Case Reports in Cardiology最新文献

Acute aortic syndrome (AAS), encompassing aortic dissection, aortic intramural hematoma (AIH), and penetrating aortic ulcer, is a life-threatening condition requiring prompt diagnosis and often immediate surgical intervention. A 65-year-old woman presented with transient loss of consciousness and hemorrhagic pericardial effusion. Initial imaging revealed no clear aortic pathology, leading to diagnostic uncertainty despite clinical suspicion of AAS. Following pericardiocentesis, her condition temporarily stabilized but later deteriorated, revealing a missed diagnosis of aortic dissection with tamponade. Retrospective analysis of initial imaging identified subtle aortic wall thickening, indicative of AIH, overlooked at two hospitals. This case highlights the diagnostic challenges in atypical presentations of AAS and emphasizes the need for comprehensive imaging protocols, careful interpretation of ancillary findings, and repeat evaluations to prevent misdiagnosis. Clinicians should maintain a high index of suspicion for acute aortic pathologies in patients with hemorrhagic pericardial effusion, ensuring timely and accurate diagnosis to improve outcomes.

A 73-year-old woman who suffered from major depressive disorder was candidated to receive electroconvulsive therapy (ECT) in combination with medical treatment. Shortly after ECT, she complained of severe chest pain. ECG findings revealed new QRS widening and ST-segment elevation in anterior leads, and echocardiography revealed anteroapical wall akinesia and reduced ejection fraction. Epicardial coronary arteries were normal in emergent coronary angiography, and the diagnosis of Takotsubo cardiomyopathy was considered. In addition, Troponin I was also elevated. The patient had a good recovery after medical treatment for heart failure, and the ejection fraction in echocardiography improved in a few days. This studied case demonstrates the increasing risk of Takotsubo cardiomyopathy following ECT, which needs special attention for patients with chest pain and ECG abnormalities after ECT.

Brugada syndrome (BrS) is a rare inherited cardiac channelopathy associated with ventricular arrhythmias and sudden cardiac death (SCD), often in individuals with structurally normal hearts. It is diagnosed by a Type 1 electrocardiographic (EKG) pattern-coved ST-segment elevation in the right precordial leads. Fever is a known trigger that can unmask Brugada patterns by worsening sodium channel dysfunction. We present the case of a 20-year-old male with a fever and an episode of syncope prior to admission who had an EKG showing a Type 1 Brugada pattern. Procainamide challenge was negative, but an atypical right bundle branch block suggested sodium channel dysfunction. Despite the absence of structural heart disease, an implantable cardioverter defibrillator (ICD) was placed for primary prevention of SCD. This case underscores the diagnostic and management challenges in intermediate-risk BrS patients.

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare condition, with clinical presentations ranging from sudden cardiac death to heart failure, although most cases remain asymptomatic until adulthood. We report the case of a 58-year-old man who presented to the emergency department with chest pain and persistent ST-segment elevation in the lateral leads (DI and aVL) on electrocardiogram (EKG). Coronary angiography revealed a subocclusive stenosis of the ramus intermedius (RIA) of the left coronary artery. Failure to selectively engage the RCA during the procedure, together with visualization of collateral circulation on aortography, raised suspicion of ARCAPA. Primary angioplasty was performed on the RIA with the implantation of a biodegradable polymer biolimus-eluting stent. The presence of ARCAPA resulted in approximately a 20% increase in door-to-balloon time compared with the institutional median of 65 min. The anomaly was subsequently confirmed by coronary computed tomography angiography (CCTA). This case highlights that coronary anomalies can increase the complexity of percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction, prolong door-to-balloon times, and require interventional cardiologists to maintain a high level of awareness, understanding, and preparedness for such conditions.

Rapid progression of vulnerable plaques due to intraplaque neovascularization and hemorrhage is deemed as an important process preceding plaque rupture leading to myocardial infarction. We present a patient with a rapidly progressive vulnerable plaque assessed by means of coronary computed tomography angiography and serial invasive coronary angiography.

Ruptured sinus of Valsalva aneurysm is a life-threatening problem that usually requires emergent surgical management. This case illustrates a transcatheter repair of a ruptured sinus of Valsalva aneurysm creating a fistula to the right atrium in a patient who was not a candidate for surgery.

Introduction: Infective endocarditis (IE) is a life-threatening condition caused by microbial infection of the heart valves or endocardium. Fungal IE, predominantly caused by the Candida species, accounts for less than 2% of IE cases, and is usually associated with immunosuppression or other risk factors. This case report describes an unusual instance of Candida albicans endocarditis with extensive aortic valve vegetation in an immunocompetent patient, highlighting the challenges in diagnosis and management. Case Report: A 26-year-old active-duty soldier with no history of chronic illness presented with dyspnea, peripheral edema, and oliguria. Examination revealed a diastolic murmur, anemia, acute renal failure, and elevated inflammatory markers. Imaging showed cardiomegaly, pleural effusion, and a bicuspid aortic valve with large, mobile vegetations. Blood cultures confirmed C. albicans, and antifungal therapy with fluconazole was initiated. Despite aggressive medical management, including hemodialysis, the patient's condition deteriorated, and due to hemodynamic instability, surgery was not feasible. The patient unfortunately succumbed to complications. Discussion: Candida endocarditis is uncommon in immunocompetent individuals; biofilms enhance resistance against antifungal therapy and the immune response, even in immunocompetent individuals. The absence of conventional risk factors poses diagnostic challenges. The case also underscores the rapid progression and poor prognosis of fungal IE, particularly with extensive vegetations and hemodynamic instability. Conclusion: Candida endocarditis is a rare but severe condition, even in healthy individuals. This case emphasizes the importance of early recognition, comprehensive management, and further research to optimize outcomes in fungal IE.

Overconsumption of energy drinks containing high levels of caffeine has been increasingly linked to cardiovascular morbidity and mortality. This case report describes a 24-year-old Caribbean-Black male with no prior comorbidities who experienced an aborted sudden cardiac death (SCD) after a recent energy drink binge a few hours prior to his ventricular fibrillation (VF) cardiac arrest. Primary percutaneous coronary intervention (PPCI) was successfully performed for a dreaded widowmaker lesion, thought to have arisen as a sequela of his excessive energy drink intake. The clinician should be cognizant of the major adverse cardiovascular events (MACEs), such as acute coronary syndromes (ACSs) and lethal arrhythmias, implicated with energy drink consumption.

We present the case of a 27-year-old woman who ingested aluminum phosphide (AlP) in a suicide attempt, leading to severe toxic myocarditis and a transient Brugada pattern (Brugada phenocopy [BrP]) on her electrocardiogram (ECG). The initial treatment included supportive measures and management of a non-ST elevation acute coronary syndrome. Despite the severity of her condition, the patient stabilized, with normalization of ECG findings and improvement in left ventricular function. This case highlights the importance of recognizing BrP as a potential manifestation of toxic myocarditis, especially in the context of AlP poisoning, and underscores the critical need for early intervention and appropriate management.

Papillary muscle rupture is a rare but serious complication during percutaneous transvenous mitral commissurotomy (PTMC). In many cases, it leads to acute significant mitral regurgitation (MR), requiring urgent surgical repair. We performed PTMC for a 49-year-old woman with symptomatic moderate rheumatic mitral stenosis. Initial balloon inflation resulted in papillary muscle rupture; however, it did not induce leaflet prolapse and worsening of MR. Finally, we succeeded in achieving a mean pressure gradient of less than 5 mmHg without worsening of MR through several balloon inflations. We experienced a rare case where papillary muscle rupture occurred during PTMC, but there was no development of acute significant MR, and salvage surgery was not required.