Case Reports in Cardiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea Wed, 01 Jul 2015 06:48:11 +0000 http://www.hindawi.com/journals/cric/2015/546395/ Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea. Cem Sahin, Fatih Akın, Nesat Cullu, Burak Özseker, İsmail Kirli, and İbrahim Altun Copyright © 2015 Cem Sahin et al. All rights reserved. Aortico-Left Atrial Fistula: A Rare Complication of Bioprosthetic Aortic Valve Endocarditis Secondary to Enterococcus faecalis Sun, 28 Jun 2015 10:29:03 +0000 http://www.hindawi.com/journals/cric/2015/473246/ Paravalvular aortic root abscess with intracardiac fistula formation is an exceedingly rare complication of infective endocarditis. This condition is even more rarely encountered in patients with bioprosthetic valve endocarditis. We report an unusual case of a 68-year-old Bosnian female with a bioprosthetic aortic valve, who developed an extensive aortic root abscess, complicated by an aortico-left atrial intracardiac fistula. This case illustrates that a high index of suspicion, prompt diagnosis by echocardiography, proper antibiotic therapy, and early surgical intervention are crucial to improving treatment outcomes for this rare condition. Abhinav Agrawal, Martin Miguel Amor, Deepa Iyer, Manan Parikh, and Marc Cohen Copyright © 2015 Abhinav Agrawal et al. All rights reserved. Pulmonic Valve Repair in a Patient with Isolated Pulmonic Valve Endocarditis and Sickle Cell Disease Tue, 23 Jun 2015 11:38:46 +0000 http://www.hindawi.com/journals/cric/2015/732073/ A 49-year-old woman with sickle cell disease presented with one month of exertional dyspnea, weakness, and fever and was diagnosed with isolated pulmonic valve endocarditis secondary to methicillin-resistant Staphylococcus bacteremia in the setting of a peripherally inserted central venous catheter. Chest computerized tomography showed multiple bilateral pulmonary nodular opacities consistent with septic emboli. Transthoracic and transesophageal echocardiograms revealed a large echodensity on the pulmonic valve requiring vegetation excision and pulmonic valve repair. In conclusion, isolated pulmonic valve endocarditis is a rare cause of infective endocarditis that warrants a high index of clinical suspicion. Furthermore the management of patients with sickle cell disease and endocarditis requires special consideration. Timothy Glew, Migdalia Feliciano, Dennis Finkielstein, Susan Hecht, and Daryl Hoffman Copyright © 2015 Timothy Glew et al. All rights reserved. Pneumopericarditis: A Case of Acute Chest Pain with ST Segment Elevation Sun, 14 Jun 2015 13:39:43 +0000 http://www.hindawi.com/journals/cric/2015/256546/ Pneumopericarditis describes a clinical scenario where fluid and air are found within the pericardial space. Although infrequent, pneumopericarditis should be considered in patients presenting with acute chest pain as a differential diagnosis. This is relevant in patients with history of upper gastrointestinal (GI) surgery, as this may lead to a fistula communicating the GI tract and the pericardium. We report a 42-year-old man with history of numerous surgical interventions related to a Nissen fundoplication that presented with acute chest pain and inferior lead ST segment elevations. Emergent coronary angiography was negative for coronary vascular disease but fluoroscopy revealed air in the pericardial space. Subsequent radiographic studies helped confirm air in the pericardial space with a fistulous communication to the stomach. Ultimate treatment for this defect was surgical closure. Erwin E. Argueta, Menfil A. Orellana-Barrios, Teerapat Nantsupawat, Alvaro Rosales, and Scott Shurmur Copyright © 2015 Erwin E. Argueta et al. All rights reserved. Beneficial Effects of Isoproterenol and Quinidine in the Treatment of Ventricular Fibrillation in Brugada Syndrome Thu, 11 Jun 2015 12:54:18 +0000 http://www.hindawi.com/journals/cric/2015/753537/ The use of an implantable cardiac defibrillator has been advocated as the only effective treatment for the management of ventricular fibrillation (VF) in patients with Brugada Syndrome (BrS). However, this device is only useful for terminating VF. Intermittent and/or recalcitrant VF for which lifesaving cardioversion occurs is a problematic situation in this patient population. The immediate use of appropriate antiarrhythmics in the acute setting has proven to be lifesaving. Quinidine has been well established as an effective antiarrhythmic in BrS, while isoproterenol (ISP) has had some recognition as well. The addition of drug therapy to prevent the induction of these arrhythmias has been shown to reduce the morbidity and mortality associated with BrS. It was proven to be especially effective in the presence of early repolarization, evidenced by the reduction or normalization of the early repolarization pattern on ECG. Thus, for the prophylactic management and long term suppression of VF in BrS, further prospective studies should be performed to determine the effectiveness of quinidine and ISP in this patient population. Melissa Dakkak, Khyati Baxi, and Ambar Patel Copyright © 2015 Melissa Dakkak et al. All rights reserved. Noncompaction Cardiomyopathy with Charcot-Marie-Tooth Disease Tue, 09 Jun 2015 16:54:27 +0000 http://www.hindawi.com/journals/cric/2015/646890/ We report a case of a 53-year-old female presenting with a new-onset heart failure that was contributed secondary to noncompaction cardiomyopathy. The diagnosis was made by echocardiogram and confirmed by cardiac MRI. Noncompaction cardiomyopathy (also known as ventricular hypertrabeculation) is a newly discovered disease. It is considered to be congenital (genetic) cardiomyopathy. It is usually associated with genetic disorders and that could explain the genetic pathogenesis of the non-compaction cardiomyopathy. Our case had a history of Charcot-Marie-Tooth disease. There is a high incidence of arrhythmia and embolic complications. The treatment usually consists of the medical management, defibrillator placement, and lifelong anticoagulation. Heart transplantation will be the last resort. Sherif Ali Eltawansy, Andrea Bakos, and John Checton Copyright © 2015 Sherif Ali Eltawansy et al. All rights reserved. Acute Anterior Myocardial Infarction Accompanied by Acute Inferior Myocardial Infarction: A Very Rare Coronary Artery Anomaly Sun, 07 Jun 2015 08:34:33 +0000 http://www.hindawi.com/journals/cric/2015/347126/ Coronary artery anomalies are rare and mostly silent in clinical practice. First manifestation of this congenital abnormality can be devastating as syncope, acute coronary syndrome, and sudden cardiac death. Herein we report a case with coronary artery anomaly complicated with ST segment myocardial infarction in both inferior and anterior walls simultaneously diagnosed during primary percutaneous coronary intervention. Y. Alsancak, B. Sezenöz, M. Duran, S. Unlu, S. Turkoglu, and R. Yalcın Copyright © 2015 Y. Alsancak et al. All rights reserved. A Complicated Case of Triple Valve Infective Endocarditis in an IV Drug User with a Bicuspid Aortic Valve Requiring Three Separate Salvage Operations: A Case Report and Literature Review Wed, 03 Jun 2015 11:56:46 +0000 http://www.hindawi.com/journals/cric/2015/291079/ Infective endocarditis (IE) is an infection of the endocardium that involves valves and adjacent mural endocardium or a septal defect. Local complications include severe valvular insufficiency, which may lead to intractable congestive heart failure and myocardial abscesses. If left untreated, IE is generally fatal. Diagnosing IE can be straightforward in patients with the typical oslerian manifestations such as bacteremia, evidence of active valvulitis, peripheral emboli, and immunologic vascular phenomena. In the acute course, however, the classic peripheral stigmata may be few or absent, particularly among intravenous drug abuse (IVDA) patients in whom IE is often due to a S. aureus infection of right-sided heart valves. We present a complicated case of a very aggressive native aortic valve MSSA (methicillin sensitive Staphylococcus aureus) IE in a young adult male with a past medical history of bicuspid aortic valve and IV drug abuse. His clinical course was complicated by aortic valve destruction and development of third-degree AV block, as well as an aorto-left atrial fistula requiring emergent operation for AV replacement and patch repair. The patient required two reoperations for recurrent endocarditis and its complications. Shahzad Khan, Athanasios Smyrlis, Dmitry Yaranov, David Oelberg, and Eric Jimenez Copyright © 2015 Shahzad Khan et al. All rights reserved. Fibromuscular Dysplasia Leading to Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest Wed, 03 Jun 2015 09:55:32 +0000 http://www.hindawi.com/journals/cric/2015/708409/ A 30-year-old previously healthy female, who was six-week postpartum, experienced sudden collapse and tonic-clonic seizure. Emergency medicine services arrived at the scene and the patient was found to be in ventricular fibrillation. Advanced cardiovascular life support (ACLS) was initiated with return of spontaneous circulation. Afterwards, her initial EKG showed atrial fibrillation with rapid ventricular rate, ST elevation in leads II, III, and aVF, and ST depression in V2–V4. She was transferred to a tertiary care hospital where emergent angiogram was performed revealing obstruction of blood flow in the proximal and mid right coronary artery (RCA). A hazy and irregularly contoured appearance of the RCA was consistent with diagnosis of fibromuscular dysplasia. Subsequently, intravascular ultrasonogram (IVUS) was performed which confirmed the diagnosis of RCA dissection. Successful revascularization of the RCA was performed using two bare mental stents. After a complicated course in hospital, she was discharged in stable condition and did very well overall. Ata Bajwa, Udit Bhatnagar, Amit Sharma, Hani El-Halawany, and Randall C. Thompson Copyright © 2015 Ata Bajwa et al. All rights reserved. Instant Stent-Accentuated Three-Dimensional Optical Coherence Tomography Guided Selection of Proper Distal Cell for Side Branch Dilatation in Bifurcation Stenting Sun, 31 May 2015 08:42:38 +0000 http://www.hindawi.com/journals/cric/2015/915084/ In the bifurcation stenting, the distal rewiring for the side branch postdilatation confirmed by two-dimensional modalities may not lead to favorable results in some cases. If there are two distal cells divided by the link bridging from the carina, the rewiring through the larger distal cell may be recommended for the side branch postdilatation. Detailed confirmation of the rewired cell by the intraprocedural instant stent-accentuated three-dimensional optical coherence tomography is important. Fumiaki Nakao Copyright © 2015 Fumiaki Nakao. All rights reserved. Undifferentiated Intimal Sarcoma of the Inferior Vena Cava with Extension to the Right Atrium and Renal Vasculature Thu, 28 May 2015 13:47:51 +0000 http://www.hindawi.com/journals/cric/2015/812374/ Primary sarcomas of the great vessels (aorta, pulmonary artery, and inferior vena cava (IVC)) are exceedingly rare. We report a rare case of an undifferentiated intimal sarcoma of the IVC with extension to the right atrium, adrenal, and renal veins. The patient underwent extensive resection, reconstruction of the IVC, and subsequent adjuvant chemotherapy. Patient has tolerated chemotherapy and, at 17 months after resection, the patient remains free of tumor recurrence. Undifferentiated intimal sarcomas remain a rare entity with only five cases of venous undifferentiated intimal sarcomas reported in the literature, two of which occurred in the IVC. Intimal sarcomas tend to carry a poor prognosis with the limited literature available on treatment approaches. Our objective is to highlight this rare entity and possible treatment approach which we utilized. Primary sarcomas of IVC need to be included as part of a complete differential diagnosis in patients with atrial masses or recurrent pulmonary emboli. Aasim M. Afzal, Jamil Alsahhar, Varsha Podduturi, and Jeffrey M. Schussler Copyright © 2015 Aasim M. Afzal et al. All rights reserved. Raghib Syndrome Presenting as a Cryptogenic Stroke: Role of Cardiac MRI in Accurate Diagnosis Wed, 27 May 2015 12:03:03 +0000 http://www.hindawi.com/journals/cric/2015/921247/ Raghib Syndrome is a rare developmental complex, which consists of persistence of the left superior vena cava (PLSVC) along with coronary sinus ostial atresia and atrial septal defect. This Raghib complex anomaly has also been associated with other congenital malformations including ventricular septal defects, enlargement of the tricuspid annulus, and pulmonary stenosis. Our case demonstrates an isolated PLSVC draining into the left atrium along with coronary sinus atresia in a young patient presenting with cryptogenic stroke without the atrial septal defect. Majority of the cases reported in the literature were found to have the lesion during the postmortem evaluation or were characterized at angiography and/or echocardiography. We stress the importance of modern day imaging like the computed tomography (CT) angiography and cardiac MRI in diagnosis and surgical management of such rare lesions leading to cryptogenic strokes. Vistasp J. Daruwalla, Keyur Parekh, Hassan Tahir, Jeremy D. Collins, and James Carr Copyright © 2015 Vistasp J. Daruwalla et al. All rights reserved. Infective Endocarditis Presented as a Right Atrium Mass in a Patient with Ulcerative Colitis Tue, 19 May 2015 12:49:05 +0000 http://www.hindawi.com/journals/cric/2015/789170/ Involvement of the heart is infrequently seen in irritable bowel syndrome (IBD). We present a case of severe acute infective endocarditis diagnosed as ulcerative colitis in further workup. Ali Asghar Moeinipour, Hamid Hoseinikhah, Mohamad Ali Kiani, Naser Tayyebi Meibodi, Mohammad Hassan Aelami, Ali Reza Sepehri Shamloo, and Shahram Amini Copyright © 2015 Ali Asghar Moeinipour et al. All rights reserved. Acute Amiodarone Pulmonary Toxicity after Drug Holiday: A Case Report and Review of the Literature Thu, 14 May 2015 12:30:40 +0000 http://www.hindawi.com/journals/cric/2015/927438/ Amiodarone is reported to cause a wide continuum of serious clinical effects. It is often challenging to detect Amiodarone-induced pulmonary toxicity (AIPT). Typically, the diagnosis is made based on the clinical settings and may be supported by histopathology results, if available. We describe a 57-year-old patient who developed severe rapidly progressive respiratory failure secondary to AIPT with acute bilateral infiltrates and nodular opacities on chest imaging. Interestingly, Amiodarone was discontinued 3 weeks prior to his presentation. He had normal cardiac filling pressures confirmed by echocardiography. To our knowledge, this is the first case of isolated acute lung injury induced by Amiodarone, three weeks after therapy cessation, with adequate clinical improvement after supportive management and high dose steroid therapy. Ahmed Abuzaid, Marwan Saad, Mohamed Ayan, Amjad Kabach, Toufik Mahfood Haddad, Aiman Smer, and Amy Arouni Copyright © 2015 Ahmed Abuzaid et al. All rights reserved. Aortopulmonary Fistula after Multiple Pulmonary Artery Stenting and Dilatation for Postarterial Switch Supravalvular Stenosis Wed, 13 May 2015 09:30:01 +0000 http://www.hindawi.com/journals/cric/2015/371925/ We present a case of iatrogenic aortopulmonary fistula following pulmonary artery (PA) stenting late after arterial switch operation (ASO) for D-transposition of the great arteries (D-TGA), an unusual complication that may be encountered more frequently in contemporary adult cardiology clinics. The diagnosis should be sought in the face of unexplained heart failure in patients who underwent ASO and subsequent PA angioplasty. Treatment should be instituted in a timely fashion, and options include surgical correction or implantation of a duct occluder or covered stent. Maude Pagé, Oana Nastase, Frédéric Maes, Joëlle Kefer, Thierry Sluysmans, Alain Poncelet, Jean Rubay, and Agnès Pasquet Copyright © 2015 Maude Pagé et al. All rights reserved. Free Floating Right Heart Thrombus Associated with Acute Pulmonary Embolism: An Unsettled Therapeutic Difficulty Mon, 11 May 2015 08:12:46 +0000 http://www.hindawi.com/journals/cric/2015/364780/ Free floating right heart thrombus is a rare phenomenon in the context of acute pulmonary embolism and it is associated with a poor outcome. The increased use of echocardiography has led to an increased detection of right heart thrombi. However, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 74-year-old woman who presented to the emergency department with acute onset dyspnea on minimal exertion which had developed over a period of 1 day. A computed tomography of the chest demonstrated massive bilateral proximal pulmonary embolism. A bedside transthoracic echocardiography performed showed a moderately dilated, poorly functioning right ventricle with visible highly mobile serpiginous thrombus moving to and fro across the tricuspid valve. Thrombolytic therapy was immediately initiated with tenecteplase which resulted in excellent results. Although there is no clear consensus for the management of right heart thrombus associated with pulmonary embolism, thrombolysis is readily available and can be effective in carefully selected patients. Clovis Nkoke, Olivier Faucher, Lise Camus, and Laurence Flork Copyright © 2015 Clovis Nkoke et al. All rights reserved. Endovascular Therapy Is Effective for Leriche Syndrome with Deep Vein Thrombosis Sun, 03 May 2015 09:32:17 +0000 http://www.hindawi.com/journals/cric/2015/395205/ A 65-year-old man presented to our hospital due to intermittent claudication and swelling in his left leg. He had Leriche syndrome and deep vein thrombosis. We performed endovascular therapy (EVT) for Leriche syndrome, and a temporary filter was inserted in the inferior vena cava. He received anticoagulation therapy for deep vein thrombosis. The stenotic lesion in the terminal aorta was stented with an excellent postprocedural angiographic result and dramatic clinical improvement after EVT. This case suggests that EVT can be a treatment for Leriche syndrome. Tasuku Higashihara, Nobuo Shiode, Tomoharu Kawase, Hiromichi Tamekiyo, Masaya Otsuka, Tomokazu Okimoto, and Yasuhiko Hayashi Copyright © 2015 Tasuku Higashihara et al. All rights reserved. Radiation Therapy-Induced Cardiovascular Disease Treated by a Percutaneous Approach Thu, 30 Apr 2015 18:45:29 +0000 http://www.hindawi.com/journals/cric/2015/851624/ We report the case of a 51-year-old woman, treated with radiotherapy at the age of two years, for a pulmonary sarcoma. Subsequently she developed severe aortic stenosis and bilateral ostial coronary artery disease, symptomatic for dyspnea (NYHA III functional class). Due to the prohibitive surgical risk, she underwent successful stenting in the right coronary artery and left main ostia with drug eluting stents and, afterwards, transcatheter aortic valve replacement with transfemoral implantation of a 23 mm Edwards SAPIEN XT valve. The percutaneous treatment was successful without complications and the patient is in NYHA II functional class at 2 years’ follow-up, fully carrying out normal daily activities. Luigi Fiocca, Micol Coccato, Vasile Sirbu, Angelina Vassileva, Giulio Guagliumi, Giuseppe Musumeci, Amedeo Terzi, Gianluca Canu, Elisa Cerchierini, Diego Cugola, and Orazio Valsecchi Copyright © 2015 Luigi Fiocca et al. All rights reserved. Comment on “Dual Prosthetic Heart Valve Presented with Chest Pain: A Case Report of Coronary Thromboembolism” Thu, 30 Apr 2015 17:20:04 +0000 http://www.hindawi.com/journals/cric/2015/325396/ Mehmet Ali Astarcıoğlu, Macit Kalçık, Mahmut Yesin, and Mehmet Özkan Copyright © 2015 Mehmet Ali Astarcıoğlu et al. All rights reserved. Transcatheter Removal of Embolized Port Catheters from the Hearts of Two Children Wed, 29 Apr 2015 12:18:09 +0000 http://www.hindawi.com/journals/cric/2015/973196/ Embolization of a port catheter is a dangerous and serious complication. In this paper, we present two cases of children, aged 4.5 months and 6 years, in whom port catheters had embolized to the right ventricle one month and 1.5 years priorly, respectively; the port catheters were retrieved via snaring. Osman Baspinar, Ayse Sulu, and Derya Aydin Sahin Copyright © 2015 Osman Baspinar et al. All rights reserved. Biatrial Cardiac Metastases in a Patient with Uterine Cervix Malignant Melanoma Tue, 28 Apr 2015 11:59:22 +0000 http://www.hindawi.com/journals/cric/2015/958756/ Primary malignant melanomas of uterine cervix are quite rarely seen neoplasms, and long-life prognosis of patients with this disease is poor. Immunohistochemical methods and exclusion of other primary melanoma sites are used to confirm the diagnosis. As with other melanomas, cervix malignant melanomas may also cause cardiac metastases. Cardiac metastases are among rarely seen but more commonly encountered cases, compared to primary cardiac tumors. Here, we present a case of biatrial cardiac metastases in a 73-year-old patient with uterine cervix malignant melanomas. The patient underwent echocardiography, cardiac magnetic resonance imaging, and computed tomography. Our report shows the importance of advanced diagnostic techniques, such as cardiac magnetic resonance, not only for the detection of cardiac masses, but for a better anatomic definition and tissue characterization. Although the cases of malignant melanomas leading to multiple cardiac metastasis were reported in literature, the metastatic concurrence of malignant melanomas in both right and left atriums is quite rarely encountered as metastatic malignant melanomas. Also, another intriguing point in our case is that the primary lesion of our case was stemmed from uterine cervix, but not skin. Caglayan Geredeli, Melih Cem Boruban, Necdet Poyraz, Mehmet Artac, Alpay Aribas, and Lokman Koral Copyright © 2015 Caglayan Geredeli et al. All rights reserved. Malignant Perivascular Epithelioid Cardiac Sarcomas: A Case Report and a Review of the Literature Wed, 22 Apr 2015 12:57:49 +0000 http://www.hindawi.com/journals/cric/2015/258140/ Cardiac tumors, either benign or malignant, are difficult to diagnose due to their rarity, variety, and nonspecific presentation. Since primary cardiac sarcoma remains an unusual diagnosis, the literature on its presentation, diagnosis, and optimal management remains scarce. To our knowledge the following case of cardiac perivascular epithelioid cell tumor is the fourth reported case found in the literature. Although complete surgical resection remains the gold standard for cardiac sarcomas, our case demonstrates that not all of them can be completely resected. Candice Baldeo, Abdul wahab Hritani, Robert Ali, Sana Chaudhry, and Fawad N. Khawaja Copyright © 2015 Candice Baldeo et al. All rights reserved. Wire in the Heart: Fracture and Fragment Embolization of Retrievable Inferior Vena Cava Filter into the Right Ventricle Tue, 21 Apr 2015 13:10:53 +0000 http://www.hindawi.com/journals/cric/2015/938184/ We report a case of a 58-year-old female who was found to have a fractured limb of her IVC filter in her right ventricle during a cardiac catheterization. A 25 mm radioopaque thin linear structure was seen in the proximal portion of the right ventricle. It was fixed and did not migrate or change position during investigations. On fluoroscopy, the IVC filter was observed in an appropriate location in the midabdomen. Yet, fractures of at least two of the metal filamentous legs of the IVC device were noticed. The patient was made aware of the many risks associated with filter removal. Due to the high risks of the procedure, she refused surgery and the filter fragment was not removed. We present this case to underscore the potential complications of IVC filters. Kshitij Thakur, Naveen Dhawan, Chia Winchester, Amandeep Singh, Vijay Bodukam, and Jaya Bahl Copyright © 2015 Kshitij Thakur et al. All rights reserved. A Giant Left Atrial Myxoma Neovascularized from the Right Coronary Artery Wed, 15 Apr 2015 13:11:48 +0000 http://www.hindawi.com/journals/cric/2015/614830/ Myxomas are benign and the most common tumors of the cardiac muscle (Reynen, 1995). They are predominantly located in the left atrium. Clinical manifestations may vary according to the localization and the size of the myxoma. On the other hand, imaging of a myxoma by contrast dye during coronary angiography is a rare sign, which displays the vascular supply of the tumor. Here, we report the case of a 51-year-old man presenting with presyncope and palpitations due to a giant left atrial myxoma having its vascular supply from the right coronary artery (RCA). Demet Menekse Gerede, Irem Muge Akbulut, Sadık Ersoz, and Mustafa Kilıckap Copyright © 2015 Demet Menekse Gerede et al. All rights reserved. The Significance of ST Depression in a Postmenopausal Woman on Estrogen Therapy during Regadenoson Myocardial SPECT Imaging Wed, 15 Apr 2015 12:20:47 +0000 http://www.hindawi.com/journals/cric/2015/653760/ The incidence of false-positive stress tests has been noted in women, especially on hormone replacement therapy. Current literature describes this phenomenon in treadmill and adenosine stress tests. The introduction of regadenoson as a vasodilator agent has been widely adopted owing to its potency and specificity. To our knowledge, false-positive stress test with regadenoson in a postmenopausal woman on estrogen has never been described. Given the higher chronotropic response with regadenoson, we believe that normal perfusion images with a higher heart rate response indicate a good prognosis in such patients. Nishaki Kiran Mehta, Charles Hardebeck, and Martha Gulati Copyright © 2015 Nishaki Kiran Mehta et al. All rights reserved. A Silent Alarm at Occupational Evaluation Two Months after a Normal Painful ECG: A Case of Wellens’ syndrome Tue, 14 Apr 2015 14:10:53 +0000 http://www.hindawi.com/journals/cric/2015/819205/ We describe a case of a 42-year-old man, with a previous episode of angina and a normal ECG and serum cardiac markers, and a two months later finding of biphasic T wave in leads V2-V3 and deeply inverted T wave in V4-V5 at a asymptomatic occupational evaluation. This is a typical ECG pattern of Wellens’ syndrome. A subsequent coronary angiography showed a critical stenosis of proximal left anterior descendent. We underline the careful value of prolonged observation in chest pain unit and repetitive ECG evaluation also during pain-free period after an angina episode, to exclude an earlier T wave pseudonormalization. Giuseppe Di Stolfo, Sandra Mastroianno, Giovanni De Luca, Domenico Rosario Potenza, Nicola Marchese, Carlo Vigna, and Raffaele Fanelli Copyright © 2015 Giuseppe Di Stolfo et al. All rights reserved. Double Orifice Mitral Valve and Bicuspid Aortic Valve: Pieces of the Same Single Puzzle? Thu, 09 Apr 2015 14:04:39 +0000 http://www.hindawi.com/journals/cric/2015/305142/ Double orifice mitral valve is a very rare congenital abnormality. Well known associations of this pathology with other congenital lesions point to a complex and central pathophysiological mechanism leading to a sequence of pathologies. These associations have long been realized and arbitrarily defined as Shone complex. We would like to present a 21-year-old patient with double orifice mitral valve associated with bicuspid aortic valve, with a brief review of the literature on possible central mechanisms leading to different subsets of congenital abnormalities involving these two. Faysal Şaylık, Ferit Onur Mutluer, Aydın Tosu, and Murat Selçuk Copyright © 2015 Faysal Şaylık et al. All rights reserved. Type 4 Dual Left Anterior Descending Artery: A Very Rare Coronary Anomaly Circulation Wed, 08 Apr 2015 11:31:15 +0000 http://www.hindawi.com/journals/cric/2015/580543/ Coronary artery anomalies are congenital changes in their origin, course, and/or structure. They are the second most frequent cause of sudden death in young athletes. Dual LAD artery is a rare coronary anomaly. We present the case of a 44-year-old man with recent onset exertional angina and documented ischemia whose coronary angiogram and computed tomography (CT) showed type 4 dual LAD artery, the rarest and most interesting variant. Marcos Danillo Peixoto Oliveira, Pedro H. M. Craveiro de Melo, Antonio Esteves Filho, Luiz J. Kajita, Expedito E. Ribeiro, and Pedro Alves Lemos Copyright © 2015 Marcos Danillo Peixoto Oliveira et al. All rights reserved. Partial PFO Closure for Persistent Hypoxemia in a Patient with Ebstein Anomaly Tue, 07 Apr 2015 09:21:09 +0000 http://www.hindawi.com/journals/cric/2015/531382/ Ebstein anomaly is characterized by deformities of the anterior leaflet of the tricuspid valve and atrialization of the right ventricle. Patients with severe tricuspid regurgitation are recommended to have tricuspid valve surgery with concomitant atrial septal defect closure. A 73-year-old female with Ebstein anomaly presented with severe hypoxemia. Transthoracic echocardiography revealed severe tricuspid regurgitation and a patent foramen ovale with right-to-left shunting. Complete percutaneous patent foramen ovale closure led to acute decompensation; however, partial closure led to hemodynamic stability and improved oxygenation. In conclusion, similar patients with “patent foramen ovale dependency” from longstanding shunts may benefit from partial patent foramen ovale closure. S. A. Zuberi, S. Liu, J. W. Tam, F. Hussain, D. Maguire, and M. Kass Copyright © 2015 S. A. Zuberi et al. All rights reserved. Multivessel Spontaneous Coronary Artery Dissection in an Unlikely Patient Mon, 06 Apr 2015 09:40:15 +0000 http://www.hindawi.com/journals/cric/2015/167243/ When approaching the symptom of acute onset chest pain in a previously healthy 26-year-old male, anchoring heuristic presents a challenge to healthcare workers. This diagnostic error is the healthcare professional’s tendency to rely on a previous diagnosis, and, in situations where a set of symptoms might mask a rare and deadly condition, this error can prove fatal for the patient. One such condition, Spontaneous Coronary Artery Dissection (SCAD), is an uncommon and malefic presentation of coronary artery disease that can lead to myocardial infarction and sudden death. We present a case of SCAD in an otherwise healthy 26 year-old male who had been experiencing chest pain during and after sports activity. In the young, athletic male with SCAD, the danger of diagnostic error was a reality due to the broad symptomatology and the betraying demographics. Waqas Jehangir, Tarek Aly, Kebir H. Bedran, Abdalla Yousif, and Mark L. Niemiera Copyright © 2015 Waqas Jehangir et al. All rights reserved.