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Intravenous thrombolysis is the mainstay medical treatment for acute ischaemic strokes, but has s... more Intravenous thrombolysis is the mainstay medical treatment for acute ischaemic strokes, but has strict eligibility criteria. Symptomatic intracranial haemorrhage (sICH) is the most adverse complication. A woman aged 76 years presented with signs of an acute stroke and despite not meeting the eligibility criteria, given her background use of warfarin, she received intravenous thrombolysis with an excellent outcome. This is the first fully documented case report of the contraindicated use of intravenous thrombolysis in a patient presenting with an acute ischaemic stroke on a background of concurrent use of warfarin with an international normalised ratio (INR) as high as 1.9. It has been perceived that the risk of thrombolysis with a raised INR outweighs the potential benefits. However, documenting its use outside of the current eligibility criteria is key to future developments.
Journal of Cardiovascular Computed Tomography
Clinical Medicine
Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and ... more Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and for which the number of UK hospital admissions is rising. A primary diagnosis of myocarditis accounted for 0.04% (36.5 per 100,000) of all hospital admissions in England between 1998 and 2017, although this is likely to be an underestimate of the true burden of myocarditis. The aetiology is broad, including infective and inflammatory conditions as well as exposure to toxic agents. Clinical features are varied and overlap with other acute cardiac conditions making diagnosis a challenge. Cardiovascular magnetic resonance imaging currently serves as the gold standard non-invasive diagnostic modality. If an underlying aetiological process is identified, then therapy may be directed at the cause; however, for most, treatment is supportive and aimed at managing any complications such as heart failure or arrhythmias. There is emerging evidence for immunosuppressive therapy in certain cases. Prognosis is generally good with recovery in most; however, up to 30% with biopsy-proven myocarditis progress to develop a dilated cardiomyopathy and its potential associated complications. All-cause mortality in the UK for patients presenting to hospital with acute myocarditis is approximately 4%.
Intravenous thrombolysis is the mainstay medical treatment for acute ischaemic strokes, but has s... more Intravenous thrombolysis is the mainstay medical treatment for acute ischaemic strokes, but has strict eligibility criteria. Symptomatic intracranial haemorrhage (sICH) is the most adverse complication. A woman aged 76 years presented with signs of an acute stroke and despite not meeting the eligibility criteria, given her background use of warfarin, she received intravenous thrombolysis with an excellent outcome. This is the first fully documented case report of the contraindicated use of intravenous thrombolysis in a patient presenting with an acute ischaemic stroke on a background of concurrent use of warfarin with an international normalised ratio (INR) as high as 1.9. It has been perceived that the risk of thrombolysis with a raised INR outweighs the potential benefits. However, documenting its use outside of the current eligibility criteria is key to future developments.
Journal of Cardiovascular Computed Tomography
Clinical Medicine
Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and ... more Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and for which the number of UK hospital admissions is rising. A primary diagnosis of myocarditis accounted for 0.04% (36.5 per 100,000) of all hospital admissions in England between 1998 and 2017, although this is likely to be an underestimate of the true burden of myocarditis. The aetiology is broad, including infective and inflammatory conditions as well as exposure to toxic agents. Clinical features are varied and overlap with other acute cardiac conditions making diagnosis a challenge. Cardiovascular magnetic resonance imaging currently serves as the gold standard non-invasive diagnostic modality. If an underlying aetiological process is identified, then therapy may be directed at the cause; however, for most, treatment is supportive and aimed at managing any complications such as heart failure or arrhythmias. There is emerging evidence for immunosuppressive therapy in certain cases. Prognosis is generally good with recovery in most; however, up to 30% with biopsy-proven myocarditis progress to develop a dilated cardiomyopathy and its potential associated complications. All-cause mortality in the UK for patients presenting to hospital with acute myocarditis is approximately 4%.