William Cardona

SPA 4003

December 10, 2015

Revista Colombiana de Cardiologia

Heroin-Induced Acute Myocardial Infarction

 Beatriz Wills (a), Andrés F. Buitrago (a, b), Nohra P. Romero (a,b) and Mariana Soto (a)

 (a) Department of Intensive and Critical Care Medicine, Hospital Universitario Fundación Santa de Fe de Bogotá, Bogotá, Colombia

(b) Department of Internal Medicine, Cardiology Section, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

Received September 17, 2013; accepted March 10, 2014. Web publication September 24, 2014

Heroin-induced myocardial infarction

Due to the symptoms of opioid intoxication and imminence of respiratory failure, a management began with airway support and management with naloxone.

During emergency care the patient indicated chest pain not irradiation, of moderate intensity, without dysautonomia or dyspnea. Given the possibility of coronary syndrome, troponin was used, with the initial results being 0.48ng/ml (reference value: 0- 0.3 ng/ml)

The initial electrocardiogram indicated St Elevation of the St on the anterolateral side (fig.2). The result of the echocardiogram ruled out abnormalities.

Due to the clinical and biochemical findings, the diagnose was acute myocardial infarction with ST-Elevation type 2, Killip-Kimball, by which a vasodilator was initiated with nitroglycerin via intravenous at low dose, Antiplatelet therapy dual (Clopidogrel and aspirin) and full anticoagulation with low molecular weight heparin.

Revista Colombiana de Cardiolgía

Adult Cardiology- Case Studies

Heroin-induced Myocardial Infarction

Beatriz Wills, Andrés F. Buitrago, Nohra P. Romero y Mariana Soto

Submitted September 17, 2013; Accepted March 10,2014.

Available Online September 24, 2014

Due to signs of opiate intoxication and imminence or respiratory failure airway support with naloxone treatment was initiated. During emergency care, the patient indicated localized non-irradiated pain of moderate intensity, without dysautonomia or dyspnea. Faced with the possibility of acute coronary syndrome, troponia was solicited, of which its initial result was 0.48 ng/ml (reference value: 0-0.3ng/ml). The initial electrocardiogram indicated anterolateral ST-segment elevations (fig. 2). The echocardiogram results ruled out abnormalities. Given the clinical and biochemical findings, diagnosis concluded acute myocardial infarction with type 2 ST-segment elevation, Killip-Kimball I, for which vasodilator administration with low dose intravenous nitroglycerin, dual antiplatelet therapy (clopidogrel and aspirin) and full anticoagulation with low molecular weight heparin was initiated.

Source: Department of Intensive and Critical Care Medicine, Hospital Universitario Fundación Santa de Fe de Bogotá, Bogotá, Colombia

Heroin- induced myocardial infarction

Beatriz Wills, Andrés F Buitrago, Nohra P. Romero, Mariana Soto

Received on September 17th, 2013

Received on March 10th 2014

Available online on September 24th, 2014

Due to the symptoms of opioid intoxication and imminence of respiratory failure, a treatment of air support and naloxone were initiated. During emergency care, the patient indicated precordial pain of moderate intensity, without dysautonomia or dyspnea. Given the possibility of acute coronary syndrome, a troponin I test was requested, with initial result of 0.48ng/ml  (reference value = 0-0.3ng/ml).The initial electrocardiogram indicated St segment elevation on the anterolateral side(Fig.2). The electrocardiogram results ruled out abnormalities. Given the clinical and biochemical findings, acute myocardial infarction with St- elevation type 2 , Killip-Kimball was diagnosed, by which the use of vasodilator with low doses of intravenous nitroglycerin was initiated, along with dual antiplatelet therapy (clopidogrel and aspirin), and full anticoagulation with low molecular weight heparin.

Revista Colombiana de Cardiologia
ADULT CARDIOLOGY- CASE PRESENTATION
Heroin- Induced Myocardial Infarction
Beatriz Wills, Andres F. Buitrago, Nohra P. Romero and Mariana Soto

Due to signs of opiate intoxication and imminence of respiratory failure, airway support and treatment with naloxone were initiated. During emergency care, the patient indicated localized precordial pain, of moderate intensity, without dysautonomia or dyspnea. Faced with the possibility of acute coronary syndrome, troponin I was requested, whose initial result was 0.48 ng/ml (reference value:0- 0.3 ng/ml.) The initial electrocardiogram showed ST segment elevation in the anterolateral region (fig. 2.) The result of the echocardiography ruled out abnormalities. Given the clinical and biochemical findings, Type II acute myocardial infarction with ST elevation, Killip I was diagnosed, so vasodilator therapy was initiated with intravenous nitroglycerin at low doses, dual antiplatelet therapy (clopidogrel and aspirin) and full anticoagulation with low molecular weight heparin.

Source : Elsevier Doyma

Acute myocardial infarction caused by heroin

Due to signs of opioid intoxication and imminence of respiratory failure, airway support and naloxone treatment were initiated. During emergency care, the patient indicated localized precordial pain, of moderate intensity, without dysautonomia or dyspnea. Before the possibility of acute coronary syndrome, troponin 1 was requested. Whose initial result was 0.48 ng/ml (reference value: 0-0.3ng/ml). The initial electrocardiogram showed a ST drop in the anterolateral (fig. 2). The results of the echocardiogram ruled out abnormalities. Given the clinical and biochemical findings, an acute myocardial infarction with ST drop type 2 Killip-Kimball 1 was diagnosed, because of this vasodilator management with intravenous nitroglycerin was started at a low dose, along with dual anti-platelet therapy (clopidogrel and aspirin) and anticoagulation full with heparin at low molecular weight.

Heroin-induced myocardial infarction

Beatriz Wills, Andres F. Buitrago, Nohra P. Romero y Mariana Soto

^aDepartment of critical medicine and intensive care, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

^bDepartment of internal medicine, section of Cardiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

Received September 17, 2013; accepted March 10, 2014.

Available online on September 24, 2014

Due to the signs of opined intoxication and imminence of respiratory failure airway support and naloxone treatment were initiated. During emergency care, the patient indicated localized precordial pain. Faced with the possibility of acute coronary syndrome, it requested triennial whose initial result was 0,48ng / mL (reference value: 0-0.3 ng / ml). The initial electrocardiogram showed ST segment elevation in the anterolateral. The result of echocardiography rule out abnormalities. I give the clinical and biochemical findings, acute myocardial infarction was diagnosed with ST elevation type 2, Killip-Kimball, whereby management with intravenous vasodilator nitro glycerin start at low doses, full anti-coagulation with low molecular weight heparin.

Revista Colombiana de Cardiología

ADULT CARDIOLOGY – CASE STUDY 

Acute myocardial infarction induced by heroin

Beatriz Wills^a , Andrés F. Buitrago^a,b, Nohra P. Romero^a,b and Mariana Soto^a  

^aDepartment of critical medicine and intensive care, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

^bDepartment of internal medicine, section of Cardiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

Received on September 17, 2013; accepted on March 10, 2014; available online on September 24, 2014

Due to the signs of poisoning by opiates and its possible link to respiratory failure, support of the airways and treatment with naloxone have been started. During emergency treatment in the ER, the patient reported chest pains, non-irradiated and of moderate intensity, without dysautonomia nor dyspnea. Due to the fear of the patient experiencing acute coronary syndrome, troponin I was administered, its initial result was 0.48 ng/ml (reference value: 0-0.3 ng/ml). The initial electrocardiogram showed abnormalities in the ST at the anterolateral side (fig. 2). The result of the Echocardiogram ruled out abnormalities. Given the clinical and biochemical findings, the patient was diagnosed with acute ST-elevation myocardial infarction type2, Killip – Kimball I, for which a treatment to handle vasodilation was administered; with low doses of intravenous nitroglycerin, dual antiplatelet therapy (clopidogrel and aspirin), and full anticoagulation with heparin of low molecular weight.