Coronary Cameral Fistula: A Rare Case Presenting With Non-ST-Segment Elevation Myocardial Infarction and Pulmonary Arterial Hypertension.

Coronary cameral fistulas (CCFs) are uncommon congenital or acquired anomalies characterized by abnormal connections between a coronary artery and a cardiac chamber. While often asymptomatic and incidentally detected, symptomatic presentations are rare, and symptoms may vary depending on the size and location of the fistula. We present the case of a 67-year-old female with complaints of intermittent typical cardiac chest pain and exertional dyspnea. Further evaluation revealed a CCF originating from the left anterior descending coronary artery and the left ventricle. Additionally, the patient was found to have pulmonary hypertension on right heart catheterization. This case highlights the importance of considering CCF in the differential diagnosis of chest pain, particularly in the presence of atypical symptoms and associated pulmonary hypertension (WHO Group 4). Further research is warranted to elucidate the optimal management strategies for symptomatic CCF, especially in cases complicated by pulmonary hypertension.

Multiple Primary Malignancies With Hypercalcemia Presentation: A Case Report.

Multiple primary malignancies (MPMs) are defined as having more than one primary malignancy and when each tumor is histologically distinct and unrelated to the others. Multiple risk factors have been found to be associated with MPMs. These include familial syndromes, sequela from treatments of previous malignancies, and environmental factors such as smoking, alcohol consumption, obesity, and male sex. Hypercalcemia has a well-known association with malignancy and is often the first abnormality that leads to further testing. Lung cancer followed by colorectal cancer has the highest mortality of all cancers in the USA, with adenocarcinoma being the most prevalent histological subtype. Further, estimates show that those with one malignancy have a 1.29 times higher risk of developing another malignancy. Hereby, we present a case of a patient with squamous cell carcinoma of the lung who presented with hypercalcemia and incidentally was found to have another primary adenocarcinoma of the colon.

Heart Block Caused by Ticagrelor Use in a Patient Who Underwent Adenosine Diastolic Fractional Reserve Assessment: A Case Report.

Ticagrelor is a direct and rapid-acting antagonist of the P2Y12-adenosine diphosphate receptor found on platelets. The drug is recommended as a first-line antiplatelet agent in patients with acute coronary syndromes, as evidenced in its superiority compared to clopidogrel according to the Platelet Inhibition and Patient Outcomes study. Specifically, the mechanism of action has been proven to show higher inhibition and less variability in its action on P2Y12 receptors compared to clopidogrel. Additionally, ticagrelor inhibits the equilibrative nucleoside transporter 1 adenosine transporter protein leading to an increased concentration of adenosine in the blood, particularly at sites of ischemia. This effect increases the biological efficacy of ticagrelor in terms of cardioprotection, anticoagulation effects, and anti-inflammatory effects. However, the effects are also thought to be responsible for some of the adverse pharmacological effects reported with ticagrelor, such as bradycardia and ventricular pauses > 3 seconds. Herein, we report a case of recurrent sinus arrest and ventricular asystole in a patient pre-treated with ticagrelor and subsequent physiological assessment of a coronary lesion with fractional flow reserve using intravenous adenosine infusion.

Clinical characteristics and outcomes of patients admitted to hospitals for posterior reversible encephalopathy syndrome: a retrospective cohort study.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus. METHODS: We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition. RESULTS: A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality. CONCLUSION: PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.

Meningitis from invasive Streptococcus agalactiae in a healthy young adult.

Streptococcus agalactiae is well known to be a potential etiology of bacterial meningitis in neonates. Invasive S. agalactiae has been also reported in nonpregnant adults. Among adults, the incidence of invasive group B Streptococcus (GBS) has been increasing 2-4 times in the past 2 decades. Chronic medical disease was suspected to increase the susceptibility for invasive GBS, especially diabetes mellitus. There was only one case reported to have GBS meningitis from acute otitis media infection in otherwise healthy individual. Hereby, we are reporting the second invasive GBS meningitis from acute otitis media infection with mastoiditis.

Metastatic Osteoarticular Infective Endocarditis by Methicillin-sensitive Staphylococcus Aureus.

Infective endocarditis (IE) is a well-known complication of bacteremia with high-risk microorganisms such as Staphylococcus and Streptococcus. Skin and soft tissue infections with Staphylococcus remain a significant cause of bacteremia and IE, even with proper prompt management of the source of infection and the absence of risk factors. Although methicillin-resistant Staphylococcus aureus is a well-known etiology for osteoarticular septic emboli in IE, healthcare providers should be aware of the hidden virulence of methicillin-sensitive Staphylococcus aureus for metastatic osteoarticular infection. We report a case of IE with septic vertebral embolic lesion complicating a properly managed acute paronychia.

Spontaneous Coronary Artery Dissection of the Left Main Coronary Artery.

Heart attacks in young populations are frequently misdiagnosed as reflux disease or anxiety. Spontaneous coronary artery dissection (SCAD) is a coronary artery disease that classically manifests around the age of 45 years and has a fatal outcome if missed. Since it was first described in 1931, our understanding of SCAD has evolved tremendously, particularly with the advent of advanced coronary angiography. Electrocardiograms can show abnormality in the ST-segment, with an elevation of cardiac damage markers. The involvement of the coronary arteries is variable. The left main coronary artery is frequently reported as the main culprit. We are hereby reporting a case of SCAD in a young woman who presented with a heart attack. Particularly, her age is younger than the reported cases, cardiac catheterization revealed a left main artery dissection with a thrombolytic extension, and her complicated case was managed with coronary artery bypass and heart transplantation.