Infective endocarditis involving native aortic valve due to Burkholderia cepacia presenting as refractory heart failure in immunocompetent host: A case report

A 44-year-old previously healthy gentle man presented with dyspnoea for three weeks which was more severe over 7 days. He had anaemia, sinus tachycardia, wide pulse pressure of 100 mmHg, heaving displaced apex beat, and features of aortic regurgitation with occasional crackles over both lung base. Echocardiogram revealed vegetations at aortic valve. He was initially treated as a case of infective endocarditis and left ventricular failure with amoxicillin, gentamycin and anti-failure treatment. However, heart failure was very refractory and even worsening; he expired five days after arrival to our hospital. Blood culture obtained after his death showed a growth of unusual organism Burkholderia cepacia. Keywords: infective endocarditis; aortic regurgitation; refractory heart failure; Burkholderia cepacia.

Extraction of apex beat waveform from acoustic pulse wave by sound sensing system using stochastic resonance

With a sound sensing system using stochastic resonance (4SR), it became possible to obtain an acoustic pulse wave (APW)—a waveform created via a mixture of apex beat and heart sound. We examined 50 subjects who were healthy, with no underlying cardiovascular diseases. We could determine boundary frequency (BF) using APW and phonocardiogram signals. APW data was divided into two bands, one from 0.5 Hz to BF, and a second one from BF to 50 Hz. This permitted the extraction of cardiac apex beat (CAB) and cardiac acoustic sound (CAS), respectively. BF could be expressed by a quadratic function of heart rate, and made it possible to collect CAB and CAS in real time. According to heart rate variability analysis, the fluctuation was 1/f, which indicated an efficient cardiac movement when heart rate was 70 to 80/min. In the frequency band between 0.5 Hz and BF, CAB readings collected from the precordial region resembled apex cardiogram data. The waveforms were classified into five types. Therefore, the new 4SR sensing system can be used as a physical diagnostic tool to obtain biological pulse wave data non-invasively and repeatedly over a long period, and it shows promise for broader applications, including AI analysis.

Surgical Treatment of Lutembacher Syndrome with a Huge Right Atrium: A Case Report

Background: Lutembacher’s syndrome (LS) is a rare cardiovascular anomaly that is defined as any combination of congenital or iatrogenic atrial septal defect (ASD) with congenital or acquired mitral stenosis (MS). The clinical features and hemodynamic effects of LS depend on the balance between ASD and MS. Case Report: In this case report, we describe a rare case of LS with a huge right atrium in a 39-year-old male patient who was admitted to the hospital with worsening fatigue and breathlessness on exertion. Clinical examination revealed central cyanosis, raised jugular venous pressure bilaterally, clear breath sounds bilaterally with no dry and wet rales, hyperdynamic apex beat, and dull heart sounds. His vital signs on admission included blood pressure of 90/60 mmHg, irregular pulse of 76 beats/min, and oxygen saturation of 90.4%. Echocardiography revealed moderate to severe MS with ASD (ostium secundum). The patient’s condition deteriorated after initial medical management, and he underwent open heart surgery for mitral valve replacement, ASD repair, tricuspid annuloplasty, and right atrial volume reduction. Conclusions: This case report describes the successful surgical management of this rare condition.

PLEOMORPHIC LIPOSARCOMA PRESENTING AS EXTRACARDIAC MEDIASTINAL MASS LEADING TO CARDIAC COMPRESSION

A 45-year-old male presented with a 3-month history of fever associated with dyspnea, orthopnea, weight loss, chest pain, and anorexia. Past history was notable for cigarette smoking of 5 packs per year. Examination findings suggested clubbing, raised jugular venous pulse and pedal edema. Characteristic findings on systemic examination were displaced apex beat, sternal heave, bibasilar crepitations, distended abdomen, and presence of shifting dullness. Echocardiography revealed an extracardiac mass collapsing mostly the right side of the heart. Later, multidetector computed tomography scan (MDCT) was done which detected a mediastinal mass crossing midline, significantly compressing right sided cardiac chambers, adjacent segments of major arteries and veins, and displaced esophagus to the left. An ultrasound guided biopsy confirmed the diagnosis of pleomorphic liposarcoma. Although it turned out to be a surgical case, but the objective of reporting this case of pleomorphic liposarcoma is to keep our differentials broad when we get cases with typical cardiac symptoms. Sometimes the etiology could be extracardiac. Key words: Pleomorphic liposarcom; Mediastinal mass; Extracardiac mass; MDCT

Kartagener’s Syndrome: A Rare Case

Kartagener’s syndrome, an autosomal recessively inherited disorder, is a subgroup of primary ciliary dyskinesias. This genetic disorder manifests from early life which distinguishes it from acquired mucociliary disorders. Kartagener’s syndrome presents as a classical triad of situs inversus, sinusitis and bronchiectasis occurring majorly due to impaired ciliary motility. Here we report a case of a four year old female child who presented to us with repeated episodes of cough and intermittent breathlessness for the past three years. Clinical examination revealed bilateral coarse basal crepitations and apex beat on right fifth intercostal space in the midclavicular line. A thorough investigation revealed situs inversus, chronic sinusitis, and bilateral bronchiectasis. The patient underwent a high-speed video microscopy analysis which was suggestive of primary ciliary dyskinesia. Considering these findings, the patient was diagnosed as a case of Kartagener’s syndrome.

Emergency extraction of accidental impacted upper denture in the Association of American Anesthesiologist IV elderly patient: A case report and review of literature

A 78-year-old retired civil servant being managed for hypertensive heart disease and combined mixed cardiac valvular diseases (aortic stenosis and incompetence, mitral stenosis and incompetence), who has been on routine medication, accidentally swallowed his upper denture during the process of his medication. He presented to the private ENT hospital about 2 h post-ingestion. His other complaints were throat pain, dysphagia, and odynophagia. Clinical examination revealed an elderly man in painful distress and anxious looking. The throat and neck examination revealed tenderness at the level of the 6th cervical vertebrae and on the right side with some pooling of saliva in the throat. The oral cavity also revealed missing upper incisor tooth. His cardiovascular system revealed his apex beat at the 7th left intercostal space, heaving with irregular heart sounds and mixed beats and pansystolic murmur. His pulse rate and blood pressure were 64 beats/min and 170/65 mmHg, respectively. The other systems were essentially normal. A review by an experienced anesthetist (ME) placed the patient in the Association of American Anesthesiologist IV (ASA IV). An assessment of emergency impacted upper denture in elderly patient with cardiac valvular lesion and ASA 1V category was made. Cervical X-ray could not be done because the X-ray machine was faulty. The patient had the denture extracted under local anesthetic agent (10% lignocaine spray) and was successfully escorted out of the theater very excited. He was sent home 2 h post-extraction.

Iatrogenic pneumothorax in a 4-week-old girl: new diagnosis of congenital lobar emphysema

A 4-week-old female patient presented with severe respiratory distress, hypoxia and apnoeic episodes on a background of a few-day history of coryza and cough. There was significantly reduced air entry on the left side and a displacement of the apex beat to the right of the chest. The examination findings with oxygen desaturations and a right-sided mediastinal shift on chest X-ray led to a diagnosis of tension pneumothorax following which a needle thoracentesis was undertaken. This appeared to worsen the patient’s clinical condition; hence, a chest drain was inserted with unsatisfactory clinical improvement. In view of the presentation and lack of clinical improvement after chest drain insertion, the case was transferred to the paediatric respiratory team in a tertiary centre where the diagnosis was revised to congenital lobar emphysema based on chest computer tomography findings. She subsequently benefited from a left upper lobectomy and lingulectomy and was discharged home 4 days after surgery.