The "Cooing Pigeon": TAVI for Acute Aortic Regurgitation Secondary to Homograft Degeneration.

We present a case of acute aortic homograft regurgitation manifesting as a new-onset "cooing" murmur in a patient with congenital heart disease who did not have signs of clinical decompensation or evidence of infective endocarditis. He underwent successful transcatheter aortic valve implantation following a diagnosis of sterile acute valvular degeneration. ().

Takotsubo cardiomyopathy associated with adrenal insufficiency in the context of long-term steroid use mimicking acute coronary syndrome.

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced.

Application of simulation technology to enhance the role of the professional nurse.

With the expected nursing shortfall, uncertain economy, and projected increase in volume of persons requiring healthcare, the current models of care delivery cannot be sustained. New delivery models are necessary to maximize nurses' knowledge, expertise, and time. The authors describe the use of computer simulation using principles of Lean to help design a care delivery model with an enhanced role for the professional nurse.