Azacitidine-induced myopericarditis in acute myeloid leukemia.

Hypomethylating agents are commonly used in the treatment of myelodysplastic syndromes and are known to cause bone marrow suppression; however, cardiac complications are rare. We describe a patient who was diagnosed with acute myeloid leukemia and developed myopericarditis after receiving chemotherapy with azacitidine. Our case highlights the importance of a thorough history, including medication review, in patients with suspected myopericarditis. It also raises awareness about the potential cardiac side effects of azacitidine.

Left main coronary artery vasospasm: A case report of misdiagnosed severe coronary artery disease.

Introduction and importance: Left main coronary artery (LMCA) vasospasm is rare and can cause demand-supply mismatch that can mimic coronary artery disease (CAD). This could lead to misdiagnosis and inappropriate referral for surgical intervention. Case presentation: A 55-year-old woman with no cardiac risk factors presented with anginal chest pain. Vital signs were stable and physical exam was unremarkable. Chest x-ray was normal and electrocardiography (ECG) revealed sinus bradycardia with nonspecific ST-segment and T-wave changes in the inferolateral leads present on prior ECGs. Echocardiography revealed a left ventricular ejection fraction of 60-65% without regional wall motion abnormalities and cardiac troponin was within normal limits. Nuclear stress test was unsuccessful due to severe reaction to regadenoson. Subsequent invasive coronary angiography revealed an isolated 70% stenosis of the LMCA. Patient was referred for surgery, however, coronary computed tomography angiography (CCTA) prior to surgery unmasked spasm and prevented unnecessary surgery. Clinical discussion: Coronary spasm is diagnosed clinically based on typical symptoms, transient ECG changes, and a negative stress test with no regional wall motion abnormalities on echocardiography. During episodes of spasm, coronary angiography would reveal an area of stenosis in the affected coronary segment. This could lead to a misdiagnosis of CAD and, in cases of LMCA stenosis, inappropriate referral for surgical intervention. Conclusion: LMCA spasm is rare but can mimic CAD leading to misdiagnosis and unnecessary surgery. Physicians should have a high suspicion for spasm especially in patients with anginal chest pain who lack CAD risk factors. CCTA can unmask spasm and prevent unnecessary interventions.

Right Heart Catheterization Through Persistent Left Superior Vena Cava, an Extremely Rare Procedure and Review of Current Literature.

Persistent left superior vena cava (PLSVC) is encountered occasionally during angiographic procedures. It usually coexists with right superior vena cava and drains to the right atrium through the coronary sinus, but multiple variations are described. Although PLSVC is extensively reported in the literature, there are very few articles addressing right heart catheterization in patients with isolated PLSVC. We present a patient with absent right superior vena cava and PLSVC draining to a dilated coronary sinus diagnosed during right heart catheterization in the setting of pulmonary hypertension. We were able to safely complete the procedure through the right internal jugular vein. Transthoracic echocardiography and chest CT scan were consistent with this finding. Although clinically silent most of the time, undiagnosed PLSVC can lead to catastrophic consequences when the patient undergoes invasive procedures. If PLSVC is suspected, the anatomy of the thoracic venous system must be identified before invasive cardiac procedures.

Beyond the bend: a literature review and case report of radial artery loop.

Transradial cardiac catheterization is an exciting technique that has many advantages over the traditional femoral approach. Most importantly it is a safe option for PCI with potential same day discharge for uncomplicated cases. Despite its advantages, some challenges may be encountered with the transradial approach. After arterial access and spasm, vascular artery anomalies constitute a significant number of procedural failure. Radial artery anomalies are encountered in greater than 17% of cases performed in literature. In particular, radial loop is an important cause of transradial procedural failure. We present a literature review and a case from our institution and outline techniques in order to traverse the loop and make the transradial approach a success.