It is important that physicians be aware of this syndrome in order to recognize it on presentation and to warn patients of the risk of such toxic exposure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. Polymorphic ventricular tachycardia.The case of a patient with torsade de pointes in the setting of congenital complete heart block is described. Lack of recognition of this polymorphic ventricular tachycardia resulted in therapy that potentiated the dysrhythmia. After correct recognition, and directed therapy, the patient responded appropriately. The clinical settings, recognition, and management options available for torsade de pointes are discussed to familiarize the emergency physician with this important and unique dysrhythmia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |