ABSTRACT
During the recent 'first wave' of the COVID-19 pandemic, the National Health Service (NHS) has triaged planned services to create surge capacity. The primary prevention implantable cardioverter-defibrillator (ICD) was in a grey area of triage guidance, but it was suggested as a procedure that could be reasonably stopped. Recent reports have highlighted deaths of patients awaiting ICDs who may have been deferred during the pandemic. In our trust we reorganised our device service and continued to implant primary prevention ICDs during the 'first wave' and, here, report that most patients wished to proceed and underwent uncomplicated implantations. One patient later died from COVID-19, although the transmission site cannot be definitively concluded. With strict adherence to public health guidance and infection prevention strategies, we believe that ICD implantation can be performed safely during the pandemic, and this should be standard practice during subsequent surges.
ABSTRACT
Syncope occurring in the setting of head and neck malignancy may have several possible causes. Local effects of a tumour in the parapharyngeal area may produce a syncopal syndrome similar to carotid sinus hypersensitivity, but with distinctive differentiating features. This article presents a case of profound vasodepressor syncope in a patient with recurrent pharyngeal malignancy, and discusses the mechanisms by which this occurs and the possible therapeutic options.
Subject(s)
Carotid Artery Diseases/etiology , Carotid Sinus , Neoplasms, Squamous Cell/complications , Pharyngeal Neoplasms/complications , Syncope, Vasovagal/etiology , Blood Pressure , Carotid Artery Diseases/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Syncope, Vasovagal/diagnosis , SyndromeSubject(s)
Angioplasty, Balloon, Coronary , Coronary Vessel Anomalies/complications , Myocardial Infarction/therapy , Adult , Angioplasty, Balloon, Coronary/instrumentation , Aortography , Coronary Angiography , Coronary Vessel Anomalies/diagnostic imaging , Emergency Treatment , Humans , Male , Metals , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/etiology , Prosthesis Design , Stents , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Aortic Aneurysm/diagnostic imaging , Aortic Dissection/diagnostic imaging , Aortography/methods , Marfan Syndrome/complications , Tomography, X-Ray Computed , Adult , Aortic Dissection/etiology , Aortic Dissection/surgery , Aortic Aneurysm/etiology , Aortic Aneurysm/surgery , Humans , Male , Marfan Syndrome/diagnostic imaging , Marfan Syndrome/surgery , Neck Pain/etiology , Vascular Surgical ProceduresABSTRACT
Athletes performing repetitive movements can develop arterial injuries. These are uncommon. We present a case of bilateral subclavian/axillary artery stenosis in a female patient referred to the rapid access chest pain clinic with a presumptive diagnosis of angina. Her symptoms were related to limb ischemia rather than cardiac insufficiency. Detailed history from this patient revealed that she had spent 8 years working as an acrobat being swung by the arms twice daily during performances.
