Pericardial effusion, electrocardiogram

Aortic arch dissection can cause profound hypotension, with global, and sometimes boundary zone, cerebral ischemia or focal cerebral ischemia if the dissection spreads up one of the neck arteries. Clues to this diagnosis are anterior chest or interscapular pain, along with diminished, unequal or absent arterial pulses in the arms or neck and a normal electrocardiogram, unlike acute myocardial infarction, acute aortic regurgitation and pericardial effusion. 

Cardiovascular A 26-year-old man was given arsenic trioxide for relapsed acute pro-myelocytic leukemia and after 14 days developed a fever (38 °C) and chest pain [18 ]. CT scan showed moderate pleural and pericardial effusions and arsenic trioxide was withdrawn. His chest pain deteriorated and the effusions enlarged, causing hypotension on day 16. An electrocardiogram showed a prolonged QT interval and sinus tachycardia and echocardiography was normal, except for diastolic ventricular failure due to the pericardial effusion. The authors thought that other causes were excluded and attributed the case to arsenic trioxide. 

A 22-year-old man with ulcerative colitis was started on therapy with both oral (1.6 g, twice daily) and rectal (2 g, at bedtime) mesalazine. After 20 days, the patient developed fever, chest pain and dyspnoea. Laboratory tests revealed leukocytosis, with elevation of inflammatory indexes and cardiac troponin 1. Electrocardiogram displayed sinus tachycardia, inverted T-waves in inferior and left precordial leads. Echocardiography showed a mildly dilated left ventricle, diffuse hypokinesis and mild mitral regurgitation without pericardial effusion. A diagnosis of acute myocarditis was made and mesalazine was discontinued. Cardiac symptoms improved within few days. About... 

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