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Diabetic ketoacidosis (DKA) is an important medical emergency and may cause electrocardiogram (ECG) changes mimicking myocardial infarction. In the literature, hyperkalemia-associated ST-segment elevations have been defined in DKA; it has been demonstrated that these changes resolve completely after the treatment of hyperkalemia. We aimed to present a case with DKA in whom ST-segment elevation in inferior derivations was observed, but serum potassium level (4.4 mEq/L) was normal. The patient was admitted to the emergency department with complaints of nausea, bloody vomiting, and epigastric pain. Intravenous 0.9% saline, soluble insulin, and proton pump inhibitor were begun. Because of bloody vomiting, antiaggregant and anticoagulant therapy was not administered and coronary angiography was not considered at the beginning. Two hours after the beginning of the treatment, the blood glucose level dramatically decreased (from 712 to 263 mg/dL), and the metabolic acidosis view in arterial blood gas sample was improved. The repeated ECG depicted complete ST segment resolution. Transthoracic echocardiogram determined normal ventricular wall motion. Cardiac biomarkers remained in normal limits in the follow-up period. Coronary angiography performed 3 days after hospital admission was evaluated as normal. The patient recovered uneventfully, and gastrointestinal tract bleeding did not repeat. The ECG was repeated, and ST segments in izoelectric line were observed.
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PMID:Acute inferior pseudoinfarction pattern in a patient with normokalemia and diabetic ketoacidosis. 1937 49

The antiphospholipid antibody syndrome is the most common acquired thrombophilia; it is a systemic autoimmune disease characterized by recurrent arterial and venous thrombosis and/or pregnancy loss, in association with circulating antiphospholipid antibodies. The pathogenic mechanisms in antiphospholipid antibody syndrome that lead to in vivo injury are incompletely understood. Like other autoimmune diseases, a combination of genetic and environmental factors is involved. We report the case of a 50-year-old woman suffering from an antero-lateral non-ST-elevation myocardial infarction. After few days, coronary angiography showed a severe occlusive arterial disease, involving anterior descending, circumflex e right coronary arteries. Percutaneous coronary intervention was performed with the implantation of a drug-eluting stent in the proximal segment of the anterior descending coronary artery. One day after discharge (10 days after the first hospitalization) the patient experienced dizziness, nausea, vomiting, swelling in absence of any electrocardiographic abnormalities or myocardial enzyme elevation; then she was hospitalized in the neurology department. Because of a similar episode, urgent cerebral computed tomography scan was performed 5 days later; it revealed two different acute ischemic areas, parietal in the right hemisphere and cerebellar in the left hemisphere. The diagnosis of antiphospholipid antibody syndrome was confirmed by high anticardiolipin antibody titers, also present in medium titer at 5 and 17 weeks apart. She was discharged without any sequelae, on warfarin and double antiplatelet therapy (aspirin and clopidogrel for 6 months), then warfarin and aspirin.
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PMID:[Myocardial and cerebral infarction as initial presentation of antiphospholipid syndrome]. 1947 82

A sixty-four year old man with a past history of hypercholesterolemia, asthma, food allergy, epilepsy and myocardial infarction was admitted to the emergency department because of a generalized erythema, nausea, vomiting, and chest pain after taking an oral dose of amoxicillin. Electrocardiography showed ST segment elevation in anterior leads. After coronary angiography, type 2 variant of Kounis syndrome was diagnosed. We present the first case of oral amoxicillin induced Kounis syndrome in an asthmatic patient with severe anaphylactic shock. The present report also shows that atopic people expressing an amplified mast cell degranulation may have more serious hemodynamic decompensation during hypersensitivity reactions. Case selective mast cell surface membrane stabilization should be considered a potential therapeutic strategy for people with food induced allergy, for atopic patients and for patients who have already experienced a first Kounis syndrome.
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PMID:Kounis syndrome secondary to amoxicillin use in an asthmatic patient. 2022 32

We report a case of a 53-year-old man with acute myocardial infarction complicated on the 5th day of hospitalisation by systemic arterial embolism and renal infarction secondary to left ventricle thrombus. Clinical manifestations included: acute onset, nausea, vomiting, abdomen and flank pain. The diagnosis was confirmed by imaging findings: echocardiography and angio-CT performed during hospitalisation. Pathogenesis, clinical manifestation, prognosis and treatment of left ventricular thrombus and arterial embolism as a complication of myocardial infarction have been discussed.
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PMID:[Systemic embolism in a course of acute myocardial infarction in a patient with left ventricular thrombus]. 2049 Oct 24

Hydatid disease is a parasitic tapeworm infestation. Anaphylactic reactions as a result of cyst perforation generally occur after trauma during a spread of cystic fluid in the intravascular space, which may also initiate anaphylaxis. The reported case was a 17-year-old boy who was admitted to the hospital emergency department with a sudden onset of nausea, vomiting and fainting, resulting in death. The cause of his sudden death was unknown. Autopsy macroscopically revealed hydatid cysts in the liver. In the histopathological examination, hydatid cyst was recognized by scolices and also an inflammatory infiltration composed mainly of mast cells in the myocardium was detected. Sudden death in this case was attributed to allergic myocardial infarction due to intravascular spread of the hydatid cyst content (Fig. 2, Ref. 10).
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PMID:Allergic myocardial infarction due to hydatid cyst: an autopsy case. 2063 82

Nearly 250,000 women die each year from cardiovascular disease, making it the leading cause of death in women. The initial clinical manifestation of coronary artery disease (CAD) in women is usually 10 years later than in men on average, with the first myocardial infarction presenting 20 years later. At any age the prevalence of CAD is lower in women, but with advancing age, this gender differential diminishes. The fact that CAD prevalence is lower in women has led to the false presumption that women are protected from cardiovascular diseases. Since women live 8 to 10 years longer than men, the absolute number of deaths from cardiovascular disease (CVD) exceeds that of men. Although there has been a decline in the overall number of cardiovascular deaths, the coronary incidence has been increasing in women and decreasing in men. Contrary to belief, CAD causes far more deaths in women than does cancer (Figure 1). Consider the statistics: approximately 1 out of 3 women will die of a cardiovascular event; more than a half-million women die of CVD each year; one women dies of CVD almost each minute in the United States; and two-thirds of the women who die suddenly have no previously recognized symptoms. Advances in diagnosis and treatment of CVD appear to have translated into a survival benefit in men but not in women. The mortality due to CVD remains high in women, with no improvement in survival trends over time compared to men (Figure 2). This may be related to differences and delays in recognizing CVD in women or in treatment strategies, and to biological differences. Women with acute coronary syndrome often delay calling for professional help and present more frequently with atypical symptoms, such as abnormal pain locations, nausea, vomiting, fatigue, and dyspnea. Women not only present later from the onset of chest pain but are also sicker at the time of diagnosis. Furthermore, there appears to be a bias against heart disease in women - both patients and their caregivers/health care providers do not recognize or treat CVD in a timely manner in women. Compared to men, women are less likely to receive appropriate treatment for heart disease such as optimal control of blood pressure, use of aspirin, cholesterol-lowering medications, thrombolytics, or referrals for interventions such as balloon/ stent or bypass surgery. Women seem to be evaluated less intensively, and referrals for cardiac catheterization are 8-fold higher in men than in women. The clinical outcomes including myocardial infarction mortality, all-cause mortality, and reinfarction rates are worse in women with CVD than in men. Many risk factors contribute to CAD in women, but menopause is one of the strongest. Risk of CAD in postmenopausal women is 40 to 50% higher than in premenopausal women, and hormone replacement therapy (HRT) increases the risk. This paper discusses the myriad risk factors for CAD in women and explores the relationship between CAD and hormone replacement therapy in postmenopausal women.
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PMID:Where do we currently stand with advice on hormone replacement therapy for women? 2108 55

In this report we describe a patient who presented with nausea, vomiting, diarrhea, tachypnea and mental impairment. The patient had elevated serum lipase, troponin-I, creatinine kinase and myoglobin along with severe hyperglycemia (> 2000 mg/dl) and no ketouria. This patient was found to have nonketotic hyperosmolar hyperglycemia with concomitant rhabdomyolysis and myocardial infarction.
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PMID:Hyperosmolar hyperglycemic syndrome with rhabdomyolysis. 2140 58

A 79-year-old woman presented to the accident and emergency department with a short history of central chest pain radiating to the arm and epigastrum, associated with vomiting. There was no history of haematemesis and no recent change of bowel habit or melaena. She had a myocardial infarction 4 months previously and had a metal prosthetic mitral valve replacement for which she was anticoagulated with warfarin, maintaining an INR between 2.5- 3.5. On examination she appeared pale, but there were no other abnormal findings; the liver was not enlarged or tender.
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PMID:Fatal intra-hepatic haemorrhage presenting with cardiac-type chest pain and anaemia. 2161 87

A previously healthy, 67-year-old, man with past medical history of myocardial infarction and hypertension was rushed to the emergency room after sudden onset of fever, chills, severe rigors, hypotension, tachycardia and vomiting. The patient was diagnosed as being in septic shock, and investigations revealed intracellular gram-negative bacilli in polymorphonuclear leukocytes in the peripheral smear. A history of dog contact was elicited after this very unusual and rare finding. Cultures confirmed septicemia due to Capnocytophaga canimorsus, a normal oral and nasal flora inhabitant of cats and dogs that can cause severe and sometimes fatal septicemia in humans. We report this very interesting case because of the common prevalence of dog homeownership and the rarity of C. canimorsus inducing sepsis.
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PMID:Septicemia due to Capnocytophaga canimorsus following dog bite in an elderly male. 2162 93

Food and Drug Administration (FDA) approved bromocriptine mesylate, a quick release formulation, 0.8 mg tablets, as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Bromocriptine products were previously approved by the FDA for the treatment of pituitary tumors and Parkinson's disease. Bromocriptine is thought to act on circadian neuronal activities within the hypothalamus to reset abnormally elevated hypothalamic drive for increased plasma glucose, triglyceride, and free fatty acid levels in fasting and postprandial states in insulin-resistant patients. Adverse events most commonly reported in clinical trials of bromocriptine included nausea, fatigue, vomiting, headache, and dizziness. These events lasted a median of 14 days and were more likely to occur during initial titration of the drug. Due to novel mechanism of action, single daily dose, and lower incidence of stroke, myocardial infarction and vascular events, bromocriptine may act as landmark in treatment of type 2 diabetes.
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PMID:Bromocriptine mesylate: Food and Drug Administration approved new approach in therapy of non-insulin dependant diabetes mellitus with poor glycemic control. 2181 51


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