Rhabdomyolysis Causing AV Blockade Due to Possible Atorvastatin, Esomeprazole, and Clarithromycin Interaction

2003 ◽  
Vol 37 (6) ◽  
pp. 808-811 ◽  
Author(s):  
Brooke E Sipe ◽  
Ronald J Jones ◽  
Gordon H Bokhart
Keyword(s):  
Chest Pain ◽  
Shortness Of Breath ◽  
Medication History ◽  
Reductase Inhibitors ◽  
Hepatic Diseases ◽  
Pacemaker Placement ◽  
History Of ◽  
Severe Weakness ◽  
Third Degree Atrioventricular Block

OBJECTIVE: To report rhabdomyolysis (RML) causing third-degree atrioventricular block secondary to a possible interaction between atorvastatin, esomeprazole, and clarithromycin. CASE SUMMARY: A 51-year-old white woman presented to the emergency department with severe weakness, near syncope, shortness of breath, and chest pain. On admission, her electrocardiogram demonstrated bradycardia (40 beats/min) and third-degree heart block. A creatine kinase (CK) level was >7000 U/L. Her medication history was significant for long-term use of atorvastatin (>1 y), a 6-week history of esomeprazole use, and three 500-mg doses of clarithromycin just prior to admission. Her symptoms of weakness, shortness of breath, and chest pain coincided with starting the esomeprazole. During her hospitalization, the woman required pacemaker placement and her CK continued to rise to >40 000 U/L. Screening for other causes of RML, such as thyrotoxicosis, infection, and immune or hepatic diseases, was negative. She gradually improved over a 26-day hospitalization. DISCUSSION: This is a case of RML resulting in third-degree atrioventricular blockade. An objective causality assessment of the adverse reaction via the Naranjo probability scale revealed a probable association with atorvastatin and a possible association with esomeprazole and clarithromycin. The pharmacokinetic profiles of these agents suggest that a possible contribution to this reaction was P-glycoprotein (PGP) inhibition by esomeprazole altering atorvastatin's normally significant first-pass clearance. CONCLUSIONS: PGP drug interactions with atorvastatin and other hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) may be associated with unreported risks for RML. Further investigation into PGP impact on HMG-CoA appears warranted.

scholarly journals The Modulating Effects of Benign Prostate Enlargement Medications on Upgrading Predictors in Patients with Gleason 6 at Biopsy

2016 ◽  
Vol 10 (2) ◽  
pp. 97-104
Author(s):  
Seyed Behzad Jazayeri ◽  
Young S. Kwon ◽  
Russell McBride ◽  
Michael Leapman ◽  
Shemille Collingwood ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Specific Antigen ◽  
Clinical Predictors ◽  
Medication History ◽  
Alpha Blockers ◽  
Reductase Inhibitors ◽  
Prostate Size ◽  
History Of ◽  
Biopsy Gleason Score

Background: Upgrading following prostate biopsy is very common in clinical practice. This study investigated whether the use of 5-alpha reductase inhibitors (ARI) and alpha blockers affect known clinical predictors of Gleason score upgrading or not. Materials and Methods: A retrospective study on 998 patients treated with robotic assisted laparoscopic prostatectomy for clinically localized biopsy Gleason score 6 prostate cancer were studied. The logarithm of prostate specific antigen concentration, prostate size and tumor volume were compared on the basis of the medication history of 5-ARIs and alpha blockers in the cohort of biopsy Gleason 6 patients with benign prostatic hyperplasia history, and patients whose prostate sizes fall in the top quartile. We compared known clinical and pathologic characteristics associated with upgrading in regression models with and without the addition of medications. Results: Alpha blockers, but not 5-ARI were associated with a bigger prostate. Upgrading was associated with older age (OR 1.03, 95% CI 1.01-1.06), higher BMI (OR 1.00 CI 1.01-1.08), higher log prostate specific antigen (OR 7.32, CI 3.546-15.52), smaller prostate size (OR 0.97, CI 0.96-0.98), fewer biopsy cores (OR 0.96 CI 0.92-0.99), more positive cores (OR 1.20, CI 1.08-1.34), and higher percentage of tumor at biopsy (OR 1.02, CI 1.01-1.03). Neither of the two medication classes were a significant predictor of upgrading. Medications made minimal changes in the multivariate predictive models. Conclusion: Although, alpha blockers were associate with bigger prostate size, the modulating effects of alpha blockers and 5-ARIs on common predictors of Gleason score upgrading was not significant.

Development of new cold antibodies in a patient with a history of warm autoimmune haemolytic anaemia

2020 ◽  
Vol 13 (6) ◽  
pp. e232224 ◽  
Author(s):  
Meghan Anderson ◽  
Megan Winter ◽  
Vinicius Jorge ◽  
Claudia Dourado
Keyword(s):  
Chest Pain ◽  
Haemolytic Anaemia ◽  
Acute Treatment ◽  
Autoimmune Disorder ◽  
Shortness Of Breath ◽  
History Of ◽  
Mixed Pattern ◽  
Lost To Follow Up ◽  
Record Review

A 31-year-old male presented to our facility with complaints of shortness of breath and left-sided chest pain. On record review, it was revealed that he had been seen in 2014 for an almost identical presentation and had been found to have haemolytic anaemia with warm autoantibodies. Following his acute treatment during that hospital admission, he was lost to follow-up. During his subsequent admission, 5 years later, he was found to have a systemic autoimmune disorder with a superimposed acute bacterial infection leading to a second case of haemolytic anaemia and at this time with both cold and warm antibodies present. While his diagnosis was initially difficult to make due to both derangements in expected laboratory values and the mixed pattern of the haemolytic anaemia, he was promptly treated with intravenous immune globulin and steroids and was able to make a full recovery.

scholarly journals Just the Facts: Protected code blue – Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 431-434 ◽  
Author(s):  
Sarah McIsaac ◽  
Randy S. Wax ◽  
Brit Long ◽  
Christopher Hicks ◽  
Christian Vaillancourt ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Chest Pain ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Negative Pressure ◽  
Shortness Of Breath ◽  
Code Blue ◽  
Palpable Pulse ◽  
History Of

Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?

scholarly journals Innovative use of mesh bolster for adult Morgagni hernia repair

2019 ◽  
Vol 2019 (7) ◽  
Author(s):  
Nabiel Azar ◽  
Robert Azar ◽  
Katie Robertson ◽  
Priya Gupta
Keyword(s):  
Chest Pain ◽  
Hernia Repair ◽  
Congenital Diaphragmatic Hernia ◽  
Shortness Of Breath ◽  
Morgagni Hernia ◽  
Adult Case ◽  
Rare Type ◽  
Lack Of Fusion ◽  
Large Size ◽  
History Of

AbstractMorgagni hernia is a rare type of congenital diaphragmatic hernia caused by lack of fusion of the pleuroperitoneal membrane anteriorly leading to a defect in the foramen of Morgagni. These are rare hernias and typically present early in life. Those that do not get repaired during infancy or adolescence often present later in life with variable symptoms including obstruction, incarceration, strangulation, pulmonary symptoms, chest pain, etc. Herein we present an adult case that was found incidentally after a screening computerized tomography (CT) chest scan was done for history of smoking. There are two unique aspects to this case: first, given the large size of her hernia, her only complaint was mild shortness of breath and second, the innovative use of mesh as a suture bolster.

Case 13.25

2014 ◽  
pp. 661-662
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Chest Pain ◽  
Right Ventricular ◽  
Signal Intensity ◽  
Ventricular Free Wall ◽  
Proton Density ◽  
Free Wall ◽  
Shortness Of Breath ◽  
Right Ventricular Free Wall ◽  
History Of ◽  
The Right

27-year-old man with a 3-month history of chest pain and mild shortness of breath Four-chamber SSFP image (Figure 13.25.1) demonstrates a large well-defined mass in the right ventricular free wall. Four-chamber double (Figure 13.25.2) and triple (Figure 13.25.3) inversion recovery FSE images with proton density- and T2-weighting reveal mildly decreased signal intensity relative to myocardium. Four-chamber MDE image (...

scholarly journals Woman with dyspnea and history of systemic lupus erythematosus

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Nicolas Kahl ◽  
◽  
Sukhdeep Singh ◽  
Jessica Oswald ◽  
◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Emergency Department ◽  
Chest Pain ◽  
Lupus Erythematosus ◽  
Lower Leg ◽  
Shortness Of Breath ◽  
Pleuritic Chest Pain ◽  
Systemic Lupus ◽  
Blood Clots ◽  
History Of

32-year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with shortness of breath and pleuritic chest pain, acutely worse over one day after a six hour flight three days prior. She became dyspneic walking from her hotel bed to the bathroom. She endorsed 3 weeks of right lower leg cramping. She denied history of blood clots. She appeared tachypneic and speaking in short phrases upon arrival. A bedside ultrasound was performed, see Figures. Vitals: T: 98.3 F, HR: 130, BP: 142/88, RR: 24, oxygen saturation 97% on room air.

scholarly journals Unresolving Pneumonia with Pleural effusion: Pulmonary Paragonimiasis

2017 ◽  
Vol 56 (206) ◽  
Author(s):  
Deepshikha Gaire ◽  
Santosh Sharma ◽  
Kumar Poudel ◽  
Pankaj Pant
Keyword(s):  
Differential Diagnosis ◽  
Chest Pain ◽  
Pleural Effusion ◽  
Clinical Manifestations ◽  
Shortness Of Breath ◽  
X Ray ◽  
Fluid Analysis ◽  
Pain Abdomen ◽  
History Of ◽  
Specific Symptoms

Paragonimiasis is a zoonosis caused by many species of Paragonimus commonly P. westermani. Human get infected by eating raw, salted, pickled, smoked, partially cooked crustaceans (crayfish or crabs). Clinical manifestations ranges from non-specific symptoms like pain abdomen, diarrhea, urticarial rashes, fever to pleuropulmonary symptoms like cough, hemoptysis, chest pain and dyspnea. 48 yrs, female presented at TUTH emergency with fever on and off for 9 months, cough and shortness of breath for 3 months, lethargy, malaise and urticaria with history of raw crab intake one month prior to the onset of symptoms. Blood and pleural fluid analysis revealed raised total counts with eosinophilia and x-ray showed bilateral infiltration of lower lobes with pleural effusion. Diagnosis was confirmed by microscopic examination of sputum for Paragonimus. She responded well to Praziquantel. Pulmonary paragonimiasis must be considered in the differential diagnosis of unresolving pneumonia and unexplained hypereosinophilia.  [PubMed]

Case 13.20

2014 ◽  
pp. 651-652
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Chest Pain ◽  
Chest Radiography ◽  
Right Atrium ◽  
Vascular Structure ◽  
Shortness Of Breath ◽  
Right Heart ◽  
Cabg Surgery ◽  
History Of ◽  
The Right

79-year-old man with a history of CABG surgery 15 years ago now has gradually increasing chest pain and shortness of breath; chest radiography demonstrated a mass along the right heart border, and echocardiography identified a corresponding lesion, likely a vascular structure, adjacent to the right atrium...

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