A 59-year-old immunocompetent man presented with a 4-month history of low-grade fever and limb ischemia due to peripheral embolism of the left dorsalis artery. Five months previously he underwent aortic valve replacement with a mechanical valve. Candida albicans was documented in blood cultures and he began antimycotic treatment. A transesophageal echocardiogram and computed tomography (CT) revealed confluent vegetations and a large pseudoaneurysm in the ascending aorta (AAo) (Fig. 1A, Supplementary Data Videos 1 and 2). Emergent hemiarch replacement with a dacron graft was performed (Fig. 1C). Three months postoperatively, despite negative blood cultures, CT revealed an abscess on the distal AAo (Fig. 1D), while positron emission tomography/CT imaging demonstrated markedly increased 18F-fluorodeoxyglucose uptake along the AAo graft (Fig. 1E). The patient was deemed inoperable, was discharged on long-term antimycotic treatment, and at the 8-month follow-up was in a stable condition. Fungal aortitis with mycotic aneurysm formation is extremely rare, with mortality being greater than 50%. (Negi and Ahmad, 2018Negi N. Ahmad A. Current updates on fungal endocarditis.Fungal Biology Reviews. 2018; 32: 1-9Crossref Scopus (8) Google Scholar). Given that the clinical signs of the infection lack specificity and the high relapse rate of fungal endocarditis, multimodality imaging is of paramount importance (Hartlage et al., 2014Hartlage G.R. Palios J. Barron B.J. et al.Multimodality imaging of aortitis.JACC Cardiovasc Imaging. 2014; 7: 605-619Crossref PubMed Scopus (87) Google Scholar) for early diagnosis and follow-up of the patients. None of the authors have conflicts of interest to declare. None
Human immunodeficiency virus (HIV) is mainly detected in young, otherwise healthy, individuals. Cardiomyopathy and peripheral artery disease affecting these patients appears to be multifactorial. Prompt and potentially more effective implementation of therapeutic measures could be enabled by pre-symptomatic diagnosis of myocardial dysfunction and peripheral artery damage. However, limited data is available to date on this specific topic. Μethods: We investigated the association between global longitudinal strain (GLS), an established index of subclinical left ventricular systolic dysfunction (LVSD) assessed by two-dimensional speckle-tracking echocardiography, and: (a) patient history; (b) demographic and clinical baseline characteristics; (c) carotid intima-media thickness (IMT) and the presence of carotid atherosclerotic plaque(s), measured by ultrasonography; (d) temperature difference (ΔT) along each carotid artery, measured by microwave radiometry; and (e) basic blood panel measurements, including high-sensitivity troponin-T (hsTnT) and NT-proBNP in people living with HIV (PLWH) and no history of cardiovascular disease.We prospectively enrolled 103 consecutive PLWH (95% male, age 47 ± 11 years, anti-retroviral therapy 100%) and 52 age- and sex-matched controls. PLWH had a significantly higher relative wall thickness (0.38 ± 0.08 vs. 0.36 ± 0.04, p = 0.048), and higher rate of LVSD (34% vs. 15.4%, p = 0.015), and carotid artery atherosclerosis (28% vs. 6%, p = 0.001) compared with controls. Among PLWH, LVSD was independently associated with the presence of carotid atherosclerosis (adj. OR:3.09; 95%CI:1.10-8.67, p = 0.032) and BMI (1.15; 1.03-1.29, p = 0.017), while a trend for association between LVSD and left ventricular hypertrophy was also noted (3.12; 0.73-13.33, p = 0.124). No differences were seen in microwave radiometry parameters, NT-proBNP, hs-TnT and c-reactive protein between PLWH with and without LVSD.Subclinical LVSD and carotid atherosclerosis were significantly more frequent in PLWH compared to a group of healthy individuals, implying a possible link between HIV infection and these two pathological processes. Carotid atherosclerosis and increased adiposity were independently associated with impaired GLS in HIV-infected individuals.
Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manifesting as stent thrombosis with left ventricular thrombus formation was triggered by a food-induced allergic reaction. The allergic reaction to food was confirmed by oral rice pudding ingredients challenge test while skin tests were inconclusive. To our knowledge, this is first report of early stent thrombosis secondary to food allergic reaction in a 70-year-old man patient who was found to have left ventricular thrombus and undiagnosed hypertrophic cardiomyopathy.
Background: A non-immediate hypertensive response after COVID-19 vaccination has been reported. Mild to moderate elevated arterial blood pressure (BP) levels have been documented a few days after a single or two-doses vaccine. This study sought to investigate this observation as a potential side effect in patients with known hypertension and healthy controls. Methods: Overall 60 vaccinated patients between the age of 50 to 70 years old were studied. They were randomly assigned to one of the approved and available vaccines (Pfizer, Astra Zeneca or Moderna) twice within a month. Half of them were hypertensives under medical treatment and half of them were not.All participants volunteered for standard daily home blood pressure measurements (HBPM) and had also ambulatory blood pressure measurements (ABPM) between the 1 st and the 30 th day after the second dose of COVID-19 vaccine. Results: All patients, hypertensives or not, had at some point a recorded and substantial hypertensive response for both systolic (SBP) and diastolic (DBP) blood pressure after the second dose of the vaccine. Hypertensives were older and with higher body mass index (BMI). Some of the hypertensive patients received additional medication whereas some of the non-hypertensive patients started life modification changes and systematic BP measurements for a possible diagnosis of hypertension. Conclusions: Vaccination for COVID 19 seems to be related with a short period of hypertensive response. This phenomenon was partial and mostly observed in older overweight hypertensives.
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