Case Reports in Cardiology最新文献

We present the case of a 47-year-old woman with persistent atrial fibrillation who underwent catheter ablation. During the procedure, real-time ST-segment elevation was observed on surface ECG. An emergency coronary angiography revealed an air embolism in the proximal segment of the left anterior descending (LAD) coronary artery. Intracoronary adenosine was administered, successfully restoring coronary flow (TIMI 3). The procedure was aborted, and the patient was subsequently managed in the coronary care unit due to biventricular cardiogenic shock secondary to myocardial stunning. This case highlights the importance of strict hemodynamic monitoring and prompt recognition and response to uncommon complications during catheter ablation procedures.

Congenital complete atrioventricular block (CAVB) is a rare cardiac condition occurring in approximately one in 15,000 to one in 22,000 live births. Maternal autoimmune diseases, with anti-ssA (Ro) and anti-ssB (La) antibodies implicated in 56%-90% of cases, are primary causes. We present a case of a 31-year-old primigravid woman referred at 29 weeks of gestation for fetal high-grade AVB, initially diagnosed as 2:1 AVB with a ventricular rate of 45 bpm. Maternal corticosteroid therapy was initiated for suspected immune-mediated etiology, pending autoantibody test results. Upon transfer, a 3:1 AVB was detected, with fetal heart failure signs. Genetic and autoimmune evaluations ruled out primary electrical heart diseases and infections. Prompt intervention was necessitated due to fetal cardiac decompensation. Sympathomimetic drugs via placental circulation were ineffective. Cesarean section was scheduled at 30 weeks and 1 day. The neonate, weighing 1280 g, had an APGAR score of 7 and a heart rate of 40 bpm. Initial resuscitation and isoproterenol infusion resulted in a moderate heart rate increase. Temporary pacing wires were surgically placed. As permanent pacemaker implantation became necessary, traditional venous access was impractical. A "tiny pacemaker" made with modification of a Medtronic Micra MC1VR01 generator connected to an epicardial lead ensured hemodynamic stability. Approval of this off-label device from the Italian Ministry of Health was swiftly obtained. Diagnosis of CAVB typically involves fetal echocardiography and fetal magnetocardiography for precise arrhythmia diagnosis. Treatment varies, with fluorinated steroids reducing block severity in autoimmune cases. Miniaturized pacemakers offer a promising solution for neonates, addressing challenges of conventional devices. Further research is needed to evaluate their long-term efficacy and safety, potentially benefiting patients with venous and cardiac abnormalities.

Misplacement of pacemakers lead into the left ventricle (LV) is a rare but clinically important complication, often facilitated by unrecognized intracardiac shunts such as a patent foramen ovale (PFO). Early recognition is essential to avoid systemic embolization and ensure safe device function. We report a man in his 70s with a background of bioprosthetic aortic valve replacement, coronary bypass grafting, hypertension, chronic kidney disease, Parkinson's disease, and prostate cancer, who underwent permanent pacemaker implantation for symptomatic sinus pauses. Follow-up echocardiography 1 year later, performed as part of surveillance of his aortic valve prosthesis, unexpectedly revealed that the ventricular lead had crossed a PFO and was positioned in the LV via the mitral valve. His 12-lead ECG demonstrated a right bundle branch block-like paced morphology, raising suspicion of LV pacing. The patient remained asymptomatic with no evidence of systemic embolization. He was anticoagulated with apixaban and subsequently underwent successful lead extraction and repositioning into the right ventricle (RV). Correct RV placement was confirmed using multiple fluoroscopic views, particularly the left anterior oblique (LAO) projection and by postprocedure ECG, chest x-ray, and echocardiogram. This case underlines the importance of careful assessment of paced ECG morphology, fluoroscopic views during implantation (especially LAO), and postimplant imaging to confirm lead location. Suspicion should be raised when an RBBB-like QRS morphology is observed during RV pacing. Timely recognition and management with anticoagulation, followed by extraction and repositioning, can prevent potentially devastating complications. Operators should remain vigilant for inadvertent LV lead placement, particularly in patients with unrecognized PFO. Routine use of multiple fluoroscopic projections and correlation with ECG and echocardiography can aid early diagnosis and improve procedural safety.

Infective endocarditis is a rare phenomenon that may have devastating consequences. While uncommon, the spectrum of causative organisms can include Corynebacterium species. Corynebacterium diphtheriae endocarditis bears a high potential for systemic complications and overall mortality. We present a case of mitral and tricuspid native valve endocarditis caused by C. diphtheriae in an immunocompetent patient and highlight the severe manifestations of this condition.

Alagille syndrome is a rare multisystemic genetic condition most commonly associated with neonatal liver disease. Variable expressivity is a defining feature of Alagille syndrome, resulting in a broad spectrum of phenotypic variation among individuals who meet the diagnostic criteria. We present an atypical case of cardiac-predominant Alagille syndrome diagnosed in adulthood after the detection of peripheral pulmonary stenosis on cardiac magnetic resonance imaging (CMR).

Chronic deep venous thrombosis (DVT) can result in a significant venous outflow obstruction, often prompting the development of extensive compensatory mechanisms to maintain adequate circulation. We report a case of recurrent DVT, presenting with left lower extremity pain and edema. Venography revealed complete occlusion of the left common femoral vein with extensive collateral venous circulation. Given the presence of well-formed collaterals and clinical stability, the patient was treated conservatively with continued anticoagulation without additional invasive intervention. This case highlights the physiologic adaptation of collateral formation that can allow for conservative management in chronic DVT and contributes to a better understanding of management strategies for high-risk patients with recurrent thrombotic events.

Background: The presence of cardiac manifestations, including bradycardia, has been described as a manifestation of coronavirus disease 2019 (COVID-19). Our case report describes a case of sinus bradycardia secondary to possible sinus node dysfunction in an otherwise asymptomatic patient with COVID-19.

Case presentation: We report the case of an unvaccinated 33-year-old female hospitalized due to bradycardia after 4 days of testing positive for COVID-19. She presented with a 1-day history of transitory lightheadedness and dizziness with no other associated symptoms. Sinus bradycardia was recorded on admission, heart rate 52/min that later dropped to 35/min on the second day of admission. Secondary causes of bradycardia were excluded based on the absence of relevant evidence from laboratory work-up and echocardiographic examination.

Decision‐making: We recommend baseline ECG monitoring in hospitalized COVID-19 patients, regardless of disease severity, to assess for potential cardiac manifestations.

Conclusion: Cardiac rhythm monitoring is an essential component of staying vigilant against potential complications. It raises the question of how physicians should respond to a patient with marked bradycardia and when should they intervene?

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasing worldwide. Patients with cardiogenic shock were the first indication for VA-ECMO according to the Extracorporeal Life Support Organization (ELSO) guidelines. However, recent studies have shown that VA-ECMO is not beneficial in patients with cardiogenic shock. This report describes the case of three patients who presented with infarct-related cardiac arrest without cardiogenic shock and received VA-ECMO to support coronary intervention. These patients tolerated the treatment and showed a good prognosis at discharge. These cases describe the potential role of VA-ECMO as a supportive intervention in patients with infarct-related cardiac arrest without cardiogenic shock.

Introduction: Wolff-Parkinson-White (WPW) syndrome is a congenital heart disorder marked by an accessory electrical pathway (AP) causing reentrant tachycardias. This report presents a case of WPW successfully treated with catheter ablation but followed by transient symptomatic premature ventricular contractions (PVCs).

Case summary: A 27-year-old WPW patient was referred due to paroxysmal tachycardias. The baseline electrocardiogram confirmed ventricular pre-excitation, and the patient underwent radiofrequency ablation targeting a right septal AP. Some days later, the patient experienced palpitations distinct from preablation symptoms. A 24-h Holter ECG and exercise testing revealed frequent, monomorphic PVCs originating from the previously pre-excited region. Low-dose beta-blocker therapy alleviated symptoms, and there was no evidence of PVC recurrence after tapering temporary beta-blocker medication.

Discussion: This case illustrates a new onset of PVC after ablation of septal AP in WPW syndrome. We postulate that transient electric instability due to AP-associated cardiac memory led to enhanced local automatic activity resulting in PVC.

The atrial lead is essential for atrial or dual-chamber pacing, requiring stable fixation to ensure reliable electrical thresholds and sensing. Despite advancements in lead designs, atrial screw-in leads still face a dislodgement rate of 0%-3.3%. This study introduces a novel technique for atrial lead fixation using real-time injury current monitoring, offering a promising method to minimize lead dislodgement and enhance clinical outcomes.