Aerococcus urinae tricuspid valve infective endocarditis.

Aerococcus urinae is an alpha-hemolytic, gram-positive coccus that is responsible for 54/1,000,000 cases of all urinary tract infections. Risk factors include male gender, advanced age, and genitourinary tract abnormalities. It has often been misidentified as Staphylococcus or Streptococcus due to its morphological similarities. Fewer than 50 cases of A. urinae infective endocarditis have been reported, most affecting the mitral or aortic valve. We present the case of a 61-year-old woman who presented with recurrent fevers and worsening dyspnea on exertion and was found to have A. urinae bacteremia. A transesophageal echocardiogram showed evidence of moderate tricuspid valve regurgitation and vegetations involving its posterior and septal leaflets. The patient was successfully treated with intravenous penicillin G for 6 weeks. She was not deemed a candidate for cardiac surgery.

Heart Failure as the Initial Presentation of Anomalous Left Coronary Artery From the Pulmonary Artery.

Coronary arteries arising from the pulmonary artery have an incidence of 0.002% in the general population. We present a 29-year-old woman who presented to our hospital with acute decompensated heart failure and atrial fibrillation with a rapid ventricular rate. She underwent a cardiac catheterization to rule out ischemic disease, which revealed retrograde contrast flow through the left coronary artery from the right coronary artery. A coronary computed tomography (CT) angiogram was pursued which showed the presence of an anomalous left coronary artery arising from the pulmonary artery (ALCAPA). For the management of her atrial fibrillation, she was electrically cardioverted. She was discharged on guideline-directed medical therapy for her heart failure, with a cardiac surgery referral for the surgical fixation of her ALCAPA.

An Unexpected Factor to Wellens Syndrome.

Factor V Leiden deficiency, the most common inherited thrombophilia, is a risk factor for venous thromboembolism in both the heterozygous and homozygous forms. An autosomal dominant genetic condition, the pattern of incomplete penetrance leads to variable manifestations of the disease. The association with arterial thromboembolism remains controversial, with studies indicating modest increases in risk of coronary artery disease, stroke. We present the case of a 53-year-old male with Wellens syndrome, with a history of heterozygous factor V Leiden deficiency and no other risk factors. Coronary angiography found a complete total occlusion of the proximal left anterior descending artery, with established collaterals, ultimately requiring coronary artery bypass graft. Laboratory testing effectively eliminated the presence of any alternative known risk factors for the advanced coronary artery disease. The literature evaluating a possible link between factor V Leiden deficiency and atherosclerosis remain conflicting. Our case highlights a concerning association and need for further studies.

Stent Embolization Mimicking Acute Myocardial Infarction.

Venous thromboembolism is associated with significant morbidity and mortality if left untreated. Anticoagulation is the cornerstone of treatment. Venous stents are a relatively newer entity that are increasingly being used to treat venous stenosis/occlusion. It is a safe procedure, but complications include vein rupture, arterial puncture, retroperitoneal bleeding, and in-stent thrombosis. Stent migration is a rare but potentially fatal complication. We present a case of venous stent embolization to the heart that presented as a non-ST segment elevation myocardial infarction.