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The Metabolic Medicine Postoperative Bariatric Surgery Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Deep vein thrombosis (DVT) prophylaxis and monitoring for DVT and pulmonary embolus (PE) are other important parts of the immediate postoperative period. Postoperative atelectasis, pneumonia and UTI are infectious issues we might address for the patient. Occasionally, the patient will have a problem advancing the diet and may need further GI or radiographic evaluation. Similarly, chest pain symptoms will require a cardiology consult and possibly a stress test. The Metabolist should be the coordinator of these non-surgical interventions in the bariatric patient.
Headache
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Adverse effects of sumatriptan are common but are usually mild and short-lived. The most frequent are tingling, paresthesias, and warm sensations in the head, neck, chest, and limbs; less frequent are dizziness, flushing, and neck pain or stiffness. The risk and intensity is greater with the fixed subcutaneous formulation. “Chest-related symptoms” include short-lived heaviness or pressure in the arms and chest, shortness of breath, chest discomfort, anxiety, palpitations, and, very rarely, chest pain. The mechanism is unknown. The risk of sumatriptan-induced myocardial ischemia in the absence of coronary artery disease appears to be acceptable (e.g. no greater than the risk of exercise-induced myocardial ischemia in athletes).27
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Chest pain is a symptom that is associated with a number of other clinical pathologies; therefore, a detailed patient history, physical examination and clinical assessment of the individual presenting with chest pain is essential to establish the risk of life-threatening problems.
AMI in (bi)ventricular pacing – do not discard the ECG
Published in Acta Clinica Belgica, 2023
T. Versyck, D. Devriese, S. Smith, P. Calle, C. Borin
Chest pain is one of the most common symptoms among patients in the emergency department. The diagnosis of AMI relies initially on the patient’s medical history and risk factors, the anamnesis and the 12-lead ECG. However, in the presence of a pacemaker rhythm, the electrocardiographic diagnosis becomes difficult, but not impossible. There is a growing body of literature that suggests that Smith-modified Sgarbossa criteria can be applied for the diagnosis of STEMI in patients with paced rhythms. The Sgarbossa criteria were originally developed for the interpretation of ECGs in chest pain patients with a LBBB, but have been expanded to paced ECGs and optimized by Smith to increase sensitivity and specificity (Figure 1). We present three cases of chest pain patients with, respectively, right ventricular and biventricular pacing and delayed STEMI diagnosis.
Current evidence of COVID-19 vaccination-related cardiovascular events
Published in Postgraduate Medicine, 2023
Sajad Khiali, Afra Rezagholizadeh, Hossein Behzad, Hossein Bannazadeh Baghi, Taher Entezari-Maleki
Regarding male predominance in the development of myocarditis and pericarditis, a highly possible explanation relates to different main sex hormones and their effects on the heart and immune system; however, underdiagnosed heart conditions could be another reason for this rate difference [20]. The occurrence of myocarditis mainly following the second dose of vaccines could be due to a hypersensitivity phenomenon after receipt of the first dose as a sensitizing dose [20,34].Evidence shows that myocarditis/pericarditis symptoms following COVID-19 mRNA vaccine administration usually begin during seven days of vaccination ranging from 6 hours to several days in some case reports [22,34,35]. The predominant symptoms are chest pain which may be respiratory‐dependent, dyspnea, palpitation, chest discomfort, myalgia, sub-febrile to febrile temperatures, and fatigue. Clinically significant signs of COVID-19 vaccine-related myocarditis included elevated troponins (peak between 48–72 h after symptom onset), C-reactive protein elevation, minor pericardial effusion, and nonspecific electrocardiographic changes, such as mild diffuse ST-segment changes, PQ segment depressions, sinus tachycardia, and rarely supraventricular or ventricular arrhythmias. Cardiac troponin values were elevated up to 400 times higher than the normal level in myocarditis cases. On the contrary, pericarditis cases usually show normal cardiac troponin levels [20,35–42].
Tackling the gap in platelet inhibition with oral antiplatelet agents in high-risk patients undergoing percutaneous coronary intervention
Published in Expert Review of Cardiovascular Therapy, 2021
Piera Capranzano, Dominick J. Angiolillo
Strategies proposed to overcome the delay of action of oral P2Y12 inhibitors have yielded differential effects (Figure 2). In particular, increasing the loading dose and the modulation of morphine, have not significantly increased platelet inhibition compared with standard oral administration of P2Y12 inhibitors. On the contrary, the effect on P2Y12-mediated platelet inhibition is dependent by the time of pre-treatment with oral agents and is enhanced by modulating the tablets formed by crushing or chewing. However, parenteral platelet inhibitors provide the highest effect on platelet inhibition compared with oral P2Y12 inhibitors. These PK/PD results taken together suggest the need to define 1) indications for opioids use and alternative strategies for chest pain alleviation in ACS and/or PCI patients; 2) the usefulness of pre-treatment with oral P2Y12-inhibitors in STEMI patients; 3) the applicability of the crushed/chewed form administration in clinical practice; and 4) indications for the clinical use of parenteral platelet inhibitors as bridging antithrombotic therapy. These relevant points are individually discussed below in the following text.