Ventricular Tachycardia and the Cystic Heart: A Case Report.

BACKGROUND: Hydatid cysts are caused by Echinococcus granulosus infection, and hydatidosis is recognized as a re-emerging zoonotic disease globally. While the liver is the most commonly affected organ, other organs can also be affected, including the heart. Because of the low sensitivity and specificity of serologic diagnostic tests, ultrasound and echocardiography are increasingly used to make the diagnosis of cardiac hydatid cyst. CASE REPORT: We report the case of a cardiac hydatid cyst, detected by point-of-care ultrasound (POCUS), in a 79-year-old woman who presented with shortness of breath and was in ventricular tachycardia. The diagnosis was further confirmed with a computed tomography scan. Although cases of alveolar and liver hydatid cysts are seen, this is the first case of a cardiac hydatid cyst in Bhutan. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the importance of POCUS in reaching a diagnosis, particularly in resource-poor areas where other sophisticated diagnostic tools are not easily available. A cardiac hydatid cyst must be in the differential for structural causes of dysrhythmias. This is especially so because treatment of unstable dysrhythmias in the acute setting of an emergency department has to be modified from the usual algorithm in the presence of a cardiac hydatid cyst, due to the potentially fatal risk of cyst rupture and anaphylaxis.

Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty.

The purpose of this study was to evaluate patient factors that might contribute to a poor result after total knee arthroplasty (TKA). Seventy-one knees (6.9%) of 1024 primary TKAs were identified at 1 year follow-up as having a poor result because of either stiffness or pain. Radiographs demonstrated well-fixed and aligned implants. This group was compared with a matched control group of 148 nonpainful or stiff TKAs, with similar range of motion preoperatively. Logistic regression analysis was performed to compare age, sex, body mass index, comorbidities, previous surgeries, preoperative narcotic use, tobacco or alcohol use, work status, insurance status, and any history of depression. Factors that were significantly associated with a stiff or painful outcome included female sex, higher body mass index, previous knee surgery, patients on disability, diabetes mellitus, pulmonary disease, and depression.