Flavio Salvaggio

Transvenous Extraction of Pacemaker Leads in Infective Endocarditis With Vegetations ≥20 mm: Our Experience

According to published evidence, treatment of infective endocarditis (IE) associated with cardiovascular implantable electronic devices (CIEDs) should include complete removal of the system. Several publications have shown that transvenous removal is an effective and safe nonthoracotomy approach in patients with large vegetations, but experiences with vegetations larger than 20 mm have rarely been reported.

Primary Cardiac Lymphoma A Rare Case of Pulmonary Tumor Embolism

Human immunodeficiency virus can cause pericarditis, myocarditis, cardiomyopathies, endocarditis, other valvular compromises, cardiac involvement by neoplasm, pulmonary hypertension, arrhythmia, and thromboembolic disease. Myocardial involvement by tumors has been reported in rare cases, with Kaposi sarcoma and non-Hodgkin lymphomas being the most frequent tumor types. In this case, we introduce a 51-year-old man who presented with a febrile syndrome lasting for 30 days. He had just been on a 7-day course of azithromycin prescribed for a respiratory infection. On day 10 after he completed the antibiotic course, fever recurred without evidence of an identifiable infectious focus. Because of the aforementioned clinical presentation and to rule out infectious endocarditis, an echocardiogram was performed on the patient, which showed an image in the right atrium that could correspond to a vegetation. On physical examination, heart rate was 100 bpm, blood pressure 120/75 mm Hg, and jugular distention 3/3 without inspiratory change. Laboratory data were as follows: white blood cells 12 300/mm3, C-reactive protein …Human immunodeficiency virus can cause pericarditis, myocarditis, cardiomyopathies, endocarditis, other valvular compromises, cardiac involvement by neoplasm, pulmonary hypertension, arrhythmia, and thromboembolic disease. Myocardial involvement by tumors has been reported in rare cases, with Kaposi sarcoma and non-Hodgkin lymphomas being the most frequent tumor types. In this case, we introduce a 51-year-old man who presented with a febrile syndrome lasting for 30 days. He had just been on a 7-day course of azithromycin prescribed for a respiratory infection. On day 10 after he completed the antibiotic course, fever recurred without evidence of an identifiable infectious focus. Because of the aforementioned clinical presentation and to rule out infectious endocarditis, an echocardiogram was performed on the patient, which showed an image in the right atrium that could correspond to a vegetation. On physical examination, heart rate was 100 bpm, blood pressure 120/75 mm Hg, and jugular distention 3/3 without inspiratory change. Laboratory data were as follows: white blood cells 12 300/mm3, C-reactive protein …

An unusual case of mesenteric ischemia in a patient with cardiac myxoma

Symptoms related to peripheral embolism are experienced in 2%-15% of cases of cardiac myxoma. We present a rare case of a 54-year-old man admitted due to sudden abdominal pain. A computed tomography (CT) scan showed occlusion of the superior mesenteric artery (SMA). As the patients response to support treatment was favorable, a non-invasive approach was adopted, with prescription of oral anticoagulation (OAC) therapy. Transesophageal echocardiography revealed a tumor in the left atrium. The cardiac mass was completely removed and diagnosed as myxoma by histopathological analysis. As periodic CT scans showed progressive improvement of blood flow through the SMA, OAC was continued. OAC may have been beneficial due to the nature of emboli originating from a cardiac myxoma: thrombi covering the surface of the tumor. At present, there is no explanation in the literature for the benefits of OAC in patients with embolism associated with cardiac myxoma.

Safety, tolerability and efficacy of ivabradine for control of sinus tachycardia in patients undergoing inotropic therapy

OBJECTIVES: To assess the safety, tolerability and efficacy of ivabradine administered to patients experiencing decompensated heart failure who were undergoing inotropic therapy and developed undesirable sinus tachycardia. METHODS: The present study prospectively included consecutive patients with ischemic-necrotic cardiomyopathy and an ejection fraction <35% who were admitted for decompensated heart failure while undergoing inotropic therapy and developed undesirable sinus tachycardia. Patients experiencing shock, or requiring respiratory or circulatory mechanical support, or those presenting with a heart rhythm other than sinus were excluded. Hemodynamic measurements using a pulmonary artery catheter were performed before and 3 h after an oral dose of 15 mg of ivabradine. Adverse side effects and tolerance were evaluated. RESULTS: The present study included 52 patients (32 men, 20 women) with a mean age of 65.6 years and a mean ejection fraction of 31.5%, who were undergoing inotropic treatment (15 μg/kg). Three hours after ivabradine administration, a reduction in mean (± SD) heart rate from 121±6 beats/min to 98±7 beats/min (P=0.00002) was observed, with an incremental increase in systolic volume from 37.9±5 mL to 47.3±8 mL (P=0.00002) and an increase in cardiac output from 4597±550 mL/min to 4825±535 mL/min (P=0.041). No differences were observed in filling pressures, or systemic or pulmonary resistances. There was good clinical tolerance without hypotension, bradycardia or episodes of atrioventricular block. CONCLUSIONS: Ivabradine proved to be useful and safe for controlling undesirable sinus tachycardia in patients undergoing inotropic treatment.

Primary Cardiac Lymphoma

Human immunodeficiency virus can cause pericarditis, myocarditis, cardiomyopathies, endocarditis, other valvular compromises, cardiac involvement by neoplasm, pulmonary hypertension, arrhythmia, and thromboembolic disease. Myocardial involvement by tumors has been reported in rare cases, with Kaposi sarcoma and non-Hodgkin lymphomas being the most frequent tumor types. In this case, we introduce a 51-year-old man who presented with a febrile syndrome lasting for 30 days. He had just been on a 7-day course of azithromycin prescribed for a respiratory infection. On day 10 after he completed the antibiotic course, fever recurred without evidence of an identifiable infectious focus. Because of the aforementioned clinical presentation and to rule out infectious endocarditis, an echocardiogram was performed on the patient, which showed an image in the right atrium that could correspond to a vegetation. On physical examination, heart rate was 100 bpm, blood pressure 120/75 mm Hg, and jugular distention 3/3 without inspiratory change. Laboratory data were as follows: white blood cells 12 300/mm3, C-reactive protein …Human immunodeficiency virus can cause pericarditis, myocarditis, cardiomyopathies, endocarditis, other valvular compromises, cardiac involvement by neoplasm, pulmonary hypertension, arrhythmia, and thromboembolic disease. Myocardial involvement by tumors has been reported in rare cases, with Kaposi sarcoma and non-Hodgkin lymphomas being the most frequent tumor types. In this case, we introduce a 51-year-old man who presented with a febrile syndrome lasting for 30 days. He had just been on a 7-day course of azithromycin prescribed for a respiratory infection. On day 10 after he completed the antibiotic course, fever recurred without evidence of an identifiable infectious focus. Because of the aforementioned clinical presentation and to rule out infectious endocarditis, an echocardiogram was performed on the patient, which showed an image in the right atrium that could correspond to a vegetation. On physical examination, heart rate was 100 bpm, blood pressure 120/75 mm Hg, and jugular distention 3/3 without inspiratory change. Laboratory data were as follows: white blood cells 12 300/mm3, C-reactive protein …