The candlenut tree is a tropical plant that has a vast number of uses which include fertilizer, dye, ink for tattooing, and fuel. The inner seed of the nut is the most utilized portion of the plant and is often sold as a food additive, natural laxative, or a weight loss supplement. Unfortunately, the seed itself is very toxic when consumed whole and in its raw state. Typical symptoms of toxicity include abdominal pain, vomiting, and diarrhea. Rarely, it can cause cardiac dysrhythmias, most commonly bradycardia and atrioventricular heart block. We present a case of a young adult female with no significant past medical history who developed typical symptoms of toxicity, as well as atrioventricular heart block following ingestion of a candlenut. Most documented cases describe complete resolution of gastrointestinal and cardiac symptoms about one week following ingestion; however, treatment while inpatient can consist of inotropes or vasopressor support, intravenous fluid hydration, electrolyte replacement, and antiemetics. Although the mechanism of action remains unclear, this report provides physicians with an understanding of the risks of ingestion and the knowledge of typical management of the toxic effects of the candlenut.
True aneurysms discovered within the internal mammary artery are extremely rare and typically have an asymptomatic occurrence. Their presentation and management have also been variable due to their low incidence, decreased detection, or lack of documentation. They have a high risk for morbidity or mortality as they can possibly rupture with increasing size and thus become life-threatening. Coronary CT angiography is the most definitive test for confirming and finding complications related to the aneurysm. With an increase in the aging population and advancement in the techniques used in coronary artery bypass grafting, it is likely that the rate of recorded occurrence of aneurysms and pseudoaneurysms will increase. Endovascular repair is currently the most favored treatment modality. In this report, we describe a case of a 74-year-old male who was incidentally found to have a left internal mammary artery aneurysm following complaints of chest pain related to another nearly occluded grafted vessel. To the best of our knowledge, and following an extensive literature review, this is likely the first documented case of a true aneurysm found within a left internal mammary artery bypass graft. The patient recovered well following placement of a covered stent; however, upon follow-up one year later, he was found to have stenosis of the same vessel, which was subsequently treated without further complication.
Giant coronary artery aneurysms are a rare, asymptomatic occurrence. Presently, there is a lack of substantial research performed in the U.S., likely due to its low prevalence. As we are increasingly becoming a global community, strengthening data for seemingly rare disease processes such as this need to be addressed, particularly when they can progress to involve complications such as pericardial effusion caused by aneurysmal rupture or infection. A popular treatment option for these aneurysms is polytetrafluoroethylene-covered stents; they have been favorable with obtaining a high percentage of procedural success rates in aneurysms not associated with myocardial infarctions. In this paper, we present a case of a giant coronary artery aneurysm located in the left circumflex coronary artery that was complicated by a pericardial effusion. We will also present its unusual repair using a long drug-eluting stent as a scaffold to overlap covered coronary stents used to help exclude the aneurysm.
A surface electrocardiogram showing type B Wolff-Parkinson-White syndrome pattern was part of the cardiac findings in a female of 24 with florid features of tuberous sclerosis. She had cardiomegaly but no intracardiac tumour was demonstrated. Wolff-Parkinson-White syndrome, though rare, has previously been described in association with tuberous sclerosis in children but not before in adults.
Background. Early diagnosis and treatment of a patient displaying symptoms of myocardial ischemia is paramount in preventing detrimental tissue damage, arrhythmias, and death. Patient-related hospital delay is the greatest considerable cause of total delay in treatment for acute myocardial infarction. Objective. To identify patient characteristics contributing to prehospital delay and ultimately developing health interventions to prevent future delay and improve health outcomes. Methods. A retrospective chart review of 287 patients diagnosed with ST-elevation myocardial infarction (STEMI) was evaluated to examine correlates of patient-related delays to care. Results. Stepwise logistic regression modeling with forward selection (likelihood ratio) was performed to identify predictors of first medical contact (FMC) within 120 minutes of symptom onset and door-to-balloon (DTB) time within 90 minutes. Distance from the hospital, being unmarried, self-medicating, disability, and hemodynamic stability emerged as variables that were found to be predictive of FMC within the first 120 minutes after symptom onset. Similarly, patient characteristics of gender and disability and having an initial nondiagnostic electrocardiogram emerged as significant predictors of DTB within 90 minutes. Conclusions. Individual attention to high-risk patients and public education campaigns using printed materials, public lectures, and entertainment mediums are likely needed to disseminate information to improve prevention strategies. Future research should focus on identifying the strengths of prehospital predictors and finding other variables that can be established as forecasters of delay. Interventions to enhance survival in acute STEMI should continue as to provide substantial advances in overall health outcomes.
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