BackgroundAcute myopericarditis and exertional rhabdomyolysis, two uncommon but well-described diseases with potentially life-threatening effects, are generally considered as independent clinical entities. However, they may in fact be pathophysiologically related under certain circumstances. This is the first ever report of influenza myopericarditis provoked by exertional rhabdomyolysis to the best of our knowledge.Case presentationA 25-year-old immunocompetent Chinese man presented with bilateral leg pain, dizziness, and shortness of breath on admission soon after completing vigorous training comprising running drills. Exertional rhabdomyolysis was diagnosed with 44 fold high serum creatine phosphokinase. Then he developed chest pain, pericardial effusion, changes of electrocardiography and positive troponin I suggestive of myopericarditis. Influenza A (H3N2) virus infection was confirmed by polymerase chain reaction analysis of nasopharyngeal wash samples. Other possible infective and autoimmune causes were excluded. Patient recovered completely with anti-inflammatory therapy and the supportive care.ConclusionThis case suggests that clinicians who treat patients with exertional rhabdomyolysis should be aware of the potential vulnerability to acute myopericarditis, especially in the presence of recent influenza A infection.
Left ventricular hypertrophy (LVH) indicates subclinical organ damage, associating with the incidence of cardiovascular diseases. From the medical perspective, electrocardiogram (ECG) is a low-cost, non-invasive, and easily reproducible tool that is often used as a preliminary diagnosis for the detection of heart disease. Nowadays, there are many criteria for assessing LVH by ECG. These criteria usually include that voltage combination of RS peaks in multi-lead ECG must be greater than one or more thresholds for diagnosis. We developed a system for detecting LVH using ECG signals by two steps: firstly, the R-peak and S-valley amplitudes of the 12-lead ECG were extracted to automatically obtain a total of 24 features and ECG beats of each case (LVH or non-LVH) were segmented; secondly, a back propagation neural network (BPN) was trained using a dataset with these features. Echocardiography (ECHO) was used as the gold standard for diagnosing LVH. The number of LVH cases (of a Taiwanese population) identified was 173. As each ECG sequence generally included 8 to 13 cycles (heartbeats) due to differences in heart rate, etc., we identified 1466 ECG cycles of LVH patients after beat segmentation. Results showed that our BPN model for detecting LVH reached the testing accuracy, precision, sensitivity, and specificity of 0.961, 0.958, 0.966 and 0.956, respectively. Detection performances of our BPN model, on the whole, outperform 7 methods using ECG criteria and many ECG-based artificial intelligence (AI) models reported previously for detecting LVH.
Rectus sheath hematoma (RSH) is a rare pathology. RSH is often misdiagnosed because its symptoms vary. Conservative management, including bed rest, analgesia, and intravenous fluid replacement, has long been the standard treatment for RSH, and problematic cases are rarely described (1). We report a case of two expanding refractory RSHs without evidence of active bleeding on contrast-enhanced computed tomography (CECT) and angiography. The patient was successfully treated by empiric transcatheter arterial embolization (TAE) of the inferior epigastric artery. Case reportAn 87-year-old woman with a history of hypertensive cardiovascular disease was admitted because of an acute cerebral infarction. She was initially treated with aspirin and dipyridamole. On the day of admission, she developed an excessive cough secondary to recurrent choking episodes. A nasogastric tube was then inserted to facilitate feeding. Antiplatelet agents were discontinued because material with a coffeeground appearance was present in the nasogastric effluent on the second day after admission. An upper gastrointestinal panendoscopy confirmed that she had active gastric ulcers. Her hemoglobin level was 13.3 g/dL. On the eighth day after admission, she experienced a paroxysm of coughing that lasted several minutes and was followed by severe abdominal pain and hypotension (blood pressure, 93/44 mmHg). Physical examination revealed a large tender mass in the lower left quadrant of the abdomen and the absence of rebound tenderness or muscular rigidity. Her hemoglobin level decreased to 8.3 g/dL, but her platelet count and coagulation profile were normal. Urgent CECT of the abdomen and pelvis revealed a 9.8×7.2×10.3 cm left RSH and a 3.2×2.3×5.9 cm right RSH. Ecchymosis developed in the periumbilical region and expanded into the bilateral inguinal regions by the thirteenth day after admission. Despite conservative treatment and transfusion of four units of erythrocyte, the size of the masses gradually increased, and persistent hemodynamic instability was present by the twenty-fourth day after admission. A repeat CECT scan was conducted on suspicion of continued bleeding and expanding hematomas. The left RSH measured 10.5×8.2×13 cm, extending into the pelvis, and the left inferior epigastric artery was engorged; the right RSH measured 4.5×2.8×7 cm (Figs. 1 and 2). Interventional radiology was conducted because of the patient's instability and poor response to conservative treatment. On angiography with selective catheterization of the left external iliac artery, the main trunk and branches of the vessel appeared normal, and there was no obvious contrast extravasation (Fig. 3). Because of the engorged left inferior epigastric artery and the patient's vigorous tussive efforts, the risk of microhemorrhage and coughinduced intermittent bleeding could not be disregarded. Consequently, INTERVENTIONAL RADIOLOGY CASE REPORT Expanding refractory rectus sheath hematoma: a therapeutic dilemmaGuo-Shiang Tseng, Guo-Shiou Liau, Hann-Yeh Shyu, Shi-Jye Chu, Fu-Ch...
Introduction We investigated the correlation and association between serum uric acid (SUA) and left ventricular diastolic dysfunction (LVDD) criteria in military individuals. Material and Methods We prospectively enrolled military individuals who visited our hospital for evaluation of electrocardiographic abnormalities detected at an annual health exam between January 1, 2018 and December 31, 2019. Hyperuricemia was defined as an SUA level ≥7 mg/dL in men and ≥6 mg/dL in women. The definitions of LVDD criteria and LV hypertrophy were according to contemporary echocardiographic guidelines. Results The study included 268 individuals (89% male), with a mean age of 32.9 ± 7.6 years and SUA of 6.1 ± 1.3 mg/dL. The hyperuricemic (n = 74) and normouricemic (n = 194) groups had no significant differences in lifestyle choices and baseline characteristics. Serum uric acid correlated weakly with heart size parameters (r = 0.354, P < .001 for left atrial diameter and r = 0.146, P = .017 for left ventricular mass index (LVMI) and average E/e' >14 (r = 0.204, P = .001). The hyperuricemic group had higher LVMI (87.6 g/m2 vs. 81.8 g/m2, P = .022), septal e' velocity <7 cm/s (14.9% vs. 5.2%, P = .019), lateral e' velocity <10 cm/s (27.0% vs. 11.3%, P = .003), and average E/e' >14 (4.1% vs. 0%, P = .020) values than the normouricemic group. In multivariate logistic regression analyses, SUA was significantly associated with septal e' velocity <7 cm/s (adjusted HR: 2.398; 95% CI, 1.427-4.030; P = .001). Conclusion Elevated SUA was significantly associated with the presence of LVDD criteria, namely, septal e' velocity <7, in military individuals. Maintaining SUA levels within normal limits may prevent the development of LVDD.
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