ABSTRACT
Tweetable abstract To reduce contrast-induced nephropathy as a complication of percutaneous coronary intervention, several thresholds have been proposed, including maximum contrast dose, contrast volume/estimated glomerular filtration rate, revised maximal contrast dose and zero-contrast percutaneous coronary intervention in select patients.
To reduce contrast-induced nephropathy as a complication of percutaneous coronary intervention, several thresholds have been proposed, including maximum contrast dose, contrast volume/estimated glomerular filtration rate, revised maximal contrast dose and zero-contrast percutaneous coronary intervention in select patients.
Subject(s)
Acute Kidney Injury , Percutaneous Coronary Intervention , Acute Kidney Injury/chemically induced , Acute Kidney Injury/prevention & control , Contrast Media/adverse effects , Coronary Angiography/adverse effects , Creatinine/adverse effects , Glomerular Filtration Rate , Humans , Percutaneous Coronary Intervention/adverse effects , Risk FactorsABSTRACT
Carcinoid heart disease is a complication of carcinoid syndrome. The role of selective serotonin reuptake inhibitors in carcinoid heart disease is unclear. We present a case of refractory heart failure due to right- and left-sided carcinoid heart disease in the setting of selective serotonin reuptake inhibitor use despite remission of carcinoid syndrome. (Level of Difficulty: Beginner.).
ABSTRACT
We report an interesting case of warfarin resistance and subtherapeutic international normalized ratio (INR) in the setting of chronic smokeless tobacco use. A 33-year-old white male with a mechanical mitral valve failed to achieve therapeutic INR despite being on warfarin doses of up to 30 mg by mouth daily. The patient admits to chewing tobacco daily for the past 16 years. While evaluating potential causes of subtherapeutic INR, nonadherence, drug interactions, genetic polymorphisms, and dietary factors were considered. Subtherapeutic INR may be due to increased exposure to vitamin K from chewing tobacco. Tobacco is rich in vitamin K, and its chronic use may have caused the failure to attain a therapeutic INR. To our knowledge, there is only one other case of warfarin resistance resulting from smokeless tobacco described in published literature.
