Case of Takotsubo cardiomyopathy after tooth extraction – Unusual trigger of a rare syndrome

AbstractWe describe a case of Takotsubo cardiomyopathy in a 75-year-old woman after an elective extraction of 10 teeth of the lower jaw using bilateral mandibular anesthesia. The patient complained of shortness of breath and chest pain after 24h. Coronary angiography showed smooth normal coronary arteries with thrombolysis in myocardial infarction III flow. Left ventriculography demonstrated apical ballooning. Three months later, the patient is symptom-free, with normal left ventricular function.We assume that the complex and robust procedures in dentistry together with a systemic absorption of epinephrine are sufficient triggers for the development of Takotsubo cardiomyopathy. In our case, we advocate an external catecholamine exposure rather than an internal catecholamine excess. We need more vigilance when assessing such patients.<Learning objective: We describe a stress-induced cardiomyopathy with late symptom development despite an uncomplicated tooth extraction. There was only one case of Takotsubo cardiomyopathy with acute symptoms described in the literature, although after complicated tooth extraction. It could be interesting for physicians that the complex and robust procedures in dentistry together with a systemic absorption of epinephrine are sufficient triggers for the development of Takotsubo cardiomyopathy.

Atrioventricular node ablation is not a prerequisite for cardiac resynchronization therapy in patients with chronic atrial fibrillation

Background: In drug-refractory heart failure, cardiac resynchronization therapy (CRT) is an established method in patients with sinus rhythm, severe reduced ejection fraction and broad QRS. Heart failure is known as a predisposition for atrial fibrillation (AF). However, the putative impact of atrioventricular node (AVN) ablation in chronic AF and CRT remains unclear. The aim of this study was to elucidate the effects of CRT in patients with chronic AF and the requirement for AVN ablation. Methods: A total of 100 patients were included in the retrospective study, 64 with sinus rhythm (SR) and 36 with chronic AF with a mean duration of 2.8 &#177; 0.5 years. Clinical parameters, QRS duration and echocardiographic parameters were compared at baseline and after a follow-up of 11 &#177; 0.34 months in patients with SR and in 27 patients with chronic AF who received optimized medication to control ventricular rate and nine patients who underwent an AVN ablation. Results: Baseline characteristics between patients with SR or AF in the presence or absence of AVN ablation were comparable. In each group, a significant improvement of NYHA class, ejection fraction could be observed, with an analogous reduction of QRS duration and a diminished left ventricular end-diastolic dimension after 11 &#177; 0.34 months of CRT. Conclusions: The present results demonstrate a comparable improvement in left ventricular function and functional capacity in all treated groups. In conclusion, AVN ablation is not a prerequisite for CRT in patients with severe heart failure and chronic AF

Six sequence variants on chromosome 9p21.3 are associated with a positive family history of myocardial infarction: a multicenter registry

<p>Abstract</p> <p>Background</p> <p>Recent genome-wide association studies have identified several genetic loci linked to coronary artery disease (CAD) and myocardial infarction (MI). The 9p21.3 locus was verified by numerous replication studies to be the first common locus for CAD and MI. In the present study, we investigated whether six single nucleotide polymorphisms (SNP) rs1333049, rs1333040, rs10757274, rs2383206, rs10757278, and rs2383207 representing the 9p21.3 locus were associated with the incidence of an acute MI in patients with the main focus on the familial aggregation of the disease.</p> <p>Methods</p> <p>The overall cohort consisted of 976 unrelated male patients presenting with an acute coronary syndrome (ACS) with ST-elevated (STEMI) as well as non-ST-elevated myocardial infarction (NSTEMI). Genotyping data of the investigated SNPs were generated and statistically analyzed in comparison to previously published findings of matchable control cohorts.</p> <p>Results</p> <p>Statistical evaluation confirmed a highly significant association of all analyzed SNP's with the occurrence of MI (p < 0.0001; OR: 1.621-2.039). When only MI patients with a positive family disposition were comprised in the analysis a much stronger association of the accordant risk alleles with incident disease was found with odds ratios up to 2.769.</p> <p>Conclusions</p> <p>The findings in the present study confirmed a strong association of the 9p21.3 locus with MI particularly in patients with a positive family history thereby, emphasizing the pathogenic relevance of this locus as a common genetic cardiovascular risk factor.</p

The ABC of a Simple Method for Pulmonary Vein Angiography

Catheter-directed intervention to treat atrial fibrillation (AF) is becoming widely accepted procedure in current clinical practice. For assessment of pulmonary vein (PV) anatomy, angiography of left atrium (LA) and/or PV is often performed. We present a new, simple angiographic method for PVs and LA opacification using SL1 sheath. Total of 100 patients in our clinic underwent this procedure. In all of the cases good angiographic results were achieved. No immediate or late complications related to this procedure were observed

Megaprosthesis for Metastatic Bone Disease—A Comparative Analysis

Background: Megaprosthetic reconstruction is sometimes indicated in advanced metastatic bone disease (MBD) of the appendicular skeleton with large degrees of bone loss or need for oncological segmental resection. Outcome after megaprosthetic reconstruction was studied in the setting of primary bone sarcoma with high levels of complications, but it is not known if this applies to MBD. Method: We performed a comparative analysis of complications and revision surgery for MBD and bone sarcoma surgery in an institutional cohort from 2005–2019. Presented are the descriptive data of the cohort, with Kaplan–Meier (K–M) rates of revision at 1, 2 and 5 years together with a competing risk analysis by indication type. Results: Rates of revision surgery are significantly lower for MBD (8% at 1 year, 12% at 2 years), in the intermediate term, compared to that of sarcoma (18% at 1 year, 24% at 2 years) (p = 0.04). At 5 years this is not significant by K–M analysis (25% for MBD, and 33% for sarcoma), but remains significant in a competing risk model (8% for MBD, and 20% for sarcoma) (p = 0.03), accounting for death as a competing event. Conclusion: Rates of revision surgery after megaprosthetic reconstruction of MBD are significantly lower than that for primary bone sarcoma in this cohort