scholarly journals COVID-19 induced ventricular tachycardia storm unmasking a clinically silent cardiomyopathy: a case report

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Saibal Mukhopadhyay ◽  
Abhimanyu Uppal ◽  
Jamal Yusuf ◽  
Ghazi Muheeb ◽  
Rupesh Agarwal
Keyword(s):  
Emergency Department ◽  
Ventricular Tachycardia ◽  
Troponin T ◽  
Past History ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Rt Pcr ◽  
Ventricular Premature Contraction ◽  
Multiple Organs ◽  
Direct Current Cardioversion ◽  
History Of

Abstract Background Coronavirus disease (COVID-19) is a systemic illness characterized by raging impact of cytokine storm on multiple organs. This may trigger malignant ventricular arrhythmias and unmask a clinically silent cardiomyopathy. Case summary A 57-year-old gentleman, known case of hyperthyroidism and diabetes, was referred to our emergency department with history of two ventricular tachycardia (VT) episodes requiring direct current cardioversion in last 3 h followed by another episode in our emergency department that was cardioverted. There was no past history of cardiac illness. His 12-lead electrocardiogram (during sinus rhythm) along with screening echocardiography suggested Arrhythmogenic right ventricular cardiomyopathy (ARVC). He was coincidentally found to be COVID-19 positive by reverse transcription-polymerase chain reaction (RT-PCR) as part of our routine screening. However, he had no fever or respiratory complaints. We noted raised systemic inflammatory markers and cardiac troponin T which progressively increased over the next 4 weeks paralleled by an increase in ventricular premature contraction burden and thereafter started decreasing and returned to baseline by 6th week when the patient became COVID-19 negative by RT-PCR. Subsequently, a single-chamber automated implantable cardioverter-defibrillator implantation was done following which there was a transient increase in these biomarkers that subsided spontaneously. The patient is asymptomatic during 6 weeks of follow-up. Discussion COVID-19-associated cytokine surge triggering VT storm and unmasking a clinically silent ARVC has not yet been reported. The case highlights a life-threatening presentation of COVID-19 and indicates a probable link between inflammation and arrhythmogenicity.

scholarly journals Problem-Based Review: Paracetamol Overdose

2011 ◽  
Vol 10 (4) ◽  
pp. 212-215
Author(s):  
Tom Heaps ◽  
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Past History ◽  
Previous History ◽  
Past Medical History ◽  
Minute Period ◽  
Normal Diameter ◽  
History Of ◽  
Self Harm ◽  
History Of Depression

A 29-year old male presents to the emergency department 1h after an overdose of cocodamol. He admits to taking approximately 60 x 8/500mg tablets, with alcohol, over a 20 minute period. He has a past history of depression, treated by his GP with citalopram 20mg OD. He has no previous history of deliberate self-harm. His past medical history is otherwise unremarkable and he is not on any additional medications. He drinks approximately 40 units of alcohol per week. Physical examination is unremarkable, his pupils are normal diameter and his Glasgow Coma Scale is 15. He weighs 82kg.

scholarly journals Do not attempt resuscitation orders at the emergency department of a teaching hospital

2017 ◽  
Vol 15 (4) ◽  
pp. 409-414 ◽  
Author(s):  
Cássia Regina Vancini-Campanharo ◽  
Rodrigo Luiz Vancini ◽  
Marcelo Calil Machado Netto ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Meiry Fernanda Pinto Okuno ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiopulmonary Resuscitation ◽  
Teaching Hospital ◽  
Past History ◽  
Advanced Age ◽  
Fisher Exact Test ◽  
Resuscitation Orders ◽  
Cross Sectional ◽  
Initial Rhythm ◽  
History Of

ABSTRACT Objective: To identify factors associated with not attempting resuscitation. Methods: A cross-sectional study conducted at the emergency department of a teaching hospital. The sample consisted of 285 patients; in that, 216 were submitted to cardiopulmonary resuscitation and 69 were not. The data were collected by means of the in-hospital Utstein Style. To compare resuscitation attempts with variables of interest we used the χ2 test, likelihood ratio, Fisher exact test, and analysis of variance (p<0.05). Results: No cardiopulmonary resuscitation was considered unjustifiable in 56.5% of cases; in that, 37.7% did not want resuscitation and 5.8% were found dead. Of all patients, 22.4% had suffered a previous cardiac arrest, 49.1% were independent for Activities of Daily Living, 89.8% had positive past medical/surgical history; 63.8% were conscious, 69.8% were breathing and 74.4% had a pulse upon admission. Most events (76.4%) happened at the hospital, the presumed cause was respiratory failure in 28.7% and, in 48.4%, electric activity without pulse was the initial rhythm. The most frequent cause of death was infection. The factors that influenced non-resuscitation were advanced age, history of neoplasm and the initial arrest rhythm was asystole. Conclusion: Advanced age, past history of neoplasia and asystole as initial rhythm were factors that significantly influenced the non-performance of resuscitation. Greater clarity when making the decision to resuscitate patients can positively affect the quality of life of survivors.

scholarly journals Routine pre admission laboratory screening investigations in aggressive patients who require sedation in the emergency department – necessary or unnecessary

2009 ◽  
Vol 15 (3) ◽  
pp. 5
Author(s):  
Shamima Saloojee
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Physical Examination ◽  
Psychiatric Illness ◽  
Past History ◽  
Behavioural Control ◽  
Full Blood Count ◽  
Laboratory Screening ◽  
History Of ◽  
Laboratory Investigations

<p><strong>Background</strong>: The triage of aggressive patients who require sedation for behavioural control in the emergency department (ED) at our hospitals is delayed because the results of mandatory screening laboratory investigations to exclude a general medical condition (GMC) must be available prior to a psychiatric referral. The monitoring of these sedated patients in the ED is the problem.</p><p><strong>Objective</strong>: The primary objective of this study was to determine the value of the results of routine pre-admission laboratory screening investigations in the differentiation of a medical from a psychiatric cause of aggression in consecutive aggressive patients who required sedation in the EDs at King Edward V111 and Addington Hospitals. Specific objectives were to determine if there was an association between a history of past psychiatric illness, the physical examination, the results of laboratory screening investigations and the cause of the aggression.</p><p><strong>Methods</strong>: a retrospective chart review of 339 consecutive aggressive patients who required intravenous or intramuscular sedation for behavioural control in the EDs of Addington and King Edward V111 Hospitals in Kwa Zulu Natal (KZN) was conducted from 01 January 2006 to 31 December 2006. Patients who required oral or no sedation were excluded from the study. <strong></strong></p><p><strong>Results:</strong> 82 (24.2%) of the 339 patients in the study had a medical cause for the aggression .40 (11.7%) of these had no previous medical history. Overall the yield of clinically significant results from laboratory investigations was 9.6%. No past history of psychiatric illness, physical examination, the Full Blood Count (FBC), Urea and Electroloyte estimation (U&amp;E) and Random Blood Glucose (RBG) had sensitivities of 28%, 63%, 57%, 40% and 21% respectively for the identification of a GMC causing the aggression. The variables that remained significantly associated with a causal GMC were an abnormal physical examination only (OR 42.151), an abnormal FBC (OR 2.363),an abnormal U &amp; E (OR 3.531) and no past history of mental illness combined with an abnormal physical examination (OR 277.442). A previous history of a mental illness only was not significantly associated with the cause of aggression. These are adjusted odds ratios, ie they are independent of the effects of the other variables.</p><p><strong> Conclusion:</strong> The high rate of a medical cause for the aggressive behaviour and the overall yield from screening laboratory investigations emphasize the need for mandatory screening to exclude a GMC in the EDs of our hospitals. Aggressive patients with a documented past psychiatric history and a normal physical examination can be referred for a psychiatric assessment prior to the results of routine laboratory investigations becoming available.</p>

scholarly journals Clinical and electrocardiographic profile of patients presenting with acute coronary syndrome in emergency department in a Tertiary Care Hospital.

2020 ◽  
Vol 27 (08) ◽  
pp. 1669-1674
Author(s):  
Zahid Mahmood ◽  
Tariq Feroze Khawaja ◽  
Anjum Iqbal ◽  
Abdul Rashid Khan ◽  
Naveed Arshad
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Chest Pain ◽  
Family History ◽  
Troponin T ◽  
Base Line ◽  
Care Hospital ◽  
Blood Samples ◽  
Coronary Syndrome ◽  
History Of

Objectives: To assess the clinical characteristics and diagnosis of ACS for timely, management and further prevention from coronary events. Study Design: Cross sectional study. Setting: Emergency Department (ED) of Punjab Institute of Cardiology (PIC) Lahore. Period: November 2017 to January 2018. Material & Methods: Included 170 diagnosed patients of ACS of both sexes presenting within approximately four hours of symptoms. At presentation ECG and initial blood samples were taken from all patients for base line and Troponin T estimation. All the patients included in the study were properly examined and complete history was taken. Blood samples of patients for diagnosis of NSTEMI were also drawn at 8hrs of arrival. The patients were categorized into STEMI, NSTEMI and UA on the basis of history, ECG and cardiac Troponin T. Results were analyzed statistically. A p-value ≤ 0.05 was considered statistically significant. Results: A total of 170 patients with established diagnosis of ACS were included. The mean age of the patients was 56 years. There was a very strong male predominance (81.76%). The major modifiable risk factors were hypertension (54.71%) and smoking (35.88%), followed by hyperlipidemia (35.29%) and diabetes (32.35%). A previous history of IHD in patients and family history of IHD were equally present (37.65%). A large proportion of patients belonged to middle class (54.12%) and lower (41.18%). Typical pain chest pain was present in 90% and majority of patients enrolled in this study had a diagnosis of myocardial infarction 77.05% and the remainder had unstable angina. We found a higher percentage of ST elevation MI in the patients with MI (84.73%), majority had anterior AMI. Of all patients, 1.77% expired during hospital stay. Conclusion: The majority of ACS patients in our country are male with STEMI. The major risk factors are hypertension, family history of IHD, smoking, hyperlipidemia and diabetes. 90% patients present with typical chest pain while remaining 10% atypical symptoms which must be of prime consideration to assess ACS.

scholarly journals Missed Registration of Disease Codes for Pediatric Anaphylaxis at the Emergency Department

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Byungho Choi ◽  
Sun Hyu Kim ◽  
Hyeji Lee
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Past History ◽  
Gastrointestinal Symptoms ◽  
University Hospital ◽  
Future Research ◽  
Hospital Emergency ◽  
Steroid Use ◽  
History Of ◽  
The University

Background. It is important to register anaphylaxis codes correctly to study the exact prevalence of anaphylaxis. The purpose of this study was to analyze the clinical characteristics and disease codes of inaccurately registered groups in pediatric anaphylaxis patients. Methods. This study reviewed the medical records of all pediatric patients who presented to the university hospital emergency department over a 5-year period. Study subjects were divided into 2 groups: the accurate group, including those registered under anaphylaxis codes, and the inaccurate coding group, including those registered under other codes. Results. From a total of 79,676 pediatric patients, 184 (0.23%) had anaphylaxis. Of these, 23 (12.5%) and 161 (87.5%) patients were classified to the accurate and inaccurate coding groups, respectively. Average age, time from symptom onset to emergency department presentation, past history of allergy, and penicillin and cephalosporin as causes of anaphylaxis differed between the 2 groups. Cardiovascular (39.1% vs. 5.6%, p=0.001) and respiratory symptoms (65.2% vs. 42.2%, p=0.038) manifested more frequently in the accurate group, while gastrointestinal symptoms (68.3% vs. 26.1%, p=0.001) were more frequently observed in the inaccurate coding group. Fluid administration (82.6% vs. 28.0%, p=0.001), steroid use (60.9% vs. 23.0%, p=0.001), and epinephrine use (65.2% vs. 13.0% p=0.001) were more common treatments for anaphylaxis in the emergency department in the accurate group. Anaphylaxis patients with cardiovascular symptoms, steroid use, and epinephrine use were more likely to be accurately registered with anaphylaxis disease codes. Conclusions. In the case of pediatric anaphylaxis, more patients were registered inaccurately under other allergy-related codes and simple symptom codes, rather than under anaphylaxis codes. Therefore, future research on anaphylaxis should consider inaccurately registered anaphylactic patients, as shown in this study.

Implantable cardiac defibrillator events in patients with arrhythmogenic right ventricular cardiomyopathy

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318415
Author(s):  
Olgierd Woźniak ◽  
Karolina Borowiec ◽  
Marek Konka ◽  
Alicja Cicha-Mikołajczyk ◽  
Andrzej Przybylski ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
Right Ventricle ◽  
Cardiac Death ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Ventricular Cardiomyopathy ◽  
Icd Implantation ◽  
Right Ventricle Dysfunction ◽  
History Of

ObjectiveArrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of sudden cardiac death. Optimal risk stratification is still under debate. The main purpose of this long-term, single-centre observation was to analyse predictors of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) interventions in the population of patients with ARVC with a high risk of life-threatening arrhythmias.MethodsThe study comprised 65 adult patients (median age 40 years, 48 men) with a definite diagnosis of ARVC who received ICD over a time span of 20 years in primary (40%) or secondary (60%) prevention of sudden cardiac death. The study endpoints were first appropriate and inappropriate ICD interventions (shock or antitachycardia pacing) after device implantation.ResultsDuring a median follow-up of 7.75 years after ICD implantation, nine patients died and six individuals underwent heart transplantation. Appropriate ICD interventions occurred in 43 patients (66.2%) and inappropriate ICD interventions in 18 patients (27.7%). Multivariable analysis using cause-specific hazard model identified three predictors of appropriate ICD interventions: right ventricle dysfunction (cause-specific HR 2.85, 95% CI 1.56 to 5.21, p<0.001), age <40 years at ICD implantation (cause-specific HR 2.37, 95% CI 1.13 to 4.94, p=0.022) and a history of sustained ventricular tachycardia (cause-specific HR 2.55, 95% CI 1.16 to 5.63, p=0.020). Predictors of inappropriate ICD therapy were not found. Complications related to ICD implantation occurred in 12 patients.ConclusionsRight ventricle dysfunction, age <40 years and a history of sustained ventricular tachycardia were predictors of appropriate ICD interventions in patients with ARVC. The results may be used to improve risk stratification before ICD implantation.

scholarly journals Calcific Pericarditis

2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Ben J. Wilson MD
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Clinical Examination ◽  
Past History ◽  
Vital Signs ◽  
Shortness Of Breath ◽  
History Of ◽  
Jugular Venous Distension ◽  
Pedal Edema

An 84-year-old woman presented to the emergency department with progressive shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and fatigue. She had a past history of atrial fibrillation and was taking digoxin. Clinical examination revealed normal vital signs, 6 cm of jugular venous distension with Kussmaul’s sign, a pericardial knock, and pedal edema.

scholarly journals Using local epidemiology to make a difficult diagnosis: a case of blastomycosis

CJEM ◽  
2005 ◽  
Vol 7 (03) ◽  
pp. 171-173 ◽  
Author(s):  
Edward W. Kesselman ◽  
Sean Moore ◽  
John M. Embil
Keyword(s):  
Emergency Department ◽  
Bacterial Pneumonia ◽  
Past History ◽  
Empiric Therapy ◽  
Mantoux Test ◽  
Gram Stain ◽  
Difficult Diagnosis ◽  
Northwestern Ontario ◽  
High Incidence ◽  
History Of

ABSTRACT An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss. His symptoms were worsening despite antibiotic treatment for presumed bacterial pneumonia. His past history included work as a seasonal labourer clearing brush. He was not hypoxic on room air, but his chest radiograph revealed a miliary pattern and bilateral infiltrates. A Mantoux test for tuberculosis was non-reactive, and the sputum gram stain was unremarkable. Empiric therapy was initiated for blastomycosis and the diagnosis was confirmed with a calcofluor stain of the sputum. Although blastomycosis is rare in most regions in North America, there is an unusually high incidence of blastomycosis in Northwestern Ontario. This case highlights the intolerance and utility of knowledge of the local epidemiology in establishing difficult diagnoses of regional importance, such as fungal pneumonias.

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