Pulmonic valve infective endocarditis from staph lugdunensis.

Pulmonic valve endocarditis is an extremely rare entity. Only 1.1% of all cases of all infective endocarditis affect the pulmonic valve. Furthermore, it is even more uncommon for such a disease process to occur in a young and healthy individual without risk factors. It takes a unique case of circumstances to have pulmonic valve infective endocarditis to occur. Staph lugdunensis is one uncommonly isolated organism that has the ability to cause infective endocarditis in various atypical manifestations. Here we describe a case of a 20-year-old male who did not possess any of the common risk factors of infective endocarditis, who developed isolated pulmonic valve endocarditis caused by Staphylococcus lugdunensis (S. lugdunensis). Based upon our literature review, only 1 other case of S. lugdunensis endocarditis affective the pulmonic valve has been reported.

Teaching Cardiopulmonary Resuscitation to Young Children (<12 Years Old).

Out-of-hospital cardiac arrest is a major public health concern. Research has shown that initiation of cardiopulmonary resuscitation (CPR) by lay bystanders increases survival rates. Evidence also shows that CPR training, delivered in various ways, is successful in a wide age range of children. This study was conducted to assess if children (average age of 12) were able to perform high quality chest compressions and whether this can be achieved by supplementing CPR instructional video with other methods to time delivery of compressions. A total of 160 study subjects were divided into 3 groups. The CPR instructional video was played for all 3 groups. One group (n = 53) was instructed to time their compressions with a popular music. Another group (n = 56) was assigned to a specially designed video game whereby they practiced how to time chest compressions. The control group (n = 51) consisted of those who only watched the video. Each group was divided in teams of 3 and observed for successful delivery of chest compressions on the little Anne Adult CPR training manikins. The control group performed a mean of 88 compressions per minute (CPM) out of which a mean of 72 clicks were appreciated. The music group performed 104 CPM with 74 clicks. Meanwhile, the video game group performed 102 CPM with 78 clicks. This study demonstrated sixth graders are capable of learning and performing effective hands only bystander CPR and this can and should be taught in schools even as young as the sixth grade level.

Who refuses enrollment in cardiac clinical trials?

OBJECTIVE: To evaluate the factors associated with refusal to participate in acute cardiac clinical trials. BACKGROUND: Cardiac clinical trials in the acute setting pose a set of unique challenges to enrollment, such as the ability to obtain meaningful informed consent. In addition, it is unclear whether enrollment is associated with the sociodemographic characteristics (such as age, race and gender) of those being recruited. While policies have been instituted to enhance the representation of women and minorities in research, limited data exist on current enrollment patterns and reasons for refusal to participate in cardiac clinical trials. METHODS: 184 patients approached to participate in one of 25 cardiac clinical trials at Duke University Medical Center from 11/01 to 05/04 were surveyed regarding reasons for or against participation in clinical trials to identify predictors of non-enrollment. RESULTS: The mean age of the respondents was 61.6 years (SD 12.2), with 36% female and 32% non-white patients. There were no differences in refusal rates by age, gender or ethnicity. Higher acuity trials had higher refusal rates OR 3.6 (1.68-7.75) as well as not reading the informed consent form OR 2.99 (1.37-6.54). The main reasons people refused enrollment were due to inconvenience and not wanting to be experimented upon. LIMITATIONS: This study was cross-sectional and conducted at a single institution that conducts a high-volume of clinical research. In addition, a majority of the patients in the procedure/device studies were enrolled in one relatively low-risk cardiac catheterization laboratory trial with a low refusal rate. These attributes may limit the generalizability of the findings reported here. CONCLUSION: Older persons, women and minorities are equally likely to agree to enroll in cardiac clinical trials as younger persons, men and non-minorities. Future efforts to increase the efficiency of recruitment should focus on improving convenience for participants in this acute setting and improving basic understanding of clinical trials.

Acute myocardial infarction in pregnancy: a United States population-based study.

BACKGROUND: The purpose of this study was to determine the incidence, mortality, and risk factors for pregnancy-related acute myocardial infarction in the United States. METHODS AND RESULTS: The Nationwide Inpatient Sample for the years 2000 to 2002 was queried for all pregnancy-related discharges. A total of 859 discharges included a diagnosis of acute myocardial infarction, for a rate of 6.2 (95% confidence interval [CI] 3.0 to 9.4) per 100,000 deliveries. Among these, there were 44 deaths, for a case fatality rate of 5.1%. The odds of acute myocardial infarction were 30-fold higher for women aged 40 years and older than for women <20 years of age. Single independent variables that were statistically and clinically significant, including age, race, and certain medical conditions and obstetric complications, were entered into a multivariable logistic regression model. Hypertension (odds ratio [OR] 21.7, 95% CI 6.8 to 69.1), thrombophilia (OR 25.6, 95% CI 9.2 to 71.2), diabetes mellitus (OR 3.6, 95% CI 1.5 to 8.3), smoking (OR 8.4, 95% CI 5.4 to 12.9), transfusion (OR 5.1, 95% CI 2.0 to 12.7), postpartum infection (OR 3.2, 95% CI 1.2 to 10.1), and age 30 years and older remained as significant risk factors for pregnancy-related acute myocardial infarction. Black race was eliminated as a risk factor in the multivariable analysis, which suggests that the increased incidence among black women is explained by an increased prevalence of other cardiovascular risk factors. CONCLUSIONS: Although acute myocardial infarction is a rare event in women of reproductive age, pregnancy increases the risk 3- to 4-fold. Certain medical conditions and complications of pregnancy increase the risk further and are potentially modifiable risk factors.

Willingness to participate in cardiac trials.

The elderly, women, and minorities are all less likely to be enrolled in randomized clinical trials (RCTs). Whether differential patient interest in RCTs contributes to these disparities is unclear. The authors surveyed 660 patients willingness to consider two potential cardiac RCTs of medical therapy vs. percutaneous coronary angioplasty or coronary artery bypass surgery, respectively. The cohorts mean age was 67 years (43% aged >or=70 years; 35% women; and 28% nonwhite). Compared with younger patients, those aged >or=70 years were equal or more likely to consider both the percutaneous coronary angioplasty (46% vs. 41%) and coronary artery bypass surgery RCTs (35% vs. 31%). Race also had no significant impact on trial enrollment, yet women were significantly less likely than men to participate in either RCT. In conclusion, patient willingness to consider RCT participation does not explain underenrollment of elderly and minority patients. Women, however, were more reluctant to consider RCTs, an area requiring further study.

Are women worrying about heart disease?

Women at risk for coronary artery disease (CAD) may not be worried about the disease. In this study, demographic, CAD-risk, and CAD-worry data collected from Durham Veterans' Affairs Medical Center women veterans were examined using bivariate and multivariate analysis with worry as the outcome. Excluding CAD patients (N = 64) and incomplete data (N = 17) of 328 women, 42% worried about CAD. Younger age, single marital status, obesity, family history, and hyperlipidemia were associated with worry. Of women with up to three risk factors, fewer than half worried about CAD. Higher-risk women were unconcerned about CAD. This could undermine prevention efforts.