scholarly journals Postmortem Findings in Two Cases of Chronic Methamphetamine Abuse

2021 ◽  
Vol 45 (3) ◽  
pp. 93-98
Author(s):  
Sohyung Park ◽  
Byung-Ha Choi
Keyword(s):  
Pulmonary Embolism ◽  
Coronary Artery ◽  
Sudden Death ◽  
Skin Infection ◽  
Past History ◽  
Postmortem Examination ◽  
Test Results ◽  
Pathological Findings ◽  
Methamphetamine Abuse ◽  
Foreign Materials

We present two cases of death associated with chronic methamphetamine abuse. Several findings were observed in chronic methamphetamine abuse; pathologic changes in the heart and coronary artery, pulmonary embolism by foreign materials (drug materials), small scars on the subcutaneous vein on the arms with skin infection and sepsis, and so on. These complications can be fatal pathological findings that explain sudden death. The toxicological test results should be carefully interpreted; the presence of methamphetamine in the toxicological results should not automatically be interpreted as acute intoxication. A meticulous postmortem examination with review of the scene, circumstances and past history is crucial in identifying these findings and interpreting them appropriately.

scholarly journals TCT-319 Pathological findings of basophilic foreign materials in 10 coronary artery and 3 intracerebral Pipeline cases

2013 ◽  
Vol 62 (18) ◽  
pp. B102
Author(s):  
Kazuyuki Yahagi ◽  
Fumiyuki Otsuka ◽  
Kenichi Sakakura ◽  
Elena Ladich ◽  
Frank D. Kolodgie ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pathological Findings ◽  
Foreign Materials

scholarly journals Postmortem Demonstration of the Source of Pulmonary Thromboembolism: The Importance of the Autopsy

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Gina Elhammady ◽  
Andrew T. Schubeck ◽  
Vicky El-Najjar ◽  
Morton J. Robinson
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Thromboembolism ◽  
Postmortem Examination ◽  
Pelvic Vein ◽  
Vein Thrombosis ◽  
Potential Source ◽  
Venous Thromboses

Periprostatic or paravaginal venous thromboses are rarely considered clinically as sites of clot origin in patients with pulmonary thromboembolism. The majority of emboli have been demonstrated to originate in the veins of the legs. This report raises awareness of pelvic vein thrombosis as a potential source of pulmonary embolism that is rarely considered or detected clinically, and which usually requires postmortem examination for recognition. It also reviews the possible routes emboli may take to reach the lungs.

scholarly journals Clinical judgement in chest pain: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Tobacco Use ◽  
Stress Test ◽  
Artery Bypass ◽  
Pretest Probability ◽  
Clinical Judgement ◽  
Test Results ◽  
Cardiac Stress ◽  
History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

scholarly journals Myocardial Fibrosis as a Predictor of Sudden Death in Patients With Coronary Artery Disease

2021 ◽  
Vol 77 (1) ◽  
pp. 29-41
Author(s):  
Abbasin Zegard ◽  
Osita Okafor ◽  
Joseph de Bono ◽  
Manish Kalla ◽  
Mauro Lencioni ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Sudden Death ◽  
Myocardial Fibrosis ◽  
Artery Disease

A Massive Pulmonary Embolism Treatment Protocol: How Trauma Performance Improvement Affects Outcome Throughout the Hospital System

2010 ◽  
Vol 76 (2) ◽  
pp. 145-148
Author(s):  
Catherine Garrison Velopulos ◽  
Mark Zumberg ◽  
Priscilla Mcauliffe ◽  
Lawrence Lottenberg ◽  
A. Joseph Layon
Keyword(s):  
Pulmonary Embolism ◽  
Sudden Death ◽  
Performance Improvement ◽  
Pulmonary Embolus ◽  
Treatment Protocol ◽  
Right Heart Failure ◽  
Hospital Performance ◽  
Massive Pulmonary Embolism ◽  
Hospital System ◽  
Submassive Pulmonary Embolism

Trauma performance improvement is the hallmark of a mature trauma center. If loop closure is to be complete, preventable deaths must result in significant change in management and the establishment of protocol-driven improvements so such an instance does not recur. The trauma performance improvement committee reviewed a case of a massive pulmonary embolus and determined that this was a preventable death. The hospital performance improvement committee then initiated a root cause analysis, which led to creation of a treatment protocol for patients with massive or submassive pulmonary embolism. A focused review of the first 6 months of the implementation of the protocol was undertaken. Four patients over a 6-month period had massive or submassive pulmonary embolus. All four had sudden death or near sudden death and were appropriately resuscitated. All four sustained right heart failure. Two patients were treated by catheter-directed fibrinolysis, one with catheter-directed suction embolectomy, and one by surgical pulmonary embolectomy. All survived with full neurologic function. Trauma performance improvement is the model by which all hospital performance improvement should be done. Preventable deaths can result in change, which can have a future impact on survival in potentially lethal scenarios.

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