The American journal of emergency medicine
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Case Reports
Supraventricular tachycardia induced by chocolate: is chocolate too sweet for the heart?
Conflicting studies have been published concerning the association between chocolate and cardiovascular diseases. Fewer articles have described the potential arrhythmogenic risk related to chocolate intake. We present a case of paroxysmal supraventricular tachycardia in a woman after consumption of large quantity of chocolate. ⋯ Our case very well describes an episode of tachycardia precipitated by large amount of chocolate consumption in a patient with underlying substrate. There are occasional case reports describing association between chocolate, caffeine, and arrhythmias. A large Danish study, however, did not find any association between amount of daily caffeine consumption and risk of arrhythmia.
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A small number of patients representing a significant demand on emergency department (ED) services present regularly for a variety of reasons, including psychiatric or behavioral complaints and lack of access to other services. A care plan program was created as a database of ED high users and patients of concern, as identified by ED staff and approved by program administrators to improve care and mitigate ED strain. ⋯ An alert program that identifies challenging ED patients with psychiatric conditions and creates a care plan appears to reduce visits and lead to more appropriate use of other resources.
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Cardiomegaly is a common but nonspecific finding in the emergency department. The etiology may be explained by left ventricular dilation, biventricular dilation, right ventricular dilation, or pericardial abnormalities, or it may be found to be spurious on the echocardiogram. Rarely, isolated abnormalities of the atrium, particularly the left atrium, may cause abnormalities on the chest radiograph but will not cause true cardiomegaly. ⋯ The diagnosis of a rare huge left atrial aneurysm was finally established by multidetector-row computed tomography, which had been seldom used as a diagnostic tool in the past. Patients with this cardiac anomaly usually are asymptomatic until the second or third decade of life, when the aneurysms can reach remarkable sizes and are often complicated with atrial tachyarrhythmia or thromboembolic events. Early surgical intervention is advised even in asymptomatic patients to prevent the occurrence of myocardial dysfunction, atrial fibrillation, and systemic embolism.