The American journal of emergency medicine
-
Brugada syndrome is characterized by the electrocardiographic (ECG) pattern of right bundle-branch block (RBBB) with a high take-off, coved ST-segment elevation in the precordial leads V1 to V3, and the risk of sudden cardiac death. Typically, there is no evidence of structural heart disease. In many cases, Brugada syndrome has been linked to a mutation of the gene SCN5A, which encodes for the fast cardiac sodium channel. ⋯ Interestingly, even in patients with a normal baseline ECG and no clinical suggestion of the Brugada syndrome, toxic doses of class I antiarrhythmic agents as well as toxicities with several nonantiarrhythmic drugs that possess sodium channel blocking properties can induce the Brugada ECG abnormality. Specifically, the beta-receptor blocker propranolol, at high doses, binds to the cardiac sodium channels and inhibits sodium uptake. In this report, we describe a case of severe propranolol toxicity, which resulted in the Brugada ECG pattern in an otherwise healthy individual who had no clinical or ECG suggestion of the genetically determined Brugada syndrome.
-
Case Reports
Case report and review: Potts disease and epididymal tuberculosis presenting as back pain and scrotal mass.
Tuberculosis (TB) is the world's leading infectious disease killer after AIDS [Tubercle. 1991;72:1-6; Lancet. 2003;362(9387):887-899]. Vertebral TB is the most common form of skeletal TB [Spine. 1997; 22(15):1791-1797], whereas male genital TB is an uncommon form of extrapulmonary TB [Urol Clin North Am. 2003;30(1):111-121]. ⋯ He was subsequently diagnosed with tuberculosis spondylitis (Potts disease) and epididymal tuberculosis. The epidemiology, clinical presentation, diagnosis, and treatment of tuberculosis spondylitis are discussed.
-
Case Reports
Cardiogenic shock associated with reversible dilated cardiomyopathy during therapy with regular doses of venlafaxine.
We report a cardiac complication in a patient treated with regular doses of venlafaxine. A 49-year-old man with prior normal cardiac function and stable chronic hepatitis C was treated for a major depressive disorder with usual doses of venlafaxine during an 8-month period until the occurrence of a cardiogenic shock in a context of dilated cardiomyopathy. ⋯ An objective assessment revealed that venlafaxine was probably implied in the subsequent development of cardiomyopathy when considering the Naranjo Probability Scale. Physicians who usually prescribe venlafaxine have to be briefed on such potential cardiac adverse effects even with usual doses.
-
The study aimed to assess, in pediatric patients presenting to the emergency department (ED), the incidence of visit to the ED for functional constipation (FC), symptoms, signs of presentation, and management from ED physicians. ⋯ Emergency department physicians have an important role in the diagnosis and management of FC despite its relatively low incidence. Indeed, ED intervention in many cases leads not only to recognition this disease but also to an approach for therapeutic strategy, avoiding complications of chronic constipation.