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Acute Myocarditis Presenting as Acute Coronary Syndrome
A 50-year-old male presented to the hospital with an approximate three-week history of nausea, fever, and back pain. Upon initial evaluation he had an electrocardiogram with ischemic changes and initial labs significant for a troponin of >25.0 ng/ml (<0.30 ng/ml), pro b-type natriuretic peptide (proBNP) of 9884 pg/ml (<125 pg/ml), and a lactic acid of 4.3 mmol/L (0.5-1.9 mmol/L). There was a concern for an acute coronary syndrome presenting as cardiogenic shock, but the patient was unable to tolerate left heart catheterization. He had a rapid clinical decline and despite all efforts, he passed away. The initial cause of death was thought to be due to an acute myocardial infarction, however, autopsy results were consistent with acute myocarditis. This case highlights the presentation of acute myocarditis as an acute coronary syndrome with complete heart block.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
Float, explode or sink: postmortem fate of lung-breathing marine vertebrates
What happens after the death of a marine tetrapod in seawater? Palaeontologists and neontologists have claimed that large lung-breathing marine tetrapods such as ichthyosaurs had a lower density than seawater, implying that their carcasses floated at the surface after death and sank subsequently after leakage of putrefaction gases (or ‘‘carcass explosions’’). Such explosions would thus account for the skeletal disarticulation observed frequently in the fossil record. We examined the taphonomy and sedimentary environment of numerous ichthyosaur skeletons and compared them to living marine tetrapods, principally cetaceans, and measured abdominal pressures in human carcasses. Our data and a review of the literature demonstrate that carcasses sink and do not explode (and spread skeletal elements). We argue that the normally slightly negatively buoyant carcasses of ichthyosaurs would have sunk to the sea floor and risen to the surface only when they remained in shallow water above a certain temperature and at a low scavenging rate. Once surfaced, prolonged floating may have occurred and a carcass have decomposed gradually. Our conclusions are of significance to the understanding of the inclusion of carcasses of lung-breathing vertebrates in marine nutrient recycling. The postmortem fate has essential implications for the interpretation of vertebrate fossil preservation (the existence of complete, disarticulated fossil skeletons is not explained by previous hypotheses), palaeobathymetry, the physiology of modern marine lung-breathing tetrapods and their conservation, and the recovery of human bodies from seawater