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Hellenic Journal of Cardiology : HJC =... May 2024To evaluate the clinical characteristics, imaging findings, treatment, and prognosis of patients with type A acute aortic syndrome (AAS-A) presenting with shock. To...
OBJECTIVE
To evaluate the clinical characteristics, imaging findings, treatment, and prognosis of patients with type A acute aortic syndrome (AAS-A) presenting with shock. To assess the impact of surgery on this patient population.
METHODS
The study included 521 patients with A-AAS enrolled in the Spanish Registry of Acute Aortic Syndrome (RESA-III) from January 2018 to December 2019. The RESA-III is a prospective, multicenter registry that contains AAS data from 30 tertiary-care hospitals. Patients were classified into two groups according to their clinical presentation, with or without shock. Shock was defined as persistent systolic blood pressure <80 mmHg despite adequate volume resuscitation.
RESULTS
97 (18.6%) patients with A-AAS presented with shock. Clinical presentation with syncope was much more common in the Shock group (45.4% vs 10.1%, p = 0.001). Patients in the Shock group had more complications at diagnosis and before surgery: cardiac tamponade (36.2% vs 9%, p < 0.001), acute renal failure (28.9% vs 18.2%, p = 0.018), and need for orotracheal intubation (40% vs 9.1%, p < 0.001). There were no significant differences in aortic regurgitation (51.6% vs 46.7%, p = 0.396) between groups. In-hospital mortality was higher among patients with shock (48.5% vs 27.4%, p < 0.001). Surgery was associated with a significant mortality reduction both in patients with and without shock. Surgery had an independent protective effect on mortality (OR 0.03, 95% CI (0.00-0.32)).
CONCLUSION
Patients with AAS-A admitted with shock have a heavily increased risk of mortality. Syncope and pericardial effusion at diagnosis are strongly associated with shock. Surgery was independently associated with a mortality reduction in patients with AAS-A and shock.
PubMed: 38729346
DOI: 10.1016/j.hjc.2024.05.005 -
Cureus Apr 2024Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents...
Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents and entrapment of extraocular muscles entrapment with no signs of any soft tissue trauma. A delay in diagnosis can lead to a life-threatening condition known as oculocardiac reflex, characterized by nausea, vomiting, bradycardia, and syncope. Many authors recommend early surgical intervention, but some patients may delay for various reasons. We hereby represent three cases of orbital fracture to prevent long-term persistent diplopia. Depending on the case scenario, two cases were operated on in which an autogenous iliac cortical graft was placed in one patient to prevent postoperative herniation of orbital content, and in one patient, only release of entrapped muscles was done. One patient was managed conservatively with a regular follow-up visit.
PubMed: 38725748
DOI: 10.7759/cureus.57915 -
European Heart Journal. Case Reports May 2024Pulmonary hypertension has been increasingly reported in association with immunotherapy, but generally lacking invasive haemodynamic confirmation in literature. We...
BACKGROUND
Pulmonary hypertension has been increasingly reported in association with immunotherapy, but generally lacking invasive haemodynamic confirmation in literature. We present the first case of pulmonary arterial hypertension following nivolumab confirmed with invasive haemodynamic measurements.
CASE SUMMARY
A 65-year-old male with gastro-oesophageal adenocarcinoma developed progressive dyspnoea with exertion, decreasing exercise tolerance after receiving nivolumab for seven months. He was admitted with acute hypoxaemic respiratory failure after syncope at home. The patient was diagnosed with pulmonary arterial hypertension (PAH) with pre-capillary aetiology with right heart catheterization (RHC): mean pulmonary artery pressure 49 mmHg, pulmonary capillary wedge pressure 7 mmHg, and cardiac index 1.3 L/min/m. Based on serial echocardiograms, the development of PAH appeared to be associated with nivolumab. The patient died of cardiac arrest 3 days after admission.
DISCUSSION
Progressive unexplained dyspnoea after receiving programmed cell death protein 1 monoclonal antibody should prompt clinicians to consider PAH and RHC.
PubMed: 38721254
DOI: 10.1093/ehjcr/ytae222 -
European Heart Journal. Case Reports May 2024Marathon running poses unique cardiovascular challenges, sometimes leading to syncopal episodes. We present a case series of athletes who experienced pre-/syncope during...
BACKGROUND
Marathon running poses unique cardiovascular challenges, sometimes leading to syncopal episodes. We present a case series of athletes who experienced pre-/syncope during the Zurich Marathon 2023, accompanied by elevated cardiac biomarkers.
CASE SUMMARY
Eight athletes (2 females, 6 males) aged 21-35 years, with pre-/syncope and various additional diverse symptoms such as dizziness and palpitations during the (half-)marathon, were admitted to two emergency departments in Zurich, Switzerland. Clinical evaluations included electrocardiogram, echocardiography, telemetry, coronary computed tomography (CT) scans, and cardiac biomarker assessments. High-sensitive troponin T (hs-cTnT) was elevated in all cases at initial assessment and returned to normal at follow-up. All athletes who received CT scans had normal coronary and brain CT results. None of the eight athletes had underlying cardiovascular disease. Renal function normalized post-admission, and neurological symptoms resolved within hours. Creatinine levels indicated transient acute kidney injury. A common feature was inexperience in running, inadequate race preparation, particularly regarding fluid, electrolyte, and carbohydrate intake, along with pacing issues and lack of coping strategies with heat.
DISCUSSION
From a clinician perspective, the case series highlights the challenge in the management of patients with a pre-/syncopal event during strenuous exercise and elevated cardiac biomarkers. Diverse initial symptoms prompted tailored investigations. Adequate training, medical assessments, and awareness of syncope triggers are essential for marathon participants. Caution and pacing strategies are crucial, especially among novices in competitive running. This information is pertinent given the growing popularity of marathon events and prompts a standardized diagnostic approach after these events.
PubMed: 38711684
DOI: 10.1093/ehjcr/ytae202 -
European Heart Journal. Case Reports May 2024The Brugada syndrome (BrS) is an inherited disorder associated with the risk of ventricular fibrillation and sudden cardiac death (SCD). The current main therapy is an...
BACKGROUND
The Brugada syndrome (BrS) is an inherited disorder associated with the risk of ventricular fibrillation and sudden cardiac death (SCD). The current main therapy is an implantable cardioverter-defibrillator (ICD). However, the risk stratification and management of patients remain challenging. Here, we present a case of BrS representative of the pitfalls that clinicians may encounter in the management of Brugada patients in routine clinical practice.
CASE SUMMARY
A 39-year-old man with BrS and recurring syncope was implanted with a subcutaneous ICD (S-ICD) (EMBLEM MRI S-ICD, Boston Scientific). Syncope recurred some months later. Subcutaneous ICD interrogation showed no arrhythmic events, but SMART Pass (high-pass filter) deactivation was noted. A query was sent to Boston Scientific clinical service, unveiling an extremely long asystolic pause as syncope determinant. Subcutaneous ICD was explanted and replaced by conventional single chamber ICD in the pre-pectoral region.
DISCUSSION
Brugada syndrome patients with high-risk features are candidates for ICD implantation to prevent SCD. Recent evidence highlighted that symptomatic patients carry a substantially higher risk compared with asymptomatic ones. Syncope may represent a pivotal symptom in BrS patients, but young patients with Type 1 Brugada pattern may experience syncope other than from tachyarrhythmias. Subcutaneous ICD is an advisable option in young ICD recipients to avoid lifetime complication related to standard transvenous systems. However, S-ICD lacks pacing capabilities and, therefore, is not indicated when an anti-bradycardia system is needed. The diagnostic workup of syncope in Brugada patients may be ineffective in elucidating the underlying aetiology whose understanding is essential to offer a personalized therapeutic approach.
PubMed: 38711682
DOI: 10.1093/ehjcr/ytae201 -
JACC. Case Reports Jun 2024A 77-year-old female patient with multiple pacemaker leads experienced hypotension and syncope during right heart catheterization. Imaging studies revealed a stenotic...
A 77-year-old female patient with multiple pacemaker leads experienced hypotension and syncope during right heart catheterization. Imaging studies revealed a stenotic inferior vena cava with superior vena cava obstruction and well-developed retrograde collateral vessels, suggesting that balloon obstruction of the sole venous return site caused low cardiac output leading to syncope.
PubMed: 38707775
DOI: 10.1016/j.jaccas.2024.102347 -
Cureus Apr 2024is a parasite that invades erythrocytes inducing hemolysis. It presents with a variety of non-specific symptoms that can be mistaken for other illnesses. A rare...
is a parasite that invades erythrocytes inducing hemolysis. It presents with a variety of non-specific symptoms that can be mistaken for other illnesses. A rare manifestation of babesiosis is splenic rupture, generally seen in a younger, healthier population with low parasitemia, which can be treated conservatively depending on the grade and clinical condition. This case describes an elderly male with multiple comorbidities who is an avid hiker in the Northern Ohio and Western Pennsylvania areas presenting with a spontaneous American Association for the Surgery of Trauma (AAST) grade V splenic rupture requiring emergent splenectomy. Subsequent re-admission was required to diagnose babesiosis, which was managed with pharmacotherapy and plasmapheresis. In lieu of other identifiable etiologies, patients with atraumatic splenic rupture in an endemic area should be screened for possible parasitic infections.
PubMed: 38707037
DOI: 10.7759/cureus.57659 -
Clinical Medicine Insights. Case Reports 2024Kartagener's syndrome, a rare autosomal recessive genetic disorder, is characterized by primary ciliary dyskinesia (PCD), resulting in defective cilia function in the...
BACKGROUND
Kartagener's syndrome, a rare autosomal recessive genetic disorder, is characterized by primary ciliary dyskinesia (PCD), resulting in defective cilia function in the respiratory tract and fallopian tubes.
CASE PRESENTATION
This case report discusses a 23-year-old female with Kartagener's syndrome, bronchiectasis, and cardiac involvement, who presented with shortness of breath, cough, and syncope. Notably, she received home oxygen therapy but became exhausted, leading to loss of consciousness. Clinical examination revealed prominent heart sounds and abnormal lung findings. Laboratory results indicated leukocytosis, and an ECG confirmed dextrocardia and cardiac abnormalities. Doppler studies identified mitral and tricuspid regurgitation along with severe pulmonary arterial hypertension. Antibiotics were administered for coagulase-negative Staphylococcus infection. The patient improved with a treatment regimen, including oxygenation and nebulization. Regular follow-up and patient education were emphasized.
CONCLUSION
This case underscores the complexity of Kartagener's syndrome and the importance of a multidisciplinary approach in managing its respiratory and cardiac manifestations.
PubMed: 38706639
DOI: 10.1177/11795476241251940 -
Journal of Surgical Case Reports May 2024Large mediastinal lipomas are rare. Complete surgical resection can be difficult due to the intricate anatomy in the mediastinum. We report the case of a 75-year-old man...
Large mediastinal lipomas are rare. Complete surgical resection can be difficult due to the intricate anatomy in the mediastinum. We report the case of a 75-year-old man with worsened retrosternal pressure, decline in performance and syncope episodes. Computed tomography revealed a large retrocardiac low-attenuated mediastinal lesion measuring 10 × 8 cm, compressing the left atrium and pulmonary veins bilaterally. Surgical exploration was achieved through a right anterolateral thoracotomy with a successful en bloc resection without any intraoperative complications. The total operation time was 185 min with a total blood loss of <250 ml. Stand-by extracorporeal life support was present throughout the procedure, but its use was not required. The postoperative course was uneventful. The pathological examination revealed a mature mediastinal lipoma without any evidence of malignancy. In the 12-month control the patient was completely free of symptoms and in a good general condition.
PubMed: 38706489
DOI: 10.1093/jscr/rjae273 -
Ugeskrift For Laeger Apr 2024Spinal anaesthesia is considered an effective and safe method for providing pain relief during procedures below the waist. However, in a small subset of patients,...
Spinal anaesthesia is considered an effective and safe method for providing pain relief during procedures below the waist. However, in a small subset of patients, life-threatening vasovagal reactions may develop leading to severe bradycardia and hypotension or ultimately asystole and complete circulatory collapse. Early recognition and prompt treatment of this condition can be lifesaving as illustrated in this case report where the patient developed asystole for ten seconds shortly after placing the spinal anaesthetic.
Topics: Humans; Anesthesia, Spinal; Bradycardia; Heart Arrest; Syncope, Vasovagal
PubMed: 38704723
DOI: 10.61409/V11230702