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Abstract Introduction Digitalis has been used for over 200 years to treat patients with heart failure, and evidence supports its use to improve clinical symptoms and quality of life, but not survival. The objective of this retrospective study was to evaluate the effects of digitalis on readmission and mortality in patients with heart failure with reduced ejection fraction (HFrEF) who were receiving current guideline recommended medical therapy. Methods We reviewed medical record data from a retrospective cohort study of 1047 patients admitted to the hospital from 2005 to 2014 with decompensated HFrEF. 244 received digitalis, at some point during patient trajectory, and 803 never received digitalis. The primary outcomes of interest were the length of stay in hospital, readmission rates after discharge at 1, 6, 12, and 24 months and the overall mortality rate, at the same time points. Results We studied the effects of digitalis after adjusting for age, sex, race, potentially confounding comorbidities, and prescription medications. Digitalis treatment is associated with decreases in EF in patients with HFrEF (OR = −2.83, P < 0.001) and was associated with an increased readmission rate for any reason after discharge from the hospital at 6, 12, and 24 months, 53%, 34%, and 35%, respectively. No statistically significant difference was found between patients who received digitalis and those who did not (referent group) for the length of hospital stay and overall mortality rate. Conclusion Digitalis use is associated with increased re-admission rates for any reason following discharge from the hospital at 6, 12, and 24 months. [ABSTRACT FROM AUTHOR]

Abstract Right ventricular (RV) dysfunction following surgical implantation of a left ventricular assist device (LVAD) is a well-documented phenomenon, and it is associated with poor outcomes. We are reporting a 25-year-old male patient who presented to the hospital with flu-like symptoms, hypotension and acute hypoxic respiratory failure. The patient's Laboratory data was significant for elevated troponin, and his Chest X-ray showed acute pulmonary edema. Echocardiogram revealed reduced left ventricular (LV) ejection fraction and normal RV function. Coronary angiography was normal, and the cardiac index was 1.3 L/min/m2. Impella 5.0 (Abiomed, MA) was placed through the left axillary artery graft and 4.5 L/min flow was achieved with an improvement in blood pressure. Thirty minutes later, he developed hypotension, the device flow dropped to 3.0 L/min, and right atrial pressure increased. The Pulmonary artery pulsatility index was consistent with RV failure. Possible causes of RV failure include unmasking of RV dysfunction with high LVAD flow and altered RV geometry due to ventricular septum shift. Impella RP (Abiomed, MA) was placed for RV support achieving a flow of 3.8 L/min with a significant improvement in impella LV flow, cardiac output and blood pressure (mean 90 mmHg). Ventricular support devices were weaned off on day 9. The patient was discharged on day 15. Conclusion: our case highlights the risk of RV failure following percutaneous LVAD placement. Early identification and appropriate mechanical support is imperative. [ABSTRACT FROM AUTHOR]

The development of a new generation of non-vitamin K oral anticoagulants represents a potential breakthrough in the management of patients with thrombotic diseases, disorders and conditions. While a large and growing body of evidence from large-scale clinical trials and registries supports a favorable safety profile, having a means to rapidly reverse their anticoagulant effects represents an unmet need among practicing clinicians. Several targeted reversal agents are currently in development and the early results are promising. Idarucizumab is a monoclonal antibody that can immediately and specifically reverse dabigatran. Andexanet alfa is a recombinant modified factor Xa that can bind and reverse oral and parenteral factor Xa inhibitors, including rivaroxaban, apixaban and edoxaban, and low molecular weight heparin. Aripazine is a small molecule that can reverse the action of factor Xa inhibitors and possibly dabigatran as well through non-covalent binding and charge–charge interactions. [ABSTRACT FROM AUTHOR]

Single ostium coronary artery is a rare coronary artery anomaly. It is reported to occur in only 0.0448% of cases who underwent invasive coronary angiography. It can be associated with angina, arrhythmias, and possibly sudden death and is a clinically important entity to rule out in patients presenting with chest pain. We report the case of a 68-year old man who presented with worsening resting chest pain and underwent invasive coronary angiography and a single ostium coronary artery was identified. Subsequent coronary computed tomography (CT) angiography revealed it to be a unique variation of class R-III of Lipton classification of single ostium coronary artery. Lipton R-III single ostium coronary artery is rare and its incidence is reported to be 0.004% in patients who had invasive coronary angiography. In our case, anomalous left coronary circumflex artery was retroaortic course combined with intramyocardial course. It also divided into multiple obtuse marginal branches in the myocardium and never coursed along the anterior and lateral aspects of the arterioventricular groove. This variation has not been reported in the literature. Coronary CT angiography played an essential role to delineate this complex coronary anomaly. < Learning objective: Single ostium coronary artery is a rare coronary artery anomaly. However, it is a clinically important entity to rule out in the evaluation of patients with chest pain. Invasive coronary angiography can identify this anomaly; however, coronary computed tomography angiography is recommended to fully characterize this condition as demonstrated in our case. Depending on the detailed anatomical information of the anomaly, the clinical management needs to be tailored for these cases.> [ABSTRACT FROM AUTHOR]

Abstract: Spontaneous aortic dissection in pregnancy is rare and life-threatening for both the mother and the fetus. It is commonly associated with connective tissue disorders or aortic valvular abnormalities. We describe a case of a hypertensive pregnant woman in whom a dilated ascending aorta was identified in a routine transthoracic echocardiogram. Careful interrogation of the ascending aorta, with the use of intravenous contrast, revealed the presence of a type A aortic dissection flap. The particulars of the case are presented and the literature regarding acute aortic dissection in pregnancy is reviewed. [Copyright &y& Elsevier]

The management of coronary thrombus is not well defined. Current therapies include medical management with anticoagulation, antiplatelet, and thrombolytic therapies or revascularization with percutaneous coronary interventions including mechanical thrombectomy, and coronary artery bypass grafting surgery. In this report, we present a patient with significant left main coronary artery thrombus burden with advanced cirrhosis and recent esophageal variceal bleeding who was successfully treated with conservative medical management. [ABSTRACT FROM AUTHOR]