Antonios N. Pavlidis

Native aortic valve endocarditis caused by Brevibacterium epidermidis in an immunocompetent patient.

Although Brevibacterium species used to be considered as nonpathogenic microorganisms until recently, it seems that they can cause a wide variety of clinical diseases by acting mostly as opportunistic pathogens. The present case is the second reported case of infective endocarditis by Brevibacterium species; however, it is the first reported infected native aortic valve in an immunocompetent patient.

Anomalous origin of coronary arteries: When one sinus fits all

A right coronary artery origin from the left coronary sinus and a left coronary origin from the right sinus although rarely encountered during routine cardiac catheterization, they represent two relatively common autopsy findings in young patients suffering sudden cardiac death. The interarterial course of the aberrant artery, between the aortic root and the pulmonary artery has been considered as a malignant variant, because of the higher risk of myocardial ischemia and sudden death. We present two rare cases of ectopic coronary origin from the opposite sinus of Valsalva.

Balloon-assisted tracking during primary percutaneous coronary intervention

Abstract Radial artery spasm is one of the most commonly encountered problems during transradial interventions with a reported incidence in the range of 6–10%. Balloon-assisted tracking (BAT) of guide catheter has recently been described as a novel technique to overcome difficult radial artery anatomies including tortuosity, loops and spasm. In this report, we describe the successful use of BAT in a patient with radial artery spasm during primary angioplasty.

Late traumatic aortic dissection

Traumatic dissection of the aorta is a well-documented entity with poor prognosis and broad spectrum of clinical presentations. We report a rare case of an asymptomatic late presentation of aortic dissection after a high-speed vehicle accident. This case highlights the importance of high clinical suspicion for the diagnosis of aortic dissection.

Prognostic Value of NT-proBNP at Rest and Peak Exercise in Patients With Impaired Left Ventricular Function

We aimed to identify whether N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) at peak exercise can provide incremental clinical information over resting levels. A total of 90 patients with systolic heart failure were prospectively studied. Levels of plasma NT-proBNP were assessed at rest and at peak exercise during a cardiopulmonary exercise test. Patients were followed-up for 30 ± 10 months. Levels of NT-proBNP at baseline and peak exercise were significantly correlated with left ventricular ejection fraction ([LVEF] r = −.629, P < .001 and r = −.630, P < .001, respectively) and peak oxygen uptake ([Vo 2] r = −.752, P < .001 and r = −.740, P < .001, respectively). Levels of plasma NT-proBNP at peak exercise demonstrated similar predictive ability for the detection of patients with low peak Vo 2 and LVEF <28%. Levels of plasma NT-proBNP can detect low-functional class patients and patients who may be the candidates for heart transplantation with high sensitivity and specificity. At baseline and peak exercise, NT–proBNP demonstrates similar prognostic and predictive ability.

Response to Letter Regarding Article, “Iatrogenic Giant Osborn Waves”

We appreciate Drs Joynt and Edelmans thoughtful comments on our recent publication.1 They suggested that the presence of Osborn waves on ECGs of patients undergoing therapeutic hypothermia depends not only on core body temperature, but also on abnormalities …

Twiddler's syndrome.

An 82-year-old woman with severely impaired mental status, presented to the Emergency department aft er sustaining a femoral fracture following syncope. She had a history of sick sinus syndrome treated with a dual chamber pacemaker 11 months earlier and has been lost to follow-up since. On clinical examination she was agitated and disorientated. ECG depicted under-sensing and non-capture of both electrodes. Chest radiography demonstrated coiling of both pacing leads within the generator pocket and displacement of their tips into the right atrium-superior vena cava junction (Figure 1). Patient was immediately transferred to the electrophysiology laboratory and underwent lead removal and successful re-implantation of two new pacing leads. Lead dislodgment is a serious complication and usually occurs within the fi rst six weeks post pacemaker implantation (1). Twiddler ’ s syndrome is the most commonly described mechanism of dislodgment due to conscious or

Five-vessel aortic arch associated with a bicuspid aortic valve.

Little information exists regarding the prevalence of aberrant or ectopic aortic arch vessels in patients with different cardiovascular anomalies. We present a young patient with an aberrant right subclavian artery associated with an ectopic left vertebral artery and a bicuspid aortic valve.

Saddle coronary thrombus after aortic valve replacement.

A 79-year-old woman with severe calcific aortic stenosis underwent aortic valve replacement (AVR) with an 18 mm bileaflet ATS mechanical prosthesis. Preoperative coronary angiography showed no significant coronary lesions (Figure 1, Movie 1) and echocardiography depicted preserved left ventricular ejection fraction. She made an uneventful postoperative recovery and was discharged five days later on oral anticoagulation therapy. Patient was re-admitted on the sixth postoperative day with cardiogenic shock and ECG changes suggestive of an extensive anterolateral acute myocardial infarction. Emergent coronary angiography was performed under haemodynamic support with inotropes and intra-aortic balloon pump and demonstrated large flow-limiting saddle thrombus extending into the proximal parts of left anterior descending (LAD) and left circumflex (LCX) arteries, with persistent myocardial blush after contrast injection (Figure 2, Movie 2). Of note, INR on admission measured 5.2. Thrombophilia screening and platelet function tests were normal. Patient was treated with thrombus aspiration, balloon angioplasty and bare metal Figure 1. Preoperative coronary angiography shows no signifi cant coronary lesions. LM, left main coronary artery; LAD, left anterior descending; LCX, left circumfl ex.

Electrocardiographic Changes in a Patient With Pulmonary Embolism and Septic Shock

Various electrocardiography (ECG) abnormalities have been reported in patients who present with pulmonary embolism (PE). Severe sepsis is also associated with ECG changes that may mimic ST elevation myocardial infarction. We report a case of an elderly patient with PE and septic shock associated with striking ECG changes.