Sepsis-induced cardiomyopathy: a review of pathophysiologic mechanisms.

Cardiac dysfunction is a well-recognized complication of severe sepsis and septic shock. Cardiac dysfunction in sepsis is characterized by ventricular dilatation, reduction in ejection fraction and reduced contractility. Initially, cardiac dysfunction was considered to occur only during the hypodynamic phase of shock. But we now know that it occurs very early in sepsis even during the hyperdynamic phase of septic shock. Circulating blood-borne factors were suspected to be involved in the evolution of sepsis induced cardiomyopathy, but it is not until recently that the cellular and molecular events are being targeted by researchers in a quest to understand this enigmatic process. Septic cardiomyopathy has been the subject of investigation for nearly half a century now and yet controversies exist in understanding it\u27s pathophysiology. Here, we discuss our understanding of the pathogenesis of septic cardiomyopathy and the complex roles played by nitric oxide, mitochondrial dysfunction, complements and cytokines

A 54 Year-Old Male with Cholangiocarcinoma and Biliary Sepsis

Case Report A 54 year-old male with a past medical history of cholangiocarcinoma and portal vein thrombosis was admitted to an outside hospital with right-sided abdominal pain, leukocytosis and hyperbilirubinemia. Prior to admission, he received 3 cycles ofgemcitabine however his tumor had increased in size leading to development of obstructive jaundice. At the hospital, his pain was attributed to hepatomegaly and biliary obstruction secondary to tumor size. He was started on Zosyn for presumed diagnosisof pneumonia and leukocytosis. He was then transferred toThomas Jefferson Hospital for a second opinion regarding his malignancy. Upon transfer, patient noted right upper quadrant abdominal pain that he described as constant and dull. He also reported fatigue and weight loss over last few months. He denied nausea,vomiting, diarrhea or any change in his bowel movements

A 40-year-old Woman with Chest Pain, ST Elevation, Elevated Troponin and Normal Coronary Arteries: A Case Report

Electrocardiographic changes resembling myocardial ischemia or infarction can be caused by a variety of causes other than ischemia. One of them is acute myocarditis which further confounds clinical judgment by causing elevation in troponins as well. We report a case of myocarditis which underscores the importance of identifying the clinical presentation of acute myocarditis and the electrocardiographic changes that can be associated with it

Dual Atrioventricular Nodal Pathways Physiology: A Review of Relevant Anatomy, Electrophysiology, and Electrocardiographic Manifestations

More than half a century has passed since the concept of dual atrioventricular (AV) nodal pathways physiology was conceived. Dual AV nodal pathways have been shown to be responsible for many clinical arrhythmia syndromes, most notably AV nodal reentrant tachycardia. Although there has been a considerable amount of research on this topic, the subject of dual AV nodal pathways physiology remains heavily debated and discussed. Despite advances in understanding arrhythmia mechanisms and the widespread use of invasive electrophysiologic studies, there is still disagreement on the anatomy and physiology of the AV node that is the basis of discontinuous antegrade AV conduction. The purpose of this paper is to review the concept of dual AV nodal pathways physiology and its varied electrocardiographic manifestations

Strongyloides stercoralis and Organ Transplantation

Strongyloides is a parasite that is common in tropical regions. Infection in the immunocompetent host is usually associated with mild gastrointestinal symptoms. However, in immunosuppressed individuals it has been known to cause a “hyperinfection syndrome” with fatal complications. Reactivation of latent infection and rarely transmission from donor organs in transplanted patients have been suggested as possible causes. Our case highlights the importance suspecting Strongyloides in transplant recipients with atypical presentations and demonstrates an incidence of donor derived infection. We also review the challenges associated with making this diagnosis

Cardiovascular disease in patients with chronic human immunodeficiency virus infection.

In 2012, the United Nations estimated that globally, 34 million people were living with human immunodeficiency virus (HIV) infection at the end of 2011. About 6.5% of AIDS-related mortality is attributable to cardiovascular disease. HIV related cardiovascular disease is diverse. In this review we explore the different disease states associated with HIV such as cardiomyopathy, coronary artery disease, dyslipidemia, electrocardiographic abnormalities, prolonged QT interval and sudden death. The pathophysiology of these numerous diseases is complex and multifactorial. Current management of these patients is challenging due to multiple drug-drug interactions and side effects. However, the approach to prevention is quite familiar, taking on the same rules that apply for any patient to minimize cardiovascular disease risk. The challenges are many, therefore for HIV patients who present after a cardiovascular event, or for prevention of cardiovascular disease, the concept of a heart team is essential, where cardiovascular specialists and the HIV care team work side by side to ensure safety of medications (avoid drug interactions) and to institute a goal directed prevention plan of care