Elevated pre-procedural glucose is associated with greater risk for CI-AKI in patients without known diabetes who undergo coronary angiography in the setting of acute myocardial infarction. Measures used to prevent CI-AKI should be considered in these patients.

There was an increase in bivalirudin use and a lower incidence of bleeding after the incorporation of individualized bleeding risk estimates into clinical practice. This implementation led to a reversal of the risk-treatment paradox, through a rational increase in bivalirudin use in patients at intermediate and high bleeding risk and decreased use in lower-risk patients.

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W e report 2 cases of fulminant myocarditis caused by the H1N1 strain of influenza. As the incidence of H1N1 influenza infection continues to rise, physicians should be aware of this rare and potentially fatal complication because early diagnosis and aggressive supportive measures are imperative. Case 1A 52-year-old woman presented with a 3-day history of chest pain, dyspnea, diffuse myalgias, and fever. The ECG demonstrated low voltage with diffuse ST segment elevation ( Figure 1). The troponin I was 5 ng/mL (0 to 0.75 ng/mL), and B-type natriuretic peptide was 1629 pg/mL (0 to 100 pg/mL). The patient was transferred to our facility for urgent left heart catheterization. On presentation, her blood pressure was 87/50 mm Hg. Coronary angiography demonstrated normal coronary arteries. Dopamine was started for blood pressure support. The patient was treated with oseltamivir 150 mg twice a day and IV ceftriaxone for suspected viral and/or bacterial myocarditis and pneumonitis. A transthoracic echocardiogram demonstrated global left ventricular systolic dysfunction with an ejection fraction of 29% and a trivial pericardial effusion. Blood cultures and rapid influenza A and B antigen tests were negative. On day 3 of hospitalization, the patient had worsening respiratory distress requiring mechanical ventilation. A repeat transthoracic echocardiogram demonstrated an ejection fraction of 10%. A milrinone infusion was started at that time. Right heart catheterization demonstrated a pulmonary artery pressure of 31/20 mm Hg and cardiac index of 1.33 L/(min ⅐ m 2 ) by the Fick method. An