Acute coronary syndrome secondary to cardiac infiltration and coronary occlusion of chronic lymphocytic leukemia - A case report.

A 72-year-old male with a history of chronic lymphocytic leukemia (CLL) was admitted to hospital with a productive cough and an episode of diarrhea and vomiting. He was initially treated for pneumonitis and sepsis. On the 12th day of his admission, he reported chest pain. Changes on his electrocardiogram were suggestive of myocardial ischemia and an elevated troponin rise was detected from his blood tests. A diagnosis of acute coronary syndrome was made but due to his frailty, he was medically managed. His echocardiogram revealed an external echogenic mass which invaded the anterolateral left ventricular wall. Further imaging with cardiac magnetic resonance imaging (MRI) and computed tomography (CT) thorax demonstrated external encasement of left circumflex coronary artery with mediastinal mass, leading into downstream myocardial ischemia and subsequent necrosis. He was considered suitable for aggressive radiotherapy/chemotherapy but passed away 7 days later. This case highlights the unusual case where an acute myocardial infarction can be attributed to direct infiltration and external compression of coronary artery by mediastinal tumor and the value of multi-modality imaging (echocardiogram, CT, and MRI) in identifying the cause of myocardial ischemia in patients with CLL in the end stages of the disease. .

Location of death among patients presenting with cardiovascular disease to the emergency department in the United states.

BACKGROUND: In-hospital deaths are an important outcome and little is known about deaths in the emergency department (ED). Among patients who died of cardiovascular diseases (CVD), we assessed causes of death, temporal trends and the relative distribution of deaths in the ED versus hospital. METHODS: Using the United States Nationwide Emergency Department Sample, we conducted a retrospective study of patients presenting to the ED with a primary diagnosis of CVD between 2006 and 2014. We used descriptive statistics to describe causes of deaths, temporal trends and location of death. RESULTS: During the study period, there were 27 144 508 visits to the ED with CVD diagnoses (~2% of all ED visits,). The most common CVD diagnoses were heart failure (n = 8 571 598), acute myocardial infarction (n = 4 827 518) and atrial fibrillation/flutter (n = 4 713 241). There were a total of 2.2 million deaths caused by the CVD, with the majority (57.6%) occurring in the ED. Cardiac arrest was the most common cause of in-hospital death (n = 1 225 095, 55.3%), followed by acute myocardial infarction (n = 279 310, 12.6%), heart failure (n = 217 367, 9.8%), intracranial hemorrhage (n = 168 009, 7.6%) and ischemic stroke (n = 151 615, 6.8%). The proportion of deaths in the ED for these causes were 91.9% cardiac arrest (n = 1 173 471), 3.6% acute myocardial infarction (n = 46 909), 1.0% heart failure (n = 12 599) and 1.1% intracranial hemorrhage (n = 13 579). There was a decrease in death for most CVDs over time. CONCLUSIONS: Inpatient CVD admissions and their associated death may not be a robust measure of the national burden of CVD since ED death-which are common for some conditions-are not captured.

Cardiac arrest and related mortality in emergency departments in the United States: Analysis of the nationwide emergency department sample.

AIMS: The aim of this study is to analyse the causes of cardiac arrests (CA) in the emergency departments (ED) in the United States and their clinical outcomes according to whether they had a primary or a secondary diagnosis of CA. METHODS: Data from the Nationwide Emergency Department Sample was assessed for episodes of CA in the emergency department (ED) for adults from 2006 to 2014. Primary and secondary diagnoses of CA and mortality outcomes were evaluated in ED, inpatient and the combined in-hospital setting. RESULTS: There were 2,852,347 ED episodes with a diagnosis of CA (50.5% primary diagnosis, 49.5% secondary diagnosis). Among patients with a secondary diagnosis of CA, ∼33% patients had a primary cardiac diagnosis, followed by infectious and respiratory diagnoses. The survival to ED discharge was 53.2%; lower for primary versus secondary CA diagnosis (20.4% vs 86.7%). The in-hospital survival rate for all CA was 28.7%, and was lower for primary versus secondary CA diagnosis (15.7% vs 41.9%). Survival to hospital discharge was highest in the age group of 41-60 years (33.0%) and was least among >80 years (20.9%). Survival was also noted to be lower among female patients (27.9% vs 29.2%) and in the winter months. CONCLUSIONS: Survival with CA in ED is <30% of patients and is greater among patients with a secondary diagnosis of CA. CAs are associated with significant mortality in ED and hospital settings and measures should be taken to better manage cardiac, infection and respiratory causes particularly in the winter months.

Women's preferences for communication with the cervical screening programme: A qualitative study.

BACKGROUND: In Scotland, invitations and results for cervical screening are sent by post. We ask the question: is this an effective means of communication in the 21st century? Consideration of other ways of communicating with women may help to increase acceptability of the cervical screening programme. OBJECTIVE: To explore perspectives of screening-eligible women, regarding methods for communication of invitations and results from the cervical screening programme to improve acceptability. METHODS: A qualitative study design using semi-structured face-to-face or telephone interviews with women aged 25-65 years. Thirty interviews were directed using visual cues to generate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis of the data was conducted using a Framework approach. RESULTS: The main advantage of the postal system is its perceived formality; however, its lack of speed was a concern. Advantages of e-communication included speed and convenience; however, concerns such as lack of confidentiality and access were mentioned. Telephone communication was deemed impractical, while face-to-face communication was highly regarded. Furthermore, the majority of participants felt screening appointments set at a specific date and time may improve uptake. Overall, participants believed there is no universal solution regarding the issue of communication. CONCLUSION: At present, the postal system may be an appropriate method for invitation and results for cervical screening; however, there may be greater scope for preference of communication to improve the acceptability of the screening programme to women.