Background Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) syndrome is a genetically inherited condition most notably affecting the central nervous system in young adults. There is limited knowledge on its association with coronary arteries, and its association with spontaneous coronary artery dissection (SCAD) has not been previously reported. Case summary A 61-year-old woman who is known to have CADASIL syndrome presented with anterior ST-segment myocardial infarction and underwent emergency angiography. This showed appearance consistent with SCAD in the mid left anterior descending artery with tubular stenosis. Discussion The association between CADASIL syndrome and SCAD has not been previously reported. The similarity in the underlying pathophysiology of these two conditions makes this case intriguing.
Kounis syndrome is a multisystem and multidisciplinary disease affecting the circulatory system that can be manifested as spasm and thrombosis. It can occur as allergic, hypersensitivity, anaphylactic, or anaphylactoid reactions associated with the release of inflammatory mediators from mast cells and from other interrelated and interacting inflammatory cells, including macrophages and lymphocytes. A platelet subset with high- and low-affinity IgE surface receptors is also involved in this process. Whereas the heart, and particularly the coronary arteries, constitute the primary targets of inflammatory mediators, the mesenteric, cerebral, and peripheral arteries are also vulnerable. Kounis syndrome is caused by a variety of factors, including drugs, foods, environmental exposure, clinical conditions, stent implantation, and vaccines. We report a unique case of a 60-year-old male with a past medical history of allergy to human albumin, alcoholic cirrhosis, and esophageal varices, who was admitted due to multiple episodes of hematemesis. Due to low hemoglobin levels, he was transfused with 3 units of red blood cells and fresh frozen plasma without any adverse reactions. On the third day of hospitalization, severe thrombocytopenia was observed and transfusion of platelets was initiated. Immediately following platelet infusion, the patient developed chest discomfort, skin signs of severe allergic reaction, and hemodynamic instability. The electrocardiogram revealed ST segment elevation in the inferior leads. Given the strong suspicion of Kounis syndrome/allergic coronary spasm, the patient was treated with anti-allergic treatment only, without any anti-platelet therapy. The clinical status of the patient gradually improved and the electrocardiographic changes reverted to normal. Based on these findings, Kounis hypersensitivity-associated acute coronary syndrome, specifically, type I Kounis syndrome, was diagnosed. Although platelet transfusion can be a life-saving therapy, each blood transfusion carries a substantial risk of adverse reactions. The aims of this report are to expand the existing knowledge of patient responses to blood transfusion and provide information on the incidence of various severe transfusion reactions to all blood components and especially to platelets. To the best of our knowledge, Kounis syndrome induced by platelet transfusionhas never been previously reported. Hypersensitivity to platelet external membrane glycoproteins in an atopic patient seems to be the possible etiology. Despite that Kounis syndrome remains an under-diagnosed clinical entity in everyday practice, it should always be considered in the differential diagnosis of acute coronary syndromes.
Drug treatment 575verse outcomes was also confirmed by a propensity score-matched analysis, and consistent results were obtained in relevant subgroups, with no significant interactions observed between digoxin and sex, history of HF, or valvular heart disease, or concomitant treatment of warfarin in the risk of all-cause death. Conclusions: In Chinese patients with AF, digoxin use was not related to a significantly increased risk of all-cause mortality and cardiovascular death. Risk of all-cause mortality was compared between three drug groups by using Cox regression analysis after propensity score matching for baseline characteristics. Results: There were 5206, 4823, 4823, 4037 and 9756 patients with OLD were treated with selective beta-blocker (BB), non-selective BB, and calcium channel blocker (CCB), and digoxin, respectively. Total of 55,306 patients did not receive any rate-control drug, who served as reference group. In patients with moderate to severe OLD, significant lower mortality risk were found in all four ratecontrol groups with selective BB (HR=0.75, 95% CI=0.61-0.93), non-selective BB (HR=0.74, 95% CI=0.71-0.88), CCB (HR=0.82, 95% CI=0.70-0.97), and digoxin (HR=0.83, 95% CI=0.76-0.92), compared to the reference group. In mild OLD, the risk of mortality was lower in patients receiving selective BB, non-selective BB and CCB (all HR<1.00, P<0.05). Conversely, the digoxin group had a higher risk of mortality in mild OLD (HR=1.03, 95% CI=1.00-1.07). Background: AF ranks among the most frequent underlying or contributory causes of death and has been increasing in the latest decades. Acute-onset atrial fibrillation is a frequent condition in emergency departments, and patients mostly present highly symptomatic with dyspnea and tachycardia. Intravenous application of electrolytes and beta-blocker have been proposed as beneficial acute therapy in small case reports. P2681 | BEDSIDEWithin the HAMBURG-AF study we aimed to evaluate the efficacy of intravenous therapy with potassium, magnesium and/ or metoprolol for cardioversion during initial stay in the emergency department. Methods:The HAMBURG-AF study is a prospective study covering all consecutive patients presenting to the emergency department of a large tertiary care center with recent-onset atrial fibrillation from July 01, 2015, to December 31, 2016. Patients with permanent and longstanding persistent atrial fibrillation were excluded, resulting in a total of 469 patients for the present analysis. While one thirds of the patients received either intravenous potassium or intravenous magnesium alone, one third did not receive any intravenous therapy, and the remaining one third received all three intravenous therapies in combination.Results: A total of 330 cases (70%) were classified as paroxysmal atrial fibril-
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