Staphylococcus aureus endocarditis complicated by bilateral pneumothorax.

Staphylococcus aureus is the most common cause of endocarditis in intravenous drug users. The organism gains access by intravenous injection or from the direct invasion of skin at injection sites. Known for its aggressiveness, the right sided endocarditis that ensues can lead to complications such as pulmonary abscesses and even death. We report the unusual case of an intravenous drug abuser, who following the occurrence of extensive pulmonary abscesses, developed bilateral pneumothoraces within a few days.

Resolution of a large left ventricular thrombus with anticoagulation alone.

Dilated cardiomyopathy and the resultant left ventricular dysfunction are risk factors for thrombus formation in the heart, reflecting the intimate relationship between structure and function in this vital organ. Once formed, depending on size, location, and mobility, left ventricular thrombi have the tendency to embolize, sometimes with dire consequences. Proper management of these thrombi is still controversial. We present a case of an unusual large thrombus, which resolved with anticoagulation therapy alone, giving hope that more invasive intervention can safely be circumvented.

Successful outcome after evacuation of intracranial hematoma following thrombolysis in acute myocardial infarction.

Thrombolytic therapy is the modality of choice for the treatment of life threatening thrombosis in various vascular territories and nowadays, is used extensively in setting of acute myocardial infarction. There is, however, the omnipresent danger of serious bleeding inherently associated with the use of all thrombolytics which if it occurs in the brain, can lead to potentially serious neurological impairment and even death. In our report, we describe the successful surgical management of a streptokinase-induced intracranial hemorrhage. Timely neurosurgical intervention is advocated as the optimal approach for this particular side effect of thrombolytic agents.

Aborted sudden nocturnal cardiac death in a young man with structurally normal heart.

Sudden cardiac death is a devastating event, particularly when it occurs to young, otherwise healthy individuals. We report here a young Burmese male who survived sudden cardiac death with structurally normal heart. His electrocardiogram revealed features consistent with Brugada syndrome. He was referred for intra-cardiac defibrillator implantation. In this article, in addition to the case presentation, a review of Brugada syndrome medical literature is also presented.

Successful outcome after evacuation of intracranial hematoma following thrombolysis in acute myocardial infarction.

Thrombolytic therapy is the modality of choice for the treatment of life threatening thrombosis in various vascular territories and nowadays, is used extensively in the setting of acute myocardial infarction. There is, however, the omnipresent danger of serious bleeding inherently associated with the use of all thrombolytics which if it occurs in the brain, can lead to potentially serious neurological impairment and even death. In our report, we describe the successful surgical management of a streptokinase-induced intracranial hemorrhage. Timely neurosurgical intervention is advocated as the optimal approach for this particular side effect of thrombolytic agents.

Door to needle time in administering thrombolytic therapy for acute myocardial infarction.

OBJECTIVE: Thrombolytic therapy is a standard treatment for patients presenting with acute myocardial infarction (MI). Early administration of these agents is crucial for the outcome of management. This audit was conducted to evaluate the time between arrival to emergency department (ED) and the administration of thrombolysis (door to needle time). METHODS: Data was collected from patients admitted to the Coronary Care Unit of Riyadh Medical Complex (RMC), Riyadh, Kingdom of Saudi Arabia, a 1500-bed community hospital, with a diagnosis of acute MI and received thrombolytic therapy over a one-year period (April 1999 to April 2000). The time between arrival to the ED to the time of administration of thrombolytic therapy was obtained as well as the time of onset of chest pain up to presentation to the hospital, and the outcome (all cause mortality) post treatment. RESULTS: A total of 271 patients (256 males) admitted to RMC with a diagnosis of acute MI received thrombolytic therapy over a one-year duration. The median door to needle time was 95 minutes. The median time of onset of chest pain to arrival to ED was 5 hours (300 minutes). The outcome of these patients obtained either alive was 260 (96%) or dead was 11 (4%) (P < 0.00001). CONCLUSION: The door to needle time was relatively similar to other centers. The delay in administering thrombolytic therapy should be reduced to a target of <70 minutes from onset of symptoms. Delay in presentation to the hospital was more important and factors contributing to this delay should be looked for and corrected. Another audit is needed to evaluate the implementation of these recommendations.

Combined brucella melitensis and streptococcal viridans endocarditis.

Infectious endocarditis is a potentially lethal inflammation of the hearts' inner lining invaded by microorganisms. The mortality from this illness increases as the number of infective organisms rises to 2, due to involvement of the left side of the heart. These microorganisms usually arise from the patient's own flora but can be acquired from the environment. Fever and heart murmurs are the principal clinical manifestations followed by a plethora of peripheral signs due to dissemination of microorganisms via the bloodstream. Echocardiographic imaging and sensitive culture techniques form the cornerstone of diagnosis. We report a patient with rheumatic heart disease who had combined brucella melitensis and streptococcus viridans endocarditis complicated by heart failure and an aortic root abscess. He was diagnosed on the basis of a history of prolonged fever and occupational risk as a shepherd, the presence of heart murmurs, positive blood cultures and echocardiographic evidence of aortic vegetations. He had an excellent response to intravenous antibiotic therapy combined with aortic valve replacement, which nowadays is regarded as the safest therapeutic approach for aortic valve endocarditis.