A stressful interaction
Article Abstract:
Subarachnoid hemorrhage can cause characteristic changes in the ECG, which measures the electrical activity of the heart. A 52-year-old man presented to a hospital with a history of headache and heartburn. His wife reported that he had experienced heartburn one hour before admission, and shortly after the heartburn resolved he had grabbed his head. An ECG revealed changes consistent with a heart attack and he was given nitroglycerin and oxygen. However, a CT scan also revealed a subarachnoid hemorrhage. For this reason, he was not given standard drug treatment for a heart attack, which includes clot-dissolving drugs and anticoagulants. Cardiac catheterization revealed substantial coronary artery disease, so it appears that the heart attack was not caused by the subarachnoid hemorrhage. Six weeks after admission, his ECG revealed the pattern typical of subarachnoid hemorrhage. Subarachnoid hemorrhage can cause changes in chemicals secreted by the brain that affect the heart.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1996
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A broken heart
Article Abstract:
Patients with severe symptoms from a minor heart attack should have an echocardiogram before receiving clot-dissolving drugs or angioplasty. A 70-year-old man was admitted to a hospital in a state of shock. He had been awakened with chest pain the previous night and an EKG revealed a minor heart attack. The discrepancy between this diagnosis and his symptoms led his doctors to suspect cardiac tamponade. Echocardiography confirmed this condition, which is caused by fluid accumulation around the heart. Surgeons opened the sac surrounding the heart, which yielded bloody fluid. They removed a large clot from the left ventricle, under which was found a small rupture of the ventricular wall. The perforation was repaired with biologic glue and a patch. Clot-dissolving drugs or angioplasty would have made the bleeding worse, with possibly fatal consequences.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1996
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The domino principle
Article Abstract:
The case of a 65-year-old woman illustrates the diagnostic dilemma when a malfunction in one body system causes a seemingly unrelated failure in another. She collapsed on the street and was admitted to an emergency department with the signs of shock. The physician ruled out cardiac shock even though an initial ECG suggested heart ischemia, a condition characterized by a reduced blood supply. He believed this was caused by low blood pressure and treated her for anaphylactic shock. She recovered, but developed chest pain 2 days later. Cardiac catheterization revealed severe coronary artery disease, which had been asymptomatic.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1996
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