Tricuspid valve endocarditis associated with intravenous nyoape use: A report of 3 cases

We report three cases of tricuspid valve infective endocarditis associated with intravenous nyoape use. Nyoape is a variable drug combination of an antiretroviral (efavirenz or ritonavir), heroin, metamphetamines and cannabis. Its use is becoming increasingly common among poor communities in South Africa. All our patients were young HIV-positive men from disadvantaged backgrounds. They all presented with tricuspid regurgitation and septic pulmonary emboli. They were treated with prolonged intravenous antibiotic courses, and one required referral for surgery

Pasteur\u27s legacy featured at UM shows, lecture

AIMS: Left atrial (LA) volume is an important predictor of morbidity and mortality in cardiovascular disease. Left atrial strain is a feasible technique for assessing LA function. The EchoNoRMAL study recently highlighted the possibility that ethnic-based differences may exist in LA size. There is a paucity of data regarding LA parameters in an African population. We sought to establish normative values for LA volumetric and strain parameters in a black population. METHODS AND RESULTS: This cross-sectional study comprised 120 individuals between 18 and 70 years of age. Left atrial volumes were measured by biplane Simpson\u27s method, and strain parameters were measured using Philips QLAB 9 (Amsterdam, The Netherlands) speckle-tracking software. The mean age was 38.7 ± 12.8 years (50% male). Maximum LA volume indexed (LAVi), pre-atrial LAVi, and minimum LAVi were 19.7 ± 5.9, 12.2 ± 4.4, and 7.7 ± 3.2 mL/m(2), respectively. Females had a higher LAVi compared with males (20.9 ± 6.3 vs. 18.6 ± 5.3 mL/m(2), P = 0.04). Peak global longitudinal strain in the reservoir phase (ɛR) was 39.0 ± 8.3%, and the peak LA strain in the contractile phase (ɛCT) was -2.7 ± 2.5%. No gender differences were noted in ɛR. Body surface area, age, and weight were the main determinants of ɛR on multivariate linear regression analysis. CONCLUSION: The data reported in this study establish the normal reference values for phasic LA volumes and strain in a normal black population and serve as a platform for future studies

An approach to the diagnosis and management of valvular heart disease

Valvular heart disease poses a common yet difficult problem in everyday clinical practice. A thorough clinical evaluation with basic commoninvestigations such as an electrocardiogram (ECG) and a chest radiograph (CXR) remains the cornerstone of diagnosis. Echocardiographyand more invasive testing, if needed, are usually performed at specialist level to confirm the diagnosis, assess severity and assist in definitivedecision-making.The causes and clinical, ECG and CXR features of the common valve lesions are described. Patients with symptomatic valve lesions shouldbe referred for specialist assessment. In most cases, medical therapy serves as a bridge to definitive mechanical or surgical therapy

Isolated left ventricular noncompaction: what do we really know?

Isolated left ventricular noncompaction (ILVNC) is a myocardial disorder thought to occur as a result of an arrest in embryogenesis. Recently, it has been classified as a genetic cardiomyopathy. Familial and sporadic forms of ILVNC have been documented. There is considerable genetic heterogeneity among familial forms, although sarcomeric mutations are the most common genetic mutations. Issues related to familial screening require careful consideration and future research. There is considerable controversy regarding several aspects relating to pathogenesis, diagnosis, and management of subjects with ILVNC. Differentiating some cases of ILVNC from normal variant myocardial architecture is challenging and requires future work. This review is intended to provide clinicians insight into several aspects of these challenging issues and offer some practical guidance in dealing with some of these difficult clinical scenarios

Thoracic Endovascular Aortic Repair in a Patient with Mobile Aortic Thrombosis

A 58-year-old female presented with acute arterial insufficiency to her left leg. Following cardiovascular evaluation using multimodality imaging, it was discovered that she had mobile thoracic thrombi overlying a normal descending thoracic aorta which had also caused a splenic infarction. This patient was treated with unfractionated heparin for three days and underwent subsequent thoracic endovascular aortic repair (TEVAR) uneventfully with no subsequent complications at one-year followup. This case highlights the diagnostic and therapeutic challenges in treating patients with this uncommon challenging clinical scenario