Sudden cardiac death due to pharmacological cardioversion of atrial fibrillation

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. The global prevalence of AF is 0.51% of the world population (37.5 million people) and has increased 33% in the last 20 years. AF may be associated with increased risk of sudden cardiac death (SCD); as well as ischemic stroke or coagulopathies. Coronary heart disease and heart failure are the two most common substrates of SCD. Therefore, the relationship between AF and SCD is particularly difficult to address. AF may have a shared molecular basis with ventricular fibrillation (VF; the most common arrhythmia underlying SCD), as both involve cellular and ion channel abnormalities, respectively, at the atrial and ventricular levels. Presentation of the case: 83-year-old woman, hypertensive, reports asthenia, adynamia and insomnia (21 days); the resting 12-lead electrocardiogram did not report ischemia or necrosis, AF was diagnosed; 160 beats per minute (BPM) (Figure 1). The transthoracic echocardiogram did not show thrombi or effusion; preserved ejection fraction. Pharmacological cardioversion (PC) of AF was performed with oral acetylsalicylic acid 100 mg every 24 h indefinitely; digoxin 0.25 mg orally every 8 hours for 24 hours (impregnation) and 0.25 mg orally every 24 hours (maintenance). After administration of the second dose of digoxin, HOLTER electrocardiographic monitoring detected sustained supraventricular tachycardia. Conclusions: VF caused SCD; the SCD prevented the administration of the third dose of digoxin. Amioradone was not indicated due to age and lack of ventricular response (VR) in AF; its use could prevent VF and SCD. VF is the rhythm that most causes SCD. 70% of SCD are due to coronary disease and, in 40% of SCD, it may be the initial manifestation of coronary disease. Arrhythmias such as VF, in this case, can cause acute ischemia (AI) and subsequently SCD. In cases of AF with VR, low output, and hypotension, electrical cardioversion (EC) is recommended. The PC of the arrhythmia depends on the severity and response of AF, age, ventricular function; atrial size; previous treatments. Cardioversion (PC/EC) is not recommended in elderly people with a history of multiple AF recurrences. According to the European Society of Cardiology and the American College of Cardiology/ American Heart Association, the AF was persistent, long-lasting, and noncardioreversible. Coronary heart disease was not observed. The VF probably caused the AI and, in turn, the AI caused the SCD without the patient reviving. No cardiomyopathies, Brugada syndrome, or coronary heart disease were observed in this case. Due to lack of resources to carry out a genetic study, the presence of single nucleotide polymorphisms associated with cardiac arrhythmias or AF in genes such as SCN5A (rs1805126) and SCN10A (rs6795970), which encoding a subunit of the voltage-gated sodium channel

Diaphragmatic Rupture Due To Closed Thoracobdominal Trauma: A Case Report

Background. Diaphragmatic injuries (DI) represent less than 1% of traumatic injuries; they are a marker of severe trauma due to associated injuries, although they often go undiagnosed as they remain hidden. If undetected, delayed herniation and strangulation of the abdominal organs into the chest cavity will result as the defect in the diaphragm is not repaired. DI occurs from penetrating or blunt trauma. The former occurs in approximately 67% of cases; direct injury to the diaphragm caused by automobile accidents has been reported. The remaining third is due to falls and crush injuries. Blunt trauma causes larger tears, even bilateral. Mortality from DI reaches 25% of cases and is higher in patients with blunt mechanisms of injury in the acute setting due to associated injuries. Mortality due to delayed presentation with hernia of abdominal contents into the chest due to previous penetrating trauma is 20% and increases with intestinal strangulation. Case presentation. Male, two years, and eight months-old, admitted to the emergency department due to thoraco-abdominal trauma due to being crushed by a truck tire. Tachypnea and stable vital signs were observed. Chest X-ray revealed elevated diaphragm and right pleural effusion. The patient continued to have dyspnea. Abdominal ultrasound confirmed elevation of the hemidiaphragm. Computed tomography of the chest showed the hepatic gland within the chest cavity. In the operating room, a right lateral thoracotomy was performed, observing diaphragmatic rupture. To correct and restore the hepatic gland to its normal anatomical site, the ruptured diaphragm was sutured with 2-0 Prolene®, supported with a bovine pericardium band, and subsequently a 12-Fr® chest tube was placed. In the end, it was closed by planes. Conclusions. The patient presented a blunt diaphragmatic injury. Intra-abdominal pressure increased above the tensile strength of diaphragmatic tissue. The patient evolved favorably in the postoperative period. He was kept under observation for ten days and was discharged without complications. After discharge, follow-up was performed without observing a diaphragmatic hernia or other injury

Clinical Characteristics and Risk Factors For Mortality During the \u27First Wave\u27 of COVID-19 In Reynosa, Tamaulipas

Background: The COVID-19 pandemic has impacted public health in Mexico. As of February 2020, there have been at least four waves of contagion that resulted in 5.82 million positive cases and more than 325 thousand deaths. At the beginning of the COVID-19 pandemic, hospital and population-based information was available, frequently with non-specific symptoms. Little was known about the risk factors for mortality in specific conditions. We described the clinical characteristics of patients with COVID-19 in Reynosa, Tamaulipas during 2020 and identified the risk factors for mortality. Methods: The COVID-19 cases registered from March to November 2020 in Reynosa were divided into survivors and non-survivors. The study had a retrospective cohort design. Data was obtained from the platform of the Respiratory Disease Surveillance System (SISVER), belonging to the National Epidemiological Surveillance System (SINAVE) of the Mexican Ministry of Health (https://sinave.gob.mx/). The variables considered were the age and gender of each patient. Twenty-five symptoms were included (fever, cough, headache, myalgia, arthralgia, among others); the outcome variable was the detection of COVID-19. Associated comorbidities were diabetes, obesity, hypertension, among others. The outcome variable was mortality. Data were analyzed using χ2 tests, Mann-Whitney tests, principal component analysis, and the Cox regression model. Results:The highest number of COVID-19 cases and deaths was observed in July, in men between 36-40 years old. The most frequent symptoms (37-51%) were headache, fever, cough, myalgia, and arthralgia. Clinical characteristics between survivors and non-survivors were significant (P Conclusions: The most frequent symptoms in positive COVID-19 patients in Reynosa during 2020 were headache, fever, cough, myalgia, and arthralgia. Age, gender and diabetes, hypertension, heart disease, COPD, and CKD increase mortality. The factors with the highest risk of death were age over 80 years, admitted to the ICU or intubated

Síncope como manifestación inicial de estenosis mitral pura: reporte de caso y revisión

La causa primaria más común de estenosis mitral es la fiebre reumática (más frecuente en países menos desarrollados). La estenosis mitral reumática ocurre con mayor frecuencia en mujeres y suele iniciar a partir de los 30-40 años de vida. La lesión valvular secundaria se relaciona a la dilatación de la aurícula izquierda debido a la fibrilación auricular crónica. Se presenta el caso de una mujer de 62 años que presentó síncope como manifestación inicial de estenosis mitral pura. En fecha anterior desconocida presentó mareos y palpitaciones sin diagnosticar. El electrocardiograma de 12 derivaciones y el monitoreo electrocardiográfico continuo (HOLTER) por 24 h demostraron la fibrilación auricular de respuesta lenta. El ecocardiograma indicó aurícula izquierda=50 mm (dilatada), área valvular mitral=9 mm2 (obstrucción grado III Carpentier); aurícula izquierda 90 x 80 mm (dilatación severa); válvula mitral con grado III Carpentier; relación E/A fusiforme; fracción de expulsión=50%. Se concluye que la paciente desarrolló dilatación severa de la aurícula izquierda que produjo la obstrucción grado III de Carpentier. En este caso se proponen dos causas: una primaria, la fiebre reumática, y una secundaria, la fibrilación auricular crónica; debido a que no se tiene un diagnóstico previo de fiebre reumática ni de fibrilación auricular