Multidisciplinary Approach to Management of Hypertrophic Cardiomyopathy With Severe Left Ventricular Outflow Obstruction in Pregnancy.

Pregnancy can worsen symptoms of hypertrophic cardiomyopathy and increase the risk of complications. Severe left ventricular outflow tract obstruction with gradient >100 mm Hg poses a high risk of deterioration during pregnancy. We present a patient with hypertrophic obstructive cardiomyopathy in the third trimester of pregnancy with a left ventricular outflow tract gradient >100 mm Hg and discuss successful interdisciplinary management.

Cardiovascular Toxicities Associated with Tyrosine Kinase Inhibitors.

PURPOSE OF REVIEW: To provide a detailed overview of cardiovascular adverse events associated with the use of tyrosine kinase inhibitors across different tumor types. RECENT FINDINGS: Despite an undeniable survival advantage of tyrosine kinase inhibitors (TKIs) in patients with hematologic or solid malignancies, the accompanying off-target cardiovascular adverse events can be life-threatening. In patients with B cell malignancies, the use of Bruton tyrosine kinase inhibitors has been associated with atrial and ventricular arrhythmias, as well as hypertension. Cardiovascular toxic profiles are heterogeneous among the several approved breakpoint cluster region (BCR)-ABL TKIS. Notably, imatinib might be cardioprotective. Vascular endothelial growth factor TKIs, constituting the central axis in the treatment of several solid tumors, including renal cell carcinoma and hepatocellular carcinoma, have strongly been associated with hypertension and arterial ischemic events. Epidermal growth factor TKIs as therapy for advanced non-small cell lung cancer (NSCLC) have been reported to be infrequently associated with heart failure and QT prolongation. While tyrosine kinase inhibitors have been demonstrated to increase overall survival across different types of cancers, special consideration should be given to cardiovascular toxicities. High-risk patients can be identified by undergoing a comprehensive workup at baseline.

Isolated accessory tricuspid valve leaflet in asymptomatic adult.

Accessory tricuspid valve (ATV) is a rare congenital anomaly that is often seen in complex congenital anomalies in children with very few reported cases in adults. We report a case of isolated ATV in an asymptomatic adult with no other congenital defects along with illustrative transesophageal echocardiographic 2D, 3D, high-resolution photo-realistic images.

Mitral annular calcification: The incremental diagnostic value of 3D transesophageal echocardiography.

Three-dimensional (3D) echocardiography is an important tool in the evaluation of mitral valve anatomy. We illustrate a case of a 67-year-old female who was admitted for non-ST-elevation myocardial infarction (NSTEMI) and underwent two-vessel coronary artery bypass grafting for surgical disease. Her two-dimensional (2D) echocardiographic images intraoperatively demonstrated a mass on the posterior mitral valve leaflet which created a diagnostic challenge; 3D transesophageal imaging was crucial in identifying the true nature of the pathology to be mitral annular calcification with supra-annular extension.

A Double Whammy: Lactobacillus acidophilus Bacteremia and Subsequent Lactobacillus rhamnosus Prosthetic Valve Infective Endocarditis in an Elderly Diabetic Patient.

The clinical significance of the relatively avirulent organ- ism, Lactobacillus, has been debated in the past. At times misdiagnosed as a contaminant, Lactobacillus has uncommonly been reported to cause intra-abdominal abscesses, peritonitis, meningitis, bacteremia, pneumonia and endocarditis, especially in the population of patients with underlying comorbid conditions including malignancy, diabetes, recent surgery or organ transplantation. We report a case of a 74-year-old male with Lactobacillus bacteremia leading to prosthetic valve infective endocarditis complicated by an aortic root abscess. He was managed with IV antibiotic therapy, ultimately penicillin G, and aortic valve replacement, and completely recovered after a period of rehabilitation. Several factors that predispose to Lactobacillus bacteremia were identified in our patient. This case further supports the proposition that Lactobacillus is not always a contaminant; when pathogenic, underlying disease conditions should be investigated.

Spontaneous coronary artery dissection in a man with intense coughing spasms.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction of emerging significance, which occurs predominantly in young women without coronary artery disease risk factors. Valsalva-like activities such as coughing have been identified as potential triggers for the development of SCAD. We report a case of SCAD in a man in whom the only identifiable predisposing factor was excessive coughing. He presented with atypical chest pain. Troponin I peaked at 29 ng/mL, and ECG showed no evidence of ischaemic changes. He underwent cardiac catheterisation via the radial approach, which revealed a linear second obtuse marginal dissection. He was managed conservatively with medical therapy with a good outcome.