Electrocardiographic Differential Diagnosis of Narrow QRS and Wide QRS Complex Tachycardias

Narrow QRS complex tachycardias or Wide QRS complex tachycardias are common problems encountered in clinical practices. Although such tachycardias often occur in patients with a normal anatomy and/or function of heart and rarely represent life-threatening conditions, they are common sources of morbidity and/or mortality. Narrow QRS complex tachycardias are fast cardiac rhythms with QRS duration of 120 ms or less while wide QRS complex tachycardias are fast cardiac rhythms with QRS duration of 120 ms or more. Origins of narrow QRS complex tachycardias are above or within the His bundle. Wide QRS complex tachycardias can be ventricular tachycardias, supra-ventricular tachycardias with bundle branch block or accessory pathway. The purpose of this chapter is to present the differential diagnosis of narrow and wide QRS complex tachycardias

Trichloroethylene Hypersensitivity Syndrome: A Disease of Fatal Outcome

Trichloroethylene is commonly used as an industrial solvent and degreasing agent. The clinical features of acute and chronic intoxication with trichloroethylene are well-known and have been described in many reports, but hypersensitivity syndrome caused by trichloroethylene is rarely encountered. For managing patients with trichloroethylene hypersensitivity syndrome, avoiding trichloroethylene and initiating glucocorticoid have been generally accepted. Generally, glucocorticoid had been tapered as trichloroethylene hypersensitivity syndrome had ameliorated. However, we encountered a typical case of trichloroethylene hypersensitivity syndrome refractory to high dose glucocorticoid treatment. A 54-year-old Korean man developed jaundice, fever, red sore eyes, and generalized erythematous maculopapular rashes. A detailed history revealed occupational exposure to trichloroethylene. After starting intravenous methylprednisolone, his clinical condition improved remarkably, but we could not reduce prednisolone because his liver enzyme and total bilirubin began to rise within 2 days after reducing prednisolone under 60 mg/day. We recommended an extended admission for complete recovery, but the patient decided to leave the hospital against medical advice. The patient visited the emergency department due to pneumonia and developed asystole, which did not respond to resuscitation

Simultaneous Detection of EGFR and VEGF in Colorectal Cancer using Fluorescence-Raman Endoscopy

Fluorescence endomicroscopy provides quick access to molecular targets, while Raman spectroscopy allows the detection of multiple molecular targets. Using a simultaneous fluorescence-Raman endoscopic system (FRES), we herein demonstrate its potential in cancer diagnosis in an orthotopically induced colorectal cancer (CRC) xenograft model. In the model, epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) were targeted with antibody-conjugated fluorescence and surface-enhanced Raman scattering (F-SERS) dots. FRES demonstrated fast signal detection and multiplex targeting ability using fluorescence and Raman signals to detect the F-SERS dots. In addition, FRES showed a multiplex targeting ability even on a subcentimeter-sized CRC after spraying with a dose of 50 µg F-SERS dots. In conclusion, molecular characteristics of tumor cells (EGFR in cancer cell membranes) and tumor microenvironments (VEGF in the extracellular matrix) could be simultaneously investigated when performing a colonoscopy

The Clinical Features and Emotional Stressors in Korean Patients with Tako-Tsubo Cardiomyopathy

Background. Tako-tsubo cardiomyopathy (TTC) is typically triggered by an acute emotional or physical stress events. Aim of this study was to investigate the impact of emotional stressors on clinical features, laboratory parameters, electrocardiographic and echocardiographic findings in patients with TTC. Methods. Of 103 patients enrolled from the TTC registry database, fifteen patients had emotional triggers (E group), and 88 patients had physical triggers or no triggers (other group). Results. Most clinical presentations and in-hospital courses were similar between the groups. However, E group had higher prevalence of chest pain (87 versus 42 %, P=0.001), palpitation (27 versus 6%, P=0.008), whereas other group had higher prevalence of cardiogenic shock (35 versus 7%, P=0.027). E group had significantly higher corrected QT intervals (median, 477.5 versus 438 ms, P=0.001), and left ventricular ejection fraction (LVEF) (mean, 45.7 versus 39.6%, P=0.001), but lower hs-CRP (median, 0.1 versus 3.3 mg/L, P=0.001), CK-MB (median, 5.5 versus 11.9 ng/mL, P=0.047), troponin-I (median, 1.0 versus 3.2 ng/mL, P=0.011), and NT-proBNP levels (median, 2145 versus 4939 pg/mL, P=0.020). Other group required more frequent hemodynamic support and had significantly longer intensive care unit (median, 3 versus 1 days, P=0.005) and in-hospital (median, 17 versus 3 days, P=0.001) durations. Conclusion. The clinical features of TTC are different between groups with and without preceding emotional stressors. The TTC group with preceding emotional stressors was more likely to have preserved cardiovascular reserve and lesser likely to require hemodynamic support than other group although the entire prognosis of TTC is excellent regardless of triggering stressors

Clinical features in adult patients with in-hospital cardiovascular events with confirmed 2009 Influenza A (H1N1) virus infection: Comparison with those without in-hospital cardiovascular events

Background: Comprehensive data regarding in-hospital cardiovascular events of adults with confirmed 2009 influenza A (H1N1) (2009 H1N1) infections are limited. The aim of this study was to determine the clinical characteristics, laboratory parameters, and electrocardiographic (ECG) findings for adults with 2009 H1N1 infections and to assess the differences in these parameters among adult patients with and without in-hospital cardiovascular events. Methods: Seventy-one patients were enrolled from the 2009 H1N1 registry database (our hospital registry of confirmed 2009 H1N1 infection during the year 2009) and divided according to the presence of in-hospital cardiovascular events. Six patients had cardiovascular events (CV group) and 65 did not (NCV group). Results: The CV group was more likely to be old (p = 0.023). Regarding co-morbidities, underlying coronary heart disease (p = 0.001), congestive heart failure (p = 0.001), diabetes (p = 0.001), and hypertension (p = 0.014) had significant influences on cardiovascular events. The CV group was also more likely to have chest pain (p = 0.034), dyspnea (p = 0.045), higher leukocyte count (p = 0.014), higher C-reactive protein (p = 0.010), higher glucose level (p = 0.001), and higher N-terminal probrain natriuretic peptide level (p = 0.010) than the NCV group. In addition, the CV group had a significantly higher in-hospital mortality rate (p = 0.010) and cardiac mortality rate (p = 0.001) than the NCV group. However, there were no significant differences in ECG findings between the two groups. Conclusion: Our study demonstrated that the CV group had higher in-hospital and cardiac mortality rates than the NCV group. A meticulous therapeutic approach should be considered for elderly patients with 2009 H1N1 infections having coronary heart disease, congestive heart failure, diabetes, hypertension, and high levels of leukocyte count, hs-CRP, glucose, and NT-proBNP at the time of admission