Amjad Kabach

Acute Amiodarone Pulmonary Toxicity after Drug Holiday: A Case Report and Review of the Literature

Amiodarone is reported to cause a wide continuum of serious clinical effects. It is often challenging to detect Amiodarone-induced pulmonary toxicity (AIPT). Typically, the diagnosis is made based on the clinical settings and may be supported by histopathology results, if available. We describe a 57-year-old patient who developed severe rapidly progressive respiratory failure secondary to AIPT with acute bilateral infiltrates and nodular opacities on chest imaging. Interestingly, Amiodarone was discontinued 3 weeks prior to his presentation. He had normal cardiac filling pressures confirmed by echocardiography. To our knowledge, this is the first case of isolated acute lung injury induced by Amiodarone, three weeks after therapy cessation, with adequate clinical improvement after supportive management and high dose steroid therapy.

Rare cause of a common symptom: primary cardiac lymphoma

Cardiac tumors may be symptomatic or found incidentally during evaluation for a seemingly unrelated problem or physical finding. Because symptoms may mimic other cardiac conditions, the clinical challenge is to consider the possibility of a cardiac tumor so that the appropriate diagnostic test(s) can be conducted. In this case, we describe an exceedingly rare cardiac tumor.

Trauma-Induced Conduction Disturbances

Background: Electrical disturbances following blunt cardiac injuries are rare but can be caused by electrical or structural damage to the heart. We present the case of a patient who had conduction abnormalities following blunt traumatic injury that were incidentally detected on telemetry. Case Report: A 64-year-old female with no history of cardiac disease was brought to the emergency department after a motor vehicle collision that resulted in chest wall bruising. The patient was found to have L-spine fractures and was admitted for observation. During her hospitalization, the patient had multiple episodes of heart block. A temporary pacemaker was inserted because of the recurrent episodes, and a dual-chamber permanent pacemaker was placed on day 4 of her hospitalization. Conclusion: Heart block as a consequence of blunt cardiac injury is rare; however, it needs to be recognized as early as possible. Permanent pacemaker placement is usually indicated for patients with prolonged or recurrent episodes.

A Case of Amitriptyline-induced Myocarditis

Amitriptyline is a widely prescribed tricyclic antidepressant (TCA) with a very concerning cardiotoxicity profile, but it is one that has not been discussed much in literature. Here, we present a case of amitriptyline toxicity presenting as myocarditis with pericardial involvement. A 21-year-old male with no previous cardiac history presented to the emergency department (ED) with a decreased level of consciousness after an amitriptyline overdose as a suicidal attempt. For concerns with airway protection, the patient was intubated and subsequently admitted to the intensive care unit (ICU). An electrocardiogram (EKG) showed sinus tachycardia, prolonged QRS complex, prolonged QTc interval, and nonspecific ST-T wave changes. Intravenous fluid resuscitation and sodium bicarbonate were administered with a target blood pH of 7.5 to 7.55. Two days later, the patient was taken off mechanical ventilation and improved clinically. However, troponin levels began to rise with a peak level of 4.08 µg/L. He then began having fevers, elevated white blood cell counts (WBCs), and elevated inflammatory markers. Transthoracic echo (TTE) revealed an ejection fraction (EF) of 45%-50%, no wall segment motion abnormalities, and a mild-to-moderate pericardial effusion. Cardiac magnetic resonance (CMR) was done, which revealed changes indicative of acute myocarditis, moderate pericardial effusion, a calculated EF of 45% with a moderate left ventricular dilation, and no coronary artery stenosis or anomalous coronary artery origin. Given the patient’s age, the absence of cardiac risk factors, and the presence of an amitriptyline overdose along with his EKG, TTE, and CMR findings, we hypothesize that this myocarditis with pericardial involvement is due to amitriptyline-induced direct toxicity.

Meta‐analysis of Randomized Controlled Trials on Atrial Fibrillation Ablation in Patients with Heart Failure with Reduced Ejection Fraction

The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF).

Dual Antiplatelet Therapy Versus Single Antiplatelet Therapy After Transaortic Valve Replacement: Meta-Analysis

BACKGROUND The current guidelines recommend empirical therapy with DAPT of aspirin and clopidogrel for six months after TAVR. This recommendation is based on expert consensus only. Giving the lack of clear consensus on treatment strategy following TAVR. Goal of this meta-analysis is to assess the efficacy and safety of mono-antiplatelet therapy (MAPT) versus dual antiplatelet therapy (DAPT) following transcatheter aortic valve replacement (TAVR). METHODS AND MATERIALS We performed a meta-analysis from randomized clinical trials (RCTs) and prospective studies that tested DAPT vs. MAPT for all-cause mortality and major bleeding of 603 patients. The primary efficacy outcomes were 30 days mortality and stroke. The primary safety outcomes were major bleeding and major vascular complications. RESULTS We included 603 patients from 4 studies. The use of MAPT was associated with similar mortality rate (5.9% vs. 6.6%; RR = 0.92; 95% CI 0.49-1.71; P = 0.68) and stroke rate compared with DAPT (1.3% vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P = 0.81). There was no difference in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI 0.23 to 1.18; P = 0.17) or minor vascular complication (4.2% vs. 7.3%; RR 0.58; 95% CI 0.25 to 1.34; P = 0.14). However, MAPT was associated with significantly less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI 0.20 to 0.70; P < 0.01) but no difference in minor bleeding (4.2% vs. 3.6%; RR 1.16; 95% CI 0.43 to 3.10; P = 0.85). CONCLUSION MAPT use after TAVR is associated with lower rates of major bleeding compared with DAPT with no significant difference in mortality, stroke or vascular complications.

STEAL SYNDROME PRETESTED AS STROKE/TRANSIENT ISCHEMIC ATTACK

Subclavian steal syndrome is frequently asymptomatic and may be discovered incidentally. However, Steal syndrome could present with different symptoms such as stroke or transient ischemic attack. 52 year old female presented with acute onset right side weakness associated with palpitation and

Image of the month: A Rare Case of Superior Mesenteric Artery Syndrome Causing Upper Gastrointestinal Bleeding.

A 21-year-old woman with a history of juvenile idiopathic arthritis and Crohn’s disease on adalimumab for the past 5 years presented to our emergency department with a 3-week history of fevers, fatigue, nausea, vomiting, diffuse abdominal pain, and peripheral adenopathy following a camping trip. Computed tomography of the abdomen showed multiple regions of small-bowel thickening and balloon-assisted enteroscopy revealed multiple severely ulcerated and hard circumferential skip lesions causing luminal narrowing. The most severe ulcer caused a pinpoint lumen at around 80 cm beyond the ligament of Treitz (left and center). Grocott silver stain at 40× highlighting the presence of fungal organisms (arrows) consistent with a clinical diagnosis of disseminated histoplasmosis (right). In addition, the histological evaluation of the biopsied lesions revealed severe jejunitis with ulceration and multinucleated cells.

Corrigendum to “Acute Amiodarone Pulmonary Toxicity after Drug Holiday: A Case Report and Review of the Literature”

[This corrects the article DOI: 10.1155/2015/927438.].