An enigmatic presentation of endocarditis: Emphasizing the role of brain magnetic resonance imaging.

Key Clinical Message: Infective endocarditis should be considered in any febrile individual with acute onset neurological symptoms. If suspicion is high, a negative brain computed tomography does not virtually exclude embolism, and magnetic resonance imaging is warranted.

Abstract: A diagnosis of infective endocarditis (IE) is often delayed, particularly in those infected with unusual organisms.

Anomalous Aortic Origin of the Right Coronary Artery: A Case Report and Review of the Literature.

Unlabelled: Patients with symptomatic or malignant anomalous aortic origin of the right coronary artery (AAORCA) warrant surgical treatment to decrease morbidity and mortality. Various surgical techniques have been implemented including unroofing, reimplantation and bypass grafting. A 43-year-old woman presented with intermittent chest pain due to malignant AAORCA and received saphenous bypass grafting, instead of reimplantation, due to intraoperative spasm.

A Massive Right Atrial Mass in Chronic Myelogenous Leukaemia: A Case Report and Literature Review.

Unlabelled: Right atrial masses are rare and diagnosis can be difficult unless histopathological specimens are obtained. In addition, the clinical course is not well documented, thereby making diagnosis and management challenging. The mass can be associated with haemodynamic instability with the potential to cause obstructive shock and embolism.

Improving Clinical Documentation in an Academic Setting: A Multidisciplinary Team Approach Focused on the Physician's Perspective.

This research article discusses the results of a pilot study at a large academic medical center to appropriately describe patient severity and the likelihood of mortality. In this study, we compare two projects, both of which use a clinical document specialist (CDS). The control case measures documentation quality using an attending physician-focused model.

Reactive Thrombocytosis Associated with Acute Myocardial Infarction following STEMI with Percutaneous Coronary Intervention.

The etiology of thrombocytosis can be classified into reactive and essential forms. The rate of thromboembolic events is higher in essential thrombocytosis, and these events include strokes, transient ischemic attacks, retinal artery or retinal vein occlusions, digital ischemia, and acute coronary syndrome. In a study of 732 medical and surgical patients with thrombocytosis, 88% had reactive thrombocytosis.

Temporary Transvenous Cardiac Pacing in Patients With Acute Myocardial Infarction Predicts Increased Mortality.

Background: Temporary pacemakers (TP) are used in emergency situations for severe bradyarrhythmias secondary to acute myocardial infarction (AMI) and to non-AMI related cardiac disorders. TP have been studied previously in AMI patients treated with thrombolytic therapy; limited information is available on current outcomes in AMI patients treated with percutaneous coronary intervention.

Methods: We reviewed the indications, complications, and mortality associated with TP insertion over a four year period (2003 - 2007) at a university hospital.

LASER endovascular atherectomy with secondary stenting of technically challenging calcified celiac trunk stenosis.

Endovascular therapy for chronic mesenteric ischemia is a proven, feasible alternative approach to open surgical repair with significantly lower morbidity and mortality. A clinical dilemma is encountered when technically challenging lesions are encountered during the procedure. We present here an 86 year-old woman who had intractable abdominal pain with postprandial exacerbation.

Monophasic synovial sarcoma presenting as mitral valve obstruction.

We report the case of a 26-year-old man who experienced progressive left-sided chest pain and 2 episodes of near-syncope. Studies revealed a 15-cm mass in the upper left lung, a 10-cm mass in the medial base of the left lung, and a 5-cm left atrial mass that involved the left lung, infiltrated the left pulmonary vein, and prolapsed into the mitral valve, causing intermittent obstruction. The patient underwent surgical excision of the left atrial tumor.

Emotional stress and tako-tsubo cardiomyopathy: observations on 2 distinct clinical phenotypes.

Background: Tako-tsubo syndrome is a transient cardiomyopathy usually precipitated by an acute emotional or physiological stress. Our study objectives were to review and analyze the impact of emotional stress on clinical variables, echocardiographic characteristics, and short-term outcomes in patients with tako-tsubo syndrome.

Methods: Retrospective chart review.

Closure of a giant saphenous vein graft aneurysm with embolization coil.

Aneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare, usually asymptomatic and found incidentally. We report a case of an 84-year-old female who was found to have 8.1 x 8.

Postpartum depression and apical ballooning syndrome (takotsubo syndrome).

Background: Acute cardiac complications occur occasionally during pregnancy and in the immediate postpartum period. Some of these cardiac scenarios are rare and provide a diagnostic challenge. We report a case of apical ballooning syndrome (ABS), also known as takotsubo cardiomyopathy or broken-heart syndrome, in a postpartum patient.

Left circumflex coronary artery to hepatic vein fistula: a case report and brief review of coronary vasculogenesis.

Coronary artery fistulas are rare coronary artery anomalies. Their clinical significance varies from a long asymptomatic course to overt heart failure and death. They are often detected incidentally with diagnostic coronary angiograms.

Aortic coarctation complicated with multiple saccular aortic aneurysms.

Aortic coarctation is a congenital malformation of the aorta that should be diagnosed and corrected early in life. The natural history of unrepaired coarctation of the aorta includes the development of systemic hypertension and subsequent morbidity and death from cardiovascular disease. Here, we present a case with replacement of the aortic arch and its branches by tortuous multilobulated aneurysms as a result of untreated aortic coarctation.

Coronary artery aneurysms in Behçet's disease.

Behçet's disease is a rare chronic autoimmune vasculitis with characteristic skin findings. Vascular involvement generally affects veins more than arteries, and coronary arterial involvement is extremely uncommon. Here we report the significant coronary artery aneurysms detected in a 41-year-old man with Behçet's disease who had been in remission for 13 years.

Do comorbid psychiatric disorders contribute to the pathogenesis of tako-tsubo syndrome? A review of pathogenesis.

Patients with tako-tsubo cardiomyopathy have unusual characteristics, including a disproportionate occurrence in postmenopausal women and a strong association with mental and physical stress. These patients present with chest pain, abnormal electrocardiographic findings, and myocardial enzyme leaks. They appear to have acute coronary syndrome but have normal epicardial coronary vessels and reversible left ventricular dysfunction.

Transient left ventricular apical ballooning during dobutamine myocardial perfusion imaging.

The transient left ventricular apical ballooning is characterized by wall motion abnormalities involving the apex in the absence of obstructive coronary disease. It is precipitated by acute emotional or physical stress and is most often reported in post-menopausal women. We report a case of transient left ventricular "apical ballooning" without significant coronary artery disease precipitated by high dose dobutamine infusion during pharmacological stress myocardial perfusion imaging.

Synergistic interactions between Ca2+ entries through L-type Ca2+ channels and Na+-Ca2+ exchanger in normal and failing rat heart.

We used confocal Ca2+ imaging and the patch-clamp technique to investigate the interplay between Ca2+ entries through L-type Ca2+ channels (LCCs) and reverse-mode Na+-Ca2+ exchange (NCX) in activating Ca2+-induced Ca2+ release (CICR) from the sarcoplasmic reticulum (SR) in cardiac myocytes from normal and failing rat hearts. In normal myocytes exposed to N(6),2'-O-dibutyryl adenosine-3',5'-cyclic monophosphate (db-cAMP, membrane-permeable form of cAMP), the bell-shaped voltage dependence of cytosolic Ca2+ transients was dramatically broadened due to activation of SR Ca2+ release at high membrane potentials (30-120 mV). This broadening of Ca2+-transient voltage dependence could be prevented by KB-R7943, an inhibitor of the reverse-mode NCX.

Embolus in transit.

A patient who presented with recurrent syncopal episodes was discovered to have a right-sided heart mass, which was revealed as an embolus in transit resulting in a lethal pulmonary embolic event. The initial focus of etiology on tumor rather than thrombus was misleading. A higher index of suspicion of thrombus in right heart mass may help future patients receive more directed therapy.

Abdominal aortic aneurysm demonstrated on renal scintigraphy.

A 74-year-old hypertensive woman presented with abdominal discomfort and a pulsatile abdominal mass. Anterior abdominal angiography during cardiac blood pool, and renal scintigraphic imaging demonstrated a large abdominal aortic aneurysm. 1, 2 Before endovascular repair with an aortoiliac endograft, the abdominal aneurysm measured 7.