RESUMO
It is estimated that 5% of patients with heart failure (HF) will progress to end-stage disease refractory to medical therapy and might require prolonged hospitalisation with inotropic support. We present the case of a patient with end-stage HF who was admitted with cardiogenic shock. During his hospitalisation, he required prolonged intravenous vasopressor therapy due to refractory hypotension. He did not qualify for heart transplantation or left ventricular-assist device strategies. Midodrine was started as a last resort attempt to wean off vasopressors. After 5 days of therapy, the patient was weaned entirely off vasopressors and was discharged home for hospice care. By the time of discharge, he was tolerating low-dose carvedilol along with midodrine. We propose midodrine as a reasonable alternative for patients with end-stage HF with reduced ejection fraction and refractory hypotension, who are dependent on intravenous vasoactive drugs and are not candidates for advanced HF therapies.
Assuntos
Insuficiência Cardíaca , Hipotensão , Midodrina , Masculino , Humanos , Midodrina/uso terapêutico , Vasoconstritores/uso terapêutico , Hospitalização , Insuficiência Cardíaca/tratamento farmacológico , Hipotensão/tratamento farmacológicoRESUMO
Multiple case reports have signaled a rise in buprenorphine abuse in the US, particularly among inmates. We present the case of limb ischemia secondary to accidental intra-arterial buprenorphine/naloxone film injection successfully treated with sublingual nitroglycerin. A 39-year-old man with history of intravenous drug use presented sudden severe left hand pain since three days prior to evaluation. Pain was preceded by self-injection of dissolved buprenorphine/naloxone sublingual film onto the affected arm. An arteriogram suggested severe vasoconstriction in the absence of frank thrombosis. Patient was initially treated with continuous heparin infusion and nifedipine. Forty-eight hours later, due to poor response, sublingual nitroglycerin was added to therapy. Digits regained color, sensation, and pain resolved within 15 minutes of administration of sublingual nitroglycerin. The presence of acute limb ischemia caused by prolonged vasospasm is a very rare complication. A normal angiogram should raise suspicion regarding vasospasm as the mechanism of ischemia, and prompt nitroglycerin therapy.
Assuntos
Combinação Buprenorfina e Naloxona/efeitos adversos , Mãos/irrigação sanguínea , Isquemia/tratamento farmacológico , Nitroglicerina/administração & dosagem , Abuso de Substâncias por Via Intravenosa/complicações , Vasodilatadores/administração & dosagem , Administração Sublingual , Adulto , Angiografia , Anticoagulantes/administração & dosagem , Combinação Buprenorfina e Naloxona/administração & dosagem , Mãos/diagnóstico por imagem , Heparina/administração & dosagem , Humanos , Isquemia/induzido quimicamente , Isquemia/diagnóstico por imagem , Masculino , Nifedipino/administração & dosagem , Dor/induzido quimicamente , VasoconstriçãoRESUMO
This report presents a case of spontaneous fungal peritonitis (SFP) in a patient with cardiogenic ascites. Physicians need to be aware of this life-threatening condition because early suspicion of SFP can improve survival.
RESUMO
Acute coronary syndrome rarely occurs in young individuals and is seldomly associated with antiphospholipid syndrome. We report the case of a 26-year-old Hispanic man who presented with acute ST-elevation myocardial infarction and was treated with urgent percutaneous transluminal coronary angioplasty. He experienced stent thrombosis within 48 h of intervention and subsequently developed a left apical thrombus. Hypercoagulable state studies were obtained at admission and 12 weeks after the event establishing the diagnosis of antiphospholipid syndrome.