ABSTRACT
We describe a case of a woman in her 80s with persistent atrial fibrillation (AF) despite being on flecainide who was admitted for AF with rapid ventricular response. Attempts with direct-current cardioversions were unsuccessful despite increased doses of the antiarrhythmic therapy. At atrioventricular (AV) nodal ablation, very high right ventricular capture thresholds resulted in abortion of the procedure as back-up ventricular pacing could not be assured with adequate margin for safety. Shortly following the electrophysiology (EP) study, the patient developed cardiogenic shock with new apical left ventricular regional wall motion abnormality suggestive of apical ballooning and a toxic-appearing wide QRS complex electrocardiogram (EKG). The patient was successfully treated with sodium bicarbonate infusion for presumed flecainide toxicity. The regional wall motion abnormality and EKG changes resolved along with normalisation of capture thresholds after 2 days of treatment. The patient underwent an uncomplicated successful AV nodal ablation several weeks later.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Pacemaker, Artificial , Takotsubo Cardiomyopathy , Atrial Fibrillation/therapy , Cardiac Pacing, Artificial , Female , Flecainide/adverse effects , HumansSubject(s)
Betacoronavirus/isolation & purification , Colitis , Coronavirus Infections , Gastrointestinal Hemorrhage , Hydroxychloroquine/administration & dosage , Intestine, Large , Pandemics , Pneumonia, Viral , Aged , Antimalarials/administration & dosage , COVID-19 , Colitis/diagnosis , Colitis/etiology , Colitis/physiopathology , Colitis/therapy , Colonoscopy/methods , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Diagnosis, Differential , Disease Transmission, Infectious/prevention & control , Feces/microbiology , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Intestine, Large/diagnostic imaging , Intestine, Large/pathology , Monitoring, Physiologic/methods , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , SARS-CoV-2 , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
While melanoma is less common than some other skin cancers, it is responsible for nearly 10,000 deaths in the USA each year alone. For many decades, very limited treatment options were available for patients with metastatic melanoma. However, recent breakthroughs have brought new hopes for patients and providers.While targeted therapy with BRAF and MEK inhibitors represents an important cornerstone in the treatment of metastatic melanoma, this chapter carefully reviews the past and current therapy options available, with a significant focus on immunotherapy-based approaches. In addition, we provide an overview of the results of recent advances in the adjuvant setting for patients with resected stage III and stage IV melanoma, as well as in patients with melanoma brain metastases. Finally, we provide a quick overview over the current research efforts in the field of immuno-oncology and melanoma.
