A 38-year-old Hispanic woman with paradoxical embolism and Libman-Sacks endocarditis involving the tricuspid valve.

Libman-Sacks endocarditis is a well-described clinical entity in patients with systemic lupus erythematosus. Transesophageal echocardiography is the definitive imaging modality used in assessing cardiac valvular involvement in this disease process. Herein we describe a young Hispanic woman with systemic lupus erythematosus and multiple tricuspid valvular vegetations who developed splenic and cerebral infarctions while on optimal anticoagulation therapy with warfarin in the setting of a newly diagnosed patent foramen ovale.

The bitter end: the ubiquitin-proteasome system and cardiac dysfunction.

Many elements contribute to congestive heart failure: changes in perfusion, hemodynamic stresses, alterations in calcium metabolism, and dysregulation of cell signaling pathways. Intervention in these processes forms the basis for current heart failure therapies. Nevertheless, heart failure is primarily a disease of wear and tear; despite everything we know about cardiac physiology and the clinical manifestations of heart failure, only in rare instances does therapy for heart failure normalize cardiac function.

Clinical predictors and characteristics of patients with chronic liver disease and intrapulmonary shunts.

Background: Intrapulmonary shunting (IPS) is a well-described phenomenon in chronic liver disease but its significance is not known.

Hypothesis: The study was undertaken to enhance our understanding of the characteristics and prevalence of IPS.

Methods: We retrospectively studied 204 consecutive patients with end-stage chronic liver disease who underwent a dobutamine stress echocardiogram, along with a saline contrast bubble study, as part of their pretransplant evaluation.

Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension.

Objectives: The aim of this study was to evaluate the relationships between echocardiographic findings and clinical outcomes in patients with severe primary pulmonary hypertension (PPH).

Background: Primary pulmonary hypertension is associated with abnormalities of right heart structure and function that contribute to the poor prognosis of the disease. Echocardiographic abnormalities associated with PPH have been described, but the prognostic significance of these findings remains poorly characterized.