A Unique Case of Goodpasture's Syndrome-Induced Cardiorenal Syndrome.

Goodpasture's syndrome (GPS) is a rare small vessel vasculitis characterized by circulating antibodies directed against the glomerular and alveolar basement membrane leading to renal and pulmonary manifestations. Here, we discuss a unique case of a 30-year-old Caucasian male smoker initially presenting with hemoptysis and anemia who was found to have biopsy-proven GPS with elevated anti-glomerular basement membrane (anti-GBM) antibodies. Unfortunately, the patient failed four months of standard treatment for GPS leading to end-stage renal disease (ESRD), while uniquely developing cardiorenal syndrome (CRS) with non-ischemic cardiomyopathy resulting in systolic and diastolic heart failure (HF).

Critical Limb Ischemia in a Young Patient With a Mechanical Aortic Valve Leading to Bilateral Above-Knee Amputation.

This case reports a 24-year-old female with prior aortic insufficiency who underwent a mechanical aortic valve replacement with subsequent transient ischemic attacks and documented subtherapeutic international normalized ratio (INR). She presented with pain and bilateral lower extremity pulselessness. Workup showed a supratherapeutic INR, no thrombus on echocardiogram, and computed tomography angiography demonstrating no flow in the bilateral common femoral arteries.

Site-specific differences in latency intervals during biventricular pacing: impact on paced QRS morphology and echo-optimized V-V interval.

Objective: To investigate differences in latency intervals during right ventricular (RV) pacing and left ventricular (LV) pacing from the (postero-)lateral cardiac vein in cardiac resynchronization therapy (CRT) patients and their relationship to echo-optimized interventricular (V-V) intervals and paced QRS morphology.

Methods: We recorded digital 12-lead electrocardiograms in 40 CRT patients during RV, LV, and biventricular pacing at three output settings. Stimulus-to-earliest QRS deflection (latency) intervals were measured in all leads.

Esophageal contour changes during cryoablation of atrial fibrillation.

Background: We have observed contour changes of the barium-filled esophagus during atrial fibrillation (AF) ablation with cryo-energy delivered in direct proximity to the esophagus.

Objective: To evaluate the frequency, location, and severity of esophageal contour changes during cryo-energy application close to the esophagus.

Methods: We retrospectively analyzed cine-fluoroscopic images acquired during hybrid cryo-radiofrequency AF ablation in 100 consecutive patients with cryo-energy delivered only in direct proximity to the esophagus.

AV junctional ablation allowing more effective delivery of cardiac resynchronization therapy in patients with intra- and interatrial conduction delay.

We report two patients with cardiac resynchronization therapy (CRT) devices and evidence of refractory heart failure in whom impaired intraatrial conduction in one patient, and interatrial conduction in the other, prohibited optimization of the atrioventricular (AV) timing sequence. The patient with intraatrial conduction delay exhibited late right atrial sensing and latency during right atrial pacing that required programming of a short-sensed AV delay and long-paced AV delay (wide differential AV delay). In both patients AV junctional ablation and echocardiography-guided device optimization significantly improved heart failure.