Subacute fungal endocarditis due to Acremonium spp: a case study and review of the literature.

A 52 years old patient is hospitalized in June 2007 in the Cardiology Clinic of Cardiovascular Diseases Medical Institute in Iasi with suspected subacute infectious endocarditis. Echocardiography shows mobile vegetation on the pulmonary valve. Acremonium spp is isolated from blood cultures after 2 weeks of incubation. The patient was treated with fluconazole, but died after 3 months due to renal failure.

[Takotsubo cardiomyopathy]. / Cardiomiopatia takotsubo.

Takotsubo cardiomyopathy or "heart broken syndrome" or transient apical ballooning syndrome is an increasingly reported syndrome characterized by the fact that most patients are women aged over 65 years. The most common electrocardiographic changes are ST-segment elevation and negative T waves in precordial leads. Symptoms at onset are similar to those of acute myocardial infarction; the ventricular dysfunction is shaped like a takotsubo (a Japanese pot for fishing octopus), echocardiography and ventriculography show akinesia, hipokinesia or diskinesia (ballooning) of apical segments of left ventricle and hyperkinesia of the basal; the coronary arteries are normal angiographic; the dysfunction improves rapidly within a few weeks. Its origins are unclear, there are several pathophysiological theories, most sustained is a myocardial stunning secondary catecholamine-induced excess of intense physical or mental stress. There is no clear standard of treatment. In cases evolving with hemodynamic instability the use of beta agonist agents must be avoided, aortic balloon counterpulsation is preferable. The patient prognosis is usually good, reaching maximum mortality of 8%. In rare situations were reported complications such as acute pulmonary oedema, cardiogenic shock, acute mitral regurgitation, potentially fatal arrythmias ventricular fibrillation or torsades de pointes. In Cardiology Clinic of Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu" Iasi were hospitalized 4 cases with Takotsubo cardiomyopathy from 2008 to 2011. Their features are presented in this paper. The difference of prognosis and treatment between Takotsubo cardiomyopathy and acute myocardial infarction require an accurate diagnosis, the clinical hypothesis result only after knowledge the clinical and paraclinical peculiarities of this pathological entity.