The American journal of emergency medicine
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Takayasu arteritis is a form of vasculitis that involves the aorta, its major branches, and the pulmonary arteries. Coronary artery involvement is not uncommon, and most frequently includes the ostia and proximal segments. ⋯ However, recent advances in imaging modalities-including magnetic resonance angiography, computed tomography (CT), sonography, and fluoro-deoxyglucose positron emission tomography (FDG-PET)/CT Isobe (2013) [2]-have facilitated earlier and more accurate diagnoses of this condition. Here we report a case in which imaging revealed stenosis in the ostia of the coronary artery.
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Case Reports
A case of cardiac arrest that occurred on a high mountain in which a favorable outcome was obtained.
A 36-year-old man started to climb Mount Fuji (3776m above sea level: ASL), from the Gotemba new fifth station (2400m ASL). He had no significant medical history, and this was his first attempt to climb such a high mountain. He began feeling chest discomfort but continued to climb. ⋯ A chest computed tomography angiogram indicated triple-vessel disease. He was discharged without any neurological deficits after undergoing bypass surgery. In high mountains that can be easily accessed by amateur climbers who may have cardiac disease, the placement of AED devices and the establishment of the chain of survival from the scene to the intensive care unit are essential for obtaining a favorable outcome when a climber suffers cardiac arrest.
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Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates. ⋯ A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea.
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We describe a 44-year-old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.
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Observational Study
Presenting phenotypes of acute heart failure patients in the emergency department: Identification and implications.
There is little known about the baseline hemodynamic (HD) profiles (beyond pulse/blood pressure) of patients presenting to the Emergency department (ED) with acute heart failure (AHF). Assessing these baseline parameters could help differentiate underlying HD phenotypes which could be used to develop specific phenotypic specific approaches to patient care. ⋯ Three distinct clusters were defined using novel noninvasive presenting HD monitoring technology in this cohort of ED AHF patients. Further studies are needed to determine whether phenotypic specific therapies based on these clusters can improve outcomes.