Cardiac contractility modulation (CCM) is an implantable technology approved by the U.S. Food and Drug Administration and intended for heart failure patients without a cardiac resynchronization therapy indication. CCM leads to reduced heart failure hospitalizations and improvements in exercise tolerance and quality of life. There are a lack of data examining the impact of CCM therapy on atrial fibrillation (AF) burden. We report the case of a 65-year-old man with a history of paroxysmal AF, hypertension, hyperlipidemia, and carotid artery stenosis who presented with newly diagnosed ischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 20%-25%. He underwent coronary artery bypass graft surgery for triple vessel disease with an improvement in LVEF to 40% after 4 months of guideline-directed medical therapy. Due to clinical heart failure and paroxysms of AF, he underwent CCM device and implantable loop recorder (ILR) implantation. His LVEF improved to 60%, and the ILR showed no AF. We postulate multiple mechanisms to explain the negligible burden of AF.
Introduction: Lemierre syndrome is a rare, potentially fatal, septic thrombophlebitis of the internal jugular vein. Treatment includes intravenous antibiotics for Fusobacterium necrophorum, the most common pathogen, as well as consideration for anticoagulation therapy. Case Report: A 27-year-old female presented with left-sided neck swelling and erythema. Computed tomography noted left anterior jugular vein thrombophlebitis and multiple cavitating foci, consistent with septic emboli. We report a rare case of Lemierre syndrome in which the thrombus was found in the anterior jugular vein, as opposed to the much larger internal jugular vein more traditionally associated with creating septic emboli. Conclusion: Based on an individual’s clinical symptoms, history, and radiologic findings, it is important for physicians to consider Lemierre syndrome in the differential diagnosis, as the condition may rapidly progress to septic shock and death if not treated promptly. The use of anticoagulation therapy remains controversial, and there is a lack of established standard care because the syndrome is so rare.
Introduction: Fever and rash is a common pediatric presentation to the emergency department but can present a diagnostic challenge to the clinician. Here we report the successful identification and treatment of a rare zoonotic exanthem that was facilitated by a thorough history and physical exam. Case Report: Rat-bite fever is a potentially fatal systemic illness characterized by relapsing fever, rash, and migratory polyarthralgias. Treatment includes antibiotics for Streptobacillus moniliformis, the most common pathogen, as well as appropriate hygiene education and prevention strategies. We report a case of S. moniliformis in the absence of an actual rodent bite. Conclusion: Due to the generally non-specific presentation of the illness, as well as the growing trend of caring for domestic rodents, it is crucial that clinicians ask details related to zoonotic and other exposures while obtaining medical histories.
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