Recurrent Staphylococcus capitis Prosthetic Valve Endocarditis Presenting With ST-Segment Elevation Myocardial Infarction: A Case Report.

We report a case of ST-elevation myocardial infarction (STEMI) due to septic emboli secondary to Staphylococcus capitis endocarditis in a 32-year-old male patient with a past medical history of infectious endocarditis requiring mechanical aortic, mitral and tricuspid valve replacement presented with sharp chest pain and shortness of breath. Electrocardiogram demonstrated an acute inferior STEMI. Coronary angiography revealed occlusion of the terminal left anterior descending (LAD) artery associated with a large apical wrap-around segment exhibiting TIMI 0 flow. Primary angioplasty was not performed given the distal location of the embolus. Clinical suspicion for septic or thrombotic coronary artery embolism was high given the patient's history of mechanical valve prosthesis and in the setting of sub-therapeutic INR. Transesophageal echocardiography revealed a new mobile echodensity on the mitral prosthesis consistent with vegetation. S. capitis was isolated from blood cultures, confirming the diagnosis of endocarditis. S. capitis is a rare cause of prosthetic valve endocarditis and should remain in the differential of septic coronary artery embolism among patients with features of infectious endocarditis.

Association of number of primary care physicians with preventable hospitalizations and premature deaths.

BACKGROUND: Primary care physicians (PCPs) may be the first providers for patients in a healthcare interaction, putting them in a unique position that may determine the health trajectory of a patient. Assessing whether PCPs improve the overall health of a community through reducing preventable hospital stays and premature deaths may provide necessary information towards improving the health outcomes at grassroots. METHODS: County-level data on the number of primary care physicians, preventable hospital stays and 'years of potential life lost' (YPLL) were obtained from the Physician Master File data of the American Medical Association, Centers for Medicare & Medicaid Services Office of Minority Health's Mapping Medicare Disparities data, and Center for Disease Control and Prevention's WONDER database, respectively. We employed linear regression model to assess the association of PCP rate with preventable hospital stays and YPLL. RESULTS: Preventable hospitalization rate in the United States was 6303.4 (95% CI, 6212.5-6394.3) hospitalizations per 100,00 population, while the average YPLL across the counties in the United States was 7792.9 (95% CI, 7697.6-7888.3) years per 100,000 population. For an increase of 1 PCP in a county, around 16 hospitalizations were prevented per 100,000 population (P = 0.001) each year. Furthermore, around 14 years of life were saved per 100,000 population for every additional PCP in a county across the United States (P < 0.001). CONCLUSION: Higher number of PCPs in a county was associated with lower hospitalizations for preventable causes and lower premature deaths. Increasing PCPs may be an important metric to improve overall health in a community.

Infective Endocarditis as a Complication of Crohn's Disease on Immunotherapy.

A patient with a history of Crohn's disease on infliximab presented to the hospital with sepsis and a new heart murmur. He was found to have native aortic valve infective endocarditis from a rare species of group D Streptococcusin his blood. The patient was also noted to be in an acute flare of Crohn's disease. The hospital course was complicated by florid heart failure from acute aortic insufficiency. He eventually improved after source control and appropriate antibiotic therapy. S. pasteuranis bacteremia and endocarditis are attributable to the patient's immunocompromised state as a result of infliximab treatment. While S. pasteuranis is infrequently grown in blood cultures, it is commonly found in normal gut flora. We hypothesize that it gained access to the bloodstream through the epithelium in the terminal ileum, which was inflamed due to an acute flare of Crohn's disease.