Cardiovascular care

Chronic Infective Endocarditis Linked to Staphylococcus epidermidis Infection of a Pacemaker Lead: A Case Report (2025)

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Type of publication:

Journal article

Author(s):

*Abdalla, Osama S; *Idris, Ghada; *Ekanayake, Darshani; *Khallaf, Laila; *Adjepon, Charlotte.

Citation:

Cureus. 17(12):e99028, 2025 Dec.

Abstract:

The diagnosis and management of pacemaker-related infective endocarditis present significant challenges, with limited available data. Accurately attributing a systemic infection to pacemaker endocarditis can be difficult, particularly in identifying vegetations and obtaining positive blood cultures from patients who have undergone non-specific antibiotic therapy. Moreover, such infections may manifest long after pacemaker implantation. Herein, we present a male patient in his 70s, with a history of pacemaker placement, who was admitted with a three-month history of fever and chills, having already completed two courses of empirical antibiotics prior to admission. Upon hospital admission, he was treated for an infection of unknown origin with intravenous antibiotics. Initial laboratory evaluations indicated leucocytosis and elevated C-reactive protein levels; however, blood cultures and infectious serologies returned normal results. A CT scan of the abdomen and pelvis was deemed unremarkable, and transthoracic echocardiography (TTE) also yielded normal findings. The empirical antibiotic regimen was discontinued, leading to three sets of blood cultures being subsequently positive for coagulase-negative Staphylococcus epidermidis. A transoesophageal echocardiography (TOE) was performed, revealing vegetation on the pacemaker lead. The patient received a triple antibiotic therapy and underwent device removal; subsequent blood cultures were negative following a four-week antibiotic course. A new pacemaker was implanted, and the patient has since remained asymptomatic. This case illustrates that coagulase-negative Staphylococcus epidermidis can infect pacemaker leads even long after installation, potentially leading to an indolent course of infective endocarditis that is difficult to diagnose and manage. Consequently, clinicians should maintain a high index of suspicion for pacemaker infective endocarditis in patients presenting with prolonged fever.

DOI: 10.7759/cureus.99028

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Autonomic Nervous System Dysregulation in Metabolic Syndrome: An Association With Hypertension and Cardiovascular Risk (2025)

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Type of publication:

Systematic Review

Author(s):

Soomra, Hoor; Mukhtar, Asad; *Asif, Fatima; Khalid, Ayesha; Noureen, Sadia; Qamar, Zeeshan; Haider, Usman.

Citation:

Cureus. 17(12):e98932, 2025 Dec.

Abstract:

Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities, including abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure, that increases the risk of type 2 diabetes and cardiovascular disease (CVD). Autonomic imbalance, characterized by increased sympathetic activity and reduced parasympathetic tone, is proposed to play an important role in the development of hypertension and adverse cardiovascular outcomes in individuals with MetS. This systematic review evaluates the association between autonomic nervous system (ANS) dysregulation and MetS. A systematic search was conducted in PubMed, Embase, Scopus, and Cochrane Library for studies published from January 2015 to September 2025. Eligible studies included human research that examined measures of autonomic function such as heart rate variability (HRV), baroreflex sensitivity, muscle sympathetic nerve activity, and plasma catecholamine levels at rest in individuals with MetS. Observational and interventional studies were included. Data were extracted and synthesized narratively. A total of 16 studies met the inclusion criteria. Most included studies reported reduced HRV, impaired baroreflex sensitivity, increased resting sympathetic nerve activity, and elevated plasma catecholamines in participants with MetS, suggesting a consistent association between ANS dysregulation and blood pressure elevation. However, causality could not be established due to the predominantly observational study designs. Current evidence indicates a significant association between autonomic dysfunction and MetS, particularly in relation to hypertension and increased cardiovascular risk. ANS biomarkers may support refined cardiometabolic risk stratification, although further prospective and mechanistic studies are needed to clarify causal pathways.

DOI: 10.7759/cureus.98932

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Vascular Eagle's syndrome: difficult diagnosis in patient with recurrent transient ischaemic attack. (2026)

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Type of publication:

Journal article

Author(s):

Lyons, T; *Saunders, T; Littleton, E; Monksfield, P; Tiwari, A.

Citation:

Annals of the Royal College of Surgeons of England. 2026 Jan 12.

Abstract:

Eagle's syndrome describes the elongation of the styloid process. The condition has been recognised for over 90 years and causes a wide range of symptoms depending on the level of compression. Compression of the internal carotid artery by the styloid process is referred to in the literature as 'stylocarotid syndrome' or 'vascular Eagle's syndrome' (VES), presenting most commonly as arterial dissection and cerebrovascular events. We present the case of a 53-year-old patient who presented with multiple cerebrovascular events over a six-month period. Computed tomography angiography (CTA) suggested VES; however, magnetic resonance imaging (MRI) of the neck revealed no arterial wall abnormalities, including dissection. Despite the escalation of medical therapy, the patient continued to experience multiple transient ischaemic attacks. Following multidisciplinary team discussion and exclusion of other sources of emboli, a transcervical styloidectomy was performed freeing compression of the carotid artery, resulting in the complete resolution of symptoms. VES should be considered in patients with recurrent or unexplained cerebrovascular or cervical neurogenic symptoms even in the absence of arterial injury. We recommend early styloidectomy when there is a strong clinical suspicion of VES to achieve definitive symptom resolution.

DOI: 10.1308/rcsann.2025.0113

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Standardising Acute Coronary Syndrome Management: The Impact of Electronic Order Sets on Prescribing Compliance in a Tertiary Cardiology Centre. (2025)

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Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Fan L.

Citation:

Heart. Conference: BACPR Annual Conference 2025. Glasgow United Kingdom. 111(Supplement 5) (pp A9), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background Acute Coronary Syndrome (ACS) management relies on timely and accurate prescribing of evidence-based pharmacological therapies as per NICE NG185 guidelines. However, inconsistencies in prescribing practices, especially between cardiology-trained and non-cardiology clinicians, can lead to delays in optimal treatment, inconsistencies in care, and suboptimal discharge planning. Aim To evaluate whether implementing a standardised electronic prescribing order set improves compliance with NICE NG185 recommendations in ACS patients admitted to a tertiary cardiology centre. Method A retrospective review was conducted using EPMA (Electronic Prescribing and Medicines Administration) preintervention (June-October 2022, n=221) and post intervention (February-March 2023, n=76). Patients admitted with STEMI or NSTEMI were assessed within 1-3 days of admission for prescribing compliance with five core ACS medications: aspirin, beta-blockers, statins, proton pump inhibitors (Table present) (PPIs) and ACE inhibitors (ACEi). Following governance approval, a standardised electronic NICE-aligned order set was implemented on the EPMA system. Prescribing compliance pre and post intervention were compared and analysed for significance. Results Pre-intervention (NSTEMI=104, STEMI=117) revealed universal aspirin prescribing (100%), but notable omissions in other therapies: beta-blockers (70.6%), PPIs (72.9%), ACEi (71.5%) and statins (91.4%) [table 1]. Post-intervention (NSTEMI=28, STEMI=48) showed significant prescribing improvements: beta-blockers: +20.2% (p=0.0007), PPIs: +15.3% (p=0.0102), and ACEi: +10.1% (p=0.1143). Statin prescribing showed smaller changes (+3.3%) [table 1]. Conclusion Introducing standardised electronic order sets significantly improved prescribing compliance for ACS medications, particularly beta-blockers and PPIs. This intervention promoted adherence to NICE NG185 guidelines, reduced prescribing variability, streamlined medication reconciliation and improved discharge readiness. Embedding digital decision-support tools into EPMA can enhance early initiation of secondary prevention and facilitate a smoother transition to cardiovascular rehabilitation to optimise ACS care. Future directions will focus on sustainability and scalability across additional clinical settings and specialties to standardise ACS care.

DOI: 10.1136/heartjnl-2025-BACPR.15

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Implementing the new BSE methods and reference ranges for the Proximal Ascending Aorta and the impact on downstream testing-experience of a District General Hospital (2023)

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Type of publication:

Conference abstract

Author(s):

*Doherty J.; *Ellis C.; *Lee E.;

Citation:

Echo Research and Practice. Conference: British Society of Echocardiography annual meeting 2023. Newport . 11(Supplement 1) (no pagination), 2024. Date of Publication: 01 Jul 2024.

Abstract:

Background: In 2020 the BSE updated the methods and reference values for assessing the proximal ascending aorta (PAA). It is important to quantify how implementing these methods alter the rate of 'dilated' PAAs identified by echocardiography, and how this will impact the wider service and patient pathway. Purpose(s): To compare the rate of dilated PAAs detected by the current BSE methods, and two other methods of assessing the PAA in our patient population. Method(s): All transthoracic echocardiograms where the PAA was measured between January 2018 and December 2019 were included. Studies with incomplete demographics or bicuspid aortic valves were excluded. The PAA was indexed to height (Method 1), body surface area (BSA) (Method 2) and height2.7 (Method 3), compared to the corresponding normal reference values and classified as 'dilated' or 'nondilated' accordingly. The rate of 'dilated' proximal ascending aortas were compared using Chi-squared test. Result(s): 11,828 studies were identified. 2189 were removed due to incomplete patient demographics and 27 with bicuspid aortic valves. 2710 studies were removed as Method 2 does not provide reference values for patients < 45 and Method 3 > 80 years old. 6902 studies were included in the analysis. Method 1 classified significantly more PAAs as 'dilated' (31%, AUC = 0.930) compared to Method 2 (10%, AUC = 0.841) and 3 (3%, AUC = 0.921) (X2(1, N = 6902) = 2435.8, p < 0.001). Figure 1 (abstract ABS004) A comparison of number of Proximal Ascending Aortas classified as dilated using three different methods of normalising and assessing the proximal ascending aorta to body size; Method 1-height and sex, Method 2-body surface area, age and sex and Method 3-height2.7, age and sex.*Significantly different from Method 1 (p < 0.001).**Significantly different to Method 2 (p < 0.001) Figure 2 (abstract ABS004) Receiver Operating Characteristic (ROC) curves of three methods for assessing the size of the proximal ascending aorta (PAA) on echocardiography; BSE recommended methods using height and sex (Method 1, green), body surface area, age and sex (Method 2, red) and height2.7, age and sex (Method 3, blue). Sensitivity and 1-specificty values for each method at the PAA diameter of 4 cm is plotted. Of the 6902 studies, 306 PAAs were > 4 cm. Method 1 classified all PAAs > 4 cm and 1885 < 4 cm as dilated; Method 2 classified 111 PAAs > 4 cm and 82 < 4 cm as dilated; and Method 3 classified 203 PAAs > 4 cm and 476 < 4 cm as dilated. Conclusion(s): Adopting the 2020 BSE recommended methods significantly increase the detection rate of dilated PAAs in our patient population. This will impact subsequent downstream testing, affecting resource planning and patient journey.

DOI: 10.1186/s44156-024-00053-0

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Eosinophilic phenotype and bacterial load in hospitalised patients with exacerbations of COPD (2025)

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Type of publication:

Conference abstract

Author(s):

*Thumbe A.; *Ahmad N.

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A122), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background COPD is a heterogenous disease, and the eosinophilic phenotype is now well recognised as a treatable trait. However, it is less well known as to what extent bacterial infections affect this group of patients.1 Aim Our primary aim was to look at the incidence of bacterial growth in eosinophilic and the non-eosinophilic phenotype within our cohort of patients with COPD. Method A retrospective analysis was conducted on patients coded has having been admitted to our Trust with COPD exacerbations from October 2020 to April 2021. Historic sputum culture results were collected from our web-based patient portal. Patients were included in the analysis if they had a sputum culture showing bacterial growth at any time. Eosinophilic phenotypes (EP) were defined as having a blood eosinophil count >=0.3×109/L and non-eosinophilic phenotypes (NEP) as having a blood eosinophil count<0.3×109/L. Results In the study period, 337 unique patients were admitted with COPD exacerbations. They had a mean age (SD) of 73 (9) years, 49.6% (167/337) were female and 64.1% (216/337) were EP. 47% (n=157/337) patients had at least one positive sputum culture. Of these, 68.8% (n=108/157) were classified as EP. 72%(n=108/150) of EP had a positive sputum culture compared to 70% (n=49/70) of NEP; Odds Ratio 1.10 (95% CI 0.59-2.06); Chi-Square 0.021; p=0.88. When compared, NEP had higher burden of H. Influenzae, Strep Pneumoniae and Moraxella (59%, 20% and 20% vs 55%, 19% and 15%, respectively) whereas EP had a higher burden of Coliforms, Pseudomonas sp and S.aureus (32%, 30% and 15% v 25%, 25% and 8%, respectively). Conclusion Our findings suggest that in COPD patients requiring hospital admission, there is no significant difference between the bacterial burden of EP and NEP. Hence, future treatments of EP should not only include biologics but also focus on the role of bacteria in preventing exacerbations.

DOI: 10.1136/thorax-2025-BTSabstracts.179

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Two decades, two destinies: When chronic obstructive pulmonary disease hearts beat differently - The divergent mortality trajectories of atrial fibrillation vs other arrhythmias (2025)

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Type of publication:

Conference abstract

Author(s):

Sarfraz M.R.; Hemida M.F.; *Ali A.; Ishtiaq S.; Patel K.; Hussein M.; Tabasum P.; Basit Kayani A.; Mehmood H.; Mushtaq I.; Rehman S.;

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A71-A73), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background While arrhythmias are recognized as potential causes of death in chronic obstructive pulmonary disease (COPD) patients. However, temporal trends in arrhythmia-related mortality among COPD patients remain unexamined. Therefore, we conducted a comparative study evaluating mortality trends between atrial fibrillation (AF) and other arrhythmias in COPD patients. Methods A retrospective analysis of was conducted from 1999-2023, using the CDC WONDER database comparing COPD patients with AF (ICD-10: I48) versus other arrhythmias (ICD-10: I47, I49). Age-adjusted mortality rates (AAMRs) per 100,000 population were stratified by demographic variables for adults >=25 years. Joinpoint regression estimated average annual percent changes (AAPC) in mortality trends. Results From 1999-2023, 537,088 COPD-AF deaths were recorded (280,378 Men; 256,710 Women). AAMRs increased significantly from 5.55 to 13.66 (AAPC: +3.87%). Conversely, 168,770 COPD patients with other arrhythmias died (96,472 Men; 72,298 Women), with AAMRs declining significantly from 5.19 to 2.04 (AAPC: -3.56%). Men consistently showed higher mortality rates in both COPD with AF and other arrhythmias. In COPD-AF, AAMRs increased significantly for both genders (p<0.000001): men (7.96 to 16.95; AAPC: +3.23%) and women (4.17 to 11.19; AAPC: +4.18%). Conversely, in the COPD with other arrhythmias cohort, mortality rates decreased significantly (p<0.000001) for both men (AAMR: 7.68 to 2.67; AAPC: -4.05%) and women (AAMR: 3.58 to 1.52; AAPC: -3.16%). Inpatient medical facilities were the most common place of death for both groups, though COPD-AF patients had fewer inpatient deaths (59,284) than those with other arrhythmias (190,982). Both cohorts showed a notable shift toward increased home deaths over the study period. Racially, Whites had the highest AAMRs in both groups (AF: 11.04; other: 3.32), followed by American Indians (AF: 8.18; other: 2.78). Regionally, the Midwest showed highest mortality with opposing trends: upward for AF (AAPC: +4.89%) and downward for other arrhythmias (AAPC: -3.30%) p<0.000001. At state level, Vermont had the highest COPD-AF mortality (AAMR: 16.33), while Ohio had the highest AAMR for other arrhythmias (5.20). Conclusion COPD-AF mortality increased dramatically while other arrhythmia mortality declined significantly. Men showed consistently higher mortality with notable demographic disparities. These opposing trends suggest AF represents an emerging threat requiring targeted interventions.

DOI: 10.1136/thorax-2025-BTSabstracts.104

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Mastering Arterial Blood Gases in Emergency Medicine: A practical Guide (2025)

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Type of publication:

Book

Author(s):

*Nwaneri, Chukwuemeka

Abstract:

Navigate Critical Decisions with Confidence
In the high-stakes environment of the emergency department, rapid, accurate diagnosis is paramount. The Arterial Blood Gas (ABG) is an indispensable diagnostic tool, yet its complex interpretation often leaves clinicians feeling overwhelmed.
"Mastering Arterial Blood Gases in Emergency Medicine: A Practical Guide" is your definitive resource for transforming intimidating numbers into clear, actionable insights at the bedside.
Authored by an experienced emergency clinician, this book is specifically designed to equip emergency physicians, clinicians, residents, advanced practice providers, and critical care nurses with the unwavering confidence to interpret ABGs accurately and efficiently.

What You'll Discover Inside:
* The Unrivalled 6-Step Systematic Algorithm: Learn a proven, step-by-step approach to ABG interpretation that simplifies complex analysis, ensuring consistent and reliable results even under pressure.
* Practical, ED-Focused Scenarios: Bridge the gap between theory and practice with dedicated chapters on common emergency presentations, including:
* Respiratory Emergencies: COPD exacerbations, acute asthma, pneumonia, ARDS, PE, opioid overdose, and neuromuscular weakness.
* Metabolic Mayhem: Diabetic Ketoacidosis (DKA), lactic acidosis, renal failure, salicylate poisoning, toxic alcohol ingestions, severe diarrhea, and electrolyte imbalances from vomiting or diuretics.
* Other Critical Conditions: Cardiac arrest, severe trauma (hemorrhagic shock), carbon monoxide and cyanide poisoning, and early sepsis.
* Demystifying Complex Concepts: Gain clarity on the Anion Gap, Delta-Delta Gap, and the nuances of mixed acid-base disorders, transforming potential pitfalls into diagnostic triumphs.
* Oxygenation & Ventilation Mastery: Understand the critical relationship between PaO2, SaO2, and the A-a gradient to precisely assess and manage your patient's oxygenation status.
* Beyond the Numbers: Learn to integrate ABG results seamlessly with the full clinical picture, treating the patient, not just the ABG. Explore the limitations of ABGs and the strategic use of Venous Blood Gases (VBGs).
* The Future of Diagnostics: Peer into the exciting advancements in Point-of-Care (POC) testing, non-invasive monitoring, and the transformative potential of AI in ABG interpretation.
Whether you're a seasoned practitioner seeking to refine your skills or a new clinician building foundational knowledge, this practical guide cuts through the complexity, empowering you to make faster, more informed decisions that directly impact patient outcomes.
Master the ABG. Master the Emergency.

ISBN: 979-8293926329

NHS blood and transplant donor echocardiography standard to improve organ utilisation in heart transplantation (2025)

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Type of publication:

Journal article

Author(s):

Akhtar W; Peck M; *Miller A; Billyard T; Goedvolk C; Ryan M; Soliman Aboumarie H; Gil FR; Berman M; Rubino A

Citation:

The Journal of the Intensive Care Society. 17511437251394267, 2025 Nov 15.

Abstract:

Focused echocardiography plays a vital role in assessing donor hearts and improving donor utilisation in the United Kingdom. A NHS Blood & Transplant working group was established and, through a review of the current evidence and modified Delphi approach, developed guidance for a minimum dataset for image acquisition in donor heart assessment. This is in intended as a pragmatic optional supplementation to current focused echocardiography protocols. We present a donor echocardiography proforma with accompanying educational materials for use in the United Kingdom.

DOI: 10.1177/17511437251394267

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Mitral Valve-in-Ring Approach for High-Risk Pannus-Related Mitral Stenosis (2025)

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Type of publication:

Journal article

Author(s):

*Yera, Hassan O; Azam, Ziyad; *Azam, Najeeb M.

Citation:

Cureus. 17(10):e94204, 2025 Oct.

Abstract:

A male patient under follow-up for degenerative mitral regurgitation, treated with a Physio annuloplasty ring two decades earlier, developed progressive shortness of breath and fluid overload, corresponding to New York Heart Association (NYHA) class III/IV. A transoesophageal echocardiogram revealed significant mitral stenosis, with a mean gradient of 11.8 mmHg due to pannus formation around the annuloplasty ring. Surgical repair posed a mortality risk of 25%-35% because of the combined risks of redo surgery, reduced left ventricular systolic function and chronic kidney disease. A transcatheter mitral valve-in-ring (TMViR) procedure was the only feasible option. A 29 mm Sapien 3 valve (Edwards Lifesciences, Irvine, CA) was successfully implanted within the mitral ring. Four months following the procedure, the patient reported significant symptom relief and an improved quality of life (QOL), with a shift to NYHA class I/II. Follow-up echocardiography demonstrated a stable valve position, a mean gradient of 4 mmHg and mild mitral regurgitation. This case highlights TMViR as a viable option for high-risk patients with pannus-related mitral stenosis.

DOI: 10.7759/cureus.94204

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