Right Atrial and Endocardial Lead Mass Secondary to Anterior Mediastinal Mass Encasing Left Subclavian Vein.

INTRODUCTION: Multimodality cardiac imaging is a valuable tool for the noninvasive evaluation of right atrial masses (tumor, vegetation, or thrombus). CASE PRESENTATION: We report a case of right atrial mass that was discovered on a transthoracic echocardiogram ordered for pacemaker-pocket erythema in a 101-year-old man with heart failure/reduced left-ventricular ejection fraction and a dual-chamber pacemaker. Transthoracic and transesophageal echocardiogram showed a large hypoechoic mobile RA mass extending from the superior vena cava, with pacemaker device lead attachment. Infective endocarditis was excluded (no symptoms of systemic infection; negative blood cultures). CT angiography of the chest revealed an anterior mediastinal mass, highly suspicious for malignancy, encasing the left subclavian vein. The patient chose not to pursue invasive assessment of the mediastinal mass. Role of anticoagulation is unclear. CONCLUSION: Computed tomography complemented echocardiographic assessment and management of a right atrial mobile echo density due to a large anterior mediastinal mass.

Lyme carditis presenting as atrial fibrillation.

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.

Relation of Obstructive Sleep Apnea to Risk of Hospitalization in Patients With Heart Failure and Preserved Ejection Fraction from the National Inpatient Sample.

Obstructive Sleep Apnea (OSA) increases the risk of diastolic dysfunction and heart failure. The impact of OSA on hospitalization for heart failure with preserved ejection fraction (HFpEF) is not well elucidated. We used data from the National Inpatient Sample for the years 2012 to 2014. We identified discharges (age ≥18 years) associated with OSA and HFpEF using the International Classification of Diseases, Ninth Revision, Clinical Modification codes (327.23 and 428.3x), respectively. Propensity score analysis, adjusting for age, gender, race, and comorbidities, compared the rates of admission for HFpEF in patients with OSA to those without OSA. Out of 12,608,637 discharges included, there were 147,463 patients with HFpEF, and 653,762 or 5.2% of all discharges had OSA. The prevalence of OSA in patients with HFpEF was 16.8%. Patients with OSA were older, more likely to be men, more likely to have diabetes, hypertension, history of coronary artery disease, chronic kidney disease, obesity, atrial fibrillation, African-American race, and smoking status. In patients with OSA, HFpEF occurred in 3.8% versus 1.0%, with adjusted odds ratio: 2.2 (95% confidence interval 2.16 to 2.23), p <0.001. Subgroup analysis showed similar results in men and women. After propensity score matching, OSA was associated with increased risk of admission with HFpEF, relative risk = 2.2 (95% confidence interval 2.12 to 2.21). In conclusion, OSA was associated with increased risk of hospitalization for HFpEF.