Air Embolism
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Air embolism is a potential complication of many operations. Children are more likely to develop air embolism, and to suffer more profound hypotension. In the conscious patient coughing, dyspnoea, chest pain and dizziness progressing to loss of consciousness may occur. In the unconscious patient diagnosis is based on the signs of developing hypotension, tachycardia, jugular venous distension and decreased pulmonary compliance during an ‘at risk operation’. The classical ‘millwheer murmur may be heard using an oesophageal or precordial stethoscope. A change from the usual swishing noise to a roaring sound is heard. A multi-orifice catheter with the tip at the caval—atrial junction is optimal for aspiration of the air embolus. The left lateral head down position may prevent a large air embolus from entering the pulmonary artery by ‘trapping’ it in the right ventricle.
Etiology of RSD
Hooshang Hooshmand in Chronic Pain, 2018
Cervical spine pathology is quite frequently accompanied by Reflex Sympathetic Dystrophy (RSD). The frequent association of RSD with cervical spine pathology is the result of the fact that vertebral arteries are accompanied by rich plexus of sympathetic nerve fibers. The complex anatomical structures of the cervical spine are richly innervated by the sympathetic nervous system. Cervical spondylosis is only matched by diabetes and syphilis as the "master immitators" in neurology. In cervical spondylosis on the basis of the same Sherrington phenomenon, the pain may radiate to the chest wall and precordial region after stimulation of the cardiac plexus. Cervicogenic RSD in rare cases can cause tremor in the hand and forearm, and in some cases it can be severe enough to cause writer's cramp and illegible handwriting. The main manifestations of the neuropsychiatric cerebral dysfunction are phobia, depression, extremely low threshold for pain, tendency for suicide, marked movement disorders in the form of spasticity and weakness of extremity.
Paediatric history and examination
Peter Kopelman, Dame Jane Dacre in Handbook of Clinical Skills, 2019
This chapter explores the key aspects of history taking and examination in children and young people. It focuses on some of the similarities that will be familiar from adult medicine and details some of the key additional areas that need a specific focus. The apex beat is best felt with the pulp tip of the third finger of the right hand lightly resting on the left fourth or fifth intercostal space between the mid-clavicular and mid-axillary lines. Precordial pulsations of left ventricular hypertrophy and right ventricular hypertrophy, and cardiac thrills, are best appreciated with the palm of the hand. Vocal resonance may be diminished in pleural effusion and increased in consolidation. Whispering pectoriloquy may be heard with consolidation. Paediatric history taking and examination can be time-consuming. The emergence of Paediatric Early Warning Score charts has helped to develop a structured way to look at what is and is not normal, and to escalate intervention appropriately.
ST-depression in right precordial leads with inferior STEMI and occluded right coronary artery: intertwined anatomy and ischemic areas
Published in Acta Clinica Belgica, 2017
Luisa De Gennaro, Natale Daniele Brunetti, Massimo Ruggiero, David Rutigliano, Nicola Locuratolo, Matteo Di Biase, Pasquale Caldarola
Right coronary artery (RCA) occlusion in inferior acute myocardial infarction is usually heralded by ST-elevation both in inferior and in right precordial leads. We report the case of a 68-year-old male, who presented marked ST-elevation in inferior leads, mirrored by ST-depression in anterior-septal and lateral leads. Right precordial lead electrocardiogram unexpectedly showed ST-depression V1R–V5R leads. Coronary angiography showed mid-left anterior descending (LAD) coronary near-complete occlusion with distal wrapping LAD. Left circumflex artery was not occluded, while RCA was occluded mid tract. The patient was treated with coronary angioplasty on RCA and LAD. Absence of ST-elevation in right precordial leads may be presumably explained by the presence of a large ischemic area distal to mid-LAD near-occlusive stenosis and of a long-wrapping LAD. Complex coronary anatomy and intertwined ischemic areas may underlie apparently discording electrocardiograms.
Adverse cardiac events to monoclonal antibodies used for cancer therapy
Published in OncoImmunology, 2014
Nicholas G Kounis, George D Soufras, Grigorios Tsigkas, George Hahalis
Monoclonal antibodies are currently used in the treatment of neoplastic, hematological, or inflammatory diseases, a practice that is occasionally associated with a variety of systemic and cutaneous adverse events. Cardiac adverse events include cardiomyopathy, ventricular dysfunction, arrhythmias, arrests, and acute coronary syndromes, such as acute myocardial infarction and vasospastic angina pectoris. These events generally follow hypersensitivity reactions including cutaneous erythema, pruritus chills, and precordial pain. Recently, IgE specific for therapeutic monoclonal antibodies have been detected, pointing to the existence of hypersensitivity and Kounis hypersensitivity-associated syndrome. Therefore, the careful monitoring of cardiovascular events is of paramount importance in the course of monoclonal antibody-based therapies. Moreover, further studies are needed to elucidate the pathophysiology of cardiovascular adverse events elicited by monoclonal antibodies and to identify preventive, protective, and therapeutic measures.
Synovial sarcoma in the right atrium and right ventricle
Published in Acta Cardiologica, 2011
Yunus Nazli, Mehmet Nuri Karabulut, Cemil Goya, Necmettin Colak
A metastatic synovial sarcoma in the right atrium and ventricle is described. A 36-year-old man was admitted to our hospital with generalized fatigue, dyspnoea, and precordial pain. Transthoracic echocardiography demonstrated a metastatic tumour in both the right atrium and right ventricle and revealed obstruction of the infl ow tract of the right ventricle caused by a metastatic right atrial tumour. Thoracic computed tomography revealed a pleural-based paravertebral mass in the left intrathoracic cavity and multiple pulmonary nodules in both lungs. Cardiac surgery was performed for palliative treatment due to right cardiac failure and a risk of fatal embolization. The patient died 12 months after the cardiac surgery.
Related Knowledge Centers
- Anatomy
- Commotio Cordis
- Pericarditis
- Heart
- Costochondritis
- Precordial Thump
- Precordial Examination