Spontaneous Coronary Sinus Thrombosis Detected by Point-of-care Transthoracic Echo: A Case Report.

INTRODUCTION: Coronary sinus thrombosis (CST) is a rare condition, primarily occurring after instrumentation of the heart, with no prior reported cases diagnosed via point-of-care ultrasound or of spontaneous occurrence without predisposing medical or surgical history. Patients typically present with critical illness, and CST has a reported mortality of 80%. CASE REPORT: We present a case of a healthy 38-year-old male with chest pain one hour after cocaine use, with an electrocardiogram pattern consistent with Wellens syndrome, whose point-of-care cardiac ultrasound revealed CST. CONCLUSION: This uncommon ultrasonographic finding has never been reported in the emergency medicine literature to our knowledge. It can be recognized by the clinician sonographer during standard point-of-care transthoracic echocardiogram.

Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician.

We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis (hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision. The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-care ultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture. Patient underwent successful emergent mitral valve replacement after initial resuscitative efforts and intraaortic balloon pump placement.

Giant Blood Cyst of the Mitral Valve in a Disseminated Tuberculosis Patient.

Cardiac blood cysts are rare with most cases stemming from the pediatric population. The few case reports in adults have not generated clear guidelines regarding management. The finding of a cardiac mass engenders a broad differential including primary cardiac benign tumors, malignant tumors both primary and metastatic, as well as infectious processes in addition to blood cysts. The clinical context, imaging results, and potential for complications must be taken into account when making diagnostic and treatment decisions. We present, to our knowledge, the first case of a giant cardiac blood cyst resected in an adult with a history of tuberculosis.

An unusual cause of congestive heart failure in a young woman.

BACKGROUND: Congestive heart failure (CHF) is a common Emergency Department (ED) disorder that accounts for >5 million ED visits annually. Although quite rare, patent ductus arteriosus (PDA) is a serious cause of CHF that if left untreated can lead to life-threatening sequelae, such as hypertensive pulmonary vascular disease, endarteritis, and aneurysms of the ductus. OBJECTIVE: To discuss a case of PDA leading to CHF that illustrates one of the common complications of untreated PDA. CASE REPORT: A 35-year-old woman presented to the ED with a 2-month history of shortness of breath, dyspnea on exertion, decreased exercise tolerance, and orthopnea. The physical examination revealed a 4/6 continuous machine-like murmur. In the presence of new CHF and an atypical murmur, a transthoracic echocardiogram was performed that confirmed the diagnosis of PDA. She underwent an uncomplicated percutaneous closure of the ductus with significant improvement in her symptoms. CONCLUSIONS: Persistent PDA in adulthood is a rare but important cause of CHF with significant morbidity and mortality if not appropriately diagnosed and treated.