According to the American Heart Association, approximately 6 million adults have been afflicted with heart failure in the United States in 2020 and are more likely to have sudden cardiac death accounting for approximately 50% of the cause of mortality. Sotalol is a nonselective β-adrenergic receptor antagonist with class III antiarrhythmic properties that has been mostly used for atrial fibrillation treatment and suppressing recurrent ventricular tachyarrhythmias. The use of sotalol in patients with left ventricular dysfunction is not recommended by the American College of Cardiology or American Heart Association because studies are inconclusive with conflicting results regarding safety. This article aims to review the mechanism of action of sotalol, the β-blocking effects on heart failure, and provide an overview of clinical trials on sotalol use and its effects in patients with heart failure. Small- and large-scale clinical trials have been controversial and inconclusive about the use of sotalol in heart failure. Sotalol has been shown to reduce defibrillation energy requirements and reduce shocks from implantable cardioverter-defibrillators. Torsades de Pointes is the most life-threatening arrhythmia that has been documented with sotalol use and occurs more commonly in women and heart failure patients. Thus far, mortality benefits have not been demonstrated with sotalol use and larger multicenter studies are required going forward.
Introduction: Triple-valve endocarditis is an extremely rare condition associated with poor prognosis and limited guidelines regarding its management. We report the unique case of a patient diagnosed with triple-valve endocarditis who underwent successful surgical intervention of all three valves. Case: A 79-year-old male with a history of benign prostatic hyperplasia requiring chronic indwelling urinary catheter presented with progressive dyspnea, lower extremity edema, and fevers. Physical exam was remarkable for a new holosystolic murmur at his right upper sternal border and jugular vein distention. Chest radiograph was consistent with pulmonary edema and cardiomegaly. A transthoracic echocardiogram revealed a large vegetation on his aortic valve with severe aortic regurgitation, moderate mitral and tricuspid valve regurgitation, and normal ejection fraction. Blood and urine cultures grew Enterococcus faecalis and Enterococcus avium , respectively. A transesophageal echocardiogram showed multiple mobile vegetations attached to his aortic valve, and small vegetations involving his mitral and tricuspid valve (Figure 1). He subsequently underwent surgical aortic valve replacement (23-mm Edwards), mitral valve replacement (27-mm Edwards), and repair of the tricuspid valve septal leaflet after excision of a 3 mm vegetation. He was discharged on ceftriaxone and ampicillin to complete 6 weeks of therapy. During his follow up visit 2 months after surgery, patient was feeling well and engaging in physical therapy. Discussion: There is a limited number triple-valve endocarditis by E. Faecalis in the current literature, and this is the first report of a patient successfully managed with three-valve surgery in this setting. We highlight the importance of early recognition and prompt surgical intervention to achieve favorable outcomes in this population.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.