IHJ Cardiovascular Case Reports (CVCR)最新文献

Background

Mucormycosis is an invasive fungal infection most commonly seen in immune compromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immune competent individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient with disseminated Mucormycosis who presented as rhino orbital Mucor mycosis with pericardial involvement.

Case summary

A 17-year-old female presented with intermittent high-grade fever of 1 month duration. She was diagnosed as Rhino orbital Mucormycosis as evidenced by MRI brain and orbits and biopsy of maxillary sinus. Patient underwent left endoscopic debridement of sinuses and left endoscopic Denker's procedure with left orbital decompression and was treated with Amphotericin B subsequently. During the course of hospitalisation, patient developed large pericardial effusion with cardiac tamponade secondary to invasive mucor infection as evidenced by pericardial fluid culture.

Conclusion

Disseminated Mucor mycosis is a rare condition that involves two or more non-contiguous organ systems. Disseminated Mucor mycosis is the least common and the worst prognosis type, and it mostly starts with lesions in the lungs and then disseminates to other sites. Cardiac dissemination of rhino orbital Mucor mycosis, like in our case, is unusual and often diagnosed post-mortem; an antemortem diagnosis is very rare. Cardiac involvement is a rare, yet fatal, complication that can occur in disseminated disease and a strong index of suspicion is necessary for prompt treatment, especially in high-risk patients.

Myotonic Dystrophy (DM) is the most common form of muscular dystrophy with onset in adults. Cardiac manifestations are common in DM, but ventricular arrhythmias are uncommon and torsades de pointes is rarely described. Here we describe a patient with primary presentation of syncope, with recurrent polymorphic ventricular tachycardias and with torsades de pointes configuration.

A rare case of large 22 mm Pulmonary artery to Left atrial (PA-LA) fistula is described. Diagnosis on transthoracic echocardiography is highlighted. It is first report to depict common occurrence of PA-LA fistula with pulmonary vein varix. Managed successfully with transcatheter approach using Atrial Septal Defect closure device.

Ivabradine is used to control heart rate in patients of heart failure with reduced ejection fraction. Although considered safe, it is reported to prolong QTc interval when given with other QTc prolonging drugs or in setting of hypokalemia or hypomagnesemia. Ivabradine causing isolated QTc interval prolongation without any provoking condition is rare. Our patient developed Torsades de Pointes after initiating Ivabradine and her QTc interval reduced after stopping Ivabradine. This may be due to a potential independent dose dependent effect of Ivabradine on QTc interval by its effects on its effects on human Ether-à-go-go-Related Gene (hERG) potassium channels.

Pregnancy poses a significant maternal and foetal risk in women with pulmonary arterial hypertension (PAH). With extremely limited treatment options available, we used Selexipag in addition to tadalafil in managing a pregnancy complicated by PAH. Selexipag may be a promising add-on therapy in this unique subset.

A 16 year old girl diagnosed with systemic lupus erythematosus (SLE) presented to our hospital with acute myocardial infarction. She was hemodynamically stable. Atherosclerosis tends to be more aggressive in these patients. We are reporting this case to highlight the fact that these patients require more intense surveillance and aggressive treatment.

Background

Acute coronary syndrome is predominantly attributed to atherosclerotic coronary artery disease. However, structural diseases leading to compromised coronary flow can also lead to similar manifestations.

Case presentation

A 35-year-old male had presented with acute coronary syndrome (ACS) NSTEMI and was found to have a cyst on echocardiogram, which was compressing on the left circumflex coronary artery.

Conclusion

Structural diseases including both developmental and anatomical lesions should be considered as a differential in the etiology of acute coronary syndrome in a young individual without any pre-existing co-morbidities.

The ChAdOx1 nCoV-19 adenoviral vector-based vaccine was the first to be approved against COVID-19 in India. Vaccine induced thrombotic thrombocytopenia (VITT) is a rare but serious adverse effect of the ChAdOx1 nCoV-19 vaccine, causing widespread thrombosis and thrombocytopenia. A 22-year-old patient, who had undergone mechanical mitral valve replacement, presented to us one week after administration of 1st dose of the ChAdOx1 nCoV-19 Coronavirus vaccine with acute prosthetic heart valve thrombosis (PVT). Laboratory investigations revealed thrombocytopenia and high D-Dimer levels, suggestive of probable VITT. In this report, we highlight the importance of identification of VITT as a cause of PVT and discuss management options.