Atherosclerotic coronary artery disease (ACAD) is a major cause of global morbidity and mortality, characterized as an inflammatory process due to damage to blood vessel walls by risk factors like aging, hyperlipidemia, hypertension, smoking, and diabetes. Infectious agents, including Chlamydia pneumoniae (Cpn), Cytomegalovirus (CMV), and Helicobacter pylori (HP), have been implicated in ACAD’s pathophysiology. A study with 56 subjects undergoing coronary artery bypass grafting (CABG) aimed to detect Cpn, CMV, and HP DNA in unaffected artery segments and explore associations with disease progression and inflammation markers. The study found infectious agents’ DNA in 21.4% of samples, HP in eight samples, and CMV and Cpn in four samples each. Significant correlations were observed between HP and overweight or obese subjects, as well as between the presence of infectious agents and inflammation marker values. An association between HP and renal function was also noted. The findings reaffirm previous discoveries of infectious agents in non-clinically affected arteries used as CABG grafts. Correlations identified between the presence of HP, CMV, and Cpn DNA in grafts and several biomarkers of inflammation and obesity emphasize the potential role of these infectious agents in ACAD pathogenesis.

Infective endocarditis (IE) of the tricuspid and pulmonary valve accounts for 5 to 10% of all IE cases and, compared with left-sided IE, is often associated with intravenous (i.v.) drug use, presence of intracardiac devices, and central venous catheters (CVCs), including permanent—Hickman catheter (HC). We report a case of a 71-year-old female patient on a chronic hemodialysis (HD) program who had developed IE. Her first symptoms were fever and malaise. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) examinations were performed, revealing vegetations on the tip of HC and the anterior and posterior leaflets of the tricuspid valve (TV). Three blood culture bottles were positive for Enterococcus spp. The HC was replaced with a new CVC to continue HD. After a six-week antibiotic treatment, most clinical symptoms were resolved, and there was a decrease in vegetation size with normalization of inflammatory markers and negative follow-up blood cultures. After this initial improvement in the patient’s condition, the clinical course was complicated by the development of Citrobacter koseri bacteremia and sepsis. Despite adequate antibiotic therapy, the condition progressed to septic shock, which was soon followed by a fatal outcome. IE treatment in HD patients requires long-term broad-spectrum antibiotic therapy, and also, in patients without arteriovenous fistula (AVF), the CVC should be replaced after each HD during IE and sepsis treatment to minimize the patient’s exposure to a foreign body that is susceptible to bacterial colonization. A colonized foreign body is a focus for sustained and spreading infection, and its presence prevents adequate antibiotic treatment until the focus of infection is removed.

Cardiac device–related endocarditis as a device-therapy complication is a growing problem due to higher life expectancy and the increasing number of abandoned leads and subclinical symptoms. We reported a case of a 47-year-old woman with an implanted pacemaker who was admitted to the clinic for cardiology due to the right-sided device-related infective endocarditis of the pacemaker leads with vegetations, predominantly in the right atrium and right ventricle and complicated by pulmonary embolism. Several years after pacemaker implantation, she was diagnosed with systemic lupus erythematosus and started immunosuppressive therapy. The patient was treated with prolonged intravenous antibiotic therapy. The atrial and ventricular lead was extirpated, and the posterior leaflet of the tricuspid valve was shaved.

Acute myocardial infarction (MI) and stroke occurring simultaneously in one patient is a rare clinical event. These medical emergencies involve many diagnostic and treatment challenges due to different causes, treatment modalities, and shifting priorities. Presence and exacerbation of bronchiectasis has been considered as a risk factor for atherosclerotic cardiovascular and cerebrovascular diseases and can trigger a cardioembolic stroke. We describe a case of a 59-year-old male patient with bronchiectasis who was treated at our tertiary care center due to concurrent MI and stroke.

Introduction: Brucellosis is one of the most common zoonotic infections in the world. Cardiac complications of the disease are usually in the form of endocarditis, and, to a lesser extent, in the form of myopericarditis. Case: We report the case of a 34-year-old female admitted with signs of fever, nausea, and headache. The patient came from Libya, where she drank unpasteurized milk. Whright-Coombs test and blood confirmed Brucella species infection, while transoesophagal echocardiogram revealed a thrombotic mass on the tricuspid valve that required cardiac surgery and antibiotic treatment, leading to complete recovery. The second case was a 37-years-old male admitted with suspected acute coronary syndrome, where further diagnostics excluded occlusions of coronary arteries and found Brucella species infection and signs of myocardial and pericardial involvement that reacted well on treatment (combination of doxycycline and rifampicin). Discussion: Brucellosis is commonly seen in people working with farm animals or using unpasteurized milk but is still often misdiagnosed. Conclusions: Tricuspid valve endocarditis, as well as isolated myopericarditis, are rare complications of Brucellosis, which can be fatal if not diagnosed and treated on time.

Infective endocarditis (IE) is associated with severe complications and high in-hospital mortality, ranging from 15% to 30%. Indicators of fatal outcome include the development of heart failure, septic shock, local uncontrolled infection or periannular complications, Staphylococcus aureus as a causative agent, negative blood cultures, and unoperated patients. This retrospective study determined clinical features and the indicators of in-hospital mortality in a cohort of 96 patients hospitalized in the cardiology clinic of the university hospital from January 1, 2018, to January 1, 2022, with definite infective endocarditis. Two-thirds of the patients were male, with a mean age of 53.5 years. Subjects with a fatal outcome (17.7%) were dominantly male (82%), and significantly older than the survivor group (61.6 vs. 51.7 years; p=0.014). There was a significantly higher presence of chronic kidney failure and malignancies in the fatal outcome subjects. Most significant complications of IE were heart failure (94.1% of subjects with a fatal outcome and 16.7% of survivors, p<0.001) and septic shock (82.4% vs. 1.3%; p<0.001). Surgery was performed in 11.8% of subjects with a fatal outcome and 57.7% of survivors (p=0.001). Cardiogenic shock and septic shock were the most common causes of death (35.3% and 23.5%, respectively). This retrospective study indicated the need for early recognition of high-risk IE patients and conservative and surgical treatment in the prevention of complications and fatal outcomes.