Search

Marantic endocarditis is a rare condition associated with autoimmune disease, malignancy, and hypercoagulable states. It is characterized by sterile friable vegetations composed of fibrin and platelets that confer a high risk of systemic embolism. Here we showcase imaging that led to the diagnosis of an interesting case of marantic endocarditis secondary to metastatic malignancy. [ABSTRACT FROM AUTHOR]

Hypomethylating agents are commonly used in the treatment of myelodysplastic syndromes and are known to cause bone marrow suppression; however, cardiac complications are rare. We describe a patient who was diagnosed with acute myeloid leukemia and developed myopericarditis after receiving chemotherapy with azacitidine. Our case highlights the importance of a thorough history, including medication review, in patients with suspected myopericarditis. It also raises awareness about the potential cardiac side effects of azacitidine. [ABSTRACT FROM AUTHOR]

Background. Chylopericardium is the accumulation of lymphatic fluid in the pericardial cavity. It can be idiopathic or secondary to trauma, cardiothoracic surgery, neoplasm, radiation, tuberculosis, lymphatic duct dysfunction, thrombosis, or other causes. We present a case of chylopericardium due to subclavian vein thrombosis in a patient with protein S deficiency. Clinical Case. A 48-year-old man with a history of protein S deficiency presented to the emergency department with shortness of breath and a productive cough. CT of the chest showed pulmonary emboli, moderate pericardial effusion, and a large thrombus of the superior vena cava, brachiocephalic vein, and subclavian veins. He developed echocardiographic evidence of cardiac tamponade so he underwent pericardiocentesis with drainage of milky-appearing fluid. Analysis of the fluid showed elevated triglycerides consistent with chylopericardium. The pericardial effusion reaccumulated, likely secondary to lymphatic duct obstruction due to his subclavian vein thrombus. Catheter-assisted thrombolysis was performed with resolution of the patient's effusion and symptoms. Conclusion. Chylopericardium is a rare but important complication of subclavian vein thrombosis. Management is typically with surgical intervention, although our case represents successful treatment with catheter-assisted thrombolysis. [ABSTRACT FROM AUTHOR]

Myocardial injury occurs in 20% to 30% of hospitalized patients with COVID-19 infection, and cardiovascular complications contribute to approximately 40% of all COVID-19–related deaths. Most cases of myocarditis related to COVID-19 infection occur in the acute phase of infection and are self-limited. We describe a case of delayed-onset fulminant myocarditis that developed 5 weeks after mild COVID-19 infection leading to cardiogenic shock and the need for mechanical circulatory support. Our case illustrates how myocarditis can occur as a late complication of COVID-19 infection, even in those with a mild initial course. [ABSTRACT FROM AUTHOR]

Intracranial hypertension and papilloedema are known to develop secondary to cerebral sinus or bilateral jugular vein thrombosis. However, in rare cases, unilateral jugular vein thrombosis may lead to increased intracranial pressure and papilloedema with resultant headache and vision changes. We describe a 45-year-old patient with squamous cell carcinoma of the larynx that developed right jugular vein thrombosis after chemoradiation therapy with cetuximab. This was later complicated by intracranial hypertension and papilloedema. The normal cerebral venous drainage, the potential role of chemoradiation therapy on the aetiology of jugular vein thrombosis, and the mechanism of increased intracranial pressure secondary to unilateral jugular vein occlusion are discussed. [ABSTRACT FROM AUTHOR]

Background: We aimed to study the efficacy of cardiac magnetic resonance imaging (CMR) and intracoronary optical coherence tomography (OCT) in detecting the etiology of myocardial infarction with non-obstructive coronary arteries (MINOCA).Methods: A systematic search was conducted in PubMed, Medline, and Cochrane databases. Search terms used: Myocardial infarction, Coronary angiography, Normal coronary arteries, CMR, and OCT. Inclusion criteria was fulfilled by 18 studies. Meta-analysis was performed with 15 studies.Results: A total of 2697 patients were included. The mean age of all the patients was 51.5 and 56.4% were men. CMR established diagnosis in 74% of the patients; 29% had acute myocarditis, 18% had true myocardial infarction and 12% had takotsubo cardiomyopathy. Combining OCT with CMR was better at finding the etiology than either modality individually.Conclusion: CMR is integral in identifying the etiology of MINOCA. Coupling OCT and CMR is better than either technique individually at finding the cause. [ABSTRACT FROM AUTHOR]

Introduction: Chronic total occlusion (CTO) in non-infarct related artery (nIRA) is associated with poor outcomes in patients with Acute Myocardial Infarction (AMI). The aim of the meta-analysis is to compare the outcomes of successfully staged percutaneous intervention (PCI) of nIRA CTO versus non revascularized CTO (failed PCI/no PCI/occluded) in patients admitted to hospital with AMI (ST segment elevation and non-ST segment elevation MI) Methods: PubMed, Embase and Cochrane databases were searched for studies comparing outcomes between staged PCI for CTO of nIRA and failed PCI/no PCI/occluded CTO patients admitted for AMI. The outcomes measured are all-cause mortality, cardiac mortality, Myocardial infarction (MI), revascularization, stroke, major adverse cardiac events (MACE) and heart failure readmission. Odds ratios (OR) and 95 % Confidence Intervals (CI) were calculated. The analysis was performed using DerSimonian and Laird random effect model. Results: A total of 9 studies met the inclusion criteria with a total of 2091 patients (Successful PCI to CTO group: 1248 and Failed or no PCI/occluded CTO group: 843). After a mean follow up of 33.6 months the patients who had successful PCI to CTO had significantly lower MACE (OR 0.49, 95% CI 0.36-0.67), all-cause mortality (OR 0.46, 95% CI 0.26-0.80), Cardiac mortality (OR 0.34, 95% CI 0.23-0.49), MI, Stroke and heart failure readmission as compared to no PCI/occluded CTO group (Table.1). The rates of revascularization were similar in both the groups Conclusions: Our meta-analysis shows that successful staged PCI of nIRA CTO in patients admitted with AMI is associated with better outcomes compared to no revascularization [ABSTRACT FROM AUTHOR]

Background: While aortic valve replacement (AVR) is indicated for symptomatic severe aortic stenosis (AS), the appropriate management of asymptomatic severe AS remains unclear. We conducted an updated meta-analysis to compare the outcomes of surgical AVR (SAVR) versus conservative treatment in patients with asymptomatic severe AS.Methods: We searched PubMed, EMBASE, Cochrane, clinicaltrials.gov, and Google Scholar for studies comparing outcomes of SAVR versus conservative treatment in asymptomatic severe AS. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for each individual study. Outcomes included all-cause mortality, cardiovascular and non-cardiovascular mortality, 30-day operative mortality, sudden cardiac death (SCD), heart failure hospitalization (HFH), myocardial infarction (MI), and stroke.Results: A total of 8 studies with 2685 patients were included. The mean age was above 60 years, and the median follow-up duration was 4 years. Compared to conservative treatment, SAVR was associated with significantly lower all-cause mortality (RR 0.39; 95% CI 0.23-0.64) and HFH rates (RR 0.18; 95% CI 0.05-0.71). There were no significant differences in cardiovascular mortality (RR 0.24; 95% CI 0.03-1.67), non-cardiovascular mortality (RR 0.49; 95% CI 0.23-1.03), 30-day operative mortality (RR 0.48; 95% CI 0.10-2.32), SCD (RR 0.37; 95% CI 0.05-2.89), MI (RR 0.48; 95% CI 0.04-5.52), and stroke rates (RR 1.20; 95% CI 0.35-4.11) between the two strategies.Conclusions: In patients with asymptomatic severe AS, SAVR is associated with significantly lower all-cause mortality and HFH compared to conservative treatment. While SAVR is a promising option for asymptomatic severe AS, most studies were observational and nonrandomized; randomized trials are needed to establish a clear benefit. [ABSTRACT FROM AUTHOR]