Endoscopic Dacryocystorhinostomy in an Elderly Patient With Severe Left Ventricular Dysfunction Under Individualized Monitored Anesthesia Care

Systolic Dysfunction ◽

Significant Risk ◽

Left Ventricular ◽

Anesthesia Care ◽

Monitored Anesthesia Care ◽

Endoscopic Dacryocystorhinostomy ◽

Safe Management

Endoscopic dacryocystorhinostomy is generally performed under general anaesthesia. However, elderly patients with multiple comorbidities can impose significant risk during conduction of general anesthesia. We report safe management of an elderly patient with hypothyroidism and severe left ventricular systolic dysfunction having implantable cardioverter defibrillator planned for endoscopic dacryocystorhinostomy using monitored anesthesia care. Emphasis is given to the specific drug choices and technique of oxygen supplementation along with assisted local anesthesia in this scenario.

A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

Case Reports in Cardiology ◽

10.1155/2015/283156 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Ronny Cohen ◽

Alla Lysenko ◽

Thierry Mallet ◽

Brooks Mirrer ◽

Michael Gale ◽

...

Keyword(s):

Bipolar Disorder ◽

Young Patient ◽

Acute Myocarditis ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Low Grade ◽

Drug Induced ◽

Coronary Syndrome

We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting.

Acute Myocardial Infarction Secondary to Suspected Paradoxical Emboli through Patent Foramen Ovale in a Young Woman

The American Heart Hospital Journal ◽

10.15420/ahhj.2011.9.2.122 ◽

2011 ◽

Vol 9 (2) ◽

pp. 122

Author(s):

Mohammad Hassan Namazi ◽

Marjan Biglari ◽

Mohammad Khani ◽

Vahid Eslami ◽

Mohammad Reza Movahed ◽

...

Keyword(s):

Myocardial Infarction ◽

Patent Foramen Ovale ◽

Systolic Dysfunction ◽

Anterior Wall ◽

Left Ventricular ◽

Foramen Ovale ◽

Anterior Myocardial Infarction ◽

Paradoxical Embolus

A 40-year-old woman presented with an extensive anterior myocardial infarction. After initial thrombolytic therapy, coronary angiography was performed a few days later revealing normal coronaries with severe left ventricular dysfunction secondary to anterior wall akinesia. Echocardiography showed severe left ventricular systolic dysfunction and a patent foramen ovale (PFO). The patient had a history of long-term oral contraceptive consumption. A paradoxical embolus into the left coronary artery via a large PFO was suspected and was successfully treated with PFO closure.

682 Cardioncology: is it time to spread the need for dedicated management?

European Heart Journal Supplements ◽

10.1093/eurheartj/suab130.001 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Michele Magnesa ◽

Grazia Casavecchia ◽

Roberta Barone ◽

Mariolina Riccardo ◽

Delia Corbo ◽

...

Keyword(s):

Case Report ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Acute Pulmonary Oedema ◽

Chemotherapy Drugs ◽

Line Therapy

Abstract Case report A 56-year-old man affected by micromolecular multiple myeloma was treated by several cycles of different chemotherapy drugs from September 2015 to December 2020. The chemotherapy regimen included 4-cycle first-line therapy with Bortezomib, Thalidomide, and Dexamethasone; 19-cycle second-line therapy with Carfilzomib, Revlimid, and Dexamethasone; 8-cycle third-line therapy with Daratumumab, Revlimid, and Dexamethasone; finally, he was started on therapy with Pomalidomide and Endoxan. During the various treatments, the patient did not follow a dedicated cardiological follow-up programme. In November 2020, he was hospitalized in the Intensive Care Unit for acute pulmonary oedema and subsequently discharged with a diagnosis of mild left ventricular systolic dysfunction (LVEF 50%). One month later, due to the worsening of dyspnoea, the patient was finally referred to our Cardioncology Unit for the medical assessment. The echocardiographic examination revealed a global and severe left ventricular dysfunction (FE 40%) with significant reduction in left ventricular global longitudinal strain (GLS −10%). For these reasons, we referred the patient to coronary angiography. Conclusions This case report wants to underline how important a dedicated cardiological follow-up is in patients undergoing chemotherapy drugs, especially if used at high doses and for many cycles.