Sildenafil citrate and Torsade de pointes

Sildenafil citrate is a drug used in the treatment of erectile dysfunction. It is an inhibitor of the enzyme phosphordiesterase-5; it slows down the breakdown of c-GMP and nitrous oxide. The cardiac effects associated with Sildenafil citrate have been extensively studied in medical literature, especially its potent vasodilatory effect when combined with nitrate-based medications, producing intractable hypotension, but a lesser known and potentially lethal side effect is prolonged cardiac repolarization when used at dosage greater than recommended, leading to QT prolongation that could theoretically lead to dangerous cardiac dysrrhythmias and sudden death in men with coronary artery disease. The authors present the case of a 49-year-old hypertensive Hispanic man who arrived to our emergency department with the chief complaint of acute epigastric pain for 3 hours of evolution after ingestion of Sildenafil citrate 50 milligrams (mg). The patient was found to have an acute ST elevation inferior myocardial infarction (STEMI). Shortly after diagnosis the patient developed a polymorphic ventricular tachycardia (Torsade de pointes) before thrombolytic administration. We present this case followed by a brief discussion, to heighten awareness of the possible association of acute inferior STEMI and the development of Torsade de Pointes after the use of Sildenafil citrate.

Head trauma and hemophilia B: case report about a challenging hematologic emergency

Bleeding emergencies are common chief complaints in visits to the Emergency Department (ED) but hemophilia, a rare congenital bleeding disorder requires immediate treatment. Hemophilia B is characterized by a deficiency of coagulation Factor IX. As emergency medicine physicians we must be prepared to deal with such emergencies. One of the most feared complications in this population is the spontaneous or post-traumatic development of intracranial hemorrhage (ICH). We present a case of a 69 year-old man with a past medical history of hemophilia B who presented to the emergency department after suffering a head trauma with development of acute and delayed ICH.