Native and Prosthetic Simultaneously Double Valve Infective Endocarditis with Enterococcus faecalis-Case-Based Review.

Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with high mortality rates despite important advances in antimicrobial therapy. It develops secondary to enterococcal bacteremia, with its origin from the gastrointestinal or genitourinary tract and predominantly affecting the elderly population with multiple comorbidities. Clinical presentation is usually less typical, and the treatment is challenging. It can be marked by antibiotic resistance, side effects, and subsequent complications. Surgical treatment can be considered if deemed appropriate. To the best of our knowledge, we present the first case-based narrative review of Enterococcus faecalis double valve endocarditis involving both the aortic native and prosthetic mitral valve, highlighting the clinical characteristics, treatment, and complications of this condition.

The role of echocardiography and 99mTc-HDP scintigraphy in non-invasive diagnosis of cardiac amyloidosis: A case series and literature review.

RATIONALE: Cardiac amyloidosis, considered for the last years to be a rare disease, is one of the determinants of HFpEF. The non-specific clinical presentation and the difficulties related to endomyocardial biopsy have made cardiac amyloidosis an underdiagnosed clinical entity. Improvement of non-invasive diagnostic techniques and the development of new therapies increased clinical awareness for this form of restrictive cardiomyopathy. We here summarize echocardiography and Tc-HDP scintigraphy findings in 6 cases of cardiac amyloidosis and review the literature data of this progressive and fatal cardiomyopathy. PATIENTS CONCERNS: The main clinical manifestations were fatigue, low exercise tolerance and edemas. The right heart failure symptoms usually dominated the clinical picture. DIAGNOSES: All cases were evaluated by echocardiography; 3 cases were further examined by bone scintigraphy and 4 cases a peripheral biopsy was performed. Electrocardiography showed low-voltage QRS complexes and "pseudo-infarct" pattern in the precordial leads, contrary to the echocardiographic aspect, which revealed thickening of ventricle walls. Biatrial dilation and diastolic disfunction were observed. Impaired systolic function was detected in advanced stages of the disease. Tc-HDP scintigraphy revealed cardiac uptake of radiopharmaceutical and managed to confirm the diagnosis in 1 case of cardiac amyloidosis in which salivary gland biopsy was negative. INTERVENTIONS: The treatment was based on managing fluid balance, with the mainstream therapy represented by diuretics. Neurohormonal agents, usually used in heart failure treatment were avoided, due to poor tolerance and worsening of disease course. The management of these 6 cases was challenging due to the refractory manifestation of congestive heart failure. OUTCOMES: During follow-up, 4 of the 6 patients from the current study died in the first year after the final diagnosis was established. LESSONS: Nuclear imaging of cardiac amyloidosis has a revolutionary development nowadays. Bone scintigraphy presents promising results for identifying patients at early stages of disease and to differentiate between cardiac amyloidosis types. Further studies are necessary for the standardization of imaging protocol and development of non-invasive diagnostic tools, especially in assessing the response to treatment and disease progression, for which little is known.

[Arrhythmogenic effects of alcohol]. / Efecte aritmogene ale etanolului.

UNLABELLED: Acute or chronic excessive consumption of alcohol can cause cardiac arrhythmias, particularly supraventricular tachyarrhythmias. Experimental and clinical data show that chronic excessive alcohol ingestion has a destructive role on cardiac tissue, which significantly deteriorates the rhythm and contractile activity, manifested by the appearance of cardiac arrythmias and dilated cardiomyopathy. AIM: The aim of this study was to evaluate and analyze the ECG changes and disturbances of cardiac rhythm and conduction in patients after an acute or chronic excessive consumption of alcohol. MATERIAL AND METHODS: The study included 187 patients (184 males and 3 females). Each patient followed biochemical and hematological analysis as well as paraclinical investigation measurements. RESULTS: The most common types of arrhythmia were permanent atrial fibrillation (61%). Paroxysmal atrial fibrillation and supraventricular extrasystoles were found in patients without significant echocardiographic deteriorations. These arrhythmias appeared after an excessive alcohol drinking and paroxysmal atrial fibrillation was converted to normal sinus rhythm after a short period of abstinence or after pharmacologic therapy. Ventricular arrhythmias (ventricular extrasystoles, non-sustained ventricular tachycardia-4.7%, torsada de point-1.5%) were less frequent. Conduction disturbance (left bundle branch-LBBB 6.3%, right bundle branch-RBBB 10%) were found in patients who had a history of consuming >150 g/day of alcohol for >10 years, with dilated heart chambers and systolic ventricular function much more deteriorated (symptomatic stage of heart failure). CONCLUSION: Excessive alcohol consumption may lead to cardiac arrhythmias in patients with existing heart disease as well as in healthy individuals.

[Sudden death and ventricular arrhythmias risk stratification after myocardial infarction]. / Stratificarea riscului de aritmii ventriculare maligne si moarte subita cardiaca post infarct miocardic acut.

Fifty percent of deaths associated with acute myocardial infarction are attributable to ventricular arrhythmias and sudden death. Lethal ventricular arrhythmias are caused by an interplay between three basic components: substrate (such as presence of potential reentry circuits within the infarct area), trigger (such as premature ventricular contractions), and modulating factors (such as ischemia, dysfunction of the autonomic nervous system and impaired left ventricular function). Noninvasive techniques, including baroreflex sensitivity, heart rate variability, heart rate turbulence, QT dispersion, T-wave alternant, Signal-Averaged Electrocardiography, exercise testing and ejection fraction can be useful for predicting the patients at risk for sudden death.