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Taxines
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
In a yew plant–related suicidal case involving a 46-year-old man, initial symptoms included nausea, vomiting, and an orange-pink urine color. Electrocardiogram (ECG) revealed sinus bradycardia, first-degree atrioventricular block, widened QRS complexes, and ST elevation followed by ventricular tachycardia, torsade de pointes, and cardiac arrest (due to bradycardia/asystole). Laboratory tests showed elevated levels of dimer D (1.19 μg/mL), gamma-glutamyl transpeptidase (119 U/L), aspartate transaminase (238 U/L), alanine transaminase (172 U/L), urea (68 mg/dL), creatinine (1.40 mg/dL), plasma glucose (323 mg/dL), and hypokalemia (3.3 mmol/L). Application of intensive cardiac care (e.g., external cardiac massage, resuscitation, defibrillations, and administration of magnesium and antiarrhythmic drugs; insertion of transvenous pacing lead), basic and advanced life support (1 mg adrenalin injections; provision of amiodarone, lidocaine, bicarbonates, and intravenous fluids), and other treatments (e.g., sedation with midazolam and fentanyl; intravenous dopamine, norepinephrine, and dobutamine infusions) was crucial in helping save his life, and allowing for his complete recovery [17].
Electrocardiogram
Published in Burt B. Hamrell, Cardiovascular Physiology, 2018
In first degree atrioventricular block every P wave is followed by ventricular depolarization. In second degree atrioventricular block there are instances where conduction from atria to ventricles fails to occur and a ventricular action potential does not follow a P wave. The cause varies and can be due to such things as drug toxicity, ischemia, and inflammation affecting some part of the conduction system. Second degree heart block also can be related to the effects of the autonomic nervous system on a normal atrioventricular node. There are two types of second degree atrioventricular block.
Pyronaridine–Artesunate
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Other quinoline drugs such as halofantrine, mefloquine, quinine, piperaquine, and chloroquine have arrhythmogenic properties that manifest as prolongation of the QT interval (White, 2007). However, minor QT prolongation is common in malaria, and may be disease related. No specific evaluations have been undertaken using robust methodologies to determine if pyronaridine–artesunate exacerbates this effect in human subjects. However preclinical animal studies have suggested that pyronaridine is far less cardiotoxic than chloroquine (Croft et al., 2012), and routine monitoring in clinical trials has suggested that the incidence of electrocardiographic abnormalities, including QT prolongation, is lower than that seen with other ACTs such as artemether–lumefantrine and artesunate–mefloquine (Bukirwa et al., 2014). First-degree atrioventricular block, sinus arrhythmia, hypertension, and hypotension have been reported as rare (1/1000) events, but it is not clear if these were truly drug related (Shin Poong Pharmaceutical Company, 2015).
Abstracts from the Seventh Annual Baylor University Medical Center Medical Education Research Forum 2021
Published in Baylor University Medical Center Proceedings, 2021
Kashif Waqiee Ahmed, Thomas Cox, Jennifer Olvera, Natalie Gittus, Kirsten Ryan, Cristie Columbus
Monomorphic ventricular tachycardia (VT) has a broad differential. We present a case illustrating the importance of utilizing various imaging modalities for noninvasively eliciting the etiology of VT. A 55-year-old African American man presented to the emergency department for a postcoital monomorphic VT arrest requiring cardioversion. An electrocardiogram showed first-degree atrioventricular block, left anterior fascicular block, and right bundle branch block. A transthoracic echocardiogram showed a left ventricular ejection fraction of 50% with hypokinesis of the basal to mid anterior and anterolateral walls along with excessive right ventricular trabeculations. Cardiac catheterization showed normal coronaries. Cardiac magnetic resonance imaging revealed a diffuse epimyocardial scar along the basal and mid anterior, inferolateral, and anterolateral walls and a subendocardial scar along the basal and mid septum. The scar pattern suggested infiltrative disorders, inflammation, or rare dysplasia with fibrosis. No scar was seen in the right ventricle. Positron emission tomography revealed few small areas of mild fluorodeoxyglucose activity in the basilar to mid anterior wall, distal anterior wall near the apex, and basilar inferoseptal region. There was also evidence of old granulomatous disease in the liver. Given the classic electrocardiographic findings, clinical picture, and imaging findings, cardiac sarcoidosis was confirmed and steroids were initiated. Cardiac sarcoidosis as a cause of monomorphic VT remains an evasive diagnosis; a multimodality imaging strategy can help confirm the diagnosis.
Novel Method for Implantation of Balloon Expandable Transcatheter Aortic Valve Replacement to Reduce Pacemaker Rate—Line of Lucency Method
Published in Structural Heart, 2020
P. Kasi Ramanathan, Salik Nazir, Ahmed M. Elzanaty, Zeid Nesheiwat, Muhammad Mahmood, William Rachwal, Christopher Riordan, John Letcher, Kellie Yenrick, Erica Boonie, Michael G. Moront, Roberta E. Redfern, Donald Crescenzo
In total, 64 patients underwent transfemoral TAVR using the line of lucency method for implant positioning during the study time frame. Fourteen patients had a preexisting permanent pacemaker and were excluded, such that 50 patients were included in this analysis. The SAPIEN 3 prosthesis was used in 48 (96%) patients and SAPIEN 3 Ultra was implanted in 2 (4%) patients. The median age of subjects was 81.5 years (interquartile range [IQR] 74.3–85.0), and 52% were female. The majority of patients had a history of hypertension (90%); other relevant comorbid conditions and baseline characteristics are shown in Table 1. Preprocedure electrocardiography (EKG) showed first degree atrioventricular block in 9 (18%), right bundle branch block in 6 (12%), and left anterior fascicular block in 8 (16%) of the patients. Most patients had ≥50% ejection fraction at baseline (Table 1); 20% of the patients had a history of prior percutaneous coronary intervention. Two patients had a preexisting bioprosthetic valve, and hence had valve-in-valve TAVR.
CYP24A1 Variants in Two Chinese Patients with Idiopathic Infantile Hypercalcemia
Published in Fetal and Pediatric Pathology, 2019
Yan Sun, Jun Shen, Xuyun Hu, Yu Qiao, Jianmei Yang, Yiping Shen, Guimei Li
Patient One was a 4-month-old female infant with hypercalcemia who presented with an upper respiratory tract infection and vomiting. She had received 8 mL of cholecalciferol cholesterol milk (containing vitamin D3 300,000 units) just 1 week before symptom onset. No family history of related diseases was reported. Physical examination of the patient revealed growth restriction (height 57 cm, <3rd percentile). Her biochemical laboratory results were diagnosed as hypercalcemia crisis (serum calcium 5.66 mM), with decreased serum phosphate (0.91–1.76 mM), elevated 25-dihydroxyvitamin D (684.50 nmol/L) and suppressed PTH (4.53 pg/mL; Table 1). Her total protein, albumin, bone-specific alkaline phosphatase (BAP) and thyroid hormones were within reference ranges. Immunoglobulin tests indicated impaired immune function (IgG <1.27 g/L, IgA <0.06 g/L and IgM of 0.27 g/L). Furthermore, her electrocardiogram showed first degree atrioventricular block. Gas chromatography mass spectrometry (GC-MC) testing and high-performance liquid chromatography–mass spectrometry (HPLC-MS) were both negative for metabolic diseases. Bone marrow examination showed a left shift. Her heart ultrasound was normal. The abdominal ultrasound revealed diffuse renal damage and medullary calcareous deposits (Fig. 1).