A Novel Case of Yamaguchi Syndrome in a Hispanic Male.

Yamaguchi syndrome or apical hypertrophic cardiomyopathy (HCM) is a unique variant of HCM. It is characterized by localized hypertrophy involving the left ventricular apex rather than the left ventricular septum. This syndrome has been traditionally seen in the Asian population, particularly those of Japanese descent. We present an interesting case of Yamaguchi syndrome seen in a Hispanic male. A 48-year-old Hispanic male presented with epigastric tenderness and was admitted to the hospital for a non-ST-segment elevation myocardial infarction. His diagnostic catheterization revealed no significant coronary artery disease. However, his echocardiogram revealed apical hypertrophy and narrowing of the left ventricular cavity at the apex, consistent with Yamaguchi syndrome. Case reports such as ours serve to help clinicians broaden their differential diagnoses when approaching patients with acute coronary syndrome-like symptoms to include diagnoses such as Yamaguchi syndrome.

Neuromyelitis Optica in a Healthy Female After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccine.

Neuromyelitis optica spectrum disorder is an autoimmune demyelinating disease with high relative prevalence in the East Asian population. Clinical manifestations include optic neuritis, longitudinally extensive transverse myelitis, area postrema syndrome, brainstem syndromes, and diencephalic syndromes. In this case report, we present a case of neuromyelitis optica spectrum disorder that developed 10 days after the first dose of the severe acute respiratory syndrome coronavirus 2 mRNA-1273 vaccine. The patient was a previously healthy White female, completely independent and functional at baseline. She presented with bilateral lower-extremity numbness/tingling, weakness, and urinary retention. Although her neuromyelitis optica IgG was negative, the MRI was consistent with neuromyelitis optica involving and spanning longitudinally the C6-T2 vertebrae. She was treated with IV steroids and her symptoms improved. Given the novelty of the COVID-19 vaccines and the paucity of literature regarding their adverse effects, case reports such as ours provide unique information that aids healthcare providers in accurately diagnosing and treating patients, ultimately minimizing long-term neurologic deficits.

A Retrospective Cohort Study on Predictors for Rehospitalizations With Recurrence of Atrial Fibrillation Post-Catheter Ablation for Atrial Fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is increasing in prevalence due to an aging population. Although medications for rhythm and rate control remain the first-line treatment options for many patients, difficulties can include arrhythmia relapse and drug side effects. Catheter ablation or radiofrequency is an alternative treatment modality that can isolate where ectopic arrhythmic sites originate. Several previous studies have examined post-ablation complications and hospitalization rates for arrhythmia recurrence. However, many of these studies used patient data from before 2015. We examined the following data using recent records: pre-procedural patient characteristics, rates of post-procedural hospitalizations with documented recurrence of AF, and patient risk factors associated with these recurrences.

Is All Hypocalcemia Due to Low Parathyroid Hormone?: An Unusual Case of Pseudohypoparathyroidism in a Young and Healthy Patient.

Pseudohypoparathyroidism is a rare disorder that is characterized by hypocalcemia and hyperphosphatemia that are unresponsive to the parathyroid hormone. We present a unique case of pseudohypoparathyroidism seen in a 33-year-old male who presented with abnormal laboratory findings including hypocalcemia, hypokalemia, hypomagnesemia, hyperphosphatemia, and positive Trousseau's sign. Pseudohypoparathyroidism is a rare phenomenon, with an estimated prevalence between 0.3 and 1.1 cases per 100,000. Genetic mutations have been noted to play a role in the presentation of pseudohypoparathyroidism. Clinical phenotypical manifestations can include brachydactyly, short stature, a stocky build, and a round face. Similar routine follow-up and treatment as traditional hypoparathyroidism is practiced. This case highlights a unique endocrinologic pathology that clinicians should be more aware of, as it can be confused with hypoparathyroidism.

Wernicke Encephalopathy in an Elderly Patient Due to Chronic Malnutrition From an Atypical Diet.

Wernicke encephalopathy has traditionally been associated with chronic alcohol abuse leading to thiamine deficiency. Clinical symptoms include mentation change, gait ataxia, and oculomotor abnormalities. However, it is often an underdiagnosed condition in patients suffering from chronic malnutrition, especially in the West. We examine a unique case of non-alcoholic Wernicke encephalopathy in an elderly patient. The patient had a long history of chronic malnutrition due to her atypical diet, consuming an unbalanced diet deprived of thiamine, unbeknownst to her. She presented with symptoms of encephalopathy, recurrent falls, and pupillary changes. After exhausting all other therapeutic interventions, she received a thiamine infusion; her mentation and other symptoms improved dramatically.  Thiamine deficiency can lead to severe complications, including Wernicke encephalopathy and cardiomyopathy. Wernicke encephalopathy can progress to Korsakoff syndrome, which is characterized by amnesia and confabulation. Case reports, such as ours, may remind clinicians to keep thiamine deficiency as a viable differential while evaluating acute encephalopathy, especially in the malnourished geriatric population.

Obstructive Sleep Apnea and Pulmonary Hypertension: A Review of Literature.

Obstructive sleep apnea (OSA) is a disease process involving recurrent pharyngeal collapse during sleep, resulting in apneic episodes. Clinically, symptoms can include snoring, sudden awakening with a choking-like sensation, excessive somnolence, non-restorative sleep, difficulty in starting or maintaining sleep, and fatigue. It results in impaired gas exchange, subsequently causing various cardiovascular, metabolic, and neurocognitive pathologies. Historically, OSA has been underdiagnosed and undertreated, especially in women. OSA is associated with WHO (World Health Organization) class III pulmonary hypertension (PH) or PH due to lung disease. PH is a concerning complication of OSA and thought to occur in roughly 20% of individuals with OSA. The pathogenesis of PH in OSA can include pulmonary artery vasoconstriction and remodeling. Patients suffering from OSA who develop PH tend to have worse cardiovascular and pulmonary changes. We present a thorough review of the literature examining the interplay between OSA and PH.

Limited Scleroderma-Induced Pulmonary Arterial Hypertension Resulting in Impaired Postoperative Respiratory Function.

Limited scleroderma falls under the umbrella of systemic sclerosis, an autoimmune disease that presents with multiorgan dysfunction that includes pulmonary arterial hypertension. We examine a case of pulmonary arterial hypertension in an elderly nonsmoker with a history of limited scleroderma.  The patient presented with abdominal tenderness and was diagnosed with a sigmoid colonic stricture. She underwent laparoscopic bowel resection. During and after her surgery, she suffered from worsening respiratory function and decompensated, developing a large pleural effusion that led to a thoracentesis and a prolonged hospital course. Patients with scleroderma can develop acute symptoms involving several organ systems, including the colonic tract and lungs, as seen in our patient. A thorough workup and continuous close management and monitoring are necessary to avoid further complications in these patients, especially in the postoperative period.

Bouveret Syndrome: A Rare Form of Gallstone Ileus.

Bouveret's syndrome is a rare variant of gallstone ileus characterized by a gastric outlet obstruction due to the impaction of a gallstone lodged in the duodenum, resulting from a cholecystoduodenal fistula. It accounts for only one to three percent of cases of gallstone ileus. We examine a case of Bouveret syndrome in an elderly Japanese female who presented with vomiting and decreased oral intake. Subsequent imaging found a gallstone ileus due to a bilioduodenal fistula. She underwent exploratory laparotomy enterolithotomy which found a large black gallstone located in the small bowel and confirmed the presence of the fistula. Despite its relative rarity, Bouveret syndrome carries a high risk of morbidity and mortality.

Thymoma Presenting as a Pleural-Based Mass.

We present a unique case of a satellite pleural-based thymoma. The patient is a 66-year-old Caucasian female with a history of a left pericardial soft tissue mass. She had been asymptomatic. Chest radiograph incidentally revealed an acute increase in the size of the mass. CT scan identified a 5.6 X 5.2 X 4.2 cm mediastinal mass in the left infrahilar region along the left lateral pericardium. Positron emission tomography (PET) scan showed the mass had an increased F18 FDG uptake with standardized uptake value (SUV) of 7.2. Left thoracotomy resected a 81g, 6 X 5.5 X 5.0 cm tan-pink well-encapsulated pedunculated mass displacing the left phrenic nerve. The mass was under the parietal pleura and not attached to the pericardium. Immunohistochemical profile identified the tumor as a thymoma, B1 type. Thymomas are relatively rare in the United States, pleural-based thymomas even more so. Early detection of thymomas is critical to avoid late-stage growths. Pericardial involvement of thymomas increases risk of pericardial effusion, tamponade and a complicated thymectomy. Pleural-based thymomas can result in diaphragmatic paralysis secondary to phrenic nerve involvement.

Complicated Post-Partum HELLP Syndrome Causing Acute Renal Failure and a Spontaneous Acute Subdural Hematoma.

HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and thrombocytopenia. It is a devastating illness that typically occurs in the third trimester of gestation. We present a unique case of complicated post-partum HELLP syndrome. The patient was a 34-year-old Caucasian G1PO woman at 40 weeks' gestational age who presented for induction of labor. She underwent successful vaginal delivery. However, postoperatively the patient developed HELLP syndrome complicated by acute renal failure. She was transferred to the intensive care unit, where her renal function continued to decline, ultimately necessitating hemodialysis. She subsequently spontaneously developed an acute subdural hematoma. Most cases of HELLP syndrome occur in the third trimester, whereas fewer manifest post-partum. The pathophysiology of HELLP syndrome is poorly understood. While the defining organ of injury in HELLP syndrome is the liver, both kidney injury and spontaneous subdural hematomas can occur, as seen in this patient. The gold standard therapy for HELLP syndrome is prompt delivery of the fetus. HELLP syndrome continues to be a serious constellation of symptoms that can affect women late in their gestational period. As illustrated in this case report, prompt diagnosis of HELLP syndrome and appropriate management is critical.

Progressive Collateral Stenosis Leading to Symptomatic Chronic Total Occlusion.

We present a case of chronic total occlusion (CTO) in a functional 79-year-old female with no past history of coronary artery disease, who was previously asymptomatic due to robust collateral circulation. A 79-year-old Caucasian female presented to the emergency department complaining of chest pain radiating to the neck, jaw, left arm with associated numbness in the left fingers, that had started earlier in the day. She has no previous cardiac history and never had similar symptoms before. Troponin levels were negative. Nuclear stress test showed findings worrisome for ischemia and was a high-risk exam. The patient underwent diagnostic angiography. There was complete total occlusion of the mid right coronary artery, with collateral circulation supplying the distal right coronary artery territory. Ultimately, it found that progressive stenosis of the left anterior descending (LAD) artery led to inadequate collateral circulation and completely occluded the right coronary artery's territory, causing the patient's new-onset angina. Afterwards, the patient underwent percutaneous coronary intervention (PCI). Successful implantation of two drug-eluting stents occurred. The final angiographic result was 0% residual stenosis and Thrombolysis in Myocardial Infarction (TIMI)-3 flow. CTO affecting one or more coronary arteries is not uncommon in patients taken to the catheterization laboratory. However, despite recent advancements in PCI outcomes, treatment of CTO by PCI remains relatively low, due to fear of adverse outcomes such as cardiac perforations. Recent research has supported the safety of performing PCIs on patients with CTO. This case report further reinforces the need to approach treating CTO via angioplasty.