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  • ISSN: 2333-6676
    Volume 5, Issue 2
    Case Report
    Shalika B. Katugaha, Matthew J. Swierzbinski, Kunal Kapoor*, and Ramesh Singh
    We present the first documented case of a Candida glabrata infection on the retained lead of a cardiovascular implantable electronic device (CIED) in an immunosuppressed heart transplant recipient. This is the first documented case of a redo upper mini-sternotomy approach for a lead removal and innominate vein reconstruction with bovine patch. The patient is a 55 year-old male with non-ischemic cardiomyopathy with biventricular implantable cardioverter defibrillator (ICD) placement who underwent orthotropic heart transplant. ICD leads were divided at that time. A contralateral pacemaker was inserted post-operatively for complete heart block. The patient presented with four weeks of fever and erythema at the site of previous ICD placement. Transesophageal echo revealed echogenic structures measuring 1.8 cm and 1.1 cm attached to the pacer wire near the junction of the right atrium and inferior vena cava. Pacemaker leads were removed successfully. However, one of the three ICD leads fractured during extraction, leaving a residual coil. Culture of the extracted leads grew C. glabrata. A multi-disciplinary team including cardiothoracic surgery, infectious diseases, and cardiology determined that the most reliable way to eradicate infection would be to combine surgical management with aggressive medical management. Given multiple prior sternotomies, risk of re-entry into the thoracic cavity posed additional risks. An alternative surgical approach was performed to minimize risk.
    Alberto Cordero*, Pilar Carrillo, Araceli Frutos, and Ramón López-Palop
    Primary angioplasty is the first-choice for acute myocardial infarction revascularization although emergent procedures can be challenged by patients´ clinical presentation, such as cardiac arrest.We present the case of a primary angioplasty, assisted by the automated cardiopulmonary compression systems (ACCS) LUCAS®, in a patient with ST-elevation acute myocardial infarction that evolved rapidly to in-hospital cardiac arrest. The patient was transported to the cath-lab with the ACCS LUCAS® after initiation of advanced cardiopulmonary resuscitation. Primary angioplasty was successfully performed with the ACCS and it could be removed. Subsequent clinical and neurological outcomes were favorable and the patient was discharged after 14 days in permanent hemodialysis. Six month later the patient was alive with no neurological deficits but still in permanent hemodialysis.
    Research Article
    Jihan Safwan*, Hana Hamwi, Lama Shamsedeen, Fouad Sakr, Michelle Cherfan, Marwan Akel, Mariam Dabbous, and Faraj Saade
    Introduction: Acute coronary syndrome (ACS) remains a major cause of mortality worldwide due to recurrent cardiovascular events, which necessitates the use of secondary prevention medications. The objectives are to determine the individual and collective prescription rates of the guideline recommended medications for ACS and the factors associated with non-adherence.
    Material and methods: This is a retrospective, multicenter, observational study conducted by clinical pharmacists on adult patients who were more than 18 years of age, of both sexes, diagnosed with ACS, and discharged alive from two Lebanese hospitals during the year 2013. Medical charts of 344 patients, who were admitted to the cardiac care unit, were reviewed.
    Results: Out of 200 included patients, the discharge note showed that 95.5% received aspirin, 89.5% thienopyridine inhibitors, 75.5% beta blockers, 61.0% angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 82.5% statins, and 40.0% the combination of all 5 agents. It has been noted that 28.33% of the non-adherent prescriptions had a reasonable explanation.
    Conclusions: Despite the strong and unequivocal benefits of these agents, there is still a considerable adherence gap and opportunity for improvement. The role of the clinical pharmacist remains crucial in ensuring the adherence to the appropriate medications after ACS so that the best patient outcomes are maintained.
    Nobila Valentin Yameogo*, Larissa Justine Kagambega, Arthur Seghda, Amalia Owona, Olivia Kabore, Elisee Kabore, Georges Rc Millogo, KJonas Kologo, BJean Yves Toguyeni, Andre K Samadoulougou, Jean L Ankoande, and Patrice Zabsonre
    In order to assess the role of bromocriptine in management of peripartum cardiomyopathy (PPCM), we conducted a randomized study from April 1, 2010 to June 30, 2012. Patients randomized for standard heart failure therapy (Br-) received heart failure conventional therapy and those randomized for bromocriptine (Br+) received standard heart failure therapy plus bromocriptine 2.5 mg twice daily for 4 weeks. Clinical assessment, electrocardiogram, and echocardiography were performed at baseline, 2 weeks, 1, 3, 6 and 12 months. Endpoints criteria were mortality, changes in dyspnea and evolution of echocardiographic parameters: End diastole Left Ventricular Diameter, End Systole Left Ventricular Diameter, Left Ventricular Ejection Fraction and Tricuspid Annular Plan Systolic Excursion (TAPSE).
    Results: Ninety six (96) women were included for the study. There were no significant differences in baseline characteristics. The mean value of EDLVD was 58.7 mm in Br+ and 57.6 mm in Br- (p = 0.091) while the ESLVD was 48.4 mm in Br+ and 48.8 mm in Br- (p = 0.074). The mean LVEF was 37.2% in Br+ and 37.5% in Br- (p = 0.129) and the mean TAPSE was 19.9 mm in Br+ and 18.9 mm in Br- (p = 0.718). At Six months, cumulative death were stayed 8 (16.6%) in Br+ but 14 (29.1 %) in Br- (p = 0.0001). Echocardiographic findings demonstrated better improvement in ventricles function in Br+. Mean EDLVD was 53.4 mm in Br+ and 55.1 mm in Br- (p = 0.002). The mean LVEF was 49.9% in Br+ and 40.9% in Br- (p = 0.001) and the mean TAPSE was 22.0 mm in Br+ and 20.7 mm in Br- (p = 0.001). At 12 months, mean LVEF was 53.9 % in Br+ and 45.9 % in Br- (p = 0.001) and mean TAPSE was 22.7 mm in Br+ and 20.9 mm in Br- (p = 0.001). LVEF increased from 37.2% on admission to 49.9% at six months and to 53.9% at 12 months in Br+ while it increased from 37.5% on admission to 40.9% at six months and to 45.9% at 12 months in Br-.
    Nadim SHAH*, Daniel A. SCHNEIDER, Carl BLECHER, Nicholas COX, Chiew WONG, Anne-Maree KELLY, and Kean SOON
    Background: Current cardiovascular guidelines do not support routine screening for coronary heart disease (CHD). Despite this however screening programs utilizing coronary computed tomography angiography (CCTA) exist based on the rationale that there is potential for an effective screening program given CHD remains the largest cause of death worldwide. The aim of this study was to estimate the prevalence of occult CHD in asymptomatic subjects as detected by CCTA in a tertiary Australian referral centre.
    Methods: Retrospective data was collected from all CCTA performed on asymptomatic subjects between January 2011 and June 2015. The outcome of interest was obstructive CHD by CCTA, which was defined by either moderate (50 - 69% stenosis) and/or severe (=70% stenosis) in at least one epicardial coronary artery.
    Results: Four hundred and eleven subjects were included in the study. The mean age was 58 ± 9 years. Two hundred and sixty four asymptomatic subjects (64%) had some degree of CHD detected on CCTA. Obstructive CHD was detected in 75 (18%) subjects. Males were more likely to have obstructive CHD than females (20% versus 12%, p=0.035). Subjects above the age of 55 years were more likely to have obstructive CHD (24% versus 10%, p<0.001). Fourteen (3%) subjects were found to have severe CHD.
    Conclusions: Approximately one fifth of asymptomatic middle-aged subjects presenting to a tertiary Australian referral centre had obstructive CHD detected on screening CCTA. Males and those over the age of 55 years were more likely to have obstructive CHD. CCTA may be a potential screening tool for detecting occult CHD in an asymptomatic, middle-aged male population but requires further investigation.
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