Brugada syndrome can be unmasked by several conditions including a febrile state, marked leukocytosis, and electrolyte disturbances. Herein, we describe a 62-year-old man with cholangiocarcinoma in the first reported case of Brugada syndrome onset following photodynamic therapy.
Bile Duct Neoplasms/*drug therapy ; *Bile Ducts, Intrahepatic ; Brugada Syndrome/diagnosis/*etiology/therapy ; Cardiopulmonary Resuscitation ; Cholangiocarcinoma/*drug therapy ; Electrocardiography ; Fatal Outcome ; Fever/etiology ; Humans ; Klatskin's Tumor/*drug therapy ; Male ; Middle Aged ; Photochemotherapy/*adverse effects ; Predictive Value of Tests ; Treatment Outcome

No abstract available.
Adolescent ; Adrenergic beta-Antagonists/therapeutic use ; Calcium Channel Blockers/therapeutic use ; Cardiomyopathy, Hypertrophic, Familial/complications/genetics/*pathology/physiopathology/therapy ; Electric Countershock ; Electrocardiography ; Female ; Genetic Predisposition to Disease ; Heart Failure/etiology/therapy ; Heart Septum/drug effects/*pathology/physiopathology/ultrasonography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pedigree ; Phenotype ; Tachycardia, Ventricular/etiology/therapy ; Treatment Outcome ; Ventricular Outflow Obstruction/etiology

Congenital coronary arteriovenous fistula (CAVF) is a rare condition which is characterized by abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium, left ventricle or pulmonary artery. In this paper, we report a case of a 68-year-old woman complaining of resting chest pain for one week. Initially, after performing a coronary arteriogram, the case was diagnosed as a CAVF combined with a pulmonary artery aneurysm. However, a multidetector-row CT (MDCT) was also performed, and the structure initially diagnosed as a pulmonary artery aneurysm was identified as a dilated pulmonary sinus. Subsequently, the patient was treated successfully with a simple ligation.
Aged ; Aneurysm ; Arteriovenous Fistula* ; Chest Pain ; Coronary Vessels ; Female ; Heart Atria ; Heart Ventricles ; Humans ; Ligation ; Pulmonary Artery

BACKGROUND AND OBJECTIVES: Proteomics is a new technology that allows the detection and identification of several proteins at a given time in a sample. There are currently few reports concerned with the proteomic study of serum from patients during acute coronary syndrome. We performed proteomics to analyze the modifications in the serum protein map of patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: We investigated the serum from 12 patients who suffered with acute myocardial infarction (AMI), 12 patients with unstable angina (UA) and 13 age- and sex-matched patients as the control group. Two-dimensional electrophoresis, Coumassie staining and image analysis were performed. Mass spectrometry was performed to identify the selected spots. RESULTS: For the two-dimensional electrophoresis with using a pH range of 3 to 10, two different areas within the serum protein map were observed, and this showed differences between the groups. In area 1, three fibrinogen gamma chain isoforms were identified. All of them were increased in the serum from the AMI and UA patients when compared with the control group. In area 2, four fibrinogen beta chain isoforms were identified. Three isoforms of them were increased in the serum from the AMI and UA patients. CONSLUSION: Three fibrinogen gamma chain isoforms were identified and they were increased in the serum from ACS patients. Four fibrinogen beta chain isoforms were identified and three isoforms of them were increased in the serum from ACS patients.
Acute Coronary Syndrome* ; Angina, Unstable ; Electrophoresis ; Fibrinogen ; Humans ; Hydrogen-Ion Concentration ; Mass Spectrometry ; Myocardial Infarction ; Protein Isoforms ; Proteomics

ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.
Aorta ; Atherosclerosis ; Chest Pain ; Coronary Occlusion* ; Coronary Vessels ; Diagnosis ; Emergencies ; General Surgery ; Humans ; Masks* ; Myocardial Infarction* ; Myocardial Revascularization

ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.
Aorta ; Atherosclerosis ; Chest Pain ; Coronary Occlusion* ; Coronary Vessels ; Diagnosis ; Emergencies ; General Surgery ; Humans ; Masks* ; Myocardial Infarction* ; Myocardial Revascularization

Polycystic kidney disease (PCKD) is rarely associated with aortic dissection (AD), which is a life-threatening disease. Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported. This case shows a 37-year-old male who had sudden onset of sharply stabbing epigastric pain with severe hypertension, who was diagnosed with TBAD and PCKD by a computed tomography and initially underwent medical treatment. Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion. Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms. We report the case of complicated TBAD in a patient with PCKD treated with endovascular stent-graft repair.
Adult ; Aortic Diseases ; Endovascular Procedures ; Humans ; Hypertension ; Leg ; Male ; Paresthesia ; Polycystic Kidney Diseases*

A 46-year-old male arrived at the emergency department with acute dyspnea. On the way to the hospital, heart massage was performed in the ambulance due to asystole on electrocardiography. After 2 hr of resuscitation, sinus rhythm was restored. Extracorporeal life support and an intra-aortic balloon pump were applied due to cardiogenic shock, but the patient showed sustained hypotension. Echocardiography showed moderate pericardial effusion with physiological evidence of cardiac tamponade; emergency pericardiocentesis was performed, which produced bloody pericardial fluid. An explorative sternotomy revealed a massive hematoma in the mediastinum and right ventricular (RV) free wall rupture. After primary repair, echocardiography showed improved left ventricular systolic function and the patient was stable clinically. This case presents RV free wall rupture as an unusual complication of prolonged heart massage. Heart rupture should be considered in hemodynamically unstable patients after prolonged heart massage.
Ambulances ; Cardiac Tamponade ; Cardiopulmonary Resuscitation* ; Death, Sudden, Cardiac* ; Dyspnea ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Heart Arrest ; Heart Massage ; Heart Rupture ; Hematoma ; Humans ; Hypotension ; Male ; Mediastinum ; Middle Aged ; Pericardial Effusion ; Pericardiocentesis ; Resuscitation ; Rupture* ; Shock, Cardiogenic ; Sternotomy

Background: Cardiac arrest during or after office-based cosmetic surgery is rare, and little is known about its prognosis. We assessed the clinical outcomes of patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics. Methods: Between May 2009 and May 2016, 32 patients who developed cardiac arrest during or after treatment at cosmetic surgery clinics were consecutively enrolled. We compared clinical outcomes, including complications, between survivors (n=19) and non-survivors (n=13) and attempted to determine the prognostic factors of mortality. Results: All 32 of the patients were female, with a mean age of 30.40±11.87 years. Of the 32 patients, 13 (41%) died. Extracorporeal life support (ECLS) was applied in a greater percentage of non-survivors than survivors (92.3% vs. 47.4%, respectively; p=0.009). The mean duration of in-hospital cardiopulmonary resuscitation (CPR) was longer for the non-survivors than the survivors (31.55±33 minutes vs. 7.59±9.07 minutes, respectively; p=0.01).The mean Acute Physiology and Chronic Health Evaluation score was also higher among non-survivors than survivors (23.85±6.68 vs. 16.79±7.44, respectively; p=0.01). No predictor of death was identified in the patients for whom ECLS was applied. Of the 19 survivors, 10 (52.6%) had hypoxic brain damage, and 1 (5.3%) had permanent lower leg ischemia.Logistic regression analyses revealed that the estimated glomerular filtration rate was a predictor of mortality. Conclusion Patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics experienced poor prognoses, even though ECLS was applied in most cases. The survivors suffered serious complications. Careful monitoring of subjects and active CPR (when necessary) in cosmetic surgery clinics may be essential.

Acute myocardial infarction is a common initial incorrect diagnosis in patients with acute aortic dissection. Distinction between these two conditions could be especially difficult in a patient who has severe chest pain and abnormal ECG findings. The consequence of such a misdiagnosis in the era of thrombolytic therapy could be catastrophic. We report a case of acute type A aortic dissection who was recovered from acute myocardial ischemia and malig nant ventricular tachycardia by emergency surgical treatment. A 54-year-old male patient with no previous cardiac history visited ER because of syncope and severe chest pain of acute onset. Physical examination was normal except for a low blood pressure (90/40 mmHg) and heart rate of 55 beats/min. The ECG showed ST depression and negative T waves in leads II, III, aVF and V4 to 6. A chest X-ray was normal. Acute myocardial infarction complicated by cardiogenic shock was diagnosed. Emergency cardiac catherization was performed. An aortogram demonstrated type A aortic dissection. The patient had a circulatory arrest with ventricular tachycardia and cardiogenic shock. Cardiopulmonary resuscitation was performed for 50 minutes. He underwent emergency surgical correction. The ST segment returned to normal and there was no evidence of myocardial ischemia after these procedures. The postoperative course was unevenful.
Cardiopulmonary Resuscitation ; Chest Pain ; Depression ; Diagnosis ; Diagnostic Errors ; Electrocardiography ; Emergencies* ; Heart Rate ; Humans ; Hypotension ; Male ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia* ; Physical Examination ; Shock, Cardiogenic ; Syncope ; Tachycardia, Ventricular* ; Thorax ; Thrombolytic Therapy