Introduction. Classically, stress-induced cardiomyopathy (SIC), also known as takotsubo cardiomyopathy, displays the pathognomonic feature of reversible left ventricular apical ballooning without coronary artery stenosis following stressful event(s). Temporary reduction in ejection fraction (EF) resolves spontaneously. Variants of SIC exhibiting mid-ventricular regional wall motion abnormalities have been identified. Recent case series present SIC as a finding in association with sudden unexplained death in epilepsy (SUDEP). This case presents a patient who develops recurrence of nonapical cardiomyopathy secondary to status epilepticus. Case Report. Involving a postoperative, postmenopausal woman having two distinct episodes of status epilepticus (SE) preceding two incidents of SIC. Preoperative transthoracic echocardiogram (TTE) confirms the patient's baseline EF of 60% prior to the second event. Postoperatively, SE occurs, and the initial electrocardiogram exhibits T-wave inversions with subsequent elevation of troponin I. Postoperative TTE shows an EF of 30% with mid-ventricular wall akinesia restoring baseline EF rapidly. Conclusion. This case identifies the need to understand SIC and its diagnostic criteria, especially when cardiac catheterization is neither indicated nor available. Sudden cardiac death should be considered as a possible complication of refractory status epilepticus. The pathophysiology in SUDEP is currently unknown; yet a correlation between SUDEP and SIC is hypothesized to exist.

Stingray envenomation is common in coastal regions around the world and may result in intense pain that can be challenging to manage. Described therapies involve hot water immersion and potentially other options such as opioid and nonopioid analgesics, removal of the foreign body, wound debridement, antibiotics for secondary infection, and tetanus toxoid. However, for some patients, this may not be enough. Peripheral nerve blockade is a frequently used perioperative analgesic technique, but it has rarely been described in the management of stingray envenomation. Here, we report a case of stingray envenomation in an otherwise healthy 36-y-old male with pain refractory to traditional therapies. After admission for pain control, the patient received an ultrasound-guided sciatic popliteal nerve block. Upon completion of the peripheral nerve block, the patient reported rapid and complete resolution of the intense pain, which did not return thereafter.

Experience with systemic heparinization during cardiac catheterization by brachial arteriotomy has been investigated by a prospective study. In 253 catheterizations no complications attributable to heparinization occurred. The incidence of impaired (2 4%) and absent (i *6%) radial pulses after catheterization was lower than in some series. The majority ofcomplications were related to local trauma at the site ofcatheter introduction and were related to the type of catheter used. The incidence of post-catheterization occlusion requiring thrombectomy was significantly lowerfor those with systemic heparinization than for those where heparin was omitted or reversed, though the numbers involved were small. We conclude that systemic heparinization is a useful and safe technique during cardiac catheterization and can help to reduce the incidence of local thrombosis.The co-operative study on cardiac catheterization investigated the complications associated with cardiac catheterization and concluded that patients on anticoagulants were at increased risk from this procedure (Swan, I968a). However, heparin in moderate doses is usually administered locally -as a routine part of left heart catheterization when performed by brachial arteriotomy (Sones, I970; Sewell, I965; Walker et al., I973), and since I968 we have used full systemic hepariniztion for routine left heart catheterization. We have considered it safe and helpful in reducing the incidence of arterial occlusion caused by distal thrombosis. In order to study the role of systemic heparinization more fully, a prospective study was carried out. PatientsDuring a io-month period from June 1972, 253 arteriotomies were performed in 250 patients over 12 years of age having routine diagnostic retrograde left heart catheterization. During this period a further 23 arteriotomies were performed, but these have been excluded from the present analysis because insufficient details of follow-up were available. However, none of those excluded was known to have had complications.Of 250 patients in the study, II3 had rheumatic heart disease, 66 ischaemic heart disease, 39 congenital heart disease, and 32 miscellaneous cardiac conditions. At the conclusion of the study period I05 had been discharged to be followed at their referring hospital and 23 had died. Of the remaining I22, 107 were examined at follow-up at least one month (mean 8-5 weeks) after catheterization. At that time the presence of symptoms in the catheterized arm was elicited by direct questioning. MethodsTwo hundred and forty-six (98 4%) of the procedures were performed by 5 operators and details of technique varied only slightly. Heparin in a dose of Ioo units/kg body weight was given through a venous catheter before the artery was opened. However, in 8 patients heparin was contraindicated because of a dissecting aneurysm of the aorta (one patient) or because there was severe aortic stenosis and direct left ventricular puncture was anticipated. In a further 9 patients the effects of heparin were reversed during the pro...