RESUMO
We report a case of an aortic-pulmonary artery fistula secondary to acute bacterial endocarditis and aortic root abscess formation. The patient presented with generalized symptoms and an initial pneumococcal pneumonia, then developed respiratory and cardiac failure necessitating ventilation and inotropic agents. An echocardiogram showed a vegetation in the aortic valve, an abscess involving the aortic root, and suggested a fistula between the aorta and main pulmonary artery, which was confirmed at emergent operation. Despite a complicated early postoperative course the patient has made a full recovery.
Assuntos
Doenças da Aorta/etiologia , Fístula Artério-Arterial/etiologia , Endocardite Bacteriana/complicações , Doenças das Valvas Cardíacas/complicações , Infecções Pneumocócicas/complicações , Artéria Pulmonar , Adulto , Aorta Torácica , Feminino , Doenças das Valvas Cardíacas/microbiologia , HumanosRESUMO
Flecainide, a class 1c antiarrhythmic, has a high mortality associated with significant overdose. We report the case of a 20-year-old female who took approximately 4 grams of flecainide and a small amount of paracetamol as an impulsive gesture. Circulatory failure unresponsive to pacing, inotropes and sodium bicarbonate was successfully treated with cardiopulmonary bypass (CPB). Resolution of her myocardial failure occurred over 24 hours and she was weaned from CPB 30 hours after its initiation. Coagulopathy and intravascular haemolysis were apparent during bypass and necessitated substantial use of blood products. Ischaemic renal dysfunction manifested early in her admission and required haemodiafiltration. Despite a prolonged period of unresponsiveness and pupillary dilatation during resuscitation and CPB she made a full recovery. We believe this is the first reported case of flecainide overdose, requiring extracorporeal circulatory support, not resulting in neurological deficit.
Assuntos
Antiarrítmicos/intoxicação , Ponte Cardiopulmonar , Flecainida/intoxicação , Adulto , Overdose de Drogas , Eletrocardiografia , Circulação Extracorpórea , Feminino , Hemodiafiltração , Humanos , Intoxicação/diagnóstico , Intoxicação/terapiaRESUMO
A 68 year-old-man presented some twelve hours after a presumed Tiger Snake bite with coagulopathy, paralysis and muscle necrosis. He suffered multi-system failure requiring prolonged ventilation, haemodialysis and supportive care, to be discharged after 26 days. Delays to antivenom therapy after tiger snake envenomation can result in significant morbidity. Australian snakes are the most venomous in the world.
