RESUMO
This 63 years old man presented to the emergency room with chest pain of more than 12 hours duration. The initial electrocardiogram showed as ST segment elevation inferior and right ventricular infarction. He developed signs and symptoms consistent with cardiogenic shock, followed by life threatening ventricular fibrillation and cardiac arrest. After repeated cardio-respiratory resuscitations and successful cardiac defibrillation, thrombolytic therapy was administered followed by clinical and hemodynamic improvements. One-week later cardiac catheterization and coronary arteriography were performed. The study showed 93% obstructive lesion in the proximal right coronary artery, an angioplasty was performed and a stent was placed. After appropriate re-adjustment of medical therapy, the patient was discharged and followed in the outpatient clinic. Although the time frame to administer thrombolytic therapy was over the 12 hours window as suggested by the AHA guidelines1, the potential risks benefits in the casepresented justifed the used of fibrinolytic therapy. Considering the multiple complications that the patient presented, fibrinolytic therapy needs to be considered even after 12 hours of symptoms initiation, particularly when facilities for primary percutaneous coronary interventions are not readily available.
Assuntos
Dor no Peito/etiologia , Fibrinolíticos/administração & dosagem , Infarto do Miocárdio/complicações , Choque Cardiogênico/etiologia , Terapia Trombolítica , Fibrilação Ventricular/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Angioplastia Coronária com Balão , Contraindicações , Estenose Coronária/complicações , Estenose Coronária/terapia , Dopamina/uso terapêutico , Quimioterapia Combinada , Eletrocardiografia , Fibrinolíticos/uso terapêutico , Hidratação , Bloqueio Cardíaco/tratamento farmacológico , Bloqueio Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/terapia , Reperfusão Miocárdica/métodos , Nitroglicerina/uso terapêutico , Choque Cardiogênico/tratamento farmacológico , Choque Cardiogênico/terapia , Stents , Fatores de Tempo , Fibrilação Ventricular/tratamento farmacológicoRESUMO
Bleeding emergencies are common chief complaints in visits to the Emergency Department (ED) but hemophilia, a rare congenital bleeding disorder requires immediate treatment. Hemophilia B is characterized by a deficiency of coagulation Factor IX. As emergency medicine physicians we must be prepared to deal with such emergencies. One of the most feared complications in this population is the spontaneous or post-traumatic development of intracranial hemorrhage (ICH). We present a case of a 69 year-old man with a past medical history of hemophilia B who presented to the emergency department after suffering a head trauma with development of acute and delayed ICH.
Assuntos
Traumatismos Craniocerebrais/complicações , Hemofilia B/complicações , Hemorragias Intracranianas/etiologia , Idoso , Humanos , MasculinoRESUMO
Sildenafil citrate is a drug used in the treatment of erectile dysfunction. It is an inhibitor of the enzyme phosphordiesterase-5; it slows down the breakdown of c-GMP and nitrous oxide. The cardiac effects associated with Sildenafil citrate have been extensively studied in medical literature, especially its potent vasodilatory effect when combined with nitrate-based medications, producing intractable hypotension, but a lesser known and potentially lethal side effect is prolonged cardiac repolarization when used at dosage greater than recommended, leading to QT prolongation that could theoretically lead to dangerous cardiac dysrrhythmias and sudden death in men with coronary artery disease. The authors present the case of a 49-year-old hypertensive Hispanic man who arrived to our emergency department with the chief complaint of acute epigastric pain for 3 hours of evolution after ingestion of Sildenafil citrate 50 milligrams (mg). The patient was found to have an acute ST elevation inferior myocardial infarction (STEMI). Shortly after diagnosis the patient developed a polymorphic ventricular tachycardia (Torsade de pointes) before thrombolytic administration. We present this case followed by a brief discussion, to heighten awareness of the possible association of acute inferior STEMI and the development of Torsade de Pointes after the use of Sildenafil citrate.