Try a new search

Format these results:

Searched for:

person:loartp01

in-biosketch:true

Total Results:

24


A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

Cohen, Ronny; Lysenko, Alla; Mallet, Thierry; Mirrer, Brooks; Gale, Michael; Loarte, Pablo; McCue, Robert
We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting.
PMCID:4568044
PMID: 26413355
ISSN: 2090-6404
CID: 5241752

A fatal case of peripartum cardiomyopathy

Cohen, Ronny; Mallet, Thierry; Mirrer, Brooks; Loarte, Pablo; Gale, Michael; Kastell, Paul
Peripartum cardiomyopathy is a life-threatening cardiac condition affecting pregnant women either late in pregnancy or early in the post-partum period. The latest studies show a dramatic improvement in the mortality rates of women affected with this disorder, which has been correlated with advances in medical therapy for heart failure. However, patients continue to die of this condition. The following case report describes a typical patient with peripartum cardiomyopathy diagnosed on clinical grounds, along with echocardiogram findings of severe systolic dysfunction and global hypokinesis consistent with dilated cardiomyopathy. Emergency cesarean delivery had to be performed for fetal distress. There was significant improvement of the patient's condition with standard pharmacological management for heart failure at the time of discharge. However, five weeks after discharge, fatal cardiac arrest occurred. It is hoped that this article will raise awareness about this rare but potentially fatal condition and promote understanding of its main clinical features, diagnostic criteria, and conventional pharmacological management.
PMID: 24754482
ISSN: 1748-2941
CID: 1059382

Thrombolytic-related complication in a case of misdiagnosed myocardial infarction

Irivbogbe, Osereme; Mirrer, Brooks; Loarte, Pablo; Gale, Michael; Cohen, Ronny
The importance of early thrombolysis in acute myocardial infarction has been highlighted in several large trials. The clinical decision is often taken by physicians who need to take a rapid action with the risk of misdiagnosing non-coronary events that mimic myocardial infarction. Here we describe a case of acute pericarditis in a 37-year-old man whom received thrombolysis and developed a sudden hemorrhagic pericardial effusion that evolved rapidly into a cardiac tamponade. These errors leading to lethal thrombolysis complications have been surprisingly rare; but a correct diagnosis of aortic dissection or hemorrhagic pericarditis needs to be stressed because even after obtaining the correct diagnosis, the prolonged disturbance of hemostasis prevents a rapid therapy being instigated.
PMID: 24749992
ISSN: 1748-2941
CID: 1059552

Epicardial rhythm devices (ERD), an alternative for hemodialysis patients [Meeting Abstract]

Cohen, R; Loarte, P; Dashkova, I; Chou, S -Y; Mirrer, B
Objectives: Sudden cardiac death in the dialysis population comprises 25% of all-cause of mortality. The epicardial approach for cardiac rhythm device leads may be preferred over transvenous leads. Background: The transvenous route has been the most frequently used method for insertion of Cardiac Rhythm Device (CRD) leads. However, this route can cause major problems including central venous stenosis and cardiac device infection during episodes of dialysis access-related bacteremia. Methods: This is a case report where a 56 year-old man on chronic hemodialysis presented with episodes of cardiac arrest due to ventricular fibrillation. He had had an amputation due to osteomyelitis and an arteriovenous-graft (AVG) infection of the right upper extremity in the past. At present evaluation he had a left upper extremity AVG. Results: Vascular evaluation revealed right subclavian vein and superior vena cava stenoses. Along with the presence of a left upper extremity AVG, this posed a dilemma regarding safety and usefulness of a transvenous rhythm device. An ERD-AICD was placed and one year later there were no cardiac or infectious events reported. Conclusions: Epicardial leads should be considered in hemodialysis patients who require a new CRD or replacement of existing transvenous CRD leads. Transvenous CRD leads can cause central venous stenosis and are vulnerable to contamination during AVG or tunneled hemodialysis catheter-related bacteremia. Because these complications are not infrequent in hemodialysis patients an alternative pathway is warranted. Epicardial leads do not traverse through the central veins and are not directly exposed to blood flow and do not cause central venous stenosis
EMBASE:71146392
ISSN: 0008-6312
CID: 550972

Myocardial stunning in hemodialysis patients: "A silent overlooked insult" [Meeting Abstract]

Loarte, P; Chou, S Y; Cohen, R; Mirrer, B
Background: Hemodialysis (HD) is capable of inducing Left ventricular dysfunction, which may persist even after hemodynamic or clinical status has returned to normal. Repeated episodes of myocardial depression result in myocardial hibernation, remodeling, and some degree of irreversible loss of contractile function. Objectives: Our goal is to highlight the impact of this phenomenon, sometimes not considered an important risk factor for cardiovascular morbidity. Methods: Review of literature, identifying predisposing factors, diagnostic approaches and therapeutic options. Discussion: Predisposing factors include dialysis-related, cardiac and medical. The most important are: * Large volume of fluid removal. * Hemodialysis-related hypotension. * Small cardiac chamber size or chamber hyperthrophy. * Microvascular endothelial dysfunction. * Overmedication with antihypertensive agents * Reduced fluid intake or volume loss. Symptoms occur during HD and include chest discomfort, palpitations, and general fatigue as well as ECG changes. Echocardiography is ideally suited to diagnose transient reversible regional wall motion abnormalities (RWMA) that are hallmark to this condition. Increase in troponin T levels is also related with presence and severity of myocardial dysfunction. The therapeutic approach is aimed to reduce the episodes of intradialytic hypotension and avoid large UF volumes. Biofeedback dialysis, reduced dialysate temperatures, frequent dialysis sessions, switch peritoneal dialysis and use of beta-blockers are some options. Conclusions: Cardiac dysfunction occurs in two-thirds of HD patients and predicts a substantial increase in mortality. As shown, HD-related myocardial ischemia with recurrent ischemic insults leads to structural and functional changes resulting in systolic dysfunction. Preliminary evidence has shown that modifications of dialysis technique may reduce the myocardial perturbation
EMBASE:71146162
ISSN: 0008-6312
CID: 550982

Intrapericardial mature cystic teratoma in an adult: case presentation

Cohen, Ronny; Mirrer, Brooks; Loarte, Pablo; Navarro, Victor
Cardiac Teratoma is a tumor of very rare occurrence in adult population. Here we report a case in a Caucasian male with history of Human immunodeficiency virus infection where the symptom as presentation was recurrent episodes of tachycardia. The chest radiograph showed a lesion in the right heart border and subsequent investigation revealed an intrapericardial lesion, which was demonstrated to be a pericardial teratoma diagnosed by histopathology. In this case the initial differential diagnosis included lymphoma or an infectious organism as possible causes in a immunocompromised patient. Cardiac teratomas are among the less common types of cardiac tumors being more frequent in child population and around 1% of all the cardiac tumors in adults. Imaging studies are very helpful. CT and MRI are the best due to their resolution and ability to assess the relationship of the mass with the surrounding structures. Echocardiogram in also helpful determining the presence of pericardial effusion because cardiac teratomas are most of the time present in the pericardium. The final diagnosis is mostly made after surgical excision and this is the most effective treatment because they are relatively resistant to chemotherapy and radiotherapy. The authors have no funding, financial relationships, or conflicts of interest to disclose.
PMID: 23007804
ISSN: 0160-9289
CID: 213262

ANTINEUTROPHIL CYTOPLASMIC (ANCA)-ASSOCIATED NECROTIZING AND CRESCENTIC GLOMERULONEPHRITIS (GN) AS INITIAL PRESENTATION OF LUPUS NEPHRITIS (LN) [Meeting Abstract]

Loarte, Pablo; Chou, Shyan-Yih; Araguez, Nayle; Cohen, Ronny
ISI:000317274900183
ISSN: 0272-6386
CID: 5253472

Cardiac tamponade as the initial manifestation of severe hypothyroidism: A case report

Cohen, Ronny; Loarte, Pablo; Opris, Simona; Mirrer, Brooks
ORIGINAL:0015632
ISSN: 2164-5329
CID: 5253512

Echocardiographic findings in pulmonary embolism: An important guide for the management of the patient

Cohen, Ronny; Loarte, Pablo; Navarro, Victor; Mirrer, Brooks
ORIGINAL:0015631
ISSN: 2164-5329
CID: 5253502

Castleman’s Disease of the Pleura: Case Presentation and Review of Literature

Loarte, Pablo; Araguez, Nayle; Flores, Rose Marie; Wu, Li-The; Cohen, Ronny
ORIGINAL:0015630
ISSN: 2158-284x
CID: 5253492