Elena Velasco

Active fixation pacemaker lead perforating cardiac wall

P d a We present the case of a 90-year-old male patient transferred from another hospital with a diagnosis of pacemaker dysfunction. A permanent pacemaker had been placed one month previously for complete atrioventricular block. At a scheduled checkup with his cardiologist, he reported that he had started experiencing exertional dyspnea and pleuritic pain a few days after discharge. The electrocardiogram showed atrioventricular block with failure of pacemaker capture. The physical exam was unremarkable and he was hemodynamically stable. Suspecting lead malposition or fracture, a chest X-ray and transthoracic echocardiography (Figure 1A) were performed which showed the lead perforating the right ventricle (arrow) and mild cardiac effusion. Computed tomography (CT) (Figure 1B and C) was then performed in order to identify the entire course of the lead. After multidisciplinary discussion involving our surgical and electrophysiological team, it was decided to disconnect the old lead and leave it in place, as the wound was sealed, and to place a new passive fixation electrode (Figure 1D). The patient has been asymptomatic with a good clinical course since the procedure.

Cardiac computed tomography in the assessment of endocarditis complications

A 44-year-old woman with a prosthetic aortic valve was admitted to the cardiology department with shortness of breath and a new diastolic murmur. Transthoracic (TTE) and transesophageal echocardiography (TEE) were performed, the latter revealing a fistula between the aortic root and the right atrium (Figure 1A). Although blood cultures were negative, the final diagnosis was endocarditis. Prior to surgery,

Knowledge of Cardiac Disease Among Hospitalized Patients

Clinicians have a wealth of resources available to help them take existing evidence into account when making decisions. However, patients are the ones who actually have to live with the disease, so educating them should be a priority if they are to be able to adequately self-manage their condition. Clinical practice guidelines for some pathologies have made recommendations regarding patient education, but levels of patient knowledge are not all they should be. Our aim was to assess patients’ level of knowledge about their disease amongst those admitted to our unit. We interviewed 100 randomly selected patients from those admitted to the cardiology department of our tertiary hospital in March 2012. Two cardiologists independently conducted verbal interviews using a pro-forma, closed-ended survey (Table 1). The study was blinded with regard to the physicians and nurses treating the patients interviewed. On admission, patients received information about their condition and the reason for