Jaime Hernandez-Montfort Md

Relaxin for Treatment of Acute Heart Failure: Making the Case for Treating Targeted Patient Profiles

Patients presenting with acute heart failure (AHF) represent a heterogeneous population with respect to demographics, clinical profiles, and precipitating factors. Despite this, most clinical trials have treated the study population as a homogeneous group in an attempt to achieve adequate statistical power for endpoint analysis. This approach has proven to be of little value in the development of new agents for treatment of AHF. By contrast, the phase III clinical trial of relaxin focused on a subset of AHF patients who were normotensive or hypertensive and who had moderate renal impairment. The study patients, who were primarily from Eastern Europe, represented a population that would be expected to have less genetic variability than the study populations in larger multinational AHF trials. A focused study design targeting specific patient profiles should be considered for future clinical AHF trials that investigate new therapies or compare the effectiveness of existing therapies.

Parainfluenza virus infection associated with posterior reversible encephalopathy syndrome: a case report

IntroductionPosterior reversible encephalopathy syndrome is a clinical and radiological entity. The most accepted theory of posterior reversible encephalopathy syndrome is a loss of autoregulation in cerebral blood flow with a subsequent increase in vascular permeability and leakage of blood plasma and erythrocytes, producing vasogenic edema. In infection-associated posterior reversible encephalopathy syndrome, a clinical pattern consistent with systemic inflammatory response syndrome develops. Parainfluenza virus has not been reported in the medical literature to be associated with posterior reversible encephalopathy syndrome.Case presentationWe report herein the case of a 54-year-old Caucasian woman with posterior reversible encephalopathy syndrome associated with parainfluenza virus infection who presented with generalized headache, blurring of vision, new-onset seizure and flu-like symptoms.ConclusionInfection-associated posterior reversible encephalopathy syndrome as well as hypertension-associated posterior reversible encephalopathy syndrome favor the contribution of endothelial dysfunction to the pathophysiology of this clinicoradiological syndrome. In view of the reversible nature of this clinical entity, it is important that all physicians are well aware of posterior reversible encephalopathy syndrome in patients presenting with headache and seizure activity. A detailed clinical assessment leading to the recognition of precipitant factors in posterior reversible encephalopathy syndrome is paramount.

Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center

OBJECTIVE: There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). PATIENTS AND METHODS: We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1‐year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). RESULTS: Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline‐recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6‐month readmission and 12‐month mortality. CONCLUSION: IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation.

Meeting Update: International Society for Heart and Lung Transplantation 2014.

The 34th annual meeting of the International Society for Heart and Lung Transplantation was convened in San Diego, California, USA on April 10-13, 2014. It was one of the best attended meetings ever with more than 3,000 attendees and the enthusiasm and excitement was palpable in the Manchester Grand Hotel where the meeting was held. This paper will describe a few of the most important contributions from this meeting, recognizing that with so many papers, it is certain that many worthwhile manuscripts will go unmentioned. The topics that will be highlighted are heart transplant trials, non-invasive detection of allograft rejection and vasculopathy, as well as mechanical circulatory support and extracorporeal membrane oxygenation (ECMO).

Spontaneous coronary artery dissection - a mimic

Spontaneous coronary artery dissection (SCAD) is a rare but potentially life-threatening condition if it goes unrecognized. Symptoms can range from chest pain to sudden cardiac death. We present a case of 33 year-old female marathon runner who presented to emergency department (ED) complaining of sudden onset of non-positional, constant, pleuritic chest discomfort. She was eventually found to have spontaneous dissection of coronary artery. The mimicking nature of SCAD is presented in this article. We conclude that spontaneous coronary dissection, although still challenging due to its mimicking nature, should be considered in the differential diagnosis of chest pain and associated myocardial injury.