The American journal of case reports
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BACKGROUND Acute chest pain is a common presentation in emergency departments worldwide. Ruling out acute coronary syndrome is essential in ensuring patient safety. Workup includes electrocardiogram (ECG) and cardiac biomarkers. ⋯ CONCLUSIONS Conventional management of patients with NSTEMI (non-ST-elevation myocardial infarction) and unstable angina with risk stratification utilizing TIMI score may not be appropriate in patient with Wellens syndrome. This highlights the importance of ECG recognition and urgent percutaneous intervention in patients with Wellens syndrome. Failure to identify this clinical syndrome could result in significant morbidity and mortality because it relates to critical stenosis and imminent large myocardial infarction.
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BACKGROUND Pulmonary edema is the accumulation of fluid in the lung secondary to increased hydrostatic pressure. Hypertensive cardiogenic pulmonary edema presents with a sudden onset of severe dyspnea, tachycardia, and tachypnea, and can occur when the systolic blood pressure exceeds 160 mmHg in association with acute decompensated congestive cardiac failure (CCF). A case is presented of hypertensive cardiogenic pulmonary edema treated with high-dose nitroglycerin and includes a review of the literature. ⋯ After 18 minutes of aggressive therapy, the patient's condition improved and he no longer required mechanical ventilation. CONCLUSIONS Hypertensive cardiogenic pulmonary edema is a challenging clinical condition that should be diagnosed and managed as early as possible, and distinguished from respiratory failure due to other causes. Although hypertensive cardiogenic pulmonary edema is usually managed acutely with high-dose diuretics, this case has highlighted the benefit of high-dose IV nitroglycerin, and review of the literature supports this treatment approach.
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Case Reports
Rhonchus and Valve-Like Sensation as Initial Manifestations of Long-Standing Foreign Body Aspiration: A Case Report.
BACKGROUND Foreign body aspiration (FBA) is an unusual medical condition among adults, with most of the cases associated with identifiable risk factors such as significant neurological impairment, drug or alcohol intoxication, and poor dentition. In some cases, however, FBA can present in an asymptomatic way, with estimates that 80% of lodged bodies are not visible on plain chest x-ray, leading to delayed diagnosis and requiring additional imaging techniques and procedures. We report an unusual case of long-standing FBA manifested as rhonchus and a thoracic valve-like sensation in an otherwise healthy man. ⋯ CONCLUSIONS Foreign body aspiration remains a rare medical condition among adults. We present an unusual case of long-standing foreign body aspiration manifested as rhonchus and a valve-like sensation in the chest. Detailed clinical examination and proper diagnostic tools should be carefully selected to support a timely diagnosis and prevent late complications of this particular disease.
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BACKGROUND Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications. Cerebral oximetry monitoring is increasingly used in these patients to detect intraoperative cerebral hypoxia or ischemic events. Near-infrared spectroscopy (NIRS) uses the near-infrared region of the electromagnetic spectrum for oximetry imaging. ⋯ Cerebral NIRS values remained within the normal range (70-80%) from the start of emergency resuscitation, during a prolonged period of extremely low global blood perfusion values, and until all resuscitation ceased. CONCLUSIONS Cerebral oximetry values reflect a balance between cerebral oxygen delivery and consumption. This case demonstrated the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest.