ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report.

BACKGROUND: Acute coronary syndrome (ACS) is a rare, but serious complication of infective endocarditis, and diagnosis can be challenging given clinical overlap with other syndromes. A rare cause of ACS in infective endocarditis is mechanical obstruction of the coronary artery. We present the case of a patient with infective endocarditis who developed ST segment myocardial infarction due to occlusion of the right coronary artery ostium by a vegetation. CASE PRESENTATION: A 53-year-old female with no prior history of coronary artery disease was transferred to our tertiary care facility for evaluation and treatment of suspected myopericarditis. After transfer she developed inferior ST segment elevations on ECG along with fever and positive blood cultures for methicillin susceptible Staphylococcus aureus (MSSA). A transesophageal echocardiogram revealed a vegetation on the aortic valve that intermittently prolapsed into the right coronary ostium. She decompensated from a hemorrhagic brain infarct and subsequently transferred to the intensive care unit. She underwent surgical aortic valve debridement without prior cardiac catheterization given the danger of septic coronary embolization. After a prolonged hospital course with multiple complications, she was able to discharge home, with no neurologic deficits on follow-up. CONCLUSIONS: ACS presents a diagnostic and therapeutic challenge in the setting of infective endocarditis. Careful attention to the history, physical exam and testing can help differentiate infective endocarditis from other conditions sharing similar symptoms. Traditional atherosclerotic ACS management may cause great harm when treating patients with infective endocarditis. The presence of a multidisciplinary endocarditis team is ideal to provide the best clinical outcomes for this population.

Calcific mitral stenosis.

The mitral valve annulus is a complex structure that is an integral part of the mitral valve apparatus. The annulus plays an active role in mitral valve leaflet coaptation and in left atrial and ventricular function. The annulus is susceptible to disease processes that are distinct from those that affect the mitral valve leaflets. Advanced annular calcification may extend onto the mitral valve leaflets, thereby causing increased diastolic gradients across the mitral valve. This review highlights risk factors for mitral annular calcification, features of calcific mitral stenosis, differentiation from rheumatic mitral valve disease, and the echocardiographic approach to this disorder.

Physical activity during daily life and brachial artery flow-mediated dilation in peripheral arterial disease.

We determined whether higher levels of physical activity in daily life are associated with better brachial artery flow-mediated dilation (FMD) among individuals with lower extremity peripheral arterial disease (PAD). Participants were 111 men and women with PAD (ankle-brachial index (ABI)