Eosinophilia and Ulcerative Colitis Associated with Eosinophilic Myocarditis.

Reactive eosinophilia is associated with inflammatory bowel disease, but its association with eosinophilic myocarditis is rare. We report a case of a 42-year-old man who presented with hypovolemic shock secondary to diarrhea and recently diagnosed nonischemic cardiomyopathy (left ventricular ejection fraction, 0.29). Laboratory evaluation revealed marked peripheral eosinophilia. Cardiac magnetic resonance imaging showed evidence of subacute-to-chronic myocarditis, and endomyocardial biopsy results were consistent with eosinophilic myocarditis. Colonic biopsy specimens revealed ulcerative colitis and no eosinophils. Hematologic evaluation was negative for an alternative cause of eosinophilia. The patient was given corticosteroids; his diarrhea resolved, but there was no short-term improvement in his ejection fraction, so an implantable cardioverter-defibrillator was placed. Follow-up at one year showed that the patient's left ventricular ejection fraction had improved to 0.42.

Single-center experience of antifungal prophylaxis for coccidioidomycosis in heart transplant recipients within an endemic area.

In endemic regions, coccidioidomycosis causes substantial morbidity and mortality for patients receiving solid organ transplants. We aimed to demonstrate the effect of antifungal coccidioidal prophylaxis in heart transplant (HT) recipients. We retrospectively reviewed the electronic health records of all patients who received HTs between October 19, 2005, and December 13, 2014. We collected information regarding antifungal regimens and determined whether patients subsequently developed infections. Our 174-person cohort all received antifungal prophylaxis for at least 6 months (mean follow-up, 53.8 months). One proven and one probable coccidioidal infection (each, 0.6%) occurred during the study period. The incidence of coccidioidomycosis was 0.6% at 1 year and 2.3% at 5 years. No cases of proven coccidioidomycosis occurred within 2 years after transplantation. No patients developed disseminated disease, and no sentinel events were attributed to coccidioidomycosis. Both fluconazole and voriconazole were well tolerated. In the absence of intolerance or contraindication, we suggest continuing a universal antifungal prophylactic regimen with fluconazole for at least 6-12 months in HT recipients residing in a coccidioidomycosis-endemic area.

Electrocardiographic Abnormalities in Disease-Free Black South Africans and Correlations With Echocardiographic Indexes and Early Repolarization.

Electrocardiographic abnormalities, and specifically early repolarization (ER) patterns, are increasingly found to be common variants in healthy populations free of heart disease or risk factors. Data are sparse in subjects of African descent, for which no increase in adverse cardiovascular outcomes have been demonstrated. A database of healthy disease-free adult volunteers of sub-Saharan African descent had 12 lead electrocardiograms (ECGs) and transthoracic echocardiograms performed. Statistical tests were then performed on the data to elicit associations; 396 volunteers (63.1% women) with a mean age of 37.4 years met the inclusion and exclusion criteria. An abnormal ECG was identified in 50.5% of volunteers, largely because of underlying ST elevation at the J point (ER), left ventricular hypertrophy (LVH) by voltage criteria, and T-wave inversion. Men were more likely to have abnormal ECGs (odds ratio [OR] 1.75; p <0.001), axes (OR 2.05; p = 0.023), display LVH by Sokolow-Lyon voltage criteria (OR 5.45; p <0.001), and have ER patterns (OR 11.61; p <0.001). Additionally, younger adults were also more likely to display LVH by voltage criteria and ER patterns. Volunteers with LVH by ECG had 5.7% higher LV mass indexes (p = 0.047). An abnormal ECG was not associated with a reduced left ventricular ejection fraction or diastolic dysfunction. ECG abnormalities, especially ER patterns, in black adults of Sub-Saharan descent are common, occurring in half of the normal adults.

Double trouble--a case report of mobile right atrial thrombus in the setting of acute pulmonary thromboembolism.

We report the case of a 51 year-old woman who, six weeks post hysterectomy, developed an acute on chronic pulmonary thromboembolism. On transthoracic echocardiography a mobile right atrial thrombus was detected at the entry of the coronary sinus into the right atrium. A 64 slice spiral CT angiogram confirmed the left sided superior vena cava and bilateral extensive thrombus in the proximal pulmonary arteries. Bilateral pulmonary endarterectomy, removal of atrial thrombus and ligation of the persistent left superior vena cava was performed which markedly improved the haemodynamic and functional status of the patient. The presence of right atrial thrombus in the setting of acute pulmonary embolism presents a unique therapeutic challenge which needs to be individualised based on a number of concomitant clinical factors.

Thoracic endovascular aortic repair in a patient with mobile aortic thrombosis.

A 58-year-old female presented with acute arterial insufficiency to her left leg. Following cardiovascular evaluation using multimodality imaging, it was discovered that she had mobile thoracic thrombi overlying a normal descending thoracic aorta which had also caused a splenic infarction. This patient was treated with unfractionated heparin for three days and underwent subsequent thoracic endovascular aortic repair (TEVAR) uneventfully with no subsequent complications at one-year followup. This case highlights the diagnostic and therapeutic challenges in treating patients with this uncommon challenging clinical scenario.