Wide Complex Tachycardia as a Rare Pointer of Intra-aortic Balloon Pump Migration Into the Left Ventricle: A Case Report and Literature Review.

Intra-aortic balloon pumps (IABPs) are used to assist with left ventricular (LV) unloading in patients with cardiogenic shock (CS). There are different mechanical devices that can be used in CS, of which the IABP represents the simplest, the easiest to insert and remove, and the most cost-effective. Compared to traditional femoral IABPs, axillary IABPs allow patients to remain ambulatory. This is especially beneficial in patients awaiting heart transplants. Our case presents a patient with CS, where axillary IABP was used to unload the LV. However, our patient developed ventricular arrhythmia secondary to IABP migration to the LV.

A Unique Presentation of Acute Immune Thrombocytopenia Secondary to Helicobacter pylori Infection.

Thrombocytopenia, a condition characterized by low platelet counts, can arise from various causes, including autoimmune diseases. Immune thrombocytopenia (ITP), a diagnosis made by excluding other possible causes, is categorized as primary or secondary, with primary ITP being idiopathic and secondary ITP associated with infections or autoimmune conditions. This study highlights a unique instance of severe thrombocytopenia triggered by Helicobacter pylori infection.

Outcomes With Malignancy-Associated High-Risk Pulmonary Embolism: A Nationwide Analysis.

OBJECTIVE: To examine the characteristics and outcomes among patients with high-risk pulmonary embolism (PE) and malignancy. PATIENTS AND METHODS: The Nationwide Readmissions Database was used to identify hospitalizations with high-risk PE from January 1, 2016, to December 31, 2019. The main outcome was the difference in all-cause in-hospital mortality. RESULTS: Among 28,547 weighted hospitalizations with high-risk PE, 4,825 (16.9%) had malignancy. Admissions with malignancy had a lower prevalence of other comorbid conditions except for anemia and coagulopathy. The use of systemic thrombolysis, catheter-directed interventions, and surgical embolectomy was less common among admissions with malignancy, whereas the use of inferior vena cava filter was more common among those with malignancy. All-cause in-hospital mortality was higher among admissions with malignancy even after adjustment (adjusted odds ratio, 1.91; 95% CI, 1.72 to 2.11; P<.001). Metastatic genitourinary, gastrointestinal (other than colorectal), and lung malignancies were associated with the highest incidence of in-hospital mortality. The incidence of intracranial hemorrhage (3.9% vs 3.1%; P=.056) and the composite of non-intracranial hemorrhage bleeding (21.9% vs 20.6%; P=.185) was not different between admissions with and without malignancy. However, admissions with malignancy had higher incidence of gastrointestinal bleeding. CONCLUSION: In this nationwide analysis of patients admitted with high-risk PE, malignancy was independently associated with an increased risk of in-hospital mortality. The risk was highest among patients with metastatic genitourinary, gastrointestinal, and lung malignancies. Advanced therapies were less frequently used among patients with malignancy.

Neurosarcoidosis: A Unique Presentation of a Rare Disease.

Sarcoidosis is defined as an immune-mediated multi-organ granulomatous disease with unknown etiology, which is characterized by the presence of multiple non-caseating granulomas in the absence of a definite infective or toxic cause. Neurosarcoidosis (NS) occurs when sarcoid granulomas invade the central or peripheral nervous systems. Sarcoidosis usually presents with non-specific manifestations, including dry cough, fatigue, night sweats, weight loss, skin changes, and eye manifestations. Many patients who develop NS present with neurological manifestations within two years of being diagnosed with sarcoidosis. Herein, we present a case of newly diagnosed sarcoidosis in a 49-year-old male patient initially presenting with neurological manifestations of unknown origin, later identified as NS on peripheral lymph node biopsy with non-caseating granuloma.

Unusual Case of Takotsubo Cardiomyopathy Secondary to COVID-19 Vaccine: Case Report and Literature Review.

COVID-19 is a serious disease with high morbidity and mortality around the globe. We present a case of a 45-year-old male who presents with substernal chest pain three days after receiving the second dose of his COVID-19 mRNA (Moderna) vaccine. A transthoracic echo showed reduced left ventricular ejection fraction of 25-30% with akinesis of the mid to distal anterior, anteroseptal, anterolateral, inferolateral, inferoseptal, and inferior walls. Patient symptoms improved significantly during his hospitalization. Repeat trans-thoracic echo four days after his hospitalization showed ejection fraction recovery without segmental wall motion abnormalities. This case demonstrates the importance of recognizing Takotsubo cardiomyopathy as a complication of COVID-19 vaccine.

Reactivation of minimal change disease after Pfizer vaccine against COVID-19.

This case follows a 54-year-old woman with a medical history of hypertension who experienced reactivation of minimal change disease (MCD) after receiving the Pfizer vaccine against COVID-19. She had her first episode of MCD 15 days after receiving the influenza vaccine in 2018. She remained in remission for over 3 years following treatment with steroids. She experienced foamy urine and leg edema after receiving the first dose of the Pfizer vaccine, but she did not consult medical professionals until she received the second dose. She wanted to be fully vaccinated because she worked in healthcare. Her initial diagnosis of MCD in 2018 was made following a kidney biopsy. The diagnosis of reactivation following COVID-19 vaccine was made with labs and presenting symptoms. At presentation, her urine protein was 9,977 mg/day. She was treated with prednisone 50 mg/day following her relapse with improvement in her urine protein to 85 mg/g within 4 weeks of starting treatment. She is currently undergoing treatment with prednisone with improvement in her presenting symptoms, which included foaming of urine and edema of legs. This case demonstrates the importance of vigilance in patients with a history of MCD when receiving the COVID-19 vaccine, particularly if they have a history of such reactions to other vaccines. Patients should discuss the benefits and risks of receiving the vaccine with their medical professionals and stay cognizant about the possibility of reactivation after receiving the COVID-19 vaccine.

ST-Segment Elevation Secondary to Spontaneous Pneumomediastinum in the Setting of COVID-19 Infection: A Case Report and Literature Review.

A 45-year-old male presented with shortness of breath, cough,and chest discomfort. He reported positive test results for coronavirus disease 2019 (COVID-19) four days prior; this was confirmed by a second test administered at the hospital. Results of a chest CT, consistent with COVID-19 pneumonia, also revealed pneumomediastinum (PM). EKG showed ST elevations in the inferior leads with no reciprocal changes. Emergent cardiac catheterization showed that he had no stenosis in his major coronary arteries. His symptoms resolved after 25 days of hospitalization and the patient was ultimately discharged. This case highlights the importance of recognizing spontaneous PM as a complication of COVID-19 along with its uncommon presentation of ST elevation in order to prevent unnecessary invasive procedures.

A Rare Case of a Failed AngioVac Procedure Used to Debride Tricuspid Vegetation Complicated by Ogilvie Syndrome.

Ogilvie syndrome is a rare disorder characterized by dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction. Its etiology is likely multifactorial with high mortality if left untreated. Here, we report for the first time a case of Ogilvie syndrome secondary to the AngioVac procedure. Because our patient had a high operative risk, we used the AngioVac system to debulk tricuspid valve vegetations to reduce bacterial load. Although AngioVac is considered safe overall, publications describing its side effects, safety, and efficacy are limited. Providers should be aware of this rare but potentially fatal complication and the importance of close clinical monitoring and serial abdominal examinations following AngioVac procedures.

Infective Endocarditis Secondary to Bacteroides Thetaiotaomicron in a Patient With Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: A Case Report and Review of the Literature.

Bacteroides species are significant clinical pathogens with an associated mortality of more than 19% and are found in most anaerobic infections. Our report documents for the first time a case of infective endocarditis (IE) secondary to Bacteroides thetaiotaomicron (BT). We discuss the case of a 65-year-old female with a medical history of smooth muscle tumor of uncertain malignant potential (STUMP) who presented to the ED with lower quadrant pain. In the hospital, she was found to be in septic shock. A transthoracic echocardiogram showed large vegetation on the aortic valve with severe aortic regurgitation and a blood culture growing BT. We urge physicians to be alert to the fact that Gram-negative anaerobes like BT can cause IE.

Watchman Device Procedure Complicated by Rare Perclose ProGlide Embolization: Case Report and Literature Review.

Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality. In this case, we present a 69-year-old man with a past medical history of atrial fibrillation on warfarin who came to the hospital for placement of the Watchman device (Boston Scientific Corporation, Marlborough, Massachusetts, United States). His procedure was complicated by Perclose ProGlide™ Suture-Mediated Closure system (Abbott Laboratories Inc., Chicago, Illinois, United States) embolism. The vascular surgery department was consulted STAT in the electrophysiology lab and was unable to fully visualize the vessel. The patient was then brought emergently to a hybrid operating room where venotomy was made. He tolerated the procedure well and was eventually discharged home.

Stress Cardiomyopathy Triggered by Status Epilepticus Secondary to Herpes Simplex Virus Encephalitis: Case Report and Literature Review.

Stress cardiomyopathy (SCM) occurs in approximately 1% of patients presenting with troponin-positive suspected acute coronary syndrome (ACS). We present here a 50-year-old female who presented to the emergency department (ED) with altered mental status. In the hospital, she was found to have status epilepticus (SE) secondary to Herpes simplex virus encephalitis. Her hospital stay was complicated by high troponins and a transthoracic echocardiogram showed reduced ejection fraction and wall motion abnormality. Repeat echo five days later showed normal ventricular systolic function with no wall motion abnormality. Extensive ischemia workup was negative. A diagnosis of stress cardiomyopathy has been made. We urge physicians to include SCM in their differential diagnosis especially in cases of status epilepticus in order to avoid invasive procedures and for better management of patients.

Guillain-Barré Syndrome Secondary to West Nile Virus in New York City.

West Nile virus (WNV) is an arthropod-borne flavivirus belonging taxonomically to the Japanese encephalitis subgroup. Usually, it is transmitted by Culex pipiens mosquitoes. Consequently, an increase in WNV-positive mosquitoes presents a rise of the number of patients, as it has been seen in NYC. We present a 65-year-old patient with WNV infection who presented with Guillain-Barré syndrome (GBS). She had a rapidly progressing ascending paralysis, a common feature in GBS patients but an uncommon presentation in WNV. Realizing WNV as an emerging pathogen along with its uncommon presentation of GBS can be potentially lifesaving if caught at an early stage.

Cervical Pannus Without Rheumatoid Arthritis or Trauma.

Although usually seen in patients with rheumatoid arthritis, cervical pannus also can develop in patients who have had spine surgery.