The postcardiac injury syndrome (PCIS) includes the postmyocardial infarction syndrome, the postcommissurotomy syndrome, and the postpericardiotomy syndrome. Dressler reported a series of patients who developed a pericarditis-like illness days to weeks after a myocardial infarction. Postcardiac injury syndrome also has been observed after cardiac surgery, percutaneous intervention, pacemaker implantation, and radiofrequency ablation. Postcardiac injury syndrome is characterized by pleuritic chest pain, low-grade fever, an abnormal chest x-ray, and the presence of exudative pericardial and/or pleural effusions. The pathophysiology of PCIS involves auto-antibodies that target antigens exposed after damage to cardiac tissue. The treatment of PCIS includes the use of nonsteroidal anti-inflammatory drugs and corticosteroids. Prophylactic use of corticosteroids before cardiac surgery has not been effective in preventing PCIS. The widespread use of reperfusion therapy and cardiac medications with anti-inflammatory properties may have reduced the incidence of PCIS. Although PCIS can follow a relapsing course, it does carry a favorable prognosis.

HIV-infected persons are at higher risk for cardiovascular disease and may undergo computed tomographic (CT) scans for early detection. Incidental findings on cardiac CT imaging are important components of the benefits and costs of testing. We determined the prevalence and factors associated with incidental findings on CT scans performed for screening for coronary artery calcium (CAC) among HIV-infected men. A clinically significant finding was defined as requiring further work-up or medical referral. A total of 215 HIV-infected men were evaluated with a median age of 43 years, 17% were current tobacco users, median CD4 count was 580 cells/ mm 3 , and 83% were receiving antiretroviral medications. Thirty-four percent had a positive CAC score of >0. An incidental finding was noted among 93 (43%) of participants, with 36 (17%) having at least 1 clinically significant finding. A total of 139 findings were noted, most commonly pulmonary nodules, followed by granulomas, scarring, and hilar adenopathy. The majority of incidental findings were stable on follow-up, and no malignancies were detected. Factors associated with having an incidental finding in the multivariate model included increasing age (OR 1.6 per 10 years, p<0.01), positive CAC score (OR 2.3, p<0.01), and current tobacco use (OR 2.5, p=0.02). In conclusion, incidental findings are common among HIV-infected persons undergoing screening CT imaging for CAC determination. Incidental findings were more common among older patients and those with detectable CAC.

Background Cardiovascular disease is an increasing concern among HIV‐infected persons and their providers. We determined if fatty liver disease is a marker for underlying coronary atherosclerosis among HIV‐infected persons. Methods We performed a cross‐sectional study in HIV‐infected adults to evaluate the prevalence of and factors, including fatty liver disease, associated with subclinical coronary atherosclerosis. All participants underwent computed tomography for determination of coronary artery calcium (CAC; positive defined as a score >0) and fatty liver disease (defined as a liver‐to‐spleen ratio <1.0). Factors associated with CAC were determined using multivariate logistic regression models. Results We included in the study 223 HIV‐infected adults with a median age of 43 years [interquartile range (IQR) 36–50 years]; 96% were male and 49% were Caucasian. The median CD4 count was 586 cells/μL and 83% were receiving antiretroviral medications. Seventy‐five (34%) had a positive CAC score and 29 (13%) subjects had fatty liver disease. Among those with CAC scores of 0, 1–100 and >100, the percentage with concurrent fatty liver disease was 8, 18 and 41%, respectively (P=0.001). In the multivariate model, CAC was associated with increasing age [odds ratio (OR) 4.3 per 10 years; P<0.01], hypertension (OR 2.6; P<0.01) and fatty liver disease (OR 3.8; P<0.01). Conclusions Coronary atherosclerosis as detected using CAC is prevalent among young HIV‐infected persons. The detection of fatty liver disease among HIV‐infected adults should prompt consideration of assessment for underlying cardiovascular disease and risk factor reduction.

An active duty male presented to the emergency room with dyspnea for 2 days after undergoing liposuction surgery. Upon presentation, the patient was afebrile, tachycardic, tachypneic, and hypoxemic. The initial chest radiograph demonstrated bilateral patchy opacities and the PaO 2 /FiO 2 ratio was Ͻ200. The patient was admitted to the medical intensive care unit for supportive care. He was treated empirically for pneumonia. Blood and sputum cultures were negative. A computed tomography angiogram of the chest was negative for pulmonary embolism but did reveal a bilateral, perihilar air space process. The patient's oxygen requirement improved and the abnormal chest radiographic findings resolved over the next 48 hours. Given his clinical presentation, negative workup, and rapid recovery, the patient was given a presumptive diagnosis of pulmonary fat embolism. Fat embolism occurs when adipocytes and small blood vessels are damaged during the liposuction procedure. Patients may present with low-grade fever, tachycardia, tachypnea, hypoxemia, and hypocapnia. The differential diagnosis includes venous thromboembolism, aspiration pneumonitis, and pneumonia. The mainstay of treatment for pulmonary fat embolism is supportive care. The risk of mortality is 5 to 15%. Case ReportA 31-year-old African-American male with no major medical problems except sickle cell trait presented to the emergency room (ER) with shortness of breath for 2 days' duration after having undergone liposuction surgery. He also complained of a cough productive of clear sputum, but he denied experiencing fevers, chills, diaphoresis, hemoptysis, rash, confusion, sick contacts, or recent travel. He also denied any anginal or pleuritic chest pain.The patient underwent liposuction for the removal of "love handles." The procedure was performed at an outpatient surgical center, lasted several hours, and involved the use of general anesthesia, but the perioperative records were not available. The patient's dyspnea began immediately after the surgery. He reported wearing compression stockings perioperatively and postoperatively, but denied being treated with any anticoagulants such as heparin or enoxaparin.The patient was discharged to his home on the day of surgery without any specific treatment for his dyspnea. On postoperative day 1, he returned to the surgical center where he was seen by the plastic surgeon, who prescribed prednisone, reportedly for upper airway edema following the recent intubation. Again, the patient was discharged home, but his dyspnea became progressively worse, such that he sought attention in the ER on postoperative day 2.The patient's past medical history was notable for sickle cell trait. His surgical history was notable only for the recent liposuction. He had no known drug allergies. His current medications included cephalexin, acetaminophen/hydrocodone, and prochlorperazine, which were prescribed after the surgery. The patient's family history was notable for a mother with sickle cell disease. He denied cigarette smoking, alcoho...

Amyloid CM is a rare and devastating disease. The natural course of the disease has made heart transplant in these patients controversial. Modern advancements in chemotherapies and advanced heart failure treatments have improved outcomes for select patients with AL amyloid CM undergoing heart transplantation. There is ongoing research seeking improvement in treatment options and outcomes for patients with this deadly disease.