Renal and hepatic injury with elevated cardiac enzymes in Amanita phalloides poisoning: a case report

2007 ◽  
Vol 26 (9) ◽  
pp. 757-761 ◽  
Author(s):  
Pinar Unverir ◽  
Burak Cem Soner ◽  
Erhan Dedeoglu ◽  
Ozgur Karcioglu ◽  
Kaya Boztok ◽  
...  
Keyword(s):  
Renal Failure ◽  
Troponin I ◽  
Blood Chemistry ◽  
Clinical Findings ◽  
Amanita Phalloides ◽  
Penicillin G ◽  
Mushroom Poisoning ◽  
Cardiac Markers ◽  
Cardiac Enzymes ◽  
Coronary Syndrome

Amatoxins are one of the most potent toxins that cause hepatic and renal failure. However, this is the first report demonstrating an elevation of cardiac enzymes in a patient with Amanita phalloides poisoning. A 56-year-old male was admitted to the emergency department (ED) 42 h after an unknown type of mushroom ingestion. Hepatic, renal function tests, amylase and cardiac enzymes (troponin I, creatine kinase (CK), CK-MB isoenzyme and myoglobin) were found elevated in his blood chemistry. The electrocardiogram disclosed sinus tachycardia. Aggressive treatment with fluids, activated charcoal, penicillin G and silibinin were started. The patient was sent to hemodialysis because of anuria. During follow-up, biochemical parameters and clinical findings improved. The patient was discharged from the hospital following the arrangement of hemodialysis schedule because of the chronic renal failure. False elevations of cardiac markers may confuse the clinicians in differantial diagnosis of myocardial infarction in ED. In our patient, amatoxins that have bound the actin filaments within myocardiocytes or renal cells and/or its effects as circulating anti-troponin antibodies might result in elevation of cardiac markers. Elevated cardiac enzyme levels without any acute coronary syndrome are probable in mushroom poisoning cases involving amatoxin ingestion. Human & Experimental Toxicology (2007) 26, 757— 761

scholarly journals Prognosis and treatment options in cases of acute liver failure caused by mushroom poisoning due to Amanita phalloides

2020 ◽  
Vol 7 (5) ◽  
pp. 875
Author(s):  
Anant Parasher ◽  
Akshay Aggrawal
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Orthotopic Liver Transplantation ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Amanita Phalloides ◽  
Penicillin G ◽  
Mushroom Poisoning ◽  
Mushroom Ingestion

Poisoning due to mushroom ingestion is a relatively rare but deadly cause of acute liver failure (ALF). Consumption of the poisonous mushroom Amanita phalloides, also known as ‘death cap’, is one of the most common causes of mushroom poisoning worldwide, being involved in the majority of human fatalities caused due to mushroom ingestion. A major portion of the liver damage due to Amanita phalloides is related to powerful toxins known as amanitins, which cause impairment in protein synthesis and subsequent cell necrosis by the inhibition of RNA polymerase II. Initially the presentation is that of an asymptomatic lag phase, followed by gastrointestinal symptoms and hepato-renal involvement. Amatoxin poisoning may progress into fulminant hepatic failure and eventually death if liver transplantation is not performed. It is based on a careful assessment of history of type and duration of mushroom ingestion, as well as the clinical manifestations. Diagnosis can be confirmed by laboratory tests measuring urinary amatoxin levels and identification of the mushroom. Although N-Acetyl Cysteine and Penicillin-G have proven to be effective therapeutic agents, Orthotopic Liver Transplantation (OLT) or Auxiliary Partial Orthotopic Liver Transplantation (APOLT) is the only treatment option for most of the cases carrying a poor prognosis.

Abstract 557: The Utility of Serial Enzymes to Rule out Myocardial Injury in Pateints with Non-Critical Disease by CT Angiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Brian J O’Neil ◽  
Patrick Medado ◽  
James Wegner ◽  
Michael Gallagher ◽  
Gil Raff
Keyword(s):  
Myocardial Injury ◽  
Troponin I ◽  
Low Risk ◽  
Blood Collection ◽  
Cardiac Events ◽  
Cardiac Enzymes ◽  
Coronary Syndrome ◽  
Normal Limits ◽  
Risk Patients ◽  
Over Time

Coronary Computed Tomography Angiography (CCTA) is a diagnostic test shown to have a high negative predictive value for coronary artery disease and major cardiac events at three months. Many emergency department, (ED), protocols mandate serial enzymes prior to discharge to capture possible myocardial injury even with normal CCTAs. Determine the value of serial cardiac enzymes in low risk patients (TIMI Risk Score <3) presenting to the ED with chest pain who have a normal or intermediate CTA, (< 25% stenosis). 307 patients received CCTA as part of clinical trials. All patients presented to the ED with suspected acute coronary syndrome and had a TIMI Risk <3, non diagnostic ECGs and negative initial enzymes. All patients had serial enzymes sampling at least 4 hours apart per protocol. Structured telephone follow up and chart review was completed at 30 and 90 days post ED visit. All data was analyzed using descriptive statistics. 68% of all CTA patients were classified as normal < 25% stenosis, with another 8% considered intermediate < 50% stenosis. Average time between blood collection was 4:30+/−1:28. All patients had normal serial Troponin I values (Normal <0.05 ng/mL) with no appreciable delta over time. 39 patients had an increase in Myoglobin values with 10 having a delta ≥20% but <50%, none of these patients had a level above our normal range (< 98 ng/ml). Only one myoglobin values was above our normal limits, but did change over time. There were no deaths or adverse cardiac events at 90 days in this population. In this study of low risk patients with suspected cardiac ischemia (TIMI <3) and a normal or intermediate CCTA, serial cardiac enzymes have no utility.

Clinical findings and follow-up evaluation of an outbreak of mushroom poisoning — survey of amanita phalloides poisoning

1986 ◽  
Vol 64 (1) ◽  
pp. 38-43 ◽  
Author(s):  
R. Fantozzi ◽  
F. Ledda ◽  
L. Caramelli ◽  
F. Moroni ◽  
P. Blandina ◽  
...  
Keyword(s):  
Clinical Findings ◽  
Amanita Phalloides ◽  
Mushroom Poisoning

scholarly journals ST-Elevation Myocardial Infarction in the Presence of Septic Shock

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Leah Ishmael ◽  
Joseph Zalocha
Keyword(s):  
Septic Shock ◽  
Cardiogenic Shock ◽  
Hemodynamic Monitoring ◽  
Troponin I ◽  
Normal Sinus Rhythm ◽  
Obstructive Coronary Artery Disease ◽  
Endothelial Damage ◽  
Cardiac Markers ◽  
Coronary Syndrome ◽  
St Segment

Elevated cardiac enzymes are often seen in the setting of sepsis. The mechanism involves hypoperfusion and possible compromise to myocardial tissue. Electrocardiogram (ECG) changes in the setting of septic shock are less common and can vary widely. Rarely, ST-segment elevations can occur. This case describes a 54-year-old female who presented with septic shock secondary to pyelonephritis and Escherichia coli bacteremia. The patient was admitted to the intensive care unit on norepinephrine and required mechanical ventilation. A significant rise in troponin I (peak 19.8 ng/mL) was seen and ECG showed ST-segment elevations in leads I and aVL with reciprocal ST depressions in leads II, III, and aVF. The patient was taken urgently for left cardiac catheterization, which showed no evidence of obstructive coronary artery disease. When distinguishing between septic shock and cardiogenic shock, insertion of a pulmonary artery catheter may help with diagnosis and treatment of cardiogenic shock. Catheter hemodynamic monitoring can also confirm the diagnosis. In our patient’s case, hemodynamic monitoring was initiated and was not consistent with cardiogenic shock. ST-segment elevations in the high lateral leads and elevated cardiac markers were likely due to severe transmural ischemia secondary to increased oxygen demand. The patient was continued on intravenous antibiotics for treatment of her septic shock. She was extubated and weaned off of norepinephrine within 48 hours. Repeat ECG performed after resolution of the infection showed normal sinus rhythm with no ST-segment changes. Cardiac dysfunction in the setting of septic shock is well described in medical literature; however, the mechanisms of dysfunction are not explicitly understood. Transient hypoperfusion, coronary vasospasm, and localized endothelial damage are possible components. It is important to think of varying etiologies, other than acute coronary syndrome when approaching patients in septic shock with acute ST-segment changes and elevated cardiac markers.

Clinical Utility of Cardiac Troponin I in the Diagnosis of Acute Coronary Syndrome in Patients With Renal Failure

2007 ◽  
Vol 14 (4) ◽  
pp. 356-360 ◽  
Author(s):  
Saravanan Balamuthusamy ◽  
Sandeep Khosla ◽  
Srinivasa Meka ◽  
Sandeep Saha ◽  
Lavanya Srinivasan ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Clinical Utility ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Coronary Syndrome

scholarly journals Is the Revascularization Strategy and Outcome Different in Patients with Acute Coronary Syndrome in COVID -19 pandemic Era:A tertiary centre experience

2020 ◽  
Author(s):  
ibrahim aktürk ◽  
Dilay Karabulut ◽  
Ersan Oflar ◽  
sait ertığrul ◽  
veli polat ◽  
...  
Keyword(s):  
Troponin I ◽  
Clinical Laboratory ◽  
Blood Chemistry ◽  
Public Health Issue ◽  
Timi Flow Grade ◽  
Coronary Syndrome ◽  
Tertiary Centre ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
Access To Medical Care

Objectives: Coronavirus disease of 2019 (COVID 19) became a major public health issue, causing millions of deaths world wide. The burden of COVID 19 pandemics on access to medical care and the treatment of patients with chronic diseases and acute coronary syndromes (ACS) is not fully determined yet. . Methods: A total of 239 patients with ACS were enrolled into the study. Patients were divided into two groups. First group was prepandemic group consisted of patients admitted at January and February 2020, before the pandemic. Second group was consisted of ACS patients admitted through April and May 2020 during pandemic. Both groups were compared according to demographic properties, blood chemistry findings, angiographic features, revascularisation strategies and clinical outcomes. Results: During pandemic period we observed an increase in total number of patient with ST elevation miyocardial infarction (STEMI) patients compared to prepandemic period ( 59(45%) vs 32 (29.6%) respectively). Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients(1953 pg/ml vs 259 pg/ml for troponın I and 14 ng/ml vs 6ng/ml for CK-MB p<0.0001, p=0.02 respectively). TYPE 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative top re-pandemic group (10 vs 0 p=0.003). Post procedural TIMI flow grade was lower in pandemic group and distal embolization and TIMI thrombus score were significantly higher in the pandemic group compared top re-pandemic group (, p=0.001, p=0.02 ,p=0.002 respectively). However; there was no statistically significant difference in hospital mortality and short –term all cause mortality, among groups (p>0.05). Conclusion: We observed that although clinical, laboratory, and angiographic features were worse in ACS patients admitted during the pandemic compared to pre-pandemic period, the mortality rate of ACS was similar. It is important to keep coronary care units open and fully-functioning during the pandemic.

Relevance of Cardiac Enzymes on Outcome after Urgent CABG for Acute Coronary Syndrome

2016 ◽  
Vol 64 (S 01) ◽  
Author(s):  
I. Slottosch ◽  
O. Liakopoulos ◽  
E. Kuhn ◽  
A. Deppe ◽  
M. Scherner ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Enzymes ◽  
Coronary Syndrome

Insights from Exercise-induced Cardioprotection-from Clinical Application to Basic Research

2019 ◽  
Vol 25 (35) ◽  
pp. 3751-3761 ◽  
Author(s):  
Hao Jiang ◽  
Beijian Zhang ◽  
Daile Jia ◽  
Wenlong Yang ◽  
Aijun Sun ◽  
...  
Keyword(s):  
Cardiovascular Health ◽  
Vascular System ◽  
Basic Research ◽  
Coronary Intervention ◽  
Clinical Findings ◽  
Central Component ◽  
Health It ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Exercise Induced

Exercise has long been recognized as a beneficial living style for cardiovascular health. It has been applied to be a central component of cardiac rehabilitation for patients with chronic heart failure (CHF), coronary heart disease (CHD), post-acute coronary syndrome (ACS) or primary percutaneous coronary intervention (PCI), post cardiac surgery or transplantation. Although the effect of exercise is multifactorial, in this review, we focus on the specific contribution of regular exercise on the heart and vascular system. We will summarize the known result of clinical findings and possible mechanisms of chronic exercise on the cardiovascular system.

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