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A 59-year-old man presented with sharp chest pain, hypoxia, and tachycardia. His past medical history included intravenous drug use (IVDU). Pseudomonas aeruginosa was isolated from his blood. Pseudomonas aeruginosa is a rare cause of endocarditis. Patient revealed that he injected drugs intravenously with tap water. Transesophageal echocardiogram revealed vegetation on the anterior mitral leaflet with associated mitral regurgitation. Patient was successfully treated with meropenem and tobramycin and underwent mitral valve replacement without complications. Majority of IVDU-related endocarditis caused by Pseudomonas involve right-sided valves, but our case is unique as it demonstrates left-sided endocarditis in a patient with IVDU. A combination of aggressive medical and early surgical treatment with valve replacement has enabled this patient to successfully recuperate.

Background: Although attenuation correction (AC) has been successfully applied to large field of view (LFOV) cameras, applicability to small field of view (SFOV) cameras is a concern due to truncation. This study compared perfusion images between a LFOV and SFOV camera with truncation compensation, using the same AC solution., Methods and Results: Seventy-eight clinically referred patients underwent rest-stress single-photon emission computed tomography (SPECT) using both a SFOV and LFOV camera in a randomized sequence. Blinded images were interpreted by a consensus of three experienced readers. The percentage of normal images for SFOV and LFOV was significantly higher with than without AC (72% vs 44% and 72% vs 49%, both P < .001). Interpretive agreement between cameras was better with than without AC (kappa = 0.736 to 0.847 vs 0.545 to 0.774). Correlation for the summed stress score was higher with than without AC (r (2) = 0.892 vs 0.851, both P < 0.001) while Bland Altman analysis demonstrated narrower limits with than without AC (4.0 to -4.3 vs 5.9 to -5.6)., Conclusion: Attenuation correction using truncation compensation with a SFOV camera yields similar results to a LFOV camera. The higher interpretive agreement between cameras after attenuation correction suggests that such images are preferable to non-attenuation-corrected images.

Background: High-fat meals and elevated triglyceride levels are associated with cardiovascular disease. In recent studies of brachial artery vasoactivity, a single high-fat meal reduced endothelial function in young healthy men. It is unknown whether coronary microcirculation is affected after high-fat meals., Objective: To evaluate change in coronary flow reserve after a single high-fat meal., Design: Controlled interventional study., Setting: University hospitals., Patients: 15 young healthy men (mean age [+/-SD], 29 +/- 4 years)., Intervention: Coronary flow reserve was determined by using transthoracic Doppler echocardiography before and after consumption of a high-fat meal in all 15 men and before and after consumption of a low-fat meal in 5 of 15 men., Measurements: Coronary flow reserve, lipid levels, and hemodynamic characteristics., Results: In all men, triglyceride levels increased significantly from baseline 5 hours after the high-fat meal, from 1.1 mmol/L to 2.8 mmol/L (100 mg/dL to 250 mg/dL) (P < 0.001). Average coronary flow reserve was 4.02 before and 3.30 5 hours after the high-fat meal (decrease, 18% [95% CI, 13% to 23%]). In the 5 men who received both meals, mean coronary flow reserve decreased by 0.79 after the high-fat meal and increased by 0.07 after the low-fat meal (difference, -0.86 [CI, -1.36 to -0.37]; P = 0.03). Mean triglyceride levels increased by 1.6 mmol/L (140 mg/dL) after the high-fat meal and 0.1 mmol/L (10 mg/dL) after the low-fat meal (difference, 1.5 mmol/L [CI, 0.3 to 2.7 mmol/L], 130 mg/dL [CI, 23 to 236 mg/dL]; P = 0.03)., Conclusions: Coronary flow reserve decreased after a single high-fat meal in young healthy men. High-fat meals may be detrimental to coronary microcirculation.