A rare case of native mitral valve infective endocarditis presenting with complete heart block and intermittent atrial flutter.

Mitral valve infective endocarditis, without aortic involvement, is a rare cause of complete heart block. It is thought that infections placed close to the conductive system of the heart may drive a conduction block. We found six cases in the literature, via searching PubMed, of mitral valve infective endocarditis with complete heart block and no aortic involvement. We report a case of complete heart block with a junctional escape rhythm in a patient with a Staphylococcus Aureus vegetation on a native mitral valve only.

A Rare Case of Loperamide-Induced Cardiac Arrest.

Loperamide (Imodium) is an opioid receptor agonist available over-the-counter and can be used for the treatment of diarrhea. When ingested in excessive doses, loperamide can penetrate the blood-brain barrier and is reported to produce euphoria, depression of the central nervous system, and cardiotoxicity. It may also be used for its euphoric effects and potentially to alleviate opioid withdrawal. Loperamide has a US boxed warning for torsades de pointes and sudden death. Loperamide has been reported to cause torsades de pointes, cardiac arrest, and death when higher than the recommended dosage is consumed. We report a rare case of ventricular arrhythmia provoked by accidental ingestion of loperamide to treat simple diarrhea.

A Case of Dronedarone-Induced Hypotensive Shock.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Dronedarone is a new antiarrhythmic used for rhythm and rate control in AF and is associated with reduced mortality in non-permanent AF. It has also been associated with increased mortality in those with heart failure and/or permanent AF. This case report presents the case of hypotensive shock after initiating treatment with dronedarone in a 73-year-old female patient. Shortly after her first dose of dronedarone, she developed hypotension that did not respond to intravenous fluids and was admitted to the intensive care unit for vasopressor administration. Dronedarone was the most likely cause of the hypotension as the patient's blood pressure normalized in 24 hours, which concurs with the half-life of dronedarone. Amiodarone and dronedarone are similar in composition; however, the absence of iodine moieties in dronedarone contributes to its improved side-effect profile. Furthermore, amiodarone has been linked to hypotensive shock likely due to a co-solvent used in some intravenous preparations; however, dronedarone-induced hypotension is less common.

Pulmonary Tumor Embolism: A Rare Cause of Acute Pulmonary Hypertension.

A rare cause of acute decompensated pulmonary hypertension is pulmonary tumor embolism (PTE), which is an uncommon complication of advanced lung malignancy. Patients diagnosed with PTE typically have a poor prognosis, and so patients with advanced lung tumors who present with signs of right heart failure and respiratory support should be evaluated for PTE. We present a case of a 54-year-old Hispanic female who initially presented with a one-month history of dysphagia, who was found to have acute pulmonary hypertension secondary to invasion of the pulmonary arteries by lung adenocarcinoma.

Adherence to the United States Preventative Services Task Force Female Screening Guidelines: An Internal Medicine Residency Program Experience.

Background Various guidelines exist for female preventative screening tests and medical resident physician adherence to the United States Preventive Services Task Force (USPSTF) guidelines varies. National screening rates for breast cancer and osteoporosis have improved but they are still below the expected target. Material and methods Ambulatory medical clinic records of female patients from the period July 2015 to December 2017 were reviewed for breast cancer and osteoporosis screening. Resident performance and commitment with regards to ordering the aforementioned screening tests according to the USPSTF guidelines were compared to the most recent national screening rates for mammograms and dual-energy X-ray absorptiometry (DXA) scans. Results Of the 1327 charts reviewed, 1025 was included in the study. Of the 545 mammograms performed, 93% of them were indicated according to the USPSTF guidelines (P < 0.0001, 95% CI: 125.9-342.0). A total of 480 mammograms were not ordered, of which 6% were indicated and 93.9% were not indicated. Out of a total of 107 DXA scans performed, 88.7% were correctly indicated (P < 0.0001, 95% CI: 37.11-132.9). Conclusion Resident physician adherence to the USPSTF screening guidelines for breast cancer and DXA scans were higher than the national and state screening rates. Our well-structured educational project (strong faculty mentorship, resident to patient continuity of care and the reasonable resident-clinic load) resulted in higher screening rates.