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Thomas J Kiernan

Publications and source records attributed to Thomas J Kiernan.

7 recordsLinked to original sources
PubMed2006

Simvastatin induced rhabdomyolysis and an important clinical link with hypothyroidism.

An 85-year-old woman with renal impairment and hypothyroidism was commenced on high dose simvastatin (80 mg) for better lipid control. Shortly after this she developed severe muscular weakness and laboratory evidence of rhabdomyolysis. Despite having hypothyroidism controlled for years with L-thyroxine (100 mcg), her biochemistry now reflected a hypothyroid state with inadequate thyroid replacement. On discontinuing her simvastatin to treat her rhabdomyolysis, the patient's TSH level decreased to normal within 4 weeks without any change in L-thyroxine dosage. To our knowledge this is only the second case reported in the literature of a rare but important interaction between simvastatin and L-thyroxine and the first case reported with associated rhabdomyolysis.

Aged, 80 and over↗
PubMed2006

Postpartum spontaneous coronary artery dissection: an important clinical link with anticardiolipin antibody.

A 34-year-old woman presented to the Emergency Department with substernal chest pain, 7 days after a normal vaginal delivery. Acute myocardial infarction was diagnosed based on ECG changes and elevated serum troponin levels. Coronary angiography revealed a spontaneous coronary dissection of the left anterior descending (LAD) coronary artery. The patient was managed medically and recovered well clinically with healing of the dissection on repeat angiography 10 days later. Of note the patient had a high titre of anticardiolipin antibody (IgM) detected and this is only the second case described in the literature of an association between spontaneous coronary artery dissection and antiphospholipid antibody syndrome.

Adult↗
PubMed2006

Primary hyperparathyroidism and the cardiovascular system.

The role of primary hyperparathyroidism (PHPT) in heart disease is still somewhat uncertain in many respects. Patients with PHPT seem to have an increase in mortality and this seems mainly due to an overrepresentation of cardiovascular death. PHPT is reported to be associated with hypertension, disturbances in the renin-angiotensin-aldosterone system, cardiac arrhythmias as well as structural and functional alterations in the vascular wall. There is an increased prevalence of cardiac structural abnormalities such as LVH and functional properties of the heart may be affected by the hyperparathyroid condition as well. We report the case of a 65-year-old woman with no cardiac risk factors apart from her age and type 2 diabetes who presented in cardiogenic shock. Extensive evaluation for the aetiology of the cardiomyopathy revealed solely a diagnosis of primary hyperparathyroidism. Cardiac manifestations of primary hyperparathyroidism have been reported before but to our knowledge this is the first description of severe left ventricular function secondary to PHPT. We believe that this atypical presentation of primary hyperparathyroidism causing left ventricular cardiomyopathy warrants further attention, and that a diagnosis of primary hyperparathyroidism should always be considered in patients with systolic as well as diastolic left ventricular dysfunction, and no other obvious cause.

Female↗
PubMed2006

Coronary embolism causing myocardial infarction in a patient with mechanical aortic valve prosthesis.

Coronary embolism as a cause of myocardial infarction is an uncommon but important entity both in terms of aetiology and treatment. Previous cases of coronary emboli in association with prosthetic mechanical valves have been reported previously but the mechanism of pharmacology and lack of patient awareness of medication importance is quite unique in this case. A 65-year-old male presented to the emergency room with an anterior ST elevation myocardial infarction after 14 h of symptoms. Past medical history included aortic valve replacement with a mechanical tilting-disc valve 18 months earlier for symptomatic severe calcific aortic stenosis. Pre-operative coronary angiography revealed normal coronary arteries. On this occasion, coronary angiography revealed an occluded LAD with an embolic occlusion at the midpoint of the vessel. Successful PTCA and stenting of the lesion were performed. Amazingly, the patient had decided 1 year earlier to stop taking his warfarin medication. He had begun taking a new "herbal remedy" which was helping with his joint pains but the combination with warfarin was causing excessive bleeding each day after facial shaving. He therefore decided to abruptly stop taking his warfarin without any medical advice. Embolic myocardial infarction is underdiagnosed and it is important to diagnose the source of embolism and treat the cause. Patient education is vital in our battle to prevent this entity in high-risk patients as in our case.

Aged↗
PubMed2006

Multiple accessory pathways, dual AV nodal physiology, non-compacted myocardium and patent foramen ovale in a patient with Ebstein's anomaly: report of a case.

Ebstein's anomaly is a rare congenital cardiac disease initially described by Wilhelm Ebstein in 1866. The primary pathology involves significant apical displacement of the septal tricuspid valve leaflet and the presence of a redundant, elongated, anterior tricuspid valve leaflet. This congenital malformation has multiple known associated morphological and electrophysiological cardiac pathologies. In the present article, we report, to the best of our knowledge for the first time in the literature, a case of Ebstein's anomaly with multiple accessory bypass tracts, dual AV nodal physiology, non-compacted left ventricular myocardium and a patent foramen ovale. Indeed, complete evaluation of the left heart is required in cases of Ebstein's anomaly to accurately assess left ventricular myocardial structure.

Adult↗