Histamine--can it cause an acute coronary event?

Myocardial infarction (MI) occurring during the course of an allergic urticarial reaction in the absence of systemic hypotension has been rarely reported. This paper reports the case of a 28-year-old woman with no significant risk factors for coronary artery disease who presented with generalized urticaria associated with chest pain and had electrocardiographic and enzymatic evidence of an acute MI. Review of the literature suggests that local histamine release may induce spasm of the coronary vasculature, thus leading to myocardial ischemia and infarction.

Emergency left main stenting in the management of postcoronary bypass graft surgery (CABG) ischemia.

Angioplasty has been used in the management of postcoronary bypass graft myocardial ischemia/infarction. A stent was successfully deployed in the left main artery in a patient with postcoronary bypass graft ischemia with hemodynamic instability. This case illustrates the potential use of emergency left main stenting in a selected patient with peri-operative ischemia, who was considered high risk for re-operation.

Catheter-induced acute aortic insufficiency with hemodynamic collapse during PTCA: an unreported complication.

Primary PTCA as a means of reestablishing coronary blood flow in the infarct related artery is preferable in certain subgroups of patients with acute myocardial infarction. While the success rate of primary PTCA is very high, the procedure is not without risk. We report a case of hemodynamic collapse during PTCA due to an Amplatz guide catheter-induced, acute, and reversible aortic insufficiency. With the increasing use of the left Amplatz catheter for better guide support during PTCA, this unusual and previously unreported complication should be borne in mind.

Refractory anaphylactoid shock potentiated by beta-blockers.

Allergic reactions, including anaphylactoid shock due to contrast material, are not uncommon. However, persistent anaphylactoid shock refractory to conventional therapy is rare. We present a case of refractory anaphylactoid shock during coronary angiography unresponsive to aggressive standard therapy in a patient on beta-blockers. Significant clinical improvement was noted upon administration of glucagon. Since beta-blockers are commonly used in patients with coronary artery disease, this potentially life-threatening complication has to be kept in mind with any procedure involving contrast media in patients on beta-blockers. Immediate access to glucagon by keeping it in the procedure room may be lifesaving in these situations.

Exploratory endodontic surgery.

Re-treatment of complicated endodontically treated teeth requires special consideration, particularly if the patient is unable to furnish the proper past history, such as where, when, and how the tooth in question was treated. In such cases most often more than just opening the pulp chamber and root canal(s) is required for a correct diagnosis. Under such circumstances exploratory endodontic surgery may become necessary to help determine prognosis and plan treatment. Thus, the amount of damage can be estimated and the possibility of successful treatment can be better evaluated through surgical exposure and direct visual examination of the area.

Dental treatment of patient with a cardiac pacemaker. Review of the literature.

Presented is a summarization of past and current literature that establishes a workable guideline for the treatment of the pacemaker wearer in the dental office. This guideline gives the practicing dentist a procedure for the management of such a patient.