Kardiol Pol
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A case of a 77 year old male with a history of multiple pacemaker replacement procedures, a new ventricular lead implanted and an old one left in place, and imminent skin erosion at the site of a pacemaker pocket is presented. Clinical diagnosis included right- -sided heart failure, pneumonia, pleural effusion and suspicion of pulmonary infarction as well as endocarditis. Chest radiogram and computerised tomography revealed an unusual location of an old ventricular lead which proximal, sharp end migrated through the venous system via right ventricle and pericardium to the left pleural cavity.
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Case Reports
[Massive pulmonary embolism treated with a reduced dose of alteplase in a patient with acute renal failure].
There are some doubts whether in a severe renal failure the dose of alteplase should not be modified, especially when its plasma clearance may be decreased by liver ischemia. The authors present a case of a 67-year old woman with massive pulmonary embolism (PE) and acute renal failure (creatinine 580 micromol/l) of a mixed etiology (renal calculosis with hydronephrosis and shock as PE presentation). Alteplase administration (10 mg bolus followed by reduced to 50 mg two hours infusion) resulted in hemodynamic stabilization but was complicated by gross subcutaneous hematomas, intensive epistaxis and hematuria, and hemoglobin decrease which required blood transfusions.