Gram-negative organisms are a rare cause of infective endocarditis. Escherichia coli, the most common cause of urinary tract infection and gram-negative septicemia involves endocardium rarely. In this case report, we describe infection of native mitral valve by E. coli following septicemia of urinary tract origin in a diabetic male; subsequently, he required prosthetic tissue valve replacement indicated by persistent sepsis and congestive cardiac failure.
Negative pressure pulmonary oedema (NPPE) is a manifestation of upper airway obstruction and is seen after extubation postoperatively. The large negative intrathoracic pressure generated by forced inspiration against an obstructed airway is thought to be the principal mechanism involved. It is a dangerous and potentially fatal condition with a multifactorial pathogenesis. The Authors report a case of negative pressure pulmonary oedema occurring periprocedurally while undergoing permanent pacemaker implantation under local anaesthesia and light sedation due to upper airway obstruction caused by falling back of the tongue.
Early repolarisation pattern on ECG when a patient presents with chest pain needs careful evaluation to exclude coronary artery disease. The Authors report here a deceptive ECG pattern of early repolarisation in a patient with severe chest pain which necessitated coronary angiogram revealing normal epicardial coronary arteries. Subsequently, patient developed the typical ECG pattern of early repolarisation. Awareness of the deceptive ECG variant of early repolarisation pattern can avoid invasive coronary angiograms in these patients.
ST-elevation myocardial infarction, in anticipation of primary percutaneous coronary intervention, clopidogrel, prasugrel or ticagrelor are given with Aspirin on presentation. The Authors report a case of acute ST elevation anterior wall myocardial infarction administered ticagrelor with Asprin with intent to treat by primary percutaneous coronary intervention, but patient subsequently opted for intravenous fibrinolytic therapy instead of primary percutaneous coronary intervention. Although fibrinolytic therapy was successful in achieving reperfusion, patient developed significant retroperitoneal bleed requiring multiple blood transfusions. Only clopidogrel is recommended in the setting of fibrinolytic therapy in the guidelines and no data are presently available with ticagrelor.
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