Pericardial effusion is not so uncommon in hypothyroidism, but pericardial tamponade is very rare entity. Hypothyroidism complicated by pericardial tamponade is very rarely referenced in the medical literature. Here we report a rare case of a 70 year old female, who presented with breathlessness and was found to have hypothyroidism with large pericardial effusion complicating into pericardial tamponade. Management included urgent pericardiocentesis followed by l-thyroxine supplementation.
INTRODUCTIONThe QT interval reflects the duration of depolarization and repolarization of the ventricular myocardium thus reflects changes in local myocardial milieu. QT dispersion is defined by Cowan and colleagues in 1988 as "the differences between the maximum and minimum QT interval measurement on the standard 12 lead ECG". 1 Dispersion of repolarisation is thought to reflect regional heterogeneity of the recovery process within the myocardium, which is believed to be important in the genesis of ventricular arrhythmias.2-5 Slowed conduction in the ischemic zone of myocardium, electrolyte disturbance and alterations in the level and kind of autonomic control after acute myocardial infarction are responsible for development of arrhythmias.6-8 After AMI, the effect of thrombolytic therapy and the patency of infarct related artery, history of re-infarction, the size of the infarction scar and left ventricular ejection fraction are linked to QTd. ABSTRACTBackground: QT dispersion is a potential marker of arrhythmic risk, myocardial ischemia and myocardial viability. Measurement of QT interval dispersion has failed to establish its place in routine clinical practice. The study aims at predicting risk of life threatening ventricular arrhythmias in patients of acute coronary syndromes using rate adjusted QT interval dispersion (QTcd) as one of the cheapest modalities of investigation. Methods: Serial measurements (at admission, after 24 hours, 48 hours, and 7 th day) of rate adjusted QT interval dispersion (QTcd) was done in 107 cases of acute coronary syndromes (ACS) namely ST-segment elevated Myocardial infarction (STEMI), non-ST-segment elevated myocardial infarction (NSTEMI) and unstable angina (UA). Patients who reported within 12 hrs of onset of chest pain and typical ECG changes were thrombolysed using streptokinase (15 lack IU). Results: Mean QTcd following acute coronary syndrome was maximum at admission and then gradually falls till day-7 as the patients clinical condition improves but it remains high in case of development of various complications (viz. hypotension, congestive heart failure (CHF), PSVT, VPC, CHB, ventricular fibrillation and death). Patients with STEMI who were thrombolysed at admission showed significantly lower mean QTcd on day-1, as well as complications and death during in-hospital stay as compared to patients who were not thrombolysed (p <0.001). Conclusions: QTcd interval could be helpful as an earliest in-hospital bedside predictor of life-threatening arrhythmias and death. Timely reperfusion by thrombolysis decreases mean Qtcd and thus reduces post-MI mortality and morbidity.
Primaquine is used in prevention of relapse of plasmodium vivax and ovale. It is known to cause haemolysis induced acute kidney injury in patients with glucose-6-phosphate dehydrogenase (G-6-PD) enzyme deficiency. Primaquine is widely used in the remote areas of Hadoti region of India by many non-registered practitioners for treatment of febrile illnesses without prior testing of G-6-PD status. Due to this practice, many patients land up with the grave consequences with significant health care burden. We report 8 such cases, which were referred to our hospital, New hospital medical college, Kota, Rajasthan, India. Our study included a series of 8 cases which were referred to our hospital with significantly deranged renal function test due to use of primaquine without prior testing of G-6-PD status. Routine blood investigations including renal function tests and G-6-PD status were measured. In our study, we found that patients with febrile illness and G-6-PD deficiency developed acute kidney injury even with a single tablet of 15 mg of primaquine. The use of even a single dose of 15 mg primaquine may not be safe in population of Hadoti region of India. Hence they should not be exposed to primaquine without prior G-6-PD testing.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.