Calcific embolus resulting in ST elevation myocardial infarction: A rare complication of mitral annular calcification.

Coronary embolism is an uncommon mechanism of myocardial infarction in comparison with atherosclerotic plaque rupture. We present a unique case of an anterior ST elevation myocardial infarction as a result of coronary embolism, the source of which appears to be calcific debris from mitral annular calcification (MAC). Although embolic phenomena in the setting of MAC has been documented previously, particularly in the setting of acute ischemic stroke, to our knowledge this is the first reported case in the literature where MAC alone appears to have resulted in a coronary embolic event. .

Internal insulation breaches in an implantable cardioverter-defibrillator lead with redundant conductors.

BACKGROUND: Internal insulation breaches (IBR) may result in implantable cardioverter-defibrillator lead failure and adverse clinical events. Concerns exist that the Durata lead may be prone to IBR. OBJECTIVE: The goals of this study were to assess Durata failures in the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database and compare them to failures in MAUDE for Endotak Reliance and Sprint Quattro Secure (QS) leads. METHODS: We searched the MAUDE database from 2008 to 2018 for IBR and other failure modes. Included were explanted leads whose manufacturers found an insulation or conductor defect not caused by extrinsic factors. RESULTS: The MAUDE search found 1011 qualifying leads. The cause of failure differed among leads (P < .001). The primary cause of Durata failure was IBR (293 of 316 leads [93%]), with IBR accounting for 47% (137 of 293); few QS (9 of 523 [1.7%]) and no Endotak Reliance leads failed because of IBR (P < .001). Durata IBR were responsible for 11 failures to treat ventricular tachycardia/ventricular fibrillation, and all were caused by high-voltage (HV) shorts between the proximal superior vena cava coil and a distal right ventricular coil cable (n = 10) or sensing conductor (n = 1); low values of HV impedance were found in these leads during defibrillation threshold testing (n = 3), after a shock or aborted shock (n = 7), and by an alert (n = 1). Inappropriate therapy was caused by 51 Durata IBR, but no QS IBR. CONCLUSION: Durata implantable cardioverter-defibrillator leads are susceptible to IBR that may result in failure to treat ventricular tachycardia/ventricular fibrillation or inappropriate therapy; such failures may occur without forewarning. HV testing of Durata leads may be indicated during pulse generator replacement or when an insulation defect is suspected.

Spontaneous Coronary Artery Dissection in a Healthy Woman after Initiating a High-Intensity Interval Training Workout Program.

Although several risk factors are associated with spontaneous coronary artery dissection, strenuous activity is an uncommon risk factor for women. We report a case of a patient who developed spontaneous coronary artery dissection shortly after starting F45, a highly strenuous fitness program. As high-intensity exercise regimens become more mainstream, clinicians should more readily consider spontaneous coronary artery dissection in young patients with history of recent strenuous activity when presenting with symptoms concerning for acute coronary syndrome.