Pregnancy in Pulmonary Arterial Hypertension: A Multidisciplinary Approach.

Pulmonary arterial hypertension (PAH), a female predominant disease, carries a high maternal and fetal mortality in pregnancy despite improved insight and the development of novel therapies. The high risk is attributed to the adaptive changes that take place to promote healthy fetal development during pregnancy, which can adversely affect the already compromised right ventricle in patients with PAH. While in the prior era emphasis was placed on termination of pregnancy, here we will illustrate through a multidisciplinary approach and meticulous planning at an expert center, these high-risk women can undergo successful childbirth.

Lidocaine Infusion: An Antiarrhythmic With Neurologic Toxicities.

As a renowned local anesthetic agent of choice, lidocaine is also a class 1b antiarrhythmic agent that is primarily used for the treatment of ventricular arrhythmias. Although lidocaine systemic toxicity is rare, it may be life-threatening; thus, its early identification and management are of vital importance. This case report details the clinical scenario of intravenous lidocaine administration to a patient at high risk of toxicity in a 64-year-old patient, who initially presented with sustained monomorphic ventricular tachycardia received lidocaine and subsequently developed neurologic manifestations of lidocaine toxicity, including altered mental status and seizure. The patient was treated promptly with benzodiazepine and discontinuation of lidocaine as the offending agent, with complete resolution of adverse effects.

Rash and Heart Block: A Unique Case of Lyme Carditis.

Lyme disease is a multisystem disease that can present as a life-threatening condition known as Lyme carditis. While most commonly manifesting as a fluctuating atrioventricular block, Lyme carditis can also emerge as myocarditis and coronary artery events. This case report will detail the clinical scenario of a 23-year-old patient who presented with acute onset fluctuating atrioventricular block and erythema migrans and was found to have Lyme carditis. The patient was treated promptly with antibiotics, thus avoiding long-term Lyme disease sequela, with a complete resolution of his disease, including his high degree atrioventricular block.