Tablet-based limited echocardiography at COVID-19-dedicated hospital during the pandemic in the context of takotsubo syndrome.

In the course of COVID-19 pandemic, many patients with diagnosed or suspected disease do require echocardiography. At the same time, when it comes to the echocardiographers, there is a fear of their being exposed to contamination. At COVID-19-dedicated hospital examinations are bedside, and in some patients hand-held or tablet-based echocardiography should be preferred; the echocardiographer routinely puts on a complete protective uniform. The prevalence of stress-induced takotsubo syndrome (TTS) during the Covid-19 pandemic is higher than previously reported. The authors present the images obtained using tabletbased limited echocardiography in patients with different forms of TTS. The time of the examination of patients and decontamination of the equipment was short (5-7 min and less than 2 min, respectively); the images were of fairly good quality.

Daily longitudinal strain evaluation for left ventricular function monitoring in a 65-year-old female with reverse syndrome takotsubo and multiple triggering factors.

Among patients with takotsubo syndrome (TTS), reverse TTS (rTTS) constitutes 1-23% of all cases reported in the literature. The highest prevalence of rTTS is observed in intracranial hemorrhage, pheochromocytoma and severe infections. A CASE REPORT: The authors describe a case of a 65-year-old female with advanced multiple myeloma in whom rTTS was recognized on admission due to streptococcal sepsis. Other possible triggering factors included: anemia, blood transfusion, transient acute renal failure with electrolyte imbalance. ECG showed ST-segment depression in precordial leads and echocardiography revealed severe left ventricular (LV) dysfunction with apical sparing and with decreased ejection fraction (EF) and global longitudinal strain (GLS): 30 % and -10 %, respectively. Daily echocardiography showed gradual normalization of GLS as well as of regional longitudinal strain (RLS) within 8 days. The authors confirm the distinctness of rTTS including clinical, ECG, echocardiographic and laboratory findings and suggest the usefulness of daily longitudinal strain evaluation for LV function recovery monitoring.

Apixaban in left ventricular thrombi treatment - a report of seven cases.

Treatment of intracardiac thrombi (ICTs) with direct-acting oral anticoagulants (DOACs) constitutes a new challenge for this group of medications. Left ventricular thrombi (LVTs) occur mainly in patients with severe left ventricular dysfunction. Advanced heart failure is characterized by a high prevalence of chronic kidney disease (CKD). Apixaban has the best renal profile among all DOACs. The authors describe a group of 7 patients with LVTs treated with apixaban; 6 of them had CKD. LVTs were screened and monitored during therapy using a sector, 3-dimensional and high frequency linear probes; the latter to exclusively assess the left ventricular apex. Examination was performed every day during the first 2 weeks, then 2-3 times a week until LVTs disappearance, then every month; transesophageal assessment was done initially and repeated when necessary. Patients' mean age was 65 years. The underlying disease was post-myocardial left ventricular dysfunction (3), dilated cardiomyopathy (3) and heart failure of unknown etiology (1).Three patients had more than one LVT. Also, three had other ICTs, one - in the right ventricle, two - in the left atrial appendage. Three patients used apixaban in a dose of 5 mg twice daily, two - 2.5 mg twice a day, two - in an increasing dose. In all patients, gradual diminishing of LVTs was observed, no complications of apixaban therapy were noted. The time needed for LVTs disappearance was between 7 and 28 days (mean: 17 days).

Eikenella corrodens endocarditis of the tricuspid valve in an intravenous drug user.

Infective endocarditis of the tricuspid valve (TVE) occurs predominantly in selected groups of patients including intravenous drug users (IVDUs). The most often cultured pathogen in IVDUs is Staphylococcus aureus. Eikenella corrodens, normally existing as a commensal in the mouth and the upper respiratory tract, is identified as an etiologic pathogen of endocarditis very rarely. The authors describe a case of a 27-year-old male with a past history of staphylococcal TVE readmitted to hospital after 5 months due to progression of right-sided heart failure. Bacteriological work-up revealed typical features and growth of E. corrodens. In echocardiography large vegetations on the damaged tricuspid valve and massive tricuspid regurgitation were seen. The prognosis of the disease, despite introduction of appropriate antibiotic therapy, was poor as he refused to undergo cardiac surgery.

[Recurrent right atrial thrombus in a patient with atrial fibrillation and heart failure]. / Nawrotowa skrzeplina w prawym przedsionku u chorego z migotaniem przedsionków i niewydolnoscia serca.

Atrial fibrillation and heart failure are factors predisposing to locally formed intracardiac thrombosis, which is usually localized in left-sided chambers. A case report. The authors present a case of a 50-year-old male with permanent atrial fibrillation and dilated cardiomyopathy in whom recurrent right atrial thrombus was observed. Initially, the lesion was detected in echocardiography while he was hospitalized due to extensive right-sided pneumonia. The thrombus was successfully treated with heparin, followed by warfarin. Even though the patient continued warfarin use properly, there was recurrence of the thrombus two years later during a new episode of heart failure exacerbation. Because the thrombus was resistant to intensified anticoagulation, cardiac surgery was needed. A large (30 x 25 mm) pedunculated thrombus, as well as two smaller ones (each of 10 x 10 mm) attached closely to the atrial wall and previously not detected either by echocardiography or by magnetic resonance imaging, were excited. A partially organized pattern of the thrombi in histological examination can explain lack of anticoagulation effectiveness.

[Hemoptysis during concomitant treatment with rivaroxaban and amiodarone in a patient with a history of pulmonary disease]. / Krwioplucie w trakcie jednoczesnego leczenia rywaroksabanem i amiodaronem u chorego z obciazonym wywiadem plucnym.

UNLABELLED: Rivaroxaban, a selective inhibitor of active factor X, is metabolized by cytochrom P450 3A4 (CYP3A4) and is a substrate for transporter protein--P-glycoprotein (P-gp). Amiodarone, an antiarrhytmic agent, is classified as moderate CYP3A4 and P-gp inhibitor. A CASE REPORT: A 75-year-old male, who underwent lobectomy for bronchiectasis many years ago, is presented. For one year the patient was treated with rivaroxaban (20 mg/d) due to venous thromboembolism and recurrent episodes of atrial fibrillation. Two weeks after amiodarone initiation (200 mg/d) hemoptysis occurred and computed tomography revealed unilateral pulmonary infiltrates with ground-glass opacities limited to the lower lobe of the left lung. The symptoms disappeared following discontinuation of the two medications and did not recur while rivaroxaban was reintroduced in a dose of 15 mg/d; measurement of anti-Xa activity confirmed it as a therapeutic dose. Amiodarone, that had been used for a short time and well tolerated a few years before, was definitely withdrawn. CONCLUSIONS: The authors suggest, that the concomitant use of rivaroxaban and amiodarone should be very careful in patients with a history of pulmonary disease.

Testing of visual field with virtual reality goggles in manual and visual grasp modes.

Automated perimetry is used for the assessment of visual function in a variety of ophthalmic and neurologic diseases. We report development and clinical testing of a compact, head-mounted, and eye-tracking perimeter (VirtualEye) that provides a more comfortable test environment than the standard instrumentation. VirtualEye performs the equivalent of a full threshold 24-2 visual field in two modes: (1) manual, with patient response registered with a mouse click, and (2) visual grasp, where the eye tracker senses change in gaze direction as evidence of target acquisition. 59 patients successfully completed the test in manual mode and 40 in visual grasp mode, with 59 undergoing the standard Humphrey field analyzer (HFA) testing. Large visual field defects were reliably detected by VirtualEye. Point-by-point comparison between the results obtained with the different modalities indicates: (1) minimal systematic differences between measurements taken in visual grasp and manual modes, (2) the average standard deviation of the difference distributions of about 5 dB, and (3) a systematic shift (of 4-6 dB) to lower sensitivities for VirtualEye device, observed mostly in high dB range. The usability survey suggested patients' acceptance of the head-mounted device. The study appears to validate the concepts of a head-mounted perimeter and the visual grasp mode.

Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis.

Safety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of neurological state (new MS lesions in magnetic resonance imaging). Moreover, there were also data indicating some anesthesiological complications and difficulties in patients with MS. We have presented a case of a patient who was treated with ECT and developed grand mal seizure after 14th electroconvulsive treatment.

[Reversible dilated cardiomyopathy as an atypical form of takotsubo cardiomyopathy]. / Odwracalna kardiomiopatia rozstrzeniowa jako nietypowa postac kardiomiopatii takotsubo.

Stress-induced cardiomyopathy is characterized by transient regional left ventricular (LV) dysfunction that may involve, in different forms, midventricular, apical or basal segments. The authors describe a case of a 41-year-old woman with reversible, but global LV systolic dysfunction, complicated with apical thrombi. Clinical symptoms of dilated cardiomyopathy were preceded by persistent stressful workplace conditions. Ischemic, inflammatory, metabolic and endocrine causes of the disease were excluded. After 6 weeks, complete recovery of LV function in echocardiography and normal cardiac magnetic resonance imaging were observed, despite only modest doses of ramipril, carvedilol and diuretics. Six months later, as a result of another episode of emotional stress, she was hospitalized for typical takotsubo cardiomyopathy. Reversible global LV hypokinesis may be an atypical variant of stress-induced cardiomyopathy.

[Severe tricuspid valve injury following blunt chest trauma--case report]. / Ciezkie uszkodzenie zastawki trójdzielnej po tepym urazie klatki piersiowe--opis przypadku.

Tricuspid valve (TV) injury is a rare complication of blunt chest trauma, most commonly as a result of a traffic collision. The authors describe a case of massive TV regurgitation due to a rupture of the chorde tendinae to the anterior and septal leaflets in a 21-year-old man, the victim of a car crash. Concomitant organ injuries included, among others, multiple rib fractures, pulmonary contusion, open femoral fracture. TV annuloplasty with Medtronic Duran ring implantation was performed one year after the accident because of right ventricular function worsening and occurrence of right heart failure symptoms. Three years after surgery only trivial TV regurgitation is detectable. The patient manifest good physical efficiency and continues occupational activity.

[Rectus sheath hematoma: a rarely diagnosed complication of anticoagulation therapy]. / Krwiak pochewki miesnia prostego brzucha--rzadko rozpoznawane powiklanie leczenia antykoagulacyjnego.

Anticoagulation therapy with vitamin K antagonist (VKA) or heparin, even properly applied, may lead to occurrence of differently localized hematomas, including rectus sheath hematoma (RSH). This uncommon complication of anticoagulation is often misdiagnosed. In the presented case of a 72-year-old man, with a history of VKA use for permanent atrial fibrillation, an additional factor which might predispose to RSH formation was intensive cough during respiratory tract infection. Hematoma was detected with delay on abdominal ultrasonography and visualized topographically on computed tomography Conservative treatment was performed. During a 5-month period, gradual reabsorption of RSH was observed on control ultrasonography examinations.

[Takotsubo cardiomyopathy as a consequence of gastrointestinal disorder--a case preceded by exacerbation of gastroesophageal reflux disease]. / Kardiomiopatia takotsubo jako nastepstwo schorzenia przewodu pokarmowego--przypadek poprzedzony zaostrzeniem zaostrzeniem zoladkowo-przelykowej choroby.

The etiology of takotsubo cardiomyopathy (TC), defined as a transient left ventricular dysfunction in the absence of significant coronary artery stenoses, still reminds unclear. Its onset is often associated with emotional stress or progression in the course of various disorders (including gastrointestinal ones), miscellaneous diagnostic and therapeutic procedures. We describe a case of a 67-year-old man, in whom severe left ventricular function impairment, completely reversible after a week, was observed during hospitalization for gastroesophageal reflux disease (GERD) exacerbation. The authors review the literature on TC cases which were preceded by digestive system illness, examination or surgery and discuss the possible mechanisms of this relationship.

[Venous thromboembolism triggered by spinning in a young woman with thrombophilia]. / Zylna choroba zakrzepowo-zatorowa sprowokowana przez spinning u mlodej kobiety z trombofilia.

Although regular sports activities decrease the risk of venous thromboembolism (VTE), VTE cases have been observed among professional and amateur athletes practicing various disciplines. The authors describe a case of a 25-year-old-woman in whom calf pain, as popliteal vein thrombosis manifestation--preceding pulmonary embolism, occurred after she took up spinning, a popular form of indoor cycling. There was no history of leg injury. In hemostasis work up, factor V Leiden mutation and acquired low antithrombin activity-related to oral contraceptives use, were found. Strenuous exercise in an untrained woman might augment prothrombotic hemostasis profile. Vigorous cycling in standing position in the last phase of spinning, seems to be most unfavorable for patients with high VTE risk.

[Psychotic disorders related with chronic use of mephedrone. Case report]. / Zaburzenia psychotyczne zwiazane z przewleklym przyjmowaniem mefedronu. Opis przypadku.

AIM: The aim of the study was to present the case of a patient with psychotic disorders, o most probably connected with persistent mephedrone use. METHOD: The analysis of the clinical case and medical documentation. RESULTS: The presented patient had used mephedrone regularly (few times a week) for four months. Because of delusions of reference, delusions of persecution, agitation and anxiety, she required psychiatric hospitalisation. During the first hospitalisation she denied using legal highs, she was diagnosed as having schizophrenia and treated with olanzapine. After discharge, she didn't stop to use legal highs and psychotic symptoms occurred once again. The patient needed another hospitalisation. Despite the fact that antipsychotic treatment wasn't administered, the symptoms resolved. Nevertheless, somnolence, apathy and social isolation were observed. CONCLUSIONS: Recently legal highs are very popular, especially among adolescents and young adults. That is the reason why physicians have become more anxious because there is little information about their contents. In most of them, synthetic or botanical substances are included. In clinical practice not only somatic but also psychiatric complications connected with legal high use are observed. It is difficult to verify why this patient developed psychotic symptoms after recurrent intoxication. It is possible that she has an individual predisposition to develop psychosis. In this case, we have no information about previous features of ultra high risk state in this patient.

[Uncommon presentation of venous thromboembolism and fatal systemic emboli in a patient with nonbacterial thrombotic endocarditis due to pancreatic cancer]. / Nietypowy obraz zylnych powiklan zakrzepowo-zatorowych i zatorowosc systemowa u chorego z nieinfekcyjnym zakrzepowym zapaleniem wsierdzia w przebiegu raka trzustki.

In the presented case of a 60-year-old man, deep vein thrombosis and pulmonary embolism symptoms preceded pancreatic cancer diagnosis. An unexpected echocardiographic finding was a longitudinal mass attached to the tricuspid valve, and extending to the pulmonary artery - suggestive of a thrombus (as confirmed further autopsy), probably embolic in origin. This uncommon situation might be due to nonbacterial thrombotic endocarditis, which involved all, but mainly tricuspid and aortic valves. During heparin therapy the patient's haemodynamic status was stable until systemic emboli occurred with multifocal ischaemic stroke that was the cause of death.

Glaucoma detection and evaluation through pattern recognition in standard automated perimetry data.

BACKGROUND: Perimetry remains one of the main diagnostic tools in glaucoma, and it is usually used in conjunction with evaluation of the optic nerve. This study assesses the capability of automatic pattern recognition methods, and in particular the support vector machines (SVM), to provide a valid clinical diagnosis classification of glaucoma based solely upon perimetry data. METHODS: Over 2,200 patient records were reviewed to produce an annotated database of 2,017 eyes. Visual field (VF) data were obtained with HFA II perimeter using the 24-2 algorithm. Ancillary information included treated and untreated intraocular pressure, cup-to-disk ratio, age, sex, central corneal thickness and family history. Ophthalmic diagnosis and classification of visual fields were provided by a consensus of at least two glaucoma experts. The database includes normal eyes, cases of suspect glaucoma, pre-perimetric glaucoma, and glaucoma with different levels of severity, as well as 189 eyes with neurologic or neuro-ophthalmologic defects. Support vector machines were trained to provide multi-level classifications into visual field and glaucoma diagnosis classes. RESULTS: Numerical validation indicates 70-90% expected agreement between multi-stage classifications provided by the automated system, using a hierarchy of SVM models, and glaucoma experts. Approximately 75% accuracy for the classification of glaucoma suspect and pre-perimetric glaucoma (which by definition do not exhibit glaucomatous defects) indicates the ability of the numerical model to discern subtle changes in the VF associated with early stages of glaucoma. The Glaucoma Likelihood Index provides a single number summary of classification results. CONCLUSIONS: Automatic classification of perimetry data may be useful for glaucoma screening, staging and follow-up.

[Dressler syndrome following pulmonary embolism]. / Zespól Dresslera po zatorowosci plucnej.

A case of a 73-year-old woman with fibrinous pericardial effusion which developed four weeks following severe pulmonary embolism. Clinical and echocardiographic data as well as an inclination to self-limited course were suggestive of Dressler syndrome diagnosis. Although there were no data that oral vitamin K antagonist use was involved in presented pericardial syndrome, pericardial effusion size required its temporary substitution by heparin.

[Complete heart block and Lyme disease: report of two different cases and literature review]. / Calkowity blok przedsionkowo-komorowy a borelioza z Lyme: opis dwóch róznych przypadków i przeglad pismiennictwa.

The most typical manifestation of cardiac involvement in Lyme disease (LD) is a high grade and usually fluctuating heart block, which is generally reversible, even self-limiting. Two cases of LD with a different course of complete heart block (CHB) are described. In a 43-year-old man admitted due to episodes of syncope, the diagnosis of LD was delayed -- after pacemaker implantation -- when he developed joint and neurological symptoms. Following ceftriaxone treatment atrioventricular conduction returned to normal. In the second case of a 26-year-old woman, presenting on admission with fatigue and flu-like symptoms, ECG showed CHB with a stable escape rhythm of about 52/min. Unlike the first case, she could recall neither a tick bite nor skin rash, but epidemiological history and serologic test results were indicative of LD. In this case, antibiotic therapy did not influence atrioventricular block, which was well tolerated. This suggested the coexistence of borreliosis and previously unrecognised congenital CHB.

[Supraventricular tachycardia as a cause of elevated troponin I in a patient with normal coronary arteries]. / Czestoskurcz nadkomorowy przyczyna podwyzszonego stezenia troponiny I u chorego z prawidlowymi tetnicami wiencowymi.

The authors describe otherwise healthy 69-year-old man admitted to the hospital with supraventricular tachycardia (193/min) accompanied by chest pain and marked ST depression on ECG. Sinus rhythm was restored after verapamil (5 mg i.v.) administration. Symptoms resolved and ECG returned to normal. However, elevation of troponin I level (1.2 ng/ml) was observed a few hours later. Echocardiography as well as coronary angiogram were normal. In electrophysiologic study typical AVNRT was diagnosed and successful ablation of the slow pathway was performed. The authors present a review of current literature on myocardial ischaemia due to supraventricular tachycardia despite normal coronary arteries. In conclusion authors suggest that elevated troponin levels may reflect subendocardial ischaemia and should prompt RF ablation of underlying arrhythmia.