Patient: Female, 46-year-old
Final Diagnosis: Coronary artery dissection and stent dislodgement
Symptoms: Chest pain
Medication: —
Clinical Procedure: PCI
Specialty: Cardiology
Objective:
Rare disease
Background:
Coronary stent dislodgement is rare but carries serious complications like thrombosis, myocardial infarction, disruption of the systemic circulation, and coronary dissection, which can lead to sudden death. Thus, rapid evaluation and intervention are needed to restore blood flow to vital organs.
Case Report:
A 46-year-old woman with no relevant past medical history except for smoking, presented to the Emergency Department (ED) with left-sided chest pain. The physical exam was unremarkable. EKG showed ST segment elevation, and troponin was 4.03. She underwent cardiac catheterization, which showed 100% occlusion of the left anterior descending coronary artery (LAD). A drug-eluting stent (DES) was placed. Later, she had chest pain similar to the initial episode. EKG showed 1-mm elevation at ST segment in leads V1 and V2 and T wave inversion in leads V2, V3, V4, and V5. She underwent a repeat heart catheterization, which revealed a dissection in the middle LAD distal to the initial stent placement. She was treated with another stent overlapping the proximal stent. While attempting to cross the proximal stent, the stent came off the balloon, slipped from the wire, and went down into the descending aorta.
Conclusions:
Coronary artery stent dislodgement is a rare event that can lead to significant complications during PCI. Patient restlessness and small-sized, severely angulated, and previously stented coronary arteries are associated risk factors. The main treatment option is stent retrieval, either surgically or using other available techniques. If retrieval of the stent is impossible, crushing it against the blood vessel wall could be considered.
Periodic paralyses are a group of disorders characterized by episodes of muscle paralyses. They are mainly divided as primary (hereditary) and secondary (acquired) periodic paralyses. Primary periodic paralyses occur as a result of mutations in genes encoding subunits of muscle membrane channel proteins such as sodium, calcium, and potassium channels, resulting in impairment of their properties. Primary periodic paralyses are further classified on the basis of affected ion channels and other associated complications. Some of these periodic paralyses are hyperkalemic periodic paralysis (Na-channel mutation), hypokalemic periodic paralysis (Na-or Ca-channel mutation), Andersen's syndrome (K-channel mutation), etc.
The current cholera outbreak in Haiti arose as a result of inadequate humanitarian aid management by the United Nations following the 2010 earthquake in the country. Nepalese peacekeepers spread the water-borne disease through improper sanitation and waste disposal, resulting in re-emergence of the infection after 150 years. In 2016, the United Nations formally apologized for its role in the spread of the cholera epidemic that has killed more than nine thousand Haitians to date. Though many studies discuss the origin of the epidemic, there is a lack of comparison between initial response practices and current practices. Therefore, it is difficult to understand how disaster relief has evolved as a result of the Haiti epidemic. This paper argues that the training of humanitarian aid workers to avoid spreading infectious diseases like cholera in areas receiving disaster relief has not sufficiently improved. Specifically, this paper will analyze what recommendations were put forth following the 2010 Haitian earthquake and to what extent those recommendations have been implemented. By comparing past and current humanitarian aid practices in areas requiring disaster relief, this paper will outline the ways in which humanitarian practices need to change to prevent the spread of infections from emergency workers.
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