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Mediastinitis

Acute

• In modern practice, most cases of acute mediastinitis result from complications of cardiovascular or endoscopic surgical procedures.
• Odontogenic (infected tooth)
• Perforation of the esophagus (Boerhaave syndrome)
• Retropharyngeal infections

Chronic

Chronic medistinitis is usually a radiologic diagnosis manifested by diffuse fibrosis of the soft tissues of the mediastinum. This is sometimes the consequence of prior granulomatous disease, most commonly histoplasmosis. Other identifiable causes include tuberculosis and radiation therapy. Fibrosing mediastinitis most frequently causes problems by constricting blood vessels or airways in the mediastinum. This may result in such complications as superior vena cava syndrome or pulmonary edema from compression of pulmonary veins.

• Asymmetric septal hypertrophy
• Acute rheumatic fever
• Adenoidectomy
• Aortic valve regurgitation
• Aortic valve stenosis
• Bacteroides
• Bicuspid aortic valves
• Biliary tract surgery
• Calcific aortic stenosis
• Calcific valvular disease
• Candida albicans
• Cardiac catheterization
• Cardiac myxoma
• Cardiac surgery
• Chronic hemodialysis
• Coagulase-negative staphylococci
• Coarctation of the aorta
• Congenital Heart Disease
• Cystoscopy
• Dental extractions
• Dental implants
• Dental sepsis
• Diphtheria
• Endoscopic retrograde cholangiopancreatography
• Enterococci
• Fungi
• Gram negative rods
• Group A streptococcus
• [[HACEK organisms]
• History of endocarditis
• HIV
• Immune impairment
• Intravascular procedure in settings of bacteremia
• Intravenous catheter-relatedinfection
• Intravenous drug use
• Marantic endocarditis
• Mitral valve prolapse with regurgitation
• Mycobacterium avium-intracellulare
• Non-HACEK gram-negative bacteria
• Other streptococci
• Paraneoplastic syndrome
• Patent ductus arteriosus
• Peritoneovenous shunts for ascites
• Pregnancy
• Previous bacterial endocarditis
• Prostatic surgery
• Prosthetic heart valve
• Prosthetic heart valves
• Q fever
• Respiratory tract procedures
• Rheumatic Heart Disease
• Root canals procedure
• S. aureus
• Salmonellosis
• Sclerotherapy
• Septal defects
• Skin infection
• Staphylococcus epidermidis
• Streptococcus bovis
• Streptococcus milleri
• Streptococcus viridans
• structural heart disease
• Surgical systemic-pulmonary shunts and conduits
• Systemic lupus erythematosus
• Tetralogy of Fallot
• Tuberculosis
• Ulcerative lesions of the colon due to inflammatory bowel disease
• Ulcerative lesions of the colon due to carcinoma
• Urethral dilation
• Ventricular septal defect
• Ventriculoatrial shunts for hydrocephalus
• Whipple disease

Ventricular Tachycardia

Common causes of ventricular tachycardia include ischemic heart disease, illicit drugs (cocaine and methamphetamine), structural heart disease (including congenital heart diseases such as tetralogy of Fallot), inherited channelopathies, drug toxicity (digoxin, drugs that prolong the QT interval) and electrolyte disturbances (such as hypokalemia, hypomagnesemia, and hypocalcemia).

Table 1. Common Bacterial Pathogens in Neutropenic Patients
Gram-Positive Pathogens
Coagulase-negative staphylococci Staphylococcus aureus, including methicillin-resistant strains Enterococcus species, including vancomycin-resistant strains Viridans group streptococci Streptococcus pneumoniae Streptococcus pyogenes
Gram-Negative Pathogens
Escherichia coli Klebsiella species Enterobacter species Pseudomonas aeruginosa Citrobacter species Acinetobacter species Stenotrophomonas maltophilia

Bloodstream infections caused by endogenous flora and reactivation of latent infections account for a majority of initial febrile episode in neutropenic patients with cancer. Common bacterial isolates that cause bacteremia in the setting of neutropenia are listed in Table 1. Certain endogenous microorganisms may be reactivated and exit latency during immunosuppression. These include herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, hepatitis B and C viruses, and Mycobacterium tuberculosis. Exogenous pathogens carried by contaminated blood products, medical equipment and devices, water sources, and health care workers represent less common sources of infection. These include Clostridium difficile, respiratory syncytial virus, vancomycin-resistant enterococci, and other multidrug resistant bacteria.

Fungal infections often take place in the setting of prolonged or profound neutropenia after administration of empirical therapy. Candidiasis may range in severity from mucosal or cutaneous infection to septicemia, endocarditis, or disseminated infection. Aspergillus, on the contrary, typically causes life-threatening infection of the sinuses and lungs, particularly after protracted neutropenia.

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetaminophen and Oxycodone, Aclarubicin, Albendazole, Alemtuzumab, Alkylating antineoplastic agent, Alkylators, Arsenicals, Auranofin, Azathioprine, Aztreonam, Boceprevir, Busulphan, carbamazepine, Carboplatin, Cefadroxil, Ceftazidime, Certolizumab pegol, Chlorpromazine, Chloramphenicol, Chlorpropamide, Cidofovir, Clomipramine, Colchicine toxicity, Cytotoxic drugs and radiation, Dactinomycin, Doxorubicin, Ethosuximide, Febuxostat, Flucytosine, Gold, Gemifloxacin mesylate, Idarubicin, indomethacin , Interferon beta- 1a, Lincomycin Hydrochloride Minocycline hydrochloride, Non steroidal anti-inflammatory drugs, Ofatumumab, Omacetaxine, Oxaprozin, Oxcarbazepine, Penicillamine, phenacemide , Phenylbutazone, Piperacillin, Pralatrexate, propylthiouracil , Pyrimethamine, Rabeprazole, Radium chloride, sulfonamides, Tamoxifen, Tolbutamide, Tolazamide, Trifluoperazine, Trimethadione, Thiothixene, Valganciclovir hydrochloride
Ear Nose Throat	No underlying causes
Endocrine	Thyroid carcinoma
Environmental	Tobacco use, Environmental/occupational (eg, benzene)
Gastroenterologic	Portal hypertension, Intestinal lymphangiectasia, Hepatitis
Genetic	Ataxia telangiectasia, Barth syndrome, Chediak-Higashi disease, defect in synthesis of adenosylcobalamin, DNA repair deficiencies, Down syndrome, Dubowitz syndrome, familial monosomy 7, Fanconi anaemia, genotoxic therapy, glutathione synthase deficiency, glycogen storage diseases, mutagen exposure, mutagen-detoxification (GSTq1-null), neurofibromatosis 1, Niemann-Pick disease, Nijmege breakage syndrome, Noonan syndrome, organic acid metabolism defect, Pearson syndrome, Seckel syndrome, Severe combined immunodeficiency, T- B+ due to JAK3 deficiency, trisomy 8 mosaicism, Wiskott-Aldrich syndrome
Hematologic	Sickle cell disease, Reticular dysgenesis, Paroxysmal nocturnal haemoglobinuria, Non-Hodgkin lymphoma, Myelpathic anemia, Myeloma, Myelofibrosis, Myelodysplastic syndrome, Megaloblastic anaemia, Malignant histiocytosis, Leucoerythroblastic anaemia, Large granular lymphocytic leukemia, Langerhans cell histiocytosis, Ineffective erythropoiesis, Hypoplastic myelodysplastic syndromes , Hypersplenism, Hodgkin lymphoma, Histiocytosis X, Hepatosplenic T-cell lymphoma, Hemoglobin H disease, Hematopoietic cell transplantation, Hairy cell leukaemia, Haemoglobin SC disease, Haemoglobin E disease, Graft versus host disease, Familial myelofibrosis, Familial histiocytic reticulosis, Eosinophilic fasciitis , Cyclical neutropenia, Congenital neutropenia (Kostmann's or Shwachman-Diamond syndrome), Common variable hypogammaglobulinaemia, Chronic myeloid leukaemia, Chronic lymphocytic leukaemia, Bleeding (Excessive), Autoimmune lymphoproliferative syndrome type 2, Autoimmune lymphoproliferative syndrome type 1, Aplastic anemia, Amegakaryocytic thrombocytopenia, Aggressive NK-cell leukemia, Acute lymphoblastic leukemia
Iatrogenic	No underlying causes
Infectious Disease	Q fever, Parvovirus B19 infection, Oklahoma tick fever, Mycobacterium tuberculosis, Legionella pneumophila, Lassa fever, Human immunodeficiency virus , Epstein-Barr virus Seronegative, Dengue, Brucellosis
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	Vitamin C deficiency, Vitamin B12 deficiency, Marasmus, Malabsorption syndrome, Kwashiorkor, Iron deficiency, Intrinsic factor deficiency, Folate deficiency, Copper deficiency
Obstetric/Gynecologic	Pregnancy
Oncologic	Thymoma , Prostate cancer, Metastatic neoplasm, Melanoma, Germ cell tumors (embryonal dysgenesis), Ewing sarcoma, Chondrosarcoma, Cancer treatment
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Anorexia nervosa
Pulmonary	No underlying causes
Renal/Electrolyte	Renal failure, chronic
Rheumatology/Immunology/Allergy	Systemic lupus erythematosus, Rheumatoid disease, Osteopetrosis autosomal recessive 2, Osteopetrosis lethal Osteoclastoma, Ankylosing spondylitis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Topoisomerase II interactive agents, Plummer-Vinson syndrome, Obesity, Idiopathic , Glue vapors, Dyskeratosis congenita Shwachman-Diamond syndrome, Diamond-Blackfan anemia, Castleman disease, Bloom's syndrome

Causes in Alphabetical Order

• Aclarubicin

• Acute lymphoblastic leukemia

• Aggressive NK-cell leukemia

• Albendazole

• Alemtuzumab

• Alkylating antineoplastic agent

• Alkylators

• Amegakaryocytic thrombocytopenia

• Ankylosing spondylitis

• Anorexia nervosa

• Aplastic anemia

• Arsenicals

• Ataxia telangiectasia

• Auranofin

• Autoimmune lymphoproliferative syndrome type 1

• Autoimmune lymphoproliferative syndrome type 2

• Azathioprine

• Aztreonam

• Benzene Solvents

• Beta-emitters (eg, radioactive P-32)

• Bleeding (Excessive)

• Bloom's syndrome

• Boceprevir

• Brucellosis

• Busulphan

• Cancer treatment

• carbamazepine

• Carboplatin

• Castleman disease

• Cefadroxil

• Ceftazidime

• Chediak-Higashi disease

• Chloramphenicol

• Chlorpropamide

• Chondrosarcoma

• Chronic lymphocytic leukaemia

• Chronic myeloid leukaemia

• Cidofovir

• Clomipramine

• Colchicine toxicity

• Common variable hypogammaglobulinaemia

• Congenital neutropenia (Kostmann's or Shwachman-Diamond syndrome)

• Copper deficiency

• Cyclical neutropenia

• Cytotoxic drugs and radiation

• Defect in synthesis of adenosylcobalamin

• Dengue

• Diamond-Blackfan anemia

• DNA repair deficiencies

• Down syndrome (trisomy 21)

• Doxorubicin

• Dyskeratosis congenita

• Shwachman-Diamond syndrome

• Environmental/occupational (eg, benzene)

• Eosinophilic fasciitis

• Epstein-Barr virus Seronegative

• Ewing sarcoma

• Familial histiocytic reticulosis

• Familial monosomy 7

• Familial myelofibrosis

• Fanconi anaemia

• Flucytosine

• Folate deficiency

• Genotoxic therapy

• Germ cell tumors (embryonal dysgenesis)

• Glue vapors

• Glutathione synthase deficiency

• Gold

• Graft versus host disease

• Haemoglobin E disease

• Haemoglobin SC disease

• Hairy cell leukaemia

• Hematopoietic cell transplantation

• Hemoglobin H disease

• Hepatitis

• Hepatosplenic T-cell lymphoma

• Histiocytosis X

• Hodgkin lymphoma

• Human immunodeficiency virus

• Hypersplenism

• Hypoplastic myelodysplastic syndromes

• Idarubicin

• Idiopathic

• indomethacin

• Ineffective erythropoiesis

• Intestinal lymphangiectasia

• Infliximab

• Intrinsic factor deficiency

• Iron deficiency

• Kwashiorkor

• Langerhans cell histiocytosis

• Large granular lymphocytic leukemia

• Lassa fever

• Legionella pneumophila

• Leucoerythroblastic anaemia

• Malabsorption syndrome

• Malignant histiocytosis

• Marasmus

• Megaloblastic anaemia

• Melanoma

• Metastatic neoplasm

• Mutagen exposure

• Mutagen-detoxification (GSTq1-null)

• Mycobacterium tuberculosis

• Myelodysplastic syndrome

• Myelofibrosis

• Myeloma

• Myelpathic anemia

• Neurofibromatosis 1

• Niemann-Pick disease

• Non steroidal anti-inflammatory drugs

• Non-Hodgkin lymphoma

• Obesity

• Oklahoma tick fever

• Osteoclastoma

• Osteopetrosis lethal

• Osteopetrosis, autosomal recessive 2

• Osteosarcoma

• Oxaprozin

• Paroxysmal nocturnal haemoglobinuria

• Parvovirus B19 infection

• phenacemide

• phenylbutazone

• Plummer-Vinson syndrome

• Portal hypertension

• Pregnancy

• Prostate cancer

• Propylthiouracil

• Pyrimethamine

• Q fever

• Radium chloride

• Renal failure, chronic

• Reticular dysgenesis

• Rheumatoid disease

• Severe combined immunodeficiency, T- B+ due to JAK3 deficiency

• Sickle cell disease

• Sulfonamides

• Systemic lupus erythematosus

• Tamoxifen

• Thymoma

• Thyroid carcinoma

• Tobacco use

• Topoisomerase II interactive agents

• Trisomy 8 mosaicism

• Valganciclovir hydrochloride

• Vitamin B12 deficiency

• Vitamin C deficiency

• Wiskott-Aldrich syndrome

• Xeroderma pigmentosum

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Anaphylaxis
• Aortic aneurysm rupture
• Bleeding
• Dehydration
• Hypothermia
• Shock

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Common Causes

• ACE inhibitors
• Addison's disease
• Alpha blockers
• Beta blockers
• Bleeding
• Calcium channel blockers
• Diabetes mellitus
• Diuretics
• Hypoglycemia
• Hypothermia
• Hypovolemia
• Pregnancy
• Sepsis
• Shock
• Tricyclic antidepressants

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Causes by Organ System

Cardiovascular	Aortic aneurysm rupture, aortic arch syndrome, aortic isthmus stenosis, aortic regurgitation, aortic stenosis, aortocaval compression syndrome, atrial myxoma, atrioventricular node conduction block, B type natriuretic peptide, baroceptor dysfunction in the elderly, capillary leak syndrome, cardiac tamponade, cardiogenic shock, carotid sinus hypersensitivity, carotid sinus syndrome, coarctation of aorta, complete heart block, constrictive pericarditis, cor triatriatum, dehydration, dissecting aortic aneurysm, distributive shock, Eisenmenger's syndrome, embolism, endotoxic shock, gray baby syndrome, heart arrhythmia, heart block, heart failure, heart injury, hemorrhagic shock, hemorrhagic shock and encephalopathy syndrome, hypertrophic obstructive cardiomyopathy, hypovolemic shock, idiopathic hypotension, iliac artery aneurysm rupture, internal bleeding, ischaemic heart disease, myocardial infarction, myocardial ischemia, obstructive shock, orthostatic hypotension, pericardial effusion, pericarditis, perimyocarditis, post-tussive syncope, postural hypotension, pulmonary embolism, shock, sick sinus syndrome, supraventricular tachycardia , syncope, tetralogy of Fallot, traumatic shock, tricuspid stenosis, vasovagal syncope, ventricular fibrillation, WPW syndrome
Chemical / poisoning	Acetaldehyde, adiponitrile , copper, cyanides, demeton-S-methyl, diazinon , dioxathion, disulfoton , ethion , fensulfothion, fenthion, honey bee bite, indian tobacco, malathion, methidathion, methiocarb, methomyl, mushroom poisoning , parathion, phosdrin, poison hemlock, profenofos, scorpion bite, sodium nitrite, terbufos, tetraethyl pyrophosphate , tetrodotoxin, tobacco , wasp bite
Dermatologic	Gray baby syndrome, mastocytosis
Drug Side Effect	Acetophenazine, alcuronium, alfuzosin, aliskiren, alseroxylon, ambenonium, ambrisentan, amifostine, aminoglutethimide, amitriptyline, amlodipine, amoxapine, amphotericin B, amrinone, amyl nitrate, antipsychotic agents, apomorphine, azilsartan medoxomil, B type natriuretic peptide, baclofen, beta blockers, bethanechol, bethanidine, bortezomib, bosentan, bretylium, bromocriptine, bupivacaine, cabergoline, calcium channel blockers, candesartan, captopril, chloroquine, chlorpheniramine, chlorpromazine, chlorthalidone, cilazapril, cinacalcet, cinnarizine, clevidipine, clomipramine, clonidine, colchicine, cyclobenzaprine, deserpidine, desferrioxamine, desipramine, dexmedetomidine, diazoxide, dichlorvos , dicobalt edetate, dicrotophos , diltiazem, diphenhydramine, dipyridamole, disopyramide, distigmine, diuretics, donepezil , dothiepin, doxazosin, doxepin, enalapril, epidural anaesthesia, eplerenone, epoprostenol, etoposide, felodipine , fenoldopam, fentanyl, fosinopril, general anaesthesia, glyceryl trinitrate, granulocyte-macrophage colony stimulating factor, gray baby syndrome, guanadrel, guanethidine, guanfacine, haloperidol, hexamethonium, hydralazine, hydroxyzine, imipramine, indapamide, indoramin, interleukin 2, iodine containing radiocontrast media, irbesartan, isosorbide dinitrate, isosorbide mononitrate, isoxsuprine, isradipine, ketanserin, labetalol, l-dopa, levomepromazine, levosimendan, lidocaine , lisinopril, lithium, lofexidine, losartan, mecamylamine, methyldopa, metirosine, metolazone, minoxidil, morphine, moxonidine, nefazodone, neostigmine, niacin, nicorandil, nifedipine, nimodipine, nitroprusside, nortriptyline, olanzapine, olmesartan, omapatrilat, opioid poisoning, paliperidone, pentamidine, perazine, pergolide, phenothiazines, phenoxybenzamine, phentolamine, pimobendan, pinacidil, pipothiazine, piribedil, pramipexole, prazosin, protamine sulfate, protriptyline, quetiapine, ramipril, rasagiline, reboxetine, reserpine, rilmenidine, risperidone, rituximab, ropinirole, rotigotine, sassafras oil, serotonin syndrome, sildenafil, silodosin, sodium nitroprusside, spironolactone, streptokinase, sulphonamides, tacrine, tadalafil, tamsulosin, terazosin, tetrabenazine, tizanidine, tolazoline, tramadol, treprostinil, trifluperidol, trimethaphan, trimipramine, tubocurarine, urapidil, valerian, valsartan, vardenafil, verapamil, ziconotide, zotepine
Ear Nose Throat	No underlying causes
Endocrine	Achalasia-addisonianism-alacrima syndrome, ACTH deficiency, Addison's disease, addisonian crisis, adrenal hemorrhage, adrenogenital syndrome, adrenoleukodystrophy , Allgrove syndrome, APECED syndrome , B type natriuretic peptide, carcinoid syndrome , congenital adrenal hyperplasia, diabetes insipidus, diabetic autonomic neuropathy, diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, hypoaldosteronism, hyporeninemic hypoaldosteronism, hypothyroidism, Myxedema, myxedema coma, panhypopituitarism, pituitary insufficiency, pseudohypoaldosteronism, Renon-Delille syndrome, serotonin syndrome, triple-A syndrome
Environmental	Snake bite, zero gravity
Gastroenterologic	Achalasia-addisonianism-alacrima syndrome, acute liver failure , acute pancreatitis, acute viral gastroenteritis, Allgrove syndrome, bowel strangulation, deglutition syncope, diarrhea, duodenal ulcer bleeding, gastric ulcer bleeding, gastric volvulus, hepatic vein thrombosis, hepatitis, intususception, mastocytosis , necrotizing enterocolitis, paralytic ileus, peritonitis , postprandial hypotension, retroperitoneal haemorrhage, small bowel obstruction, splenic rupture, superior mesenteric artery occlusion, triple A syndrome, tropical sprue , variceal bleeding, vomiting
Genetic	Achalasia-addisonianism-alacrima syndrome, acute intermittent porphyria, Allgrove syndrome, APECED syndrome, Bartter syndrome, corticosteroid-binding globulin deficiency , familial juvenile hyperuricemic nephropathy type 2, hereditary peripheral nervous disorder, hereditary sensory and autonomic neuropathy type 3, pseudohypoaldosteronism, Renon-Delille syndrome, Riley-Day syndrome, triple A syndrome, Wohlwill-Andrade syndrome
Hematologic	Acute intermittent porphyria, anemia
Iatrogenic	After a major surgery, blood transfusion , dialyzer hypersensitivity syndrome, epidural anesthesia, gastric acid stimulation test using histamines, general anesthesia, mechanical ventilation, post-operative, renal dialysis, transfusion reaction
Infectious Disease	Acute viral gastroenteritis, botulism, cholera, dengue hemorrhagic fever, hantavirus, lassa fever, rocky mountain spotted fever , septic shock, septicemia , toxic shock syndrome, vibrio vulnificus, Waterhouse-Friederichsen syndrome, Weil syndrome
Musculoskeletal / Ortho	Cervical spine injury, fracture of bone, vertebral fracture
Neurologic	Autonomic failure, autonomic neuropathy, Binswanger's disease , Bradbury-Eggleston syndrome, diabetic autonomic neuropathy, DOPA decarboxylase deficiency, dopamine beta hydroxylase deficiency, dysautonomia, glossopharyngeal neuralgia, Guillain-Barre syndrome, hemorrhagic shock and encephalopathy syndrome, hereditary peripheral nervous disorder, hereditary sensory and autonomic neuropathy type 3, multiple system atrophy, neurogenic shock, Parkinson's disease, polyradiculitis, Riley-Day syndrome, seizures, Shy-Drager syndrome, syringomyelia, tabes dorsalis, vasovagal syncope, Wohlwill-Andrade syndrome
Nutritional / Metabolic	Dehydration,excessive dieting,kwashiorkor
Obstetric/Gynecologic	Aortocaval compression syndrome, ectopic pregnancy rupture, ovarian hyperstimulation syndrome, postpartum haemorrhage, pregnancy, puerpural shock, septic abortion , uterine rupture
Oncologic	Atrial myxoma, carcinoid syndrome , mastocytosis , pheochromocytoma, serotonin-secreting tumor
Opthalmologic	No underlying causes
Overdose / Toxicity	Acetophenazine, alcuronium, alfuzosin, aliskiren, alseroxylon, ambenonium, ambrisentan, amifostine, aminoglutethimide, amitriptyline, amlodipine, amoxapine, amphotericin B, amrinone, antipsychotic agents, apomorphine, azilsartan medoxomil, baclofen, beta blockers, bethanechol, bethanidine, bortezomib, bosentan, bretylium, bromocriptine, bupivacaine, cabergoline, calcium channel blockers, candesartan, captopril, chloroquine, chlorpheniramine, chlorpromazine, chlorthalidone, cilazapril, cinnarizine, clevidipine, clomipramine, clonidine, colchicine, cyclobenzaprine, deserpidine, desferrioxamine, desipramine, dexmedetomidine, diazoxide, dichlorvos , dicobalt edetate, dicrotophos , diltiazem, diphenhydramine, dipyridamole, disopyramide, distigmine, diuretics, donepezil , dothiepin, doxazosin, doxepin, enalapril, epidural anaesthesia, eplerenone, epoprostenol, etoposide, felodipine , fenoldopam, fentanyl, fosinopril, general anaesthesia, glyceryl trinitrate, granulocyte-macrophage colony stimulating factor, guanadrel, guanethidine, guanfacine, haloperidol, hexamethonium, hydralazine, hydroxyzine, imipramine, indapamide, indoramin, interleukin 2, irbesartan, isosorbide dinitrate, isosorbide mononitrate, isoxsuprine, isradipine, ketanserin, labetalol, l-dopa, levomepromazine, levosimendan, lidocaine , lisinopril, lithium, lofexidine, losartan, magnesium overdose, mecamylamine, methyldopa, metirosine, metolazone, minoxidil, morphine, moxonidine, nefazodone, neostigmine, niacin, nicorandil, nifedipine, nimodipine, nitroprusside, nortriptyline, olanzapine, , olmesartan, omapatrilat, opioid poisoning, paliperidone, pentamidine, perazine, pergolide, phenothiazines, phenoxybenzamine, phentolamine, pimobendan, pinacidil, pipothiazine, piribedil, pramipexole, prazosin, protamine sulfate, protriptyline, quetiapine, ramipril, rasagiline, reboxetine, reserpine, rilmenidine, risperidone, rituximab, ropinirole, rotigotine, sassafras oil, sildenafil, silodosin, sodium nitroprusside, spironolactone, streptokinase, sulphonamides, tacrine, tadalafil, tamsulosin, terazosin, tetrabenazine, tizanidine, tolazoline, tramadol, treprostinil, trifluperidol, trimethaphan, trimipramine, tubocurarine, urapidil, valerian, valsartan, vardenafil, verapamil, ziconotide, zotepine
Psychiatric	Anorexia nervosa, depression
Pulmonary	Post-tussive syncope, pulmonary edema, pulmonary embolism, tension pneumothorax
Renal / Electrolyte	Bartter syndrome, dehydration, familial juvenile hyperuricemic nephropathy type 2, hypermagnesaemia, hypokalemia, hyponatremia
Rheum / Immune / Allergy	Amyloidosis, anaphylactic shock, anaphylactoid reaction, blood transfusion , dialyzer hypersensitivity syndrome, food additive allergy, Guillain-Barre syndrome, honey bee bite, mastocytosis, scorpion bite, transfusion reaction, urticaria, wasp bite, Wohlwill-Andrade syndrome, x-ray studies using contrast media
Sexual	Renon-Delille syndrome
Trauma	Blood vessel trauma, burns, cervical spine injury, chemical burn, fracture of bone, heart injury, pericardial effusion, shaken baby syndrome, tension pneumothorax, traumatic shock
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcohol, alcohol withdrawal syndrome, decompression sickness, deglutition syncope, dehydration, fatigue, heat exhaustion, hypothermia, insufficient fluid intake, low salt diet, micturition syncope, prolonged bed rest, snake bite, syncope, volume depletion , zero gravity

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Causes in Alphabetical Order

• Abdominal aortic aneurysm
• Acetaldehyde
• Acetophenazine
• Achalasia-addisonianism-alacrima syndrome
• ACTH deficiency
• Acute intermittent porphyria
• Acute liver failure
• Acute pancreatitis
• Acute viral gastroenteritis
• Addisonian crisis
• Addison's disease
• Adiponitrile
• Adrenal cortex insufficiency
• Adrenal hemorrhage
• Adrenogenital syndrome
• Adrenoleukodystrophy
• After a major surgery
• Alcohol
• Alcohol withdrawal syndrome
• Alcuronium
• Alfuzosin
• Aliskiren
• Allgrove syndrome
• Alseroxylon
• Ambenonium
• Ambrisentan
• Amifostine
• Aminoglutethimide
• Amitriptyline
• Amlodipine
• Amoxapine
• Amphotericin B
• Amrinone
• Amyl nitrate
• Amyloidosis
• Anaphylactic shock
• Anaphylactoid reaction
• Anemia
• Anorexia nervosa
• Antipsychotic agents
• Aortic aneurysm rupture
• Aortic arch syndrome
• Aortic isthmus stenosis
• Aortic regurgitation
• Aortic stenosis
• Aortic valve incompetence
• Aortocaval compression syndrome
• APECED syndrome
• Apomorphine
• Atrial myxoma
• Atrioventricular node conduction block
• Autoimmune adrenalitis
• Autonomic failure
• Autonomic neuropathy
• Azilsartan medoxomil
• B type natriuretic peptide
• Baclofen
• Baroceptor dysfunction in the elderly
• Bartter syndrome
• Beta blockers
• Bethanechol
• Bethanidine
• Binswanger's disease
• Blood transfusion
• Blood vessel trauma
• Bortezomib
• Bosentan
• Botulism
• Bowel strangulation
• Box jellyfish poisoning
• Bradbury-Eggleston syndrome
• Bretylium
• Bromocriptine
• Bupivacaine
• Burns
• Cabergoline
• Calcium channel blockers
• Candesartan
• Capillary leak syndrome
• Captopril
• Carcinoid syndrome
• Cardiac arrhythmias
• Cardiac failure, left sided
• Cardiac tamponade
• Cardiogenic shock
• Carotid sinus hypersensitivity
• Carotid sinus syndrome
• Cervical spine injury
• Charcot-Marie-Tooth disease
• Chemical burn
• Chloroquine
• Chlorpheniramine
• Chlorpromazine
• Chlortalidone
• Cholera
• Chronic pyelonephritis
• Chronic renal failure
• Cilazapril
• Cinnarizine
• Clevidipine
• Clomipramine
• Clonidine
• Coarctation of aorta
• Colchicine
• Complete heart block
• Congenital adrenal hyperplasia
• Constrictive pericarditis
• Copper
• Cor triatriatum
• Corticosteroid-binding globulin deficiency
• Cyanides
• Cyclobenzaprine
• Decompression sickness
• Deglutition syncope
• Dehydration
• Demeton-S-methyl
• Dengue hemorrhagic fever
• Depression
• Deserpidine
• Desferrioxamine
• Desipramine
• Dexmedetomidine
• Diabetes insipidus
• Diabetic autonomic neuropathy
• Diabetic ketoacidosis
• Dialyzer hypersensitivity syndrome
• Diarrhea
• Diazinon
• Diazoxide
• Dichlorvos
• Dicobalt edetate
• Dicrotophos
• Diltiazem
• Dioxathion
• Diphenhydramine
• Dipyridamole
• Disopyramide
• Dissecting aortic aneurysm
• Distigmine
• Distributive shock
• Disulfoton
• Diuretics
• Donepezil
• DOPA decarboxylase deficiency
• Dopamine
• Dopamine beta hydroxylase deficiency
• Dothiepin
• Doxazosin
• Doxepin
• Duodenal ulcer bleeding
• Dysautonomia
• Dysrhythmia
• Ectopic pregnancy rupture

• Eisenmenger's syndrome
• Embolism
• Enalapril
• Endotoxic shock
• Epidural anaesthesia
• Eplerenone
• Epoprostenol
• Ethion
• Etoposide
• Excessive dieting
• Excessive fluid loss through dialysis
• Familial juvenile hyperuricemic nephropathy type 2
• Fatigue
• Felodipine
• Fenoldopam
• Fensulfothion
• Fentanyl
• Fenthion
• Focal cerebral ischemia
• Food additive allergy
• Fosinopril
• Gastric acid stimulation test using histamines
• Gastric ulcer bleeding
• Gastric volvulus
• General anaesthesia
• Gitelman syndrome
• Glossopharyngeal neuralgia
• Glyceryl trinitrate
• Granulocyte-macrophage colony stimulating factor
• Gray baby syndrome
• Guanadrel
• Guanethidine
• Guanfacine
• Guillain-Barre syndrome
• Haloperidol
• Hantavirus
• Heart arrhythmia
• Heart block
• Heart failure
• Heart injury
• Heat exhaustion
• Hemorragic fever with renal syndrome
• Hemorrhage
• Hemorrhagic shock
• Hemorrhagic shock and encephalopathy syndrome
• Hepatic vein thrombosis
• Hepatitis
• Hereditary peripheral nervous disorder
• Hereditary sensory and autonomic neuropathy type 3
• Hexamethonium
• Histamine
• HIV
• Honey bee bite
• Hydralazine
• Hydroxyzine
• Hyperglycemia
• Hypermagnesemia
• Hyperosmolar hyperglycemic nonketotic coma
• Hypertrophic obstructive cardiomyopathy
• Hypoaldosteronism
• Hypokalemia
• Hyponatremia
• Hyporeninemic hypoaldosteronism
• Hypothermia
• Hypothyroidism
• Hypovolemia
• Hypovolemic shock
• Idiopathic hypotension
• Iliac artery aneurysm rupture
• Imipramine
• Indapamide
• Indian tobacco
• Indoramin
• Infliximab
• Insufficient fluid intake
• Interleukin 2
• Internal bleeding
• Intususception
• Iodine containing radiocontrast media
• Irbesartan
• Ischaemic heart disease
• Isoprenaline
• Isosorbide dinitrate
• Isosorbide mononitrate
• Isoxsuprine
• Isradipine
• Ketanserin
• Kwashiorkor
• Labetalol
• Lactic acidosis
• Lassa fever
• L-dopa
• Levomepromazine
• Levosimendan
• Lidocaine
• Lisinopril
• Lithium
• Lofexidine
• Losartan
• Low salt diet
• Lyme disease
• Lysuride
• Magnesium overdose
• Malathion
• MAOI
• Marijuana
• Mastocytosis
• Maternal hypotension syndrome
• Mecamylamine
• Mechanical ventilation
• Methidathion
• Methiocarb
• Methomyl
• Methyldopa
• Methyldopate
• Metirosine
• Metolazone
• Micturition syncope
• Minoxidil
• Mitral stenosis
• Mitral valve incompetence
• Morphine
• Moxonidine
• Multiple system atrophy
• Mushroom poisoning
• Myocardial infarction
• Myocardial ischemia
• Myocarditis
• Myxedema
• Myxedema coma
• Necrotizing enterocolitis
• Nefazodone
• Neostigmine
• Neurogenic shock
• Niacin
• Nicorandil
• Nifedipine
• Nimodipine
• Nitroprusside
• Nortriptyline
• Obstructive shock
• Olanzapine
• Olmesartan
• Omapatrilat
• Opioid poisoning
• Orthostatic hypotension
• Ovarian hyperstimulation syndrome
• Paliperidone
• Pancreatitis
• Panhypopituitarism
• Paralytic ileus
• Parathion

• Parkinson's disease
• Pentamidine
• Perazine
• Pergolide
• Pericardial effusion
• Pericarditis
• Perimyocarditis
• Peritonitis
• Phenothiazines
• Phenoxybenzamine
• Phentolamine
• Pheochromocytoma
• Phosdrin
• Pick's disease
• Pimobendan
• Pinacidil
• Pipothiazine
• Piribedil
• Pituitary insufficiency
• Poison hemlock
• Polyradiculitis
• Post-operative
• Postpartum haemorrhage
• Postprandial hypotension
• Post-tussive syncope
• Postural hypotension
• Pramipexole
• Prazosin
• Pregnancy
• Primary pulmonary hypertension
• Profenofos
• Prolonged bed-rest
• Protamine sulfate
• Protriptyline
• Pseudohypoaldosteronism
• Puerpural shock
• Pulmonary edema
• Pulmonary embolism
• Pulmonary stenosis
• Pyogenic pericarditis
• Quetiapine
• Ramipril
• Rasagiline
• Reboxetine
• Renal dialysis
• Renal tubular dysgenesis
• Renon-Delille syndrome
• Reserpine
• Respiratory acidosis
• Retroperitoneal haemorrhage
• Rickettsia prowazekii
• Riley-Day syndrome
• Rilmenidine
• Risperidone
• Rituximab
• Rocky mountain spotted fever
• Ropinirole
• Rotigotine
• Sarcoidosis
• Sassafras oil
• Scorpion bite
• Seizures
• Sepsis
• Septic abortion
• Septic shock
• Septicemia
• Serotonin syndrome
• Serotonin-secreting tumor
• Severe bleeding
• Shaken baby syndrome
• Shock
• Shy-Drager syndrome
• Sick sinus syndrome
• Sildenafil
• Silodosin
• Sjogren syndrome
• Small bowel obstruction
• Snake bite
• Sodium nitrite
• Sodium nitroprusside
• Spironolactone
• Splenic rupture
• Streptokinase
• Sulphonamides
• Superior mesenteric artery occlusion
• Supraventricular tachycardia
• Syncope
• Syphilis
• Syringomyelia
• Systemic candidiasis
• Tabes dorsalis
• Tacrine
• Tadalafil
• Tamsulosin
• Tension pneumothorax
• Terazosin
• Terbufos
• Tetrabenazine
• Tetraethyl pyrophosphate
• Tetralogy of Fallot
• Tetrodotoxin
• Thoracic aortic aneurysm
• Tizanidine
• Tobacco
• Tolazoline
• Toxic shock syndrome
• Toxoplasmosis
• Tramadol
• Transfusion reaction
• Trauma
• Traumatic shock
• Treprostinil
• Tricuspid stenosis
• Tricyclic antidepressants
• Trifluperidol
• Trimethaphan
• Trimipramine
• Triple A syndrome
• Tropical sprue
• Tuberculous pericarditis
• Tubocurarine
• Ulcerative colitis
• Urapidil
• Uremic pericarditis
• Urticaria
• Uterine rupture
• Valsartan
• Vancomycin resistant enterococcal bacteremia
• Vardenafil
• Variceal bleeding
• Vascular neuropathy
• Vasovagal syncope
• Ventricular familial preexcitation syndrome
• Ventricular fibrillation
• Verapamil
• Vertebral fracture
• Vibrio vulnificus
• Viral pericarditis
• VLCAD deficiency
• Volume depletion
• Vomiting
• Wasp bite
• Waterhouse-Friederichsen syndrome
• Weil syndrome
• Wohlwill-Andrade syndrome
• WPW syndrome
• Xamoterol
• X-ray studies using contrast media
• Zero gravity
• Ziconotide
• Zotepine

Sandbox Ochuko developed by WikiDoc.org

Primary treatment option Atropine ❑ Administer a first dose 0.5 mg IV bolus ❑ Repeat every 3-5 minutes ❑ Administer a maximum dose of 3 mg

Secondary treatment options If atropine ineffective: ❑ Administer dopamine infusion (2-10 mcg/kg/min) OR ❑ Administer epinephrine infusion (2-10 mcg/min) OR ❑ Proceed with transcutaneous pacing

❑ Consult a cardiologist ❑ Consider transvenous pacing

• Adenine phosphoribosyltransferase deficiency
• Allopurinol
• Aniline
• Behcet's disease
• Benign prostatic hyperplasia
• Benzidine
• Bladder incontinence
• Bladder stones
• Bleomycin
• Candida
• Carbenicillin
• Cetirizine
• Chemical cystitis
• Chlamydia
• Chlordimeform
• Congenital abnormalities of the urinary tract
• Crohn's disease
• Cyclophosphamide
• Cystoscopy
• Danazol
• Dehydration
• Diabetes
• Diabetic neuropathy
• Diaphragm
• Diarrhea
• Diverticulitis
• Doxorubicin
• Drug induced cystitis
• Endometriosis
• Enterobacter
• Episiotomy scar infection
• Escherichia coli
• Ether
• Foreign body cystitis
• Gonorrhea
• Gynecological cancers
• Hemorrhagic cystitis
• Honeymoon cystitis
• Hunner's ulcer
• Ifosfamide
• Immobility
• Interstitial cystitis
• Intravesical acetic acid
• Kidney stones
• Klebsiella
• Lupus
• Methaqualone
• Methenamine mandelate
• Methicillin
• Methotrexate
• Mucoepithelial dysplasia, Witkop type
• Nonoxynol-9 suppositories
• NSAIDS
• Penicillin VK
• Penicillins
• PID
• Piperacillin
• Posterior urethral valves
• Prostatitis
• Pseudomonas aeruginosa
• Radiotherapy
• Schistosomiasis
• Serratia
• Sexually transmitted diseases
• Spermicidal jellies
• Spinal cord injury
• Staphylococcus saprophyticus
• Tampon
• Temozolomide
• Tiaprofenic acid
• Ticarcillin
• Toluidine
• Trichomoniasis
• Tuberculosis
• Urachal cancer
• Urachal cyst
• Urethral syndrome
• Urethritis
• Urinary catheter
• Urinary obstruction
• Urinary stones
• Urofacial syndrome
• Vesicoenteric fistula
• Xanthinuria

Diagnosis

Complete Evaluation

A01

B01

C01

D01

D02

E01

E02

F01