scholarly journals First Case of Acute Poisoning with Amiodarone and Flecainide in Attempted Suicide Successfully Managed with Lipid Emulsion Therapy in the Emergency Department: Case Report and Literature Review

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 671
Author(s):  
Cristina Bologa ◽  
Catalina Lionte ◽  
Alexandra Popescu ◽  
Victorita Sorodoc ◽  
Laurentiu Sorodoc
Keyword(s):  
Emergency Department ◽  
Large Dose ◽  
Ventricular Arrhythmias ◽  
Lipid Emulsion ◽  
Mechanical Circulatory Support ◽  
Cardiac Pacing ◽  
Acute Poisoning ◽  
Circulatory Support ◽  
First Case ◽  
Therapeutic Measures

Acute antiarrhythmics poisoning represents a challenge in the Emergency Department (ED). These patients often develop malignant arrhythmias in need of exceptional therapeutic measures in the ICU. We report a 47-year-old patient admitted to the ED 5 h after the ingestion of a large dose of amiodarone and flecainide in a suicide attempt. During their ED stay, the patient developed signs of cardiotoxicity evidenced by electrocardiogram and ventricular arrhythmias. The toxicological results showed a level of 4.8 mg/L amiodarone and 2.98 mg/L flecainide. He was successfully treated in the ED using a large dose of sodium bicarbonate and lipid emulsion therapy. After hospital admission, he remained stable, with no need for exceptional therapeutic measures such as mechanical circulatory support, cardiac pacing or ECMO. We emphasize the importance of an early start of pharmacological therapies in the ED, which might improve the outcome in antiarrhythmic acute poisoning.

scholarly journals Loperamide overdose causing torsades de pointes and requiring Impella temporary mechanical support: a case report

2019 ◽  
Vol 3 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Jonathan D Cicci ◽  
Sarah M Jagielski ◽  
Megan M Clarke ◽  
Robert A Rayson ◽  
Matthew A Cavender
Keyword(s):  
Ventricular Arrhythmias ◽  
Mechanical Circulatory Support ◽  
Torsades De Pointes ◽  
Left Ventricular ◽  
Polymorphic Ventricular Tachycardia ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
High Dose ◽  
Ventricular Ejection Fraction ◽  
Vein Thrombosis

Abstract Background Loperamide is a widely available oral μ-opioid receptor agonist, and loperamide abuse is increasing by those seeking intoxication. Loperamide has potent QTc-prolonging properties, placing patients at risk for ventricular arrhythmias and sudden cardiac death. Case summary A 23-year-old woman was found to be in pulseless ventricular fibrillation with a QTc of 554 ms and received multiple defibrillations and IV lidocaine. Her toxicology studies were negative. She subsequently experienced multiple episodes of torsades de pointes and was found to be in cardiogenic shock with a left ventricular ejection fraction of 5%. Following multiple defibrillations, an Impella® mechanical circulatory support device was placed, and she was given IV magnesium and IV lidocaine. After mechanical circulatory support was withdrawn, she experienced major bleeding and was found to have a deep vein thrombosis, bilateral radial artery thrombosis, and multiple pulmonary embolisms in the setting of heparin-induced thrombocytopenia. After stabilizing, she admitted to taking 80 tablets of loperamide 2 mg in pursuit of euphoria. Discussion Loperamide is an increasingly popular agent of abuse. Loperamide-associated ventricular arrhythmias are rare with normal doses but more common with high doses, chronic ingestion, or interacting medications. Loperamide cardiotoxicity may be prolonged due to a long half-life and accumulation. Loperamide abuse may be under-recognized, leading to delays in treatment. Intravenous fluids, magnesium supplementation, chronotropes, transcutaneous or transvenous pacing, and defibrillation may be helpful in mitigating loperamide-associated polymorphic ventricular tachycardia. Clinicians should monitor for drug interactions in patients taking loperamide and screen for electrocardiographic abnormalities in those taking chronic or high-dose loperamide.

Abstract 14494: Once You 1c It, You Can’t Unsee It: A Case of Flecainide Toxicity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Balint Laczay ◽  
Venu Menon
Keyword(s):  
Ventricular Arrhythmias ◽  
Mechanical Circulatory Support ◽  
Structural Heart Disease ◽  
Circulatory Support ◽  
Simultaneous Evaluation ◽  
Life Threatening ◽  
History Of ◽  
Cardiac Intensive Care ◽  
High Index Of Suspicion ◽  
Flecainide Overdose

Introduction: Flecainide is a class 1c antiarrhythmic commonly used for the treatment of atrial and ventricular arrhythmias in the absence of underlying structural heart disease. The significant proarrhythmic effects of the drug warrant familiarity with the drug and its toxicity. Flecainide overdose, whether intentional or iatrogenic, is a life threatening emergency with mortality rates as high as 22.5%. We present a case of intentional flecainide overdose and its management. Case: A 78-year-old man with a history of heart failure, paroxysmal atrial fibrillation on flecainide, presented to a local ED after a suicide attempt. He was initially hemodynamically stable and a 12-lead EKG revealed a wide-QRS bradyarrhythmia (See figure 1). Electrolyte panel showed normal potassium and pH. During transport to our tertiary cardiac intensive care unit, the patient declined and was critically ill on arrival. The diagnosis of flecainide toxicity was suspected and therapy was initiated on arrival. Despite therapy with sodium bicarbonate and fat emulsion, the patient continued to decline. Renal replacement therapy was started and the patient was evaluated for mechanical circulatory support. Ultimately, the patient’s family elected for palliative extubation. The patient’s flecainide level returned more than four times above the therapeutic range. Discussion: This case highlights the importance of a high index of suspicion when faced with a wide-QRS arrythmia in a patient with suspected antiarrhythmic overdose. The persistence of these rhythms after correction of acid-base abnormalities and electrolyte derangements should prompt aggressive, empiric treatment of potential overdose. The presence of electromechanical dyssynchrony in this context is an ominous sign and should prompt simultaneous evaluation for biventricular mechanical circulatory support concomitant with medical therapy for suspected overdose. Figure 1

scholarly journals A case report of a large intracardiac thrombus in a COVID-19 patient managed with percutaneous thrombectomy and right ventricular mechanical circulatory support

2020 ◽  
Author(s):  
Amir Kaki ◽  
Hemindermeet Singh ◽  
Gerald Cohen ◽  
Theodore Schreiber
Keyword(s):  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Anticoagulation Therapy ◽  
Stable Condition ◽  
Adverse Outcomes ◽  
Right Atrial ◽  
Circulatory Support ◽  
Intracardiac Thrombus ◽  
First Case ◽  
Percutaneous Thrombectomy

Abstract Background The coronavirus disease 2019 (COVID-19) has caused a global pandemic with an unprecedented burden on health and the economy worldwide. Although it primarily involves the respiratory tract system, cardiovascular complications, particularly arterial and venous thrombosis, are frequently reported and are associated with adverse outcomes. Case summary We describe the case of a 57-year-old female who presented with acute hypoxic respiratory failure and shock. She was found to have left lower extremity deep vein thrombosis and a suspected pulmonary embolism. A large mobile right atrial mass was found on echocardiogram. Given the large thrombus burden that portended an extremely high risk for embolization to the pulmonary arteries, emergent percutaneous aspiration of an organized thrombus (rather than thrombolysis) was performed using the AngioVac system (Angiodynamics Inc., Latham, NY, USA) complicated by haemodynamic collapse due to acute right ventricular failure. An Impella RP (Abiomed, Danvers, MA, USA) was then placed, with rapid stabilization of haemodynamics. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). She was treated with antimicrobial and systemic anticoagulation therapy. She was successfully weaned off the Impella RP on post-operative day 4 and was extubated on day 5. She was discharged on day 16 in a stable condition. Discussion Incident venous thrombo-embolism is frequently encountered in COVID-19 patients. We report the first case of a large intracardiac thrombus associated with SARS-CoV-2 infection managed successfully with percutaneous thrombectomy and right ventricular mechanical circulatory support.

scholarly journals Fulminant myocarditis in a COVID-19 positive patient treated with mechanical circulatory support – a case report

2020 ◽  
Author(s):  
Joanna-Maria Papageorgiou ◽  
Henrik Almroth ◽  
Mattias Törnudd ◽  
Henriëtte van der Wal ◽  
Georgia Varelogianni ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Mechanical Circulatory Support ◽  
Clinical Presentation ◽  
Low Voltage ◽  
Troponin T ◽  
Left Ventricular ◽  
Fulminant Myocarditis ◽  
Circulatory Support ◽  
Positive Polymerase Chain Reaction ◽  
First Case

Abstract Background Coronavirus disease 2019 (COVID-19) spreading from Wuhan, Hubei province in China, is an expanding global pandemic with significant morbidity and mortality. Even though respiratory failure is the cardinal form of severe COVID-19, concomitant cardiac involvement is common. Myocarditis is a challenging diagnosis due to heterogeneity of clinical presentation, ranging from mild symptoms to fatal arrhythmia and cardiogenic shock (CS). The aetiology is often viral and endomyocardial biopsy (EMB) is the gold standard for definite myocarditis. However, the diagnosis is often made on medical history, clinical presentation, magnetic resonance imaging, and blood tests. Case summary We present a 43-year-old man with mixed connective tissue disease treated with hydroxychloroquine who rapidly developed CS 4 days from symptom onset with fever and cough, showing positive polymerase chain reaction nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. While computed tomography of the thorax was normal, high-sensitivity troponin T was elevated and electrocardiogram showed diffuse ST elevation and low voltage as signs of myocardial oedema. Echocardiography showed severe depression of left ventricular function. The myocardium recovered completely after a week with mechanical circulatory support (MCS). EMB was performed but could neither identify the virus in the cardiomyocytes, nor signs of inflammation. Still the most probable aetiology of CS in this case is myocarditis as a sole symptom of COVID-19. Discussion COVID-19 patients in need of hospitalization present commonly with respiratory manifestations. We present the first case of fulminant myocarditis rapidly progressing to CS in a COVID-19 patient without respiratory failure, successfully treated with inotropes and MCS.

Mechanical circulatory support in the management of life-threatening arrhythmia

EP Europace ◽  
2020 ◽  
Author(s):  
Paolo Della Bella ◽  
Andrea Radinovic ◽  
Luca Rosario Limite ◽  
Francesca Baratto
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Mechanical Circulatory Support ◽  
Adverse Outcomes ◽  
Electrical Storm ◽  
Circulatory Support ◽  
Relevant Role ◽  
Life Threatening ◽  
Multiple Devices ◽  
Feasible Alternative

Abstract Life-threatening refractory unstable ventricular arrhythmias in presence of advanced heart failure (HF) may determine haemodynamic impairment. Haemodynamic mechanical support (HMS) in this setting has a relevant role to restore end-organ perfusion. Catheter ablation (CA) of ventricular tachycardia (VT) is effective at achieving rhythm stabilization, allowing patient’s weaning from HMS, or bridging to permanent HF treatments. Acute heart decompensation during CA at anaesthesia induction in presence of advanced heart disease, in selected cases requires a preemptive HMS to prevent periprocedure adverse outcomes. Substrate ablation during sinus rhythm (SR) might be an effective strategy of ablation in presence of unstable VTs; however, in a minority of patients, it might have some limitations and might be unfeasible in some settings, including the case of the mechanical induction of several unstable VTs and the absence of ablation targets. In case of the persistent induction of unstable VTs after a previous failure of a substrate-based ablation in SR, a feasible alternative strategy of ablation might be VT activation/entrainment mapping supported by HMS. Multiple devices are available for HMS in the low-output states related to electrical storm and during CA of VT. The choice of the device is not standardized and it is based on the centres’ expertise. The aim of this article is to provide an up-to-date review on HMS for the management of life-threatening arrhythmias, in the context of catheter ablation and discussing our approach to manage critical VT patients.

Long-term survival on mechanical circulatory support

2008 ◽  
Vol 7 ◽  
pp. 173-173
Author(s):  
A GKOUZIOUTA ◽  
E LEONTIADIS ◽  
S ADAMOPOULOS ◽  
A MANGINAS ◽  
G KARAVOLIAS ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Term Survival ◽  
Long Term Survival

Supraventricular tachycardia under mechanical circulatory support systems

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
H Welp ◽  
V Kösek ◽  
G Mönnig ◽  
A Hoffmeier ◽  
A Rukosujew ◽  
...  
Keyword(s):  
Supraventricular Tachycardia ◽  
Mechanical Circulatory Support ◽  
Support Systems ◽  
Circulatory Support
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