scholarly journals Acute Myocarditis Due to Scorpion Sting in a 9-year-old Girl

2021 ◽  
Author(s):  
Mohammad Reza Khalilian ◽  
Seyyed Abdolhossein Tavallai Zavareh ◽  
Ali Reza Norouzi ◽  
Mohammad Ghazavi ◽  
Ali Ahmad Goudarzi
Keyword(s):  
Critical Care ◽  
Ejection Fraction ◽  
Critical Care Unit ◽  
Acute Myocarditis ◽  
Signs And Symptoms ◽  
Normal Ejection Fraction ◽  
Scorpion Sting ◽  
Cardiac Enzymes ◽  
Scorpion Envenomation

A 9-year-old girl with signs and symptoms of acute toxic myocarditis and cardiogenic shock with elevated cardiac enzymes was admitted to the Critical Care Unit (CCU) of our hospital with an ejection fraction of 25%. The patient was managed with supportive care and the administration of polyvalent antivenom and inotropes, and after 8 days, she was discharged without any complication with normal ejection fraction. Toxic myocarditis can be a result of scorpion envenomation. After two months of follow-up, the patient recovered completely and medications were discontinued.

Echocardiographic Evaluation of the Response to Prazosin Treatment in Scorpion Sting

2020 ◽  
Author(s):  
Khaled A Abdel Baseer ◽  
Mohamed Gamil Aboelela ◽  
Heba M Qubaisy
Keyword(s):  
Cardiogenic Shock ◽  
Pulmonary Edema ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Scorpion Sting ◽  
Scorpion Envenomation ◽  
Echocardiographic Evaluation

Abstract Background Scorpion envenomation is a major public health problem in children that can induce lethal neurological, respiratory and cardiovascular complications. We aimed to evaluate cardiovascular complications with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Methods This was a prospective study conducted for children who presented with scorpion sting to Emergency and Intensive Care units. Demographic, clinical and laboratory findings of patients were recorded. Cases with suspected clinical and electrocardiographic manifestations of myocarditis were subjected to bedside echocardiography with follow-up at the end of the first week and the first month. Results Scorpion sting cases presented to our hospital were 81 cases during 1-year study; of them, 17 cases were stable without systemic manifestations after 12 h observation and discharged. Sixty-four cases suffered systemic organic complications and needed ICU admission; their mean age was 11.52 ± 3.74 and 64% of them were males. Twenty-eight of admitted cases showed manifestations of myocarditis and by echocardiography, all of them had evidence of left ventricular dysfunction. On follow-up, there was significant improvement at the end of first week and complete improvement at the end of first month except three cases who died due to pulmonary edema and cardiogenic shock. Conclusion Acute toxic myocarditis is a common and an important cause of morbidity and mortality following scorpion envenomation that necessitates early and aggressive management. High index of suspicion, serial electrocardiogram monitoring and echocardiography are three integrative lines required to recognize this serious complication. Lay summary Acute toxic myocarditis is a common cause of morbidity and mortality following scorpion envenomation that necessitates rapid medical treatment. We aimed to evaluate cardiovascular complications after scorpion sting with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Tachycardia was the most frequent observed cardiac sign followed by hypotension, while the least was bradycardia and hypertension. All cases with manifestations suggestive of myocarditis were evaluated by bedside two-dimensional echocardiography and showed evidence of left ventricular dysfunction, that begin to regress within 1 week of treatment unless progressive pulmonary edema and resistant cardiogenic shock occurred. On follow-up for survivors, complete improvement at the end of first month was noticed. Clinical suspicion, serial ECG monitoring and echocardiography are required for rapid and early diagnosis. Early use of prazosin therapy can prevent long-term residual damage as evidenced by echocardiographic evaluation.

Pulmonary Hypertension: Overview and Case Study

2020 ◽  
Vol 31 (1) ◽  
pp. 57-66
Author(s):  
Brook Powell ◽  
Barbara Leeper
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Critical Care ◽  
Critical Care Unit ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Diagnosis And Treatment ◽  
Broad Overview

This article provides a broad overview of pulmonary hypertension, including classifications, risk factors, signs and symptoms, diagnosis, and treatment options. Nursing considerations and optimization of hemodynamic values in patients with pulmonary hypertension in a critical care unit are reviewed through the lens of a case study. Preventing decompensation is essential in the successful care of these patients.

scholarly journals Ischaemic stroke in a patient with myasthaenic crisis and antiphospholipid antibody syndrome

2019 ◽  
Vol 12 (8) ◽  
pp. e231239
Author(s):  
Jose Danilo B Diestro ◽  
Maria Kristina C Dorotan ◽  
Vida Margarette D Andal ◽  
Arnolfo B Tomas ◽  
Romergryko G Geocadin ◽  
...  
Keyword(s):  
Critical Care ◽  
Autoimmune Diseases ◽  
Ischaemic Stroke ◽  
Plasminogen Activator ◽  
Critical Care Unit ◽  
Recombinant Tissue Plasminogen Activator ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Tissue Plasminogen

While autoimmune diseases have been frequently found to coexist in the same patients, the co-occurrence of myasthaeniagravis and antiphospholipid antibody syndrome (APAS) has only been reported in eight cases. We present a case of a 46-year-old Filipina who developed ischaemic stroke while admitted at the neurocritical unit for myasthaenic crisis. She was successfully thrombolysed with intravenous recombinant tissue plasminogen activator (rTPA), given a regimen of intravenous Ig and a dose of cyclophosphamide prior to discharge. Extensive workup revealed APAS to be the aetiology of her stroke. Twenty-one months into her follow-up, she is doing well with a modified Rankin Score of 0. Our case suggests that rTPA followed by immunomodulators may be given safely in myasthaenic crisis patients who develop ischaemic stroke. We emphasise the importance of doing a comprehensive neurological evaluation in agitated patients in the critical care unit.

QRS fragmentation in children with suspected myocarditis: a possible additional diagnostic sign

2020 ◽  
Vol 30 (7) ◽  
pp. 962-966 ◽  
Author(s):  
Paolo Ferrero ◽  
Isabelle Piazza
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Acute Myocarditis ◽  
Paediatric Population ◽  
Gadolinium Enhancement ◽  
Diagnostic Features ◽  
Qrs Fragmentation

AbstractAims:We aim to assess the diagnostic role of QRS fragmentation in children with suspected acute myocarditis.Background:Diagnosis of myocarditis in the paediatric population is challenging. Clinical suspicion, electrocardiogram, and laboratory tests are the main diagnostic features at presentation. However, electrocardiogram in patients with myocarditis is usually considered aspecific. We have previously described QRS fragmentation in adult patients with acute myocarditis.Methods:Patients aged less than 18 years, admitted between 2003 and 2019, and discharged with a diagnosis of acute myocarditis were included. Standard electrocardiogram, laboratory, and echocardiographic findings at admission and follow-up were reviewed. QRS fragmentation was defined by the presence of multiphasic R′ spikes. Cardiac magnetic resonance and biopsy were performed in selected patients.Results:Twenty-one patients were analysed, 16 males (76%), median age 9.5 (2.5–16) years. At presentation, 12 patients (57%) displayed QRS fragmentation. Median ejection fraction was 40% (27–60). Nine patients (43%) underwent cardiac magnetic resonance and displayed late gadolinium enhancement. One patient underwent biopsy that showed borderline findings. Electrocardiogram leads showing QRS fragmentation correlated with distribution of late gadolinium enhancement. Median follow-up was 600 (190–2343) days. All patients were alive at last follow-up. Six patients (33%) patients displayed persistence of QRS fragmentation. Median ejection fraction was 60% (60–65%). In three patients (14%), ejection fraction remained depressed, two of which showed persistence of QRS fragmentation.Conclusion:In this cohort of children with suspected myocarditis, QRS fragmentation was confirmed as a new additional diagnostic finding to look for at admission and during follow-up.

scholarly journals Predictors of unfavorable course of acute myocarditis with reduced left ventricular ejection fraction

2019 ◽  
Vol 23 (2) ◽  
pp. 251-256
Author(s):  
S. V. Cherniuk
Keyword(s):  
Ejection Fraction ◽  
Cardiovascular Events ◽  
Clinical Course ◽  
Acute Myocarditis ◽  
Disease Onset ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Strain ◽  
Ventricular Ejection Fraction

Early prediction of myocarditis clinical course still remains one of the actual tasks of cardiological science, which has a significant practical value. The purpose of the study was to determine the predictors of unfavorable course of myocarditis with reduced ejection fraction (EF) of the left ventricle (LV) on the basis of follow-up during 24 months. The study included 90 patients with acute myocarditis and reduced LV EF, who were examined in the first month after the disease onset, after 6, 12 and 24 months of follow-up. All patients underwent for echocardiography, Holter monitoring of the electrocardiogram and cardiac magnetic resonance imaging. Statistical processing of the results was performed using the Excel XP software (Місrosoft Office, USA) and Statistica for Windows v. 6.0 (Statsoft, USA). It was found that restoration of cardiac contractility in patients with myocarditis and reduced LV EF began with an increase in the index of LV longitudinal global systolic strain, which occurred 6 months after the debut of the disease and was associated with a decrease in the number of LV segments affected by the inflammatory process, and a significant increase of LV EF and a decrease of LV end-diastolic volume were observed only 1 year after the disease onset. The predictors of cardiovascular events in patients with acute myocarditis during the next 24 months from the onset of the disease, were detected in the 1st month from the debut of the disease and included following pathological changes: value of the LV EF ≤ 30%; reduction of LV longitudinal global systolic strain ≤ 7.0%; evidence of non-sustained ventricular tachycardia, presence of inflammatory changes in ≥6 LV segments, presence of delayed enhancement in ≥ 5 LV segments. Prospects for further research are the creation of registries of patients with myocarditis on the basis of multicenter clinical trial results on a large number of patients surveyed in order to improve diagnosis, prediction of clinical course and identification of early diagnostic markers of cardiovascular events and quantitative risk assessment of their development.

Sign in / Sign up

Export Citation Format

Share Document