by Tyler Kemnic, James Choi, Manel Boumegouas and Shaurya Srivastava
Case Report
A 49-year-old male with a past medical history of smoking (20 pack-years), 25 years of daily drinking, type 2 diabetes, alcoholic liver cirrhosis, hyperlipidemia, and hypertension presented with a complaint of weakness, shortness of breath and dizziness. Three days prior the patient completed an echocardiogram that revealed tricuspid regurgitation with right ventricular dilation and a right ventricular systolic pressure of 116 mmHg. Cardiology was consulted and completed right heart catheterization, VQ scan, as well as autoimmune and infectious investigations. The patient was diagnosed with Portopulmonary Hypertension (PPHTN) complicated by liver cirrhosis. Treatment was initiated with sildenafil, amlodipine, aspirin and continuous oxygen with scheduled outpatient appointments for both IV prostacyclin treatment and pre-liver transplant (LT) evaluation.
American Journal of Medical Case Reports. 2020, 8(5), 137-139. DOI: 10.12691/ajmcr-8-5-7
Pub. Date: March 24, 2020
3465 Views479 Downloads
by Jonathan Francois, Pramod Theetha Kariyanna, Amog Jayarangaiah, Tobin Matthew and Isabel M McFarlane
Case Report
Coronary artery anomalies are diagnosed in approximately 1% of patients who undergo coronary angiography (CAG). Several anomalies are life threatening but are generally asymptomatic and clinically insignificant. Nonetheless, proper recognition and adequate visualization is necessary for proper medical management, especially in patients undergoing percutaneous coronary intervention or cardiac surgery. In this report, a 73-year-old female was admitted for NSTEMI. Coronary angiography revealed a stenotic right coronary artery and separate ostium of the left circumflex artery and left anterior descending artery from the left Valsalva sinus. The patient was treated with percutaneous coronary intervention of the RCA lesion.
American Journal of Medical Case Reports. 2020, 8(5), 134-136. DOI: 10.12691/ajmcr-8-5-6
Pub. Date: March 19, 2020
4953 Views784 Downloads
by Pramod Theetha Kariyanna, Jessica Yager, Louis Salciccioli, Jason. M. Lazar, David John Polman, Harshith Priyan Chandrakumar and Isabel M. McFarlane
Original Research
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has been found to be associated with an increased risk of cardiovascular disease, and the development of arterial aneurysms in particular, intracranial aneurysms. In this review, we will review the reported HIV-associated extracranial aneurysms (HECAA) and their possible association with HIV/AIDS. We will discuss the proposed pathogenetic pathways leading to arterial aneurysms. HECAA, a subset of HIV/AIDS-associated arterial aneurysm (HAA), is more commonly seen in the adult population and in those with lower CD4+ T-cell counts and higher HIV viral loads. There also appears to be an advantage to early diagnosis of HECAA. There are viable treatment options available, as 61.4% of patients with HECAA underwent a corrective procedure. Furthermore, the mortality rate of 1.75% in HECAA was much lower when compared to HICAA.
American Journal of Medical Case Reports. 2020, 8(5), 128-133. DOI: 10.12691/ajmcr-8-5-5
Pub. Date: March 19, 2020
3689 Views698 Downloads
by Pramod Theetha Kariyanna, Ruchi Yadav, Vivek Yadav, Amog Jayarangaiah, Maya Srinivasan, Harshith Priyan Chandrakumar and Isabel M. McFarlane
Original Research
Marijuana (Cannabis) is the most commonly produced and illicit drug used worldwide with an estimated 182.5 million users globally, constituting 3.8% of the world population. There is a rising trend in the reporting of cardiovascular complications related to cannabis use. Marijuana is composed of more than 460 chemicals with delta-9- tetrahydrocannabinol (THC) being the psychotropic ingredient. It acts via CB1 and CB2 G-protein coupled cannabinoid receptors. Various cardiac manifestations, associated with marijuana use, such as bradyarrhythmia, tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia and fibrillation, asystole have been reported so far. To the best of our knowledge, there is a single case report of atrioventricular nodal reentrant tachycardia (AVNRT) triggered by smoking marijuana. Our case report is unique and probably the only one reported, in which AVNRT is triggered by edible marijuana, which was consumed in the form of marijuana burger. As compared to inhaled marijuana, marijuana ingestion has a delayed onset ranging from half an hour to three hours, with its effect lasting up to 12 hours. The effects of marijuana on the cardiovascular system are extremely worrisome owing to the legalization of marijuana for medicinal and recreational use across many states in the USA. Our case emphasizes the importance of keeping marijuana as one of the possible causes of AVNRT, not explained by any other cause. Physicians should keep in mind while elucidating history from the patient, all the possible routes of marijuana consumption and detailed and repetitive questionnaire should be put to the patient in order to reach a conclusive diagnosis.
American Journal of Medical Case Reports. 2020, 8(5), 123-127. DOI: 10.12691/ajmcr-8-5-4
Pub. Date: March 18, 2020
4904 Views877 Downloads
by Mohammed Al-Sadawi, Romy Rodriguez Ortega, Naseem Hossain, Yusra Qaiser and Samy I. McFarlane
Case Report
Iatrogenic air embolism is associated with significant morbidity and mortality. Retrograde cerebral venous air embolism is most frequently associated with manipulation of venous access most commonly from central venous catheters. The ascension of air to the cerebral circulation is possibly due to the low specific gravity of air compared to blood and the performance of procedures in the sitting position. Increased right ventricular pressures in the setting of pulmonary thromboembolism may also contribute to the retrograde flow of air. We present the case of a 61-year-old woman who developed a massive pulmonary embolism and pneumocephalus, which was evident during contrast enhanced CT pulmonary angiography. Neurological deficits were not apparent and air resorption occurred after 48 hours of high flow oxygen therapy.
American Journal of Medical Case Reports. 2020, 8(5), 119-122. DOI: 10.12691/ajmcr-8-5-3
Pub. Date: March 14, 2020
4801 Views766 Downloads
by Evan Botti MD, Michelle Likhtshteyn MD, Ghulam Ilyas MD, Evan Marzouk and Kakin R. Iong MD
Case Report
Drug Induced Liver Injury (DILI)accounts for around 11% of all Acute Liver Failure (ALF)cases and are usually associated with over the counter supplements [1]. Hepatotoxicity due to Hydralazine is not commonly reported [2]. Often times DILI may have variable presentations and latency times, making diagnosis difficult. Here we present a 70-year-oldfemale with multiple medical problems who presented to the hospital with jaundice and abdominal pain and concluded to have hydralazine induced liver injury.
American Journal of Medical Case Reports. 2020, 8(5), 115-118. DOI: 10.12691/ajmcr-8-5-2
Pub. Date: March 10, 2020
4315 Views557 Downloads
by John Hart
Original Research
Timing of an intervention is an important part of quality clinical care, including chiropractic care. In this case study the heart rate tests of resting heart rate (RHR) and heart rate variability (HRV) were used as outcome measure and for determining when to administer a chiropractic spinal adjustment. Optimal post-adjustment results were observed when the tests showed worse pre-adjustment values. Further application in other patients is planned.
American Journal of Medical Case Reports. 2020, 8(5), 112-114. DOI: 10.12691/ajmcr-8-5-1
Pub. Date: March 13, 2020
5781 Views1094 Downloads