A review on cardiac manifestation of parasitic infection.

Parasites are uncommon causes of heart diseases except in endemic areas, and very few data are available which deals with parasites infecting human heart. However, literatures demonstrated that certain parasites such as protozoan and helminths can lead to significant cardiac complications. Although all organs can be affected, the heart and the lungs are the most frequently affected organs either directly or indirectly. It may involve all layers of the heart including pulmonary vasculature, thus producing a wide variety of clinical manifestations, which may present as myocarditis, pericarditis, cardiomyopathy, endomyocardial fibrosis, and pulmonary hypertension.

Renal Subcapsular Hematoma Due to Reperfusion Injury Following Renal Angioplasty in Fibromuscular Dysplasia: A Dilemma in Diagnosis and Management.

Fibromuscular dysplasia (FMD) is a potentially treatable cause of renovascular hypertension and it typically affects young females. FMD usually involves distal two-thirds of the renal artery and percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice for FMD with resistant hypertension. PTRA is a safe procedure with minimal complications. However, renal subcapsular hematoma due to reperfusion injury is a rare complication following PTRA. A 32-year-old male presented with resistant hypertension. Arteriography of renal arteries showed >90% stenosis of ostial-proximal left renal artery with a string of beads appearance. PTRA was performed with the deployment of a 4 x 10 mm balloon-expandable stent in the stenotic segment of the left renal artery. However, computed tomography of the abdomen revealed massive left perinephric subcapsular hematoma without peritoneal collection. As the patient was hemodynamically stable, no invasive intervention was done, and discharged without requiring any anti-hypertensive medication. Putative reperfusion injury may provoke bleeding complications after renal angioplasty in a case of long-standing renal artery stenosis and can be managed conservatively with close surveillance in certain cases.

Giant Coronary Aneurysm Causing Ostial Occlusion of Coronary Artery by Mass Effect: A Case Report.

Coronary atherosclerosis can rarely lead to complications like giant coronary aneurysm (GCA), and acute myocardial infarction (AMI) due to thrombosis in the GCA is even rarer. Multimodality imaging is preferred over relying solely on selective coronary angiogram in such cases due to the limitations of invasive coronary angiogram in visualizing thrombosed aneurysms. We report a rare case of a patient with ST-elevation myocardial infarction caused by ostial occlusion of a right coronary artery (RCA) due to mass effect created by thrombosis in a GCA, thereby highlighting a mechanism of AMI that has not been previously described in GCA. Multimodality imaging led to the correct diagnosis and detection of the underlying mechanism, which had been completely missed by invasive coronary angiography (ICA). We also discuss the utility of multimodality imaging in such cases.

Eustachian valve myxoma: a rare cause of Budd-Chiari syndrome.

Budd-Chiari syndrome caused by right atrial myxomas are extremely rare. We report the case of a patient who presented with chronic liver disease who upon consequent investigation was found to have a mass occupying the right atrium and ventricle consistent with cardiac tumour. Intraoperatively, a giant mass was removed from the right atrium with the tumour stalk originating from the Eustachian valve. Histologic findings were consistent with myxoma.

Hirayama Disease: A Rare Disease with Unusual Features.

Hirayama disease, also known as monomelic amyotrophy (MMA), is a rare cervical myelopathy that manifests itself as a self-limited, asymmetrical, slowly progressive atrophic weakness of the forearms and hands predominantly in young males. The forward displacement of the posterior dura of the lower cervical dural canal during neck flexion has been postulated to lead to lower cervical cord atrophy with asymmetric flattening. We report a case of Hirayama disease in a 25-year-old Indian man presenting with gradually progressive asymmetrical weakness and wasting of both hands and forearms along with unusual features of autonomic dysfunction and upper motor neuron lesion.