Oral Waldo

Remission of recurrent gastrointestinal bleeding after septal reduction therapy in patients with hypertrophic obstructive cardiomyopathy‐associated acquired von Willebrand syndrome

Gastrointestinal hemorrhage is considered to be a severe complication of von Willebrand disease. The optimal therapy for acquired von Willebrand syndrome and severe gastrointestinal bleeding with hypertrophic cardiomyopathy is undefined.

The 3 “Rs”—Relax, Reflect, and Regroup: Avoiding Burnout During Cardiology Fellowship

Whether you believe that the Creator created the 24-h, 7-day, or 365-day cycle for a reason or that evolution selected cycles for a specific purpose, the fact remains that cycles are essential for optimal operation of any system. Only systems with set cycles or checkpoints for replenishing can

Clinical Diagnosis and Management of Hypertension Compared With the Joint National Committee 8 Panelists' Recommendations

The panelists of the Joint National Committee recently published new recommendations for the management of hypertension. Our study aims to evaluate how current practice compares.

46-Year-Old Man With Abdominal Pain and Hypotension

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Jacksonville, FL (O.A.W., D.F.S.); Adviser to residents and Consultant in Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL (N.L.D.). A 46-year-old man with a history of type 2 diabetes, tetralogy of Fallot, and a bioprosthetic pulmonary valve replacement presented to the emergency department feeling generally unwell after eating a meal at a restaurant. The patient was in his usual state of health until starting dinner at the restaurant. The meal included cooked seafood, which consisted of different types of fish, shrimp, and scallops. A few minutes into his meal, he was overtaken by a sudden onset of severe back pain and cramping that radiated to his abdomen, mainly in the periumbilical region. He rated the pain as 8 of 10 on the severity scale. The pain was followed by progressively worsening dizziness and blurry vision. He also experienced intense palpitations, giving him the sensation of “wanting to pass out.” The patient had no known allergies to fish, seafood, or iodine. He had never experienced any of these symptoms before. None of his colleagues who ate with him had any similar symptoms. He had not recently traveled. On arrival at the emergency department, he became nauseated and vomited 6 times. He appeared to be moderately distressed. He was afebrile, his heart rate was 115 beats/min, and his blood pressure was 78/ 56 mm Hg. Physical examination yielded unremarkable findings except for erythema on his cheeks and mild wheezing on pulmonary examination. Laboratory tests, including complete blood cell count, metabolic profile, and liver function tests, revealed normal values except for a lactate level of 2.1 mmol/L (reference range, 0.6-2.3 mmol/L). Electrocardiography detected sinus tachycardia, and computed tomography of the abdomen with contrast medium revealed diffuse small-bowel wall thickening, edema, and mesenteric fluid with engorgement of the vasa recta. He was admitted to the hospital for further evaluation and treatment.

Eosinophilia and Ulcerative Colitis Associated with Eosinophilic Myocarditis

Reactive eosinophilia is associated with inflammatory bowel disease, but its association with eosinophilic myocarditis is rare. We report a case of a 42-year-old man who presented with hypovolemic shock secondary to diarrhea and recently diagnosed nonischemic cardiomyopathy (left ventricular ejection fraction, 0.29). Laboratory evaluation revealed marked peripheral eosinophilia. Cardiac magnetic resonance imaging showed evidence of subacute-to-chronic myocarditis, and endomyocardial biopsy results were consistent with eosinophilic myocarditis. Colonic biopsy specimens revealed ulcerative colitis and no eosinophils. Hematologic evaluation was negative for an alternative cause of eosinophilia. The patient was given corticosteroids; his diarrhea resolved, but there was no short-term improvement in his ejection fraction, so an implantable cardioverter-defibrillator was placed. Follow-up at one year showed that the patients left ventricular ejection fraction had improved to 0.42.

CHRONIC RIGHT VENTRICULAR PACING: EFFECTS ON HEART FAILURE HOSPITALIZATION AND MORTALITY IN THE PRESENCE OF NORMAL LEFT VENTRICULAR EJECTION FRACTION

Background: Guidelines indicate Biv pacemaker (PM) in pts with left ventricular (LV) EF 40% right ventricular (RV) pacing. We examined the effect of chronic RV pacing in pts with baseline LVEF >50%. Methods: 80/220 pts with insertion of RV PM for bradycardia b/w 2006-16, and baseline

LONG-TERM EFFECTS OF RIGHT VENTRICULAR PACING ON LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION AND SYNCHRONY BY STRAIN IMAGING IN PATIENTS WITH NORMAL BASELINE LEFT VENTRICULAR EJECTION FRACTION

Background: 2D strain can assess myocardial function & synchrony & has not bee evaluated in chronic right ventricular (RV) pacing. Methods: 117 pts implanted with dual chamber pacemaker b/w 2006-2016 & LVEF>50% were enrolled. Echo data at 2-yrs (3.30 ± 1.19 yrs)

PREVALENCE AND RESPONSE OF BLEEDING, INCLUDING TRANSFUSION DEPENDENT BLEEDING, TO INTERVENTION IN HYPERTROPHIC CARDIOMYOPATHY

Loss of high molecular weight multimers (HMWM) of von Willebrand factor (VWF) and clinically significant bleeding have been described in hypertrophic obstructive cardiomyopathy (HOCM). However, there are no data describing the prevalence of bleeding and only case reports describing the effects of

IMPACT OF AGE, GENDER, AND METABOLIC SYNDROME COMPONENTS ON THE RATE OF PROGRESSION OF MILD CALCIFIC AORTIC VALVE DISEASE

Demographic and metabolic factors which promote progression of calcific aortic stenosis in its early phase are poorly understood. We identified patients with an initial aortic valve peak velocity of ≥ 1.8 but < 3.0 m/s by echo, and examined the effects of age, gender, and components of the