Tariq Siddiqui

Recurrent myopericarditis as a complication of Marijuana use.

Patient: Male, 29 Final Diagnosis: Myopericarditis Symptoms: Chest pain Medication: Ibuprofen Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Cannabis is the most commonly used illegal substance worldwide and its consumption portends significant side effects. Nowadays, in order to increase its psychotropic effect, various substances are being added constantly to it to promote its potency that might hold toxic effects to different organs including the heart and might lead to other unreported complications such as myopericarditis. Herein, we are presenting a unique case of recurrent myopericarditis after the consumption of contaminated marijuana, an association that has not been reported in literature before. Case Report: A 29-year-old man presented to our institution with pressure-like left-sided chest pain that is aggravated by cough and deep inspiration and relieved by sitting and leaning forward. Examination revealed pericardial rub and workup showed elevated white blood cell count, C-reactive protein and troponin I level of 2.99 ng/ml. ECG upon admission showed ST-segment elevation in the inferior leads with PR-segment depression. Echocardiogram revealed only concentric hypertrophy. Patient was admitted to another institution with similar symptoms 2 months earlier. Patient admitted to using adulterated Marijuana on both occasions prior to hospitalization. Review of medical records from the outside hospital revealed similar ECG and laboratory findings. Treatment with Ibuprofen resulted in resolution of patient’s symptoms and ECG abnormalities. Conclusions: Recurrent myopericarditis in our patient is likely the result of consumption of contaminated Marijuana. Careful history taking in patients presenting with myopericarditis is crucial as it might be the causal link.

Anabolic androgenic steroid–induced acute myocardial infarction with multiorgan failure

ABSTRACT The abuse of anabolic androgenic steroids (AAS) has remained on the rise despite their well-known deleterious effects. We describe a case of AAS-induced multisystem failure following an extensive history of abuse in a 41-year-old bodybuilder. Furthermore, we review pertinent literature and discuss the different pathophysiologic mechanisms through which AAS affect the heart and other organs. This case points to the possibility of multiorgan involvement and severe cardiac effects of AAS abuse in young individuals who may not have any past medical history.

Adverse Effects of Domperidone: Prolonged QuesT for Knowledge?

Domperidone, a dopamine (D) receptor antagonist which blocks D2 receptors in the chemoreceptor trigger zone centrally and the enteric nervous system peripherally, is an anti-emetic and prokinetic medication predominantly used for treating symptomatic gastroparesis. An important recent concern regarding the safety of domperidone is whether it can prolong the QT interval, increasing the probability of developing ventricular arrhythmias with consequent cardiac death, based on publications addressing its possible cardiotoxicity [1–7]. Unlike metoclopramide, another D2 antagonist which has significant adverse effects particularly related to central nervous system and is approved by the Food and Drug Administration (FDA) as a prokinetic agent in the USA, domperidone cannot be marketed legally for clinical use in this country, but is nevertheless available through an investigational new drug (IND) application. The decisions made by FDA regarding the safety of domperidone have wide implications for restrictions in the use of this medication in patients diagnosed with gastroparesis or suffering from nausea and vomiting of other origins. Therefore, it is important to clarify and understand the balance between the therapeutic efficacy and the reported adverse effects of domperidone. In the current issue of Digestive Diseases and Sciences, Schey et al. [8] have published an interesting article discussing the benefits and adverse effects of domperidone in gastroparesis. In their study, domperidone was prescribed at a dose of 10 mg QID or TID to 125 patients with refractory gastroparesis symptoms who were observed for symptomatic improvement and for adverse effects. Tachycardia and palpitations were observed in six and three patients, respectively, with one patient developing QT prolongation necessitating discontinuation of the medication. In total, 14 patients stopped taking the medication for different reasons. Observation of 101 patients for a mean of 2.4 months taking an average domperidone dose of 36 mg/day revealed some degree of symptomatic improvement in 69 patients, with 45 reporting at least moderate improvement. The findings of Schey et al. [8] are in agreement with previous studies of domperidone in gastroparesis. Based on a systematic review, 64 % of the included studies reported symptomatic improvement, 60 % reported improved gastric emptying, and 67 % of the studies described a reduction of hospital admissions. No serious complications such as sudden cardiac death or serious cardiac events were described [9]. A list of previous published trials on domperidone in gastroparesis is shown in Table 1. In the most recent publication on this topic by our research group, 64 patients received a twofold to threefold greater dose of domperidone (40–120 mg daily) than standard for 3 months to 4 years; indicated in 52 for gastroparesis and in eight for chronic nausea and vomiting. Seventy-three percent of the patients had a clinically meaningful response to domperidone with no reported serious adverse effects. Only three of the 64 patients chronically receiving domperidone at high doses reported palpitations but without any complaints of chest pain, and & Richard W. McCallum richard.mccallum@ttuhsc.edu

Reverse takotsubo cardiomyopathy with use of male enhancers.

Reverse takotsubo cardiomyopathy is a rare heart failure condition characterized by systolic dysfunction of the basal segments of the left ventricle in the absence of obstructive coronary artery disease. We present a case of a 54-year-old man with an overdose of Extenze (a male enhancer pill containing yohimbine) who was hospitalized with heart failure due to reverse takotsubo cardiomyopathy.

Finger necrosis due to cryoglobulinemic vasculitis in association with membranous nephropathy

Cryoglobulinemic vasculitis is a small vessel vasculitis that has been associated with chronic infections and autoimmune, lymphoproliferative, and neoplastic disorders. When no significant etiological factors are identified, it is called essential mixed cryoglobulinemia. A detailed and thorough laboratory investigation is required to exclude all possible causes of cryoglobulin formation. Although cryoglobulin testing is simple, careful temperature regulation is needed to avoid false-negative results. Consensus diagnosis should be developed and implemented for appropriate cryoglobulin detection and accurate clinical diagnosis for cryoglobulinemic vasculitis. Here we present an interesting, first-ever case report of a 54-year-old Hispanic-American woman with essential mixed cryoglobulinemia presenting with significant digital necrosis in association with membranous nephropathy.