An Unusual Etiology of Aortic Insufficiency: A Case Report.

Identifying the etiology of aortic insufficiency (AI) is essential in the management of the patient with valvular heart disease. We report the case of a 34-year-old male who presented with New York Heart Association (NYHA) class IV symptoms. The physical exam was consistent with AI, which was confirmed on echocardiography. Interestingly, the trileaflet aortic valve (TAV) was comprised of three retracted cusps, a rarely cited anatomic abnormality yielding AI. The patient underwent an uncomplicated aortic valve replacement (AVR).

Trends and Outcomes of ST-Segment-Elevation MI in Hospitalized Patients Without Standard Modifiable Cardiovascular Risk Factors.

Mixed results were seen in hospital outcomes comparing the first episode of ST-elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs) than with risk factors. To understand whether the first episode of STEMI SMuRFs has worse in-hospital outcomes than patients with risk factors and to identify confounders that contribute towards worse results. We queried the Nationwide Inpatient Sample for hospitalizations with a primary diagnosis of STEMI but no prior coronary disease from 2016 to 2019. Our study population was divided into 2 comparative cohorts, SMuRFs and SMuRFless STEMI, based on cardiovascular risks. We assessed demographics, in-hospital mortality, complications of the 2 groups. SMuRFless patients were statistically more likely than those with SMuRFs to be younger, white, male, and underweight (BMI < 20) and were significantly less likely to receive percutaneous coronary intervention (85.8 vs 90.7%, P < 0.001) or cardiac bypass (3.8 vs 5.9%, P < 0.001). SMURFless patients were more likely to have in-hospital mortality (15.7 vs 7.1%, unadjusted odds ratio: 2.41, 95% confidence interval: 2.27-2.56, P < 0.001), a finding that persisted when adjusted for all factors found significant in univariate analysis (adjusted odds ratio: 2.48; 95% confidence interval: 2.30-2.67, P < 0.001). Incidence of cardiac complications, including cardiogenic shock, ventricular arrhythmia, cardiac arrest, were significantly higher in the SMuRFless patients, even after statistical adjustment and sensitivity analysis. SMuRFless patients represent a sizable minority of patients presenting with STEMI and have higher mortality, complications and receive fewer invasive procedures. Patient-level studies may be necessary to understand better how to treat this subset of myocardial infarction patients. SMuRFless STEMI were statistically more likely than those with SMuRFs to be younger, white, male, and underweight (BMI < 20) and were significantly less likely to receive percutaneous coronary intervention. SMURFless patients were more likely to have in-hospital mortality, a finding that persisted when adjusted for all factors found significant in univariate analysis. Incidence of cardiac complications, including cardiogenic shock, ventricular arrhythmia, cardiac arrest, were significantly higher in the SMuRFless patients, even after statistical adjustment and sensitivity analysis. SMuRFless patients represent a sizable minority of patients presenting with STEMI and have higher mortality, complications and receive fewer invasive procedures.

Sex-based differences in clinical outcomes and resource utilization of type 2 myocardial infarction.

BACKGROUND: Sex-based differences in clinical outcomes have been previously well described in type 1 myocardial infarction (T1MI). However, type 2 myocardial infarction (T2MI) is more common in contemporary practice, with scarce data regarding sex-based differences of outcomes. METHODS: The Nationwide Readmission Database 2018 was queried for hospitalizations with T2MI as a primary or secondary diagnosis. Complex samples multivariable logistic and linear regression models were used to determine the association between T2MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions) in females compared to males with T2MI. RESULTS: A total of 252,641 hospitalizations [119,783 (47.4%) females and 132,858 (52.6%) males] were included in this analysis. Females with T2MI was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI] 0.88-0.96; P < 0.001), shorter LOS (adjusted parameter estimate [aPE] -0.28; 95% CI -0.38-0.17; P < 0.001), less hospital costs (aPE -1510.70; 95% CI -1916.04-1105.37; P < 0.001), and increased nursing home discharges (aOR 1.08; 95% CI 1.05-1.12; P < 0.001) compared to males with T2MI. Females and males with T2MI had similar rates of 30-day all-cause readmission (aOR 1.00; 95% CI 0.97-1.04; P = 0.841). CONCLUSION: Among T2MI hospitalizations, females have lower in-hospital mortality, hospitalization costs, shorter LOS, and increased rates of nursing home discharge compared to males. Although statistically significant, the clinical significance of these small differences are unknown and require future studies.

Idiopathic intrafascicular reentrant left ventricular tachycardia in an elite cyclist athlete.

A 32 year-old Caucasian male, an elite athlete, was admitted to the emergency department because of a sudden onset of palpitations which had lasted more than 12 hours and were associated with chest discomfort. He had a two-year history of recurrent stress-induced palpitations. He denied either episodes of syncope or any family history of sudden death. Physical examination was normal. He had no evidence of structural heart disease. The electrocardiography (ECG) documented during the event supported the diagnosis of idiopathic reentrant left ventricular tachycardia. Ventricular tachycardia ablation was successful. This case demonstrates that a careful physical examination and correct ECG diagnosis can lead to an appropriate arrhythmia management.