A case report of pulmonary embolism during electroconvulsive therapy and its further application after somatic stabilization

We describe a case of a 49-year-old, male, Caucasian, pharmaco-resistant patient with a recurrent major depressive disorder, who developed acute pulmonary embolism during a course of inpatient right-unilateral ultra-brief electroconvulsive therapy. After the stabilization of his somatic condition, we were able to safely continue with further ECT applications until his mood normalized and he was able to return to his normal life outside the hospital. Case reports on this topic are scarce – our article demonstrates that electroconvulsive treatment, with proper precautionary measures (anti-aggregative or anti-coagulation prophylaxis) is safe and can be administered without unnecessary delay.
Source: Brain Stimulation - Category: Neurology Source Type: research

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DiscussionAtrial repolarization waves are recognized by a downsloping PR segment and are a common cause of false positive stress tests.  They are augmented by tachycardia.See this paper:Sapin PM et al. Identification of false positive exercise tests with use of electrocardiographic criteria: a possible role for atrial repolarization waves. JACC 18(1):127-35; July 1991.  (link is full text)Link to abstract: http://www.onlinejacc.org/content/18/1/127.abstractHere is a schematic from my book,The ECG in Acute MI (this is a link to a free pdf)Learning Points:1. Recognize the atrial repolarization wave. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
A 40-something male with no PMH of any kind presented  to urgent care on a weekend (cath team is at home) with cough starting 2 weeks prior and SOB one week prior.He underwent a chest x-ray:As this was consistent with " pulmonary edema vs. viral infection, " and he was transferred to the EDThe faculty physician did an immediate cardiac and lung ultrasound:Many B lines (probable pulmonary edema)Parasternal short axis cardiac ultrasound:The anterior wall is closest to the transducer and shows an obvious wall motion abnormalityFurther history:The patient denied chest pain but stated that he had had ab...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina.  If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI.  If that is a result of plaque rupture, then it is a type I MI.  The clinical presentat...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
CONCLUSIONS: The German PEmb-QoL questionnaire is a reliable instrument for assessing QoL six months after PE. QoL was affected by dyspnea, pre-existing pulmonary disease and PPEI and was associated with long-term mortality. This article is protected by copyright. All rights reserved. PMID: 31344319 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: J Thromb Haemost Source Type: research
This study sought to investigate what could be learned from how these men have fared. The men were born in 1925-1928 and similar health-related data from questionnaires, physical examination, and blood samples are available for all surveys. Survival curves over various variable strata were applied to evaluate the impact of individual risk factors and combinations of risk factors on all-cause deaths. At the end of 2018, 118 (16.0%) of the men had reached 90 years of age. Smoking in 1974 was the strongest single risk factor associated with survival, with observed percentages of men reaching 90 years being 26.3, 25.7, ...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
ConclusionAcute organophosphate poisoning treated with atropine showed a potential for inducing prothrombotic coagulation abnormalities, presented with PT. This life-threatening complication may additionally contribute to prolonged morbidity and mortality in OP poisonings, especially in patients with medical history of comorbidites.
Source: Toxicology Reports - Category: Toxicology Source Type: research
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI?  This large registry in Circulatio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI. What percent of shockable arrests without STE have an OMI?  This large registry in Circ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
ConclusionAcute organophosphate poisoning treated with atropine showed a potential for inducing prothrombotic coagulation abnormalities, presented with PT. This life-threatening complication may additionally contribute to prolonged morbidity and mortality in OP poisonings, especially in patients with medical history of comorbidites.
Source: Toxicology Reports - Category: Toxicology Source Type: research
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