International journal of cardiology
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3,4-Methylenedioxymethamphetamine (MDMA, 'ecstasy') is an amphetamine synthetic analog widely used as an recreational drug. Acute and severe toxic effects following MDMA ingestion include hyperthermia, arrhythmias, rhabdomyolisis, disseminated intravascular coagulation, hepatotoxicity and even death. Recently, we treated a patient in whom hyperkalemia, in the absence of renal failure, aggravated the expected toxic complications of MDMA, becoming the immediate cause of his death.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent cardiac events at suspicion of unstable coronary syndromes.
Troponin is a specific marker of myocardial damage. For early prediction of coronary events in patients with suspicion of acute coronary syndromes the assay also needs to be highly sensitive. ⋯ In a population with non-ST elevation acute coronary syndrome a positive rapid troponin I assay is a specific indicator of troponin elevation and a predictor of early outcome. However, a negative rapid troponin I is not a reliable indicator of the absence of myocardial damage and does not indicate a low risk of subsequent cardiac events. A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial and related to a centrally analyzed quantitative troponin T test. A positive rapid troponin I was well corresponding to any elevation of troponin T (>0.01 microg/l) and predicted an unfavorable outcome at 30 days. However, a negative rapid troponin I was corresponding to troponin T < or =0.01 microg/l in only half of the patients. Troponin T >0.1 microg/l vs. < or =0.1 microg/l provided a better risk stratification than the rapid troponin I result. For patients with troponin T elevation (>0.1 microg/l) the 30 day event rate was high regardless of the rapid troponin I result.
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Letter Case Reports
Floating thrombi on the Eustachian valve as a complication of venous thromboembolic disease.
Floating right heart thrombi can occur in 4-18% of patients with pulmonary embolism. Usually, the diagnosis is done by echocardiography and carries an important prognostic significance as thrombi can embolize at any moment and severe pulmonary embolism is the most frequent way of floating right heart thrombi presentation (mortality rate >40%). We present a case report of floating right thrombi in a patient with proven deep venous thrombosis complicated with nonmassive pulmonary embolism that was successfully treated with thrombolysis.