Mr. B is a 51-year-old male that presented to the Emergency Department at DSMC with a history of hypertension, hyperlipidemia, and Human Immunodeficiency Virus (HIV). The patient stated that he had been experiencing a “weird” heart rate for roughly four years. During his HIV wellness checks, he stated that the staff had told him that his heart rate was elevated. He stated during the interview that he experienced an episode of a high heart rate every day and that these would last several hours. He also stated that he used to be a runner, often running three miles at a time, but with the elevated heart rate, he was experiencing shortness of breath when he tried to run and was unable to run more than a single mile. He said that he was experiencing orthopnea, shortness of breath when lying flat, and shortness of breath at night when trying to sleep. He explained that he had also been experiencing weakness because of his high heart rate but had not seen a doctor about it until he came to the emergency room. Upon examination, the patient appeared well and was fully aware of his surroundings. He demonstrated an appropriate mood and affect for his situation and was anxious to understand what was happening to him. When he had his EKG read, he was shown to be in atrial fibrillation with rapid ventricular rate. The cardiology team was contacted to determine if pharmacologic or cardioversion would help him. When the team arrived and performed a history and physical which showed the atrial fibrillation rhythm to be long standing, it ruled out the efficacy of cardioversion. An echocardiogram was ordered and performed which showed a mildly reduced ejection fraction of 40 percent and provided the team some concern that the patient might also have some cardiomyopathy as a result of the tachycardia. The team determined that the atrial fibrillation was most likely the result of his uncontrolled hypertension. To address his atrial fibrillation, the underlying cause, and take preventative action against consequences of his disease state, the patient was placed on four different medications. These medications were carvedilol to lower his heart rate, digoxin to help with the heart rate control, apixaban to prevent clot formation, and lisinopril to help with his high blood pressure. He was sent home with an appointment to meet with a cardiologist in two weeks’ time.
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Potassium plays an important role in the electrophysiological regulation of myocardium, and the conduction system. Hyperkalemia can frequently cause arrhythmias, including high-grade AV conduction abnormalities. These AV conduction abnormalities due to hyperkalemia are usually reversible with conventional treatment of hyperkalemia. We present a case of persistent high-grade AV conduction abnormalities which were not completely reversed with treatment of hyperkalemia, necessitating permanent pacemaker implantation.
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Fifty-two-year-old man with diagnosed heart failure presented to the ED with a history of peripheral edema, dyspnea, and tachycardia among other symptoms. After many tests, the patient was found to have a large aortic root abscess and heart block and underwent surgery to receive a bovine aortic valve.
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Coronavirus Disease 2019 (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. The common clinical manifestations are related to airway involvement. However, manifestations in other organs should not be ignored. This review sought to describe the possible ocular presentations of COVID-19 infection. A total of 11articles was included by searching PubMed, SciELO and Lilacs databases for articles published between December 2019 and April 2020.Conjunctivitis and keratoconjunctivitis can be the initial symptoms in infected patients. The virus can be identified in tear and conjunctival secretions, requiring highest attention. This review study recommends that there is a potential risk of transmission from the conjunctiva and requires appropriate precautionary and mitigation strategies especially for ophthalmologist who may encounter presymptomatic patients with COVID-19. However, with the evolving COVID-19 pandemic and with its high infectivity, it is mandatory to rearrange ophthalmologist routine clinical practice to control viral spread and try to maximize patient and health-care provider’s safety.
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Novel Coronavirus-2019 has widely spread all over the world and seriously threatened people’s life. The virus has spread to at least 218 countries and more than 66,501,425 confirmed cases and 1,529,154 deaths have been recorded world-wide. Now a days for early diagnosis of COVID-19, nucleic acid-based technique like real-time reverse transcription polymerase chain reaction (rRT-PCR) is the most consistent and the gold-standard method for the clinical diagnosis of COVID-19 and used all over the world. The current study was carried out to detect 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR method at Sheikh Hasina Medical College, Jamalpur, Bangladesh from 12thMay 2020 to 29th November, 2020. A total of 10675 samples were tested from different upazilas of Jamalpur district of Mymensingh division for rRT-PCR. Among them 1321 (12.7%) patients were positive for SARS-CoV-2. Out of 1321 positive cases 933(70.6%) were male and 388(29.4%) were female. Maximum positivity was found in Bakshiganjupazilaof Jamalpur district, followed by Sarishabari, Jamalpur Sadar, Islampur, Melandaha, Madarganj and Dewanganj respectively. This is the first base line study for genetic detection of 2019-nCoV in Jamalpur district of Mymensingh division which may reflect nearly the total scenario of Bangladesh situation.
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