Kounis Syndrome: A Case of Vancomycin-Associated Coronary Artery Vasospasm Resulting in Myocardial Infarction.

We describe a case of Kounis syndrome, an allergic reaction causing coronary artery vasospasm, triggered by a vancomycin infusion, in a healthy 32-year-old man. The patient initially presented with an inguinal abscess requiring intravenous vancomycin. During his third infusion, he developed typical chest pain that resolved with cessation of the infusion.

EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography.

Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'.

Screening and Initiating Supportive Care in Patients With Heart Failure.

Patients with heart failure (HF) experience a major symptom burden and an overall reduction of quality of life. However, supportive care (SC) remains an under-utilized resource for these patients. Among the many existing barriers to integrating SC into routine care, identifying patients with SC needs remains challenging.

Hydroxychloroquine-induced cardiomyopathy: case report, pathophysiology, diagnosis, and treatment.

Drug-induced heart and vascular disease remains an important health burden. Hydroxychloroquine and its predecessor chloroquine are medications commonly used in the treatment of systemic lupus erythematosus, rheumatoid arthritis, and other connective tissue disorders. Hydroxychloroquine interferes with malarial metabolites, confers immunomodulatory effects, and also affects lysosomal function.

Multifaceted support for a new medical school in Nepal devoted to rural health by a Canadian Faculty of Medicine and Dentistry.

Nepal and Alberta are literally a world apart. Yet they share a common problem of restricted access to health services in remote and rural areas. In Nepal, urban-rural disparities were one of the main issues in the recent civil war, which ended in 2006.

2010 Canadian Cardiovascular Society/Canadian Society of Echocardiography Guidelines for Training and Maintenance of Competency in Adult Echocardiography.

Guidelines for the provision of echocardiography in Canada were jointly developed and published by the Canadian Cardiovascular Society and the Canadian Society of Echocardiography in 2005. Since their publication, recognition of the importance of echocardiography to patient care has increased, along with the use of focused, point-of-care echocardiography by physicians of diverse clinical backgrounds and variable training. New guidelines for physician training and maintenance of competence in adult echocardiography were required to ensure that physicians providing either focused, point-of-care echocardiography or comprehensive echocardiography are appropriately trained and proficient in their use of echocardiography.

The correlation of standard heart failure assessment and palliative care questionnaires in a multidisciplinary heart failure clinic.

Context: Heart failure (HF) is a leading cause of death and disability, and despite optimal care, patients may eventually require palliative care. Little is known about how palliative care questionnaires (the Edmonton Symptom Assessment Scale [ESAS] and the Palliative Performance Scale [PPS]) perform compared with HF assessment using the New York Heart Association (NYHA) functional class and the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Objectives: To assess the utility of a palliative care questionnaire in patients with HF.

Left atrial appendage thrombus in a patient in sinus rhythm with endocarditis and a severe aortic valve insufficiency.

A left atrial thrombus is most often associated with atrial fibrillation and/or rheumatic mitral stenosis. It is very infrequently detected in the presence of sinus rhythm. The present report describes the case of a 66-year-old woman who presented with a stroke and was subsequently found to have two potential sources of embolization, including a vegetation on the native aortic valve, with associated severe aortic insufficiency, and a left atrial appendage thrombus despite being in sinus rhythm.

Effect of invasive coronary revascularization in acute myocardial infarction on subsequent death rate and frequency of chronic heart failure.

There is debate about whether therapies that reduce mortality in acute myocardial infarction (AMI) will increase the risk for heart failure. In this study, an inception cohort of patients hospitalized with AMIs from April 1, 1994, to March 31, 1999 (without previous diagnoses of heart failure or myocardial infarction), were followed for a mean of 32 months to explore whether invasive coronary revascularization during the index AMI hospitalization was associated with a trade-off between reduced mortality in the short term and increased heart failure in the intermediate term. Of 13,472 patients (mean age 65 +/- 13 years, 70% men), 3,278 (24%) underwent invasive coronary revascularization during their index AMI hospitalizations.

Effect of long-term aspirin use on embolic events in infective endocarditis.

Background: In a recent clinical trial, aspirin therapy was initiated approximately 34 days after the onset of symptoms but did not reduce the risk of embolism in patients with endocarditis. However, it is possible that aspirin used early in the course of the disease may be beneficial. The purpose of the study is to assess the effect of long-term daily aspirin use on the risk of embolic events in patients with infective endocarditis.

Proportion of patients followed in a specialized heart failure clinic needing an implantable cardioverter defibrillator as determined by applying different trial eligibility criteria.

Numerous trials have demonstrated survival benefits using implantable cardioverter defibrillators (ICDs) for primary prevention in selected patients with left ventricular (LV) systolic dysfunction. However, eligibility criteria differed across these trials. Without a risk stratification scheme that clearly identifies those who will benefit, there remains debate about which patients with heart failure (HF) should receive ICDs for primary prevention.

How many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective cohorts.

Aims: To determine what proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT).

Methods And Results: Eligibility criteria from the trials establishing the efficacy of CRT were applied to two prospective cohorts: the first enrolled patients with newly diagnosed heart failure discharged from 103 hospitals between April 1999 and March 2001 ('the hospital discharge cohort'); the second enrolled patients seen in a specialized clinic between August 2003 and January 2004 ('the specialty clinic cohort'). In the hospital discharge cohort, 73 patients (3% of the 2640 patients with ischaemic or dilated cardiomyopathy and 1% of all 9096 patients with heart failure discharged alive) met trial eligibility criteria: LVEF< or =0.

Guidelines for the provision of echocardiography in Canada: recommendations of a joint Canadian Cardiovascular Society/Canadian Society of Echocardiography Consensus Panel.

Recognizing the central role of echocardiographic examinations in the assessment of most cardiac disorders and the need to ensure the provision of these services in a highly reliable, timely, economical and safe manner, the Canadian Cardiovascular Society and Canadian Society of Echocardiography undertook a comprehensive review of all aspects influencing the provision of echocardiographic services in Canada. Five regional panels were established to develop preliminary recommendations in the five component areas, which included the echocardiographic examination, the echocardiographic laboratory and report, the physician, the sonographer and indications for examinations. Membership in the panels was structured to recognize the regional professional diversity of individuals involved in the provision of echocardiography.

The effect of age upon care and outcomes in patients hospitalized for congestive heart failure in Alberta, Canada.

We describe the age-specific outcomes for patients hospitalized with newly diagnosed congestive heart failure using administrative hospital abstracts from Alberta, Canada, from April 1, 1994, to March 31, 2000. Seniors (aged 65 years and older) constituted about 85 per cent of the 16,162 patients. Both co-morbidity and severity of illness tended to increase with age.

Association between physician specialty and volumes of treated patients and mortality among patients hospitalized for newly diagnosed heart failure.

Purpose: To assess the effects of hospital care by a specialist or nonspecialist physician, and by volume of treated patients, on mortality among hospitalized patients with newly diagnosed heart failure.

Methods: Data describing heart failure patients in Alberta, Canada, from April 1, 1994, to March 31, 2000, were extracted from hospital abstracts and analyzed using hierarchical regression, with adjustment for patient demographic characteristics, comorbid conditions, physician volume, physician specialty, and hospital volume.

Results: There were 16,162 hospital discharges for heart failure.

The province of Alberta, Canada avoids the hospitalization epidemic for congestive heart failure patients.

Background: We assessed the incidence and prevalence of congestive heart failure (CHF) in patients diagnosed at the time of hospitalization and patients diagnosed in specialists offices without prior hospitalization in order to compare the trends in Canada with previously published trends in the USA and other industrialized countries.

Methods: Administrative data for Alberta, Canada from 1 April 1994 to 31 March 2000.

Results: There was a small but statistically significant decline in the age-sex incident and prevalent hospitalization rates for CHF between 1994/1995 (incidence per 1000 of 1.

Home care before and after hospitalization for acute myocardial infarction in Alberta, Canada.

Unlabelled: Home care services are provided to about 10% of those admitted to hospital for acute myocardial infarction and about 20% of those discharged from hospital. The use of home care in patients with an acute myocardial infarction is growing in Alberta over the brief time span of this four year study. Those that received home care prior to a hospitalization for acute myocardial infarction were "old and frail" with a high mortality rate during and after hospitalization.

The use of beta-blockers in a tertiary care heart failure clinic: dosing, tolerance, and outcomes.

Background: Little is known about the dosing, tolerability, and impact of beta-blockers in nontrial participants. This study was conducted to evaluate the use and outcomes of beta-blockers in a tertiary care heart failure clinic.

Methods: Analysis of prospectively collected data from a cohort of 1041 patients with heart failure seen at the University of Alberta Heart Function Clinic, Edmonton, from September 1, 1989, through July 1, 2001, with objective measurement of ejection fraction at baseline and prospective collection of data at all subsequent clinic visits.

Acute myocardial infarction in Alberta: temporal changes in outcomes, 1994 to 1999.

Background: The current survival trends in patients with acute myocardial infarction (AMI) are not known. A population-based study using administrative data to examine the short and long term survival of patients after AMI in Alberta between 1994 and 1999 was conducted.

Methods: AMI patients were identified from hospital discharge data.

Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada.

Objectives: We sought to evaluate the common utilization of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors or receptor blockers (RBs) in congestive heart failure (CHF).

Background: We assessed the association between prescriptions of beta-blockers and ACE inhibitors or RBs within three months after hospitalization and mortality for newly diagnosed CHF in Alberta, Canada seniors (age 65 years and older).

Methods: Administrative hospital discharge abstracts and drug data during October 1, 1994, to December 31, 1999, were analyzed.

Rural and urban outcomes after hospitalization for congestive heart failure in Alberta, Canada.

Objectives: We compare the hospitalization rate, duration, cost, and mortality for newly diagnosed congestive heart failure in patients admitted to rural and metropolitan hospitals in one Canadian province.

Methods: Administrative data for Alberta, Canada, from April 1, 1994, to March 31, 2000.

Results: Hospitalizations (16,162) for newly diagnosed congestive heart failure constituted 50% of all hospitalizations for congestive heart failure.

A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis.

Objectives: This study examined the effect of aspirin on the risk of embolic events in infective endocarditis (IE).

Background: Embolism is a major complication of IE, and studies in animal models have shown that platelet inhibition with aspirin can lead to more rapid vegetation resolution and a lower rate of embolic events.

Methods: We conducted a randomized, double-blinded, placebo-controlled trial of aspirin treatment (325 mg/day) for four weeks in patients with IE to test the hypothesis that the addition of aspirin would reduce the incidence of clinical systemic embolic events.