Subject(s)
Breast Feeding , Hospitals, County/trends , Age Factors , Female , Health Education , Health Policy , Humans , Infant , Infant, Newborn , Pregnancy , Rhode Island , Societies, Medical , United Nations , United States , World Health OrganizationABSTRACT
After injecting the solution extracted from a Primatene Mist inhaler, a patient experienced epinephrine overdose that resulted in an acute myocardial infarction and acute renal failure. The exact amount of epinephrine injected was unknown, but was thought to be between 82.5 and 124 mg, more than 25 times higher than the amount normally administered. Health care providers should be aware of this readily available source of epinephrine and the potential adverse effects associated with its inappropriate use.
Subject(s)
Acute Kidney Injury/etiology , Atrial Fibrillation/etiology , Epinephrine/poisoning , Myocardial Infarction/etiology , Substance-Related Disorders , Adult , Drug Overdose , Female , HumansABSTRACT
Previous studies have indicated that the combination of single photon emission computed tomography (SPECT) and quantitative "bull's eye" analysis (QBA) TI-201 cardiac stress imaging may improve the detection of myocardial ischemia over that achieved with planar (PLN) imaging. This study will evaluate the sensitivity and specificity of SPECT and QBA in the detection of disease in the left anterior descending (LAD), left circumflex (LCX), and right coronary artery. Ninety-nine patients who underwent both TI-201 stress imaging and coronary arteriography were evaluated retrospectively. Of the 99, 62 had PLN imaging and 37 were evaluated with SPECT; 23 of these 37 had QBA. The overall sensitivity and specificity were as follows: PLN, 94% and 50%; SPECT, 90% and 67%; QBA, 100% and 20%; and SPECT with QBA, 92% and 72%, respectively. The regional sensitivity and specificity of PLN for individual coronary arteries were as follows: RCA, 78% and 74%; LAD, 89% and 60%; LCX, 50% and 89%, respectively. For SPECT, the results were: RCA, 86% and 93%; LAD, 85% and 88%; and LCX, 60% and 88%. For QBA alone, the results were: RCA, 100% and 75%; LAD, 88% and 53%; and LCX, 100% and 89%. The results for QBA with SPECT were: RCA, 100% and 94%; LAD, 88% and 80%; and LCX, 67% and 95%. Thus, SPECT interpreted on conjunction with QBA showed higher sensitivity for evaluation of ischemia in the RCA and LCX arteries and higher specificity in the detection of LAD and RCA disease than did PLN TI-201 imaging. Because of the low specificity of QBA (20%), caution is advised in the interpretation of QBA alone without reviewing SPECT images.
Subject(s)
Coronary Disease/diagnostic imaging , Heart/diagnostic imaging , Tomography, Emission-Computed/methods , Coronary Angiography , Evaluation Studies as Topic , Exercise Test , Female , Humans , Male , Middle Aged , Retrospective Studies , Thallium RadioisotopesABSTRACT
A 6-year-old female with an anomalous left coronary artery (ALCA) originating from the main pulmonary artery underwent a resting Tl-201 SPECT examination before and after surgical reimplantation. Preoperative Tl-201 SPECT images demonstrated decreased perfusion to the anterior wall and a dilated left ventricle. Post operative Tl-201 SPECT images showed marked improvement of perfusion to the anterior wall as well as a decreased left ventricular size. This is one of the few documented demonstrations of a perfusion defect due to an ALCA in a young child using Tl-201 SPECT imaging methods in conjunction with other tests.
