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Central venous lines are often inserted but their removal requires some precautions. We describe a 51-year-old female patient who was due for discharge but had an unfortunate event arising from removal of her central venous line even though the appropriate measures had been taken. She experienced an acute ischaemic stroke secondary to air embolism. The deficits persisted even though extensive efforts were made to reverse them. This case reminds clinicians that bedside procedures can result in devastating complications even if all precautions have been followed. We review the mechanisms of air embolism, provide suggestions to limit its incidence following central line removal, and recommend therapeutic measures.Precautions should be taken when removing a central venous line to reduce the risk of air embolism.Air embolism can manifest with acute stroke.Acute stroke in this setting requires hyperbaric oxygen therapy.

Introduction: The need for increased utilization of hospice in the dying patients has been recognized in multiple fields including cardiology recently. The aim of this study to examine the trends in location of deaths in acute myocardial infarction (AMI) related deaths in the United States from 2003 to 2019. Methods: The CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access the National Vital Statistics System data from 2003 to 2019. AMI related deaths in patients ≥ 25 years of age were identified from multiple causes of death. Joinpoint regression was used to examine changes in trend, annual percentage change (APC), and average annual percentage change (AAPC). Location of death was categorized as home, medical facility, hospice facility, nursing home/long term care (NH/LTC) and other/unknown. Results: Of AMI related deaths, 23.62% occurred at home, 0.94% at hospice facility, 39.64% at medical facility and 13.30% at NH/LTC. From 2003-2019, the number of deaths has increased at hospice facility (AAPC 24.7[95% CI, 18.1 to 31.6]) and decreased at both medical facilities (AAPC -3.1[95% CI, -3.5 to -2.8]) and NH/LTC (AAPC -4.3[95% CI, -4.6 to -3.9]). The number of deaths initially decreased at home till 2009 (APC -1.9[95% CI, -2.5 to -1.3]) followed by increase till 2019 (APC 1.5[95% CI, 1.2 to 1.8]). Conclusion: Although there was an increasing trend in AMI related mortality at hospice and home locations, rates of utilization of hospice facility remain very low.

Purpose This study explores the impact of severe sepsis and septic shock on morbidity, mortality and length of stay in patients admitted to the hospital with a primary diagnosis of heart failure in acute exacerbation. Methods We examined National Inpatient Sample (NIS) database from years 2007-14 for all hospital admissions with heart failure admitted with acute exacerbation with vs without sepsis. ICD9 codes were utilized for selecting the study group. We compared baseline characteristics of the two groups using parametric and non-parametric tests for continuous variables and Chi-Squares test for dichotomous variables. Multivariate logistic regression was used to draw comparisons between incidence of cardiogenic shock, in-hospital mortality and length of stay (LOS). Our analysis adjusted for age, sex, race, payer, income quartiles, hospital location, region, size and teaching status. Comorbidities in charlson comorbidity Index were accounted for in our analysis. Missing values for covariates in the regression analysis were adjusted by using multivariate imputation by chained equations technique to ensure valid statistical inference. Results From 2007-2014, a total of 7,000,805 patients were included in the aforementioned study group. 1.08% (75,765) of the study population had concomitant diagnosis of Sepsis. Study population did not significantly differ in age (mean age 72.8 yrs. (HF)vs 71.4 yrs. (HF w Sepsis) p>0.05).HF with sepsis group were more likely to be males (p Conclusion This nation-wide study indicates that concomitant sepsis in patients admitted for heart failure exacerbation significantly increases morbidity and mortality in terms of cardiogenic shock and longer length of stay.

Atrial fibrillation (AF) is known to increase morbidity and mortality of heart failure with reduced ejection fraction (HFrEF) but its impact on HFrEF status post implantable cardioverter-defibrillator admitted for an acute exacerbation is largely unknown. This study examined the NIS (National

Purpose Obesity is associated with several cardiovascular diseases including aortic valve stenosis. Studies have demonstrated a beneficial effect of obesity on patients with cardiovascular disease, deemed the “obesity paradox.” This paradox is also present in obese patients undergoing total aortic valve replacement (TAVR) when examining both short and long-term mortality rates, although the data is conflicting. We aim to investigate the effects of obesity on mortality, length of hospital stay, and rates of stroke and cardiogenic shock in patients undergoing TAVR. Methods We examined National Inpatient Sample (NIS) database from years 2011-14 for all hospital admissions, for TAVR with and without obesity. ICD-9 codes were utilized for selecting the study group. We compared baseline characteristics of the two groups using parametric and non-parametric tests for continuous variables and Chi-Squares test for dichotomous variables. Multivariate logistic regression was used to draw comparisons between incidence of cardiogenic shock, stroke,in-hospital mortality and length of stay(LOS). Our analysis adjusted for age, sex, race, payer, income quartiles, hospital location, region, size and teaching status. Multiple co-morbidities were also accounted for during our analysis (e.g. DM, CKD,HTN, history of CABG and PCI etc.). Results From 2007-2014, a total of 42268 patients were included in the aforementioned study group. 13.2% (5,572) of the study population had concomitant diagnosis of obesity. Study population with obesity was significantly younger (mean age 76.1yrs (TAVR w obesity)vs 81.9 yrs. (TAVR) p 0.05) was not statistically significant. Interestingly in-hospital mortality (OR 0.67, CI (0.20,0.44); p Conclusion This nation-wide study indicates that obese patients undergoing TAVR are at significantly higher risk for cardiogenic shock and longer LOS. Interestingly, our study also found the ‘obesity paradox’ to be valid in this study.

Introduction Primary hyperparathyroidism is strongly associated with cardiovascular disease. It is related to hypertension, left ventricular hypertrophy, cardiac valvular abnormalities, arrhythmias, and heart failure. While primary hyperparathyroidism can lead to ventricular stiffness, coronary artery and valvular calcifications, we aim to investigate the effects of primary hyperparathyroidism on mortality and length of hospital stay in patients admitted for acute congestive heart failure exacerbation. Methods National Inpatient Sample (NIS) database from years 2007-14 was examined for all hospital admissions with HF with and without hyperparathyroidism. Baseline characteristics were compared using parametric and non-parametric tests for continuous variables and Chi-Squares. Multivariate logistic regression was used to draw comparisons between incidence of cardiogenic shock, in-hospital mortality and length of stay (LOS). Our analysis was adjusted for age, sex, race, payer, income quartiles, hospital location, region, size and teaching status and included multiple comorbidities. Results A total of 7,000,805 patients were admitted for CHF exacerbation and of those 21,765 (0.31%) also had hyperparathyroidism. Mean age for hyperparathyroid patients was 72.0 years vs. 72.8 yrs (p Conclusion Overall, while our results showed that patients with hyperparathyroidism admitted for CHF exacerbation had a decreased in-hospital mortality, they had more comorbidities and tended to stay in the hospital longer. While in-hospital mortality could be multifactorial, a longer LOS can possibly be due to the underlying physiological changes that PTH and calcium levels have on the heart, including increased LV stiffness and LV hypertrophy, lengthening the time to euvolemia.

Patients suffering from True Posterior Wall Myocardial Infarction (MI) have been classically described as being at an elevated risk of delayed diagnosis. This is due to absence of ‘traditional’ electrocardiographic infarct signs such as ST-segment elevation, which may result in errors or delays