An Itchy Lead: First Reported Case of Ventricular Pacemaker Lead Self-Extraction.

We present a particularly rare case and the first ever report of a ventricular self-extraction in a 98-year old female. Our patient had a past medical history significant for severe Alzheimer's dementia, paroxysmal atrial fibrillation, and sick sinus syndrome who was admitted in clinically stable condition following the unwitnessed self-extraction the ventricular lead of her dual chamber pacemaker. This case highlights the potential risks and other clinical challenges of pacemaker and ICD placement in elderly patients and in patients with cognitive impairment.

Aortic valve endocarditis complicated by ST-elevation myocardial infarction.

Infective endocarditis complicated by abscess formation and coronary artery compression is a rare clinical event with a high mortality rate, and diagnosis requires a heightened degree of suspicion. We present the clinical, angiographic, and echocardiographic features of a 73-year-old woman who presented with dyspnea and was found to have right coronary artery compression that was secondary to abscess formation resulting from diffuse infectious endocarditis. We discuss the patient's case and briefly review the relevant medical literature.

When catastrophe strikes - a case of atrial myxoma with distal embolization.

Primary tumors of the heart are rare, with an incidence between 0.0017 and 0.19 percent in unselected patients at autopsy.

Complete resolution of acute renal failure after left renal artery angioplasty and stent placement for total renal artery occlusion.

A 25-year-old female, 17 weeks pregnant presented to our hospital with complaints of progressively increasing dyspnea. She was hypertensive with creatine of 1.0; she was transferred to ICU with multiple medications to control her blood pressure, without success.

Severe dilatation of saphenous vein grafts: a late complication of coronary surgery in which the diagnosis is suggested by chest x-ray.

Aneurysmal dilatation of saphenous vein graft (SVG), first reported in 1975, is secondary to true aneurysm or pseudoaneurysm. We report 1 case and review 107 cases published since 1975. Severe SVG dilatations are large (6 +/- 3 cm), occur remote from surgery (12 +/- 4 years) and are life threatening, with 15.

Implementation of the ACC/AHA guidelines for preoperative cardiac risk assessment in a general medicine preoperative clinic: improving efficiency and preserving outcomes.

Background: The American College of Cardiology/American Heart Association (ACC/AHA) publishes recommendations for cardiac assessment of patients undergoing noncardiac surgery with the intent of promoting evidence-based, efficient preoperative screening and management. We sought to study the impact of guideline implementation for cardiac risk assessment in a general internal medicine preoperative clinic.

Methods: The study was an observational cohort study of consecutive patients being evaluated in an outpatient preoperative evaluation clinic before and after implementation of the ACC/AHA guideline.

Prognostic significance of an elevated creatine kinase in the absence of an elevated troponin I during an acute coronary syndrome.

In patients with troponin-negative acute coronary syndromes, creatine kinase (CK)-MB elevation predicts a significantly higher risk of death and major acute cardiac events compared with CK-MB negative patients. This risk is accentuated in troponin-negative, CK-MB positive patients who do not demonstrate ST elevation by electrocardiogram.