The American journal of emergency medicine
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Cardiac syncope can be classified as being either structural or dysrhythmogenic in origin, and it may be the only warning symptom of sudden cardiac death. One of the causes of dysrhythmic sudden cardiac death in young adults with structurally normal hearts is Brugada syndrome. Electrocardiogram (ECG) of Brugada syndrome is characterized by an ST-segment elevation in the right precordial leads. ⋯ This pattern was reverted back to normal 5 minutes later and never showed up again on his future ECGs. In our case, it was only the earliest ECG that made the diagnosis possible since all future ECGs showed a perfectly normal pattern throughout the follow-up period. In all syncope patients, initial ECGs should be kept and filed to be reviewed again in case the primary physician is not competent enough for the evaluation of ECG.
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Behçet's disease is a multisystemic, potentially life-threatening condition with vascular involvement and thrombotic tendency. The disease course is characterized by exacerbations and remissions. Lower extremity vein thrombosis is the most frequent manifestation of vascular involvement, followed by vena cava thrombosis, pulmonary artery aneurysms, peripheral artery aneurysms, dural sinus thrombosis and abdominal aorta aneurysms. The case in this report was considered worth reporting due to vena cava thrombosis extending from brachiocephalic to jugular vein, accompanying thrombosis of the contralateral brachiocephalic vein and jugular veins as well as simultaneous dural sinus thrombosis, and also benefit from thrombolytic therapy.
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Observational Study
Clinical features of patients inappropriately undiagnosed of pulmonary embolism.
The objective of this study was to identify clinical factors associated with delayed diagnosis of acute pulmonary embolism (PE) in the emergency department (ED). ⋯ Delay in diagnosis of acute PE is frequent despite current diagnostic strategies. Patients are sent home or admitted to hospital with a wrong diagnosis depending on clinical presentation or coexisting medical conditions.
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Torsade de pointes (TdP) is a life-threatening polymorphic ventricular tachycardia that is related to QT prolongation. Although QT prolongation is commonly seen in acute stroke, TdP is rare. ⋯ We hypothesized that an increase in intracranial pressure may result in neurohormonal activation, QT prolongation, and then myocardial damage, leading to TdP. We highlight that new onset of TdP in a patient with stroke may reflect neurologic deterioration, requiring further evaluation and specific intervention.
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Observational Study
Outcomes of patients admitted for hanging injuries with decreased consciousness but without cardiac arrest.
The objective of this study is to provide appropriate treatment of patients who showed decreased mentality but did not suffer cardiac arrest (CA) from hanging injury, from reviewing the characteristics and analyzing the outcomes in such patients. ⋯ Unconscious patients without CA from hanging could recover consciousness through conservative treatment.