Silent aortic regurgitation in systemic hypertension.

Mild aortic regurgitation (AR) is a common finding in echocardiograms. Although some early reports suggested that hypertension predisposes to aortic root enlargement and AR, other pathological and echocardiographic studies have not shown such an association. The incidence and clinical importance of mild aortic insufficiency in hypertensive populations is unknown. This case-control study was undertaken along with a literature review in order to explore the relationship between hypertension and trivial to mild AR. Multivariate logistic regression analysis identified the presence of hypertension, defined as being treated with anti-hypertensive drugs for some non-zero duration of time, as well as increased aortic root dimension as being significantly associated with increased odds for the occurrence of aortic insufficiency. It appeared that the chronicity of hypertension rather than the actual blood pressure value was associated with the development of AR.

Cardiac Resynchronization Therapy Upgrade in a Patient with Dextrocardia and Situs Inversus Totalis, Facilitated by Coronary Sinus Cannulation with Electrophysiology Catheters from Both Femoral and Axillary Venous Approaches.

Cardiac resynchronization therapy in patients with dextrocardia with situs inversus totalis can be technically challenging. There are few case reports of cardiac resynchronization therapy implantation in these individuals. Here, we describe a procedure of cardiac resynchronization therapy upgrade in a patient with dextrocardia and situs inversus totalis facilitated by coronary sinus cannulation from both the femoral and axillary venous approaches.

Cocaine-induced renal infarction: report of a case and review of the literature.

BACKGROUND: Cocaine abuse has been known to have detrimental effects on the cardiovascular system. Its toxicity has been associated with myocardial ischemia, cerebrovascular accidents and mesenteric ischemia. The pathophysiology of cocaine-related renal injury is multifactorial and involves renal hemodynamic changes, alterations in glomerular matrix synthesis, degradation and oxidative stress, and possibly induction of renal atherogenesis. Renal infarction as a result of cocaine exposure, however, is rarely reported in the literature. CASE PRESENTATION: A 48 year-old male presented with a four-day history of severe right flank pain following cocaine use. On presentation, he was tachycardic, febrile and had severe right costovertebral angle tenderness. He had significant proteinuria, leukocytosis and elevated serum creatinine and lactate dehydrogenase. Radiographic imaging studies as well as other screening tests for thromboembolic events, hypercoagulability states, collagen vascular diseases and lipid disorders were suggestive of Cocaine-Induced Renal Infarction (CIRI) by exclusion. CONCLUSION: In a patient with a history of cocaine abuse presenting with fevers and flank pain suggestive of urinary tract infection or nephrolithiasis, cocaine-induced renal infarction must be considered in the differential diagnosis. In this article, we discuss the prior reported cases of CIRI and thoroughly review the literature available on this disorder. This is important for several reasons. First, it will allow us to discuss and elaborate on the mechanism of renal injury caused by cocaine. In addition, this review will demonstrate the importance of considering the diagnosis of CIRI in a patient with documented cocaine use and an atypical presentation of acute renal injury. Finally, we will emphasize the need for a consensus on optimal treatment of this disease, for which therapy is not yet standardized.

Adenoviral bronchopneumonia in an immunocompetent adult: computed tomography and pathologic correlations.

Acute febrile lung disease associated with "patchy ground-glass pattern" on high-resolution computed tomography (HRCT) of the lung in an immunocompromised patient is suggestive of Pneumocystis carinii pneumonia; however, in an immunocompetent young person, it is suggestive of an atypical pneumonia, including viral bronchopneumonia. We studied a 31-year-old man who presented with fever, cough and hypoxemia. HRCT showed bilateral patchy ground-glass opacification. HIV test was negative and lung biopsy specimen grew adenovirus on viral culture. Histopathology of the lung was compatible with bronchopneumonia. In patients without HIV who present with acute lower respiratory infections and patchy ground-glass opacification on HRCT, adenoviral bronchopneumonia should be included in the differential diagnosis.