Unique Presentation of a Ubiquitous Organism: Capnocytophaga canimorsus Meningitis With Pneumocephalus.

Capnocytophaga canimorsus is a bacterium commonly found in the oral cavities of cats and dogs. Infections are particularly common in immunocompromised patients who have been exposed to bites or come in contact with saliva from these animals. The manifestations of infection include bacteremia, fever, and, rarely, meningitis. Diagnosis is challenging given the bacteria has slow growth on culture media. The organism is susceptible to beta-lactam antibiotics, with higher-generation cephalosporins recommended for treating meningitis. We present a case of a 74-year-old woman with altered mental status and no signs of immunosuppression. She was diagnosed with meningitis caused by Capnocytophaga, with an intriguing finding of pneumocephalus, which is a rare occurrence as per literature review.

A Case of Infective Endocarditis in a Middle-Aged Patient With Trisomy 21 and an Incidentally Discovered Patent Foramen Ovale (PFO).

Trisomy 21 often leads to cardiac complications, usually associated with congenital heart disease, such as atrial septal defects, ventricular septal defects, and patent ductus arteriosus. This case describes an unexpected instance of infective endocarditis (IE) in a middle-aged patient with an incidentally discovered patent foramen ovale (PFO). The common risk factors for IE include previous valve surgery, artificial heart valves, pacemakers, prior IE, congenital defects like bicuspid aortic valve, IV drug use, and the congenital defects mentioned earlier.

Peri-Myocarditis as a Dire Consequence of Coronavirus Disease: A Clinical Challenge.

Myocarditis is an inflammation of the heart muscle, most commonly caused by viral infections, with other contributing factors including medications or systemic inflammatory conditions. Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 virus). In this report, we present a case of fulminant myocarditis in a patient with COVID-19 infection. Fulminant myocarditis is an aggressively progressive and severe variant that can result in substantial cardiac impairment. We present a case of fulminant myocarditis with a unique time course, progression, and potential challenges faced in diagnosis and management. Healthcare providers need to remain vigilant and anticipate the potential rapid progression of this disease.

Navigating the evolving landscape of HFpEF management: A detailed look at key ACC/AHA/ESC guideline updates.

Heart failure, a growing concern in the United States, significantly impacts both morbidity and mortality. Classified by ejection fraction, heart failure with preserved ejection fraction (HFpEF) now accounts for half of all cases and is steadily rising. Unlike its counterpart, heart failure with reduced ejection fraction (HFrEF), HFpEF lacks clear management guidelines. Recognizing this critical gap, we aim to review existing recommendations and formulate effective management strategies for HFpEF.

Impact of Obstructive Sleep Apnea Treatment on Cardiovascular Disease Associated Mortality and Morbidity: A Systematic Review.

The association between untreated obstructive sleep apnea (OSA) and cardiovascular disease (CVD) is well known. In this literature review, we aim to review the existing literature on treatment effects of OSA and its impact on CVD morbidity and mortality, stratified by gender. We systematically reviewed PubMed, Medline, and Scopus per PRISMA guidelines and included 25 studies in the final review. Primary outcomes were CVD-associated morbidity and mortality. Out of 25 studies, 10 were meta-analysis, 8 observational, and 7 randomized controlled trials. The treatment modality was continuous positive airway pressure (CPAP) in 23 studies, noninvasive positive pressure ventilation, and oral appliance therapy in 2. Secondary prevention of CVD was the endpoint in 23 studies. A total of 165,775 participants between 45 and 75 years of age, 60%-90% males, and the average Epworth Sleepiness Scale (ESS) score was 5-9. CV outcomes included myocardial infarction, angina, heart failure (HF), acute coronary syndrome (ACS), coronary artery disease (CAD), ischemic heart disease, cardiomyopathy, atrial fibrillation (AF), and hypertension. In 4 studies, CPAP was associated with a reduction in CVD mortality, and 10 studies showed improvement in morbidity. Our review of literature did not show consistent benefits in CV outcomes in OSA patients. We identified many potential research areas, especially the lack of studies demonstrating dose-dependent effect of OSA treatment on CV outcomes, especially when stratified by severity of OSA and gender. Larger prospective studies with longer follow-up will be helpful to study these parameters.

An Unusual Case of Lyme Carditis With Persistent Third-Degree Heart Block.

Lyme's carditis and neuroborreliosis are common manifestation of disseminated Lyme disease. However, third-degree atrioventricular blocks with Lyme's carditis requiring permanent pacemaker with neuroborreliosis and Lyme's disease-associated immunodeficiency are uncommon. Here we present a case of 64-year-old female presenting with neurological symptoms and electrocardiogram changes suggestive of complete heart block with no improvement in the degree of heart block with intravenous antibiotics, requiring permanent pacemaker implantation and course complicated by fungemia.

A Case of Mitral Valve Infective Endocarditis and Atrial Fibrillation Complicated by Hemorrhagic Stroke: A Challenging Clinical Scenario and Approach to Management.

This case report presents a rare and intricate clinical scenario involving a 58-year-old male with a history of hypertension, intravenous drug use (IVDU), and cocaine abuse. The patient presented with profound hypotension and symptoms suggestive of impending shock. Septic workup revealed Staphylococcus aureus in all four blood culture bottles, confirming a diagnosis of infective endocarditis (IE). Transthoracic echocardiography demonstrated a large vegetation measuring 1.9x1.7 cm on the mitral valve. Additionally, the patient exhibited non-ST segment elevated myocardial infarction (NSTEMI) type II in the setting of cocaine use, atrial fibrillation, and therapeutic anticoagulation. Subsequent imaging studies raised concerns regarding hemorrhagic stroke. A multidisciplinary team comprising cardiology, cardiothoracic surgery, infectious disease, and neurology collaborated to develop an optimal management strategy. Considering the high-risk features of the IE and the need to address the hemorrhagic stroke, anticoagulation was temporarily halted, and the patient was transferred for urgent mitral valve replacement surgery. This case highlights the complex interplay between substance abuse, cardiovascular complications, IE, and neurological events, underscoring the challenges encountered in managing such patients.

Chemotherapy-Induced Atrial Fibrillation With Rapid Ventricular Response in a Patient With Pleomorphic Rhabdomyosarcoma: A Case Report and Approach to Management.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Its prevalence in cancer patients undergoing treatment with radiation or chemotherapeutic agents has been on the rise. The most common offending agents are alkylating agents and anthracyclines causing various types of arrhythmias, including AF. We report a case of a 62-year-old male who was diagnosed with stage IV pleomorphic rhabdomyosarcoma and was started on chemotherapy with a mesna-ifosfamide and doxorubicin (MAI) regimen. He developed AF with a rapid ventricular rate soon after his second cycle of treatment, which got better with the initiation of beta-blocker therapy. Since low blood counts, including low platelet levels, are expected in patients with chemotherapy, the continual use of anticoagulation therapy varies on a case-to-case basis.

Trends in incidence and clinical outcome of non-ST elevation myocardial infarction in patients with amyloidosis in the United States, 2010-2020.

Study objective: To assess temporal changes in clinical profile and in-hospital outcome of patients with amyloidosis presenting with non-ST elevation myocardial infarction, NSTEMI. Design/setting: We conducted a retrospective observational study using the National Inpatient Sample (NIS) database from January 1, 2010, to December 31, 2020. Main outcomes: Primary outcome of interest was trend in adjusted in-hospital mortality in patients with amyloidosis presenting with NSTEMI from 2010 to 2020. Our secondary outcomes were trend in rate of coronary revascularization, and trend in duration of hospitalization. Results: We identified 272,896 hospitalizations for amyloidosis. There was a temporal increase in incidence of NSTEMI among patients aged 18-44 years from 15.5 % to 28.0 %, a reverse trend was observed in 45-64 years: 22.1 % to 17.7 %, p = 0.043. There was no statistically significant difference in rate of coronary revascularization from 2010 to 2020; 16.3 % to 14.2 %, p = 0.86. We observed an increased odds of all-cause in-hospital mortality in patients with NSTEMI compared to those without NSTEMI (aOR = 2.2, 95 % CI: 1.9-2.6, p < 0.001) but there was a decrease trend in mortality from 21.5 % to 11.3 %, p = 0.013 for trend. Hospitalization duration was also observed to decreased from 14.1 days to 10.9 days during the study period (p = 0.055 for trend). Conclusion: In patients with amyloidosis presenting with NSTEMI, there was increased incidence of NSTEMI among young adults, a steady trend in coronary revascularization, and a decreasing trend of adjusted all-cause in-hospital mortality and length of hospitalization from 2010 to 2020 in the United States.