A Cold Taken to Heart
| العنوان: | A Cold Taken to Heart |
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| المؤلفون: | Ulrich P. Jorde, Nir Uriel, James J. Lyons, Kanika P. Mody |
| المصدر: | Circulation. 131:1703-1711 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Adult, medicine.medical_specialty, Fever, Respiratory rate, Sinus tachycardia, Adenoviridae Infections, Biopsy, Shock, Cardiogenic, Hemodynamics, Spironolactone, Parvoviridae Infections, Ventricular Dysfunction, Left, Physiology (medical), Internal medicine, Heart rate, Humans, Pericarditis, Medicine, business.industry, Myocardium, Cardiovascular Agents, medicine.disease, Combined Modality Therapy, Surgery, Myocarditis, Blood pressure, Heart failure, Shock (circulatory), Cardiovascular agent, Disease Progression, Cardiology, Female, Heart-Assist Devices, Emergencies, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Defibrillators |
| الوصف: | Information about a real patient is presented in stages (boldface type) to expert clinicians (Dr Uriel and Dr Jorde), who respond to the information, sharing their reasoning with the reader (regular type). A discussion by the authors follows. A 35-year-old woman with no past medical history presented to her local emergency room with 2 days of fevers, chills, and myalgias. She was febrile with a temperature of 102°F, blood pressure of 95/60 (72) mm Hg, heart rate of 110 bpm, respiratory rate of 20 breaths per minute, and an oxygen saturation of 100% on 2 L oxygen. The physical examination was notable for cool extremities, clear lungs, and tachycardic heart sounds with no s3, s4, or friction rub. The patient decompensated quickly and developed hypotension, requiring rapid uptitration of norepinephrine to 12 μg·kg − 1 · min − 1 . The ECG ( Figure 1) showed sinus tachycardia with ST-segment elevation in the inferolateral leads. Laboratory results were notable for cardiac troponin of 3.89 ng/mL (normal range, 0–0.08 ng/mL), venous lactate of 3.5 mmol/L (normal range, 0.50–2.20 mmol/L), white blood cell count of 17.0×109 per 1 L (normal range, 3.5–9.1×109 per 1 L), and hemoglobin of 12.4 g/dL (normal range, 13.3–16.2 g/dL) with preserved hepatic and renal function. Figure 1. ECG from the emergency room demonstrating sinus tachycardia, subtle ST-segment elevations in the inferolateral leads Dr Uriel: Interpretation of the clinical course so far: A young woman with no medical history presents with an infectious syndrome and rapidly deteriorates. At this point, one must consider the different processes that would result in such a dramatic clinical picture. It is important to begin to rapidly rule out life-threatening processes and to perform the appropriate clinical testing in a manner that will not delay treatment. Given the increasing hypoxia, an assessment of the lung parenchyma … |
| تدمد: | 1524-4539 0009-7322 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1883d210fe2be3db33392d037f0934be https://doi.org/10.1161/circulationaha.114.013355 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....1883d210fe2be3db33392d037f0934be |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15244539 00097322 |
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