Transthyretin Cardiac Amyloidosis Presenting as Bradycardia, Renal Failure, Atrioventricular-Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Case Report.

BRASH syndrome involves the chain of events resulting from the collective effects of Bradycardia, Renal failure, Atrioventricular (AV)-nodal blockade, Shock, and Hyperkalemia. BRASH syndrome can rapidly progress to cardiac arrest. Early recognition is crucial. We present a case of transthyretin cardiac amyloidosis (ATTR-CA) in an elderly woman who presented with BRASH syndrome shortly after an AV-nodal blocker was prescribed for atrial fibrillation.

Assessment of Cardiovascular Disease Among Predominantly Black Gout Patients.

INTRODUCTION: Although the association between gout and cardiovascular disease (CVD) has been extensively studied, scarce data are available for the Black population. We aimed to assess the association between gout and CVD in a predominantly Black urban population with gout. METHODS: A cross-sectional analysis was performed between a gout cohort and an age-/sex-matched control group. Clinical parameters and 2D echocardiograms were reviewed for the patients with gout and heart failure (HF). The primary outcome studied includes the prevalence and strength of association between gout and CVD. Secondary outcomes studied includes strength of association of gout and HF categorized by ejection fraction, mortality, and HF readmissions. RESULTS: Four hundred seventy-one patients with gout had a mean age of 63.7 ± 0.5 years; 89% were Black, 63% were men, and mean body mass index was 31.3 ± 0.4 kg/m 2 . Hypertension, diabetes mellitus, and dyslipidemia were present in 89%, 46%, and 52%, respectively. Compared with controls, patients with gout had significantly higher rates of angina, arrhythmia, coronary artery disease/stents, myocardial infarction, coronary artery bypass graft surgery, cerebrovascular accident, and peripheral vascular disease. The adjusted odds ratio for CVD was 2.9 (95% confidence interval, 1.9-4.5; p < 0.001). Gout patients had a higher prevalence of HF with 45% (n = 212) compared with controls with 9.4% (n = 44). Adjusted odds ratio for HF risk was 7.1 (95% confidence interval, 4.7-10.6; p < 0.01). CONCLUSIONS: Gout in a predominantly Black population confers 3 times the CVD risk and 7 times HF-specific risk compared with age- and sex-matched cohort. Further research is needed to confirm our findings and to develop interventions to reduce morbidity associated with gout.

Staphylococcus lugdunensis Infectious Endocarditis Complicated by Embolic Stroke After Colonoscopy in a 58-Year-Old Female.

There are a significant number of colonoscopies and esophagogastroduodenoscopies (EGDs) done in the United States every year and post-endoscopic infections are frequently seen. Data demonstrating causality between endoscopic procedures and infectious endocarditis (IE) or that antibiotic prophylaxis prior to endoscopic procedures protects against IE is still lacking. Here we have presented the case of a patient who underwent diagnostic colonoscopy as part of a malignancy workup and was later found to be septic with Staphylococcus lugdunensis bacteremia and had IE. We hypothesized that the infection was most likely contracted during colonoscopy as a result of bacterial translocation from the perineal region to the bloodstream. This case report highlights the need for further studies investigating the efficacy of prophylactic antibiotics in reducing the risk of IE after colonoscopies.

First Reported Case of Hemopericardium Related to Dabigatran Use Reversed by New Antidote Idarucizumab.

Dabigatran, the first novel oral anticoagulant (NOAC) with a reversal agent, heralded a paradigm shift in the treatment of nonvalvular atrial fibrillation. The potential for life-threatening hemorrhagic events with the use of NOACs has been highly debated since the effectiveness of reversal agents such as idarucizumab is based primarily on pharmacologic data. It is known that cancer patients are at an increased risk of bleeding with anticoagulation, though specific studies demonstrating the risks or efficacy of NOACs in this population are lacking. We provide the first report of hemopericardium resulting in multiorgan failure related to dabigatran use that was successfully reversed by idarucizumab in a man with prostate cancer on chemotherapy.

Determinants of a blunted carotid-to-radial pulse wave velocity decline in response to hyperemia.

Carotid-radial pulse wave velocity (PWV) decreases in normal healthy individuals following hyperemia provoked by release of arterial cuff occlusion. To determine the effects of specific cardiovascular (CV) risk factors on the hyperemic PWV response, we measured PWV before and after brachial artery (BA) occlusion in 218 participants (66% males, age 56 +/- 19 years), with and without CV risk factors/disease. DeltaPWV ranged from -46% to +35% and values were normally distributed. On univariate analyses, DeltaPWV correlated with age, hypertension (Htn), hypercholesterolemia, diabetes mellitus (DM), coronary disease, congestive heart failure (CHF), smoking, and mean arterial pressure (MAP). On multivariate analysis, DeltaPWV was independently related to Htn (B = 4.56, P = .03) and CHF (B = 7.34, P = .008) and trended toward a higher MAP (B = .113, P = .067), DM (B = 4.01, P = .11), and hypercholesterolemia (B = 3.36, P = .12). In conclusion, hyperemic changes in carotid-radial PWV values are independently related to Htn and CHF and possibly DM and hyperlipidemia.

Autonomic consequences of kainic acid-induced limbic cortical seizures in rats: peripheral autonomic nerve activity, acute cardiovascular changes, and death.

PURPOSE: Autonomic consequences of seizures are common, but can be severe. We sought to define changes in autonomic activity from limbic cortical seizures and their impact on the heart. METHODS: We studied kainic acid (KA)-induced seizures in urethane-anesthetized rats using peripheral nerve, blood pressure (BP), and ECG recordings and echocardiography. RESULTS: Seizures were associated with massive increases in parasympathetic (vagus nerves) and sympathetic (cervical sympathetic ganglion >renal nerve >splanchnic nerve) activity. Seizure-associated activity increases were greater than activity changes induced by nitroprusside or phenylephrine (each producing BP changes of >50 mmHg). Increases in c-fos expression were found in both sympathetic and parasympathetic medullary regions (as well as hypothalamic areas). Baroreceptor reflex function (tested with nitroprusside and phenylephrine) was impaired during seizures. Finally, a significant fraction of the animals died and the mechanism of death was defined through ECG, BP, and echocardiographic measures to be profound cardiac dilatation and bradyarrhythmia leading to hypoperfusion of the brain and ultimately hypoperfusion of the heart. Cardiovascular changes occur within seconds (or less) of autonomic nerve activity changes and death by these mechanisms takes minutes. DISCUSSION: We propose that the massive parasympathetic and sympathetic outflow that occurs during a seizure gets compounded by respiratory distress (driving both autonomic nervous system divisions in the same direction) causing mechanical dysfunction, slowing the heart, and hypoperfusing the brain.