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Höwel D, Leitz P, Frommeyer G, Ritter MA, Reinke F, Füting A, Reinsch N, Eckardt L, Kochhäuser S, Dechering DG. Predictors of Atrial Fibrillation in Patients with Embolic Stroke of Unknown Etiology and Implantable Loop Recorders-Further Insights of the TRACK AF Study on the Role of ECG and Echocardiography. J Clin Med 2023; 12:6566. [PMID: 37892704 PMCID: PMC10607500 DOI: 10.3390/jcm12206566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Aims-Electrocardiography (ECG) and echocardiographic left atrial (LA) parameters may be helpful to assess the risk of atrial fibrillation (AF) in embolic stroke of unknown etiology (ESUS) and could therefore guide intensity of ECG monitoring. Methods-1153 consecutive patients with ischemic stroke or transient ischemic attack (TIA) were analyzed. An internal loop recorder (ILR) was implanted in 104 consecutive patients with ESUS. Multiple morphologic P-wave parameters in baseline 12-channel ECG and echocardiographic LA parameters were measured and analyzed in patients with and without ILR-detected AF. Using logistic regression, we evaluated the predictive value of several ECG parameters and LA dimensions on the occurrence of AF. Results-In 20 of 104 (19%) patients, AF was diagnosed by ILR during a mean monitoring time of 575 (IQR 470-580) days. Patients with AF were significantly older (72 (67-75) vs. 60 (52-72) years; p = 0.001) and premature atrial contractions (PAC) were more frequently observed (40% vs. 2%; p < 0.001) during baseline ECG. All morphologic P-wave parameters did not show a significant difference between groups. There was a non-significant trend towards a larger LA volume index (31 (24-36) vs. 29 (25-37) mL/m2; p = 0.09) in AF patients. Conclusions-Age and PAC are independently associated with incident AF in ESUS and could be used as markers for selecting patients that may benefit from more extensive rhythm monitoring or ILR implantation. In our consecutive cohort of patients with ESUS, neither morphological P-wave parameters nor LA size were predictive of AF.
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Affiliation(s)
- Dennis Höwel
- Department of Cardiology, St. Marienhospital Vechta, Marienstr. 6-8, 49377 Vechta, Germany
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Patrick Leitz
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Martin A. Ritter
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Reinke
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Nico Reinsch
- Department of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Lars Eckardt
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Simon Kochhäuser
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
- Department of Internal Medicine/Cardiology, Marienhospital Osnabrück, 49074 Osnabrück, Germany
| | - Dirk G. Dechering
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
- Department of Internal Medicine/Cardiology, Marienhospital Osnabrück, 49074 Osnabrück, Germany
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Atchinson PRA, Hatton CJ, Roginski MA, Backer ED, Long B, Lentz SA. The emergency department evaluation and management of massive hemoptysis. Am J Emerg Med 2021; 50:148-155. [PMID: 34365064 DOI: 10.1016/j.ajem.2021.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Massive hemoptysis is a life-threatening emergency that requires rapid evaluation and management. Recognition of this deadly condition, knowledge of the initial resuscitation and diagnostic evaluation, and communication with consultants capable of definitive management are key to successful treatment. OBJECTIVE The objective of this narrative review is to provide an evidence-based review on the management of massive hemoptysis for the emergency clinician. DISCUSSION Rapid diagnosis and management of life-threatening hemoptysis is key to patient survival. The majority of cases arise from the bronchial arterial system, which is under systemic blood pressure. Initial management includes patient and airway stabilization, reversal of coagulopathy, and identification of the source of bleeding using computed tomography angiogram. Bronchial artery embolization with interventional radiology has become the mainstay of treatment; however, unstable patients may require advanced bronchoscopic procedures to treat or temporize while additional information and treatment can be directed at the underlying pathology. CONCLUSION Massive hemoptysis is a life-threatening condition that emergency clinicians must be prepared to manage. Emergency clinicians should focus their management on immediate resuscitation, airway preservation often including intubation and isolation of the non-bleeding lung, and coordination of definitive management with available consultants including interventional radiology, interventional pulmonology, and thoracic surgery.
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Affiliation(s)
- Patricia Ruth A Atchinson
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Colman J Hatton
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Matthew A Roginski
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Elliot D Backer
- Dartmouth-Hitchcock Medical Center, Section of Critical Care Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America
| | - Skyler A Lentz
- Division of Emergency Medicine and Pulmonary Disease and Critical Care Medicine, The University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
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Mahoney JJ, Haile CN, De La Garza R, Thakkar H, Newton TF. Electrocardiographic characteristics in individuals with cocaine use disorder. Am J Addict 2017; 26:221-227. [DOI: 10.1111/ajad.12524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/09/2017] [Accepted: 02/12/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- James J. Mahoney
- Department of Behavioral Medicine and Psychiatry; West Virginia University School of Medicine; Morgantown West Virginia
| | - Colin N. Haile
- Menninger Department of Psychiatry and Behavioral Sciences; Baylor College of Medicine; Houston Texas
| | - Richard De La Garza
- Menninger Department of Psychiatry and Behavioral Sciences; Baylor College of Medicine; Houston Texas
| | - Harsh Thakkar
- Menninger Department of Psychiatry and Behavioral Sciences; Baylor College of Medicine; Houston Texas
| | - Thomas F. Newton
- Menninger Department of Psychiatry and Behavioral Sciences; Baylor College of Medicine; Houston Texas
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Asferg CL, Andersen UB, Linneberg A, Hedley PL, Christiansen M, Goetze JP, Jeppesen JL. Serum proatrial natriuretic peptide does not increase with higher systolic blood pressure in obese men. Heart 2016; 103:154-158. [PMID: 27496822 DOI: 10.1136/heartjnl-2016-309462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/06/2016] [Accepted: 07/13/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Obese persons have low circulating natriuretic peptide (NP) concentrations. It has been proposed that this 'natriuretic handicap' could play a role in obesity-related hypertension. The normal physiological response of the NP system to an increase in blood pressure (BP) is an increase in NP secretion with concomitant higher circulating NP concentrations. In this study, we investigated whether higher BP would also be related to higher circulating NP concentrations in obese men; furthermore, we verified that BP had affected the hearts of our study participants, by determining left ventricular mass (LVM). METHODS We examined 103 obese healthy medication-free men. We measured 24-hour ambulatory BP (ABP). LVM was calculated using the Cornell voltage-duration product method. Fasting serum concentrations of midregional proatrial NP (MR-proANP), a surrogate for active ANP, were measured. Linear regression analysis was used to calculate age-adjusted standardised regression coefficients (β). RESULTS LVM and BP increased across systolic ABP quartiles (mean LVM±SD: 1599.1±387.2 mm ms in first vs 2188.5±551.3 mm ms in fourth quartile, p<0.001; mean systolic ABP±SD: 114.5±4.2 mm Hg in first vs 149.0±7.7 mm Hg in fourth quartile, p<0.001). Systolic ABP was robustly associated with LVM (ß=0.48, p<0.001). Despite evidence of BP-related increases in LVM, serum MR-proANP was negatively associated with systolic ABP (ß=-0.32, p=0.004) and with diastolic ABP (ß=-0.45, p<0.001). CONCLUSIONS Contrary to known physiological BP responses, MR-proANP was negatively associated with ABP in our study. This suggests that a low amount of circulating NPs could play a role in the early stage of obesity-related hypertension.
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Affiliation(s)
- Camilla L Asferg
- Department of Clinical Physiology, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Ulrik B Andersen
- Department of Clinical Physiology, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Experimental Research, Rigshospitalet, University of Copenhagen, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Paula L Hedley
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | | | - Jens P Goetze
- Department of Clinical Chemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen L Jeppesen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Medicine, Amager Hvidovre Hospital Glostrup, University of Copenhagen, Glostrup, Denmark
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Rendina D, Ippolito R, D'Elia L, Giacchetti G, Lonati C, Gianfrancesco F, Fallo F, Rebellato A, Ruggiero C, Rubattu S, Volpe M, Gennari L, Merlotti D, Isaia GC, D'Amelio P, Spertino E, Fabris B, Sechi LA, Catena C, Maresca AM, Gessi V, Dalbeni A, Strazzullo P. Hypovitaminosis D and organ damage in patients with arterial hypertension: a multicenter double blind randomised controlled trial of cholecalciferol supplementation (HYPODD) : study design, clinical procedures and treatment protocol. High Blood Press Cardiovasc Prev 2015; 22:135-42. [PMID: 25771895 DOI: 10.1007/s40292-015-0080-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/13/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION At this time, good quality randomized clinical trials assessing the effects of vitamin D supplementation on cardiometabolic outcomes are lacking in the international literature. AIM To fill this gap, the Working Group on Vitamin D and Cardiorenal Disorders established jointly by the Italian Society of Hypertension (SIIA) and the Forum in Bone and Mineral Research conceived the HYPODD study (HYPOvitaminosis D and organ Damage). METHODS HYPODD is a no-profit multicenter 12-month parallel-group double-blind placebo controlled randomized trial aiming to assess the effects of cholecalciferol supplementation on blood pressure control, antihypertensive drugs consumption and progression of target organ damage in patients with essential hypertension and 25-hydroxyvitamin D serum level lower than 20 ng/ml (vitamin D deficiency). HYPODD is coordinated by the European Society Excellence Center of Hypertension of Federico II University, Naples, and involves 12 academic institutions in Italy (Ancona, Milan, Padua, Perugia, Rome, Siena, Trieste, Turin, Udine, Varese, and Verona). RESULTS AND CONCLUSION The HYPODD study has been registered at the Agenzia Italiana del Farmaco-Osservatorio sulla Sperimentazione Clinica del Farmaco (AIFA-OsSC) and EUDRACT sites (n° 2012-003514-14) and has been approved by the Ethical Committees of all the Centers involved in the study. The patients' recruitment is currently underway.
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Affiliation(s)
- Domenico Rendina
- Department of Clinical Medicine and Surgery, Excellence Center of Hypertension, ''Federico II University'' Medical School, via Sergio Pansini 5, 80131, Naples, Italy,
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Lee S, Cowan P, Yoo W, Wetzel G. Determining Left Ventricular Hypertrophy in Overweight-Obese Youth Using Electrocardiogram Criteria. J Nurs Meas 2013; 21:178-87. [DOI: 10.1891/1061-3749.21.2.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Purpose: There is an escalating prevalence of obesity in youth that increases the risk for cardiovascular alterations such as left ventricular hypertrophy (LVH). The purpose of this study is to identify the most effective electrical voltage measurement for determining LVH in youth who are overweight and obese. Methods: A retrospective chart review was conducted to determine sensitivity, specificity, and the receiver operator characteristic (ROC) curve of 4 popular electrical voltage measures. Results: Our findings indicated the sensitivity and specificity for Cornell product (50.0%; 96.2%), Cornell voltage (52.9%; 98.0%), Romhilt Estes (50.0%; 100.0%), and Sokolow-Lyon index (60.0%; 86.4%) consecutively. Conclusion: The Romhilt-Estes and Cornell voltage measures displayed the highest specificity and could prove to be beneficial as a screening method to rule out LVH in overweight and obese youth.
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Abstract
Findings on electrocardiogram may hint that pulmonary embolism (PE) is present when interpreted in the proper context and lead to definitive imaging tests. However, it would be useful to know if electrocardiographic (ECG) abnormalities also occur in patients with pneumonia and whether these are similar to ECG changes with PE. The purpose of this investigation was to determine ECG findings in patients with pneumonia. We retrospectively evaluated 62 adults discharged with a diagnosis of pneumonia who had no previous cardiopulmonary disease and had electrocardiogram obtained during hospitalization. The most prevalent ECG abnormality, other than sinus tachycardia, was minor nonspecific ST-segment or T-wave changes occurring in 13 of 62 (21%). Right atrial enlargement occurred in 4 of 62 (6.5%). QRS abnormalities were observed in 24 of 62 (39%). Right-axis deviation and S(1)S(2)S(3) were the most prevalent QRS abnormalities, which occurred in 6 of 62 (9.7%). Complete right bundle branch block and S(1)Q(3)T(3) pattern occurred in 3 of 62 (4.8%). ECG abnormalities that were not present within 1 month previously or abnormalities that disappeared within 1 month included left-axis deviation, right-axis deviation, right atrial enlargement, right ventricular hypertrophy, S(1)S(2)S(3), S(1)Q(3)T(3), low-voltage QRS complexes, and nonspecific ST-segment or T-wave abnormalities. In conclusion, electrocardiogram in patients with pneumonia often shows QRS abnormalities or nonspecific ST-segment or T-wave changes. ECG findings are similar to ECG abnormalities in PE and electrocardiogram cannot assist in the differential diagnosis.
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8
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Grossman A, Prokupetz A, Koren-Morag N, Grossman E, Shamiss A. Comparison of usefulness of Sokolow and Cornell criteria for left ventricular hypertrophy in subjects aged <20 years versus >30 years. Am J Cardiol 2012; 110:440-4. [PMID: 22534054 DOI: 10.1016/j.amjcard.2012.03.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/09/2012] [Accepted: 03/09/2012] [Indexed: 01/12/2023]
Abstract
The use of electrocardiography in sports or military screening is considered an effective tool for diagnosing potentially fatal conditions. The present study was designed to compare the yield of electrocardiographic criteria for left ventricular hypertrophy (LVH) criteria for the diagnosis of LVH and hypertrophic obstructive cardiomyopathy in subjects aged <20 years and >30 years. The association between the electrocardiographic (ECG) criteria for LVH (ECG-LVH) and echocardiographic findings was compared in 4 groups of air force academy candidates: (1) young candidates undergoing echocardiography because of ECG-LVH findings (n = 666); (2) young candidates without ECG-LVH findings undergoing routine echocardiography (n = 4,043); (3) older designated aviators undergoing echocardiography because of ECG-LVH findings (n = 196); and (4) older designated aviators undergoing routine echocardiography without ECG-LVH findings (n = 1,098). The predictive value of ECG-LVH findings for echocardiographic LVH, left ventricular mass, posterior wall thickness, and interventricular septal thickness were compared among the 4 groups. The ECG criteria in young subjects correlated with the left ventricular mass and posterior wall thickness but not with the interventricular septal thickness. In older subjects, these criteria correlated with left ventricular mass, interventricular septal, and posterior wall thickness. The positive and negative predictive value of ECG-LVH findings for the echocardiographic diagnosis of LVH in young subjects was 6.0% and 99.0%, respectively. In older subjects the positive and negative predictive value of ECG-LVH findings was 34% and 93%, respectively. In conclusion, ECG criteria are probably a useful tool for exclusion of LVH in young and older subjects; however, their low positive predictive value would probably lead to unnecessary echocardiographic tests, particularly in young subjects.
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Affiliation(s)
- Alon Grossman
- Israeli Airforce Aero Medical Center, Tel Hashomer, Israel.
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9
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Oh JE, Shin JW, Sohn EH, Jung JO, Jeong SH, Song HJ, Kim JM, Lee AY. Effect of cardiac function on cognition and brain structural changes in dementia. J Clin Neurol 2012; 8:123-9. [PMID: 22787496 PMCID: PMC3391617 DOI: 10.3988/jcn.2012.8.2.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 01/06/2012] [Accepted: 01/06/2012] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Cardiovascular risk factors are considered to also be risk factors for dementia. Recent studies have shown that the prevalence of cognitive dysfunction is high in patients with cardiac diseases. However, few studies have investigated the influence of cardiac function on cognition and brain structural changes in dementia. The aims of this study were to determine the relationship between cardiac and cognitive function, and to characterize any structural changes in the brain that could be caused by cardiac function in patients with dementia. Methods Dementia patients (n=93) were recruited prospectively with checking for the presence of vascular risk factors such as hypertension. Cognitive function was measured by the Mini-Mental State Examination, modified Mini-Mental State test, and Korean version of the Dementia Rating Scale. Brain magnetic resonance imaging was conducted to evaluate the cerebral white-matter changes (WMC), ventricular dilation, and cortical and hippocampal atrophy. Cardiac function was evaluated using two-dimensional echocardiography. We divided the patients into two groups according to the presence (+) or absence (-) of WMC. Results In the entire cohort, the size of the left atrium (LA) was positively correlated with the degree of WMC, irrespective of age (p<0.05). The LA was larger in the WMC (+) group (n=42) than in the WMC (-) group. General cognitive function was significantly lower in the WMC (+) group than in the WMC (-) group. Subjects with an enlarged LA tended to exhibit lower cognitive function and more-severe cerebral WMC. Conclusions Cardiac dysfunction represented by LA enlargement could be related to cognitive decline and WMC of the brain resulting from impairment of the cerebral hemodynamic process in dementia.
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Affiliation(s)
- Ji Eun Oh
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
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10
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Lee S, Cowan PA, Wetzel GT, Velasquez-Mieyer P. Prediabetes and blood pressure effects on heart rate variability, QT-interval duration, and left ventricular hypertrophy in overweight-obese adolescents. J Pediatr Nurs 2011; 26:416-27. [PMID: 21930028 DOI: 10.1016/j.pedn.2010.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 08/09/2010] [Accepted: 08/12/2010] [Indexed: 11/18/2022]
Abstract
This ancillary, descriptive correlational study examined the effect of glucose regulation, blood pressure (BP), and their combined effects on cardiac autonomic function in 128 overweight-obese 11-18-year-olds. Measures included body mass index, resting BP, fasting glucose, glucose tolerance, and cardiac autonomic function (heart rate variability, QT, and Cornell voltage). After adjusting for age and gender, multivariate analysis of covariance revealed no differences in cardiac autonomic measures based on glucose regulation (p = .319), BP (p = .286), or the interaction between glucose regulation and BP (p = .132). The additive effect of prediabetes and elevated BP did not impact cardiac autonomic function in overweight-obese youth.
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van Beers EJ, Stam J, van den Bergh WM. Licorice consumption as a cause of posterior reversible encephalopathy syndrome: a case report. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R64. [PMID: 21332974 PMCID: PMC3221997 DOI: 10.1186/cc10040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/25/2010] [Accepted: 02/18/2011] [Indexed: 11/21/2022]
Abstract
Introduction A 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision. At the time of presentation, her blood pressure was 219/100 mmHg, her arterial pH was 7.64 and her potassium level was 2.7 mM/l. Methods The combination of sequential computed tomography (CT) and the triad of hypertension, hypokalemia and metabolic alkalosis in this patient suggested the diagnosis. Supplementary anamnesis and long-term follow-up confirmed it. Results Brain computed tomography imaging showed minor bleeding in the left Sylvian fissure and bilateral occipital edema, suggestive of posterior reversible encephalopathy syndrome (PRES). Repeated brain CT after 10 days showed a complete resolution of radiological signs. The patient informed us that she had quit smoking 2 weeks ago and had started consuming large amounts of licorice instead of smoking. After she abandoned licorice consumption, her blood pressure normalized. Her latest blood pressure reading was 106/60 mmHg without the use of any antihypertensive drugs. Conclusions To the best of our knowledge, this is the first case report describing licorice consumption as a cause of PRES. Glycyrrhizic acid, a component of licorice, inhibits 11β-hydroxysteroid dehydrogenase and subsequently causes mineralocorticoid excess. Mineralocorticoid excess in turn causes high blood pressure and ultimately gives rise to malignant hypertension. Physicians should remember that licorice use is a very easy-to-treat cause of hypertension, hypertensive encephalopathy and PRES.
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Affiliation(s)
- Eduard J van Beers
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Meibergdreef 19, Amsterdam NL-1100 DD, the Netherlands.
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Abstract
BACKGROUND Several studies suggest that electrocardiographers tend to neglect lead aVR during the reading of electrocardiograms (ECGs). Our objective was to provide a systematic review of the most important diagnostic and prognostic uses of lead aVR. METHODS We performed a thorough review of the literature about the lead aVR using PubMed, MEDLINE and the archives of the University at Buffalo libraries. RESULTS We found that lead aVR may provide important additional information in the diagnosis of coronary artery disease. It may provide a clue to the location of a lesion as well as the possibility of three vessel disease during an acute coronary syndrome. Lead aVR was found useful in the locus of arrhythmias and in differentiation of narrow and wide QRS complex tachycardias. It provides useful prognostic information for patients with the Brugada syndrome and tricyclic antidepressant toxicity. Lead aVR provides alternative criteria for the electrocardiographic diagnosis of left ventricular hypertrophy and left anterior fascicular block. CONCLUSION Lead aVR provides very important additional diagnostic and prognostic information in multiple cardiac conditions and can be used either alone or in conjunction with other electrocardiographic leads.
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13
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Sohaib SMA, Payne JR, Shukla R, World M, Pennell DJ, Montgomery HE. Electrocardiographic (ECG) criteria for determining left ventricular mass in young healthy men; data from the LARGE Heart study. J Cardiovasc Magn Reson 2009; 11:2. [PMID: 19149884 PMCID: PMC2647921 DOI: 10.1186/1532-429x-11-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 01/16/2009] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Doubts remain over the use of the ECG in identifying those with increased left ventricular (LV) mass. This is especially so in young individuals, despite their high prevalence of ECG criteria for LV hypertrophy. We performed a study using cardiovascular magnetic resonance (CMR), which provides an in vivo non-invasive gold standard method of measuring LV mass, allowing accurate assessment of electrocardiography as a tool for defining LV hypertrophy in the young. METHODS AND RESULTS Standard 12-lead ECGs were obtained from 101 Caucasian male army recruits aged (mean +/- SEM) 19.7 +/- 0.2 years. LV mass was measured using CMR. LV mass indexed to body surface area demonstrated no significant correlation with the Cornell Amplitude criteria or Cornell Product for LV hypertrophy. Moderate correlations were seen with the Sokolow-Lyon Amplitude (0.28) and Sokolow-Lyon Product (0.284). Defining LV hypertrophy as a body surface area indexed left ventricular mass of 93 g/m(2), calculated sensitivities [and specificities] were as follows; 38.7% [74.3%] for the Sokolow-Lyon criteria, 43.4% [61.4%] for the Sokolow-Lyon Product, 19.4% [91.4%] for Cornell Amplitude, and 22.6% [85.7%] for Cornell Product. These values are substantially less than those reported for older age groups. CONCLUSION ECG criteria for LV hypertrophy may have little value in determining LV mass or the presence of LV hypertrophy in young fit males.
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Affiliation(s)
- Syed M Afzal Sohaib
- Centre for Cardiovascular Genetics, BHF Laboratories, Royal Free & University College Medical School, 5 University Street, London, UK
- Army Training Regiment Lichfield, Staffordshire, UK
| | - John R Payne
- Centre for Cardiovascular Genetics, BHF Laboratories, Royal Free & University College Medical School, 5 University Street, London, UK
| | - Rajeev Shukla
- Centre for Cardiovascular Genetics, BHF Laboratories, Royal Free & University College Medical School, 5 University Street, London, UK
| | - Michael World
- Royal Centre for Defence Medicine, Selly Oak Hospital, Birmingham, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
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Moreira LB, Gus M, Nunes G, Gonçalves CBC, Martins J, Wiehe M, Fuchs FD. Association between pregnancy-related hypertension and severity of hypertension. J Hum Hypertens 2008; 23:415-9. [PMID: 19020534 DOI: 10.1038/jhh.2008.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypertension in pregnancy is an emerging sex-specific risk factor for cardiovascular disease and may lead to more severe hypertension after pregnancy. The objectives of this study were to investigate the frequency of pregnancy-related hypertension among patients referred to a hypertension clinic and its association with the severity of hypertension and evidence of end-organ damage. In this cross-sectional study, women with hypertension were submitted to a systematic clinical evaluation. The occurrence of pregnancy-related hypertension was investigated by questionnaire. The association between pregnancy-related hypertension and severity of hypertension (stage 2 according to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII)) and end-organ damage was assessed in a logistic regression model. The mean age, systolic and diastolic blood pressure and body mass index (BMI) of the 768 women examined were 51.6+/-12.7 years, 158.2+/-26.6 mm Hg, 93.8+/-14.3 mm Hg and 29.4+/-5.6 kg/m(2), respectively. The proportion of women with pregnancy-related hypertension was 32.9%. It was significantly associated with hypertension at stage 2 (OR: 1.60, 95% CI: 1.14-2.24; P=0.01) after controlling for confounders. The occurrence of a pregnancy-related hypertension was not associated with evidence of optic fundi abnormalities, left ventricular hypertrophy or abnormalities in kidney function. In conclusion, pregnancy-related hypertension is frequent in women referred to a hypertension clinic, and is associated with severe hypertension but not with evidence of end-organ damage.
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Affiliation(s)
- L B Moreira
- Division of Clinical Pharmacology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Lee SW, Song JH, Kim GA, Lim HJ, Kim MJ. Plasma brain natriuretic peptide concentration on assessment of hydration status in hemodialysis patient. Am J Kidney Dis 2003; 41:1257-66. [PMID: 12776279 DOI: 10.1016/s0272-6386(03)00358-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) is released into circulation in response to ventricular dilatation and pressure overload. Plasma BNP concentration correlates with left ventricular mass and dysfunction, which is prevalent in hemodialysis (HD) patients. METHODS To evaluate the potential of BNP level for determination of hydration status, we measured inferior vena caval diameter (IVCD) and BNP levels and performed bioimpedance analysis in 49 HD patients. RESULTS Pre-HD BNP levels remained unchanged after HD. Agreement between IVCD and pre-HD BNP level in overhydration was significant (kappa = 0.304). The area under the receiver operating characteristic (ROC) curve for overhydration was 0.819 for pre-HD BNP level. When extracellular fluid/total-body water (ECF/TBW) ratios of HD patients were compared with those of 723 controls, pre- and post-HD BNP levels were significantly greater in overhydrated patients. The area under the ROC curve for overhydration by ECF/TBW ratio was 0.781 for pre-HD BNP level. However, there was no significance for pre- or post-HD BNP levels on assessment of normohydration or underhydration. Pre-HD BNP level correlated significantly with post-HD BNP level, post-HD diastolic blood pressure, pulse pressure, and ECF/TBW ratio. IVCD correlated significantly with post-HD BNP level. CONCLUSION BNP level seems to have a limited potential for assessment of overhydration in HD patients.
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Affiliation(s)
- Seoung Woo Lee
- Kidney Center, Inha University Hospital, Inchon City, South Korea
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