A Lethal Side Effect of Treatment by Macitentan

2020 ◽  
Author(s):  
Oumaima Naour
Keyword(s):  
Chest Pain ◽  
Side Effects ◽  
Side Effect ◽  
Acute Myocarditis ◽  
Human Case ◽  
Double Outlet Right Ventricle ◽  
St Segment Elevation ◽  
Cardiac Side Effects ◽  
St Segment ◽  
Pulmonary Arterial

Pulmonary arterial hypertension is a progressive and ultimately fatal disease despite the availability of a number of new therapies, including endothelin receptor antagonists. Many side effects have been reported with the use of these drugs, such as hepatotoxicity, peripheral edema, anemia and other digestive reactions. Cardiac side effects have been rarely mentioned. We report the case of a 17-year-old girl with Eisenmenger syndrome secondary to double outlet right ventricle and sub-pulmonary ventricular septal defect, Macitentan treatment has been started, three days later, she presented a ST segment elevation in septo-apico- lateral territory which shortly complicated with cardiogenic shock and death. A coronary arteritis or acute myocarditis of toxic origin was the two evoked diagnoses. This is the first human case in the medical literature describing a relationship between initiation of Macitentan and the onset of this event. This case highlights a lethal side effect of Macitentan, which should prompt patients to notify their doctors of any symptoms suggestive of coronary or myocardial injury (chest pain, dyspnea, heart failure symptoms), and implementation of electrocardiogram in combination with a control in any patient who develops chest pain on Macitentan.

scholarly journals What the Cardiologist Needs to Consider in the Management of Oncologic Patients with STEMI-Like Syndrome; A Case Report and Literature Review

2021 ◽  
Vol 14 (6) ◽  
pp. 563
Author(s):  
Aneta Aleksova ◽  
Giulia Gagno ◽  
Alessandro Pierri ◽  
Carla Todaro ◽  
Alessandra Lucia Fluca ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Side Effects ◽  
Single Agent ◽  
St Segment Elevation ◽  
Cardiac Catheterization Laboratory ◽  
Cardiac Side Effects ◽  
Coronary Syndrome ◽  
St Segment ◽  
Oncologic Patients

In pre-hospital care, an accurate and quick diagnosis of ST-segment elevation myocardial infarction (STEMI) is imperative to promptly kick-off the STEMI network with a direct transfer to the cardiac catheterization laboratory (cath lab) in order to reduce myocardial infarction size and mortality. Aa atherosclerotic plaque rupture is the main mechanism responsible for STEMI. However, in a small percentage of patients, emergency coronarography does not reveal any significant coronary stenosis. The fluoropyrimidine agents such as 5-Fluorouracil (5-FU) and capecitabine, widely used to treat gastrointestinal, breast, head and neck cancers, either as a single agent or in combination with other chemotherapies, can cause potentially lethal cardiac side effects. Here, we present the case of a patient with 5-FU cardiotoxicity resulting in an acute coronary syndrome (ACS) with recurrent episodes of chest pain and ST-segment elevation.. Our case report highlights the importance of widening the knowledge among cardiologists of the side effects of chemotherapeutic drugs, especially considering the rising number of cancer patients around the world and that fluoropyrimidines are the main treatment for many types of cancer, both in adjuvant and advanced settings.

scholarly journals A Case of Coronary Vasospasm after Repeat Rituximab Infusion

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Calvin Ke ◽  
Amit Khosla ◽  
Margot K. Davis ◽  
Cameron Hague ◽  
Mustafa Toma
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Coronary Artery ◽  
Side Effects ◽  
Cardiac Risk ◽  
Coronary Vasospasm ◽  
Cardiac Side Effects ◽  
Multiple Exposures ◽  
St Segment ◽  
Multiple Cycles

Coronary artery vasospasm (CAV) can be triggered by medication reactions. CAV occurring after multiple exposures to rituximab has not been previously described. A 61-year-old woman with no cardiac risk factors was treated with the sixth cycle of gemcitabine, cisplatin, dexamethasone, and rituximab therapy. Fifteen minutes after rituximab infusion commenced, she developed typical cardiac chest pain with ST segment elevations on electrocardiogram. Angiogram revealed evidence of coronary vasospasm. The patient was successfully treated with amlodipine. This case underlines the importance of monitoring cardiac side effects of rituximab therapy, even after multiple cycles.

scholarly journals To Be or Not to Be … Acute Coronary Syndrome

2016 ◽  
Vol 62 (3) ◽  
pp. 363-367
Author(s):  
Pintilie Irina ◽  
Scridon Alina ◽  
Șerban Răzvan Constantin
Keyword(s):  
Chest Pain ◽  
Troponin I ◽  
Enzyme Inhibitor ◽  
Acute Myocarditis ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

AbstractIntroduction: The association between ST segment abnormalities, elevated cardiac enzymes, and chest pain is usually a marker of acute coronary injury. However, certain other pathologies can sometimes mimic acute coronary syndromes.Case report: A 40-year-old Caucasian male, former smoker, with no other cardiovascular risk factors, presented to the Emergency Department for typical ischemic, prolonged chest pain. The ECG demonstrated inverted T waves in leads I, II, aVL, and V3 to V6. The patient presented high cardiac necrosis markers (troponin I 2.65 ng/ml). Based on these findings, the case was interpreted as non-ST segment elevation myocardial infarction, but coronary angiography excluded the presence of significant coronary lesions. The ventriculography showed an efficient left ventricle, with mild hypokinesia of the two apical thirds of the anterior left ventricular wall. Cardiac magnetic resonance imaging demonstrated areas of hypersignal on the T2-weighted imaging sequence in the left ventricular myocardium, suggestive for acute myocarditis. The patient was started on antiplatelet, beta-blocker, and angiotensin converting enzyme inhibitor, with favorable evolution.Conclusion: This case underlines the polymorphic appearance of acute myocarditis, which can often mimic an acute coronary event.

scholarly journals Case Report: Acute Myocarditis Following the Second Dose of Mrna-1273 Sars-Cov-2 Vaccine

2021 ◽  
Author(s):  
Prashant D Tailor ◽  
Aoife M Feighery ◽  
Bassim El-Sabawi ◽  
Abhiram Prasad
Keyword(s):  
Chest Pain ◽  
Cardiac Function ◽  
Acute Myocarditis ◽  
Complete Recovery ◽  
St Segment Elevation ◽  
St Segment ◽  
Post Marketing Surveillance ◽  
Post Marketing ◽  
Artery Disease

Abstract Background The SARS-CoV-2 pandemic has led to the development of the first mRNA vaccines used in humans. The vaccines are well tolerated, safe and highly efficacious; however, post marketing surveillance is revealing potential rare adverse effects. We report a case of symptomatic acute myocarditis following administration of the second dose of mRNA-1273 SARS-CoV-2 Vaccine. Case Summary A 44-year-old man presented with chest pain and ST-segment elevation four days after receiving a second dose of mRNA-1273 SARS-CoV-2 Vaccine. Emergent coronary angiogram showed minimal coronary artery disease. Cardiac magnetic resonance imaging confirmed acute myocarditis. Diagnosis of vaccine-associated myocarditis was made given the temporal relationship and supportive treatment initiated. Follow-up at one month confirmed complete symptomatic recovery and echocardiogram demonstrated normalization of cardiac function. Discussion Acute myocarditis should be considered in patients who present with chest pain or dyspnoea within days of receiving mRNA-1273 SARS-CoV-2 vaccination, especially after the second dose. This may be managed successfully with supportive therapies with complete recovery of cardiac function and symptoms. Further research is warranted to determine the mechanisms by which mRNA vaccines may cause myocarditis and for potential long-term cardiovascular injury.

Posterior wall myocardial infarction: A case report

2017 ◽  
Vol 70 (1-2) ◽  
pp. 44-47
Author(s):  
Milenko Cankovic ◽  
Snezana Bjelic ◽  
Vladimir Ivanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Dalibor Somer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Myocardial Revascularization ◽  
Posterior Wall ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Therapeutic Benefits ◽  
St Segment ◽  
Therapeutic Algorithms

Introduction. Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia. ST segment depression in leads V1?V3 on the electrocardiogram points to the anterior wall ischemia, although it is actually ST elevation with posterior wall myocardial infarction. In the absence of clear ST segment elevation, it may be overlooked, leading to different therapeutic algorithms which could significantly affect the outcome. Case report. A 77 year-old female patient was admitted to the Coronary Care Unit due to prolonged chest pain followed by nausea and horizontal ST segment depression on the electrocardiogram in V1?V3 up to 3 mm. ST segment elevation myocardial infarction of the posterior wall was diagnosed, associated with the development of initial cardiogenic shock and ischemic mitral regurgitation. An emergency coronarography was performed as well as primary percutaneous coronary intervention with stent placement in the circumflex artery, the infarct-related artery. Due to a multi-vessel disease, surgical myocardial revascularization was indicated. Conclusion. Posterior wall transmural myocardial infarction is the most common misdiagnosis in the 12 lead electrocardiogram reading. Routine use of additional posterior (lateral) leads in all patients with chest pain has no diagnostic or therapeutic benefits, but it is indicated when posterior or lateral wall infarction is suspected. The use of posterior leads increases the number of diagnosed ST segment elevation myocardial infarctions contributing to better risk assessment, prognosis and survival due to reperfusion therapy.

scholarly journals Acute Pericarditis after Percutaneous Coronary Intervention: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 490
Author(s):  
Greta Rodevič ◽  
Povilas Budrys ◽  
Giedrius Davidavičius
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Troponin I ◽  
Stable Condition ◽  
Coronary Intervention ◽  
Prior History ◽  
Acute Pericarditis ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Background: Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI. Case Summary: A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset. Conclusions: Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.

scholarly journals Escherichia coli bacteremia due to urinary tract infection complicated by acute myocarditis: A rare complication

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110236
Author(s):  
Mohamadanas Oudih ◽  
Thana Harhara
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Myocarditis ◽  
Rare Complication ◽  
Kidney Injury ◽  
St Segment Elevation ◽  
Infection Treatment ◽  
St Segment

Acute myocarditis is a rare complication of Escherichia coli urinary tract infection and sepsis. We report the case of a previously healthy 55-year-old female who presented to our emergency department with diarrhea and hypotension. The basic metabolic panel results showed an increase in inflammatory markers and an acute kidney injury. Urine and blood cultures grew Escherichia coli. The patient subsequently developed sudden chest pain and shortness of breath, diffuse ST-segment elevation, and cardiac enzymes’ elevation. Coronary angiogram was normal, and transthoracic echocardiogram demonstrated normal ventricular functions. Cardiac magnetic resonance imaging was highly suspicious of myopericarditis. The patient made a full recovery after infection treatment with intravenous antibiotics, aspirin, and colchicine.

Predictors of short-term outcome in acute chest pain without ST-segment elevation

2003 ◽  
Vol 92 (2-3) ◽  
pp. 193-199 ◽  
Author(s):  
Juan Sanchis ◽  
Vicent Bodı́ ◽  
Ángel Llácer ◽  
Lorenzo Facila ◽  
Julio Núñez ◽  
...  
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
Short Term ◽  
Term Outcome ◽  
St Segment Elevation ◽  
Short Term Outcome ◽  
St Segment

Abstract 15848: Impact of the Covid-19 Pandemic on D2B Activations in a Single, Tertiary Care, Urban Medical Center in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Philip Lavenburg ◽  
Michael Gannon ◽  
Brian O'Murchu ◽  
Vladimir Lakhter ◽  
Deborah L Crabbe ◽  
...  
Keyword(s):  
Chest Pain ◽  
Symptom Onset ◽  
Mechanical Circulatory Support ◽  
Medical Center ◽  
Acute Chest Pain ◽  
Fluoroscopy Time ◽  
Medical Attention ◽  
Circulatory Support ◽  
St Segment Elevation ◽  
St Segment

Introduction: Initial reports suggest that patients may delay seeking medical attention during the Coronavirus Disease 2019 (COVID-19) pandemic. Our aim was to determine if the COVID-19 outbreak is associated with a higher incidence of late presentations for patients with STEMI, greater need for mechanical circulatory support and PCI. Methods: We retrospectively evaluated consecutive patients that presented to a single, academic medical center with acute chest pain and ST-segment elevation on ECG from March 15 through June 17 in years 2019 and 2020. All patients were referred for emergent coronary angiography and the final cohort consisted of 32 patients. Medical records were reviewed to determine time between symptom onset and hospital arrival, need for PCI and/or mechanical circulatory support, total fluoroscopy time and volume of contrast administration during catheterization. Results: There was no significant difference in age, gender, cardiac risk factors or history of CAD between the cohorts that presented in 2019 compared with 2020 (Table 1). The mean time from symptom onset to arrival in the ED was 6.5 ± 8 and 9.2 ± 17 hours in 2019 and 2020 (p=0.55), respectively. PCI was performed during the index catheterization in 5 (50%) and 21 (95%) patients in 2019 and 2020 (p=0.01), respectively. Mean volume of contrast media used per case was 142 ± 65 ml in 2019 and 237 ± 104 ml in 2020 (p=0.017). There was a trend towards greater need for mechanical circulatory support and total fluoroscopy time during cases in 2020 (Table 1). Conclusions: In patients with suspected STEMI during the COVID-19 pandemic, there was a trend towards longer duration between symptom onset and arrival to the ED. More patients presenting with ST-segment elevation required PCI and there was a trend towards greater utilization of mechanical circulatory support. These findings may reflect a decline in access to outpatient services and/or delays in patients seeking care for acute chest pain.

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