Showing papers by "Thomas J. Cahill published in 2011"
TL;DR: A 29-year-old woman presented in February 2010 with acute-onset severe chest pain and was diagnosed with myopericarditis and discharged from the accident and emergency department with nonsteroidal anti-inflammatories.
Abstract: A 29-year-old woman presented in February 2010 with acute-onset severe chest pain. This radiated to the left shoulder and was associated with breathlessness. She was afebrile, her saturations were 100% on air, and her clinical examination was entirely normal. An electrocardiogram showed diffuse 2- to 3-mm ST-segment elevation. At presentation, troponin I was elevated at 2.4 ng/mL (normal <0.1 ng/mL). Full blood count, chest radiograph, arterial blood gas, and bedside echocardiogram were unremarkable. She was diagnosed with myopericarditis and discharged from the accident and emergency department with nonsteroidal anti-inflammatories.
Two days later, she returned with worsening chest pain and was admitted for investigation. She had a full blood count, and urea and electrolytes were within the normal range. Troponin I was significantly elevated at 15.2 ng/mL, C-reactive protein was >160 mg/L (normal 20 000 μg/L (normal 0 to 500 μg/L). Her electrocardiogram showed further widespread ST elevation, and repeat bedside echocardiogram demonstrated a mass at the left ventricular apex, with apical hypokinesis (Figure 1 and online-only Data Supplement Movie I). A cardiac magnetic resonance scan revealed apical scarring consistent with a small myocardial infarct, with adherent apical thrombus in both the left and right ventricles (Figures 2 and 3 and online-only Data Supplement Movies II and III).
Figure 1.
A, Electrocardiogram showing diffuse ST-segment elevation. B, Transthoracic echocardiogram: apical 4-chamber view in systole showing …
20 citations
01 Jan 2011
TL;DR: A 29-year-old woman presented in February 2010 with acute-onset severe chest pain, and over the 3 days after admission, she developed an isolatedneutropenia, with her neutrophil count dropping to 0.9210.
Abstract: 29-year-old woman presented in February 2010 withacute-onset severe chest pain. This radiated to the leftshoulder and was associated with breathlessness. She wasafebrile, her saturations were 100% on air, and her clinicalexamination was entirely normal. An electrocardiogram showeddiffuse 2- to 3-mm ST-segment elevation. At presentation,troponinIwaselevatedat2.4ng/mL(normal 0.1ng/mL).Fullblood count, chest radiograph, arterial blood gas, and bedsideechocardiogram were unremarkable. She was diagnosed withmyopericarditis and discharged from the accident and emer-gency department with nonsteroidal anti-inflammatories.Two days later, she returned with worsening chest pain andwas admitted for investigation. She had a full blood count,and urea and electrolytes were within the normal range.Troponin I was significantly elevated at 15.2 ng/mL,C-reactive protein was 160 mg/L (normal 10 mg/L), andD-dimer was 20 000 g/L (normal 0 to 500 g/L). Herelectrocardiogram showed further widespread ST elevation,and repeat bedside echocardiogram demonstrated a mass atthe left ventricular apex, with apical hypokinesis (Figure 1and online-only Data Supplement Movie I). A cardiac mag-netic resonance scan revealed apical scarring consistent witha small myocardial infarct, with adherent apical thrombus inboth the left and right ventricles (Figures 2 and 3 andonline-only Data Supplement Movies II and III).Coronary angiography showed no evidence of coronaryartery disease. To exclude paradoxical embolism, a bubbleechocardiogram was performed, which was normal. In viewof her intracardiac thrombus, therapeutic dose low–molecular-weight heparin was commenced.Over the 3 days after admission, she developed an isolatedneutropenia, with her neutrophil count dropping to 0.9210
TL;DR: A previously fit 30-year old software technician was admitted with a 2-week history of severe abdominal pain, associated with nausea and bloody diarrhoea, and was afebrile, with central abdominal tenderness but no evidence of peritonism.
Abstract: A previously fit 30-year old software technician was admitted with a 2-week history of severe abdominal pain, associated with nausea and bloody diarrhoea. He had no medical or surgical history, was a non-smoker and took no medication or recreational drugs. His mother, brother and maternal grandmother had had deep vein thromboses or pulmonary emboli.
On examination he was afebrile, with central abdominal tenderness but no evidence of peritonism. His white cell count (16.1×109/litre) and C-reactive protein (CRP, 138 mg/litre) were elevated. Serum amylase and lactate were normal.
Chest and plain …