scholarly journals Food finds its way to a woman’s heart: Campylobacter jejuni-associated myopericarditis

2017 ◽  
Vol 2017 (1) ◽  
Author(s):  
Manivannan Veerasamy ◽  
Craig T Alguire
Keyword(s):  
Heart Failure ◽  
Chest Pain ◽  
Campylobacter Jejuni ◽  
Antimicrobial Therapy ◽  
Conservative Management ◽  
Cardiac Mri ◽  
Gastrointestinal Symptoms ◽  
Stool Culture ◽  
Cardiac Enzymes ◽  
History Of

Campylobacter jejuni-associated myopericarditis (CAM) has been reported infrequently in the literature. We describe a case of immunocompetent young woman presenting with chest pain, with history of recent travel and diarrhea. Evaluation led to diagnosis of myopericarditis associated with this infection. The patient improved with conservative management. The pathogenesis of CAM remains unknown. Patients present with chest pain, heart failure, pulmonary edema and arrhythmias. Diagnostic evaluation includes EKG, cardiac enzymes, echocardiogram, cardiac MRI and stool culture. Conservative management recommended and routine use of antimicrobial therapy is controversial. CAM is a rare but severe complication of C. jejuni infection. It should be considered as a diagnosis in patients presenting with chest pain with associated gastrointestinal symptoms. 

scholarly journals Campylobacter jejuni myocarditis: A journey from the gut to the heart

2017 ◽  
Vol 5 ◽  
pp. 2050313X1771314
Author(s):  
M Toba Obafemi ◽  
Homeyra Douglas
Keyword(s):  
Chest Pain ◽  
Campylobacter Jejuni ◽  
Inflammatory Markers ◽  
Stool Culture ◽  
Diagnosis And Treatment ◽  
Uneventful Recovery ◽  
Transthoracic Echocardiogram ◽  
History Of ◽  
Prompt Diagnosis ◽  
High Sensitive Troponin

Objectives: Campylobacter jejuni is an unusual cause of myocarditis and could easily be missed. Methods: We describe a case of a 25 year old man, who presented with 3 day history of vomiting and diarrhoea, followed by chest pain and significant high sensitive troponin rise. Results: The patient’s profuse diarrhoea was accompanied by raised inflammatory markers, electrocardiogram changes and evidence of cardiomyopathy on transthoracic echocardiogram. Various aetiological viral serologies which were tested for came back negative. However, stool culture was positive for the bacteria, Campylobacter jejuni. He was successfully treated with antibiotics and made an uneventful recovery. Conclusions: Campylobacter jejuni gastroenteritis has a worldwide prevalence. Therefore, prompt diagnosis and treatment is crucial when this organism is implicated in myocarditis.

Myocarditis case associated with Campylobacter jejuni

2018 ◽  
Vol 43 (5) ◽  
pp. 568-570
Author(s):  
Hakan Ayyildiz ◽  
Mehmet Kalayci ◽  
Nadire Cinkilinc ◽  
Mahmut Bozkurt ◽  
Makbule Kutlu Karadag
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Campylobacter Jejuni ◽  
Bacterial Infections ◽  
Troponin I ◽  
Normal Sinus Rhythm ◽  
Cardiac Enzymes ◽  
Normal Sinus ◽  
Anterior Hemiblock ◽  
High Sensitive Troponin

Abstract Objective Myocarditis is an inflammatory disease of the heart caused by various agents and especially enteroviruses, and it is difficult to diagnose and treat. Myocarditis is rarely associated with bacterial infections. Although the most common bacterial infections are Salmonella spp. and Shigella spp., extremely rare cases of Myocarditis due to Campylobacter jejuni are also reported. Patient and methods A 17-year-old male patient with no previous chronic illness was admitted to our emergency department with complaints of abdominal pain, diarrhea, vomiting, and chest pain. He stated that symptoms began after eating a chicken burger a few days ago. Results In the laboratory tests performed, CK-MB and high sensitive Troponin I values were determined as 33.8 IU/L and 1816 ng/L, respectively. Electrocardiogram results revealed left axis left anterior hemiblock in the normal sinus rhythm as well as a ST-T change in the inferior and lateral derivations. Campylobacter jejuni was detected in the stool sample of the patient. Conclusion Myocarditis is one of the rare complications of C. jejuni infection. Bacterial myocarditis should be considered when troponin and cardiac enzymes are elevated in patients admitted to the emergency department with diarrhea and chest pain.

scholarly journals Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽  
2010 ◽  
Vol 12 (02) ◽  
pp. 128-134 ◽  
Author(s):  
Erik P. Hess ◽  
Jeffrey J. Perry ◽  
Pam Ladouceur ◽  
George A. Wells ◽  
Ian G. Stiell
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Chest Radiography ◽  
Clinical Decision ◽  
Chest Radiographs ◽  
Clinical Decision Rule ◽  
Coronary Syndrome ◽  
History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

scholarly journals Erythema Nodosum: A Manifestation of Salmonella Infection

2019 ◽  
Vol 13 (3) ◽  
pp. 456-461
Author(s):  
Ali Hassan ◽  
Amna Alsaihati ◽  
Malak Al Shammari ◽  
Mohammed Sharroufna ◽  
Haitham Alaithan ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Punch Biopsy ◽  
Stool Culture ◽  
Delayed Type Hypersensitivity ◽  
Breast Abscess ◽  
Salmonella Infection ◽  
Cutaneous Lesions ◽  
History Of

Erythema nodosum is a delayed-type hypersensitivity reaction with an unknown trigger in the majority of cases. It is characterized by the development of erythematous tender nodules on the shins. Septal panniculitis without vasculitis is a characteristic histopathological finding. We report the case of a 26-year-old woman who presented with a four-day history of an erythematous swollen left lower limb. She was treated with intravenous clindamycin for suspected cellulitis. However, her symptoms persisted. Punch biopsy revealed findings consistent with erythema nodosum. Two days later, she developed colicky abdominal pain associated with non-bloody diarrhea. Stool culture yielded Salmonella enterica serotype enteritidis. Two days after discharge, she presented again with a right breast abscess for which she underwent incision and drainage along with antibiotic therapy. After discharge, she was symptom-free with complete resolution of the cutaneous lesions. The presented case is unique as it had multiple clinical manifestations of Salmonella infection including erythema nodosum, diarrhea, and presumably a breast abscess. It should be kept in mind that gastrointestinal symptoms are not necessarily the initial presentations of Salmonella infection.

scholarly journals Extensive Subcutaneous Emphysema and Pneumomediastinum after Ecstasy Ingestion

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
A. Gungadeen ◽  
J. Moor
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Young Adult ◽  
Conservative Management ◽  
Subcutaneous Emphysema ◽  
Rare Case ◽  
Relevant Literature ◽  
Radiological Imaging ◽  
Neck Swelling ◽  
History Of

Objective. To present a rare case of extensive subcutaneous emphysema and spontaneous pneumomediastinum following ingestion of Ecstasy in a young adult. We also review the relevant literature and discuss how this case supplements it.Case Report. We report a case of a 19-year-old man with a history of painless neck and chest swelling, and no chest pain or breathlessness, after consuming Ecstasy tablets. Radiological imaging showed evidence of pneumomediastinum and extensive subcutaneous emphysema. The patient remained well under observation and his symptoms improved with conservative management.Conclusions. Subcutaneous emphysema and pneumomediastinum after Ecstasy ingestion is uncommon. Cases are often referred to the otolaryngologist as they can present with neck and throat symptoms. Our case showed that the severity of symptoms may not correlate with severity of the anatomical abnormality and that pneumomediastinum should be suspected in Ecstasy users who present with neck swelling despite the absence of chest symptoms. Although all cases reported so far resolved with conservative management, it is important to perform simple investigations to exclude coexisting serious pathology.

scholarly journals Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Case Newsom ◽  
Rebecca Jeanmonod ◽  
Karl Weller ◽  
Nabil Boutros ◽  
Mark Reiter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Alcohol Abuse ◽  
Decision Rule ◽  
Predictive Value ◽  
Breath Sounds ◽  
History Of ◽  
Sensitivity Specificity

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.

scholarly journals Isolated Interrupted Aortic Arch: Unexpected Diagnosis in a 63-Year-Old Male

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Hassan Javadzadegan ◽  
Jahan Porhomayon ◽  
Alireza Sadighi ◽  
Mehrdad Yavarikia ◽  
Nader Nader
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Chest Pain ◽  
Aortic Arch ◽  
Aortic Root ◽  
Interrupted Aortic Arch ◽  
Advanced Heart Failure ◽  
Arterial Blood ◽  
Brachiocephalic Trunk ◽  
History Of

A 63-year-old male with history of hypertension, dyspnea on exertion, and chronic chest pain was admitted for elective cardiac angiography. Arterial blood pressure was 160/90 mmHg in both arms. Femoral and popliteal pulses were extremely weak, and third (S3) and fourth (S4) heart sounds were audible. Aortography showed a mildly dilated aortic root with double brachiocephalic trunk and interruption of aortic arch at isthmus. Profuse and well-developed collaterals appeared at neck and thorax. The patient was recommended to take medical treatment for his hypertension and advanced heart failure. The aim of this paper, is to review the diagnostic and therapeutic options for treatment of the interrupted aortic arch.

scholarly journals Left Ventricular Thrombus as a Complication of Clozapine-Induced Cardiomyopathy: A Case Report and Brief Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Shahbaz A. Malik ◽  
Sarah Malik ◽  
Taylor F. Dowsley ◽  
Balwinder Singh
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Chest Pain ◽  
New Left ◽  
Left Ventricular ◽  
Heart Failure Therapy ◽  
Bundle Branch Block ◽  
Ventricular Thrombus ◽  
First Case ◽  
History Of

A 48-year-old male with history of schizoaffective disorder on clozapine presented with chest pain, dyspnea, and new left bundle branch block. He underwent coronary angiography, which revealed no atherosclerosis. The patient’s workup was unrevealing for a cause for the cardiomyopathy and thus it was thought that clozapine was the offending agent. The patient was taken off clozapine and started on guideline directed heart failure therapy. During the course of hospitalization, he was also discovered to have a left ventricular (LV) thrombus for which he received anticoagulation. To our knowledge, this is the first case report of clozapine-induced cardiomyopathy complicated by a LV thrombus.

Abstract O.55: Utility of Adenosine Cardiac Stress MRI to Evaluate Ischemia in Patients with Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Michael J Campbell ◽  
Piers Barker ◽  
Jennifer Li
Keyword(s):  
Chest Pain ◽  
Kawasaki Disease ◽  
Cardiac Mri ◽  
Imaging Modality ◽  
Coronary Bypass ◽  
Adenosine Stress ◽  
Clinical Indication ◽  
Cardiac Stress ◽  
Coronary Abnormalities ◽  
History Of

Background: Patients with Kawasaki Disease (KD) and a history of coronary artery disease (CAD) are at risk of myocardial ischemia/infarction. Adenosine stress cardiac MRI (CMR) has been increasingly used in adults to evaluate for atherosclerotic CAD. This modality has not been widely used in the evaluation of CAD in children and young adults, but may be useful in those with a history of KD. Methods: Patients with a history of Kawasaki disease and a clinical indication for a stress cardiac MRI were prospectively enrolled in the study. SSFP cine and delayed enhancement CMR (DE-CMR) were performed in a standard manner. Adenosine stress perfusion was performed with administration of adenosine (140 ug/kg/min) for 2-4 minutes and gadolinium (0.1 mmol/kg) using a standard adult protocol. Results: A total of 13 procedures were performed between 2010 and 2014 on 8 patients with a history of KD (ages 8 to 22, 3F/5M). Seven of eight patients presented with chest pain. Seven of eight patients had documented moderate to giant aneurysms and one had a previous coronary bypass operation. Scans were performed 3-16 years after initial episodes of KD. Three of 16 (19%) scans demonstrated inducible regional ischemia in the distribution of coronary abnormalities. Of these, all underwent cardiac catheterization and 1 patient subsequently underwent coronary bypass surgery. All patients with negative scans were followed clinically with no evidence of further symptoms. Conclusion: As a non-invasive imaging modality, adenosine cardiac stress MRI is feasible in patients with KD and coronary abnormalities and may obviate the need for invasive studies in order to rule out significant CAD. Further studies are needed to evaluate this imaging modality as a more definitive test in the evaluation of KD and chest pain.

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