Lyme carditis represents a rare cardiac complication of Borrelia burgdorferi infection, often causing conduction disturbances but rarely causing malignant arrhythmias. Inflammatory acute coronary syndrome, driven by immune-mediated plaque erosion rather than rupture, represents a nontraditional ischemic mechanism. This case highlights their overlap. The case of a previously healthy man with Lyme disease who experienced cardiac arrest because of ventricular tachycardia is reported. Imaging showed myocardial inflammation together with coronary plaque erosion instead of plaque rupture. The patient underwent advanced diagnostic testing and received multidisciplinary medical care, which led to complete cardiac recovery and implantable cardioverter-defibrillator placement.
Background: Continuous-flow left ventricular assist devices (LVADs) are increasingly used as destination therapy. Although postimplantation stroke rates have been described in the context of bridge-to-transplant or mixed cohorts, stroke development is not well evaluated in patients who receive continuous-flow LVAD with a destination therapy indication. This report characterizes the stroke profile of a modern institutional cohort of patients undergoing destination therapy and evaluates their risk factors for stroke onset. Methods: Patients implanted with continuous-flow LVAD as destination therapy at the reporting institution between January 2010 and June 2020 were retrospectively reviewed and analyzed. Stroke was defined as any neurologic deficit caused by an abrupt disruption in cerebral blood flow that did not resolve within 24 hours and that was confirmed by imaging. Terminal outcomes of stroke development and death were assessed using a competing-risks model. Fine-Gray regression was used to evaluate potential predictors of stroke development. Results: Patients who received continuous-flow LVAD (N = 311) were classified by device type: Heart-Mate II (Abbott; n = 97); HeartMate 3 (Abbott; n = 72); and HeartWare Ventricular Assist Device (Medtronic; n = 42). Thirty-five percent of patients (110/311) developed postoperative atrial fibrillation (AF). Estimated stroke incidence was 15% at 1 year, 24% at 3 years, and 27% at 5 years. According to multivariable Fine-Gray regression, receiving a HeartMate 3 device (subdistribution hazard ratio [HR], 0.41 [95% CI, 0.19-0.90]; P = .03) and amiodarone at discharge (HR, 0.55 [95% CI, 0.33-0.94]; P = .03) were associated with lower stroke risk. Postoperative AF (HR, 1.68 [95% CI, 1.03-2.73]; P = .04) was associated with increased stroke risk. Conclusion: The HeartMate 3 was associated with decreased stroke rates, but risk remained high for patients who developed postoperative AF. Further investigation into protective strategies and use of amiodarone to treat AF after continuous-flow LVAD implantation is needed.
This case study explores the journey of an 80-year-old male patient with a history of hypertension, diabetes, coronary artery disease after coronary artery bypass grafting, atrial fibrillation, and heart failure. Nine months before he presented to the emergency department, he had undergone mitral valve clipping for severe mitral valve regurgitation. Despite initial improvement, the patient experienced return of symptoms, including dyspnea at rest and lower limb edema. The results of this case—discovery of the need for mitral valve replacement—provides insights into the management of complications from mitral valve clipping and emphasizes that management requires a nuanced, meticulous approach.
Background: Mitral valvuloplasty is considered the best treatment for pediatric mitral valve regurgitation. The objective of this analysis was to identify risk factors for postoperative mitral valve regurgitation progression and evaluate valvuloplasty effectiveness. Methods: This retrospective, single-center study investigated the clinical efficacy of mitral valvuloplasty and identified factors that affect prognosis. Pediatric patients with moderate or severe mitral valve regurgitation who had undergone mitral valvuloplasty between September 2016 and August 2023 were included. Kaplan-Meier survival analysis was used to assess freedom from both mitral valve deterioration and cardiovascular death. Univariate and multivariate Cox regression analyses were performed to identify potential risk factors. Results: The study comprised 137 pediatric patients (mean age, 37.5 months [range, 2.4-167.6 months]) who had moderate (64/137 [46.7%]) or severe (73.137 [53.3%]) mitral valve regurgitation. At midterm follow-up (median, 55.3 months), mitral valve regurgitation had statistically significantly decreased compared with preoperative levels (P < .001, Wilcoxon signed-rank test); freedom from cardiovascular death was 97.5%, and freedom from worsening mitral valve regurgitation was 89.4%. Cox regression analysis identified body weight (P = .02), left ventricular end-diastolic diameter (P = .005), and left ventricular ejection fraction (P = .01) at 1 month and cardiopulmonary bypass time (P = .007) as independent risk factors for deterioration. Patients weighing 10 kg or more (P = .04) or with a ventricular septal defect 8 mm or larger (P = .04) had worse outcomes. Conclusion: Mitral valvuloplasty resulted in low mortality and positive long-term results in pediatric patients with mitral valve regurgitation. Early aggressive therapy is recommended to avoid late postoperative mitral valve deterioration.
Key pathobiological components of ischemic heart disease have been identified as follows: (1) In 1970 to 1973, myocardial infarct size was found to be the primary determinant of prognosis after acute myocardial infarction (AMI); (2) in 1973 to 1989, vulnerable coronary artery plaques were found to predispose individuals to coronary plaque disruption and thrombosis, causing major AMI; (3) in 1972, timely coronary reperfusion was demonstrated to limit the size of evolving AMI but with risk of reperfusion injury; and (4) in 1986, myocardial conditioning was found to be a clinically significant modulator capable of delaying AMI progression. Promising cardioprotective strategies combining timely reperfusion with conditioning in experimental animal and proof-of-concept human studies have not been shown to optimize cardioprotection, and this area of research has stalled. Nevertheless, opportunities for further progress against ischemic heart disease have come from new perspectives and approaches, including (1) recognition that functionally significant ischemic heart disease can result from microvascular dysfunction or epicardial coronary atherosclerosis; (2) rapid diagnosis of AMI subtypes through application of the Universal Definition of Myocardial Infarction based on high-sensitivity cardiac troponin measurements; (3) the Canadian Cardiovascular Society classification of AMI based on stages of tissue injury severity, as detected by advanced imaging; (4) implementation of the occlusion vs nonocclusion MI paradigm to prompt aggressive management of all ST-segment elevation MI and the one-third of non-ST-segment elevation MI with total occlusion; and (5) implementation of the Early Heart Attack Care program, which emphasizes prodromal symptom recognition to prevent AMI progression.
This report highlights a case of early structural valve deterioration with a cusp tear in a second-generation Abbott Trifecta Glide Technology bioprosthetic heart valve. A 70-year-old man had undergone aortic valve replacement with a Trifecta Glide Technology valve 30 months earlier for severe bicuspid aortic valve stenosis. He suddenly developed acute heart failure with dyspnea resulting from severe aortic valve regurgitation, with a cusp tear in the Trifecta Glide Technology valve, as demonstrated by transthoracic echocardiography. The patient was successfully treated with urgent repeat aortic valve replacement.
A 63-year-old man with a history of hypertension, prediabetes, and sleep apnea presented with pedal edema, weight loss, and flushing. Laboratory work revealed elevated B-type natriuretic peptide and normocytic anemia. Echocardiography showed right ventricular enlargement, severe tricuspid valve regurgitation, and thickened tricuspid valve leaflets, raising suspicion for carcinoid heart disease. Further testing confirmed a neuroendocrine tumor with liver metastasis. Despite somatostatin therapy, the patient's symptoms were refractory to diuretics. Surgical intervention with tricuspid and pulmonary valve replacement was undertaken. Postoperatively, the patient demonstrated substantial improvement in functional tolerance and quality of life. This case highlights the importance of surgical intervention in advanced carcinoid heart disease.
The Micra device is a leadless pacemaker implanted in the right ventricle via a femoral vein transcatheter approach. There are several indications for and advantages to using a leadless pacemaker, and the device's role in the field of cardiology will probably continue to increase. This article presents the case of a rare complication probably due to inadvertent placement of the device in the left ventricle across an undiagnosed patent foramen ovale.
Rhabdomyosarcoma represents almost 20% of all primary malignant neoplasms of the heart. In the majority of cases, the tumor arises from the ventricular wall, although these tumors can also arise from the atrial walls and mimic atrioventricular valve stenosis. This report presents a case of a patient diagnosed with an atrial mass that was detected by transthoracic echocardiography and confirmed by histopathology. The mass was successfully resected during an uneventful surgical intervention, but the patient died 6 months after the procedure.
Platypnea-orthodeoxia syndrome is a rare condition characterized by positional dyspnea and hypoxemia, with symptoms presenting in the upright position and improving when recumbent. Hypoxemia in platypnea-orthodeoxia syndrome is defined as a drop in Pao2 of more than 4 mm Hg or oxygen saturation greater than 5% when moving from a supine to an upright position. Etiologic mechanisms include intracardiac or pulmonary shunts and ventilation perfusion ratio mismatch. Platypnea-orthodeoxia syndrome has been described as part of COVID-19 pneumonia sequelae, with differing physiologic mechanisms from cardiac pathologies. This report presents the case of a patient with platypnea-orthodeoxia syndrome of multifactorial etiology: intracardiac shunting secondary to a patent foramen ovale and ventilation perfusion ratio mismatch as a sequela of COVID-19 pneumonia.
Takotsubo cardiomyopathy (stress cardiomyopathy, or broken-heart syndrome), characterized by reversible left ventricular dysfunction without clinically significant coronary artery obstruction, is rare but has been more commonly reported recently. Esophagogastroduodenoscopy as a cause of takotsubo cardiomyopathy remains exceedingly rare. The case report of an 84-year-old female patient with a complex medical history who had acute stress cardiomyopathy following esophagogastroduodenoscopy, which required prolonged hospitalization and hemodynamic support, is presented. This case emphasizes the importance of recognizing and considering this uncommon pathology and its complications in differential diagnosis. Diagnostic modalities and treatment options for this condition are also discussed.
Background: Dilated cardiomyopathy (DCM) is one of the most common types of cardiomyopathies. The current study constructs a proposed genetic risk score and assesses its potential as a predictive tool for individual DCM susceptibility. Methods: A total of 1,000 patients with idiopathic DCM and 828 control participants from the study institution were enrolled. The top 25 up-regulated and down-regulated genes from tandem mass spectrometry analysis of 6 hearts with DCM and 7 control hearts (from a study by Chen et al) were selected for logistic analysis using whole-exome sequencing data. Statistically significant variants were prepared for genetic risk score construction. The predictive power of the genetic risk score and a composite variable for DCM risk were evaluated using receiver operating characteristic curve analysis. Results: A total of 5 variants associated with DCM susceptibility were identified to develop the genetic risk score. A score of at least 6.4 was more strongly associated with increased risk of DCM (odds ratio, 2.4; P < .001) than scores lower than 6.4. Statistical significance remained evident in multivariate analysis after adjusting for traditional risk factors, including age, sex, hypertension, diabetes, and smoking status (odds ratio, 2.54; P < .001). Individuals with a score of at least 6.4 exhibited a decrease in left ventricular ejection fraction and an increase in left ventricular end-diastolic diameter compared with individuals with a score lower than 6.4 (P < .001). Stratification by age, sex, history of hypertension, diabetes, and smoking status did not substantially affect the association between genetic risk score and the risk of DCM. The discriminant power of the genetic risk score is excellent, with a C statistic of 0.72. Conclusion: The genetic risk score, which consists of 5 variants, could effectively identify individuals at high risk of DCM in the study population and aid in the implementation of early prevention strategies in clinical practice.
Background: Although Houston, Texas, is a diverse city with opportunities for economic prosperity, many Houston residents have low socioeconomic status and poor access to health care. Cardiovascular disease rates in Houston differ by ethnicity. It is therefore crucial to understand how the risk of cardiovascular disease differs among diverse ethnic and sexual minority populations. Methods: This study assessed the recruitment methods and demographic composition of the Houston HeartReach Registry, a database repository of cardiovascular disease trends and risk factors in Houston's population. The self-reported demographics of the participants recruited to date were analyzed with descriptive statistics. The primary end point of this interim study was the number of women recruited from each location by year, ethnicity, socioeconomic status, health care status, and sexual orientation. The number of women of each ethnicity recruited from each location was also examined. Results: Currently, 1,476 women are enrolled in the registry, including 996 (67.48%) Hispanic women, 233 (15.79%) non-Hispanic White women, 190 (12.87%) Black women, 24 (1.63%) Asian women, and 29 (1.97%) women from other races and ethnicities. Of these 1,476 women, 352 (23.85%) had an annual income of $10,000 to $24,000, 375 (25.41%) had private health insurance, and 342 (23.17%) were heterosexual. Most women enrolled in the registry (1,082 [73.31%]), including most of the Hispanic participants, were recruited at BakerRipley events. Conclusion: To date, 1,476 of a planned 5,000 participants have been enrolled in the Houston HeartReach Registry. At present, Hispanic women make up the majority of participants, indicating an underrepresentation of other ethnic demographics. The enrollment of individuals from sexual minority groups, from varied socioeconomic backgrounds, and with diverse health care statuses aligns proportionally with the total count of recruited women to date. The application of deliberate, culturally nuanced, and demographic-specific recruitment strategies should facilitate the inclusion of desired participants in a comprehensive manner.
Acute type A aortic dissection is a catastrophic cardiovascular event characterized by severe pain and hemodynamic instability. The standard of care is emergency surgery, which, despite its benefits, carries substantial perioperative risks. Conservative management is an alternative approach reserved for older patients with clinically significant comorbidities or for whom surgical risk is prohibitive and perioperative mortality may outweigh potential benefits. The case is presented of a 75-year-old patient who opted for conservative management and has been followed up with favorable outcomes for 9 years since the index event.
