Cardiac complications

Signs and Symptoms Sudden onset of fever, headache, conjunctival congestion, generalized aches, swollen, painful lymph nodes, and inflammation of the lung tissue (pneumonitis). A dull red to dark purple maculopapular rash appears first on the trunk then spreads to the arms and legs. Can progress to pulmonary, encephalitic, and/or cardiac complications. 

Hepatotoxicity Rarely, elevations of 1 or more liver enzymes have occurred in patients receiving zafirlukast. Most of these have been observed at doses 4 times higher than the recommended dose. The following hepatic events predominantly in females) have been reported in patients who have received the recommended dose of zafirlukast (40 mg/day) Cases of symptomatic hepatitis without other attributable cause and, rarely, hyperbilirubinemia without other elevated liver function tests. In most, symptoms abated and the liver enzymes returned to healthy or near healthy after stopping zafirlukast. If liver dysfunction is suspected, discontinue zafirlukast. Eosinophilia Physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or neuropathy presenting in their patients. In rare cases, patients on zafirlukast therapy may present with systemic eosinophilia. These events usually, but not always, have been associated with the... 

Eosinophilia Physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or neuropathy in their patients. In rare cases, patients on therapy with montelukast may present with systemic eosinophilia. These events usually, but not always, have been associated with the reduction of oral corticosteroid therapy. 

Occasionally patients develop a dramatically acute and severe form of thyrotoxicosis which may be life-threatening, termed thyroid crisis or thyroid storm. In this condition the patient is at risk of cardiac complications, notably arrhythmia and ventricular failure, and it requires very urgent treatment. It is essential to use high doses of anti-thyroid drugs, and PTU is often preferred for this, particularly because of its fast absorption. Iodides or ipodate are often... 

The patients in the Zielinski et al. (1993) study developed more severe cardiac complications than did those of Rice et al. (1994). This discrepancy may result from the former study requiring rigorous evaluation of cardiac illness, with strict inclusion criteria, and thus may have involved relatively sicker patients. Nonetheless, even in the Zielinski et al. (1993) study, 38 of 40 cardiac patients completed a course of ECT. Indeed, with proper monitoring and management, patients with cardiac disease can be safely treated with ECT (American Psychiatric Association Task Force on Electroconvulsive Therapy 1990). 

Goldberg RJ, Capone RJ, Hunt JD Cardiac complications following tricyclic antidepressant overdose issues for monitoring policy. JAMA 254 1772-1775, 1985... 

When used along with levodopa, the plasma half life of levodopa is prolonged and dose may be markedly reduced. Also the most common side effect i.e. nausea and vomiting are not prominent and cardiac complications are minimized. It has no effect on involuntary movements, behavioral abnormalities and postural hypotension. 

CNS toxicity is a serious problem with maprotiline and is the probable mechanism of death rather than cardiac complications. 

Williams RB, Shertu C. Cardiac complications of tricyclic antidepressant therapy. Ann intern Med 1971 74 395-398. 

Nevertheless, the lesions provoked by HF are dreadful and may even endanger the vital prognosis of the individual because of the cardiac complications that it can engender in case of associated facial projection. Why Simply because to the initial destruction of the structures of the eye by its acid potential (ion H ), is added the chelating and toxic action of the fluoride ion (F ) (Fig. 3.57). This action will develop gradually, in situ in the layers of the cornea, as the HF breaks up. This results in a deep damage with a necrotic character. 

Hoping to avoid such side effects as the sleep disruption and the occasional cardiac complications of the tricyclic antidepressants, and following the principle that clean drugs are theoretically preferable to dirty ones, the pharmaceutical industry has developed the selective serotonin reuptake blockers, a third generation of chemical agents to relieve depression. 

Abciximab is indicated in patients with heart disease caused by poor blood flow in the arteries of the heart (ischemic cardiac complications). It is also used in patients with unstable angina not responding to conventional treatment and for precutaneous coronary intervention. It can reduce the incidence of abrupt closure and restenosis... 

In a series of thyrocardiac patients, of those dying primarily from thyrotoxicosis more than 21% did so within 3 weeks of 131I treatment (8), presumably reflecting too sudden a change in metabolic activity for patients with existing cardiac complications. 

Reductions in VLDL cholesterol, LDL cholesterol, and chylomicrons may contribute to a reduction in cardiac complications. Pioglitazone reduced both lipoprotein(a) and the remnant particles (cholesterol-rich particles after the release of triglycerides from the chylomicrons), whereas troglitazone caused increases in lipoprotein(a) (86). 

Following the acute phase, most infected people enter into a chronic phase. The chronic phase of the infection is considered as an intermediate phase by some authors because the infection may remain silent for decades or even for life. The chronic phase is characterized by the presence of T. cruzi in the patient s organs like the heart and intestine. The symptoms of the chronic phase are cardiac complications (e.g., cardiomyopathy, heart failure, altered heart rate or rhythm, and cardiac arrest) and digestive complications, especially megaesophagus and megacolon. 

ReoPro /Abciximab Immunoglobulin G (fragment) Ischemic cardiac complications... 

Lyme disease, first reported in 1975, typically begins with a unique skin lesion, erythema chronicum migrans, accompanied by systemic symptoms. Late sequelae include neurologic or cardiac complications and arthritis. The disease is caused by a spirochete and is transmitted by ticks (S34). The majority of patients have Clq-reactive material in their sera early in the course of disease. In most patients immune complex levels subside. However, in those likely to develop neurologic or cardiac sequelae, immune complex levels persist, and, thus, the test is of prognostic value. Those patients... 

Eckart RE, Love SS, Atwood JE, et al. Incidence and follow-up of inflammatory cardiac complications after smallpox vaccination. J Am Coll Cardiol 2004 44(1) 201-5. 

Serafimovski N, Thorball N, Asmussen I, Lunding M. Tricyclic antidepressive poisoning with special reference to cardiac complications. Acta Anaesthesiol Scand Suppl... 

A retrospective chart review was conducted to explore metamfetamine-associated acute coronary syndromes in patients who presented to the emergency room at a University Center between 1994 and 1996 (1). There were 36 admissions, three of which were repeat patients. Nine of these patients had acute coronary syndrome. Of these, one had an acute anterior Q wave myocardial infarction with cardiac arrest, seven had non-Q wave myocardial infarctions, and one had unstable angina. There were potentially life-threatening cardiac complications in three subjects (8%). The authors suggested that acute coronary syndromes and life-threatening complications associated with the use of metamfetamine are not uncommon, as evidenced by their experience in this study. 

Therapy for SEE is both complex and, in many instances, disappointing for both patient and practitioner. Management of the systemic signs and symptoms may not improve the ocular manifestations of the disease. The most common therapy for the arthritic and cardiac complications is NSAID use. Hydroxychloroquine and chloroquine are particularly effective in treating the discoid rash associated with the disease. In some cases oral steroids are used either alone or in combination with other immunosuppressive agents. Methotrexate can effectively reduce the need for systemic steroids in the treatment of mild to moderate SEE. Cyclophosphamide and... 

Neither aspirin nor adrenal steroid prevents the development of late cardiac complications. 

Hemodjmamic and cardiac complications are the major limitations of high-dose aldesleukin and have been described in both adults (19,20) and children (21). Significant hypotension requiring meticulous maintenance therapy with intravenous fluids or low-dose vasopressors was observed in most patients (22). The clinical findings were very similar to the hemodynamic pattern seen in early septic shock. Aldesleukin-induced increases in plasma nitrate and nitrite concentrations correlated with the severity of hypotension (23). 

Hypokinetic heart wall motion abnormalities and early signs of chronic cardiomyopathy have been identified as a significant toxic effect of mitoxantrone in patients who received cumulative doses of 32-174 mg (31). Electrocardiographic T wave inversion and cardiac complications have been described from intensive therapy with mitoxantrone 40 mg/m over 5 days and cyclophosphamide 1550 mg/m for 4 days, given before bone marrow transplantation for metastatic breast cancer. All the patients had had previous exposure to doxorubicin in cumulative doses that did not exceed 442 mg/m (19). 

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