Infected Retained Catheter-Related Sheath, an Underrecognized Complication of Central Venous Catheter Insertion: A Case Report.

BACKGROUND Central venous catheters are indicated for a variety of conditions, including hemodynamic monitoring, hemodialysis, and long-term antibiotic and chemotherapy delivery. Several million are placed each year. Development of a fibrin sheath around the catheter is a common occurrence, with a reported incidence of 42-100% within 7 days of catheter placement. It is uncommon for these sheaths to be left in the patient upon removal of the catheter and even far more uncommon for these retained sheaths to lead to complications. CASE REPORT We present the case of a 45-year-old woman with a previous history of superior mesenteric artery syndrome and chronic protein calorie malnutrition on total parenteral nutrition through a long-term indwelling central venous catheter. She presented with concerns of persistent bacteremia despite outpatient intravenous antibiotic therapy, requiring removal of her central venous catheter. A transesophageal echocardiogram was performed to rule out infective endocarditis. Findings showed a highly mobile mass extending from the superior vena cava into the right atrium, most consistent with a retained catheter-related sheath. Due to concern for this being a nidus of her persistent bacteremia, she underwent mechanical thrombectomy, with excellent results and subsequent clearing of her bacteremia. CONCLUSIONS Placement of central venous catheters is becoming a commonplace occurrence, with millions placed each year. Retained catheter-related sleeves are a potential complication, with further research needed to help determine the clinical significance and best treatment approach.

Right Atrial and Ventricular Collapse After Cardiopulmonary Resuscitation.

Prompt and effective chest compressions is the cornerstone cardiopulmonary resuscitation and has been found to improve cardiac arrest outcomes. Despite being rare, a wide variety of cardiac and pulmonary complications due to chest compressions have been identified. We present a case of a young, otherwise healthy female developing toxic shock syndrome and ultimately cardiac arrest requiring chest compressions found to cause right atrial and ventricular collapse on echocardiography.

Pseudoaneurysm Development after Free Wall Rupture Post Myocardial Infarction.

Background: According to the World Health Organization, cardiovascular disease is the number one cause of death globally, claiming millions of lives each year with an increasing prevalence. Myocardial infarction (MI) makes up a large sum of these deaths each year. While MI in itself is lethal, there are several complications that can increase the morbidity and mortality of an MI, such as left ventricular wall rupture and aneurysms. Case Presentation: We present a case of an elderly male with an extensive cardiac history who presented with a non-ST segment myocardial infarction (NSTEMI) managed with percutaneous coronary intervention. Hours after, he became hemodynamically unable and was found to have a pseudoaneurysm of the left ventricle. Despite aggressive efforts, his pseudoaneurysm ruptured and he ultimately succumbed to his condition. Conclusions: Left ventricular pseudoaneurysm is usually seen after myocardial infarctions with a rupture rate of up to 45% leading to a mortality rate of about 50%. While cardiac catheterization with left ventriculography is the gold standard for diagnosis, echocardiography can also be used as an alternative. Treatment is emergent cardiac surgery but still holds a high operative risk. Therefore, patients may be medically stabilized and managed prior to ultimate surgical intervention.

A Fatal Case of Pembrolizumab-Induced Myocarditis in Non-Small Cell Lung Cancer.

Immune channel inhibitor-induced myocarditis is rare, and its management is challenging. Recently, guidelines were established for all ICIs, yet they do not take into account individual drug toxicities or screening protocols for prevention. We present a rare case of rapidly progressive pembrolizumab-induced fatal myocarditis in an initially asymptomatic patient. (Level of Difficulty: Beginner.).

Anti-hypertensive mechanisms of cyclic depsipeptide inhibitor ligands for Gq/11 class G proteins.

Augmented vasoconstriction is a hallmark of hypertension and is mediated partly by hyper-stimulation of G protein couple receptors (GPCRs) and downstream signaling components. Although GPCR blockade is a key component of current anti-hypertensive strategies, whether hypertension is better managed by directly targeting G proteins has not been thoroughly investigated. Here, we tested whether inhibiting Gq/11 proteins in vivo and ex vivo using natural cyclic depsipeptide, FR900359 (FR) from the ornamental plant, Ardisia crenata, and YM-254890 (YM) from Chromobacterium sp. QS3666, or it's synthetic analog, WU-07047 (WU), was sufficient to reverse hypertension in mice. All three inhibitors blocked G protein-dependent vasoconstriction, but to our surprise YM and WU and not FR inhibited K+-induced Ca2+ transients and vasoconstriction of intact vessels. However, each inhibitor blocked whole-cell L-type Ca2+ channel current in vascular smooth muscle cells. Subcutaneous injection of FR or YM (0.3 mg/kg, s.c.) in normotensive and hypertensive mice elicited bradycardia and marked blood pressure decrease, which was more severe and long lasting after the injection of FR relative to YM (FRt1/2 ≅ 12 h vs. YMt1/2 ≅ 4 h). In deoxycorticosterone acetate (DOCA)-salt hypertension mice, chronic injection of FR (0.3 mg/kg, s.c., daily for seven days) reversed hypertension (vehicle SBP: 149 ± 5 vs. FR SBP: 117 ± 7 mmHg), without any effect on heart rate. Our results together support the hypothesis that increased LTCC and Gq/11 activity is involved in the pathogenesis of hypertension, and that dual targeting of both proteins can reverse hypertension and associated cardiovascular disorders.