Cardiac MRI in infiltrative disorders: a concise review

Cardiac MR imaging is an effective method for noninvasive imaging of the heart. The technology has been limited in the past because of imaging difficulties associated with cardiac motion. In recent years, however, cardiac MR imaging has broadened its spectrum of applications in cardiovascular disease with impressive advances in spatial and temporal resolution and increased imaging speeds. This review presents the current clinical applications of cardiac MR imaging for evaluation of cardiac disease in infiltrative disorders such as amyloidosis, hemochromatosis, and sarcoidosis.

Dronedarone for atrial fibrillation: How does it compare with amiodarone?

Dronedarone (Multaq), an analogue of amiodarone (Cordarone), was designed to cause fewer adverse effects than the parent compound. Studies have indeed shown dronedarone to be safer than amiodarone, but less effective. Its official indication is to reduce the risk of hospitalization in patients with paroxysmal or persistent atrial fibrillation or atrial flutter and other cardiovascular risk factors, reflecting the parameters of its effectiveness in clinical trials.

Percutaneous intervention of superior mesenteric artery stenosis in elderly patients

This review article focuses on stent placement in mesenteric arteries in older patients with an increasingly common diagnosis of chronic mesenteric ischemia (CMI). We reviewed the articles that focused on the treatment of this gastrointestinal disorder by stenting/open surgical revascularization to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in mesenteric arteries are discussed in comparison to open surgical revascularization. In summary, the low morbidity and high technical success rate of catheter-based techniques have made this approach the first line of therapy for CMI due to superior mesenteric artery stenosis for many elderly patients especially high-risk operative candidates.

Popliteal artery pseudoaneurysm following FoxHollow atherectomy: a rare complication

Atherectomy using the FoxHollow device is an exciting treatment as an alternative to lower extremity arterial bypass for treatment of peripheral vascular disease in symptomatic patients with critical limb ischemia and disabling claudication. We present an interesting case of popliteal artery pseudoaneurysm following FoxHollow atherectomy, which is a rare complication. Mechanical factors have been implicated in causation of trauma to the vessel wall during atherectomy. Endovascular treatment of peripheral vascular disease has become increasingly common, thus it is important to know the rare complications associated with it. Pseudoaneurysm is one of the rare complications associated with the use of the FoxHollow atherectomy device.

Aberrant origin of the left anterior descending artery and quadrifurcation of coronary vessels associated with coronary artery disease: evaluation by computed tomographic angiography and coronary angiography

Coronary artery anomalies occur in approximately 0.2-12.2% of the adult population. Origin of left anterior descending artery and left circumflex artery from the right coronary cusp is relatively rare. The case we present is unique in that all 4 vessels (right coronary, left anterior descending, left circumflex and atrioventricular nodal branch) take off from the right coronary cusp, making a quadrifurcation. In this case, the left main artery is also absent. To our knowledge, there are few published case reports of anomalous origin of left anterior descending artery, but the total absence of a left main artery and quadrifurcation are unique to our case.

Treatment of Massive Fluid Overload as a Result of Constrictive Pericarditis With Ultrafiltration in the Emergency Department

We present a case of massive fluid overload as a result of chronic lupus-related constrictive pericarditis, which was treated in the emergency department (ED) with ultrafiltration. With this novel technique, a large volume (7,350 mL) was extracted during 19 hours, with dramatic clinical improvement. The patient was hemodynamically stable throughout the intervention, and the procedure was tolerated without complication. This report highlights the challenges associated with the treatment of such individuals and the potential benefits of ultrafiltration in the ED setting.

Complex Endocarditis in an Immunocompromised Host: The Role of Three-Dimensional Echocardiography

This case report emphasizes the role of different echocardiography imaging modalities, including three-dimensional imaging, in defining the invasive complications of infective endocarditis. We report the case of an immunocompromised patient who was admitted for stroke workup and found to have complex culture negative endocarditis. Echocardiography showed an aortic root abscess and a large intramyocardial, echogenic area with central liquefaction, suggestive of an intramyocardial abscess. An aneurysm of the mitral-aortic intervalvular fibrosa was also visualized along with a prominent aneurysm of the right coronary cusp, best visualized with three-dimensional imaging. Our patient was considered inoperable and died of this illness 2 weeks later.

Treatment of Severe Decompensated Heart Failure With High-Dose Intravenous Nitroglycerin: A Feasibility and Outcome Analysis

STUDY OBJECTIVE

We perform a feasibility and outcome assessment of the treatment of severe decompensated heart failure with high-dose nitroglycerin.

METHODS

This study was designed as a nonrandomized, open-label, single-arm study of high-dose nitroglycerin. Patients with hypertension (systolic blood pressure > or = 160 mm Hg or mean arterial pressure > or = 120 mm Hg) who were refractory to initial therapy were eligible for inclusion. Enrolled patients began receiving a titratable nitroglycerin infusion and were given a bolus of high-dose nitroglycerin (2 mg). Repeated administration of high-dose nitroglycerin was allowed every 3 minutes, up to a total of 10 doses. Predefined effectiveness and safety outcomes were tracked throughout hospital admission. To provide a frame of reference for these outcomes, data were retrospectively compiled for similar patients with severe decompensated heart failure who did not receive high-dose nitroglycerin.

RESULTS

Twenty-nine patients received high-dose nitroglycerin. Endotracheal intubation was required in 13.8% of patients, bilevel positive airway pressure (BiPAP) ventilation in 6.9%, and ICU admission in 37.9%. Symptomatic hypotension developed in 1 patient (3.4%), and biomarker evidence of myocardial infarction was found in 17.2% of patients. The mean dose of high-dose nitroglycerin was 6.5 mg (+/-3.4). For patients who were treated without high-dose nitroglycerin (n=45), endotracheal intubation occurred in 26.7%, BiPAP in 20.0%, and ICU admission in 80.0%. None of these patients developed symptomatic hypotension, and biomarker evidence of myocardial infarction was observed in 28.9% of patients.

CONCLUSION

In this nonrandomized, open-label trial, high-dose nitroglycerin was associated with endotracheal intubation, BiPAP, and ICU admission less frequently than expected to occur without high-dose nitroglycerin, and adverse events were uncommon. Treatment of hypertensive, severely decompensated heart failure patients with high-dose nitroglycerin seems promising, but a randomized, blinded study is needed to more completely define its clinical utility. According to this trial, such a study seems feasible.

Clinical experience with Staphylococcus lugdunensis bacteremia: a retrospective analysis

We report a retrospective review of all cases of Staphylococcus lugdunensis bacteremia identified during a period of more than 10 years (January 1990 to May 2002) in a large medical center. Twenty-one cases occurred over that period; 20 cases were available for review. In six instances, the organism appeared to be clinically significant and was most commonly related to a vascular line infection. No deaths, secondary suppurative complications, prolonged bacteremia, or prolonged fever appeared to be caused by S. lugdunensis in our experience. Twenty-five percent of our isolates were resistant to multiple antibiotics, including oxacillin.