Vaccine-preventable disease hospitalized patients with heart failure with reduced ejection fraction.

BACKGROUND: Over five million Americans suffer from heart failure (HF), and this is associated with multiple chronic comorbidities and recurrent decompensation. Currently, there is an increased incidence in vaccine-preventable diseases (VPDs). We aim to investigate the impact of HF with reduced ejection fraction (HFrEF) in patients hospitalized with VPDs. HYPOTHESIS: Patient with HFrEF are at higher risk for VPDs and they carry a higher risk for in-hospital complications. METHODS: Retrospective analysis from all hospital admissions from the 2016-2018 National Inpatient Sample (NIS) using the ICD-10CM codes for patients admitted with a primary diagnosis of VPDs with HFrEF and those without reduced ejection fraction. Outcomes evaluated were in-hospital mortality, length of stay (LOS), healthcare utilization, frequency of admissions, and in-hospital complications. Multivariate regression analysis was conducted to adjust for confounders. RESULTS: Out of 317 670 VPDs discharges, we identified 12 130 (3.8%) patients with HFrEF as a comorbidity. The most common admission diagnosis for VPDs was influenza virus (IV) infection (75.0% vs. 64.1%; p < .01), followed by pneumococcal pneumonia (PNA) (13% vs. 9.4%; p < .01). After adjusting for confounders, patients with HFrEF had higher odds of having diagnosis of IV (adjusted [aOR], 1.42; p < .01) and PNA (aOR, 1.27; p < .01). Patients with VPDs and HFrEF had significantly higher odds of mortality (aOR, 1.76; p < .01), LOS, respiratory failure requiring mechanical ventilation, and mechanical ventilation for less than 96 h. CONCLUSION: Influenza and PNA were the most common VPDs admitted to the hospital in patients with a concomitant diagnosis of HFrEF. They were associated with increased mortality and in-hospital complications.

Acute coronary artery dissection after multiple bee stings.

The occurrence of an acute coronary syndrome following an anaphylactic or anaphylactoid reaction is known as Kounis syndrome. Previous reports of Kounis syndrome described an acute coronary syndrome due either to vasospasm or atherosclerotic rupture of a coronary artery in the presence of cutaneous manifestation from the anaphylactic reaction. We report a case of a 33-year-old man who presented with anterior wall acute myocardial infarction immediately after honeybee stings without the presence of cutaneous manifestations other than the bee sting lesions. Emergent coronary arteriography revealed dissection of the proximal left anterior descending artery, which was treated with balloon dilation with an excellent outcome.

Loeffler Endocarditis and Associated Parasitosis: A Diagnostic Challenge.

Loeffler endocarditis is relatively under-recognized and can impose a diagnostic challenge. We present a case of Loeffler endocarditis where eosinophilia was associated with parasitosis. This case highlights the importance of clinical clues in a patient with restrictive cardiomyopathy, and appropriate ancillary testing which helps guide further management.

Left ventricular myxoma: A contractile mass causing intracavitary obstruction and severe pulmonary hypertension.

Cardiac myxomas can be fatal and left ventricular (LV) myxomas with papillary muscle and mitral valve (MV) involvement are rare. The following case is that of a 55-year-old woman who developed signs and symptoms of pulmonary hypertension. Imaging revealed a contractile mass in the LV that was in continuum with the papillary muscles and affected MV function. Her clinical course, radiologic, and hemodynamic findings are discussed. Finally, her surgical extraction technique is described in addition to potential complications encountered.