Mycotic aneurysms are rare in patients with congenital heart disease, but may occur in those with aortic coarctation and abnormal aortic valve. Rapid diagnosis of mycotic aneurysm is of extreme importance given the significant reported incidence of morbidity and mortality across all age groups. Aortic aneurysm is uncommon before the second decade of life, and here we report a 10-year-old male patient with new diagnosis of aortic coarctation and bicuspid aortic valve, who developed a rapidly enlarging mycotic aneurysm from Streptococcus pneumoniae. Cardiac magnetic resonance imaging was crucial in making the diagnosis, as well as in follow-up.
There is a clinically staggering burden of disease stemming from cerebrovascular events, of which a majority are ischemic in nature and many are precipitated by atrial fibrillation (AF). AF can occur in isolation or in association with myocardial or structural heart disease. In the latter case, and when considering health at an international level, congenital and acquired valve-related diseases are frequent contributors to the current pandemic of AF and its clinical impact. Guidelines crafted by the American Heart Association, American College of Cardiology, European Society of Cardiology and Heart Rhythm Society underscore the use of vitamin K antagonists (VKAs) among patients with valvular heart disease, particularly in the presence of concomitant AF, to reduce the risk of ischemic stroke of cardioembolic origin; however, the non-VKAs, also referred to as direct, target-specific or new oral anticoagulants (NOACs), have not been actively studied in this particular population. In fact, each of the new agents is approved in patients with AF not caused by a valve problem. The aim of our review is to carefully examine the available evidence from pivotal phase 3 clinical trials of NOACs and determine how they might perform in patients with AF and concomitant valvular heart disease.
Background: The hyperosmolar hyperglycemic state (HHS) is a dangerous complication that can arise with diabetes mellitus. Emergent treatment is necessary to reinstate hemodynamic stability, as mortality rates for HHS are exceptionally high and can have multiple complications.Case Report: A 42-year-old female presented unresponsive to the emergency department. Upon arrival, the patient's examination was consistent with hypovolemia and tachycardia. Review of systems included a one-week history of nausea and vomiting. The patient had stopped all of her medications one year prior, only restarting metformin one week prior to admission. Her presenting systolic blood pressure was 119 mmHg before she developed respiratory failure secondary to a poor mental state. The presenting blood sugar level was 1263 mg/dL, and ketones were not detected in her urine. The patient recovered from her HHS and was discharged in a stable condition.Conclusion: This case study postulates that the patient's excessive nausea and vomiting led to pancreatitis secondary to ischemia, which induced a HHS. This is important because hyperglycemia superimposed on any ischemic insult can increase the risk of multiorgan failure, as with our patient. Thus, recognition and management of resulting complications needs to be emergent.
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