Intractable/ Persistent Hiccups Due to Acute Subdural Haemorrhage as a Result of Prolonged Inr in a 55 Year Old Man with Rheumatic Mitral Valvular Heart Disease and Atrial Fibrillation: A Case Report

A 58 year old man was brought to hospital in state of deep coma following severe headache for one day. His GCS was 3/15 and had flaccid all 4 limbs with equivocal planter response on both sides on arrival. NECT head showed acute subdural haemorrhage with surrounding cerebral oedema, mid-line shift and corning of brain stem. After giving mannitol and dexamethasone, four hours later, he became fully conscious and orientated; his motor power returned to normal. He was on warfarin 3mg daily for rheumatic mitral valvular heart disease with atrial fibrillation and his INR on arrival was 3.5. He had intractable hiccups once he regained consciousness. Both pharmacological and non-pharmacological measures were tried for distressing hiccups; there was no therapeutic success. His hiccups disappeared completely only after removing the haematoma by burr hole surgery.

Atrial Fibrillation Caused by Intractable Hiccups: A Unique Cause and Cure

We present the case of a 61-year-old male who developed persistent hiccups concurrently with the onset of atrial fibrillation (AF). The hiccups were refractory to traditional treatment but resolved immediately upon electrical cardioversion (ECV) to normal sinus rhythm (NSR). The patient has remained in NSR and free of hiccups. The potential etiologies for hiccups are numerous and varied, and the management of persistent hiccups can be difficult. Cardiac associations including myocardial infarction and pericarditis have been described, while few cases of first-time onset of atrial fibrillation leading to hiccups have been documented. This case discusses a unique instance demonstrating a connection between hiccups and cardiac pathology and an overview of its management.

Establishing the Groundwork for Clinical Trials With Hiccupops® for Hiccup Palliation

Objective Because hiccup palliation remains an unmet clinical need, we report here on an early experience with Hiccupops, ® a patented product designed for the express purpose of providing a mechanism-based intervention for hiccup palliation. Methods Meter Health, the developer and manufacturer of this patented product, used a purposive sampling approach to allow individuals with hiccups and a desire for hiccup palliation to purchase their agent and then to report on its efficacy or lack thereof. The authors of this report were provided these outcome data and allowed to analyze, report, and publish with no input from Meter Health with the exception of comments on accuracy. Results This report focused on 43 surveys that were completed. In response to the question, “Did the Hiccupops work for the person they were purchased for?” 29 (67%) responded, “yes.” Seven individuals (16%) responded, “no;” and 7 (16%) were “not sure.” Write-in comments appeared to substantiate the effective palliative nature of the intervention: “A friend with 10 days of hiccups following… brain tumor surgery, after 2 days, they stopped!!!#.” Another noted the following: “I like that if my hiccups get painful they’re there as a quick relief.” Less favorable comments were also noted: “She couldn’t get past the…. taste.” Another read as follows: “They were not effective in stopping my father’s intractable hiccups…. I like that there is someone out there who cares about trying to stop people’s hiccups.” Conclusions This patented product appears to palliate hiccups in some individuals and merits further study.

Etiologi Dan Patofisiologi Kasus Intractable Hiccups Pada Pasien Laki-Laki 57 Tahun

Latar belakang : Hiccup adalah hembusan napas yang mengacu dari suara yang dihasilkan kontraksi diafragma dan otot intercostal secara tidak sadar dan mendadak dilanjutkan dengan kontraksi mendadak dari glotis. Hiccup merupakan gejala yang biasa dikenal setiap orang namun tetap merupakan gejala patologis. Laporan kasus : Dilaporkan laki laki usia 57 tahun dengan cegukan sejak 1 tahun. Pemeriksaan laringoskopi fleksibel menunjukkan adanya LPR (RFS 15). Pasien didiagnosis LPR dan intractable hiccup ec susp gangguan sentral (CNS), diagnosis banding psikogenik. Pasien diberikan terapi metochlopramid dan chlorpromazine selama 5 hari. Hasil evaluasi pasien mengeluh cegukan tidak berkurang. Pasien lalu diberikan terapi omeprazole 20 mg per 12 jam. Pembahasan : Persistent dan intractable hiccup merupakan gejala yang sulit diobati, bila penyebab diketahui maka diobati sesuai penyebabnya, namun bila penyebab tidak diketahui terapi empiris dilakukan untuk menekan GERD sehingga gejala hiccup perbaikan. Apabila terapi ini gagal agen farmakologi ditujukan ke reseptor dopaminergik dan GABA-ergik. Kesimpulan : Penatalaksanaan hiccup perlu diketahui etiologi terutama gangguan LPR, GERD dan CNS hingga perlu penanganan multidisipliner dari bagian THT, interna, neurologi dan psikiatri.