Case Reports in Cardiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Penetrating Heart Injury due to Screwdriver Assault Sun, 05 Apr 2015 09:16:26 +0000 http://www.hindawi.com/journals/cric/2015/140507/ Penetrating heart injuries cause wounds in the cardiac chambers. Most of them are due to gunshot or stabbing by knives. Screwdriver is an uncommon weapon. Authors report a case of stab wound by screwdriver, treated at cardiovascular center in Dakar. This is a 16-year-old boy who experienced physical aggression. He was assaulted with a screwdriver and had stab wound on the anterior wall of the chest. Physical examination showed a screwdriver penetrating the sternum bone over a right angle. He had a mild pericardial blood effusion and a right ventricle wound 5 mm in diameter with transection of the right coronary vein. The screwdriver was removed without cardiopulmonary bypass (CPB) and the ventricle wound repaired by direct suture of stitches reinforced with Teflon pledgets. The right coronary artery was ligated. Postoperative period was free of events. Screwdriver is uncommonly used as a weapon. It is a dangerous device because of its rigid structure and narrow tip. P. A. Dieng, M. S. Diop, A. G. Ciss, P. S. Ba, S. Diatta, M. Gaye, M. L. Fall, A. Ndiaye, and M. Ndiaye Copyright © 2015 P. A. Dieng et al. All rights reserved. Bilateral Ductal Stenting for Discontinuity of the Pulmonary Artery via the Femoral and Carotid Arteries in an Infant Sun, 29 Mar 2015 06:51:40 +0000 http://www.hindawi.com/journals/cric/2015/619653/ Bilateral ductal stenting should be performed in cases of discontinuity of the pulmonary branches and pulmonary atresia. Performing this procedure via the carotid artery in small infants can be very difficult and challenging. We present a case of bilateral ductal stenting via both the femoral and carotid arteries in a little child with tetralogy of Fallot with pulmonary atresia and a nonconfluent pulmonary artery and bilateral ductus arteriosus. Osman Baspinar and Derya Aydin Sahin Copyright © 2015 Osman Baspinar and Derya Aydin Sahin. All rights reserved. Acquired Aorto-Right Ventricular Fistula following Transcatheter Aortic Valve Replacement Thu, 26 Mar 2015 12:40:07 +0000 http://www.hindawi.com/journals/cric/2015/608539/ Transcatheter aortic valve replacement (TAVR) techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD) formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient. Muhammad Tariq Shakoor, Ashequl M. Islam, and Samia Ayub Copyright © 2015 Muhammad Tariq Shakoor et al. All rights reserved. Comment on “A Unique Case of Cardiac Arrest following K2 Abuse” Thu, 26 Mar 2015 11:40:03 +0000 http://www.hindawi.com/journals/cric/2015/739149/ Joachim Alexandre, Danièle Debruyne, Antoine Coquerel, and Reynald Le Boisselier Copyright © 2015 Joachim Alexandre et al. All rights reserved. A Case of Coronary Vasospasm after Repeat Rituximab Infusion Wed, 18 Mar 2015 15:38:44 +0000 http://www.hindawi.com/journals/cric/2015/523149/ Coronary artery vasospasm (CAV) can be triggered by medication reactions. CAV occurring after multiple exposures to rituximab has not been previously described. A 61-year-old woman with no cardiac risk factors was treated with the sixth cycle of gemcitabine, cisplatin, dexamethasone, and rituximab therapy. Fifteen minutes after rituximab infusion commenced, she developed typical cardiac chest pain with ST segment elevations on electrocardiogram. Angiogram revealed evidence of coronary vasospasm. The patient was successfully treated with amlodipine. This case underlines the importance of monitoring cardiac side effects of rituximab therapy, even after multiple cycles. Calvin Ke, Amit Khosla, Margot K. Davis, Cameron Hague, and Mustafa Toma Copyright © 2015 Calvin Ke et al. All rights reserved. Acute Ventricular Wall Thickening: Sepsis, Thrombotic Microangiopathy, or Myocarditis? Sun, 15 Mar 2015 07:10:41 +0000 http://www.hindawi.com/journals/cric/2015/275825/ Background. Acute myocardial oedema has been documented in experimental models of ischemia-reperfusion injury or sepsis and is usually investigated by magnetic resonance imaging. Purpose. We describe a case of acute ventricular wall thickening documented by echocardiography in a patient developing sepsis and thrombotic microangiopathy. Case Description. A 40-year-old woman, with a history of mixed connective tissue disease, was admitted with laryngeal oedema and fever. She developed Streptococcus pneumoniae septicaemia and subsequent laboratory abnormalities were consistent with a thrombotic microangiopathy. Echocardiography revealed an impressive diffuse thickening of the whole myocardium (interventricular septum 18 mm; posterior wall 16 mm) with diffuse hypokinesia and markedly reduced left ventricular ejection fraction (31%). There was also a moderate pericardial effusion. Echocardiography was normal two months before. The patient died from acute heart failure. Macroscopic and microscopic examination of the heart suggested that the ventricular wall thickening was induced by oedematous changes, together with an excess of inflammatory cells. Conclusion. Acute ventricular wall thickening that corresponded to myocardial oedema as a first hypothesis was observed at echocardiography during the course of septicaemia complicated by thrombotic microangiopathy. Nicolas De Schryver, Delphine Hoton, Diego Castanares-Zapatero, and Philippe Hantson Copyright © 2015 Nicolas De Schryver et al. All rights reserved. Complete Heart Block with Diastolic Heart Failure and Pulmonary Edema Secondary to Enlarging Previously Diagnosed Thrombosed Aneurysm of Sinus of Valsalva in a Patient with History of Autosomal Dominant Polycystic Kidney Disease Wed, 11 Mar 2015 13:22:38 +0000 http://www.hindawi.com/journals/cric/2015/281716/ Autosomal dominant polycystic kidney disease (ADPKD) is associated with vascular aneurysms that can affect any part of the vascular tree, like ascending aorta or coronary arteries. Sinus of Valsalva is known as an anatomical dilation at the root of aorta above the aortic valve and very few cases show aneurysm at that site in patients with ADPKD. Sinus of Valsalva aneurysm (SVA) can present with rupture and acute heart failure and infective endocarditis or could be asymptomatic accidentally discovered during cardiac catheterization. We report a case of a 76-year-old male with a unique constellation of cardiovascular anomalies associated with ADPKD. Patient was previously diagnosed with aneurysms affecting ascending aorta, sinus of Valsalva, and coronary arteries. Several years later, he came with complete heart block which was discovered later to be secondary to enlargement of his previously diagnosed thrombosed SVA. His case was complicated with acute heart failure and pulmonary edema. Conclusion. Patients with ADPKD can present with extrarenal manifestations. In our case, aneurysm at sinus of Valsalva was progressively enlarging and presented with complete heart block. Sherif Ali Eltawansy, Martin Miguel Amor, Maria Joana Thomas, and Jeffrey Daniels Copyright © 2015 Sherif Ali Eltawansy et al. All rights reserved. Acute Spontaneous Coronary Artery Thrombosis as Initial Presentation of HIV Infection in a Young Man Mon, 02 Mar 2015 10:33:02 +0000 http://www.hindawi.com/journals/cric/2015/342348/ Introduction. The presentation of acute coronary syndrome (ACS) in young HIV patients may be atypical with different pathophysiological and clinical features. Acute coronary thrombosis, as a presentation of acute coronary syndrome in young patients with HIV, raises diagnostic and treatment challenges. Case Presentation. We describe a case of a 33-year-old African man, without traditional atherosclerotic risk factors, who presented with chest pain of acute onset. Emergent coronary angiography revealed extensive thrombus in the left anterior descending coronary artery with no evidence of atherosclerosis in this or other coronary vessels. Plaque and/or thrombus prolapse through the stent was noted following percutaneous coronary intervention (PCI). Resolution of chest pain and improvement in ST-segment elevation was noted after the procedure. A diagnosis of HIV infection was made during the workup for HIV infection. Conclusion. In young patients without traditional risk factors, HIV infection is a possible etiological factor for spontaneous coronary artery thrombosis. Percutaneous coronary intervention in patients with this presentation may be compounded with atherothrombotic complications. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation. James Kayima, Wilson Nyakoojo, Damalie Nakanjako, Marco A. Costa, Christopher T. Longenecker, and Daniel I. Simon Copyright © 2015 James Kayima et al. All rights reserved. Right Atrial Metastatic Melanoma with Unknown Primaries Mon, 23 Feb 2015 12:48:43 +0000 http://www.hindawi.com/journals/cric/2015/483520/ A 54-year-old male with history of anemia and rheumatoid arthritis presented with a three-month history of dyspnea on exertion and lower extremity edema. Patient was referred for a transthoracic echocardiogram that revealed a large right atrial mass with reduced ejection fraction of 40% and an incidental large liver mass. Subsequent cardiac MRI revealed a lobulated right atrial mass measuring 5.4 cm 5.3 cm with inferior vena cava compression and adjacent multiple large liver lesions confirmed to be malignant melanoma through biopsy. Interestingly, no primaries were found in the patient. PET/CT imaging displayed hypermetabolic masses within the right atrium and liver that likely represent metastases, as well as bilateral pleural effusions, most likely due to heart failure. Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery. The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. The patient is currently being administered ipilimumab for systemic therapy of metastatic melanoma. Robin Kuriakose, Rakhi Melvani, Venkataramanan Gangadharan, and Michael Cowley Copyright © 2015 Robin Kuriakose et al. All rights reserved. Isolated Perforation of Left Coronary Cusp after Blunt Chest Trauma Mon, 23 Feb 2015 11:42:38 +0000 http://www.hindawi.com/journals/cric/2015/235629/ Left coronary cusp perforation is an extremely rare consequence of blunt chest trauma. A 22-year-old male presented after a motor vehicle accident with dyspnea. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) showed moderate to severe aortic regurgitation with prolapsing right coronary cusp. In the operating room he was found to have a left coronary cusp tear near the annulus and an enlarged right cusp. The patient recovered well after successful aortic valve replacement with a mechanical valve. Traumatic aortic regurgitation with left cusp perforation is serious and surgical intervention may be lifesaving if performed timely. Rohit Maini, Razvan T. Dadu, Daniel Addison, Luke Cunningham, Ihab Hamzeh, Matthew Wall Jr., Nasser Lakkis, and Rashed Tabbaa Copyright © 2015 Rohit Maini et al. All rights reserved. Myocarditis Leading to Severe Dilated Cardiomyopathy in a Patient with Dengue Fever Mon, 23 Feb 2015 09:00:26 +0000 http://www.hindawi.com/journals/cric/2015/319312/ Background. Majority of dengue fever cases follow a benign self-limiting course but recently rare presentations and complications are increasingly seen due to rising burden of disease. Cardiac involvement in dengue fever with fatal outcome is a very rare complication. We report a case of 44-year-old patient who presented with symptoms of severe acute congestive heart secondary to myocarditis induced cardiomyopathy caused by dengue virus infection. Case Presentation. A 44-year-old man presented to ER with the complaints of high fever, fatigue, and shortness of breath. Patient was lethargic and blood pressure was low when he was brought to the ER. CXR showed cardiomegaly with pulmonary congestion and echocardiography revealed dilated left ventricle and ejection fraction of 10%. Patient condition worsened and he got admitted to the ICU because of acute hypoxic respiratory failure. Despite aggressive measures, patient died on day 5. Conclusion. Dilated cardiomyopathy is a rare complication of dengue myocarditis. Early recognition of acute DCM caused by dengue myocarditis is imperative in the management of dengue fever as early detection and management of cardiac failure can improve the survival of patient. Hassan Tahir, Vistasp Daruwalla, and Saleem Hayat Copyright © 2015 Hassan Tahir et al. All rights reserved. Thrombus Formation in Left Atrium on Dabigatran Therapy Sun, 22 Feb 2015 11:45:24 +0000 http://www.hindawi.com/journals/cric/2015/518982/ Dabigatran is a direct thrombin inhibitor, approved in the United States for stroke prevention in nonvalvular atrial fibrillation and prevention and treatment of thromboembolism. It has been also used in patients with documented left atrial thrombus, where treatment with dabigatran effectively led to thrombus resolution. We present a rare case of left atrial thrombus formation in a patient with chronic atrial fibrillation being treated with dabigatran 150 mg twice a day. The patient presented with multiple embolic strokes. There are only three such cases reported in the literature till date, all of whom had thrombus in the left atrium. The possible mechanisms of dabigatran failure include compensatory increase in upstream coagulation factors due to single level downstream blockade of thrombin, lack of inhibition of all available thrombin, and lack of monitoring measures that can be implemented in common clinical laboratories that lead to failure to assess adherence, which in turn can lead to dabigatran failure. Priyank Shah, Priyam Mithawala, Donna Konlian, Aderemi Soyombo, and Mahesh Bikkina Copyright © 2015 Priyank Shah et al. All rights reserved. Emergent Unilateral Renal Artery Stenting for Treatment of Flash Pulmonary Edema: Fact or Fiction? Sun, 22 Feb 2015 06:03:30 +0000 http://www.hindawi.com/journals/cric/2015/659306/ Flash pulmonary edema is characteristically sudden in onset with rapid resolution once appropriate therapy has been instituted (Messerli et al., 2011). Acute increase of left ventricular (LV) end diastolic pressure is the usual cause of sudden decompensated cardiac failure in this patient population. Presence of bilateral renal artery stenosis or unilateral stenosis in combination with a single functional kidney in the susceptible cohort is usually blamed for this condition. We describe a patient who presented with flash pulmonary edema in the setting of normal coronary arteries. Our case is distinct as our patient developed flash pulmonary edema secondary to unilateral renal artery stenosis in the presence of bilateral functioning kidneys. Percutaneous stent implantation in the affected renal artery resulted in rapid resolution of pulmonary edema. Asaad Akbar Khan and Eugene Patrick McFadden Copyright © 2015 Asaad Akbar Khan and Eugene Patrick McFadden. All rights reserved. Dual Prosthetic Heart Valve Presented with Chest Pain: A Case Report of Coronary Thromboembolism Mon, 16 Feb 2015 14:06:28 +0000 http://www.hindawi.com/journals/cric/2015/895473/ Coronary embolism from a prosthetic heart valve is a rare but remarkable cause of acute coronary syndrome. There is no definite management of an entity like this. Here we report a case of 54-year-old male with a history of rheumatic heart disease with dual prosthetic heart valve and atrial fibrillation who developed chest pain from acute myocardial infarction. The laboratory values showed inadequate anticoagulation. Cardiac catheterization and thrombectomy with the aspiration catheter were chosen to be the treatment for this patient, and it showed satisfactory outcome. Supakanya Wongrakpanich, Natanong Thamcharoen, Pakawat Chongsathidkiet, and Sarawut Siwamogsatham Copyright © 2015 Supakanya Wongrakpanich et al. All rights reserved. Subacute Right Ventricle Perforation by Pacemaker Lead Presenting with Left Hemothorax and Shock Mon, 16 Feb 2015 06:37:03 +0000 http://www.hindawi.com/journals/cric/2015/983930/ Cardiac perforation by pacemaker is a rare but potentially fatal complication. Acute perforations occurring within twenty-four hours of insertion of pacemaker can lead to hemopericardium, cardiac tamponade, and death. Hemothorax occurring as an acute complication of pacemaker insertion is reported but extremely rare. Previously, hemothorax and shock as a subacute complication following pacemaker insertion have not been reported. We report the case of an 85-year-old patient who presented with shock from hemothorax caused by pacemaker perforation, two weeks after insertion. Device interrogation showed normal function. Chest X-ray and echocardiogram missed lead dislocation and the diagnosis was made on computed tomogram (CT) of the chest. Following surgical repair, a new ventricular pacemaker was placed transvenously in the right ventricular septum. This case illustrates that CT scan of the chest should be performed in all patients in whom cardiac perforation by pacemaker is suspected but not diagnosed on chest X-ray and echocardiogram. Normal functioning of pacemaker on device interrogation does not exclude perforation. Julianne Nichols, Natalie Berger, Praveen Joseph, and Debapriya Datta Copyright © 2015 Julianne Nichols et al. All rights reserved. Second-Degree Interatrial Block in Hemodialysis Patients Tue, 10 Feb 2015 14:34:31 +0000 http://www.hindawi.com/journals/cric/2015/468493/ Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB) has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB. Andres Enriquez, Marco Marano, Anna D’Amato, Antoni Bayes de Luna, and Adrian Baranchuk Copyright © 2015 Andres Enriquez et al. All rights reserved. A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures Tue, 10 Feb 2015 09:26:23 +0000 http://www.hindawi.com/journals/cric/2015/978906/ A 60-year-old man presented with typical angina and had a positive stress test. He declined both drug therapy and invasive testing. Instead, he chose to adopt a whole-food plant-based diet, which consisted primarily of vegetables, fruits, whole grains, potatoes, beans, legumes, and nuts. His symptoms improved rapidly, as well as his weight, blood pressure, and cholesterol levels. Plant-based diets have been associated with improved plasma lipids, diabetes control, coronary artery disease and with a reduction in mortality. Adoption of this form of lifestyle therapy should be among the first recommendations for patients with atherosclerosis. Daniele Massera, Tarique Zaman, Grace E. Farren, and Robert J. Ostfeld Copyright © 2015 Daniele Massera et al. All rights reserved. Successful Stent Graft Insertion for Endovascular Aneurysm Repair and Closure of Patent Ductus Arteriosus in an Adult Patient Thu, 29 Jan 2015 14:07:43 +0000 http://www.hindawi.com/journals/cric/2015/317061/ Patent ductus arteriosus (PDA) is sometimes undetected until adulthood, and surgical closure of a PDA is dangerous because of the calcification of the ductus. Percutaneous approaches such as coil embolization and use of a PDA occluder are less invasive; however, these devices are not suitable for PDA with thoracic aortic aneurysm (TAA). We present the case of a 72-year-old female patient who underwent successful stent graft insertions for PDA with TAA. Toshiki Kuno, Koji Tsutsumi, and Yohei Numasawa Copyright © 2015 Toshiki Kuno et al. All rights reserved. Aspiration Thrombectomy in a Patient with Suprarenal Inferior Vena Cava Thrombosis Tue, 27 Jan 2015 14:09:06 +0000 http://www.hindawi.com/journals/cric/2015/495065/ DVT has rarely been observed in the inferior vena cava (IVC). Pulmonary embolism (PE), which can be life-threatening, often occurred in patients with IVC thrombosis. Therefore, an IVC filter is frequently used in those patients for the prevention of PE. A case of successful endovascular treatment of an IVC thrombus in a patient with relative contraindications to implantation of an IVC filter is presented. This case report shows that aspiration of thrombi caught in the removable IVC filter may be an alternative to surgery in high-risk patients with catheter-related suprarenal inferior vena cava thrombosis. Hideyuki Kishima, Masashi Fukunaga, Kunihiko Nishian, Ten Saita, Tetsuo Horimatsu, Masataka Sugahara, Takanao Mine, and Tohru Masuyama Copyright © 2015 Hideyuki Kishima et al. All rights reserved. Radiofrequency Ablation of Typical Atrial Flutter via Right Jugular Vein due to Bilateral Obstructed Iliac Veins in a Patient with Dilated Cardiomyopathy Tue, 27 Jan 2015 13:42:21 +0000 http://www.hindawi.com/journals/cric/2015/401580/ Ablation of cavotricuspid isthmus (CTI) is the gold standard method in the treatment of isthmus dependent atrial flutter (AFl). Venous access was obtained usually via right or left femoral veins. In rare cases of obstruction of iliofemoral veins, ablation of CTI can be performed only through the superior approach. We present a 74-year-old woman of typical AFl and dilated cardiomyopathy that was ablated through the right jugular vein because of obstruction of the left and the right iliac veins. This is the first report of successful ablation of CTI in a patient with dilated cardiomyopathy via superior approach. Tolga Aksu, Tumer Erdem Guler, Sukriye Ebru Golcuk, Kazım Serhan Ozcan, and Ismail Erden Copyright © 2015 Tolga Aksu et al. All rights reserved. Impella Induced Massive Hemolysis: Reemphasizing Echocardiographic Guidance for Correct Placement Tue, 27 Jan 2015 09:43:12 +0000 http://www.hindawi.com/journals/cric/2015/464135/ The Impella LP 2.5 (Abiomed, Danvers, MA) has been a tool of use for high risk coronary procedures and for cardiogenic shock. As with any invasive or intracardiac device, improper placement can result in disastrous complications. Hemolytic anemia secondary to Impella implantation is one of the documented complications. However, cases of severe hemolytic anemia are rare in the literature. Proven imaging modalities like ultrasound need to be used to guide proper placement. We present a case of device induced severe hemolysis due to Impella insertion and the need to use ultrasound guidance to avoid such an unnecessary complication. Shaun Cardozo, Tasneem Ahmed, and Kevin Belgrave Copyright © 2015 Shaun Cardozo et al. All rights reserved.