Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy, which is
characterized by hypertrabeculations and deep recesses of the left ventricle. A patient could be
asymptomatic or presented with common manifestations, including reduced systolic function, arrhythmia,
thromboembolic events and heart failure. The rarity of the condition as well as lack of proper assessment
has probably led to this condition to be largely underdiagnosed or unrecognized. A 23-year-old lady had
collapsed at home thirty one days after delivering her first child. She had a history of goitre diagnosed a
year ago and noted to be fairly well throughout the pregnancy. Post mortem findings showed increased
trabeculations of the left ventricle. Further history was obtained after the procedure, revealing symptoms
such as syncopal attacks and bilateral lower limb weakness dated back as far as five years prior to her
sudden demise. These features were in keeping with hypotension hypoperfusion effects resulted from
reduced systolic function and decreased ejection fraction, as a result of left ventricular dysfunction. While
LVNC remains a rare type of disease, we would like to highlight the importance of a good anamnesis. It may
help to uncover some uncommon pathology such as this heart disease, thus warranting an appropriate
cardiac imaging to be engaged to clinch the primary diagnosis.
A previously healthy man presented with fever for 2 days and rapidly progressive purpuric rash for 1 day. He progressed into hypotension, disseminated intravascular coagulation and refractory shock despite resuscitation and early antibiotic commencement. Blood culture grew Streptococcus pneumoniae This case report highlights the fact that purpura fulminans can be a rare presentation of S. pneumoniae infection as well.
Intracranial subdural hematoma following lumbar surgery is a devastating but rare complication. It has been implicated due to intracranial hypotension secondary to persistent cerebrospinal fluid leakage. The resultant drop in intracranial pressure presumably causes traction and tearing of venous structures. Patients typically present with postural headaches. However, other symptoms of subdural hematoma, intracranial hypotension and cerebrospinal fluid leak must also be cautioned.
Differentiating between anaphylaxis and hypotension during general anaesthesia is difficult, especially when patients present with only hypotension and without any of the other classical features of anaphylaxis. We report the successful management of an anaphylactic reaction to rocuronium that presented as isolated hypotension in a 45-year-old Indonesian man presented with lacerations on the scalp and right pinna caused by an assault to the head after the induction of general anaesthesia, refractory to fluids and high doses of vasopressors. This case highlights that a possible indicator of anaphylaxis can be the presence of isolated hypotension during.
We have evaluated the effects of a B2 receptor antagonist (B5630) of kinins on BK and captopril-induced acute hypotensive responses in anaesthetized SHR. Intravenous treatment of BK (1.0 microgram) and captopril (0.3 mg/kg) caused significant (p < 0.05) fall in the SBP and DBP. Whereas BK caused greater fall in the SBP (p < 0.05), DBP (p < 0.01) and duration of hypotension (p < 0.05) when administered after captopril (Fig 1 and 2). All the hypotensive effects of BK and captopril were significantly antagonised (p < 0.05) in the presence of B5630 (2.0 mg/kg). Further, the duration of hypotensive responses of BK and captopril were blocked (p < 0.05) by B5630. The agonists and BK-antagonist did not cause significant (p > 0.05) alterations in HR during the entire investigation. These findings provide evidence to support the suggestion that B2 receptor might be involved in the regulation of the hypotensive actions of BK and captopril. Kinins should also have valuable functions in the antihypertensive property of captopril-like drugs.
Induction of anaesthesia with propofol is often associated with a significant decrease in arterial pressure, especially in the older population. The aim of this study is to determine the efficacy of phenylephrine in two different doses i.e. 100mcg and 200mcg, given during induction to counteract the anticipated hypotensive effect of propofol in older patients aged over 55 years.
Syzygium polyanthum (Wight) Walp. var. polyanthum leaves are consumed as a traditional Malay treatment of hypertension. This study investigates hypotensive potential of aqueous (AESP) and residual methanolic (met-AESP) extracts of S. polyanthum leaves and possible involvement of autonomic receptors. AESP and met-AESP (20 to 100 mg/kg) were intravenously administered into anaesthetized Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Blood pressure and heart were monitored for 20 min. AESP and met-AESP induced significant dose-dependent hypotension, but only 100 mg/kg AESP caused mild bradycardia (n = 5). AESP-induced hypotension was more potent than that of met-AESP in WKY. AESP has a faster onset time than that of met-AESP in both WKY and SHR. However, met-AESP-induced hypotension was more sustained than that of AESP in SHR. Blockages of autonomic ganglion and α -adrenergic receptors using hexamethonium and phentolamine (n = 5 for each group) partially attenuated AESP-induced hypotension, suggesting involvement of α -adrenergic receptors. Blockages of autonomic ganglion, β -adrenergic, cholinergic receptors, and nitric oxide production using hexamethonium, propranolol, atropine, and N- ω -nitro-l arginine methyl ester (L-NAME) (n = 5 for each group) partially attenuated met-AESP-induced hypotension, suggesting involvement of β -adrenergic and cholinergic receptors via nitric oxide production.
We conducted a double-blind, randomised, placebo-controlled study evaluating the efficacy of prophylactic metaraminol for preventing propofol-induced hypotension. Thirty patients aged 55-75 years undergoing general anaesthesia were randomly allocated to receive either metaraminol 0.5 mg or saline before administration of fentanyl 1 microg.kg(-1) and propofol 2 mg.kg(-1). Induction of anaesthesia was associated with a decrease in mean and systolic arterial pressure in both groups (p = 0.0001). However, there was no significant difference between the two groups. These results show that prophylactic use of metaraminol 0.5 mg does not prevent the decrease in blood pressure following fentanyl and propofol induction in older patients.
The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel's index). The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, P < 0.05), age group more than 75 (OR: 2.97, P < 0.05), retinopathy (OR: 2.19, P < 0.05), and orthostatic hypotension (OR: 2.87, P < 0.05) were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, P < 0.05). In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score.
Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Questionnaires, Scales, Device: Tinetti Balance and Gait Assessment; 5.07 Semmes- Weinstein monofilament; Barthel’s index
Study site: Diabetic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia