A 60-year-old woman presented to an emergency department with chest pain. At a wedding the day before, she had eaten wasabi thinking it was avocado and experienced chest pressure, which did not go away.

Avocado on the left; wasabi on the right.

Cardiac catheterization showed no obstructive coronary artery disease, but ventriculography showed features of takotsubo cardiomyopathy (“broken heart syndrome”), which is usually associated with emotional or physical stress. A left ventricular ejection fraction of 35% was noted. The right ventricle was normal. She was treated with ACE inhibitors, beta blockers and aldosterone antagonists. After cardiac rehab, the LV ejection fraction returned to normal.

“Ballooning” of the heart in takotsubo cardiomyopathy.

A 40-year-old woman underwent treatment for fibromyalgia by a professional acupuncturist in Norway. A needle was inserted into the Ren 17 acupuncture point in the sternum at the level of the fourth intercostal space. Just after a needle was placed, she had chest pain and said she thought she was going to die. The needle was removed. She was taken to the nearest hospital but was dead on arrival.

She had 320 mL of blood in the pericardial cavity and puncture holes were seen in the pericardium and anterior right ventricle. A post mortem chest x-ray showed a congenital foramen in the lower third of the sternum. According to the Lancet paper, sternal foramina are found in 9.6% of men and 4.3% of women.

Left: The Ren 17 acupuncture point. Right: The unfortunate patient’s sternal foramen.

Almost 6 years ago, I blogged about some cases of invasive cavity searches done on prisoners in emergency rooms by physicians who agreed to perform procedures demanded by police. One such prisoner underwent two digital rectal exams, three enemas, and a colonoscopy without his consent. No drugs were found. He sued the government entities involved, and the case was settled for $1.6 million.

 

Container in the red circle

Progress has been made. Last month a prisoner in Jefferson County, Missouri underwent a body scan by equipment similar to what the TSA uses. A container was identified. When it was removed, white powder was found inside and was sent to a laboratory for analysis.

While makeup was being applied for a Halloween photo shoot, a woman had a panic attack and was taken to a hospital. At first, the staff at the level I trauma center did not realize she was wearing makeup. The patient said she didn’t tell them because she assumed they could see that it was fake. She says she heard someone say, “Let’s get her back to trauma now and she’s probably going into shock, she’s not making any sense.”

Realistic makeup that temporarily fooled the doctors.

The hospital issued a  statement: “The emergency room is not a place for fun and games. They see many patients with severe medical issues where lives are at stake. Doctors need to be able to focus on those patients with true emergencies.” I guess a panic attack is considered fun and games.

Thanks to  @caulimovirus for the link to the cardiac tamponade case.

 

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times.For the last 9 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.

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