A Case of Tick Bite Induced Babesiosis With Lyme Disease.

The Ixodes tick may transmit multiple pathogens, Lyme disease being the most common. Early detection of tick bites and using prophylaxis measures is the key to prevent tick bite-associated diseases like babesiosis, anaplasmosis, and Lyme disease. It is recommended to follow preventive measures like using diethyltoluamide (DEET) on the skin, applying permethrin on clothes while visiting the tick-infested areas.

Clinical application of cine-MRI in the visual assessment of mitral regurgitation compared to echocardiography and cardiac catheterization.

Background: Detecting and quantifying the severity of mitral regurgitation is essential for risk stratification and clinical decision-making regarding timing of surgery. Our objective was to assess specific visual parameters by cine-magnetic resonance imaging (MRI) in the determination of the severity of mitral regurgitation and to compare it to previously validated imaging modalities: echocardiography and cardiac ventriculography.

Methods: The study population consisted of 68 patients who underwent a cardiac MRI followed by an echocardiogram within a median time of 2.

Effect of obstructive sleep apnea on QT dispersion: a potential mechanism of sudden cardiac death.

Objectives: QT dispersion (QT(d)) measures the variability of the ventricular recovery time. QT(d) may identify patients at risk for ventricular arrhythmias and sudden cardiac death (SCD). The purpose of our study was to determine the effect of obstructive sleep apnea (OSA) on QT(d).

Incidence of caffeine in serum of patients undergoing dipyridamole myocardial perfusion stress test by an intensive versus routine caffeine history screening.

The coronary vasodilatory effect of dipyridamole is competitively blocked by caffeine. The purposes of this study were to (1) assess the incidence of having detectable serum caffeine and (2) evaluate whether an intensive caffeine history screening strategy was superior to routine history screening before dipyridamole myocardial perfusion imaging. One hundred ninety-four patients who were randomized to an intensive or a routine screening history strategy were prospectively evaluated.

Long-term effect of chronic oral anticoagulation with warfarin after acute myocardial infarction.

Background: Antiplatelet therapy is the principal component of the antithrombotic regimen after acute myocardial infarction. It remains unclear whether additional chronic oral anticoagulation (OAC) improves outcomes. We set out to evaluate the risk and benefit of long-term OAC after myocardial infarction.

Precision and accuracy of risk scores for in-hospital death after percutaneous coronary intervention in the current era.

Background: Various risk assessment scores were proposed in the last decade for prediction of in-hospital mortality in patients undergoing percutaneous coronary intervention (PCI). We sought to apply two validated scores, the Mayo Clinic Risk Score (MCRS) and the New York Risk Score (NYRS) to a contemporary cohort treated at a single institution and to simplify the NYRS, such that the parameters used in both scores are similar.

Methods And Results: Patients undergoing PCI in 2005-2007 were included.

Three-year survival after percutaneous coronary intervention according to appropriateness criteria for revascularization.

Objectives: We sought to compare 3-year outcomes of percutaneous coronary intervention (PCI) according to recently published appropriateness criteria for PCI.

Background: The choice of revascularization between PCI and coronary artery bypass grafting (CABG) remains uncertain in many patients despite numerous randomized clinical trials and meta-analyses.

Methods: Consecutive patients undergoing a first PCI at a single, large-volume institution were included if they did not have prior CABG and did not need emergency PCI.

Effect of renal function loss on NT-proBNP level variations.

Objective: NT-proBNP level is used for the detection of acute CHF and as a predictor of survival. However, a number of factors, including renal function, may affect the NT-proBNP levels. This study aims to provide a more precise way of interpreting NT-proBNP levels based on GFR, independent of age.

Enhancing the diagnostic performance of troponins in the acute care setting.

Background: Current guidelines define cardiac troponin I (TnI) as an indicator of necrosis when the concentration exceeds the 99% upper limit of a healthy reference population, a reference value near the assay's lowest detectable level. We assessed the utility of a modified TnI cutoff point derived from a population at low risk for coronary artery disease (CAD) and evaluated its utility in determining acute myocardial infarction (MI).

Methods: A modified TnI cutoff point was derived by the receiver operating characteristic (ROC) curve from 737 consecutive patients who underwent serial TnI measurements for exclusion of MI.

Late presentation of a lead perforation as a complication of permanent pacemaker insertion.

Lead perforation is a less-recognized delayed complication of device implantation. Delay in recognition may prove fatal. Predictors of postimplantation pericardial effusion, which serves as a marker of perforation, include concomitant use of transvenous pacemaker, steroid use within 7 days, and older age.

Postaortic valve replacement bradycardia induced torsades de pointes.

The authors present an unusual case of torsades de pointes (Tdp) in an elderly woman with a history of aortic stenosis, status post aortic valve replacement. She was admitted for atrial fibrillation with a slow ventricular response. At the time of admission, the patient was asymptomatic and not taking any medications known to be associated with QT prolongation.

The case of the disappearing myxoma.

We present a case demonstrating the utility of cardiovascular magnetic resonance (CMR) in the diagnosis of a cardiac mass. A 70-year-old female who presented with chest pressure and left sided jaw pain was found to have a cardiac mass on transthoracic and transesophageal echocardiography that was diagnosed as an atrial myxoma. A cardiac magnetic resonance test determined the mass to be more consistent with a thrombus than a myxoma through a stepwise approach using multiple pulse sequences.

Acute upper extremity arterial occlusion: a novel role for the use of rheolytic thrombectomy and intravascular ultrasound.

Acute peripheral arterial occlusion may be caused by thrombosis or embolism. The objectives of therapy are to preserve limb and life by restoration of blood flow. Thrombolytic therapy has been the mainstay, but is limited by a high risk of bleeding.

The significance of elevated troponin T in patients with nondialysis-dependent renal insufficiency: a validation with coronary angiography.

Background: Patients with elevated troponin are at high risk of adverse outcomes, future cardiac events, and are more likely to have hemodynamically significant coronary artery stenoses. Elevated troponin T (cTnT) in patients with poor renal function portends a poor prognosis; however, findings of significant coronary artery disease (CAD) by coronary angiography have not been demonstrated in patients with poor renal function and elevated cTnT.

Hypothesis: The purpose of this study was to correlate the angiographic findings of patients with elevated cTnT with respect to renal function in patients with nondialysis-dependent renal insufficiency.