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Ayurzana A, Avirmed A, Avarzed A, Batkhuu B, Amgalanbaatar D. A low dose of amiodarone-indused sinoatrial node dysfunction: a case report. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.118120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We recently treated a case similar to that reported by Mun et al and Chinushi M. Holter ECG demonstrated paroxysmal atrial fibrillation, frequent ventricular ectopy’s, atrial tachycardia. The patient complained of palpitation. We have prescribed and amiodarone (100 mg/day) per day for 2 months. In the second visit, the palpitation attacks were relieved. It was effective in decreasing palpitation and atrial fibrillation. However, the patient was readmitted because of a new complaint of feeling weak, dizziness, confusion, and fainting. Holter monitoring revealed a long sinus pause (4–7,9 seconds). Because such a sinus pause had not been observed before the amiodarone treatment, it is likely that the development of sick sinus syndrome was related to amiodarone. Therefore, it seems inappropriate to apply this incidence of amiodarone-related sinoatrial node dysfunction to patients who are prescribed amiodarone for the treatment of ventricular tachyarrhythmia and atrial fibrillation who have prescribed a lower maintenance dose of amiodarone.
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Fegley MW, Cardi A, Augoustides JG, Horak J, Gutsche JT, Nanda S, Kornfield ZN, Saluja A, Sanders J, Marchant BE, Fernando RJ. Acute Lung Injury Associated With Perioperative Amiodarone Therapy-Navigating the Challenges in Diagnosis and Management. J Cardiothorac Vasc Anesth 2021; 36:608-615. [PMID: 34172364 DOI: 10.1053/j.jvca.2021.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Mark W Fegley
- Critical Care Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alessandra Cardi
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Jiri Horak
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sudip Nanda
- Clinical Electrophysiology, Cardiology Associates, St. Luke's University Health Network, Bethlehem, PA
| | - Zev N Kornfield
- Critical Care Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abhishek Saluja
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, School of Medicine, Wayne State University, Henry Ford Health System, Detroit, MI
| | - Joseph Sanders
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, School of Medicine, Wayne State University, Henry Ford Health System, Detroit, MI
| | - Bryan E Marchant
- Division of Cardiothoracic Anesthesia and Critical Care, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
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Duffy B, Li L, Lu S, Durocher L, Dittmar M, Delaney-Baldwin E, Panawennage D, LeMaster D, Navarette K, Spink D. Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent. TOXICS 2020; 8:E8. [PMID: 31991538 PMCID: PMC7151740 DOI: 10.3390/toxics8010008] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023]
Abstract
Beginning in June of 2019, there was a marked increase in reported cases of serious pulmonary injury associated with vaping. The condition, referred to as e-cigarette or vaping product use-associated lung injury (EVALI), does not appear to involve an infectious agent; rather, a chemical adulterant or contaminant in vaping fluids is suspected. In August of 2019, the Wadsworth Center began receiving vaporizer cartridges recovered from patients with EVALI for analysis. Having no a priori information of what might be in the cartridges, we employed untargeted analyses using gas chromatography-mass spectrometry and high-resolution mass spectrometry to identify components of concern. Additionally, we employed targeted analyses used for New York medical marijuana products. Here, we report on the analyses of 38 samples from the first 10 New York cases of EVALI for which we obtained cartridges. The illicit fluids had relatively low cannabinoid content, sometimes with unusual Δ9-/Δ8-tetrahydrocannabinol ratios, sometimes containing pesticides and many containing diluents. A notable diluent was α-tocopheryl acetate (vitamin E acetate; VEA), which was found in 64% of the cannabinoid-containing fluids. To investigate potential sources of the VEA, we analyzed six commercial cannabis-oil diluents/thickeners. Three were found to be >95% VEA, two were found to be primarily squalane, and one was primarily α-bisabolol. The cause(s) of EVALI is unknown. VEA and squalane are components of some personal care products; however, there is growing concern that vaping large amounts of these compounds is not safe.
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Affiliation(s)
- Bryan Duffy
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Lingyun Li
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Shijun Lu
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Lorie Durocher
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Mark Dittmar
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Emily Delaney-Baldwin
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Deepika Panawennage
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - David LeMaster
- Laboratory of Molecular Diagnostics, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA;
| | - Kristen Navarette
- Center for Environmental Health, New York State Department of Health, Albany, NY 12201, USA;
- Albany Medical Center, Department of Pediatrics, Albany, NY 12208, USA
| | - David Spink
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
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