Cardiol J
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This anesthetic drug may cause a rare condition named propofol infusion syndrome, characterized by unexplained lactic acidosis, lipemia, rhabdomyolysis, cardiovascular collapse and Brugada-like electrocardiographic pattern or Brugada electrocardiographic phenocopy changes following high-dose propofol infusion over prolonged periods of time. Several articles have contributed to our understanding of the cause of the syndrome, and the growing number of case reports has made it possible to identify several risk factors. ⋯ The favorable recovery profile associated with propofol offers advantages over traditional anesthetics in clinical situations in which rapid recovery is important. Propofol is a safe anesthetic agent, but propofol infusion syndrome is a rare lethal complication.
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Review Case Reports
Acute myocardial infarction in a patient with post-splenectomy thrombocytosis: a case report and review of literature.
Unlike essential thrombocytosis, which is associated with thrombotic and hemorrhagic complications, reactive thrombocytosis (RT) is usually considered a benign process without thrombotic complications. We describe a case of acute myocardial infarction in a young heavy smoker with RT following splenectomy. Coronary angiography showed a linear filling defect at mid-part of left anterior descending artery. ⋯ His in-hospital course was uneventful and platelet count returned to the normal range at four month follow-up. We concluded that RT may not be an entirely benign process, especially in patients with a history of smoking. Regular monitoring of platelet count, and possibly antithrombotic agents like aspirin prescription for high risk patients with moderate thrombocytosis, may be useful.
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Inappropriate sinus tachycardia (IST) is an uncommon disorder characterized by an exaggerated heart rate (HR). It is mostly treated with b-blockers or verapamil leaving the sinus node modulation for refractory cases. Ivabradine, a pure HR lowering agent, has proven anti-anginal efficiency linked to the If current inhibition. We conducted a small prospective experience investigating its efficacy in IST. ⋯ IST causes an elevated HR and its control is the treatment objective. If future data confirm our results, ivabradine could be used for this purpose. More information is necessary in order to define its role: initial option, second step (beta-blockers non-responders or intolerants) or combined (refractory cases).
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Review Case Reports
Lead-dependent infective endocarditis: an old problem, a new name.
This paper presents a literature review on right heart endocarditis in patients with a permanent pacemaker (PM) or implantable cardioverter-defibrillator (ICD). We postulate putting a great deal more emphasis on separation of lead-dependent infective endocarditis from other types of infective endocarditis. We stress the need for screening patients with PM/ICD and pulmonary signs using transesophageal echocardiography. Antibiotic therapy and PM/ICD removal is the treatment of choice in such patients.
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The identification of a good prognostic factor of neurological outcome after cardiac arrest is needed. S-100B protein seems to be a promising early predictor of brain damage. Yet it is necessary to reach a consensus on cut-off values, time of blood sampling and the predictive accuracy of S-100B protein. The present review summarizes the data about the clinical implications of S-100B protein after brain injury, especially in patients after cardiac arrest.