Pułapki diagnostyczne zawału mięśnia sercowego typu drugiego w wyniku stosowania kokainy

Introduction. Results of cocaine intake can be such cardiovascular complications as hypertension, myocardial infarction, arrhythmia, and cardiomyopathy. Anabolic androgenic steroids use is related to hypertension, cardiomyopathy and lipid metabolism derangements. Case report. On admission to the cardiology department a 37-year-old man presented prolonged pain at rest located in the middle part of the chest, which occurred 2 days earlier. He was after the use of cocaine, tetrahydrocannabinol, and alcohol. Smoking and using the growth hormone and anabolic androgenic steroids (AAS) in the past were present in the patient’s medical history. Physical examination with no deviation, heart rate 72/min, and blood pressure 130/90 mm Hg. Features of anterior wall myocardial infarction (MI) were present in electrocardiogram — ST-elevation up to 3 mm in V2–V5. In laboratory tests, troponin T rise (1.99 ng/mL) and D-dimer (503 ng/mL) were observed. In echocardiography — apex hypokinesis and concentric left ventricular hypertrophy — max. thickness: 19 mm. No significant abnormalities were detected in an immediate coronary angiography. Heart damage of vascular etiology involving an apical region and partial interventricular septum were confirmed in magnetic resonance imaging. No significant arrhythmias are present in electrocardiogram Holter monitoring. Conservative treatment was prescribed: beta blockers, atorvastatin, enoxaparin, captopril, acetyl salicylic acid (ASA), electrolytes i.v. and was released from hospital after 4 days. On discharge in a good general condition with a recommended further treatment. Conclusions. The presented case is an example of ST-elevation myocardial infarction (STEMI) in a young patient with left ventricular hypertrophy of multifactorial aetiology (hypertrophic cardiomyopathy, athlete’s heart, hypertrophy due to anabolic steroids, and growth hormone intake). Immediate coronary angiography showed no significant abnormalities. The patient during STEMI was after ingestion of cocaine and other stimulants which, apart from pulmonary embolism, vasospastic angina, and Takotsubo cardiomyopathy, can be an aetiology factor. Elimination of all modifiable risk factors is the key factor influencing successful therapy in this case.Wstęp. Kokaina stanowi drugą pod względem popularności substancję narkotyczną. Jej zażywanie może skutkować chorobą niedokrwienną serca w postaci ostrych zespołów wieńcowych, arytmii, kardiomiopatii czy nadciśnienia tętniczego. Przyjmowanie steroidów anabolicznych związane jest z rozwojem nadciśnienia tętniczego, kardiomiopatii oraz zaburzeń w gospodarce lipidowej. Opis przypadku. 37-letni mężczyzna został przyjęty na oddział kardiologii z powodu przedłużającego się od dwóch dni epizodu bólu w klatce piersiowej o charakterze dławicowym bez objawów towarzyszących. Stwierdzono stan po spożyciu kokainy, tetrahydrokannabinolu, alkoholu, w przeszłości palenie tytoniu, przyjmowanie steroidów anabolicznych, hormonu wzrostu. W wywiadzie obecność celiakii, stan po operacji w obrębie kręgosłupa szyjnego. W badaniu fizykalnym nie stwierdzono odchyleń od normy (ciśnienie krwi 130/90 mm Hg, rytm serca 72/min). W badaniu elektrokardiograficznym (EKG) zaobserwowano uniesienie odcinka ST do 3 mm w V2–V5, ujemne załamki T w V3, aVF (niedokrwienie przedniej ściany mięśnia sercowego). W badaniach laboratoryjnych stwierdzono znaczący wzrost stężenia hsTnT, obniżone stężenie kreatyniny, anemię mikrocytarną. Podczas badania echokardiograficznego uwidoczniono koncentryczny przerost lewej komory (LV), hipokinezę okolicy koniuszka LV, frakcja wyrzutowa LV 58%. Wykonano koronarografię w trybie pilnym, nie stwierdzono istotnych zmian. W MRI zaobserwowano zmiany sugerujące zawał koniuszka oraz dystalnej części IVS. Monitorowanie EKG metodą Holtera nie ujawniło arytmii. Wdrożono standardową terapię OZW: enoksaparyna, ASA, atorwastatyna, kaptopryl, IPP, bisoprolol, nebiwolol, NaCl, PWE. Po 4 dniach hospitalizacji pacjent w dobrym stanie ogólnym został wypisany z oddziału z zaleceniem kontynuacji leczenia za pomocą ASA, atorwastatyny, nebiwololu, IPP, zofenoprylu, oraz kontrolą w poradni w ciągu 2–3 tygodni. Wnioski. Prezentowany przypadek stanowi przykład STEMI u młodego pacjenta z przerostem lewej komory o wieloczynnikowym podłożu (HCM, serce sportowca, wtórny przerost w wyniku stosowania steroidów anabolicznych i hormonu wzrostu). Wykonana w trybie pilnym koronarografia nie wykazała zmian w naczyniach wieńcowych. Chory w momencie STEMI był pod wpływem kokainy oraz innych używek, co może stanowić czynnik etiologiczny obok zakrzepicy tętniczej, dławicy wazospastycznej, kardiomiopatii Takotsubo. Eliminacja wszystkich modyfikowalnych czynników ryzyka jest kluczowa w leczeniu tego chorego

The impact of various factors on the occurrence and type of visual experiences during the cataract surgery

Aims: The aim was to check whether there is a relationship between ophthalmic and non-ophthalmic concomitant diseases and visual experiences during surgery. In addition, we wanted to verify whether visual experiences are influenced by such factors as age, gender, education, stress, etc. Methods: The patients phoned a few days after the surgery in order to be interviewed post-operatively by a 30-question questionnaire. Questions were asked on demographic data, concomitant diseases, both ophthalmic and non-ophthalmic, emotional and visual experiences during the cataract surgery p-value was calculated from the Chi-Square Test. Results: The study comprised 121 women and 87 men. 63.9% of patients underwent cataract surgery for the first time. Among 208 respondents 73 (35.1%) had light impressions and 77 (37%) reported visual impressions. Patients under 60 were more likely to experience both light and visual impressions (p < 0.05). Particular visual defects and concomitant diseases, both ophthalmic and non-ophthalmic, can influence the type of visual experiences. Stress was positively correlated with the occurrence of both light and visual impressions (p < 0.05) but it did not influence the exact type of visual experiences. For half of the respondents (51.0%), the impressions seen during the surgery were neutral. Only 14.4% of patients assessed these sensations as pleasant. Conclusion: Patients experienced a variety of visual sensations, which are not usually unpleasant, however they occurred more often among stressed patients and could also raise the stress level. Proper preoperative counselling is needed to help patients cope with the stress before surgery

Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis

BackgroundPercutaneous pericardiocentesis represents a salvage procedure in case of cardiac tamponade and diagnostic procedure in chronic pericardial effusion of unknown source. The study aimed to analyze the clinical characteristics of patients subject to pericardiocentesis and the predictors of in-hospital mortality.MethodsThe study represents a registry that covered consecutive patients undergoing percutaneous pericardiocentesis from 2011 to 2022 in high-volume tertiary reference center. Electronic health records were queried to obtain demographic and clinical variables. The primary endpoint was in-hospital mortality, while secondary endpoint was the need for recurrent pericardiocentesis.ResultsOut of 132 456 patients hospitalized in the prespecified period, 247 patients were subject to percutaneous pericardiocentesis (53.9% women; median age of 66 years) who underwent 273 procedures. In-hospital death was reported in 14 patients (5.67%), while recurrent pericardiocentesis in 24 patients (9.72%). Iatrogenic cause was the most common etiology (42.5%), followed by neoplastic disease (23.1%) and idiopathic effusion (14.57%). In logistic regression analysis in-hospital mortality was associated with myocardial infarction (MI)-related etiology (p = 0.001) and recurrent/persistent cardiogenic shock (p = 0.001).ConclusionsIatrogenic etiology and neoplastic disease seem to be the most common indications for pericardiocentesis, while in-hospital mortality was particularly high in patients with spontaneous tamponade in the course of MI