Left bundle branch pacing utilizing three dimensional mapping.

Introduction: Permanent His bundle pacing is feasible and effective in patients with atrioventricular block or left bundle branch block. However, pacing thresholds to capture the distal His bundle is often higher. Recently left bundle branch area pacing (LBBP) has been shown to be feasible by advancing the lead transvenously, deep into the interventricular septum to reach the left ventricular endocardial surface.

Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing.

Objectives: The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP.

Background: HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction.

Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing.

Background: His bundle pacing (HBP) is the most physiologic form of pacing but associated with higher thresholds and lower success in patients with His-Purkinje conduction disease. Recent reports have described transvenous left bundle branch area pacing (LBBAP).

Objective: We aimed to prospectively evaluate the feasibility and the electrophysiologic and echocardiographic characteristics of LBBAP.

An Uncommon Association of Familial Partial Lipodystrophy, Dilated Cardiomyopathy, and Conduction System Disease.

A 46-year-old African American woman presented with severe respiratory distress requiring intubation and was diagnosed with nonischemic cardiomyopathy. She had the typical phenotype of familial partial lipodystrophy 2 (FPLD2). Sequence analysis of LMNA gene showed a heterozygous missense mutation at exon 8 (c.

Amphetamine-related ischemic colitis causing gastrointestinal bleeding.

A 43-year-old woman presented with acute lower intestinal bleeding requiring blood transfusion. Multiple initial investigations did not reveal the cause of the bleeding. Colonoscopy performed 2 days later showed features suggestive of ischemic colitis.

Streptococcus agalactiae pyomyositis in diabetes mellitus.

Pyomyositis is an acute infectious disorder affecting the skeletal muscle. Although seen more commonly in the tropics, cases are being reported in temperate countries, including the United States. We report a case of nontropical pyomyositis in a 58-year-old diabetic man who presented with a vague chest wall swelling.

Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects.

Idiopathic intracranial hypertension (IIH) is an uncommon disorder characterized by increased intracranial pressure without radiological or laboratory evidence of intracranial pathology except empty sella turcica, optic nerve sheath with filled out cerebrospinal fluid spaces, and smooth-walled nonflow-related venous sinus stenosis or collapse. This condition typically affects obese women. The incidence of IIH is increasing with the rising prevalence of obesity.

An Uncommon Complication With Use of Topical Local Anesthetic Agents: Methemoglobinemia.

Although the use of topical local anesthetics is generally safe, several potentially fatal complications have been reported. Methemoglobinemia is a rare but potentially fatal complication. Methemoglobin is a naturally occurring oxidized metabolite of hemoglobin, and physiologic levels (<1%) are normal.

Indications and appropriateness of inferior vena cava filter placement.

Background: Several professional societies have published guidelines for the placement of inferior vena cava (IVC) filters. The authors wanted to determine how frequently patients in their hospital had IVC filters placed based on current indications and to compare guidelines published by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiologists (SIR).

Methods: The authors performed a structured review of the medical records of 180 patients identified by International Classification of Diseases, Ninth Revision, codes who had IVC filter placement at their hospital between July 1, 2007, and June 30, 2012.

Mach band sign: an optical illusion.

The chest radiograph of a 63-year-old woman who was found unresponsive was concerning for pneumopericardium, but lacked the other corroborative features suggestive of pneumopericardium. None of the follow-up chest radiographs showed evidence of air around the heart. The radiolucent shadow that mimicked pneumopericardium in this case was due to an artifact known as Mach band sign, an illusion created by lateral inhibition in the light receptors in the retina.

Cardiac repolarization abnormalities among patients with various stages of chronic kidney disease.

Background: Patients with chronic kidney disease (CKD) are at increased risk of life-threatening cardiovascular arrhythmias. Although these arrhythmias are usually secondary to structural heart diseases that are commonly associated with CKD, a significant proportion of cases with sudden cardiac death have no obvious structural heart disease. This study aims to explore the relationship of cardiac repolarization in patients with CKD and worsening kidney function.

The alien hand syndrome.

A 77-year-old woman presented with the complaint of observing her left hand moving without her knowledge while watching television. Her left hand stroked her face and hair as if somebody was controlling it. These movements lasted only half an hour but on recovery, she had left hemiparesis.

Intracranial hypertension and intracranial hypotension causing headache in the same patient.

Intracranial hypertension and intracranial hypotension are on the opposite end of the intracranial pressure spectra. It is extremely uncommon for both to cause headache in the same patient within a span of several days. This report describes a young man with intracranial hypertension who developed a severe excruciating headache due to intracranial hypotension after a diagnostic lumbar puncture.

Comparison of patients rehospitalized for heart failure with versus without a history of habitual alcohol consumption.

Alcohol paradoxically is known to have a protective and a deleterious effect on the heart. The effect of alcoholism on the growing problem of heart failure (HF) readmissions is not known. This study addressed this issue with a population of adult patients (>20 years old) who were readmitted for HF within 30 days after a hospitalization for HF at a university hospital in West Texas for a period of 5 years.

Fatal Clostridium septicum infection in a patient with a hematological malignancy.

A 49-year-old woman with acute myeloid transformation of myelodysplastic syndrome was admitted with mild erythema and pain in the right thigh and left forearm. She was doing well and had been discharged the previous day after consolidation chemotherapy. Examination showed only mild erythema and tenderness of the right thigh.

Anomalous Right Coronary Artery from Left Main Coronary Artery and Subsequent Coursing between Aorta and Pulmonary Trunk.

Anomalous origin of left main coronary artery or right coronary artery from the aorta with subsequent coursing between the aorta and pulmonary trunk is rare and can be sometimes life threatening. After hypertrophic cardiomyopathy, coronary artery anomalies are the second most common cause of sudden cardiac deaths among young athletes. This is a case presentation of an anomalous origin of right coronary artery from left main coronary artery coursing between the pulmonary trunk and aorta.

Syndrome of inappropriate antidiuretic hormone secretion associated with prolonged keterolac use.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesics. Although rare, clinicians need to keep in mind that their use may precipitate hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH), especially in high-risk patients with multiple comorbidities. In the kidneys, prostaglandins attenuate the water retention effect of antidiuretic hormone.

Antibiotic-induced cardiac arrhythmias.

This review aims to clarify the underlying risk of arrhythmia associated with the use of macrolides and fluoroquinolones antibiotics. Torsades de pointes (TdP) is a rare potential side effect of fluoroquinolones and macrolide antibiotics. However, the widespread use of these antibiotics compounds the problem.

Kernohan's Notch: A Forgotten Cause of Hemiplegia-CT Scans Are Useful in This Diagnosis.

Hemiparesis ipsilateral to a cerebral lesion can be a false localizing sign. This is due to midline shift of the midbrain resulting in compression of the contralateral pyramidal fibers on the tough dural reflection tentorium cerebelli. This may result in partial or complete damage to these fibers.

The association of α-blockers and 5-α reductase inhibitors in benign prostatic hyperplasia with fractures.

Background: Alpha-blockers and 5-alpha reductase inhibitors are common drugs used to treat benign prostatic hyperplasia (BPH), a prevalent problem in older men associated with significant morbidity and cost. Data regarding how these medications affect skeletal health and fracture risk remain scarce.

Methods: Studies were identified by searching PubMed, EMBASE, the Cochrane library and Thomson Reuters Web of Knowledge.

Chest pain and diarrhea: a case of Campylobacter jejuni-associated myocarditis.

Background: Diarrhea and chest pain are common symptoms in patients presenting to the emergency department (ED). However, rarely is a relationship between these two symptoms established in a single patient.

Objective: Describe a case of Campylobacter-associated myocarditis.

Electrocardiographic predictors of sudden cardiac death in patients with left ventricular hypertrophy.

Background: Left ventricular hypertrophy (LVH) has been associated with increased risk of sudden cardiac death (SCD), and improvements in risk stratification methodology are warranted.

Methods: We evaluated electrocardiographic intervals as potential markers of SCD risk in LVH. Corrected QT, QRS, and JT intervals were evaluated in consecutive cases with SCD and LVH from the ongoing Oregon Sudden Unexpected Death study who underwent a 12-lead electrocardiogram (EKG) and echocardiogram prior to and unrelated to the SCD event.

I lost weight, but I became weak and cannot walk--a case of nutraceutical (T3)-induced thyrotoxic periodic paralysis.

Thyrotoxic periodic paralysis (TPP) is a rare reversible cause of paralysis and cramping. TPP is usually precipitated by common causes of thyrotoxicosis such as Grave disease or multinodular goiter. TPP precipitated by exogenous triiodothyronine (T3) intake is an extremely rare occurrence with only 3 cases reported to date.