scholarly journals Unique ECG Findings in Acute Pulmonary Embolism: STE with Reciprocal Changes and Pathologic Q Wave

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Amanda Grant-Orser ◽  
Brennan Ballantyne ◽  
Wael Haddara
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Case Report ◽  
Acute Pulmonary Embolism ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Presumptive Diagnosis ◽  
Coronary Syndrome ◽  
First Case ◽  
Pulmonary Angiogram

A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1–V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction. His ongoing metabolic acidosis and dependence on an intra-aortic balloon pump, despite adequate cardiac output, prompted a CT pulmonary angiogram which showed multiple segmental filling defects. He was treated for a pulmonary embolism and was discharged 5 days later. Acute pulmonary embolism (APE) has variable clinical presentations. To our knowledge, this is the first case report of an APE presenting with these ECG findings suggestive of myocardial ischemia. In this case report, we discuss the underlying physiological mechanisms responsible and offer management suggestions for emergency department and critical care physicians to better expedite the treatment of APE mimicking acute coronary syndrome on ECG.

McConnell’s Sign As An indicator of Right Ventricular Infarction: A Case Report

2021 ◽  
Author(s):  
Judah Nijas Arul ◽  
Preetam Krishnamurthy ◽  
Balakrishnan Vinod Kumar ◽  
Thoddi Ramamurthy Muralidharan ◽  
Senguttuvan Nagendra Boopathy ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Medical Management ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Ventricular Infarction ◽  
Coronary Syndrome ◽  
Pulmonary Angiogram ◽  
Ventricular Infarction

Abstract BackgroundMcConnell’s sign is a specific echocardiographic finding that was first described in patient with acute pulmonary embolism signifying right ventricular dysfunction. It remains an under-recognized sign in patients with right ventricular infarction.Case PresentationAn 80-year-old woman presented with sudden onset chest pain and breathlessness. The electrocardiogram showed features suggestive of inferior, posterior, and right ventricular infarction with complete heart block and McConnell’s sign was seen on the echocardiography. CT pulmonary angiogram ruled out the present of pulmonary thromboembolism. Coronary angiogram revealed an occluded right coronary artery with collateral supply from the left circulation. Medical management was planned after patient-physician discussion. Patient symptomatically improved with medical management.ConclusionAlthough McConnell’s sign is suggestive of acute pulmonary embolism, it may also be present in patients with right ventricular dysfunction due to infarction. The presence of McConnell’s sign in a patient presenting with acute coronary syndrome should prompt evaluation for right ventricular infarction in the absence of acute pulmonary embolism.

scholarly journals Expanding the discussion on fibrinolytic contraindications

2021 ◽  
Vol 38 (4) ◽  
pp. 672-674
Author(s):  
Ertan SÖNMEZ ◽  
Serdar ÖZDEMİR ◽  
Bedia GÜLEN ◽  
Bahadır TAŞLIDERE ◽  
Ayşe Büşra ÖZCAN
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Head Trauma ◽  
Acute Pulmonary Embolism ◽  
Fibrinolytic Therapy ◽  
European Resuscitation Council ◽  
First Case

The European Resuscitation Council Guidelines recommend the administration of fibrinolytic therapy when acute pulmonary embolism is a known or suspected cause of cardiac arrest. However, contraindications that limit the use of fibrinolytics are sometimes challenged by clinicians, including head trauma in the previous three weeks. We report on the successful use of rescue fibrinolytic therapy on a patient with acute head trauma who had a cardiac arrest in the emergency department as a result of a pulmonary embolism (PE). To the best of our knowledge, this is the first case of successful fibrinolytic therapy for a patient with acute head trauma in the literature.

scholarly journals Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19

2020 ◽  
Vol 77 (23) ◽  
pp. 1961-1964 ◽  
Author(s):  
Lisa M Sagardia ◽  
Lisa M Daniels
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Case Report ◽  
Anticoagulation Therapy ◽  
Massive Pulmonary Embolism ◽  
Heparin Therapy ◽  
Spontaneous Circulation ◽  
Low Molecular Weight ◽  
First Case

Abstract Purpose Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)–associated massive pulmonary embolism with cardiac arrest is reported. Summary This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest–associated massive pulmonary embolism after failure of previous anticoagulation efforts. Conclusion Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.

scholarly journals Acute Pulmonary Embolism in Emergency Department Patients Despite Therapeutic Anticoagulation

2018 ◽  
Vol 19 (3) ◽  
pp. 510-516 ◽  
Author(s):  
Michelle Liu ◽  
Dustin Ballard ◽  
Jie Huang ◽  
Adina Rauchwerger ◽  
Mary Reed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Therapeutic Anticoagulation ◽  
Emergency Department Patients

scholarly journals Value of the Delta Neutrophil Index for Predicting 28-Day Mortality in Patients With Acute Pulmonary Embolism in the Emergency Department

Shock ◽  
2018 ◽  
Vol 49 (6) ◽  
pp. 649-657 ◽  
Author(s):  
Taeyoung Kong ◽  
Yoo Seok Park ◽  
Hye Sun Lee ◽  
Sinae Kim ◽  
Jong Wook Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Delta Neutrophil Index

scholarly journals Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine

2020 ◽  
Author(s):  
Tara Burleigh ◽  
Khandalavala Birgit
Keyword(s):  
Acute Coronary Syndrome ◽  
Case Report ◽  
Left Ventricular ◽  
Ventricular Wall ◽  
Takotsubo Syndrome ◽  
Coronary Syndrome ◽  
First Case ◽  
Combined Use ◽  
Menopausal Women ◽  
Post Menopausal

Objectives: This is the first case report of iatrogenic Takotsubo syndrome (TS) due to a combination of lisdexamfetamine and phentermine. Background: TS is characterized by transient acute ballooning of the left ventricular wall. Typically, it occurs in extremely stressed post-menopausal women, however a few iatrogenic causes have been described recently. Results: A 55-year old woman prescribed lisdexamfetamine and phentermine, presented with acute substernal chest pain. Acute coronary syndrome was excluded. The echocardiogram was diagnostic of TS, and she recovered spontaneously, with supportive care. Conclusion: Caution with the use of sympathomimetic medications in post-menopausal women appears warranted.

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