Complete Recovery of an Occluded Coronary Artery Secondary to Spontaneous Coronary Artery Dissection With Medical Management in a Young Patient Presenting With Acute Coronary Syndrome.

Spontaneous coronary artery dissection (SCAD) is defined as a tear in the coronary arterial wall. The clinical presentation is similar to acute coronary syndrome (ACS); however, most of the patients are usually younger and do not have typical risk factors such as atherosclerosis. In addition, the management of SCAD varies from case to case unlike that of ACS due to atherosclerotic plaque rupture; therefore, recognizing and treating it appropriately is crucial. We present a case of a 47-year-old female who presented with typical clinical findings of ACS and was diagnosed with occlusion of the left anterior descending coronary artery due to SCAD on emergent coronary angiography. The patient was treated with medical management only, and a repeat coronary angiography showed complete healing of the vessel wall after six weeks. This article highlights that early diagnosis, recognition, and medical management of SCAD can prevent unnecessary invasive intervention.

Heart in a shell-a cascade of classical findings: a case report.

Background: Idiopathic chronic constrictive pericarditis (CP) is an uncommon yet very important clinical entity as prompt diagnosis and early treatment are affiliated with improved outcomes. We describe an uncommon case of CP with a series of textbook findings and received successful treatment with surgical pericardiectomy (SP). Case summary: A 58-year-old male presented to the emergency department with exertional dyspnoea and anasarca. The past medical history was negative for infections like tuberculosis, viral, etc., connective tissue disease, prior cardiac surgery, human immunodeficiency virus, or any radiation therapy. The vital signs were within normal limits except mild hypoxia while the physical examination was consistent with congestive heart failure. Further investigations with laboratory testing, imaging with chest X-ray, computed tomography, echocardiogram, and invasive study with right heart catheterization were all consistent with idiopathic chronic CP. The patient underwent successful SP with significant improvement in clinical condition. Discussion: This case highlights the classical signs and symptoms along with important diagnostic features of CP. It is uncommon to see all the classical features of CP in one patient as described in the above case. Familiarity with these findings is crucial to make the diagnosis as early treatment is affiliated with improved outcomes.

Fear of COVID-19 leading to late presenting myocardial infarction complicated by cardiogenic shock due to ventricular septal rupture.

Post myocardial ventricular septal rupture (VSR) is one of the most fatal complications of acute myocardial infarction (AMI) in spite of percutaneous and surgical closure. With the advancement of percutaneous coronary interventions in a timely manner, incidence of post MI VSR has declined remarkably. However, the COVID-19) pandemic-related late hospital presentations with AMI increases the possibilities of a potential upward shift in the incidence of post MI VSR. This case report aimed to increase awareness of negative contributions of the current pandemic to AMI and its fatal complications.

Novel Modification of Impella Sheath to Prevent Limb Ischemia.

Limb ischemia is a dreaded complication of large-bore access during prolonged Impella support. We report a novel technique to modify 14F Impella sheath by creating two perfusion holes in the dorsal sheath surface to enable distal limb perfusion via dead space surrounding 9F Impella catheter in flow-occlusive iliofemoral arteries.

Effect of Transradial Catheterisation on Patency Rates of Radial Arteries Used as a Conduit for Coronary Bypass.

BACKGROUND: Transradial catheterisation is known to be associated with occlusion of the radial artery with an estimated incidence of 2-10% (1). There are very few studies looking at the patency of radial artery as a bypass graft after utilisation for catheterisation. METHODS: We conducted a retrospective review of patients undergoing coronary artery bypass grafting (CABG) utilising a radial artery graft. RESULTS: Long term patency rates were 59% in radial artery grafts utilised for catheterisation prior to CABG, compared to 78% if it were not (p= 0.035). CONCLUSION: Patency rates of radial artery grafts are significantly lower when the same radial artery was utilised for angiography prior to coronary artery bypass grafting (CABG).

Tacrolimus as a Rare Cause of Pericardial Effusion in a Renal Transplant Recipient.

Pericardial effusion in a renal transplant recipient represents a diagnostic conundrum with a variety of differential diagnoses. Immunosuppressive medications such as sirolimus have been linked to pericardial effusions in the reported literature. Tacrolimus has been reported to be associated with pleural effusions and ascites. We present a case of a patient with tacrolimus as the likely cause of a recurrent pericardial effusion.

Isolated aortic dissection during coronary intervention: rare but challenging.

Catheter-induced aortic dissection without involvement of the coronary arteries is an extremely rare complication of percutaneous coronary intervention. Management strategies vary depending on clinical scenarios, however, the choice of strategy prompt recognition and early aggressive management is key to patient outcomes.

Emergent echocardiography and extracorporeal membrane oxygenation: Lifesaving in massive pulmonary embolism.

Massive pulmonary embolism is a life-threatening emergency that results in circulatory failure. The main challenges in management are early diagnosis and maintenance of hemodynamic stability. We present a case of a 63-year-old male who was in cardiac arrest. After resuscitation, massive pulmonary embolism was diagnosed with the help of bedside echocardiography and extracorporeal membrane oxygenation (ECMO). We were able to maintain hemodynamic stability and improve hypoxia until the patient underwent embolectomy. This case demonstrates a common presentation of massive pulmonary embolism highlighting the main challenges in its management and the role of echocardiography and ECMO in improving outcomes in such scenarios.

Rituximab induced left bundle branch block.

Rituximab (a monoclonal antibody directed against CD 20) therapy can be acutely complicated by infusion reactions and cardiac arrhythmia on rare occasions. We report the first case of a new onset left bundle branch block (LBBB) after rituximab therapy for Wegener's vasculitis.

Myocardial ischemia in a patient with peripheral vascular disease, an arteriovenous fistula, and patent coronary artery bypass grafts.

Patients with coronary artery disease often have concurrent peripheral vascular disease. The presence of concurrent vascular pathologies can pose unique challenges among patients who have undergone coronary artery bypass grafting utilizing the left internal mammary artery. We describe a patient with peripheral vascular disease and prior history of coronary artery bypass grafting, who presented with recurrent anginal symptoms and an abnormal stress test despite the absence of significant residual unrevascularized coronary artery disease. Additional evaluation led to the identification of an ipsilateral severe subclavian stenosis with a concomitant ipsilateral upper extremity arteriovenous fistula. Patient's symptoms resolved with the treatment of the underlying vascular lesions.

Reverse Takotsubo cardiomyopathy: a story of a critically ill man with transient cardiac dysfunction.

Reverse Takotsubo cardiomyopathy (TCM) is a recently described variant of classic TCM. In contrast to classic TCM, the regional wall motion abnormalities are localized in the basal segments. The condition can be triggered by acute stressful events, including acute medical illnesses. The wall motion abnormalities and left ventricular dysfunction are usually completely reversible. We present a case of an 84-year-old man with a complicated postoperative course after laparoscopic cholecystectomy with multiple laparotomies and recurrent sepsis. Echocardiographic evaluation demonstrated left ventricular dysfunction and wall motion abnormalities in a pattern resembling reverse TCM. He had no significant coronary disease on angiography and follow-up echocardiography showed complete resolution of left ventricular systolic dysfunction and regional wall motion abnormalities.

Another cause of chest pain: Staphylococcus aureus sternal osteomyelitis in an otherwise healthy adult.

Chest pain requires a detailed differential diagnosis with good history-taking skills to differentiate between cardiogenic and noncardiogenic causes. Moreover, when other symptoms such as fever and elevated white blood cell count are involved, it may be necessary to consider causes that include infectious sources. A 53-year-old female with no significant past medical history returned to the hospital with recurrent complaints of chest pain that was constant, substernal, reproducible, and exacerbated with inspiration and expiration. The chest pain was thought to be noncardiogenic, as electrocardiography did not demonstrate changes, and cardiac enzymes were found to be negative for signs of ischemia. The patient's blood cultures were analyzed from a previous admission and were shown to be positive for Staphylococcus aureus. The patient was started empirically on vancomycin, which was later switched to ceftriaxone as the bacteria were more sensitive to this antibiotic. A transthoracic echocardiogram did not demonstrate any vegetation or signs of endocarditis. There was a small right pleural effusion discovered on X-ray. Therefore, computed tomography as well as magnetic resonance imaging of the chest were performed, and showed osteomyelitis of the chest. The patient was continued on intravenous ceftriaxone for a total of 6 weeks. Tests for HIV, hepatitis A, B, and C were all found to be negative. The patient had no history of childhood illness, recurrent infections, or previous trauma to the chest, and had had no recent respiratory infections, pneumonia, or any underlying lung condition. Hence, her condition was thought to be a case of primary sternal osteomyelitis without known cause.

Intravenous lipid emulsion in wide complex arrhythmia with alternating bundle branch block pattern from cocaine overdose.

We describe the management of a young patient who had experienced a cocaine overdose. The patient presented with altered mental status and seizures and subsequently developed a wide complex arrhythmia with a rare alternating bundle branch block pattern. Intravenous lipid emulsion was administered following initial resuscitation and endotracheal intubation, because conservative methods of treating the persistent cardiac arrhythmias failed.

Nonobstructive hypertrophic cardiomyopathy with left ventricular aneurysm: the role of cardiac magnetic resonance.

Hypertrophic cardiomyopathy with concomitant left ventricular aneurysm is rare and has important clinical implications, including an increased risk of sudden cardiac death. Most patients with this rare combination have obstructive hypertrophic cardiomyopathy, but we treated a 26-year-old woman who had nonobstructive hypertrophic cardiomyopathy and a family history of probable sudden cardiac death. In our patient, coronary angiograms showed distal occlusion of the left anterior descending coronary artery. Late gadolinium-enhanced cardiac magnetic resonance images showed scattered fibrosis within and beyond the left ventricular aneurysm. Precautionary therapy with an implantable cardioverter-defibrillator yielded an uneventful outcome. Cardiac magnetic resonance has emerged as a promising method for diagnosing these aneurysms and detecting associated myocardial fibrosis, thereby enabling patient risk stratification and the determination of appropriate therapeutic options. We discuss the role of cardiac magnetic resonance imaging in the management of this rare clinical entity.

Giant interatrial septal aneurysm mimicking a left atrial mass.

Interatrial septal aneurysm (IASA) consists of redundant atrial septal tissue, which bulges into either the left or the right atrium. The clinical implications of this entity are not entirely clear; however, if it is associated with other cardiac abnormalities such as patent foramen ovale and atrial septal defects. It may assume significance by increasing the risk of cardioembolic events such as stroke. We present a case of an individual with giant IASA detected by transesophageal echocardiography, which was mimicking a left atrial mass on transthoracic echocardiography. This case emphasizes the superiority of transesophageal imaging over transthoracic echocardiography for this clinical entity.