Phaeochromocytoma-induced myocarditis mimicking acute myocardial infarction.

A 44-year-old woman presented with sudden onset of chest pain, headache and nausea. Physical examination was remarkable for mild hypotension and tachycardia. ECG demonstrated sinus tachycardia with poor R wave progression in precordial leads and T wave inversion in leads V1-3. Cardiac enzymes were raised. Echocardiographic examination revealed normal cavity diameters with basal and mid left ventricular hypokinesia and an ejection fraction of 45%. A diagnosis of non-ST elevation myocardial infarction was made. A few orthostatic hypotensive attacks occurred at follow-up. A coronary angiogram showed normal coronary arteries. Within a few days, the echocardiographic findings, ECG and all cardiac markers had returned to normal. Two months later she presented with headache, palpitation, fever, neck swelling, flushing and hypertensive attacks. Phaeochromocytoma was diagnosed on the basis of increased metanephrine on urinalysis and a left suprarenal mass on CT scan.

Incessant monomorphic ventricular tachycardia during febrile illness in a patient with Brugada syndrome: fatal electrical storm.

A 55-year-old male with structurally normal heart presented with sustained monomorphic ventricular tachycardia (VT) and was cardioverted into sinus rhythm revealing a right bundle branch block pattern at baseline electrocardiography. Sustained monomorphic and nonsustained polymorphic VT were reproducibly inducible during electrophysiological study. During the diagnostic workup, the patient experienced fever due to hospital based pneumonia, which unmasked typical ST segment changes of Brugada syndrome. In the intensive care unit, fever became intractable leading to incessant monomorphic VT, which was resistant to all medical manoeuvers resulting in the patient's death.

Left anterior descending coronary artery occlusion after left lateral free wall accessory pathway ablation: what is the possible mechanism?

We describe a complication after radiofrequency (RF) ablation of a left free wall accessory pathway that resulted in acute occlusion of proximal left anterior descending (LAD) coronary artery in a 32-year-old male non-cocaine abuser. An interesting feature is the site of coronary artery occlusion which is remote from the RF application site. The RF energy applications were performed in the left lateral annulus remote from the LAD. The occlusion was successfully treated with placement of an intracoronary stent.

Assessment of minimal mitral regurgitation: comparative study with Doppler echocardiography and ventriculography.

This study was designed to assess color Doppler echocardiographic parameters in subjects with minimal mitral regurgitation (MR) in an otherwise normal heart. Study cases were selected during a five month period from 2500 young males with an echocardiographic indication on the basis of subjects' complaints and physical examination. Left ventriculography was performed and subjects were dichotomized into group-1 (n = 30) if there was angiographically MR and into group-2 (n = 30) if they were intact. Patients in group-1 were described as to have 'true MR' and MR flow in group-2 was named 'physiological'. Doppler echocardiographic variables of true and physiological MR are compared to each other. The following echocardiographic variables were significantly different between group-1 and group-2: 1) the ratio of the max. duration of MR/mean systolic interval in parasternal long axis (0.710 +/- 0.244 vs 0.430 +/- 0.268, respectively, p < 0.001), 2) the ratio of the maximum duration of MR/mean systolic interval in apical four chamber view (0.550 +/- 0.361 vs 0.317 +/- 0.272 respectively, p = 0.007), 3) the peak velocity of the regurgitant flow in parasternal log axis (180 +/- 77 vs 120 +/- 69, respectively, p = 0.003), 4) the regurgitant jet area in parasternal long axis (0.813 +/- 0.651 vs 0.411 +/- 0.431, respectively, p = 0.007). The maximal duration of MR/mean systolic time interval > or = 0.6, regurgitant jet area > or = 0.4 cm2, and regurgitant peak velocity > or = 130 cm/sec. in parasternal long axis dichotomize the cases into true with a predictive value of 76%, 67% and 63%, respectively.