Tension pneumothorax presenting as ST segment elevation: Look, Listen, Act!

We present a unique case of a patient with a tension pneumothorax that presented with electrocardiogram (ECG) characteristics typical for ST segment elevation myocardial infarction. The clinical diagnosis was clinched by focused physical examination. Treatment of the pneumothorax lead to resolution of the electrocardiographic abnormalities. Our experience from this unique case is useful for cardiologists and critical care physicians who encounter these patients routinely.

Propofol-related infusion syndrome: rare and fatal.

Propofol is one of the most commonly used sedating agents in critical care units worldwide. It is generally well tolerated and preferred for its pharmacokinetic profile. Here, we describe a rare and devastating adverse effect of propofol, the propofol-related infusion syndrome.

Impact of hepatitis C seropositivity on the risk of coronary heart disease events.

Chronic infections have been shown to enhance atherogenicity. However, the association between chronic hepatitis C (HCV) and coronary heart disease (CHD) remains controversial. We examined the risk for CHD events in patients with HCV with an emphasis on the risk of CHD events with active infection. We conducted a retrospective cohort study using the enterprise data warehouse at the University of Arkansas for Medical Sciences. HCV positive and negative patients were identified based on serology, and incident CHD events were studied. Patient characteristics at entry were compared either by the analysis of variance or F test (continuous variables) or by a chi-square test (categorical variables). The joint effect of risk factors for incident CHD was evaluated using logistic regression. A total of 8,251 HCV antibody positive, 1,434 HCV RNA positive, and 14,799 HCV negative patients were identified. Patients with HCV antibody and RNA positivity had a higher incidence of hypertension, diabetes mellitus, obesity, and chronic lung disease, but lower serum cholesterol levels compared with patients who were HCV negative (p <0.001). HCV seropositive patients had a higher incidence of CHD events compared with controls (4.9% vs 3.2%, p <0.001). In the HCV cohort, patients with detectable HCV RNA had a significantly higher incidence of CHD events compared with patients who were only HCV antibody positive with no detectable RNA (5.9% vs 4.7%, p = 0.04). In multivariate logistic regression analyses, both HCV antibody positivity (odds ratio 1.32, 95% confidence interval 1.09 to 1.60, p <0.001) and HCV RNA positivity (odds ratio 1.59, 95% confidence interval 1.13 to 2.26, p <0.001) were independent risk factors for incident CHD events. In conclusion, there is an increased incidence of CHD events in patients with HCV seropositivity and the incidence is much higher in patients with detectable HCV RNA compared with patients with remote infection who are only antibody positive. Lipid profile does not appear to be a good cardiovascular risk stratification tool in patients with HVC.