scholarly journals Atypical chest pain in a young woman with an interatrial bronchogenic cyst

2021 ◽  
Vol 14 (4) ◽  
pp. e241736
Author(s):  
Essam Saad ◽  
Pooja Singh ◽  
Marc Iskandar
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Sinus Rhythm ◽  
Cardiac Mri ◽  
Bronchogenic Cyst ◽  
Normal Sinus Rhythm ◽  
Pathology Report ◽  
Atypical Chest Pain ◽  
Normal Sinus

A 31-year-old woman presented to the emergency department with atypical retrosternal chest pain and dyspnoea. Investigations initially revealed atrial flutter on her electrocardiogram and an interatrial septal mass on CT angiography of the chest. Additional workup with cardiac MRI and transoesophageal echocardiogram were able to delineate the cardiac mass. Electrophysiology and cardiothoracic surgery were consulted. The mass was excised in the same hospitalisation and the pathology report demonstrated a bronchogenic cyst. After mass excision, the patient chest pain has decreased, and she reverted back to normal sinus rhythm. On further follow-up, her flecainide and metoprolol were stopped.

Myocarditis case associated with Campylobacter jejuni

2018 ◽  
Vol 43 (5) ◽  
pp. 568-570
Author(s):  
Hakan Ayyildiz ◽  
Mehmet Kalayci ◽  
Nadire Cinkilinc ◽  
Mahmut Bozkurt ◽  
Makbule Kutlu Karadag
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Campylobacter Jejuni ◽  
Bacterial Infections ◽  
Troponin I ◽  
Normal Sinus Rhythm ◽  
Cardiac Enzymes ◽  
Normal Sinus ◽  
Anterior Hemiblock ◽  
High Sensitive Troponin

Abstract Objective Myocarditis is an inflammatory disease of the heart caused by various agents and especially enteroviruses, and it is difficult to diagnose and treat. Myocarditis is rarely associated with bacterial infections. Although the most common bacterial infections are Salmonella spp. and Shigella spp., extremely rare cases of Myocarditis due to Campylobacter jejuni are also reported. Patient and methods A 17-year-old male patient with no previous chronic illness was admitted to our emergency department with complaints of abdominal pain, diarrhea, vomiting, and chest pain. He stated that symptoms began after eating a chicken burger a few days ago. Results In the laboratory tests performed, CK-MB and high sensitive Troponin I values were determined as 33.8 IU/L and 1816 ng/L, respectively. Electrocardiogram results revealed left axis left anterior hemiblock in the normal sinus rhythm as well as a ST-T change in the inferior and lateral derivations. Campylobacter jejuni was detected in the stool sample of the patient. Conclusion Myocarditis is one of the rare complications of C. jejuni infection. Bacterial myocarditis should be considered when troponin and cardiac enzymes are elevated in patients admitted to the emergency department with diarrhea and chest pain.

scholarly journals TREMORS MIMICKING ATRIAL FLUTTER IN AN ELDERLY LADY

2022 ◽  
Vol 54 (4) ◽  
pp. 370-372
Author(s):  
Intisar Ahmed ◽  
Hunaina Shahab ◽  
Aamir Hameed Khan
Keyword(s):  
Chest Pain ◽  
Sinus Rhythm ◽  
Hospital Stay ◽  
Atrial Flutter ◽  
Normal Sinus Rhythm ◽  
Correct Diagnosis ◽  
Normal Sinus ◽  
Inappropriate Treatment ◽  
History Of

A 77 -year-old lady with history of hypertension and Parkinson`s disease was admitted with cough and fever and diagnosed as pneumonia. On second day of admission, she started having chest pain, initial ECG was interpreted as atrial flutter. When her ECG was reviewed by a cardiologist, ECG features were found to be consistent with artifacts due to tremors. A repeat 12 leads ECG clearly demonstrated normal sinus rhythm and the patient remained completely asymptomatic throughout the hospital stay. Tremor induced artifacts can be mistaken for arrhythmias. Correct diagnosis is important, in order to avoid inappropriate treatment and unnecessary interventions.

scholarly journals Bucindolol Decreases Atrial Fibrillation Burden in Patients with Heart Failure and the ADRB1 Arg389Arg Genotype

2021 ◽  
Author(s):  
Jonathan P. Piccini ◽  
Christopher Dufton ◽  
Ian A. Carroll ◽  
Jeff S. Healey ◽  
William T. Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Sinus

Background - Bucindolol is a genetically targeted β-blocker/mild vasodilator with the unique pharmacologic properties of sympatholysis and ADRB1 Arg389 receptor inverse agonism. In the GENETIC-AF trial conducted in a genetically defined heart failure (HF) population at high risk for recurrent atrial fibrillation (AF), similar results were observed for bucindolol and metoprolol succinate for the primary endpoint of time to first atrial fibrillation (AF) event; however, AF burden and other rhythm control measures were not analyzed. Methods - The prevalence of ECGs in normal sinus rhythm, AF interventions for rhythm control (cardioversion, ablation and antiarrhythmic drugs), and biomarkers were evaluated in the overall population entering efficacy follow-up (N=257). AF burden was evaluated for 24 weeks in the device substudy (N=67). Results - In 257 patients with HF the mean age was 65.6 ± 10.0 years, 18% were female, mean left ventricular ejection fraction (LVEF) was 36%, and 51% had persistent AF. Cumulative 24-week AF burden was 24.4% (95% CI: 18.5, 30.2) for bucindolol and 36.7% (95% CI: 30.0, 43.5) for metoprolol (33% reduction, p < 0.001). Daily AF burden at the end of follow-up was 15.1% (95% CI: 3.2, 27.0) for bucindolol and 34.7% (95% CI: 17.9, 51.2) for metoprolol (55% reduction, p < 0.001). For the metoprolol and bucindolol respective groups the prevalence of ECGs in normal sinus rhythm was 4.20 and 3.03 events per patient (39% increase in the bucindolol group, p < 0.001), while the rate of AF interventions was 0.56 and 0.82 events per patient (32% reduction for bucindolol, p = 0.011). Reductions in plasma norepinephrine (p = 0.038) and NT-proBNP (p = 0.009) were also observed with bucindolol compared to metoprolol. Conclusions - Compared with metoprolol, bucindolol reduced AF burden, improved maintenance of sinus rhythm, and lowered the need for additional rhythm control interventions in patients with HF and the ADRB1 Arg389Arg genotype.

scholarly journals “Wait and See” Approach to the Emergency Department Cardioversion of Acute Atrial Fibrillation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Brian Doyle ◽  
Mark Reeves
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Routine Care ◽  
Spontaneous Resolution ◽  
Electrical Cardioversion ◽  
Normal Sinus ◽  
Degree Of Satisfaction ◽  
Wait And See

Objective. Acute atrial fibrillation often spontaneously resolves. This study aimed to investigate the outcomes and satisfaction of an evidence-based ED protocol employing a “wait and see” approach.Methods. A prospective observational cohort study of adult patients presenting to the Emergency Department with stable acute atrial fibrillation was performed. Patients were excluded if they were considered to be unstable, need hospitalization, or poor candidates for ED procedural sedation. Routine care was provided on the index visit, and suitable candidates were discharged and asked to return to the ED the following day for possible electrical cardioversion. Outcome measures included spontaneous reversion to sinus rhythm, success of cardioversion, length of stay, adverse event and return visits for AF within 30 days, and patient satisfaction.Results. Thirty five patient encounters were analysed over a 21-month period. Twenty two of the 35 patients (63%) had spontaneous resolution of atrial fibrillation upon presentation for potential cardioversion. All of the remaining patients underwent successful cardioversion to normal sinus rhythm without significant adverse events recorded. No patients required hospitalization. Three patients (9%) returned to the ED within 30 days for recurrence of atrial fibrillation. All patients were reported to be “very satisfied” with this approach.Conclusion. A “wait and see” approach to the ED electrical cardioversion of atrial fibrillation showed that almost two-thirds of patients had spontaneous resolution without requiring cardioversion or observation in the ED or hospital. All patients were successfully reverted to normal sinus rhythm and had a high degree of satisfaction.

scholarly journals TO DETERMINE THE ROLE OF RANOLAZINE FOR RHYTHM CONTROL STRATEGY IN PATIENTS WITH NON- VALVULAR ATRIAL FIBRILLATION- AN OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTER. (RANOVA STUDY)

2020 ◽  
pp. 48-53
Author(s):  
Praveen Shukla ◽  
Awadhesh Kumar Sharma ◽  
Biswajit Majumder ◽  
Pritam Kumar Chatterjee ◽  
Vinay Krishna ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Control Strategy ◽  
Normal Sinus Rhythm ◽  
Rhythm Control ◽  
Normal Sinus ◽  
History Of ◽  
Group A ◽  
Group B

Objectives – Non- valvular atrial fibrillation (NVAF) is the most commonly occurring arrhythmia worldwide .Ranolazine is an emerging drug with a ray of hope in the management of NVAF. This is the first large observational study with longer follow up of one year. Methods - It is a hospital based observational prospective study. A total of 100 patients was recruited for the study .The primary objective was to determine the efficacy of ranolazine in converting NVAF to sinus rhythm & the secondary objective was to study epidemiological aspects of NVAF. Results –After 1 month of follow up conversion to normal sinus rhythm was 12% in group A & 6% in group B (6%), it was not significant statistically (Z=1.48p=0.13). After 6 months, conversion to normal sinus rhythm was increased from 12% to 18% in group A which was preserved at 12 months of follow up and statistically significant and higher than that of group B (6.0%) (Z=2.61p=0.009). In predisposing risk factors & other co-morbidities HTN was present in 61%, obesity together with overweight in 37%, smoking in 44%, history of moderate amount of alcohol intake in 35%, history of CVA/TIA in 13%, DM in 11%, CKD in 4%, CAD in 30%, COPD in 20% and congestive heart failure in 15% of the patients. Conclusion- Ranolazine is an effective option when used for rhythm control strategy in NVAF. HTN is the predominant predisposing risk factor.

Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
Y Ancedy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Tricuspid Regurgitation ◽  
Normal Sinus Rhythm ◽  
Integrated Approach ◽  
Pharmacological Therapy ◽  
Normal Sinus ◽  
Direct Current Cardioversion ◽  
Group A

Abstract Background The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed. Purpose Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus. Methods We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M. Results At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p&lt;0.001 for 2D ED TA diameter; ρ=0.34, p&lt;0.005 for 3D ES RA Vi; ρ=0.33, p&lt;0.005 for 3D ED RV Vi; ρ=0.29, p&lt;0.005 for 3D ES RV Vi). Conclusion Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted. TR Evolution Funding Acknowledgement Type of funding source: None

scholarly journals A perfect refractory electrical storm by acute toxicity of accidental aconitine intake

2021 ◽  
Vol 17 (2) ◽  
Author(s):  
Francesca Menichetti ◽  
Paola Bartolucci ◽  
Maria Luisa Matteucci ◽  
Luigi Gori ◽  
Alessandra Ieri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Direct Current ◽  
Normal Sinus Rhythm ◽  
Correct Diagnosis ◽  
Electrical Storm ◽  
Qrs Complex ◽  
Accidental Ingestion ◽  
Normal Sinus

A 51-years-old male presented with drooling, hematemesis and diarrhea in emergency department after accidental ingestion of homemade aconitine tincture. Examination revealed shock and initial ECG showed atrial fibrillation. The patient suddenly developed a pulseless wide QRS complex tachycardia requiring resuscitation maneuvers. The rhythm varied from monomorphic ventricular tachycardia to torsade de point to ventricular fibrillation. Repeated direct-current cardioversions were unsuccessful. After intravenous electrolyte correction and anti-arrhythmic drugs administration, a last direct-current shock was finally successful. Bradycardia and ventricular excitability persisted over 12 hours with gradual normalization. Patient was discharged in normal sinus rhythm without any medication and on follow-up he was totally asymptomatic. With the increasing popularity of traditional medicine, clinicians should be alerted to the risk of herbal substances with low margins of safety like Aconitum in order to allow correct diagnosis and treatment. The general public should be educated that herbal medicine is not always safe.

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