ABSTRACT
Hepatopulmonary syndrome (HPS) is one of the recognised complications of liver cirrhosis which warrants urgent liver transplantation. The symptoms usually improve post transplantation but might take 6-12 months to resolve completely. Severe hypoxemia post liver transplantation, especially when done for hepatopulmonary syndrome has been reported. iNO use for the same has been reported in literature with good response. However, it is practically very difficult to continue iNO in a stable child on a portable ventilator due to problems of scavenging.We report a case of 7-year-old girl who underwent orthotopic liver transplantation (OLT) for severe HPS. Post transplantation the patient had a stormy respiratory course and became severely hypoxemic. She was started on inhaled NO and showed a good response. However, the patient then became NO dependent and multiple attempts to wean iNO failed albeit minimal ventilatory requirements. Following IV L-Arginine infusion, iNO could be weaned within 6 hours without recurrence of hypoxemia. L-Arginine infusion should be considered as a treatment option when facing difficulties to wean iNO in an otherwise well responding patient.
ABSTRACT
Introduction: Smoking is an independent risk factor forischemic heart disease and acute myocardial infarction.Smoking raise both heart rate and blood pressure, thusincreasing myocardial oxygen demand, moreover it alsodecreases the dimension of coronary vessel and coronaryblood flow. Inferior wall Myocardial Infarction is consequenceof disease in usually Right coronary artery, whereas anteriorwall Myocardial Infarction is usually disease in left coronaryartery. The aim of the study is to evaluate whether smokinginfluence the incidence of inferior wall MI (Right coronaryartery). Study objective was to find out whether there was anassociation between smoking and inferior wall MyocardialInfarction and an early association of atherosclerosis andischemic heart disease with smoking.Material and methods: 126 patients of ST ElevationMyocardial Infarction admitted from the outdoor patientdepartment/ emergency department/ Cardiology OPD inMMIMSR, Mullana, Ambala, considered for study. Thosewho are willing to participate and fulfilling the inclusion andexclusion criteria.Result: In our study there was a high proportion of smokerin patient with inferior wall MI than other location of MI.Smokers were prone to get myocardial infarction at a youngerage as compared to others. Mortality was higher in anteriorwall MI as compared to Inferior wall MI. Anterior wall MIpresented with more complications i.e. cardiogenic shock andarrhythmias.Conclusion: Smoking enhance the risk of inferior wall MImore than other MI. Smoking thus appear to adversely affectthe Right coronary artery to greater extent than left coronaryarterial circulation by mechanism yet to be explored. Smokingleads to ischemic heart disease at early age.
ABSTRACT
Background: The management of ventricular electrical storm can prove to be a challenge for the clinician given its complexity and life threatening consequences. Case characteristics: 8-year-old boy with repeated life-threatening polymorphic ventricular tachycardia following aortic valve replacement surgery. Intervention: Defibrillated 45 times in addition to multiple antiarrhythmic drugs. Outcome: Conversion to stable sinus rhythm with normal neurological outcome. Message: Electric storm can be controlled by combination of multiple intravenous antiarrhythmic drugs.