The American journal of emergency medicine
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Case Reports
Recurrent vasodilator-refractory acute coronary syndrome as the exclusive manifestation of Graves disease.
Whether recurrent acute coronary syndrome could be the exclusive manifestation of Graves disease remains unreported. We describe a premenopausal woman who had angiographically normal coronary arteries yet had 3 episodes of acute coronary events in forms of unstable angina, ST elevation, and non-ST elevation myocardial infarction despite the active therapy of calcium-channel blockade. She was finally diagnosed as with Graves disease, treated with antithyroid medication, and free from any angina relapse for up to 18 months. Thus, recurrent coronary events might be the only manifestation of subclinical hyperthyroidism in patients with angiographically normal coronary arteries and could only be prevented by antithyroid agents instead of conventional vasodilators.
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For joint reductions, adequate sedation is often required. Propofol has increasingly been used for sedation in the emergency department (ED) in recent years. The benefits of propofol are the rapid onset of action and the short recovery time. However, whether these characteristics can shorten the duration of ED stay is not been proved. ⋯ Propofol is a safe sedative with few complications and higher successful rates when applied in the joint reductions. It can also shorten the duration of ED stay.
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Hiatus hernia (HH) is a frequent condition and is asymptomatic most of the time. Common symptoms can include epigastric pain, postprandial fullness, and nausea. We report a case of postprandial acute right and left heart failure caused by an intrathoracic stomach in a previously asymptomatic woman. ⋯ To the best of our knowledge, ours is the first report of both acute right and left heart failure due to an HH. The prompt placement of a nasogastric tube was lifesaving. We believe that the diagnosis of HH ought to be taken into consideration by emergency physicians and included in the differential diagnosis for acute postprandial heart failure.
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Computed tomography (CT) has been used in diagnosing acute appendicitis since late 1990s. Appropriate use of CT has not been studied prospectively in patients with suspected acute appendicitis and relative low Alvarado score. ⋯ Computed tomography scan is necessary for patients with relatively low Alvarado score when leukocytosis is noted. In female patients without leukocytosis, further large-scale prospective studies are necessary to change the current diagnostic strategy.
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Acute carbamate intoxication can cause cardiac manifestations. We present the case of a 53-year-old man who had been a heavy smoker, admitted to our hospital for recent anterior wall myocardial infarction complicated with congestive heart failure. Percutaneous transluminal coronary angioplasty with stent implantation, coronary artery bypass graft, and mitral annuloplasty were performed, but refractory heart failure and ventricular arrhythmia were still noted. ⋯ The donor was a 50-year-old man who had died of brain death due to carbamate intoxication, and the crossmatch before transplantation was negative. The recipient died 24 hours after the operation due to acute left ventricular dysfunction. This report reviews the cardiac manifestations of acute carbamate intoxication and the possibility of heart transplantations from donors who died of carbamate intoxication.