Heart & lung : the journal of critical care
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Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a clinical entity first described in the early 1990s in Japan and now receiving increased attention in the United States. The clinical features include an onset of chest pain mimicking that of an acute myocardial infarction, electrocardiogram changes similar to those of an acute myocardial infarction, normal coronary arteries on cardiac catheterization, and a signature appearance on echocardiogram. Takotsubo cardiomyopathy results in a significantly decreased ejection fraction that, as long as the patient receives appropriate hemodynamic support, typically undergoes spontaneous reversal. This article describes the history, clinical presentation, and management strategies for Takotsubo cardiomyopathy and provides a case study.
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Respiratory distress is the suffering that results from asphyxiation, and is characterized by observable behaviors. Standard measures of dyspnea rely on the patient's ability to self-report. However, not all patients who experience dyspnea are able to self-report because of temporary impairments or declining cognition, making them vulnerable to under-recognition and undertreatment of their distress. ⋯ The proposed model relies on primitive, subcortical, emotional, and autonomic neurologic systems that are rapidly triggered in response to an asphyxial threat to sustain survival. The near-immediate activation of autonomic and fear responses from subcortical brain areas produces observable and measurable behaviors. This proposed model has clinical and scientific usefulness, if testing characterizes and confirms one or more patterns of patient behaviors, in response to an asphyxial threat.
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Congestive heart failure is a common cardiac disorder associated with a high mortality. There are a limited number of prognostic scales predicting in-hospital outcomes after an acute episode of congestive heart failure. ⋯ The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.
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Job's syndrome (hyperimmunoglobulin E syndrome) is a congenitally acquired primary immune deficiency. The primary host defense defect in Job's syndrome is impaired phagocytosis. Accordingly, patients with Job's syndrome have difficulties eradicating staphylococcal infections. ⋯ The patient was treated with 8 weeks of high-dose daptomycin therapy with no adverse effects. If MRSA and methicillin-sensitive S. aureus bacteremias are unresponsive to usually effective antistaphylococcal agents, and surgical drainage of abscesses and removal of infected devices are not clinically possible, then a prolonged, high dose of daptomycin is a therapeutic alternative in such situations. To the best of our knowledge, this is the first case of MRSA mitral valve ABE complicated by extensive epidural abscesses and vertebral osteomyelitis in a patient with Job's syndrome.
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Case Reports
Atypical presentation of varicella-zoster virus encephalitis in an immunocompetent adult.
Varicella-zoster virus encephalitis is uncommon, but not rare, in immunocompetent adults. Typically, patients develop stroke with hemiplegia caused by large vessel vasculopathy days to weeks after herpes zoster ophthalmicus. ⋯ This is a case of varicella-zoster virus encephalitis in an immunocompetent patient presenting without typical rash and with clinicoradiologic features of multifocal encephalitis, which characterize immunosuppression.