Biomedical subjects
Publications and source records attributed to E R Leibovitch.
This report describes a case in which a young woman died from embolization of her prosthetic aortic valve. The discussion includes the embolization's association with chronic intravenous narcotism, recurrent bacterial endocarditis, and acute cocaine toxicity.
Congestive heart failure (CHF), a disease seen primarily in the older patient, can be due to either systolic or diastolic dysfunction. Management is quite different if the heart failure is due to a filling abnormality as compared to poor ventricular systole. The disorder also poses many diagnostic pitfalls in the elderly. Current understanding of CHF and its influence on diagnosis and management is the focus of this review.
A 30-year-old man had endocarditis and hip arthritis associated with the recently recognized fungus, Scedosporium inflatum. Inhibition, and possibly cure, of endocarditis occurred with medical therapy alone. Data from in vitro susceptibility testing did not predict clinical response. This case also illustrates the need to standardize fungal susceptibility testing and to remain vigilant for emerging pathogens.
Accompanying the aging of the population has been a change in the presentation and the manifestations of valvular heart disease. Calcific aortic stenosis is now the most frequent reason for valvular heart surgery and differs greatly from the stenosis produced by rheumatic fever or a congenital bicuspid valve. Mitral insufficiency is found with increasing frequency and is often due to a calcified mitral valve annulus. Mitral valve prolapse, once thought to be a disease found in younger patients, is being diagnosed more and more in the elderly and is a significant cause of mitral regurgitation. It is important for the physician caring for the older patient to be aware of the differing presentations, manifestations, and implications of valvular diseases in the elderly.