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
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
severe symptomatic tricuspid stenosis often requires intervention.When the etiology is bioprosthetic valve failure,a challenging situation is met.Surgical valve replacement is the gold standard of treatment for severe...severe symptomatic tricuspid stenosis often requires intervention.When the etiology is bioprosthetic valve failure,a challenging situation is met.Surgical valve replacement is the gold standard of treatment for severe tricuspid valve(TV)disease.[1]However,a redo sternotomy is rarely performed for isolated TV disease due to very high perioperative mortality.[2]Evolving percutaneous technology presents new frontiers in treatment,with the valveinvalve procedure emerging as an alternative.We present a case of a 65year woman with progressive symptoms due to failure of a bioprosthetic valve in the tricuspid position who was not a surgical candidate but underwent percutaneous intervention with significant clinical improvement.展开更多
The left atrial appendage(LAA)is the most common site of left atrial thrombus with more than 90%of thrombi formed within this structure.[1]Transesophageal echocardiography(TEE)is the gold standard imaging technique fo...The left atrial appendage(LAA)is the most common site of left atrial thrombus with more than 90%of thrombi formed within this structure.[1]Transesophageal echocardiography(TEE)is the gold standard imaging technique for identifying LAA thrombus,with sensitivity and specificity both of 95%–100%.[1,2]An imaging modality that is used on most cardiac patients is the transthoracic echocardiogram(TTE).While quick and noninvasive,it is not known for its ability to detect left atrial appendage thrombi.Detecting a thrombus on TTE is a great advantage as it allows for rapid initiation of anticoagulation and avoidance of cardioversion early in atrial fibrillation patients.This case demonstrates the rare occurrence of a patient who was found to be in atrial fibrillation in the setting of thyrotoxicosis who was subsequently discovered to have a left atrial appendage thrombus on TTE.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
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severe symptomatic tricuspid stenosis often requires intervention.When the etiology is bioprosthetic valve failure,a challenging situation is met.Surgical valve replacement is the gold standard of treatment for severe tricuspid valve(TV)disease.[1]However,a redo sternotomy is rarely performed for isolated TV disease due to very high perioperative mortality.[2]Evolving percutaneous technology presents new frontiers in treatment,with the valveinvalve procedure emerging as an alternative.We present a case of a 65year woman with progressive symptoms due to failure of a bioprosthetic valve in the tricuspid position who was not a surgical candidate but underwent percutaneous intervention with significant clinical improvement.
文摘The left atrial appendage(LAA)is the most common site of left atrial thrombus with more than 90%of thrombi formed within this structure.[1]Transesophageal echocardiography(TEE)is the gold standard imaging technique for identifying LAA thrombus,with sensitivity and specificity both of 95%–100%.[1,2]An imaging modality that is used on most cardiac patients is the transthoracic echocardiogram(TTE).While quick and noninvasive,it is not known for its ability to detect left atrial appendage thrombi.Detecting a thrombus on TTE is a great advantage as it allows for rapid initiation of anticoagulation and avoidance of cardioversion early in atrial fibrillation patients.This case demonstrates the rare occurrence of a patient who was found to be in atrial fibrillation in the setting of thyrotoxicosis who was subsequently discovered to have a left atrial appendage thrombus on TTE.
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).
