Objective: To assess serum levels of carbohydrate antigen 125 (CA125) in patients with chronic congestive heart failure (CHF) and to assess any correlation with clinical symptoms and echocardiographic indices. Patients and methods: We enrolled 77 male patients (mean age: 73F10 years) admitted to the Cardiology Emergency Department (ED) with cardiac symptoms requiring hospitalization. Diagnosis of CHF was based upon medical history or initial echocardiographic evaluation on current admission. Serum CA125 was measured by an enzyme immunoradiometric assay, on admission and before discharge. Results: The median overall CA125 value was 22.4 (11.5-48.9) U/ml. Serum CA125 levels were related to the severity of CHF [New York Heart Association (NYHA) class I: 19.2 (7.2-31) U/ml, NYHA class II: 17.6 (10-23) U/ml, NYHA class III: 32 (25-77) U/ml and NYHA class IV: 34.3 (18.6-77) U/ml ( pb0.04)]. Patients in NYHA classes III and IV had significantly higher mean values of CA125, than patients in class II ( pb0.005 and pb0.05, respectively). Moreover, patients with fluid congestion (pulmonary congestion, ankle edema) had higher levels of serum CA125 than patients without congestion ( p=0.002 and pb0.03, respectively). Finally, levels of serum CA125 correlated weakly with right ventricular systolic pressure (RVSP) and renal function, while no significant correlation was found between CA125 and E wave deceleration time on Doppler echocardiography, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), liver function and the medical treatment prescribed. Conclusion: Serum CA125 is associated with the clinical severity of CHF and the symptoms and signs of fluid congestion and therefore may be a useful additional tool for the evaluation and clinical staging of these patients.
We report the case of a 78-year-old woman, with previous narrow QRS atrial fibrillation, who in the presence of mild digoxin intoxication and severe hyperkalaemia, caused by chronic renal failure and usage of potassium sparing drugs, presented on her ECG two distinct wide QRS tachycardias. Initial treatment with low doses of procainamide resulted in severe bradycardia. Her original rhythm was restored after partial correction of hyperkalaemia with haemodialysis under continuous infusion of lidocaine. The electrocardiographic manifestations of hyperkalaemia and digoxin intoxication as well as the effect of lidocaine and procainamide on hyperkalaemia-induced wide QRS tachycardias are discussed.
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