Complications of a Giant Left Atrium - Extensive Thrombus Formation Despite Therapeutic Anticoagulation
Charles Croughan, MD, Balaj Rai, MD, Zachary Gilbert, MD, William David Nickell PA-C, Nathaniel Dittoe, MD, Brian Schwartz, MD and Peter Pavlina, MD
Article Type: Case Report | First Published: 2023/09/11
Left atrial thrombus (LAT) formation is a feared complication of atrial fibrillation, as it can lead to thromboembolic stroke or thromboembolism to another peripheral region causing ischemia. Despite therapeutic anticoagulation, recurrence of thrombi is still possible, although unlikely. Prevention strategies may include reducing left atrial size along with treatment by surgical removal. We present a case of a patient with a large left atrial thrombus in the setting of previous mitral valve sten...
Hypertrophic Cardiomyopathy? Think Again, PRKAG2 Syndrome
Juan Linares, MD, Charles Croughan, MD, Damian Valencia, MD, Rehan Ahmed, MD and Vaskar Mukerji, MD
Article Type: Case Report | First Published: 2023/09/10
Hypertrophic cardiomyopathy (HCM) is a disorder characterized by ventricular hypertrophy and myocyte disarray that increases the risk of arrhythmic sudden cardiac death. HCM phenocopies are disease entities sharing a left ventricular hypertrophy phenotype but arising from a different pathologic mechanism. Patients with PRKAG2 syndrome (PS), a glycogen storage disease, are often misdiagnosed as having HCM. Clinicians must be familiar with red flags alerting to the possibility of this important di...
Emergent TAV-in-TAV Following Acute Hemolytic Anemia Secondary to Undersized Transcatheter Heart Valve Prosthesis
Agata Sularz, MB BChir MA(Cantab.), Hashrul Rashid, MBBS(Hons), PhD, Jane Hancock, MB ChBPhD, Nikolaos Papamichael, MD, PhD, Bernard Prendergast, BMBS, DM, Simon Redwood, MBBS, MD and Tiffany Patterson, MBBS, BSc, PhD
Article Type: Case Report | First Published: 2023/05/13
Paravalvular leak (PVL) driven intravascular hemolysis (IVH) is a recognized complication of surgical aortic valve replacement. This has been described less following transcatheter aortic valve implantation (TAV). We present a case of a patient with severe life-threatening hemolytic anemia following TAV, requiring multiple blood transfusions, and emergent TAV-in-TAV procedure....
External Multicenter Validation of the Mehran Risk Score for Contrast Induced Acute Kidney Injury
Article Type: Original Article | First Published: December 16, 2021
Contrast induced acute kidney injury (CIAKI) is a known complication of percutaneous coronary intervention (PCI). Mehran Risk Score (MR score) has been previously shown to predict CIAKI, renal replacement therapy (RRT), and one-year mortality in patients undergoing PCI. The purpose of our study was to externally validate the MR score. To examine the utility of the MR score we reviewed records of 931 adult patients who underwent PCI in 2005 at 3 academic medical centers. Patients with acute myoca...
Clinical Characteristics and Clinical Outcomes of Patients with Heart Failure Who Receive Public Assistance in Japan
Shingo Watanabe, MD
Article Type: Original Article | First Published: November 25, 2021
The number of patients with heart failure (HF) is increasing, which is a socio-economic problem. Past overseas studies have reported that low-income patients with HF do not receive adequate treatment for financial reasons and have poor clinical outcomes. In Japan, medical expenses are free if they receive public assistance called Seikatsu hogo (PA), and there is no disadvantage to low-income patients regarding medical expenses. The purpose of this study is to investigate the clinical characteris...
Cardiac Arrhythmia Associated with Remdesivir in COVID-19
Sristee Niraula, MD, Shital Oli, MD and Janette Lee, MD
Article Type: Case Report | First Published: November 15, 2021
During the pandemic, Remdesivir was approved as a treatment for severe COVID-19. Little is known about its adverse side effects, as it had not been in clinical use prior to the pandemic, and we continue to learn more daily about its impact-both positive and negative-on our patients. In this case report, we present a patient who developed sinus bradycardia on the third day of Remdesivir administration, NSVT on the fifth day of Remdesivir, and whose arrhythmias resolved after cessation of Remdesiv...
A Rare Association: Apical Hypertrophic Cardiomyopathy with Multiple Coronary Artery-Left Ventricular Fistulae
Isabel Monedero-Sánchez, MD, Pablo Robles-Velasco, MD, Amador Rubio-Caballero, MD, Yago González-Doforno, MD, Cecilia Marco-Quirós, MD, Victoria Espejo-Bares, MD, Verónica Artiaga-de-la-Barrera, MD and Carla Jiménez-Martínez, MD
Article Type: Case Report | First Published: October 20, 2021
A 59-year-old woman was referred for evaluation of chest pain and she was diagnosed of acute coronary syndrome. Coronary arteriography showed a severe stenosis of left anterior descending artery but also the presence of multiple coronary artery-left ventricle micro-fistulae. Echocardiographic findings were consistent with apical hypertrophic cardiomyopathy and the fistulae were also patent by colour Doppler echocardiography. Little is known about clinical features of micro-fistulae arising from ...
Surviving the Death Roll; Unveiling the Undiagnosed: Case of Hispanic Man with Covid-19 Pneumonia
Michael Khorsandi, MD, Nirmala Manjappachar, MD, Elnaz Ebrahimihoor, MD and Nargiz Muganlinskaya, MD, MMS, FACP
Article Type: Case Report | First Published: October 15, 2021
Brugada syndrome (BrS) is an inherited electrophysiological abnormality which typically manifests in patients with diverse ethnicities as ventricular arrhythmias or sudden cardiac death. The onset is frequently unmasked by various precipitating factors including but not limited to febrile diseases. Severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) infection and associated COVID-19 illness continues to evolve. We are reporting a severe case of Covid-19 infection unveiling the un...
Giant Obstructive Myxoma with Hemolytic Anemia and Multiple Nevi in a 10-Year-Old Girl
John Jairo Araujo, MBBS, MASt, MD, MSIAC, Edwin Antonio González, MD, Rafael José Meza, MD, Eliana María Arcila, MD and Veronica Herrera Roldan, MD
Article Type: Case Report | First Published: August 23, 2021
Myxomas are low-prevalence heart tumors in the pediatric population. They are located in the left atrium in 75-86% of cases, and 30-50% are accompanied by general symptoms such as fever, weight loss, myalgias, arthralgias and elevated inflammatory markers caused by IL-6 release. They are rapidly growing heart tumors, and their most important complications are valvular and ventricular inflow tract obstruction, which may cause sudden death. Three to ten percent of cases are associated with Carney ...
A COVID-19 from Laboratory Suspicion to Confirmatory Tests: Controversial Debatable
Yasser Mohammed Hassanain Elsayed
Article Type: Editorial | First Published: July 31, 2021
A coronavirus-2019 (COVID-19) patient is currently balanced between laboratory suspicion and confirmatory tests. This is still controversial debatable. Sometimes, the cost and test availability push the physician towards this area. The disease severity, high infectivity, test sensitivity, and specificity are other playing factors. The strong willingness for mortality predictors is an essential tool for clinicians to rapidly triage the severe COVID-19 patients at admission into critical care depa...
Impella Device is Superior to an Intra-Aortic Balloon Pump in Cardiogenic Shock
Muhammad Zubair Khan, MD, Sona Franklin, MD and Richard Hyman, MD
Article Type: Case Report | First Published: July 03, 2021
A Percutaneous assist device is commonly used in cardiogenic shock to improve hemodynamics. The Impella provided superior hemodynamic support in the ISARSHOCK study compared with an intra-aortic balloon pump (IABP), with no change in clinical outcome. In this trial, the IABP was used in one group, and the Impella was placed in a comparator group. We present a case in which the hemodynamics of cardiogenic shock was assessed in the same patient after IABP and after Impella placement. In our case, ...