IHJ Cardiovascular Case Reports (CVCR)最新文献

Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, has been shown in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study to significantly decrease mortality or hospitalisation in patients with heart failure with reduced ejection fraction (HFrEF). We describe a case of a patient with noncompaction cardiomyopathy (NCCM) who initially responded partially to guideline-directed medical therapy, which included an angiotensin receptor-neprilysin inhibitor (ARNI). However, the patient's symptoms returned, and the addition of dapagliflozin was able to provide a definitive improvement in his clinical-echocardiographic parameters. There is currently no data indicating that dapagliflozin is beneficial for patients with NCCM and HFrEF which progressive disorder.

Pantoea Agglomerans is an environmental gram-negative aerobic bacillus in the Enterobacteriaceae family. Typically, it is not responsible for infections in humans. We present the case of an immunocompetent patient who developed Pantoea Agglomerans bacteremia, Cardiovascular Implantable Electronic Device (CIED)-related endocarditis, and cholecystitis following a cat scratch. Following this case, we performed a review of the available literature regarding Pantoea Agglomerans. Overall, infections in humans are very well-treated with few strains of Pantoea Agglomerans demonstrating resistance to antimicrobial therapy.

Learning objective

Recognize uncommon bacterial etiologies of endocarditis and review treatment modalities for Pantoea infections.

Aim and objective

Ventricular Septal Rupture (VSR) is a fatal mechanical complication of myocardial infarction. The aim of this study is to evaluate the early outcomes of the surgical repair and also to identify the risk factors related to early mortality at our centre.

Materials and methods

It is a retrospective study that includes the assessment of clinical data of 8 adult patients with post infarct VSR who underwent surgical repair at our centre. The study duration was between January 2017 and December 2021. All the patients included in the study underwent surgical repair of Post infarct VSR.

Results

The median age of the patients was 68 years (Range 52–77 years). The most common location of VSR was predominantly in the anterior and apical septum (62.5%). The overall early mortality in our study was 50% (n = 4). The risk factors and preoperative complications were similar among the survivors and non survivors.

Conclusion

Post infarct ventricular septal repair has high early operative mortality. It is difficult to predict the risk factors contributing to the high rate of early mortality in these patients.

This case report describes a 30 years old female who presented to the Emergency with multiple blackouts the previous 3 days. In the Emergency a Torsades de pointes (TdP) polymorphic ventricular tachycardia was observed on the cardiac monitor that spontaneously resolved into complete atrioventricular block accompanied by significantly prolonged QT and corrected QT (QTc)intervals. The patient underwent immediate temporary pacing, followed by permanent dual chamber implantation the next day. There were no further episodes of TdP subsequent to pacemaker implantation; the patient was discharged on a beta-blocker. Complete atrioventricular block when accompanied by increased QTc interval can result in lethal ventricular tachyarrhythmia manifesting as pre syncope, syncope, cardiac arrest, or death. Such patients, albeit uncommon, may be managed by permanent pacing and beta blocker therapy.

The efficacy and safety of percutaneous transvenous mitral commissurotomy by the Inoue technique, in patients with rheumatic mitral stenosis is well known. However, presence of left atrial/appendage thrombus or difficult LV entry entails the use of ‘over the wire’(OTW)technique. Here we describe a case series highlighting the utility and modifications of OTW technique.

A 56-year-old lady presented with chest discomfort for 2 days. Electrocardiography showed deep T wave inversions in the anterior leads. Cardiac Troponin was elevated. Her creatine phosphokinase (CPK) was disproportionately high compared to the elevation of creatine kinase myocardial band (CKMB). The patient had severe hyponatremia which was due to decreased cortisol levels. Her coronary angiogram was normal. She was a known hypothyroid, other hormonal analyses showed low levels of cortisol, Adreno Corticotropic Hormone (ACTH), Follicle Stimulating Hormone (FSH), and Luteinizing Hormone (LH), hence diagnosis of panhypopituitarism, Sheehan's syndrome was made. The patient was stabilized and discharged on oral steroids.

Permanent junctional reciprocating tachycardia (PJRT) is a form of atrioventricular reentrant tachycardia which is common in infants and children and presents rarely in adults. It is an incessant form of tachycardia which can lead to tachycardia induced cardiomyopathy. It tends to be unresponsive to most drug treatment but potentially treatable by radiofrequency ablation. Here we report a case of PJRT in an adult patient presenting as tachycardia induced cardiomyopathy.

Left main coronary artery compression is an underrecognized condition in patients with pulmonary artery hypertension. If present, it may lead to dismal outcome. In young patients with pulmonary hypertension or in patients with hugely dilated pulmonary artery with symptoms of angina, left main coronary compression must be ruled out.

Dislodgement of a fully deployed stent is an uncommon but dangerous complication associated with coronary interventions. A new stent may get stuck that may inadvertently remove the previous stent in a piggybacking fashion. We hereby present a case of piggybacking of stents which was managed without any further complications.