Use of Lumason Contrast Echocardiography in Post-myocardial Infarction Ventricular Septal Defect.

We report herein the case of an elderly female who presented with myocardial infarction complicated by ventricular septal defect (VSD) that was evident on cardiac auscultation and contrast echocardiography using Lumason® (Bracco Diagnostics Inc, Monroe Township, USA). Patient underwent surgical repair for her VSD post-infarct along with coronary artery bypass grafting after being treated for cardiogenic shock. We also highlight the management strategies in patients with similar complications. In this report, we shed the light on the importance of using Lumason contrast for the identification of shunt and for the diagnosis of VSD. Lumason contrast is widely available and licensed.

Thyrotoxicosis Mimicking ST Elevation Myocardial Infarction.

Hyperthyroidism is well known to be associated with cardiac disease. Delay in making the diagnosis and occurrence of complications are common and are associated with a worse outcome. A 54-year-old male, non-smoker, with no past medical history and no significant family history presented to our hospital with severe left sided chest pain, "crushing" in nature. Electrocardiogram showed ST-segment elevations in the inferior leads. Troponin I level was 0.32 ng/mL (normal range 0-0.05 ng/mL) on presentation. The patient underwent an emergent coronary angiography which showed no evidence of occlusive coronary artery disease. The patient's symptoms and signs prompted a high suspicion of thyrotoxicosis which was subsequently confirmed by a low thyroid stimulating hormone and high free thyroxine levels. The patient was given Methimazole and atenolol and his symptoms resolved. Awareness of coronary vasospasm due to thyrotoxicosis should be raised in patients presenting with typical angina pectoris with subsequent normal coronary angiographic results. History and physical examination may suggest underlying hyperthyroidism, but the absence of typical findings does not rule out the diagnosis.

A rare case of double-chambered right ventricle associated with ventricular septal defect and congenital absence of the pulmonary valve.

Double-chambered right ventricle (DCRV) is a rare congenital heart disorder involving 2 different right ventricle (RV) pressure compartments that is often associated with ventricular septal defect (VSD). Usually, the obstruction is caused by an anomalous muscle bundle crossing the RV from the interventricular septum to the RV free wall. We are reporting a case of double-chambered right ventricle associated with ventricular septal defect and congenital absence of the pulmonary valve, a rare form of congenital infundibular pulmonary stenosis. In addition to ventricular septal defect, our patient had congenital absence of the pulmonary valve, which is very unusual and has never been reported to our knowledge.

A giant left atrial myxoma.

Atrial myxomas are the most common primary cardiac tumors. Patients with left atrial myxomas generally present with mechanical obstruction of blood flow, systemic embolization, and constitutional symptoms. We present a case of an unusually large left atrial myxoma discovered incidentally in a patient with longstanding dyspnea being managed as bronchial asthma.