Acute Congestive Heart Failure in a Young Woman.

We describe the case of an adult First Nations woman employed as a daycare worker who presented with clinical symptoms, signs, and imaging suggestive of acute heart failure. In our report, we discuss the likely diagnosis of acute rheumatic fever. Novel teaching points: The incidence of rheumatic fever in Canada is likely underestimated, and it is important to consider the diagnosis of acute rheumatic fever in individuals presenting with acute heart failure. More research is needed in Canada to further identify groups most at risk for developing this disease.

Nous exposons le cas d'une femme adulte d'origine autochtone travaillant dans une garderie dont les symptômes et signes cliniques ainsi que les résultats aux examens d'imagerie évoquaient une insuffisance cardiaque aiguë. Nous expliquons pourquoi nous avons plutôt envisagé un diagnostic de rhumatisme articulaire aigu. Nouveaux points d'enseignement : l'incidence des cas de rhumatisme articulaire aigu au Canada est vraisemblablement sous-estimée, et il importe d'envisager ce diagnostic chez les personnes présentant des signes évocateurs d'une insuffisance cardiaque aiguë. D'autres recherches s'imposent au Canada afin de mieux cerner les groupes les plus susceptibles de présenter une telle affection.

Pulmonary Embolism: The Value of the Angiographic Diagnosis.

We describe the case of a 55-year-old patient with a history of pulmonary embolism who presented in shock with ST-elevation on his electrocardiogram. He was triaged to the catheterization laboratory where he suffered a cardiac arrest. A pulmonary embolism was diagnosed angiographically, the thrombus was aspirated, and he received systemic thrombolysis. The combination of clot debulking and systemic thrombolysis acted synergistically to improve his right ventricular function by resolving his pulmonary hypertension. Although it is associated with a higher bleeding risk, the combination of clot aspiration with a thrombolytic agent in the treatment of massive pulmonary embolism in young patients might warrant further study.

Expedited transfer for primary percutaneous coronary intervention: a program evaluation.

BACKGROUND: A shorter time from symptom onset to reperfusion is associated with improved outcomes for patients with ST-segment elevation myocardial infarction (MI). Primary percutaneous coronary intervention is a favourable method of reperfusion if performed effectively and expeditiously. We sought to evaluate the impact of an expedited pre-hospital diagnosis and transfer pathway developed by a multidisciplinary team on the door-to-balloon time in a large urban community. METHODS: We included all patients with ST-segment elevation MI who presented within 12 hours after symptom onset and who sought medical attention through Emergency Medical Services within the boundaries of the city of Calgary in the 16 months following the introduction of the pathway in June 2004. The primary aim was to determine the proportion of patients who received percutaneous coronary intervention within the recommended door-to-balloon time of 90 minutes. RESULTS: The 358 patients (268 men) in the study cohort had a mean age of 63.2 (standard deviation 12.7) years; 140 (39.1%) had an anterior MI; and 23 (6.4%) had cardiogenic shock. The introduction of the pathway resulted in a median door-to-balloon time of 62 (interquartile range 45-84) minutes. A door-to-balloon time within 60 minutes and within the currently recommended 90 minutes was achieved in 48.9% and 78.8% of the patients respectively. The in-hospital and 30-day mortality rates were both 3.1%. INTERPRETATION: In a community with multiple regional hospitals and a single facility for percutaneous coronary intervention, the implementation of a multidisciplinary pre-hospital diagnosis and transfer pathway was feasible and resulted in most patients in the study cohort receiving primary percutaneous coronary intervention within the recommended door-to-balloon time of 90 minutes.