Life Threatening Acute Heart Failure in Two Young Adults Treated with Antidepressant Medication

Objective:To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.Methods:A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.Results:The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.Conclusions:Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.

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Article Commentary: Acute Heart Failure: Is it Peripartum Cardiomyopathy or Not?

Obstetric Medicine ◽

10.1258/om.2012.120042 ◽

2013 ◽

Vol 6 (1) ◽

pp. 42-44

Author(s):

Katrin Bachelier-Walenta ◽

Denise Hilfiker-Kleiner ◽

Karen Sliwa

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Peripartum Cardiomyopathy ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Life Threatening

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening disease that occurs in women of childbearing age.

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A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.3.45002 ◽

2020 ◽

Vol 4 (2) ◽

pp. 193-196

Author(s):

Ryan Gallagher ◽

Michelle Wilson ◽

Pamela Hite ◽

Bradley Jackson

Keyword(s):

Heart Failure ◽

Case Report ◽

Aortic Valve ◽

Acute Heart Failure ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Complication Rates ◽

Threatening Condition ◽

Valve Insufficiency ◽

Life Threatening

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair. Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours. Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aortic valve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy. Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy.

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Thyroid Storm Triggered by Strangulation in a Patient with Undiagnosed Graves’ Disease

Case Reports in Endocrinology ◽

10.1155/2018/4190629 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jorge I. Conte ◽

Marilyn A. Arosemena ◽

Kunal Kapoor ◽

Naomi G. Dempsey ◽

Megan L. Zaleski ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Acute Heart Failure ◽

Altered Mental Status ◽

Thyroid Storm ◽

Graves Disease ◽

First Case ◽

Local Trauma ◽

Life Threatening ◽

High Degree

Thyroid storm is the life-threatening end-organ manifestation of severe thyrotoxicosis. If left untreated, thyroid storm may cause acute heart failure, multiorgan dysfunction, and death. A high degree of suspicion is necessary to make the diagnosis and start antithyroid medications to decrease mortality. Thyroid storm is generally seen in patients with Graves’ disease but should also be suspected in patients with fever, tachycardia, altered mental status, and risk factors including local trauma to the neck, such as strangulation. Based on our review, we report the first case of thyroid storm after strangulation as the presentation of previously undiagnosed Graves’ disease.

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Acute heart failure: immediate management/stabilization

ESC CardioMed ◽

10.1093/med/9780198784906.003.0440 ◽

2018 ◽

pp. 1917-1921

Author(s):

Francisco J. Martín-Sánchez ◽

Òscar Miró ◽

Héctor Bueno

Keyword(s):

Heart Failure ◽

High Risk ◽

Acute Heart Failure ◽

Medical Condition ◽

High Risk Patient ◽

Risk Patient ◽

Circulatory Support ◽

Haemodynamic Instability ◽

Invasive Monitoring ◽

Life Threatening

Acute heart failure (AHF) is a potentially life-threatening medical condition requiring emergency hospital evaluation. This chapter highlights aspects of early diagnosis, risk stratification, and treatment. The high-risk patient with AHF is characterized by the presence of severe respiratory failure and haemodynamic instability with or without systemic hypoperfusion, and the presence of potentially life-threatening AHF causes CHAMP (acute Coronary syndrome, Hypertensive emergency, Arrhythmias, acute Mechanical cause, and acute Pulmonary embolism). This high-risk patient is a potential candidate for respiratory and circulatory support, invasive monitoring with an arterial line, and the treatment of CHAMP. After ruling out a high-risk situation, AHF diagnosis must be confirmed with clinical evaluation and additional investigations, including 12-lead electrocardiography, chest X-ray, and laboratory assessment with natriuretic peptide levels. This non-high-risk patient requires non-invasive monitoring and early initiation of appropriate therapy guided by systolic blood pressure.

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Acute heart failure: diagnosis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0439 ◽

2018 ◽

pp. 1911-1917 ◽

Cited By ~ 2

Author(s):

Adriaan A. Voors ◽

Piotr Ponikowski

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Medical Condition ◽

Specific Treatment ◽

Length Of Hospital Stay ◽

Clinical History ◽

Life Threatening ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

Acute heart failure is a life-threatening medical condition typically leading to urgent hospital admission. Early diagnosis is of great importance, since it will lead to earlier and better targeted treatment, leading to a decrease in length of hospital stay, and most importantly to improved clinical outcome. The initial diagnostic work-up includes a clinical history, evaluation of symptoms and signs, an electrocardiogram, chest X-ray, natriuretic peptide levels, echocardiography and perhaps lung ultrasound. After the initial work-up, a clinical classification according to blood pressure, congestion, and peripheral perfusion should be performed, since it will guide treatment. During the diagnostic work-up, treatable and life-threatening conditions always need to be considered since they need immediate and case-specific treatment.

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“Never Trust to General Impressions, My Boy, but Concentrate Yourself upon Details”: An Unusual and Challenging Presentation of Pheochromocytoma

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8060071 ◽

2021 ◽

Vol 8 (6) ◽

pp. 71

Author(s):

Umberto Barbero ◽

Mario Matta ◽

Mirko Parasiliti Caprino ◽

Francesca Maletta ◽

Giuseppe Giraudo ◽

...

Keyword(s):

Heart Failure ◽

Cardiogenic Shock ◽

Acute Heart Failure ◽

Acute Myocarditis ◽

Unknown Origin ◽

Neurofibromatosis Type ◽

Good Prognosis ◽

Nf1 Gene ◽

Life Threatening ◽

Plasma Metanephrines

We present the case of a 45-year-old woman admitted to our unit with acute heart failure and cardiogenic shock, requiring an intra-aortic balloon pump insertion and inotropes and vasopressors infusion. Despite such treatment, the patient developed multi organ failure and intravascular disseminated coagulation with haemolysis. The initial diagnosis of acute myocarditis was subsequently denied by the finding of bilateral adrenal masses by MRI scan, and urine and plasma metanephrines measurements confirmed a pheochromocytoma (PCC). Genetic analysis revealed a mutation in the neurofibromatosis type 1 (NF1) gene, and an accurate physical examination drew attention to small cafè-au-lait spots, usually associated with this syndrome. PCC diagnosis should be promptly considered in patients presenting with unexplained acute heart failure and cardiogenic shock of unknown origin, considering its life-threatening complications and the good prognosis after radical surgery.

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Problem-based review: The patient with acute heart failure

Acute Medicine Journal ◽

10.52964/amja.0284 ◽

2013 ◽

Vol 12 (1) ◽

pp. 44-50

Author(s):

Tim Holzmann ◽

◽

Georgina Eltenton ◽

Simon Anderson ◽

Stephen J Bonny ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Emergency Department ◽

Acute Heart Failure ◽

Clinical Scenario ◽

Cardiogenic Pulmonary Oedema ◽

Initial Management ◽

Life Threatening ◽

Underlying Causes ◽

The Uk

Acute heart failure is a common and potentially life threatening presentation to hospitals in the UK. Acute Physicians at the front door of the hospital will often be involved with the initial management of these patients. Despite its many underlying causes, certain general treatment principles exist. We present a typical clinical scenario followed by an overview of the pathophysiology and management of acute heart failure and cardiogenic pulmonary oedema. The aim is to cover a broad spectrum of therapies ranging from medical treatment up to invasive devices, thereby discussing the available options from the Emergency Department to the Intensive Care Unit.

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Acute heart failure: treatment

ESC CardioMed ◽

10.1093/med/9780198784906.003.0441 ◽

2018 ◽

pp. 1921-1926

Author(s):

Dimitrios Farmakis ◽

John Parissis ◽

Gerasimos Filippatos

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Outpatient Care ◽

Management Plan ◽

Second Phase ◽

Oral Medications ◽

Third Phase ◽

Threatening Condition ◽

Life Threatening ◽

Disease Modifying

Acute heart failure (AHF) is a potentially life-threatening condition that requires rapid evaluation and treatment and usually results in hospitalization of the patient. The in-hospital management of AHF may be divided into three phases: a first phase of acute care, a second phase of stabilization, and a third phase of discharge. In the first phase, the main goals are the rapid management of life-threatening conditions; the effective resolution of congestion and/or peripheral hypoperfusion with stabilization of patient haemodynamics; and protection of vital organ function. In the second phase, the main goals are the transition from intravenous to oral medications; the initiation, reinstitution, or titration of disease-modifying medications; any further cardiac assessments and treatments; and the identification and management of co-morbid conditions. Finally, the third phase includes the assessment of the readiness for discharge; the development of a chronic disease management plan; and the transition to outpatient care.

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The Modern Aspects of Acute Heart Failure Management

Archive of Clinical Medicine ◽

10.21802/acm.2017.1.8 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Sergiy Fedorov ◽

Nataliya Izhytska ◽

Tomasz Kulpok-Baginski ◽

Klaudiusz Nadolny

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Medical Condition ◽

First Year ◽

Heart Failure Management ◽

Expert Opinions ◽

Severe Reduction ◽

Common Causes ◽

Life Threatening ◽

Contemporary Perspective

Acute heart failure (AHF) is one the most common causes of morbidity and mortality. The prognosis of patients admitted with AHF remains dismal, with over 20% experiencing recurrent HF admission and over 20% dying during the first year after initial admission.The purpose of this study was to provide contemporary perspective for hospital management of AHF within the context of the most recent data and to provide guidance, based on expert opinions, to practicing physicians and other healthcare professionals. Material and methods: In this paper we reviewed of current updated European Cardiology Society (ESC) HF guideline (2016) and modern trials for AHF from Medscape database. Results: Diuretics are the main medications in the treatment of patients with AHF and signs of fluid overload and congestion. Intravenous vasodilators are the second most used agent in AHF. Their use was shown to be associated with lower mortality, and a delay in administration was associated with a higher mortality.Use of an inotropic medications (such as dopamine, dobutamine, milrinone, levosimendan, epinephrine, norepenephrine) should be reserved for patients with a severe reduction in cardiac output resulting in compromised vital organ perfusion, which occurs most often in hypotensive AHF. Conclusion: Acute heart failure is a life-threatening medical condition, which needs emergency management for death prevention.

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