BackgroundAntiplatelet agents used in coronary heart disease (CHD) cause gastrointestinal side effects. Omeprazole can prevent and cure these antiplatelet side effects. Clopidogrel combined with aspirin increases the risk of gastrointestinal tract ulcers and bleeding. This research studied the effect of omeprazole on the antiplatelet effect of clopidogrel.MethodsCHD patients using clopidogrel and aspirin receive omeprazole 20 mg in a single dose for 10 days. Platelet antiaggregation point for clopidogrel was measured using VerifyNow P2Y12. The cutoff points used were: low on treatment platelet reactivity (LPR) <85 P2Y12 reaction unit (PRU), normal on treatment platelet reactivity (NPR) 85–208 PRU, and high on treatment platelet reactivity (HPR) >208 PRU.ResultsUsing the paired t-test PRU points pre- and post-omeprazole were 154 ± 85.89 PRU and 169.4 ± 56.15 PRU, respectively. The PRU points were consistent or decreased from the previous PRU points below the HPR cutoff (p: 0.215; >0.05). Before omeprazole use, five patients were categorized as NPR, two patients as LPR, and three patients as HPR. After omeprazole use, two patients, each from HPR and NPR category had a PRU point >208; the rest showed results below the HPR point.ConclusionsIn this study the PRU points of clopidogrel after omeprazole use showed a PRU <208. The hypothesis that omeprazole may reduce the antiaggregation effect of clopidogrel as shown by the increase in PRU above the cutoff points >208 PRU (HPR) was not proven.

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. An intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.

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SAŽETAK: Uvod: Infektivni endokarditis (IE) fokalna je infekcija uzrokovana bakterijskim, virusnim ili gljivičnim mikroorganizmima, koja unutar srca zahvaća endokard i zalistke. Streptococcus alactolyticus, klasificiran po IV DNA klasterom S. bovis / S. equinus kompleksa, bakterija je koja se rijetko nalazi u izolatu te koja malokad uzrokuje IE u ljudi. Kocuria kristinae je gram-pozitivna bakterija. Dosad je objavljeno samo šest slučajeva IE-a uzrokovanih infekcijom bakterijom K. kristinae. Trombocitopenija i disfunkcija trombocita mogu se pojaviti u IE-u te su povezani s kliničkim ishodom. Postoje različite hipoteze o mehanizmima kojima se objašnjava trombocitopenija u IE-u. Prikaz slučaja: Predstavljamo slučaj dvadesetpetogodišnje bolesnice koja se žalila na palpitacije dva tjedna prije primitka u bolnicu. Prvi je simptom bila povišena temperatura šest mjeseci prije primitka. Hemokulture su utvrdile S. alactolyticus i K. kristinae. Ehokardiografskom su pretragom pronađene vegetacije na anteriornom i posteriornom listiću mitralnog zalistka uz tešku mitralnu regurgitaciju. Bolesnica je tijekom hospitalizacije imala tešku trombocitopeniju bez znakova krvarenja. Šesnaestog dana hospitalizacije naglo se počela žaliti na abdominalnu bol i zaduhu. Bolesnica je umrla, a uzrok smrti bili su septički emboli. Zaključak: Prikazan je slučaj IE-a uzrokovana rijetkim bakterijskim patogenima (S. alactolyticus i K. kristinae) koji je pogoršala trombocitopenija. Liječenje IE-a s trombocitopenijom zahtijeva oprez jer je to stanje povezano s lošim ishodima. U ovom se slučaju loši ishodi mogu povezati s trombocitopenijom uz prisutnost specifične bakterije, S. alactolyticus, koja je poznata kao bakterija koja često uzrokuje septičku emboliju. SUMMARY: Introduction: Infective endocarditis (IE) is a focus infection caused by bacterial, viral, or fungal microorganisms within the heart that involves the endocardium and heart valves. Streptococcus alactolyticus, classified under DNA cluster IV of the S. bovis/S. equinus complex, is a sparse isolated bacterium that rarely cause IE in humans. Kocuria kristinae is a gram-positive bacteria. Until now, there have been only six IE cases caused by K. kristinae infections reported in the literature. Thrombocytopenia and platelet dysfunction can manifest in IE cases and are related to the clinical outcome. Different mechanisms have been hypothesized to explain thrombocytopenia in IE. Case report: We report the case of a 25-year-old female patient who complained of palpitation two weeks before admission. Initially, the patient complained of fever arising six months before admission. Blood cultures showed S. alactolyticus and K. kristinae. Echocardiography examination showed vegetation on anterior and posterior mitral valves with severe mitral regurgitation. During hospitalization, the patient also suffered from severe thrombocytopenia without bleeding signs. On day 16 after hospitalization, the patient suddenly complained of abdominal pain and dyspnea. The patient was declared deceased with cause ...

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. A intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.