The dilemma of refractory hypoxemia after inferior wall myocardial infarction.

Patent foramen ovale (PFO) occurs in 25% of people. The decision on whether to close the PFO found after myocardial infarction and specifically right ventricular infarction is debated, with no solid guidelines addressing this subject. Here we present the case of a 59-year-old man who presented with a myocardial infarction and was found to have PFO. He was treated with revascularization of the culprit artery, followed by supportive care.

Double right coronary artery and its clinical significance: Review of the literature.

Double right coronary artery is a very rare anomaly that is usually discovered incidentally during conventional coronary angiography. Double right coronary artery may have clinical implications in symptomatic patients requiring percutaneous coronary intervention and may be associated with other congenital abnormalities, myocardial ischemia and ventricular fibrillation in the absence of atherosclerosis. Here the reported cases in the literature are reviewed and a case of double right coronary artery with ischemia in inferior left ventricular wall is presented.

Hypertrophic Cardiomyopathy from A to Z: Genetics, Pathophysiology, Imaging, and Management.

Hypertrophic cardiomyopathy (HCM) is a heterogeneous group of diseases related to sarcomere gene mutations exhibiting heterogeneous phenotypes with an autosomal dominant mendelian pattern of inheritance. The disorder is characterized by diverse phenotypic expressions and variable natural progression, which may range from dyspnea and/or syncope to sudden cardiac death. It is found across all racial groups and is associated with left ventricular hypertrophy in the absence of another systemic or cardiac disease. The management of HCM is based on a thorough understanding of the underlying morphology, pathophysiology, and clinical course. Imaging findings of HCM mirror the variable expressivity and penetrance heterogeneity, with the added advantage of diagnosis even in cases where a specific mutation may not yet be found. The diagnostic information obtained from imaging varies depending on the specific stage of HCM-phenotype manifestation, including the prehypertrophic, hypertrophic, and later stages of adverse remodeling into the burned-out phase of overt heart failure. However, subtle or obvious, these imaging findings become critical components in diagnosis, management, and follow-up of HCM patients. Although diagnosis of HCM traditionally relies on clinical assessment and transthoracic echocardiography, recent studies have demonstrated increased utility of multidetector computed tomography (CT) and particularly cardiac magnetic resonance (MR) imaging in diagnosis, phenotype differentiation, therapeutic planning, and prognostication. In this article, we provide an overview of the genetics, pathophysiology, and clinical manifestations of HCM, with the spectrum of imaging findings at MR imaging and CT and their contribution in diagnosis, risk stratification, and therapy.

Contrast-enhanced cardiac magnetic resonance imaging.

Cardiac magnetic resonance (CMR) imaging has significantly evolved in the past decade and is well established in the evaluation of coronary artery disease (CAD). The evaluation of cardiac anatomy and contractility by high-resolution CMR can be improved by using intravenous administration of gadolinium-based contrast agents. Delayed enhancement CMR imaging has become the gold standard for quantification of myocardial viability in CAD. Contrast-enhanced CMR imaging may circumvent the need for endomyocardial biopsy or localize the involved regions, thereby improving the diagnostic yield of this invasive procedure. The application of contrast-enhanced CMR as an advanced imaging technique for ischemic and nonischemic diseases is reviewed.

Cardiovascular complications of cocaine: imaging findings.

Cocaine is the second most commonly abused illicit drug in the US and the most common one involved in emergency department visits, the majority of which are related to the cardiovascular system. Cardiovascular complications related with cocaine abuse include myocardial ischemia and infarction, myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic dissection, thrombosis, stroke and cerebral hemorrhage, and different forms of visceral ischemia, among others. In an era where cocaine use has reached epidemic proportions, it is necessary for the radiologist to understand the pathophysiology, clinical presentation, and imaging characteristics of its cardiovascular complications.