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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case is presented of a 66 year old woman who attended the emergency department with severe abdominal pain subsequent to a bout of coughing, following a week's history of productive cough. She was known to have chronic obstructive pulmonary disease and was also on warfarin for recurrent deep vein thromboses. She had no history of ischaemic heart disease. She was found to have a rectus sheath haematoma and an international normalised ratio of 7.7, and admission was arranged for coagulation control and analgesia. However, a routine electrocardiograph (ECG) demonstrated an ST elevation pattern consistent with an acute inferior infarction. Subsequent ECGs showed no ST elevation, although the axis and chest lead QRS morphology remained the same throughout the first 12 hours. Over the next three days, R wave progression decreased in the chest leads. Troponin I at admission and 24 hours later were both <0.2 ng/ml. ECG changes compatible with acute myocardial infarction have been reported in association with a number of non-cardiac presentations; however, to our knowledge, it has never been reported in relation to a rectus sheath haematoma. We speculated on the possible mechanism of such "pseudo myocardial infarction" and the importance of treating the patient, not the ECG.
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PMID:Pseudo myocardial infarction. 1685 85

A 65-year-old man with known ischemic heart disease and previous coronary artery bypass grafts was admitted having been found collapsed in the street. He was a smoker with a history of alcohol abuse. On clinical examination he was unkempt, febrile, hemodynamically stable, and had no systemic deficits. The O2 saturation on air was 99%, with a po2 of 9.2, and pco2 of 4.0. Ventilation perfusion (VQ) scan was performed to rule out a pulmonary embolism. While in the department he was noted to be dyspneic and generally unwell. The perfusion images showed reduced perfusion to both lower zones more marked on the right. The ventilation study was markedly abnormal on the initial views with no ventilation to the right lung. However, the patient had recurrent episodes of cough with expectoration of sputum before the anterior view was imaged, which subsequently demonstrated ventilation defects in the right mid and lower zones. A repeat ventilation sequence was performed which confirmed these findings in all views. Chest x-ray performed prior to the lung scan was normal.
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PMID:Zero ventilation: a transient episode. 1788 69

Class I recommendations for treating patients with current or prior symptoms of heart failure with reduced left ventricular ejection fraction (LVEF) include using diuretics and salt restriction in individuals with fluid retention. Use angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and angiotensin II receptor blockers if intolerant to ACE inhibitors because of cough or angioneurotic edema. Nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and calcium channel blockers should be avoided or withdrawn. Exercise training is recommended. Implant cardioverter-defibrillator (ICD) is recommended in individuals with a history of cardiac arrest, ventricular fibrillation, or hemodynamically unstable ventricular tachycardia. ICD is indicated in patients with ischemic heart disease for at least 40 d post-myocardial infarction or nonischemic cardiomyopathy, an LVEF of 30% or less, New York Heart Association (NYHA) class II or III symptoms on optimal medical therapy, and an expectation of survival of at least 1 yr. Cardiac resynchronization therapy should be used in individuals with an LVEF of 35% or below, NYHA class III or IV symptoms despite optimal therapy, and a QRS duration greater than 120 ms. An aldosterone antagonist can be added in selected patients with moderately severe to severe symptoms of heart failure who can be carefully monitored for renal function and potassium concentration (serum creatinine should be <or=2.5 mg/dL in men and <or=2.0 mg/dL in women; serum potassium should be <5.0 mEq/L).
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PMID:Treatment of heart failure with decreased left ventricular ejection fraction. 1789 26

Underlying causes and precipitating causes of heart failure (HF) should be treated when possible. Persons with HF and normal left ventricular ejection fraction (LVEF) should have maintenance of sinus rhythm, treatment of hypertension, myocardial ischemia, dyslipidemia, and anemia, slowing of the ventricular rate below 90 bpm, and reduction of salt overload. First-line drug treatment in the management of these persons is the use of loop diuretics combined with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. If persons are unable to tolerate ACE inhibitors because of cough, angioneurotic edema, rash, or altered taste sensation, angiotensin II type I receptor antagonists (ARBs) should be given. If HF persists despite diuretics, beta blockers, and ACE inhibitors or ARBs, isosorbide dinitrate plus hydralazine should be administered. Beta blockers, verapamil, diltiazem, and digoxin may be used to slow a rapid ventricular rate in persons with supraventricular tachyarrhythmias. Digoxin should not be used in persons with HF in sinus rhythm with normal LVEF. Exercise training should be encouraged in persons with mild to moderate HF to improve functional status and to decrease symptoms.
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PMID:Treatment of heart failure with normal left ventricular ejection fraction. 1802 14

57-year-old woman with a history of ischaemic heart disease, arterial hypertension and after myocardial infarction was admitted to the university hospital because of progressive hearing loss and fever of unknown origin. Shortly before hospitalization she developed cough, hemoptysis and conjunctivitis. On the basis of clinical presentation Wegener's granulomatosis was suspected. To confirm the diagnosis, CT scans of the chest, sinuses and ears were performed and revealed massive lesions especially in tht tympanic cavity, mastoid antrum and cells. Infiltrations were also observed in sinuses, especially maxillary, and typical granulomas were found in the lungs. Moreover, the biopsy taken from the mucous membrane of the nose showed abnormalities typical of Wegener's granulomatosis. Antineutrophil cytoplasmatic antibodies (ANCA) were also examined. It is of interest that c-ANCA (cytoplasmatic) were negative and p-ANCA (perinuclear) were positive which is rare in this disease. The patient was treated with immunosuppressive drugs (intravenous methylprednisolone, oral prednisolone and cyclophosphamide). Following therapy fever, hemoptysis and conjunctivitis subsided, while inflammatory parameters normalized. This case report presents on unusual clinical manifestation of Wegener's granulomatosis with the leading sign of hearing loss.
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PMID:[Progressive hearing loss as the leading sign of Wegener's granulomatosis]. 1803 Aug 78

A 60-year old male patient with obesity and type 2 diabetes mellitus consulted due to high blood pressure, fearful of suffering ischemic heart disease. He also had a background of smoking 20 cigarettes/day for the last 30 years, but this did not concern him. In the questioning, he reported, although he did not consider it important, that he had cough and dyspnea on moderate exertions for some years. It is very unlikely that any internal medicine physician would doubt about whether to evaluate and treat his type 2 diabetes mellitus or high blood pressure, calculate his cardiovascular risk or if he has a metabolic syndrome, attempt to reduce his obesity and to make him stop smoking. However, should we label him as having chronic bronchitis or COPD? Should we perform a spirometry and bronchodilator test, treat his probable COPD? All his current symptoms are probably only due to COPD.
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PMID:[Approach to COPD management in Internal Medicine]. 2034 75

A 70-year-old male smoker, with a three-month status of post-balloon angioplasty for ischaemic heart disease, presented with a one-week history of fever, haemoptysis and chest discomfort on coughing. The patient did not report any loss of weight or appetite. On examination, he was febrile. Pulmonary function tests revealed obstructive airway disease. High resolution computed tomography of the lungs revealed fibrosis with bronchiectasis in both the upper lobes, and a spiculating subpleural mass in the posterior aspect of the right lung apex. Subsequent bronchoalveolar lavage (BAL) culture yielded the Scopulariopsis species. Our patient was treated with a four-week course of amphotericin B, followed by itraconazole. At the 24-month follow-up, the patient was asymptomatic. Subsequent BAL cultures revealed no fungal growths, and radiological studies showed a regression in the lesion.
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PMID:Pulmonary Scopulariopsis in a chronic tobacco smoker. 2084 53

Myocardial infarction is a rare condition in children. We present the case of a 14-year-old girl with known cardiac abnormalities admitted to our pediatric cardiology department with cough, cyanosis, low level of consciousness, and difficult breathing. Two days after her admission, she developed severe thoracic pain associated with tachycardia and agitation. The electrocardiogram revealed myocardial ischemia and then myocardial infarction with a rapid onset of cardiac arrest not responding to resuscitation techniques. Postmortem examination confirmed the diagnosis.
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PMID:[Myocardial infarction in children. Case report]. 2149 6

Chest pain is a worrisome symptom that often causes parents to bring their child to emergency department(ED) for evaluation. In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing enough to cause children to miss school. The clinician's primary goal in ED evaluation of chest pain is to identify serious causes and rule out organic pathology. The diagnostic evaluation includes a thorough history and physical examination. Younger children are more likely to have a cardiorespiratory source for their chest pain, whereas an adolescent is more likely to have a psychogenic cause. Children having an organic cause of chest pain are more likely to have acute pain, sleep disturbance due to pain and associated fever or abnormal examination findings, whereas those with non-organic chest pain are more likely to have pain for a longer duration. Chest radiograph is required in some, especially in patients with history of trauma . In children, myocardial ischemia is rare, thus routine ECG is not required on every patient. However, both pericarditis and myocarditis can present with chest pain and fever. Musculoskeletal chest pain, such as caused by costochondritis and trauma, is generally reproducible on palpation and is exaggerated by physical activity or breathing. Pneumonia with or without pleural effusion, usually presents with fever and tachypnea; chest pain may be presenting symptom sometimes. In asthmatic children bronchospasm and persistent coughing can lead to excess use of chest wall muscles and chest pain. Patients' who report acute pain and subsequent respiratory distress should raise suspicion of a spontaneous pneumothorax or pneumomediastinum. ED management includes analgesics, specific treatment directed at underlying etiology and appropriate referral.
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PMID:Acute chest pain. 2154 47

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung condition that affects 3 million adult Canadians aged 40 years or older. Most patients have mild to moderate disease and as such have only modest symptoms of cough and breathlessness. However, many will go on to experience ischemic heart disease and stroke and die of cardiovascular complications rather than from their lung disease. Indeed, nearly 50% of all hospitalizations and 25% of all deaths in patients with mild to moderate COPD are cardiovascular system related. Experimental and epidemiologic data from the past 20 years provide compelling evidence that chronic lung inflammation (related to COPD or exposure to irritants such as tobacco smoke or air pollution) contributes to atherosclerotic plaque progression and that acute inflammatory stimulus such as acute respiratory tract infections or acute exacerbations of COPD induce plaque rupture, leading to cardiovascular events. In this paper, we provide an overview of the epidemiologic and experimental data linking COPD with cardiovascular disease and highlight the clinical implications of this linkage for clinicians who evaluate and manage patients with COPD, cardiovascular diseases, or both.
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PMID:Vascular risk in chronic obstructive pulmonary disease: role of inflammation and other mediators. 2341 Oct 45


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