ABSTRACT
Cocaine use is associated with adverse events in nearly every organ system. Cardiovascular complications include hemorrhagic and ischemic stroke, aortic dissection, cardiomyopathy, accelerated coronary artery disease, myocardial infarction, and sudden cardiac death. Syncope may be the presenting symptom in these conditions. However, cocaine-induced bradyarrhythmias have been scarcely mentioned. As this case exemplifies, clinicians should be aware of this association when they evaluate syncope, especially in young patients.
Subject(s)
Bradycardia/chemically induced , Cocaine/poisoning , Dopamine Uptake Inhibitors/poisoning , Syncope/etiology , Adult , Bradycardia/complications , Cocaine-Related Disorders/complications , Electrocardiography/drug effects , Female , Humans , Remission, SpontaneousSubject(s)
Atrial Flutter/therapy , Cardiac Pacing, Artificial/adverse effects , Pulmonary Edema/etiology , Acute Disease , Atrial Flutter/complications , Atrial Flutter/physiopathology , Heart Failure/complications , Humans , Hypertension/complications , Male , Middle Aged , Mitral Valve Insufficiency/complications , Pulmonary Edema/physiopathologyABSTRACT
Sepsis is associated with altered blood rheology. Fluid infusion is an essential component of therapy for septic shock. The purpose of this study was to compare the rheologic changes associated with saline, albumin, and hydroxyethyl starch in sepsis. Whole blood was obtained from five normal controls and five patients with severe sepsis. The samples were centrifuged, and the erythrocytes were resuspended in autologous plasma or autologous plasma plus the buffy coat at an hematocrit (Hct) of 40%. The sample was diluted to an Hct of 30%, 20%, and 10% with saline, albumin, or hydroxyethyl starch. Viscosity was measured at low and high shear rates and erythrocyte aggregation was measured by the ratio of viscosity at low to high shear rates. Erythrocyte deformability was assessed by filtration. The viscosity of hydroxyethyl starch was greater than saline, albumin, or autologous plasma (p < .01). Erythrocyte viscosity was greater (p < .01) and deformability less (p < .01) in septic blood compared with normals. Dilution with hydroxyethyl starch increased erythrocyte viscosity as compared with saline (p < .01) and albumin (p < .01). Erythrocyte deformability was decreased with both hydroxyethyl starch (p < .001) and albumin (p < .05) compared with saline. Increased erythrocyte aggregation was also observed with hydroxyethyl starch (p < .05) and albumin (NS) in septic cells when compared with saline. These data indicate that hydroxyethyl starch increases blood viscosity, decreases erythrocyte deformability, and increases erythrocyte aggregation when compared with saline. These changes are less significant with albumin. In patients with sepsis, these effects may further compromise the already altered erythrocyte rheology.
