William H. Carter

Fluoroscopy-Induced Chronic Radiation Dermatitis

A 62-year-old man with a history of 2 previous cardiac catheterizations presented with an itchy, nontender skin lesion over his right scapula. The skin lesion had been present for >5 years. Review of the medical records found evidence of a prolonged and complicated cardiac catheterization 8 years previously. Physical examination revealed an 8 × 6 cm, well-demarcated, erythematous reticulated atrophic plaque with telangiectasias and ulceration. Biopsy confirmed histologic changes consistent with radiation dermatitis. In conclusion, the characteristic histologic findings of radiation dermatitis, along with the location over the right scapula and the history of prolonged fluoroscopic exposure during cardiac catheterization, led to the clinical diagnosis of fluoroscopy-induced chronic radiation dermatitis.

Carotid pulse tracings in hypertrophic subaortic stenosis

Abstract Twenty of 23 patients with the diagnosis of IHSS displayed distinctive carotid pulse tracings. Except for those patients with pure aortic insufficiency, only 5 of the 124 patients with other cardiac disorders had similar abnormalities. These abnormalities were: (1) a UST LVET ratio less than 0.27 before amyl nitrite inhalation, (2) a UST LVET ratio of less than 0.23 after amyl nitrite inhalation, and (3) an increase in LVET greater than 0.06 sec. after amyl nitrite inhalation.

Reversal of hemodynamic and phonocardiographic abnormalities in idiopathic hypertrophic subaortic stenosis

Abstract A 17 year old girl had typical electrocardiographic and phonocardiographic findings of idiopathic hypertrophic subaortic stenosis in 1960. Left ventricular-systemic arterial gradients of at least 95 mm Hg were verified by left heart catheterization on 3 occasions in 1960 and 1961 without pharmacological stimulation. Over the next 10 years, the murmur and abnormal cardiac catheterization findings disappeared. Catheterization in 1968 demonstrated no significant resting gradient and only a minimal gradient after administration of isoproterenol. The phonocardiogram and carotid pulse tracing were normal in 1970.

Pacemaker pseudodysfunction with a coronary sinus pacemaker

Abstract A permanent transvenous coronary sinus pacemaker functioned effectively for 22 months both as an atrial and ventricular pacemaker. Slow atrial flutter resulted in failure of the pacemaker to capture the myocardium and thus incorrectly suggested pacemaker dysfunction. Transtelephonic evaluation of this phenomenon was particularly difficult and could have resulted in unnecessary replacement of the pacing unit

Respiratory variation of left ventricular ejection time in patients with pericardial effusion

Abstract Left ventricular ejection times were measured by external carotid pulse tracing in 2 patients with pericardial effusion who had at most only an equivocal paradoxical pulse. Both patients demonstrated a 50 msec variation of ejection time with respiration at a constant heart rate. None of 10 control patients had variation in ejection time of more than 10 msec. These observations confirm the original observations of Weissler et al., who noted variations in left ventricular ejection time in a patient with pericardial effusion; the findings also indicate that such changes may be present when there is no significant paradox during intraarterial pressure recording.

Short-duration oral amiodarone for prevention of atrial fibrillation post heart surgery

BACKGROUND Atrial fibrillation occurs in 20% to 40% of patients post cardiac surgery. Prophylactic amiodarone decreases the incidence of atrial fibrillation, especially in those not taking β-blockers. Studies, however, vary in dosage, duration of treatment, and route of administration. Limited studies evaluating short duration use of oral amiodarone show conflicting results. We hypothesize that an order set for use of short duration, oral amiodarone started the night before surgery and continued for 4 to 6 days will decrease atrial fibrillation after heart surgery. METHODS The Society of Thoracic Surgeons database was used to identify 471 patients who received amiodarone per order set and 151 patients that did not receive amiodarone. The amiodarone order set included amiodarone 600 mg the night before surgery and 400mg twice daily for 4 to 6 days post heart surgery. After propensity matching, 112 patients remained in each group. We compared outcomes for the 2 groups as a case-controlled, retrospective, study. RESULTS Atrial fibrillation occurred in 43% (48 of 112) of the patients that did not receive amiodarone vs 23% (26 of 112) receiving prophylactic amiodarone (P=<.001). There was no increased incidence of hemodynamic, pulmonary, or other adverse outcomes observed between the 2 groups. CONCLUSIONS This practical order set for, short duration, oral amiodarone, with or without adjunct β-blocker therapy started the night before heart surgery and continued for up to six days post surgery, appears to be a safe and effective treatment for reducing the incidence of atrial fibrillation following heart surgery.

Proton pump inhibitors not associated with hypomagnesemia, regardless of dose or concomitant diuretic use: PPIs are not associated with hypomagnesemia

Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide, with dramatic efficacy for upper gastrointestinal acid‐related disorders. In recent years, however, the safety of long‐term PPI use has been questioned. One issue based on scant and conflicting literature is the possibility of PPI‐related hypomagnesemia. Our purpose was to assess for any clinically significant alteration in serum magnesium levels in large groups of patients taking different PPIs in varying doses, with or without diuretics.