Incidental Finding of Right Atrial Mass in a Patient With Hodgkin Lymphoma: Utilization of Multimodal Cardiac Imaging in Diagnosis.

Right atrial masses can be found incidentally on imaging studies, which could represent cardiac or non-cardiac tumors, vegetations, or thrombi. Catheter-related right atrial thrombosis is an uncommon and underdiagnosed condition, but has been associated with significant mortality risk. Herein, we present a case of a 56-year-old man with Hodgkin lymphoma who was found to have a right atrial mass on routine transthoracic echocardiogram. The diagnosis of right atrial thrombus was made by using transesophageal echocardiogram and cardiac magnetic resonance imaging. He was managed with intravenous heparin and was being evaluated for possible thrombectomy when he died from complications of septic shock.

Optimizing Non-Pharmacologic Management of Hypertriglyceridemia.

The cornerstone of initial management for hypertriglyceridemia (HTG) is lifestyle modification. The combination of weight loss through caloric restriction, alteration in macronutrient composition and increased energy expenditure reduces TG levels by approximately 50%. The addition of cinnamon, cacao products and isocaloric substitution of 1 serving of nuts may contribute another 5-15% lowering of TG. This can be particularly beneficial in patients with HTG who are at increased risk of cardiovascular disease.

The diuresis clinic: a new paradigm for the treatment of mild decompensated heart failure.

BACKGROUND: Heart failure results in approximately 1 million hospital admissions annually in the United States and is the leading cause of 30-day readmissions. METHODS: This study explores the impact of a diuresis clinic on heart failure outcomes and cost. Data were collected prospectively on all consecutive patients who received intravenous diuretics and multidisciplinary care in the clinic from its establishment from October 2011 to December 2012, as well as a comparison cohort of patients with heart failure who were admitted to the hospital for <48 hours. The percentage of hospitalized days was calculated for both cohorts 180 days before and 180 days after each patient's index visit. RESULTS: In the diuresis clinic group, 106 patients (mean age, 68.2 ± 13 years; 48% were women) were treated over 328 visits (1-22 visits per person), with a mean intravenous furosemide dose of 100 mg, average urine output of 1460 ± 730 mL, and weight loss of 2.3 ± 1.8 kg. Days hospitalized decreased from 38.3 to 31.2 per 1000 patient-days after the index diuresis clinic visit (P < .01). In the comparison group, 143 patients (mean age, 69 ± 16 years; 54% were women) were admitted for <48 hours. Days hospitalized increased from 14.4 to 21.0 per 1000 patient-days after index admission (P < .01). On multivariate analysis, the diuresis clinic was associated with 3 fewer days in the hospital per 180 days per patient, with an estimated annual savings of $12,113 per patient. CONCLUSIONS: Compared with a brief hospital stay, treatment of mild decompensated heart failure in a diuresis clinic resulted in a substantial and cost-effective decline in the rate of subsequent hospitalization.

Relation of hepatic steatosis to atherogenic dyslipidemia.

Hepatic steatosis is closely associated with the metabolic syndrome. We assessed for an independent association between hepatic steatosis and atherogenic dyslipidemia after adjustment for obesity, physical activity, hyperglycemia, and systemic inflammation. We studied 6,333 asymptomatic subjects without clinical cardiovascular disease undergoing a health screen in Brazil from November 2008 to July 2010. Hepatic steatosis was diagnosed by ultrasound. Atherogenic dyslipidemia was defined using 2 definitions: criteria for (1) metabolic syndrome or (2) insulin resistance (triglyceride/high-density-lipoprotein cholesterol ratio of ≥2.5 in women and ≥3.5 in men). In hierarchical multivariate regression models, we evaluated for an independent association of hepatic steatosis with atherogenic dyslipidemia. Hepatic steatosis was detected in 36% of participants (average age 43.5 years, 79% men, average body mass index 26.3 kg/m(2)). Subjects with hepatic steatosis had similar levels of low-density-lipoprotein cholesterol, with significantly lower level of high-density-lipoprotein cholesterol and higher level of triglyceride compared with those without steatosis. Hepatic steatosis remained significantly independently associated with atherogenic dyslipidemia of both definitions (metabolic syndrome [odds ratio 2.47, 95% confidence interval 2.03 to 3.02] and insulin resistance [odds ratio 2.50, 95% confidence interval 2.13 to 2.91]) after multivariate adjustment. Stratified analyses showed a persistent independent association in nonobese subjects, those without metabolic syndrome, those with normal high-sensitivity C-reactive protein, nonalcohol abusers, and those with normal liver enzymes. Hepatic steatosis was significantly associated with atherogenic dyslipidemia independent of obesity, physical activity, hyperglycemia, and systemic inflammation after multivariate adjustment. In conclusion, this adds to the growing body of evidence that hepatic steatosis may play a direct metabolic role in conferring increased cardiovascular risk.

Changing from aprotinin to tranexamic acid results in increased use of blood products and recombinant factor VIIa for aortic surgery requiring hypothermic arrest.

OBJECTIVE: Aprotinin, once used to reduce allogeneic blood product transfusion during cardiac surgery, was withdrawn from the market in late 2007 over concerns of causing increased mortality. This study was undertaken to determine what, if any, the impact of changing antifibrinolytic agents (from aprotinin to tranexamic acid) for deep hypothermic circulatory arrest cases would have on blood bank resource utilization. DESIGN: This a retrospective review. SETTING: All cases were performed at a single university hospital. PARTICIPANTS: All patients underwent cardiac surgical procedures requiring deep hypothermic circulatory arrest performed by a single cardiac surgeon between January 2006 and November 2008. INTERVENTION: All patients prior to November 15, 2007 received aprotinin as antifibrinolytic therapy, while those after that date received tranexamic acid for antifibrinolytic therapy. MEASUREMENTS AND MAIN RESULTS: Blood transfusion data and recombinant factor VIIa use during the pre- and immediate postoperative period was collected for all patients during the study time period. There were no significant differences between the aprotinin (n = 82) and tranexamic acid (n = 78) groups with regard to baseline coagulation status or operative characteristics. Patients treated with tranexamic acid required more fresh frozen plasma (2.5 units, p < 0.001), platelets (0.5 units, p < 0.01), and cryoprecipitate (25 units, p < 0.001), and had a higher incidence of recombinant factor VIIa use (34.6% v 12.2%, p < 0.01) compared with patients in the aprotinin group. CONCLUSIONS: Patients treated with tranexamic acid required more clotting factors than the control group receiving aprotinin.