by Nayana E. George, Benjamin Tharian, Helen Lyo, Apoorva Jayarangaiah, Irini Youssef, Joie Singh, Samy I. McFarlane and Shivakumar Vignesh
Original Research
Endoscopic ultrasound guided brachytherapy (EGBT) has been reported to be useful in certain malignancies including esophageal and pancreatic cancers. Percutaneous or surgical placement of radioactive seeds into the liver secondaries (brachytherapy) has been done successfully, however, the utility of EGBT in liver metastasis remains largely unclear. In this case report, we demonstrate the safety, efficacy and feasibility of EUS guided brachytherapy (EGBT) in liver metastasis secondary to leiomyosarcoma.
American Journal of Medical Case Reports. 2018, 6(9), 189-192. DOI: 10.12691/ajmcr-6-9-5
Pub. Date: October 14, 2018
10986 Views3063 Downloads
by Taylor M. Douglas, Perry Wengrofsky, Syed Haseeb, Eric Kupferstein, Pramod Theetha Kariyanna, Jacob Schwartz, Louis Salciccioli and Samy I. McFarlane
Review Article
Takotsubo Cardiomyopathy is a syndrome characterized by transient and reversible regional myocardial dysfunction in the absence of obstructive coronary artery disease classically resulting in ventricular apical ballooning. It has a strong female predominance with onset generally in seventh decade of life, with hypothesized pathophysiology related to excess of catecholaminergic stimulation, particularly during episodes of physical or emotional stress. Takotsubo cardiomyopathy has been previously reported during myasthenic crisis, the acute deterioration of myasthenia gravis typically involving respiratory failure that is also associated with physical or emotional stress. We present the case of an atypically young male patient with classical takotsubo cardiomyopathy in the setting of myasthenic crisis after thymectomy initially concerning for ST segment elevation myocardial infarction, and a review of the literature of takotsubo cardiomyopathy in myasthenic crisis.
American Journal of Medical Case Reports. 2018, 6(9), 184-188. DOI: 10.12691/ajmcr-6-9-4
Pub. Date: October 11, 2018
13806 Views4025 Downloads
by Alexandra Kreps M.D., Karen Paltoo B.A. and Isabel McFarlane M.D
Case Report
Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with a wide range of clinical features and variable clinical course. SLE tends to affect women during childbearing years and is characterized by multi-organ involvement. Cardiac complications in SLE, which have been described to occur in about 50% of the cases, contributes to significant morbidity and mortality in this population. We describe a patient with SLE and established lupus nephritis who subsequently developed cardiac manifestations including valvular abnormalities, arrythmia and end stage heart failure. The clinical features, work up and management will be discussed. Case presentation: A 35 year-old African American woman diagnosed with SLE in her twenties presented to our hospital for evaluation of shortness of breath. After SLE diagnosis, the patient had been prescribed hydrochloroquine and low dose steroids for joint and skin manifestations. Four years after initial presentation, she developed biopsy proven lupus nephritis for which standard induction therapy was administered. She was placed on maintenance immunosuppression with stable renal function. On admission, the patient¡¯s symptoms included dyspnea on exertion, chest pain, palpitations, and a non-productive cough. Initial evaluation identified atrial fibrillation and new onset of heart failure given elevated brain natriuretic peptide (BNP) levels and left ventricular ejection fraction (EF) of 15% by echocardiogram. Cardiac catheterization revealed global hypokinesis and non-obstructive coronary artery disease (CAD). The patient was deemed not a suitable candidate for cardiac transplant and was offered a life vest as bridging to an implantable cardioverter (ICD). Twenty-four months after discharge, the patient continued to be managed medically and has not had any subsequent hospitalizations. Conclusion: Cardiac complications, reported in about 50% of SLE patients, are associated with high morbidity and mortality. Pericarditis is the most common, however conduction defects, valvular damage and heart failure are also observed among SLE patients. The pathogenesis of cardiac involvement seems to be multifactorial. The management of heart failure in SLE entails medical therapy and implantable device use. Further research is needed to explore new options to arrest the development and progression of cardiac disease among lupus patients.
American Journal of Medical Case Reports. 2018, 6(9), 180-183. DOI: 10.12691/ajmcr-6-9-3
Pub. Date: October 10, 2018
8200 Views2611 Downloads
by Syed Haseeb, Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Ganesh Thirunavukkarasu, Sudhanva Hegde, Jonathan D. Marmur, Sneha Neurgaonkar and Samy I. McFarlane
Original Research
Brugada syndrome is a rare cardiac arrhythmia which is associated with right bundle branch block pattern (RBBB) and ST-segment elevation in right precordial leads. SCNA5 mutation is the most common genetic abnormality associated with Brugada syndrome. Brugada pattern not related to genetic mutations has been previously reported in the setting of fever, metabolic conditions, lithium use, marijuana and cocaine abuse, ischemia and pulmonary embolism, myocardial and pericardial diseases. Multiple isolated cases of Brugada pattern associated with diabetic ketoacidosis (DKA) have been previously reported. We here present a case of type 1 Brugada pattern in a 23 year-old-male who presented with DKA. Brugada pattern in DKA is attributed to acidosis and multiple electrolyte abnormalities including hyperkalemia which alter ion channel expression in the heart thus leading to Brugada pattern which subsequently resolved with treatment of DKA. In such patients, Brugada pattern is not reproducible on procainamide induction cardiac electrophysiology study (EPS). Our scoping study demonstrates male predominance 20/22 cases of (DELETE this highlighted area) Brugada pattern in DKA, a finding that is consistent with prevalence of this disease among males.
American Journal of Medical Case Reports. 2018, 6(9), 173-179. DOI: 10.12691/ajmcr-6-9-2
Pub. Date: October 07, 2018
16750 Views2770 Downloads
by Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Navneet Singh, Teresa Song, Stanley Soroka, Abhimanyu Amarnani, Justina Ray and Samy I. McFarlane
Original Research
Marijuana is the most common drug of abuse in the United States. Marijuana has more than 460 active chemical compounds including δ-9- tetrahydrocannabinol (THC). It acts via the CB1 and CB2 receptors that are distributed in various tissues in the body. Marijuana is known to cause tachycardia, bradycardia, hypertension, to decrease time angina, myocardial infarction and cardiac arrest. Till date, four cases of myocarditis/perimyocarditis associated with marijuana use have been reported. In one such case, it led to the development of heart failure in a young male patient. It is not clear if marijuana in and of itself causes myocarditis/perimyocarditis or if the etio-pathogenesis is actually related to the contaminants in marijuana such as pesticides and heavy metals. We hereby present a young male who with myocarditis related to marijuana use. Clinicians should have suspicion for myocarditis or perimyocarditis in patients presenting with chest pain following marijuana use.
American Journal of Medical Case Reports. 2018, 6(9), 169-172. DOI: 10.12691/ajmcr-6-9-1
Pub. Date: September 26, 2018
10875 Views3409 Downloads