A 71-year-old male with a medical history of sick sinus syndrome with dual-chamber pacemaker system implantation six years prior,and hypertension presented to the emergency department with complaints of generalized ma...A 71-year-old male with a medical history of sick sinus syndrome with dual-chamber pacemaker system implantation six years prior,and hypertension presented to the emergency department with complaints of generalized malaise,fever,and severe lower back pain.His evaluation was significant for a 2.3 cm × 1.2 cm epidural abscess.展开更多
Cardiac tamponade can result from a variety of intrapericardial or extrapericardial sources of compression of the heart and great vessels.Cardiac tamponade can be acute or subacute and results from fluid or gas collec...Cardiac tamponade can result from a variety of intrapericardial or extrapericardial sources of compression of the heart and great vessels.Cardiac tamponade can be acute or subacute and results from fluid or gas collection in the pericardial space leading to impairment in cardiac function.Postoperative cardiac tamponade following open heart surgery can be caused by hemorrhage within the pericardial sac or by mediastinal hematoma formation.展开更多
Papillary fibroelastoma(PFE)is a primary,histologically benign endocardial neoplasm.Though PFE has long been reported as the second most common primary cardiac neoplasm,it has since pulled ahead of cardiac myxomas,lar...Papillary fibroelastoma(PFE)is a primary,histologically benign endocardial neoplasm.Though PFE has long been reported as the second most common primary cardiac neoplasm,it has since pulled ahead of cardiac myxomas,largely due to evolving cardiac imaging modalities.While PFEs are benign histologically,they have the potential for devastating clinical consequences,transient ischemic attack,stroke,myocardial infarction,syncope,pulmonary,and peripheral embolism.Despite increased detection rate,there remains uncertainty regarding etiology,exact prevalence,and clinical management of PFEs.This paucity of information is reflected by the lack of official guidelines on this matter.In this article,we aim to summarize the current state of understanding regarding PFE and discuss areas of ongoing controversy.展开更多
Liposarcoma is one of the most common soft tissue sarcomas,representing 50%of all retroperitoneal sarcomas.A large retroper-itoneal sarcoma can exert mass effect on intraab-dominal organs and the thoracic cavity produ...Liposarcoma is one of the most common soft tissue sarcomas,representing 50%of all retroperitoneal sarcomas.A large retroper-itoneal sarcoma can exert mass effect on intraab-dominal organs and the thoracic cavity producing symptoms similar to those seen in acute decompe-nsated heart failure(HF),such as abdominal swell-ing,dyspnea on exertion,and orthopnea.However,the presentation with new-onset HF masking a mas-sive retroperitoneal liposarcoma is exceedingly rare.Here,we present an interesting case of an elderly patient with new-onset decompensated HF in the setting of multi-vessel coronary artery disease who responded well to intravenous diuretic therapy with-out complete symptom resolution.Further workup showed a massive retroperitoneal sarcoma as the con-tributing etiology.Given his poor cardiac function,he was not initially a surgical candidate.However,after being placed on appropriate goal-directed med-ical therapy,he experienced recovery in his ejection fraction(EF)and is now a surgical candidate.展开更多
An 80-year-old male with type Ⅱ diabetes mellitus,hypertension and hyperlipidemia presented with chest pain.Vital signs were significant for severely elevated blood pressure of 190/100 mmHg,but otherwise normal.Physi...An 80-year-old male with type Ⅱ diabetes mellitus,hypertension and hyperlipidemia presented with chest pain.Vital signs were significant for severely elevated blood pressure of 190/100 mmHg,but otherwise normal.Physical examination was unrevealing.Chest X-ray and electrocardiogram were unremarkable.In Figure 1A,the transthoracic echocardiogram demonstrated an ejection fraction of 55%–60%with a parachute mitral valve(PMV),which had no stenosis or regurgitation.The patient’s chest pain resolved with normalization of his blood pressure and he was discharged with medical management.展开更多
An 85-year-old female with history of dementia presented with concern for severe sepsis and was found to have methicillin sensitive staphylococcus aureus bacteremia complicated by atrial fibrillation.For further worku...An 85-year-old female with history of dementia presented with concern for severe sepsis and was found to have methicillin sensitive staphylococcus aureus bacteremia complicated by atrial fibrillation.For further workup,a transoesophageal echocardiography(TOE)was obtained.The study revealed a large echogenic density with multiple echolucent areas within the finding.There was evidence of blood flow in these echolucent areas based on color flow imaging.This mass was intermittently protruding into the left ventricle causing a function mitral stenosis.The collective findings on echocardiography,in context of bacteremia,were highly suggestive of mitral valve abscess(Figure 1).展开更多
Acute decompensated heart failure(HF)is the most common cause of hospital ad-mission in patients older than 65 years.Mean length of hospital stay is about 5-6 days and with a frequent number of hospital readmission ra...Acute decompensated heart failure(HF)is the most common cause of hospital ad-mission in patients older than 65 years.Mean length of hospital stay is about 5-6 days and with a frequent number of hospital readmission rates of 25%to 50%at 30 days and 6-12 months,respect-ively.[1]Treatment options are vast and depend on certain patient characteristics,including hemody-namics,which drive the acute management.A pop-ular modality to assess hemodynamics in acute HF is the right heart catheterization(RHC).While in-vasive,the use of RHC gives providers the oppor-tunity to evaluate values that directly contribute to the management of the patient.These numbers can calculate the cardiac output as well as help establish the underlying etiology of the patient’s symptoms and guide therapy.展开更多
文摘A 71-year-old male with a medical history of sick sinus syndrome with dual-chamber pacemaker system implantation six years prior,and hypertension presented to the emergency department with complaints of generalized malaise,fever,and severe lower back pain.His evaluation was significant for a 2.3 cm × 1.2 cm epidural abscess.
文摘Cardiac tamponade can result from a variety of intrapericardial or extrapericardial sources of compression of the heart and great vessels.Cardiac tamponade can be acute or subacute and results from fluid or gas collection in the pericardial space leading to impairment in cardiac function.Postoperative cardiac tamponade following open heart surgery can be caused by hemorrhage within the pericardial sac or by mediastinal hematoma formation.
文摘Papillary fibroelastoma(PFE)is a primary,histologically benign endocardial neoplasm.Though PFE has long been reported as the second most common primary cardiac neoplasm,it has since pulled ahead of cardiac myxomas,largely due to evolving cardiac imaging modalities.While PFEs are benign histologically,they have the potential for devastating clinical consequences,transient ischemic attack,stroke,myocardial infarction,syncope,pulmonary,and peripheral embolism.Despite increased detection rate,there remains uncertainty regarding etiology,exact prevalence,and clinical management of PFEs.This paucity of information is reflected by the lack of official guidelines on this matter.In this article,we aim to summarize the current state of understanding regarding PFE and discuss areas of ongoing controversy.
文摘Liposarcoma is one of the most common soft tissue sarcomas,representing 50%of all retroperitoneal sarcomas.A large retroper-itoneal sarcoma can exert mass effect on intraab-dominal organs and the thoracic cavity producing symptoms similar to those seen in acute decompe-nsated heart failure(HF),such as abdominal swell-ing,dyspnea on exertion,and orthopnea.However,the presentation with new-onset HF masking a mas-sive retroperitoneal liposarcoma is exceedingly rare.Here,we present an interesting case of an elderly patient with new-onset decompensated HF in the setting of multi-vessel coronary artery disease who responded well to intravenous diuretic therapy with-out complete symptom resolution.Further workup showed a massive retroperitoneal sarcoma as the con-tributing etiology.Given his poor cardiac function,he was not initially a surgical candidate.However,after being placed on appropriate goal-directed med-ical therapy,he experienced recovery in his ejection fraction(EF)and is now a surgical candidate.
文摘An 80-year-old male with type Ⅱ diabetes mellitus,hypertension and hyperlipidemia presented with chest pain.Vital signs were significant for severely elevated blood pressure of 190/100 mmHg,but otherwise normal.Physical examination was unrevealing.Chest X-ray and electrocardiogram were unremarkable.In Figure 1A,the transthoracic echocardiogram demonstrated an ejection fraction of 55%–60%with a parachute mitral valve(PMV),which had no stenosis or regurgitation.The patient’s chest pain resolved with normalization of his blood pressure and he was discharged with medical management.
文摘An 85-year-old female with history of dementia presented with concern for severe sepsis and was found to have methicillin sensitive staphylococcus aureus bacteremia complicated by atrial fibrillation.For further workup,a transoesophageal echocardiography(TOE)was obtained.The study revealed a large echogenic density with multiple echolucent areas within the finding.There was evidence of blood flow in these echolucent areas based on color flow imaging.This mass was intermittently protruding into the left ventricle causing a function mitral stenosis.The collective findings on echocardiography,in context of bacteremia,were highly suggestive of mitral valve abscess(Figure 1).
文摘Acute decompensated heart failure(HF)is the most common cause of hospital ad-mission in patients older than 65 years.Mean length of hospital stay is about 5-6 days and with a frequent number of hospital readmission rates of 25%to 50%at 30 days and 6-12 months,respect-ively.[1]Treatment options are vast and depend on certain patient characteristics,including hemody-namics,which drive the acute management.A pop-ular modality to assess hemodynamics in acute HF is the right heart catheterization(RHC).While in-vasive,the use of RHC gives providers the oppor-tunity to evaluate values that directly contribute to the management of the patient.These numbers can calculate the cardiac output as well as help establish the underlying etiology of the patient’s symptoms and guide therapy.
