Case Reports in Cardiology最新文献

Background: Purulent pericarditis is a rare, life-threatening condition that has become exceedingly uncommon due to widespread use of antibiotics. However, immunocompromised patients remain susceptible to such opportunistic infections. It is typically caused by direct extension or hematogenous spread from a secondary bacterial source. Case Description: We report a 55-year-old man with HIV cardiomyopathy who was transferred from an outside facility for chest pain and dyspnea, with an electrocardiogram suggestive of an ST-segment elevation myocardial infarction, prompting emergent cardiac catheterization, which revealed normal coronary arteries. A bedside echocardiogram revealed a large pericardial effusion with tamponade physiology, leading to pericardiocentesis. The pericardial fluid analysis revealed a high white blood cell count and a significantly elevated lactate dehydrogenase level, and cultures were positive for Streptococcus pneumoniae. Despite receiving antibiotics, the effusion reaccumulated, necessitating a subxiphoid pericardial wash and drainage. The xiphoid biopsy was consistent with acute osteomyelitis. The patient was discharged with long-term antibiotics and scheduled outpatient follow-ups. Conclusion: This case illustrates an unusual presentation of HIV-AIDS, highlighting advancements in managing pneumococcal pyopericardium with tamponade and the ongoing risk of opportunistic infections despite antiretroviral treatment. Though rare, pyopericardium can be fatal; so prompt diagnosis and multidisciplinary management are essential to improve outcomes.

Mechanical circulatory support devices, such as the Impella catheter (Abiomed, Danvers, Massachusetts), continue to become more commonplace in patients undergoing high-risk percutaneous coronary intervention (PCI) or those in cardiogenic shock. Thrombus in the left ventricle is a contraindication to Impella placement. Here, we present a patient with an anterior ST elevation myocardial infarction who underwent primary PCI with subsequent development of cardiogenic shock followed by Impella placement, who then later developed an LV thrombus. The Impella was removed after placement of a Sentinel cerebral protection device (Boston Scientific, Massachusetts). The left carotid filter of the Sentinel captured a thrombus fragment. The patient did not have any neurological compromise. This case represents the first report of actual capture of LV thrombus by a Sentinel system in this context. The case suggests the potential value of the Sentinel cerebral protection device to lower the risk of an embolic event during Impella removal in selective clinical scenarios.

Background: Anterior ST-elevation myocardial infarction (STEMI) is frequently associated with severe complications, such as myocardial dysfunction and conduction abnormalities. Complete atrioventricular block (CAVB), especially when combined with bifascicular block, is a rare but critical presentation that reflects extensive myocardial damage, often linked to proximal left anterior descending (LAD) artery occlusion. Case Presentation: A 76-year-old male with a history of hypertension, diabetes mellitus, and dyslipidemia presented to the emergency department with a 6-day history of gastrointestinal symptoms and recurrent syncope. On arrival, he exhibited bradycardia, hypotension, and mottling, progressing to cardiac arrest. The return of spontaneous circulation was achieved after one cycle of advanced cardiovascular life support. Electrocardiography revealed CAVB with a ventricular escape rhythm displaying right bundle branch block morphology, left anterior fascicular block, and anterior ST-segment elevation. Emergency interventions included endotracheal intubation, Swan-Ganz catheterization, transvenous pacing, and vasopressor support. Echocardiography demonstrated severe left ventricular systolic dysfunction with an ejection fraction of 25%. Coronary angiography identified critical proximal stenoses in the LAD and circumflex arteries, managed with percutaneous coronary intervention and stent placement. Persistent conduction abnormalities and systolic dysfunction necessitated implantation of a cardiac resynchronization therapy defibrillator (CRT-D). Despite extensive rehabilitation efforts, the patient died after 60 days of hospitalization. Discussion: This case highlights the importance of rapid recognition and intervention in anterior STEMI complicated by CAVB and bifascicular block, signaling significant proximal LAD involvement. Advanced therapeutic options, including CRT-D, are crucial for addressing these rare, life-threatening conduction disturbances. The fatal outcome underscores the need for vigilant follow-up and individualized preventive strategies to improve prognosis in such complex STEMI cases.

A 67-year-old male presented with non-ST elevation myocardial infarction (NSTEMI) with underlying anomalous origin of the right coronary artery (RCA) and a malignant course between the aorta and pulmonary artery. Previous CABG with LIMA and RIMA grafts had failed, leaving the patient with severe in-stent restenosis (ISR) in the LAD and degenerated, blocked grafts. The patient underwent percutaneous coronary intervention (PCI) to the anomalous RCA, which posed challenges in engagement due to its anomalous course. This case report discusses the complexities of managing such anatomies, emphasizing the role of CT coronary angiography, the difficulty of engaging anomalous arteries, and the techniques used to achieve successful PCI.

Despite advances in imaging and diagnostics, calcific constrictive pericarditis (CCP) remains a rare and challenging entity, often masquerading as other cardiopulmonary conditions, leading to delayed diagnosis. We present a 70-year-old male with a history of heart failure, atrial fibrillation (AF), cirrhosis, chronic obstructive pulmonary disease (COPD), and prior pleural effusion, who was admitted with acute hypoxic respiratory failure and AF with rapid ventricular response (RVR). Imaging revealed extensive pericardial calcifications, leading to a diagnosis of CCP. The patient's clinical course was marked by refractory hypotension, altered mental status, and progressive cardiohepatic syndrome. Given his high surgical risk, he was managed conservatively and transitioned to palliative care. This case underscores the diagnostic and therapeutic challenges of CCP, particularly in patients with complex comorbidities where surgical intervention is not feasible. It highlights the need for early recognition and individualized management strategies to optimize outcomes in this challenging subset of patients.

A 78-year-old man underwent Micra AV implantation due to complete atrioventricular block. He developed diffuse left ventricular systolic dysfunction and dyssynchrony, 2 years later, suggesting pacing-induced cardiomyopathy. Given the critical need for an upgrade to cardiac resynchronization therapy (CRT), an extraction of the Micra AV was scheduled. Initially, the Micra extraction using a solitary snare catheter was attempted, but capturing the retrieval feature on the proximal side of the device was unsuccessful due to excessive movement caused by the heartbeats. Consequently, an axis-guided dual snare technique employing two snare catheters was implemented. A triple-loop snare catheter was inserted into a steerable sheath, which was threaded through the loop of a single-loop snare catheter placed outside the sheath. The triple-loop snare successfully grasped the Micra body and stabilized its movement. Subsequently, the single-loop snare was advanced along the shaft of the triple-loop snare catheter towards the retrieval feature. The single-loop snare finally captured the retrieval feature, enabling the smooth retraction of the Micra into the sheath. Following the successful extraction of the Micra, a CRT device was implanted without complications.

A 58-year-old female presented with new-onset dyspnea. Two years prior, she had undergone a transcatheter aortic valve replacement with a 26-mm Edwards Sapien 3 valve. Diagnostic testing included transthoracic and transesophageal echocardiograms that revealed increased transvalvular gradients and suspected prosthetic thrombosis. Laboratory testing included blood cultures that unexpectedly grew Streptococcus sanguinis. This case highlights the difficulty in differentiating prosthetic valve thrombosis from infective endocarditis and the possible therapeutic complications that could arise.

Activating mutations of FMS-like Tyrosine Kinase 3 (FLT3) occur in a subset of patients with acute myeloid leukemia (AML) and confer a poor prognosis. Gilteritinib, an oral FLT3 inhibitor approved for the treatment of relapsed or refractory AML, has been shown to improve survival and remission rates compared with salvage chemotherapy. This case report presents two patients initiated on gilteritinib for relapsed AML who developed new onset left ventricular systolic dysfunction. After ruling out other common etiologies, gilteritinib was discontinued due to concern for cancer therapy-related cardiac dysfunction with subsequent improvement in ejection fraction. These cases demonstrate a rare but serious adverse effect of gilteritinib, cardiotoxicity manifested as left ventricular systolic dysfunction, for which more studies are needed to elucidate the underlying pathophysiology.

Takotsubo cardiomyopathy (TC), or 'broken heart syndrome,' is marked by transient left ventricular dysfunction in the absence of acute, severe coronary artery disease that explains the pattern and degree of LV dysfunction. Both emotional and physical stressors have been associated with TC. We present a case of TC that was precipitated by a routine magnetic imaging resonance scan, highlighting a rare and previously unreported trigger for TC.

The AngioVac mechanical aspiration system has emerged in the literature as a viable treatment option for patients with intracardiac masses and thrombi and who are deemed high risk for cardiac surgery. Notably, it has been shown to be an effective treatment modality for the debulking of thrombi in the setting of malignancy. We present a case of repeat AngioVac debulking of a large right atrial thrombus with extension from the hepatic vein in the setting of advanced malignancy complicated by Enterococcus faecium endocarditis.