Marijuana: cardiovascular effects and legal considerations. A clinical case-based review.

Though coronary artery disease primarily occurs in those over the age of 40 years, younger individuals who use recreational drugs may be afflicted with coronary events. Cannabis is one such perilous agent that can cause myocardial infarction (MI) and is one of the most common psychoactive drugs used worldwide. Cannabis (also known as marijuana, weed, pot, dope or grass) is the most widely used illegal drug in the UK. The desired euphoric effects are immediate, as are life-threatening hazardous ones. In this article, we briefly describe a case series of two unique but similar cases of cannabis-induced ST-elevation MI witnessed at our hospital in quick succession. We will analyse the composite pathophysiology in acute coronary syndromes provoked by cannabis and discuss the evolving legality around the use of the drug.

Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era.

Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy (DAPT) to reduce stent thrombosis and avoid target lesion failure. The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome, and 6 mo for patients with chronic coronary syndrome or high bleeding risk. The new generation of drug-eluting stents have metallic platforms with thinner struts, associated with significantly less stent thrombosis. Shortened DAPT has been investigated with these stents, with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes. This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations. This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.

Concurrent Large Pericardial Cyst with Giant Thoracic Aortic Aneurysm-Presentation and Natural Evolution.

We report the first case of a patient with large pericardial cyst occurring concurrently with a very large thoracic aortic aneurysm. There have been no patients reported in the literature with this constellation of syndromes. Additionally, this case was followed through a period of 4 years, enabling the natural evolution of both pathologies to be visualised.

Clenbuterol-Induced Myocarditis: A Case Report.

OBJECTIVE: We present a case of a 22-year-old bodybuilder diagnosed with myocarditis secondary to clenbuterol use. RESULTS: The patient was primarily managed conservatively by the discontinuation of clenbuterol and the temporary use of dual anti-platelets, beta-blockers and nitrates. CONCLUSION: Clenbuterol is a long-acting beta-2 agonist primarily used in veterinary medicine. In recent years, it has been illegally marketed as a weight loss supplement because of its anabolic properties and is popular among fitness enthusiasts. It is our aim to use this case to underscore the adverse effects of this drug with hopes that tighter regulations will be instituted to stem its illegal distribution. LEARNING POINTS: Clenbuterol is primarily a veterinary drug with bronchodilator and tocolytic properties.It is illegally used as a performance enhancer by athletes and bodybuilders because of its anabolic properties.Clenbuterol misuse can result in myocardial injury.

Right sided heart failure secondary to hypereosinophilic cardiomyopathy - clinical manifestation and diagnostic pathway.

Hypereosinophilic cardiomyopathy is a rare restrictive cardiomyopathy which often presents with left-sided heart failure. We present an interesting case of a 58-year-old male patient with known hypereosinophillic syndrome who had presented with congestive cardiac failure with predominant features of right-sided volume overload. Cardiac magnetic resonance imaging confirmed the diagnosis by demonstrating obliteration of the right ventricular apex and endocardial-delayed gadolinium enhancement at the mid-septal and inferior segment, at both the right ventricular and left ventricular apical region, consistent with fibrosis. He was successfully treated with intravenous diuretics to good effect. This case report demonstrates a rare clinical presentation of right ventricle involvement in hypereosinophilic cardiomyopathy and the current pathway for diagnosis with the favoured emergence of cardiac magnetic resonance imaging. All patients with hypereosinophilic syndrome should be closely monitored for signs of cardiac involvement, as early treatment carries a better prognosis.

Recurrent Infective Endocarditis with Mycotic Aneurysm - Imaging Modalities for the Detection of an Infective Focus.

Staphylococcus aureus bacteremia (SAB) and infective endocarditis (IE) are infections associated with considerable morbidity, requiring prompt accurate diagnosis and treatment. We present a case of a 58-year-old male patient with four episodes of recurrent symptomatic SAB treated for IE, but without positive findings on transthoracic echocardiography, transesophageal echocardiography, and fluorodeoxyglucose-positron emission tomography (FDG-PET). On the last admission, FDG-PET showed increased uptake in the right atrial appendage, and white blood cell single-photon emission computerized tomography (WBC-SPECT) was able to identify the infective focus as IE of the aortic valve. CT of the thorax also identified an associated mycotic aneurysm of the right coronary sinus. He was subsequently treated with mechanical aortic prosthesis and right coronary sinus plasty, and his symptoms did not recur till 2 years postcardiothoracic surgery. This case report demonstrates the emergence of nuclear cardiovascular imaging modalities in the diagnostic workup of IE and the utility of FDG-PET and WBC-SPECT in the identification of the infective focus. Patients with possible IE from the modified Duke criteria should be considered for FDG-PET or WBC-SPECT to enhance sensitivity. Peripheral mycotic aneurysms are a common complication of left-sided IE, which can present late into the disease process, and aortic imaging should be considered in patients with recurrent endocarditis to identify this.