The American journal of emergency medicine
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Case Reports
Post-partum hemorrhage complicated by reverse-Takotsubo cardiogenic shock; a novel therapeutic approach.
Takotsubo Cardiomyopathy (TTC) is a type of transient, yet severe left ventricular systolic dysfunction, rarely complicating extreme emotional stress ("primary" TTC) or critical medical/surgical illness ("secondary" TTC forms). Although usually reversible, TTC may result in cardiogenic shock with dismal prognosis. "Secondary" TTC forms are particularly in danger for this complication, bearing significantly worse short and long-term prognosis. Herein, we report a rare case of a life-threatening "secondary" TTC in a patient with post-cesarean section severe hemorrhage, and we point out that early co-administration of esmolol and levosimendan might be an effective and safe therapeutic approach in "reversing" TTC-induced cardiogenic shock, especially when invasive therapeutic strategies are practically unfeasible.
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Case Reports
Trauma-induced acute myocardial infarction due to delayed dissection of the left anterior descending coronary artery.
Acute myocardial infarction is a very rare, life-threatening complication of blunt chest trauma. A 27-year-old man with no previous medical history was admitted to the emergency department due to multiple trauma following a car accident. After 48h following the accident, the patient's condition rapidly deteriorated, with severe dyspnea at rest, tachycardia, and increasing chest pain. ⋯ Primary percutaneous coronary intervention with a Biolimus A9™-eluting stent implantation were successfully performed. The further course was uneventful. At 12-month follow-up, the patient has remained asymptomatic with no recurrence of cardiovascular symptoms.
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Hiccups (singultus) is often a benign, common and self- limited condition. A case of profound electrolyte disturbances presenting with chief complaint of hiccups is presented in which chlorpromazine was not administered and could have been problematic had it been given. For those who present to the ED with chief complaint of hiccups, it is critical to consider a life threatening etiology as the cause of their symptom. This case presents a potential pitfall in the management of singultus.
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We illustrate the case a patient with left bundle branch block (LBBB) and electrocardiogram (ECG) changes consistent with those described in Wellens' syndrome. The characteristic ECG findings of Wellens' syndrome identify patients who have a particularly high rate of important coronary events in the near future, however these findings have previously been described only in the setting of normal conduction. A review of Wellens' syndrome, its criteria and pathophysiology, and its proposed appearance in the setting of LBBB is presented.
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A meta-analysis of randomized controlled trials on evaluating the clinical efficacy of Xuebijing in treating patients with sepsis had been recently published in this journal, however, in our opinion, at least 6 questions or doubts existed about the content and methodology of the systematic review, thus, we write this letter to the journal to share these questions with the editor and readers with the hope of getting these questions solved and learning more about the true effects which Xuebijing should have on in treating patients with sepsis.