18561524 Visualization

An 18 Age - year Age - old Age male Sex was diagnosed with attention Disease_disorder - deficit Disease_disorder hyperactivity Disease_disorder disorder Disease_disorder ( ADHD Disease_disorder ) in 2005 Date .
He was overweight History with a body Diagnostic_procedure mass Diagnostic_procedure index Diagnostic_procedure ( BMI Diagnostic_procedure ) of 40 Lab_value .
He was started on quetiapine Medication fumarate Medication (Seroquel®) Medication 900 Dosage mg Dosage daily Dosage in April Date 2005 Date and methylphenidate Medication (Concerta®) Medication 54 Dosage mg Dosage daily Dosage in September Date 2005 Date .
In the beginning Date of Date August Date 2006 Date he was admitted Clinical_event to his local Nonbiological_location hospital Nonbiological_location with severe Severity dyspnoea Sign_symptom , tachypnea Sign_symptom , tachycardia Sign_symptom , and cyanosis Sign_symptom .
On admission Clinical_event the blood Diagnostic_procedure pressure Diagnostic_procedure was 120/80 Lab_value mmHg Lab_value , and the arterial Diagnostic_procedure blood Diagnostic_procedure gas Diagnostic_procedure revealed a pH Diagnostic_procedure of 7.45 Lab_value , pCO2 Diagnostic_procedure of 3.55 Lab_value kPa Lab_value , paO2 Diagnostic_procedure of 7.76 Lab_value kPa Lab_value , and BE Diagnostic_procedure of −5.1 mmol/l.
C Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure was not Lab_value elevated Lab_value .
The chest Biological_structure X Diagnostic_procedure - ray Diagnostic_procedure showed an enlarged Sign_symptom heart Sign_symptom .
He developed hemoptysis Sign_symptom and was treated with unfractionated Detailed_description heparin Medication in suspicion of pulmonary Biological_structure embolism Sign_symptom .
He subsequently developed cardiogenic Disease_disorder shock Disease_disorder and was treated with vasoactive Medication drugs Medication .
In spite of the treatment he became oliguric Sign_symptom and his liver Diagnostic_procedure enzymes Diagnostic_procedure were rising Lab_value .
He was referred Clinical_event to our hospital Nonbiological_location for further treatment.
On admission Clinical_event the blood Diagnostic_procedure pressure Diagnostic_procedure was 90/60 Lab_value mmHg Lab_value , despite infusion Administration with noradrenaline Medication .
His heart Diagnostic_procedure rate Diagnostic_procedure was 130/minute Lab_value and his temperature Diagnostic_procedure was 38.4 Lab_value °C Lab_value .
A thoracic Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure scan Diagnostic_procedure did Sign_symptom not Sign_symptom show Sign_symptom pulmonary Sign_symptom embolism Sign_symptom .
Echocardiography Diagnostic_procedure revealed biventricular Sign_symptom failure Sign_symptom and left Diagnostic_procedure ventricular Diagnostic_procedure end Diagnostic_procedure diastolic Diagnostic_procedure diameter Diagnostic_procedure was 7 Distance cm Distance .
The left Biological_structure ventricle Biological_structure was severely Severity hypokinetic Lab_value with an ejection Diagnostic_procedure fraction Diagnostic_procedure ( EF Diagnostic_procedure ) of 20%–25%.
The left Diagnostic_procedure ventricular Diagnostic_procedure end Diagnostic_procedure diastolic Diagnostic_procedure pressure Diagnostic_procedure was markedly elevated Lab_value , and there was a moderate Lab_value mitral Sign_symptom regurgitation Sign_symptom .
Intermittent Detailed_description hemodialysis Therapeutic_procedure was initiated.
His liver Diagnostic_procedure function Diagnostic_procedure improved Lab_value slightly Severity , but despite dialysis Coreference the renal Diagnostic_procedure function Diagnostic_procedure deteriorated Lab_value with increasing Lab_value creatinine Diagnostic_procedure values Diagnostic_procedure .
After Date three Date days Date there was a further worsening Lab_value of the left Diagnostic_procedure ventricular Diagnostic_procedure systolic Diagnostic_procedure function Diagnostic_procedure with an ejection Diagnostic_procedure fraction Diagnostic_procedure of 10%–12% and marked pulmonary Sign_symptom hypertension Sign_symptom with systolic Diagnostic_procedure pulmonary Diagnostic_procedure pressure Diagnostic_procedure estimated to 30 Lab_value mmHg Lab_value .
The clinical picture resembled dilated Detailed_description cardiomyopathy Disease_disorder with low Sign_symptom output Sign_symptom failure Sign_symptom causing renal Biological_structure and liver Biological_structure failure Sign_symptom .
We suspected drug Detailed_description - induced Detailed_description cardiomyopathy Coreference and methylphenidate Medication and quetiapine Medication fumarate Medication were discontinued.
Screening Diagnostic_procedure for Diagnostic_procedure infectious Diagnostic_procedure pathogens Diagnostic_procedure , immunological Diagnostic_procedure markers Diagnostic_procedure , and iron Diagnostic_procedure or amyloid Diagnostic_procedure deposition Diagnostic_procedure were all negative Lab_value .
After Date three Date days Date he was transferred Clinical_event to the National Nonbiological_location Hospital Nonbiological_location (Rikshospitalet, Nonbiological_location Oslo) Nonbiological_location with ongoing noradrenaline Medication and dobutamine Medication infusions Administration .
Shortly after admission Clinical_event an intraaortic Therapeutic_procedure balloon Therapeutic_procedure pump Therapeutic_procedure ( IABP Therapeutic_procedure ) was inserted and noradrenaline Coreference was replaced by nitroprusside Medication .
Coronary Diagnostic_procedure angiography Diagnostic_procedure was normal Lab_value .
Endomyocardial Biological_structure biopsy Diagnostic_procedure from the right Biological_structure ventricle Biological_structure did not reveal any distinct myocardial Disease_disorder pathology Disease_disorder .
On treatment with IABP Coreference , nitroprusside Coreference , and dialysis Therapeutic_procedure , the clinical Diagnostic_procedure situation Diagnostic_procedure gradually improved Lab_value and the liver Diagnostic_procedure function Diagnostic_procedure returned to normal Lab_value .
His renal Diagnostic_procedure function Diagnostic_procedure also improved Lab_value with increasing diuresis Sign_symptom and creatinine Diagnostic_procedure fell from 798 Lab_value to 98 Lab_value μmol/l.
His EF Diagnostic_procedure was still markedly reduced Lab_value ( 15% Lab_value ).
Because of behavioral Sign_symptom problems Sign_symptom and adipose Sign_symptom stature Sign_symptom , he was denied Clinical_event a heart Therapeutic_procedure transplant Therapeutic_procedure .
He was treated with IABP Coreference for 26 Duration days Duration , and after Duration 28 Duration days Duration he was transferred Clinical_event back to our Nonbiological_location hospital Nonbiological_location .
At that time his liver Diagnostic_procedure and Diagnostic_procedure renal Diagnostic_procedure functions Diagnostic_procedure were normal Lab_value .
He was treated with an angiotensin Medication - converting Medication enzyme Medication (ACE)-inhibitor, a beta Medication - blocker Medication , and diuretics Medication .
During the following two Duration weeks Duration his clinical Diagnostic_procedure status Diagnostic_procedure improved Lab_value and he was subsequently discharged Clinical_event to his Nonbiological_location home Nonbiological_location .
The echocardiography Diagnostic_procedure still showed markedly dilated Lab_value left Biological_structure ventricle Biological_structure with EF Diagnostic_procedure of 20% Lab_value .
In March Date 2007 Date , his clinical Diagnostic_procedure status Diagnostic_procedure was improved Lab_value and he was in function Diagnostic_procedure class Diagnostic_procedure II Lab_value ( New Detailed_description York Detailed_description Heart Detailed_description Association Detailed_description ) with an EF Diagnostic_procedure estimated by echocardiography Diagnostic_procedure to 30%–35%.