Salbutamol misuse or abuse with fatal outcome: A case-report

2010 ◽  
Vol 30 (11) ◽  
pp. 1869-1871 ◽  
Author(s):  
Alexandra Boucher ◽  
Christine Payen ◽  
Christelle Garayt ◽  
Hervé Ibanez ◽  
Anne Dieny ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Adrenergic Receptors ◽  
Fatal Outcome ◽  
Lung Edema ◽  
Acute Dyspnea ◽  
Past Medical History ◽  
History Of ◽  
The Right ◽  
Acting Agonist ◽  
Sudden Collapse

Salbutamol is a short-acting agonist of the β2 adrenergic receptors sometimes misused or abused, which can result in various cardiovascular adverse effects. We report one case of fatal salbutamol misuse or abuse in a 36-year-old poorly controlled female asthmatic patient with a past medical history of alcoholism and a recent smoking cessation. She died shortly after hospital admission following acute dyspnea and sudden collapse at home. Toxicological analyses evidenced salbutamol overdose, and necropsy showed acute lung edema and marked dysplasia of the right ventricle and revealed the patient was pregnant. The involvement of an initial disorder of the ventricular rhythm leading to cardiac failure is suggested by the presence of several combined pro-arrhythmogenic factors, such as arrhythmogenic right ventricle dysplasia, hypoxemia related to bronchospasm and salbutamol overdose.

scholarly journals Neuroleptic malignant syndrome

2011 ◽  
Vol 69 (5) ◽  
pp. 751-755 ◽  
Author(s):  
Mariana Moscovich ◽  
Felipe T.M. Nóvak ◽  
Artur F. Fernandes ◽  
Tatiana Bruch ◽  
Tabita Tomelin ◽  
...  
Keyword(s):  
Adverse Event ◽  
Neuroleptic Malignant Syndrome ◽  
Fatal Outcome ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Past Medical History ◽  
History Of ◽  
High Doses ◽  
Symptoms And Signs ◽  
Gathering Data

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS.

scholarly journals October 2021 Critical Care Case of the Month: Unexpected Post-Operative Shock

2021 ◽  
Vol 23 (4) ◽  
pp. 93-97
Author(s):  
Sharanyah Srinivasan ◽  
◽  
Sooraj Kumar ◽  
Benjamin Jarrett ◽  
Janet Campion
Keyword(s):  
Lower Extremity ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Intravenous Drug Use ◽  
Past Medical History ◽  
Incision And Drainage ◽  
Lower Extremity Wound ◽  
History Of ◽  
The Right ◽  
Operative Assessment

No abstract available. Article truncated after 150 words. History of Present Illness: A 55-year-old man with a past medical history significant for endocarditis secondary to intravenous drug use, osteomyelitis of the right lower extremity was admitted for ankle debridement. Pre-operative assessment revealed no acute illness complaints and no significant findings on physical examination except for the ongoing right lower extremity wound. He did well during the approximate one-hour “incision and drainage of the right lower extremity wound”, but became severely hypotensive just after the removal of the tourniquet placed on his right lower extremity. Soon thereafter he experienced pulseless electrical activity (PEA) cardiac arrest and was intubated with return of spontaneous circulation being achieved rapidly after the addition of vasopressors. He remained intubated and on pressors when transferred to the intensive care unit for further management. PMH, PSH, SH, and FH: • S/P Right lower extremity incision and drainage for suspected osteomyelitis as above • Distant history of endocarditis related …

WED 142 ‘anti-hu syndrome’ – a case of paraneoplastic sensory neuropathy with encephalitis

2018 ◽  
Vol 89 (10) ◽  
pp. A16.3-A16
Author(s):  
Gupta Srishti ◽  
Jaiswal Amit ◽  
Knopp Michael
Keyword(s):  
Sensory Neuropathy ◽  
Middle Lobe ◽  
Past Medical History ◽  
Small Cell Lung ◽  
Mri Brain ◽  
Brain Scan ◽  
History Of ◽  
Right Middle Lobe ◽  
T2 Hyperintensity ◽  
The Right

A 75-year-old female was referred to the neurology outpatients department with a 6 month history of progressive amnesia and cognitive decline as well as symptoms/signs suggestive of a sensory neuropathy. Past medical history included TIA, cervical spondylosis and recent investigation for hyponatraemia which had been attributed to SIADH. She had been a smoker with a 50+pack year history and consumed minimal alcohol. An MRI brain scan demonstrated bilateral hippocampal T2 hyperintensity. A lumbar puncture demonstrated normal CSF constituents and negative viral PCRs. Full autoimmune and paraneoplastic screening was undertaken which was all normal except for a positive anti-Hu antibody. A CT-TAP highlighted a mass lesion in the right middle lobe of the lung and biopsy confirmed small cell lung cancer (T1aN2M0). A diagnosis of anti-Hu antibody related paraneoplastic syndrome was made and an initial treatment course of IV Methylprednisolone was administered. The patient’s cancer was treated with chemotherapy and adjuvant radiotherapy. Despite a good response with regard to her tumour and hyponatraemia, the patient did not improve significantly cognitively. This case highlights the need for awareness of the combination of symptoms/signs of the described ‘anti-Hu syndrome’ with paraneoplastic sensory neuropathy and/or encephalomyelitis.

Natural history of congenital pulmonary valvar stenosis: an echo and Doppler cardiographic study

1999 ◽  
Vol 9 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Hanneke Gielen ◽  
Otto Daniëls ◽  
Henk van Lier
Keyword(s):  
Right Ventricle ◽  
Pressure Gradient ◽  
Pulmonary Valve ◽  
Anterior Wall ◽  
Jet Stream ◽  
Significant Relation ◽  
Severe Stenosis ◽  
History Of ◽  
The Right ◽  
Pulmonary Valvar Stenosis

AbstractDoppler echocardiography allows accurate serial assessment of pulmonary valvar stenosis by measuring the velocity of the jet stream through the pulmonary valve. Between 1979 and 1997, we saw 174 patients with isolated pulmonary valvar stenosis. At admission their ages ranged from 9 days to 22.5 years. We measured the velocity over the pulmonary valve, and the thickness of the anterior wall of the right ventricle, and made a study of their electrocardiograms. We found that rapid increases and decreases occurred in almost every age-group. For patients with a trivial, mild or moderate level of stenosis, severe stenosis developed in 3, 10 and 9%, respectively. In most of the patients, 122 (90%), in whom there was more than one examination, a change in pressure gradient between −12mmHg/year and +3mmHg/year was found. Only 7 patients had an increase of more than 10mmhg per year. In contrast with our patients having aortic stenosis, these with stenosis of the pulmonary valve showed no rapid increase in early childhood. Indeed, in 58% the severity of the stenosis decreased. No correlation was found when comparing the echocardiographic measurements of the thickness of the anterior wall of the right ventricle with the voltages on the electrocardiogram. A significant relation was found however, between an increasing pressure gradient and thickened valvar leaflets (p = 0.017).

scholarly journals Heavy Eye Syndrome Mimicking Abducens Nerve Palsies

2020 ◽  
Vol 47 (5) ◽  
pp. 683-684
Author(s):  
Caberry W. Yu ◽  
Jonathan A. Micieli
Keyword(s):  
Medical History ◽  
Abducens Nerve ◽  
Double Vision ◽  
Spherical Equivalent ◽  
Past Medical History ◽  
Pathological Myopia ◽  
Bilateral Cataract ◽  
Retinal Tears ◽  
History Of ◽  
The Right

A 70-year-old woman was seen in neuro-ophthalmology consultation for a progressive right esotropia. She had a past medical history of asthma and osteoporosis, and her ocular history was significant for pathological myopia (spherical equivalent of −23.00 D OD and −21.00 D OS), bilateral cataract surgeries, and laser retinopexy for retinal tears. Twenty-five years prior to presentation, she developed binocular horizontal diplopia and was found to have a limitation of abduction to 60% and 80% of normal in the right and left eyes, respectively, by a previous neuro-ophthalmologist. She developed a progressive maculopathy in the right eye secondary to myopia, resulting in the resolution of double vision. The resolution occurred because the double vision was binocular in nature and the loss of vision in her right eye functioned similar to monocular occlusion. However, she noticed that her right eye continued to turn in toward her nose.

Differential changes in left and right ventricular adenylyl cyclase activities in congestive heart failure

1997 ◽  
Vol 272 (2) ◽  
pp. H884-H893 ◽  
Author(s):  
R. Sethi ◽  
K. S. Dhalla ◽  
R. E. Beamish ◽  
N. S. Dhalla
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Adenylyl Cyclase ◽  
Adrenergic Receptors ◽  
The Status ◽  
Left And Right ◽  
The Right

The status of beta-adrenergic receptors and adenylyl cyclase in crude membranes from both left and right ventricles was examined when the left coronary artery in rats was occluded for 4, 8, and 16 wk. The adenylyl cyclase activity in the presence of isoproterenol was decreased in the uninfarcted (viable) left ventricle and increased in the right ventricle subsequent to myocardial infarction. The density of beta1-adrenergic receptors, unlike beta2-receptors, was reduced in the left ventricle, whereas no change in the characteristics of beta1- and beta2-adrenergic receptors was seen in the right ventricle. The catalytic activity of adenylyl cyclase was depressed in the viable left ventricle but was unchanged in the right ventricle. In comparison to sham controls, the basal, as well as NaF-, forskolin-, and 5'-guanylyl imidodiphosphate [Gpp(NH)p]-stimulated adenylyl cyclase activities were decreased in the left ventricle and increased in the right ventricle of the experimental animals. Opposite alterations in the adenylyl cyclase activities in left and right ventricles from infarcted animals were also seen when two types of purified sarcolemmal preparations were employed. These changes in adenylyl cyclase activities in the left and right ventricles were dependent on the degree of heart failure. Furthermore, adenosine 3',5'-cyclic monophosphate contents were higher in the right ventricle and lower in the left ventricle from infarcted animals injected with saline, isoproterenol, or forskolin in comparison to the controls. The results suggest differential changes in the viable left and right ventricles with respect to adenylyl cyclase activities during the development of congestive heart failure due to myocardial infarction.

scholarly journals Hepatocellular Carcinoma to the Right Ventricle

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
George R. Marzouka ◽  
Apurva Badheka ◽  
Alexis P. Rodriguez ◽  
Sandra V. Chaparro
Keyword(s):  
Hepatocellular Carcinoma ◽  
Right Ventricle ◽  
Hospice Care ◽  
Lower Extremity Edema ◽  
The World ◽  
Liver Transplantations ◽  
History Of ◽  
Jugular Venous Distension ◽  
Right Ventricular Apex ◽  
The Right

Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer in the world, but metastatic disease to the heart is rare. We present a case of a 63-year-old man with history of hepatitis C and cirrhosis, which had progressed to HCC. The patient had undergone two prior liver transplantations. He presented to the hospital complaining of worsening lower extremity edema. His exam was also pertinent for jugular venous distension, a 3/6 crescendo-decrescendo murmur, and hepatosplenomegaly. A transthoracic echocardiogram showed a large irregular lobulated mass in the apex of the right ventricle with a mobile pedunculated component. An MRI of the heart revealed a 4.4 × 3.4 × 4.0 cm mass within the right ventricular apex, which was subsequently biopsied and found to be moderately differentiated HCC with myocardial fragments. The patient opted out of any further therapy, or intervention, and was enrolled in hospice care.

scholarly journals A Case of Sudden Death: Subarachnoid Hemorrhage, Pheochromocytoma, Berry Aneurysm

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Ana B. Arevalo ◽  
Jacxelyn Moran ◽  
Stephen Zink ◽  
Binny Khandakar
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pulseless Electrical Activity ◽  
Young Female ◽  
Aneurysm Rupture ◽  
Medical Emergency ◽  
Uncontrolled Hypertension ◽  
Past Medical History ◽  
Common Cause ◽  
History Of ◽  
The Right

Subarachnoid hemorrhage is a medical emergency. Berry aneurysm rupture is the second most common cause following trauma. Diagnosis is often challenging. Neurogenic heart syndrome often complicates subarachnoid hemorrhage. A concomitant pheochromocytoma can be deadly causing sudden cardiac arrhythmia. Here, we describe a case of subarachnoid hemorrhage with concomitant incidental pheochromocytoma in a relatively young female who died suddenly, diagnosed during autopsy. A 57-year-old Hispanic woman with past medical history of asthma, prediabetes, and uncontrolled hypertension collapsed unexpectedly. She initially had ventricular tachycardia, followed by pulseless electrical activity and finally asystole without response to resuscitation. In the emergency department she was on epinephrine, calcium, naloxone, and tPA with suspected thrombotic stroke. Despite measures, she was pronounced dead. Autopsy revealed subarachnoid hemorrhage due to a ruptured berry aneurysm. Additionally, pheochromocytoma was detected in the right adrenal gland. Subarachnoid hemorrhage has a grave prognosis by itself. This case describes the uncommon detection of pheochromocytoma in the setting of subarachnoid hemorrhage.

scholarly journals P1242 Giant right atrium aneurysm presenting as right heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F V Moniz Mendonca ◽  
J A S Sousa ◽  
J M Monteiro ◽  
M R Mraquel ◽  
M N Neto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Right Ventricle ◽  
Right Atrium ◽  
Adult Life ◽  
Right Heart Failure ◽  
Outflow Tract ◽  
Right Heart ◽  
History Of ◽  
The Right

Abstract Introduction Idiopathic aneurysmal dilatations of the right atrium are rare anomalies. It can be diagnosed at any time between foetal and adult life. This exceptional condition can be confused with other conditions that involve enlargement of right atrium. We report a clinical case of a symptomatic adult who was diagnosed with giant right atrium aneurysm. Case report An 83-year-old female presented with complaints of fatigue, paroxysmal nocturnal dyspnoea, exertional dyspnoea, orthopnoea and cough since last week. There were no history of syncope, convulsions or evidence of thromboembolism. There were a medical history of diverticulosis and atrial fibrillation (warfarin therapy). The principal findings on physical examination included holosystolic murmur at the left middle sternal border, pulmonary rales, jugular venous distension, enlarged liver and peripheral oedema. An electrocardiogram showed an atrial fibrillation with a controlled heart rate response, right axis deviation, right bundle-branch block. A chest radiography posteroanterior view showed a markedly enlarged cardiac silhouette, increased pulmonary vascular congestion, and bilateral pleural effusions. Computed tomography (CT) scan showed aneurysmal dilated right atrium communicating with right ventricle. Right ventricle (RV) and RV outflow tract were dilated with normal pulmonary arteries. Two-dimensional transthoracic echocardiography revealed aneurysmal dilated right atrium measuring 398mL/m2. The tricuspid valve was no displaced. There was severe tricuspid regurgitation and no stenosis. The right atrium was kinetic without any intracavitary thrombus. The intertrial and interventricular septa were intact. The right ventricle and outflow tract were mildly dilated with preserved systolic function. The left atrium and left ventricle were normal. The patient was admitted to the cardiology department with the diagnosis of right heart failure. Conclusion Aneurysm of right atrium is an uncommon condition. It is diagnosed as a disproportionately enlarged right atrium compared to the other cardiac chambers in the absence of other cardiac or hemodynamic abnormalities and must be distinguished from other anomalies causing structural pathology of the right atrium. Approximately, one-half of the patients have no symptoms. Others presented with arrhythmia, palpitations, chest pain, shortness of breath, and fatigue. The major rhythm abnormality is atrial fibrillation or atrial flutter. Our patient presented with symptoms of right heart failure and atrial fibrillation. The right enlargement is usually associated with tricuspid annular dilatation responsible for functional regurgitation, which can be severe in some cases. The diagnosis of right atrium malformation can be established by echocardiography, CT or magnetic resonance imaging. Literature reports various ways to manage these patients. Treatment ranges from conservative to surgical resection specially in the presence of arrhythmias. Abstract P1242 Figure. Aneurysm of right atrium

scholarly journals Fatal Outcome of Imatinib in a Patient with Idiopathic Hypereosinophilic Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Ashraf Abugroun ◽  
Ahmed Chaudhary ◽  
Gabriel Rodriguez
Keyword(s):  
Hypereosinophilic Syndrome ◽  
Fatal Outcome ◽  
Treatment Protocol ◽  
System Response ◽  
Cytokine Storm ◽  
Idiopathic Hypereosinophilic Syndrome ◽  
Past Medical History ◽  
Life Threatening ◽  
History Of ◽  
Immune System Response

Cytokine storm is a poorly explained clinical entity caused by an undesired and aggrandized immune system response leading to unregulated activation of the proinflammatory cascade, often contributing to multisystem organ failure and even death. Its potentially diverse etiologies and sepsis-like presentation have made it even more challenging to diagnose, and so far, no well-established treatment protocol has been proposed. Its association with certain medications, especially with monoclonal antibodies, has well been reported in literature. To the best of our knowledge, so far, no previous case of cytokine storm associated with imatinib has been reported. We herein present a case report of a 77-year-old male with a past medical history of hypereosinophilic syndrome who developed acute fatal cytokine storm following treatment with imatinib. This study highlights a life-threatening complication of the medication that may be underrecognized.

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