An Unusual Presentation of Left Ventricular Non-compaction Cardiomyopathy in an Elderly Patient.

Left ventricular non-compaction cardiomyopathy (LVNC) is a rare cardiomyopathy. The true prevalence of LVNC is unclear. The clinical presentation of LVNC varies widely from asymptomatic to end-stage heart failure or sudden cardiac death, and the diagnostic criteria are not standardized. Moreover, there is an increased risk for thromboembolic events with LVNC. We present an unusual case of LVNC first diagnosed in a septuagenarian.

Cardiac Rhabdomyoma in Adult.

Cardiac rhabdomyoma is a hamartoma comprised of cardiac myocytes. It is the classic cardiac manifestation of tuberous sclerosis complex (TSC) which is an autosomal dominant genetic syndrome with multi-organ involvement, but highly variable phenotype. Cardiac rhabdomyoma is most commonly diagnosed in infancy, 70 to 90% of whom have TSC. However, TSC-associated cardiac rhabdomyoma usually shows spontaneous regression within the first two years of life and hence is extremely rare in adults. We present a 34-year-old woman with TSC who was found to have a cardiac rhabdomyoma when she was referred to the cardiology clinic for evaluation and to establish care. Cardiac rhabdomyoma is usually asymptomatic. However, depending on size and location, it can cause outflow or inflow tract obstruction and aberrant electrical conduction. Hence, appropriate surveillance is important.

Chronic Aortocaval Fistula Presenting as Right Heart Failure: A Case Report and Review of Literature.

Iatrogenic aortocaval fistula (ACF) is an infrequent cause of heart failure. A 65-year-old man presented to the cardiology clinic eight months after an open abdominal aortic aneurysm (AAA) repair. He developed predominantly right-sided cardiac failure after surgery, with minimal response to guideline-directed medical therapy. A transthoracic echocardiogram revealed decreased right-sided systolic function. A computed tomography angiographic scan of the abdomen revealed a large ACF at the distal end of the AAA repair. The patient was referred for closure surgery. ACF should be considered in a patient with unexplained right heart failure, especially in the setting of a known AAA or recent AAA repair.

Large Unilateral Pleural Effusion with Pacemaker-associated Post-cardiac Injury Syndrome.

Post-cardiac injury syndrome (PCIS) as a delayed complication of permanent pacemaker implantation has rarely been reported in the literature. A 67-year-old man who recently underwent a dual chamber permanent pacemaker implantation came to the hospital for increasing dyspnea and chest discomfort. A diagnosis of pericarditis was made, and the patient was discharged on ibuprofen therapy. He presented to our facility a month later with worsening dyspnea and chest discomfort despite recommended therapy. A computerized tomography (CT) scan of the chest revealed a large right-sided pleural effusion, requiring chest tube placement and drainage. A pleural fluid analysis revealed exudative effusion with elevated pH. The pleural fluid analysis was negative for infectious etiology. A perforation of the atrial wall was considered given the proximity of the atrial pacer lead and overlying pericardial effusion. However, no conclusive evidence of cardiac chamber perforation was found on echocardiogram or CT scan. A pacemaker interrogation was normal. A repeat CT scan showed the resolution of pleural effusion, and the chest tube was discontinued. A possible explanation for the absence of predominant pericardial findings may be the previous use of non-steroidal anti-inflammatory therapy.