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Left ventricular free wall rupture usually leads to acute hemopericardium and sudden cardiac death resulting in cardiac tamponade. Rarely, only a few patients with subacute free wall rupture such as oozing-type ventricular rupture or left ventricular false aneurysm may permit time for pericardiocentesis and surgery. We report a 63-year-old man with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention about 12 hours from the onset, and cardiac tamponade occurred on the second day. An intra-aortic balloon pump (IABP) was immediately inserted for hemodynamic support. After 100 mL of pericardial fresh blood was drained from the percardial cavity, his hemodynamic collapse was promptly improved with IABP support. In the following 24 hours, about 600 mL of hemorrhagic pericardial fluid was drained. The most likely diagnosis was concerning for oozing-type ventricular rupture, and a conservative approach was decided. The patient survived to the acute phase under IABP support and was discharged with complete recovery. [ABSTRACT FROM AUTHOR]

Background: Chinese herbal medicine has a long history of human use. A novel herbal formula, antiasthma herbal medicine intervention (ASHMI), has been shown to be an effective therapy in a murine model of allergic asthma. Objective: This study was undertaken to compare the efficacy, safety, and immunomodulatory effects of ASHMI treatment in patients with moderate-severe, persistent asthma with prednisone therapy. Methods: In a double-blind trial, 91 subjects underwent randomization. Forty-five subjects received oral ASHMI capsules and prednisone placebo tablets (ASHMI group) and 46 subjects received oral prednisone tablets and ASHMI placebo capsules (prednisone group) for 4 weeks. Spirometry measurements; symptom scores; side effects; and serum cortisol, cytokine, and IgE levels were evaluated before and after treatment. Results: Posttreatment lung function was significantly improved in both groups as shown by increased FEV1 and peak expiratory flow findings (P < .001). The improvement was slightly but significantly greater in the prednisone group (P < .05). Clinical symptom scores, use of β2-bronchodilators, and serum IgE levels were reduced significantly, and to a similar degree in both groups (P < .001). TH2 cytokine levels were significantly reduced in both treated groups (P < .001) and were lower in the prednisone-treated group (P < .05). Serum IFN-γ and cortisol levels were significantly decreased in the prednisone group (P < .001) but significantly increased in the ASHMI group (P < .001). No severe side effects were observed in either group. Conclusion: Antiasthma herbal medicine intervention appears to be a safe and effective alternative medicine for treating asthma. In contrast with prednisone, ASHMI had no adverse effect on adrenal function and had a beneficial effect on TH1 and TH2 balance. [Copyright &y& Elsevier]

Electrical storm is the clustering of hemodynamically destabilizing ventricular tachycardia or ventricular fibrillation. Effective management of electrical storm during acute myocardial infarction is a challenge. We report the case of a 53-year-old man who had a witnessed cardiac arrest with ventricular fibrillation in the emergency department. He required continuous chest compressions, tracheal intubation, and emergency cardiac defibrillation. Although he was defibrillated 10 times and intravenous antiarrhythmic drugs were administered, the ventricular arrhythmias were still not under control. In the setting of his hemodynamic collapse, an intraaortic balloon pump (IABP) was immediately inserted for hemodynamic support. The electrical storm was successful terminated under the IABP support. After successful resuscitation, electrocardiogram showed ST-segment elevation in leads II, III, and aVF as well as the right precordial leads. With the IABP support for more than half an hour, the patient had spontaneous recanalization of the occluded infarct-related artery; and coronary angiography confirmed the entire coronary artery patency. [ABSTRACT FROM AUTHOR]

Coronary artery spasm can lead to sudden cardiac death due to ventricular arrhythmias or heart block. Cardiopulmonary resuscitation guidelines recommend the use of epinephrine during cardiopulmonary arrest. However, in the event of cardiac arrest caused by coronary artery spasm, the use of epinephrine may be harmful. We report 2 cases who had witnessed cardiac arrest due to ventricular fibrillation and complete heart block. Intravenous epinephrine was administered during resuscitation. Their hemodynamics did not improve. Emergent coronary angiography revealed that the entire right and left coronary artery systems diffuse spasm. One patient's coronary artery spasm was successfully reversed immediately with administration of intracoronary boluses of nitroglycerin. The other patient's hemodynamic instability persisted, requiring temporary mechanical circulatory support with an intraaortic balloon pump. His hemodynamics finally improved with administration of intravenous diltiazem and nitroglycerin under the intraaortic balloon pump support. They both were discharged from the hospital without any other complications. [ABSTRACT FROM AUTHOR]

Anaphylactic shock is a serious allergic reaction, setting in rapidly, which may lead to life-threatening circulatory failure and necessitates aggressive support to ensure full recovery. We report the case of a 50- year-old man who developed cardiovascular collapse and cardiac arrest to iodine contrast media, occurring during coronary angiography. He was required temporary mechanical circulatory support with an venoarterial extracorporeal membrane oxygenation system by failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy. He had full recovery of cardiac function and released from the hospital 21 days after admission without a neurologic deficit. [ABSTRACT FROM AUTHOR]