In this patient, inadequate attention had been paid to warning signs. The initial heavy workload of the Bruce protocol (5 METs), infrequent blood pressure monitoring, continuation of the test despite a blunted blood pressure response, and physician inexperience may all have contributed to this catastrophe. Fortunately, the patient survived and…
Physical Examination Blood pressure was 150/90 mm Hg, regular pulse rate of 86, and respirations 16. He was a well developed, well nourished elderly white male. HEENT was normal, and the neck was supple without adenopathy Jugular venous pulse was non-distended with normal a and v waves. Carotids were slightly…
Effort syncope in patients with aortic stenosis (AS) has long been recognized in the medical literature. Recent guidelines regarding exercise testing by the American Heart Association and American College of Cardiology list moderate to severe AS as a contraindication for exercise testing. The following report illustrates the potential danger of…
The other expected complications of demyelinating diseases were observed, especially cutaneous and urinary infections. Yet, the absence of any thromboembolic events defies explanation. Bell et al reported on the clinical features of 167 patients with arigiographi-cally established pulmonary emboli. Thirty-two percent of the 167 patients were at bed rest of…
Finally, Tribe described autopsy data on 150 acute and chronic paraplegic patients. Among the 28 patients who expired in the acute period (defined as less than two months duration), six deaths were ascribed to pulmonary embolism, and in all six deep venous clots were found. In the remaining 122 cases…
Why pulmonary embolism and deep venous thrombophlebitis have not been observed here is obscure. Ellison et al in their extensive review of multiple sclerosis did not mention thromboembolic complications. Neither did McFarlin and McFarland, where they basically addressed epidemiology, etiology, and treatment. A total review of the multiple sclerosis literature…
The age, sex, and ethnic distributions of MS patients are shown in Table 2. The largest representation of patients was in the fourth decade, but significant numbers of patients were observed in other age groups up to age 59. The sex ratio is at variance with some texts and shows…