rifampin and Cardiac-Output--Low

We present a case of 29-year-old male, with coronary artery disease in mother's history, after suicidal poisoning with 30 g of rifampicin, who presented severe chest pain, ST elevations in ECG, low values of blood pressure and elevated troponin I. Echocardiography revealed generalised hypokinesia, and depressed contractility--left ventricle ejection fraction was 7%. Urgent coronary angiography has shown normal epicardial arteries with slow contrast inflow. The toxic properties of rifampicin as well as hypotension due to dehydration are considered reasons of symptoms in the presented case.

Topics: Acute Disease; Adult; Angina, Unstable; Cardiac Output, Low; Chest Pain; Coronary Angiography; Diagnosis, Differential; Drug Overdose; Electrocardiography; Humans; Male; Rifampin; Suicide, Attempted; Treatment Outcome; Troponin I

We report a case of Q fever endocarditis in a patient who presented with a slight pyrexia and acute cardiac failure due to aortic incompetence. The diagnosis was made by detecting high titres of serum IgG and IgA antibody against Coxiella burnetii phase I antigens and confirmed by demonstrating C. burnetii on the excised aortic valve using immunofluorescence and electron microscopy. Aortic valve replacement was followed by initially successful antibiotic treatment for 15 months. Reappearance of IgA anti-phase I antibodies 5 months later suggested continued presence of bacteria, although the patient's condition remained satisfactory. In endemic areas, such as rural southern France, Q fever endocarditis should be considered when there is evidence of acute heart valve damage but are few other features of infection.

Topics: Acute Disease; Adult; Animals; Antibodies, Bacterial; Cardiac Output, Low; Coxiella; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; France; Humans; Male; Q Fever; Rifampin; Rural Population; Sheep