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Zhu K, Solin S, Deming MS. When Zebras Collide: A Case of Synchronous Wolff-Parkinson-White Syndrome and Pheochromocytoma. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934137. [PMID: 34866133 PMCID: PMC8667631 DOI: 10.12659/ajcr.934137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Male, 36-year-old
Final Diagnosis: Pheochromocytoma
Symptoms: Chest discomfort • headache • shortness of breath • symptomatic tachyarrhythmia
Medication: —
Clinical Procedure: —
Specialty: General and Internal Medicine
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Affiliation(s)
- Kaiwen Zhu
- Rochester Regional Health Internal Medicine Residency Program, Rochester, NY, USA.,Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Stacey Solin
- Department of Internal Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Madeleine S Deming
- Department of Internal Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Sagray E, Allison TG, Wackel PL. Is a high-intensity exercise test better than a graded exercise test in eliciting exercise-related arrhythmias? HeartRhythm Case Rep 2021; 7:549-552. [PMID: 34434706 PMCID: PMC8377273 DOI: 10.1016/j.hrcr.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ezequiel Sagray
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Thomas G Allison
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Philip L Wackel
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Treatment of caffeine toxicity with metoprolol. Am J Emerg Med 2019; 37:562.e5-562.e10. [DOI: 10.1016/j.ajem.2018.11.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/20/2018] [Accepted: 11/24/2018] [Indexed: 12/25/2022] Open
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Abstract
The hyperinflation of isoproterenol, a 75-year-old drug, in early 2015 was unbelievable. The attention of health-care professionals, health system administrators, legislators, and the general public was quickly focused on Valeant Pharmaceuticals, purchaser of several generics solely to raise their price. With isoproterenol easily launched toward the top of drug expenditures, pharmacists in many hospitals were forced to engage stakeholders in the investigation and implementation of alternatives, explore utilization and optimize inventory, reduce cost through sterile product preparation, where possible, restrict use to settings that were beneficial to their budget, and become legislative advocates. The alternatives drugs and strategies will be reviewed.
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Affiliation(s)
- Julie D'Ambrosi
- 1 Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT, USA
| | - Nilesh Amin
- 1 Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT, USA
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Cismaru G, Gusetu G, Muresan L, Rosu R, Andronache M, Matuz R, Puiu M, Mester P, Miclaus M, Pop D, Mircea PA, Zdrenghea D. Recovery of Ventriculo-Atrial Conduction after Adrenaline in Patients Implanted with Pacemakers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:857-63. [PMID: 25850362 DOI: 10.1111/pace.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/15/2015] [Accepted: 03/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventriculo-atrial (VA) conduction can have negative consequences for patients with implanted pacemakers and defibrillators. There is concern whether impaired VA conduction could recover during stressful situations. Although the influence of isoproterenol and atropine are well established, the effect of adrenaline has not been studied systematically. The objective of this study was to determine if adrenaline can facilitate recovery of VA conduction in patients implanted with pacemakers. METHODS A prospective study was conducted on 61 consecutive patients during a 4-month period (April-July 2014). The presence of VA conduction was assessed during the pacemaker implantation procedure. In case of an impaired VA conduction, adrenaline infusio was used as a stress surrogate to test conduction recovery. RESULTS The indications for pacemaker implantation were: sinus node dysfunction in 18 patients, atrioventricular (AV) block in 40 patients, binodal dysfunction (sinus node+ AV node) in two patients and other (carotid sinus syndrome) in one patient. In the basal state, 15/61 (24.6%) presented spontaneous VA conduction and 46/61 (75.4%) had no VA conduction. After administration of adrenaline, there was VA conduction recovery in 5/46 (10.9%) patients. CONCLUSIONS Adrenaline infusion produced recovery of VA conduction in 10.9% of patients with absent VA conduction in a basal state. Recovery of VA conduction during physiological or pathological stresses could be responsible for the pacemaker syndrome, PMT episodes, or certain implantable cardiac defibrillator detection issues.
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Affiliation(s)
- Gabriel Cismaru
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Gabriel Gusetu
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Lucian Muresan
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Radu Rosu
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Marius Andronache
- CHU de Nancy, Department of Cardiology, University Hospital Nancy, France
| | - Roxana Matuz
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Mihai Puiu
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Petru Mester
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Maria Miclaus
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Dana Pop
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Petru Adrian Mircea
- Department of Gastroenterology, Medical Clinic No 1, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Dumitru Zdrenghea
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
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