The Canadian journal of cardiology
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Case Reports
Infective endocarditis presenting as an isolated aneurysm of the posterior mitral leaflet.
We describe the case of a 64-year-old woman in whom an aneurysm located on the posterior mitral leaflet was detected. Blood cultures grew methicillin-sensitive Staphylococcus epidermidis, and histologic examination of the operative specimen showed polymorphonuclear neutrophilic infiltration of the valve wall associated with fibrin and necrosis, consistent with a diagnosis of endocarditis. The posterior mitral location of the aneurysm and the absence of vegetation are exceptionally rare in this setting. This case demonstrates that a mitral aneurysm may be the sole cardiac presentation of infective endocarditis.
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Streptococcus pneumoniae endocarditis is uncommon. It has a predilection for the aortic valve and is associated with high mortality. ⋯ This case series illustrates the aggressive nature of pneumococcal endocarditis and the need for early diagnosis. Echocardiography should be considered in all individuals with persistent extracardiac pneumococcal infections.
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Review Meta Analysis
A meta-analysis of randomized controlled trials comparing percutaneous coronary intervention with medical therapy in stable angina pectoris.
There continues to remain uncertainty regarding the effect of percutaneous coronary intervention (PCI) vs medical therapy in patients with stable angina. We therefore performed a systematic review and study-level meta-analysis of randomized controlled trials of patients with stable angina comparing PCI vs medical therapy for each of the following individual outcomes: all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), and angina relief. We used 8 strategies to identify eligible trials including bibliographic database searches of MEDLINE, PubMed, EMBASE, and the Cochrane Controlled Trials Registry until November 2011. ⋯ We did not detect differences between PCI vs medical therapy for all-cause mortality (663 events; relative risk [RR], 0.97 [confidence interval (CI), 0.84-1.12]; I(2) = 0%), CV mortality (214 events; RR, 0.91 [CI, 0.70-1.17]; I(2) = 0%), MI (472 events; RR, 1.09 [CI, 0.92-1.29]; I(2) = 0%), or angina relief at the end of follow-up (2016 events; RR, 1.10 [CI, 0.97-1.26]; I(2)=85%). PCI was not associated with reductions in all-cause or CV mortality, MI, or angina relief. Considering the cost implication and the lack of clear clinical benefit, these findings continue to support existing clinical practice guidelines that medical therapy be considered the most appropriate initial clinical management for patients with stable angina.
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It is unclear whether diabetes mellitus or use of particular glucose-lowering agents is associated with increased risk of mortality after noncardiac surgery in patients with known cardiac disease. ⋯ Neither diabetes nor exposure to common classes of glucose-lowering drugs preoperatively were associated with increased perioperative mortality in cardiac patients undergoing noncardiac surgery. However, cardiac patients not using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, or statins preoperatively exhibited higher mortality rates, emphasizing the importance of optimizing evidence-based therapy before elective surgery in these patients.