Left atrial myxoma with cardiogenic shock following a myocardial infarction: a case report.

BACKGROUND: Myxomas are the most common primary cardiac tumor and typically originate in the left atrium. Atrial myxomas may present following complications of obstruction and emboli. If an atrial myxoma goes untreated, complications such as congestive heart failure, embolic stroke, and sudden death can occur. CASE PRESENTATION: A 58-year-old Caucasian male presented following a cardiac arrest. He was taken emergently to the cardiac catheterization lab and received two drug eluting stents. Following the procedure, he was found to have a left atrial mass that was intermittently obstructing the mitral valve on echocardiography. After leaving the cardiac catheterization lab, he was hypotensive and placed on multiple intravenous medications for hemodynamic support as well as an Impella device. Following medical optimization, he underwent one vessel coronary artery bypass graft as well as surgical excision of the left atrial mass, which pathology had shown to be an atrial myxoma. CONCLUSION: This patient's case of cardiogenic shock following revascularization was complicated by the identification of an atrial myxoma, which, when large enough, can obstruct blood flow through the mitral valve leading to acute mitral dynamic stenosis. This condition results in circulatory collapse due to obstruction of the left ventricle in diastole as the myxoma occludes the mitral valve.

Takotsubo Syndrome: An Epidemiologic Evaluation.

Takotsubo syndrome is characterized by regional wall motion abnormalities that reflect impairment of myocardial contractility in the absence of culprit epicardial coronary artery disease. The pathophysiologic mechanisms responsible for Takotsubo syndrome remain unknown and predominately occur in postmenopausal females suffering either a psychological or physical stressor. This study used the Hospital Corporation of America (HCA) Healthcare database evaluating demographic distribution of patients with Takotsubo syndrome to identify what comorbid conditions were most prevalent in patients found to have Takotsubo syndrome in the United States population and compare them to the traditional patient population with the condition. The patient population in the HCA Healthcare United States database was similar to prior known demographic factors including postmenopausal females and Caucasian ethnicity. Interestingly, in both the previously diagnosed group and diagnosed at the time of presentation with the Takotsubo syndrome group, there was a mismatch between the number of patients diagnosed with an underlying mood disorder and on psychiatric medication. This may provide further evidence of Takotsubo syndrome being a dramatic presentation of a mood disorder.

Antithrombotics and Gastrointestinal Prophylaxis: A Systematic Review.

Antithrombotic medications include both antiplatelet and anticoagulants and are used for a wide variety of cardiovascular conditions. A common complication of antithrombotic use is gastrointestinal bleeding. As a result, gastrointestinal prophylaxis is a common consideration for patients on a single or combination antithrombotic regimen. Prophylaxis is typically achieved through use of either proton pump inhibitors or histamine 2 receptor antagonists. Current recommendations for use of gastrointestinal prophylaxis with concomitant use of antithrombotic medications are scarce. In this systematic review, we explore the current evidence and recommendations regarding gastrointestinal prophylaxis for patients on antiplatelet or anticoagulant therapy as well as combination regimens.

A Rare Case of a Right Atrial Paraganglioma in an Individual with the SHDB Mutation.

Paragangliomas are extra-adrenal chromaffin cell tumors. A small percentage of these tumors can be found in the thoracic cavity and, when in the heart, are typically in the left atrium. In this case report, we discuss the case of an individual with a history of several paragangliomas with the SHDB mutation who was found to have two cardiac paragangliomas in the right atrium.

Serotonin Syndrome Induced Tako-Tsubo Syndrome.

Tako-tsubo syndrome is characterized by temporary systolic dysfunction of the left ventricle in the absence of coronary artery disease. Serotonin syndrome is a life-threatening condition associated with increased serotonergic activity in the central nervous system (CNS). We report a case of Tako-tsubo syndrome following seizures secondary to serotonin syndrome.

Myelodysplastic syndrome in a case of new-onset pancytopenia.

Myelodysplastic syndrome (MDS) is an infrequent cause of pancytopenia, which is a decrease in all three peripheral blood cell lines. We report the case of new-onset pancytopenia following administration of a COVID-19 vaccine and recurrent Zosyn use who was later found to have myelodysplastic syndrome.

Abiotrophia defectiva Infective Endocarditis: A Rare and Dangerous Cause of Endocarditis.

Infective endocarditis is an uncommon heart infection, typically involving heart valves. Abiotrophia defectiva is a rare cause of endocarditis, typically found within the GI tract, and is usually difficult to isolate and requires specialized media. We report a case of Abiotrophia defectiva endocarditis following a root canal.

What Skills Do Clinical Evaluators Value Most In Oral Case Presentations?

Phenomenon: Trainees and practicing physicians are judged by the way that they present patients. We therefore invest heavily in teaching students how to do oral case presentations (OCPs), but the relative weights by which different aspects of these complex tasks contributes to an overall evaluation is poorly understood. Approach: We sought to contrast how clinical evaluators assess students' OCPs and how medical students expect OCPs to be evaluated. Multiple linear regression and correlation matrices assessed how individual components of 3rd-year medical students' OCPs affect overall faculty assessment of students' performance using the previously validated Patient Presentation Rating tool. Preclinical medical students were surveyed to determine how they expect their OCPs to be evaluated. Findings: Faculty evaluations of students' overall organization and descriptions of patients' situations and vital signs were strongly associated with their overall OCP evaluation. Students believed that describing the patient's situation, chief complaint, and history of present illness would be highly valued but not organization or vital signs descriptions. Insights: Students and faculty differ about what is important in OCPs. Aligning these perceptions through intentional redesign of curricula and feedback instruments may facilitate teaching clinical communication to students.

Impact of light exposure on thyroid-stimulating hormone results using the Siemens Advia Centaur TSH-3Ultra assay.

Background Thyroid-stimulating hormone (TSH) is used as the first-line test of thyroid function. Siemens Healthcare Diagnostics recommend that Siemens Centaur reagents must be protected from light in the assay information and on reagent packaging. We have compared the effect of light exposure on results using Siemens TSH-3Ultra and follicle-stimulating hormone reagents. The thyroid-stimulating hormone reagent includes fluoroscein thiocyanate whereas the follicle-stimulating hormone reagent does not. Methods Three levels of quality controls were analysed using SiemensTSH-3Ultra and follicle-stimulating hormone reagent packs that had been kept protected from light or exposed to light at 6-h intervals for 48 h and then at 96 h. Results Thyroid-stimulating hormone results were significantly lower after exposure of TSH-3Ultra reagent packs to light. Results were >15% lower at all three levels of quality control following 18 h of light exposure and continued to decrease until 96 h. There was no significant difference in follicle-stimulating hormone results whether reagents had been exposed to or protected from light. Conclusions Thyroid-stimulating hormone results but not follicle-stimulating hormone results are lowered after exposure of reagent packs to light. Laboratories must ensure that TSH-3Ultra reagents are not exposed to light and analyse quality control samples on every reagent pack to check that there has not been light exposure prior to delivery. The labelling on TSH-3Ultra reagent packs should reflect the significant effect of light exposure compared with the follicle-stimulating hormone reagent. We propose that the effect of light exposure on binding of fluoroscein thiocyanate to the solid phase antibody causes the falsely low results.