A 58-Year-Old Woman With ST-Segment Elevation, Seizures, and Altered Mental Status in the Setting of Opiate Withdrawal
| Autor: | Brent W. Kinder, Stephen Adjei, Mian Yousuf |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Pulmonary and Respiratory Medicine
Physical examination Critical Care and Intensive Care Medicine Electrocardiography Epilepsy Seizures Takotsubo Cardiomyopathy medicine Humans Myocardial infarction biology medicine.diagnostic_test Lumbar puncture business.industry ST elevation Middle Aged Opioid-Related Disorders medicine.disease Substance Withdrawal Syndrome Anesthesia biology.protein Eptifibatide Vomiting Female Creatine kinase medicine.symptom Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Chest. 135:1098-1101 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.08-2164 |
| Popis: | (CHEST 2009; 135:1098–1101) A 58-year-old woman with history of fibromyalgia and opiate dependence presented after being unable to obtain prescription opiates for 1 week. She had been experiencing dysphoria, rhinorrhea, diaphoresis, nausea, and vomiting, and was brought to the emergency department in a post-ictal state after having a witnessed seizure. She was intubated on arrival for airway protection. Physical examination and laboratory evaluation were unremarkable. Findings on ECG, noncontrast computerized axial tomographic scan of the head, and lumbar puncture were unrevealing. She was empirically started on IV vancomycin, ceftriaxone, and fentanyl based on a working diagnoses of meningoencephalitis, toxin-induced seizures, and opiate withdrawal. She was triaged to the medical ICU. Eight hours later in the medical ICU, a repeat ECG (Fig 1) showed diffuse STsegment elevation in precordial leads V2 through V6. Laboratory evaluation revealed elevated cardiac biomarker levels: creatine kinase, 4,294 units/L; creatine kinase MB, 30.6 ng/mL; relative index, 0.7%; and troponin, 10.2 ng/mL. A diagnosis of ST-segment elevation myocardial infarction was entertained and treated initially with aspirin, metoprolol, simivastatin, heparin, and an IV eptifibatide. Emergent coronary angiography was performed, which revealed patent |
| Databáze: | OpenAIRE |
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