A Case Report On Peripartum Cardiomyopathy

A 32 year-old primigravida with gestational diabetes & subclinical hypothyroidism on replacement therapy and no previous cardiac problem, developed features of shock few hours after elective caesarian section at term, in the absence of any chest pain or palpitation. Following resuscitation she developed features of acute left ventricular failure. ECG showed nonspecific T changes, chest x-ray revealed enlarged cardiac shadow with pulmonary congestion, arterial blood gas analysis was normal with supplemental oxygen. Serial cardiac markers were normal & serum d-Dimer was negative. Echocardiogram revealed dilatation of all cardiac chambers with global hypokinesia & severe left ventricular (LV) systolic dysfunction. She was diagnosed as a case of peripartum cardiomyopathy and treated conservatively with medications. Her condition improved dramatically & she became symptom-free by the 5th post-operative day (POD) and subsequently discharged on 9th POD. Follow-up echocardiogram after 6 weeks revealed regional wall motion abnormality, normal chamber dimensions and fair LV systolic function. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12387 Birdem Med J 2011; 1(1): 37-42

Download Full-text

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Cardiorenal Medicine ◽

10.1159/000369588 ◽

2014 ◽

Vol 5 (1) ◽

pp. 20-30 ◽

Cited By ~ 13

Author(s):

Silvia Lai ◽

Alessio Molfino ◽

Gaspare Elios Russo ◽

Massimo Testorio ◽

Alessandro Galani ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Volume Overload ◽

Blood Gas Analysis ◽

Left Ventricular ◽

Gas Analysis ◽

Metabolic Parameters ◽

Dialysis Patients ◽

Arterial Blood Gas ◽

Cardiothoracic Ratio ◽

Arterial Blood

Introduction: Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. Materials and Methods: 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated. Results: LVMI was higher in PD than HD patients (139 ± 19 vs. 104 ± 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. Conclusions: Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored. © 2014 S. Karger AG, Basel

Download Full-text

Methaemoglobinemia Induced by MDMA?

Case Reports in Pulmonology ◽

10.1155/2011/494328 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

L. L. W. Verhaert

Keyword(s):

Clinical Presentation ◽

Good Condition ◽

Blood Gas Analysis ◽

Supplemental Oxygen ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Brown Colour ◽

Arterial Blood Gas Analysis ◽

Life Threatening

Case. A 45-year-old man with a blank medical history presented at the emergency room with dizziness and cyanosis. Physical examination showed cyanosis with a peripheral saturation (SpO2) of 85%, he did not respond to supplemental oxygen. Arterial blood gas analysis showed a striking chocolate brown colour. Based on these data, we determined the arterial methaemoglobin concentration. This was 32%. We gave 100% oxygen and observed the patient in a medium care unit. The next day, patient could be discharged in good condition. Further inquiry about exhibitions and extensive history revealed that the patient used MDMA (3,4- methylenedioxymethamphetamine, the active ingredient of ecstasy).Conclusion. Acquired methaemoglobinemia is a condition that occurs infrequently, but is potentially life threatening. Different nutrients, medications, and chemicals can induce methaemoglobinemia by oxidation of haemoglobin. The clinical presentation of a patient with methaemoglobinemia is due to the impossibility of O2binding and transport, resulting in tissue hypoxia. Important is to think about methaemoglobin in a patient who presents with cyanosis, a peripheral saturation of 85% that fails to respond properly to the administration of O2. Because methaemoglobin can be reduced physiologically, it is usually sufficient to remove the causative agent, to give O2, and to observe the patient.

Download Full-text