Summary:
A man with dilated cardiomyopathy presented with decompensated heart failure and heart transplant evaluation had to be temporarily removed from the candidate list due to fever. No infectious source was identified and drug fever was suspected. Given prior clinical experience dobutamine was discontinued with his fever defervesced and eventually received an orthostatic heart transplantation without complication. Explanted heart showed isolated eosinophilic myocarditis. The importance of this report is to have a greater awareness of dobutamine-induced fever. In febrile patients receiving dobutamine with no other evidence of infection, consideration should be given to discontinuing dobutamine or switching to an alternative inotrope such as milrinone.
Course:
A 66-year-old male with a 7-year history of dilated cardiomyopathy was admitted to our medical center for heart transplant evaluation. His initial chest X-ray showed moderate cardiomegaly and pulmonary vascular congestion. His prior left heart catheterization showed mild diagonal branch disease. Echocardiogram showed left ventricular ejection fraction of 17% and moderate mitral regurgitation. Cardiac catheterization done at local hospital showed the following pressure (mm Hg): right atrial: 21, pulmonary artery: 36/25, pulmonary wedge 32 and reduced cardiac index 1.4 Liter/minute/meter2 (cardiac output 3.1 Liter/minute). Home lisinopril and spironolactone was continued and furosemide was switched to bumetanide. He was started on dobutamine and dopamine for inotropic support. Eventually cardiac index improved to 2.86 Liter/minute/meter2 (cardiac output 6.46 Liter/minute). By day 14 of admission, patient began to have fevers reaching 102.3 Fahrenheit. Infectious source...
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Cynthia Adae was taken to Clinton Memorial Hospital on June 28, 2006. She was taken to the hospital with back and chest pain. A doctor concluded that she was at high risk for acute coronary syndrome. She was transferred to the Clinton Memorial hospital emergency room. She reported to have pain for two or three weeks and that the pain started in her back or her chest. The pain sometimes increased with heavy breathing and sometimes radiated down her left arm. Cynthia said she had a high fever of 103 to 104 degrees. When she was in the emergency room her temperature was 99.3, she had a heart rate of 140, but her blood
Adderall is a combination of amphetamine and dextroamphetamine, which work on the central nervous system as stimulants. A stimulant is a drug that produces a temporary increase of function activity by affecting the chemicals in the brain. There are 4 salts the combine to for the active ingredients, dextroamphetamine saccharate, dextroamphetamine sulfate, amphetamine aspartate monohydrate, and amphetamine. Inactive ingredients are also present, but they do not play a role in Adderall’s function.
Sildenafil Citrate, more commonly known by the brand name Viagra, has become one of the most commonly prescribed drugs in America. Viagra is used to treat erectile dysfunction, also known as impotence. Erectile Dysfunction is best defined as the inability to maintain an erection necessary for sexual satisfaction. Sildenafil has been shown to be effective for a "broad range ED patients, including those with a history of mellitus, depression, … hypertension, diabetes, …and spinal chord injury" (Sildenafil Citrate, par. 29).
There has been an increase in the Misuse and Abuse of prescription drugs to treat Attention Deficit Hyperactivity Disorder (ADHD). the number of children on medication for ADHD has grown from 600,000 in 1990 to 3.5 million in 2013 according to the Centers for Disease Control and Prevention. But although there is an over-medication of ADHD drugs, there is actually and under-medication since not all the right people are getting medicated. Many individuals lack insurance or are insured with health plans that do not cover the outpatient prescription drugs they need and cannot afford.10 Therefore, Individuals covered by various health plans and programs, and those who have no prescription drug coverage, pay significantly different prices for the same medications. As the demand for ADHD drugs grows, higher prescribing rates and increasing drug prices result, which creates problems for these number of Americans who cannot afford the treatment they require.
C. L. a 52-year-old male scheduled for a colonoscopy. Indication was for an initial screening. The patient is allergic to the pertussis vaccine. Vital signs included: temperature 97.1, respiration rate 20, heart rate 98, blood pressure 137/98, and oxygen 98% on room air. Lungs clear bilaterally upon auscultation. The IV attempt was successful on the first try made by me. I placed the IV in the patient’s left hand. This concluded my visit with this patient.
In the late 1800’s it was discovered that papa-amino-phenol, could reduce fever, but the drug was too toxic to use. A less toxic extract called phenacetin was later found to be just as effective but also had pain-relieving properties. In 1949, it was learned that phenacetin was metabolized into an active but also less toxic drug, acetaminophen. Since then, acetaminophen has been sold under many over the counter brand names, most popular being Tylenol.
[12] Ho, Carolyn Y, MD; López, Begoña, PhD; Coelho-Filho, Otavio R, MD; Lakdawala, Neal K, MD; Cirino, Allison L, MS, CGC; Jarolim, Petr, MD, PhD; Kwong, Raymond, MD; González, Arantxa, PhD; Colan, Steven D, MD; Seidman, JG, PhD; Díez, Javier, MD, PhD; Seidman, Christine E, MD. (2010) Myocardial Fibrosis as an Early Manifestation of Hypertrophic Cardiomyopathy, Boston, MA: Massachusetts Medical Society
In February of this year the patient did present to a local emergency department, with a chief complaint of chest pain. However, he left the emergency
These sign and symptoms can be associated with other disease processes. But following open heart surgery a combination of these with the inclusion of physical findings will give rise to the conclusion of a cardiac tamponade.
As the name suggests, immunosuppressant drugs given to limb transplant patients greatly lower the body's immune system (4). This puts limb transplant patients at a much greater risk of cancer, infections, and other disorders (5), as has been the case in renal and liver transplants (6). Even with these drugs, the patient still has a great risk of rejection. Six weeks after Jerry Fisher's hand transplant, he had already experienced three episodes of rejection, a common and expected occurrence in limb transplant patients (7).
chronic stages.Treatment recommendations may vary with the age of the patient and other factors. There are significant side effects with these drugs, which must be given long term. In case of chronic stage, treatment of cardiomyopathy is mainly symptomatic and similar to the treatment of the other causes of heart disease. There may be a need in pacemaker and a heart transplant can be considered.
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
“Damage to the mitral valve… can [also] cause problems with the heart later in life… [causing]… atrial fibrillation [and] heart failure” (Rheumatic fever, 2015). It is very important to be seen by your doctor about heart complications from rheumatic fever because it can impair your hearts ability to pump blood. In order to see if the heart was affected by rheumatic fever an electrocardiogram would be given by your doctor. Typically the heart can recover if only the muscle has been affected. The problem lies in the valves. However, recurrent rheumatic fever can cause permanent damage (Rheumatic Fever and the Heart, 2015).
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.