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Objective: The goal of this study was to determine if an interactive voice response system (IVRS) with daily self-management and clinical monitoring messages would be well accepted by patients and reduce 30-day congestive heart failure (CHF) readmissions., Background: Patient adherence to a treatment regimen contributes to successful management following discharge for CHF. Cost-effective, scalable technology solutions can be useful tools in reducing readmissions., Methods: Sixty inpatients with a primary diagnosis of CHF were provided voice messages delivered via an Mp3 player. Following discharge, patients received daily IVRS messages with self-management tips based on self-reporting of symptoms., Results: Greater than a 50% reduction in the 30-day readmission rate was realized for intervention patients., Conclusions: An IVRS self-management support system can be an effective technology to reduce CHF readmissions.

An unusual case of essential thrombocythemia in a young man presenting with progressive angina pectoris is presented. Angiography revealed proximal left anterior descending artery stenosis. Successful percutaneous transluminal angioplasty along with antiplatelet therapy and a calcium channel blocking drug have rendered this patient asymptomatic.

Forty-six tricuspid valve operations were performed over 12 years. Operations were conservative (two valvotomies, eight DeVega annuloplasties, seven Carpentier rings) in 17 and valve replacement (17 mechanicals, 12 tissues) in 29. Operative mortality rate was improved with better preoperative functional class, use of cardioplegia, or use of annuloplasty. Heart block occurred less with annuloplasty (6 vs 24 percent). Long-term survival was similar with annuloplasty or porcine valve replacement, but was poorer with mechanical valve replacement. Four of eight DeVega annuloplasties failed during the operative (two) or late (two) period. When the anatomy is suitable, we believe the Carpentier ring annuloplasty to be safe and effective. When valve replacement cannot be avoided, we believe replacement with a tissue valve is preferable.

We have reported the fifth case of endocarditis due to Salmonella enteritidis and the first known survivor of native aortic valve endocarditis from this pathogen. Despite appropriate antibiotic therapy, aortic valve replacement was necessary because of heart failure and embolism. The patient also had concurrent viral hepatitis B infection.

Mexiletine is an antiarrhythmic agent, structurally similar to lidocaine, but useful orally as well as intravenously. The safety and efficacy of mexiletine was compared with quinidine in a double-blind, parallel, randomized study of patients with chronic ventricular ectopia of various causes. Mexiletine was statistically more effective (P less than .05) than quinidine, though the total number of patients studied was small. Like quinidine, side effects limited the usefulness of mexiletine in certain patients, but these side effects are quite distinct from those of quinidine and other type I antiarrhythmic drugs. Mexiletine should be a useful addition to the armamentarium of antiarrhythmic drugs when it is released for clinical use in the United States.

A second coronary artery revascularization procedure often yields poor results. Nifedipine, a calcium antagonist, was added to the current medical therapy consisting of maximal doses of beta blockers and nitrates in a group of 18 patients who had had one revascularization procedure and subsequently had class 3 and 4 angina pectoris. The overall favorable clinical response was 72%. The average dose of nifedipine to achieve a clinical response was 90 mg/day. Left ventricular function improved with time. We believe nifedipine is an important adjunct in the management of angina after coronary bypass operation.