Acute Myocardial Infarction Secondary to Triple Coronary Arteries Dissection in a Patient With Takayasu Vasculitis.

Synchronous spontaneous triple coronary artery dissection with Takayasu arteritis has not been previously reported in the literature. We describe the case of a young man with acute inferior wall myocardial infarction secondary to triple-vessel coronary artery dissection. Takayasu arteritis was diagnosed upon further investigation. (Level of Difficulty: Intermediate.).

Takotsubo (stress) cardiomyopathy induced by acute asthma exacerbation in elderly woman.

A 73-year-old patient who was admitted secondary to acute asthma exacerbation that required frequent salbutamol and adrenaline nebulization. Takotsubo cardiomyopathy (TTC) was diagnosed after the new onset of chest pain with modest troponin elevation and normal coronary angiogram. Low ejection fraction and apical akinesia were completely resolved after her symptoms got improved.

Immediate Single-Leaflet Device Detachment in a Patient with Marfan Syndrome Treated with Bail-Out Edge-to-Edge Mitral Valve Repair.

Mitral transcatheter edge-to-edge repair (MTEER) is the first transcatheter technique for mitral valve repair (MVR) in patients with severe mitral regurgitation (MR) who are considered at high risk for surgical intervention. Mitral valve prolapse with subsequent MR is a common manifestation of Marfan syndrome. MTEER has never been reported as a treatment option in such kind of patients. We describe the case of a 30-year-old patient who was known to have Marfan syndrome which was complicated with severe symptomatic MR. The surgical risk was high, and he preferred transcatheter intervention. MTEER was complicated with an immediate single-leaflet detachment of the first deployed MitraClip XTR. Bail-out edge-to-edge MVR with two additional MitraClip XTR was performed successfully to stabilize the detached clip. The patient's symptoms and quality of life improved significantly after 10 months of follow-up.

Left main and two vessels calcified coronary aneurysms presented as out of hospital cardiac arrest in young patient.

A 37-year-old patient was admitted secondary to ventricular fibrillation induced out of hospital cardiac arrest. Coronary angiogram revealed left main, left anterior descending, and right coronary arteries aneurysms. The patient underwent bypass surgery with four grafts. Ejection fraction improved from 30% upon admission to 45% at 3 months of follow-up.

Acute ST-Elevation Myocardial Infarction in Patient with Severe Uncontrolled Hyperthyroidism Complicated by Thyroid Storm.

Acute ST-elevation myocardial infarction is a life-threatening medical emergency that needs to be recognized early and treated properly to prevent deleterious complications, including death. A thyroid storm (TS) is a rare but severe manifestation of uncontrolled hyperthyroidism that might present with serious cardiovascular or neurological problems. We described a case of a 40-year-old male patient, known to have uncontrolled hyperthyroidism, who presented with acute onset of central chest pain, agitation, tachycardia, and pulmonary congestion. Fast atrial fibrillation with ST-segment elevation in anterior leads was detected on electrocardiogram. Thyroxin level (T4) was very high with undetectable thyroid stimulating hormone. Initially, the patient refused any type of coronary revascularization; therefore, he was admitted to the cardiology intensive care unit, and medical treatment was commenced for both TS and acute coronary syndrome. High-risk coronary angiography was done 2 h later because he had worsening persistent chest pain and started to develop signs of heart failure. It showed embolic occlusion of the distal left anterior descending artery that was treated medically with anti-coagulation. There were no complications. Chest pain and thyroid function tests settled down during his hospital stay with close cardiology and endocrinology follow-up.

Acute sensorineural hearing loss as atypical presentation of typhoid fever in adult patient.

Salmonella Typhi is the main cause of an acute febrile, sometimes fatal, multisystemic illness called typhoid fever. The diverse presentations of this disease make it a diagnostic challenge in some patients. Involvement of the neurological system, including cochleovestibular system, is very rare with less than a handful of reported cases. This case report describes the condition of a previously healthy 23-year-old Pakistani man with acute onset of hearing loss associated with fever, headache, and disorientation. The most likely differential diagnoses were bacterial or viral meningoencephalitis, and other bacterial infections, such as Rickettsial and spirochetal diseases. Salmonella Typhi grew on blood culture; thus, treatment with intravenous antibiotics and systemic steroids was provided with excellent response. Hearing loss gradually improved and almost completely resolved within 3 to 4 weeks.