Sagger Mawri

Rare Case of Unileaflet Mitral Valve

Unileaflet mitral valve is the rarest of the congenital mitral valve anomalies and is usually life threatening in infancy due to severe mitral regurgitation (MR). In most asymptomatic individuals, it is mostly due to hypoplastic posterior mitral leaflet. We present a 22-year-old male with palpitations, who was found to have an echocardiogram revealing an elongated anterior mitral valve leaflet with severely hypoplastic posterior mitral valve leaflet appearing as a unileaflet mitral valve without MR. Our case is one of the 11 reported cases in the literature so far. We hereby review those cases and conclude that these patients are likely to be at risk of developing worsening MR later in their lives.

PREDICTORS OF LATE BLEEDING IN THE TAVR POPULATION

Background: TAVR patients are often elderly with multiple comorbidities increasing their susceptibility to late bleeding. Post-TAVR anticoagulation is without data for guidance. To provide insight, the relationships between late bleeding, comorbidities and discharge medications were assesed.

Cardiac Dysrhythmias and Neurological Dysregulation: Manifestations of Profound Hypomagnesemia

Magnesium is the second most common intracellular cation and serves as an important metabolic cofactor to over 300 enzymatic reactions throughout the human body. Among its various roles, magnesium modulates calcium entry and release from sarcoplasmic reticulum and regulates ATP pumps in myocytes and neurons, thereby regulating cardiac and neuronal excitability. Therefore, deficiency of this essential mineral may result in serious cardiovascular and neurologic derangements. In this case, we present the clinical course of a 76-year-old woman who presented with marked cardiac and neurological signs and symptoms which developed as a result of severe hypomagnesemia. The patient promptly responded to magnesium replacement once the diagnosis was established. We herein discuss the clinical presentation, pathophysiology, diagnosis, and management of severe hypomagnesemia and emphasize the implications of magnesium deficiency in the cardiovascular and central nervous systems. Furthermore, this case highlights the importance of having high vigilance for hypomagnesemia in the appropriate clinical setting.

THE VALUE OF ADDITIONAL TESTING AFTER NON-DIAGNOSTIC STRESS ECHOCARDIOGRAPHY IN PATIENTS PRESENTING WITH CHEST PAIN: A SINGLE-CENTER ANALYSIS

Stress echocardiography (SE) is an important tool in the risk stratification and prognosis of patients with suspected coronary artery disease (CAD). Data regarding outcomes of patients with non-diagnostic SE are mixed. There is significant downstream resource utilization with additional testing in

COST-EFFICIENT SELECTION OF STRESS TEST FOR LOW-RISK CHEST PAIN

The 2013 Multimodality Appropriate Use Criteria was published by the American College of Cardiology (ACC) to inform decision-making in the detection and risk assessment of stable ischemic heart disease. We sought to evaluate the impact on utilization if these guidelines were used to select the most

Vancomycin-induced acute generalized exanthematous pustulosis (AGEP) masquerading septic shock-an unusual presentation of a rare disease.

Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous adverse reaction characterized by acute sterile pustular eruptions, mostly induced by medications. Antibiotics are the most commonly implicated drugs; however, there have only been two previous reports of vancomycin-induced AGEP in the literature. In this case, we present the clinical course of a 56-year-old man who was admitted to the intensive care unit with an unusually severe form of AGEP mimicking septic shock, which developed after the recent use of vancomycin. Despite cessation of the offending agent, our patient continued to clinically decline with development of worsening skin eruptions and hemodynamic instability necessitating vasopressor support. The patient promptly responded to systemic steroid therapy with complete resolution of AGEP. In addition to highlighting the implication of vancomycin in AGEP, we herein discuss the clinical presentation, diagnosis, and management of AGEP, particularly in severe cases admitted to the intensive care unit.